Clinical Manual for Management of the HIV-Infected ... - myCME.com

Sinusitis
Background
Sinusitis is defined as an inflammation involving the
membrane lining of any sinus, and is a frequent finding
in people with HIV disease. It occurs very commonly
as part of a viral upper respiratory infection (URI), and
usually is self-limited. Bacterial sinusitis usually occurs
as a secondary complication of a viral URI, which causes
decreased patency of the nasal ostia, decreased nasal
ciliary action, and increased mucus production. Acute
sinusitis is defined as lasting up to 4 weeks, whereas
chronic sinusitis persists for at least 12 weeks.
HIV-infected patients are susceptible to sinusitis for a
number of reasons related to their immunosuppression.
Pathophysiologic mechanisms for this susceptibility
may include proliferation of lymphatic tissue
contributing to nasal obstruction, defects in B-cell and
T-cell immunity due to HIV, and defects in production
of immunoglobulins, specifically IgE, resulting in an
exaggerated allergic response in the nasal mucosa. As
in the general population, the most common pathogens
causing acute bacterial sinusitis are Streptococcus
pneumoniae, Moraxella catarrhalis, and Haemophilus
influenzae. However, HIV-infected patients have a
greater incidence of sinusitis caused by Staphylococcus
aureus and Pseudomonas aeruginosa. The bacterial causes
of chronic sinusitis are not well understood, but may
involve more polymicrobial and anaerobic infections. In
patients with severe immunosuppression, particularly
those with CD4 counts