Академический Документы
Профессиональный Документы
Культура Документы
ACUTE BACTERIAL
RHINOSINUSITIS
ACE WILLIAM G. PASION, MD-3
2
INNATE ACQUIRED
Self/ non-self
Present Present
discrimination
Lag phase Present Absent
Specificity Limited High
Diversity Limited Extensive
Memory Absent Present
6
EXTERNAL DEFENSES
INTERNAL DEFENSES
A. Cellular
1. Phagocytosis
10
INTERNAL DEFENSES
A. Cellular
1. Phagocytosis
2. Mast Cells
▸ Resemble basophils
▸ Release powerful chemical
mediators
▸ E.g. Histamine, cytokines,
GM-CSF
▸ Plays a role in hypersensitivity
reactions
11
INTERNAL DEFENSES
A. Cellular
1. Phagocytosis
2. Mast Cells
3. NK cells
▸ Mediate cytolytic reactions and
kill target cells without prior
exposure to them
▸ Transitional cell bridging innate
and acquired immune response
12
INTERNAL DEFENSES
B. Humoral
1. Complement
13
INTERNAL DEFENSES
B. Humoral
1. Complement
14
INTERNAL DEFENSES
B. Humoral
1. Complement
15
INTERNAL DEFENSES
B. Humoral ▸Major APR is CRP
1. Complement
2. APR’s
▸CRP functions in:
▹Opsonization
▹Activation of
complement
▹Agglutination
▹Precipitation
16
INTERNAL DEFENSES
B. Humoral ▸TLR-2 =recognizes
1. Complement
2. APR’s
teichoic acid and
3. Toll-like receptors peptidoglycan
▸TLR-4=recognizes
lipopolysaccharides
17
INTERNAL DEFENSES
B. Humoral
1. Complement
2. APR’s
3. Toll-like receptors
4. Cytokines
18
CLINICAL
CORRELATE:ACUTE
BACTERIAL RHINOSINUSITIS
32
DIAGNOSIS AND
MANAGEMENT OF ACUTE
BACTERIAL RHINOSINUSITIS
43
2-10%
Estimated prevalence of ARBS
90-98%
Large proportion which is viral caused
44
Further work-up may include, but not limited to, the following:
▸3.1 CT of the Paranasal Sinuses
▸3.2 Sinus or meatal culture
▸3.3 Immune system studies
Treatment of ABRS
PSOHNS-CPG for ABRS
Other recommendations:
▸1. Watchful waiting is an option in uncomplicated ABRS
(Temperature 4. <38.3oC, no extra-sinus complications),
provided that there is good follow-up. (GoR A, LoE 1A)
▸2. Nasal saline irrigation (NSI) is safe to use and is
recommended as an adjunctive treatment. (GoR A, LoE 1A)
▸3. Intranasal Corticosteroid Sprays (INCS) may be used as
monotherapy or adjunct therapy to antibiotics in the empiric
treatment of ABRS. (GoR A, LoE 1A)
4. There is a lack of available RCTs supporting the efficacy
and use of 7. topical and oral decongestants, and
antihistamines in the treatment of ABRS (GoR D, LoE 5)
Treatment of ABRS
PSOHNS-CPG for ABRS
Other recommendations:
▸5. In the management of patients with ABRS, patient
education is 8. important and should emphasize avoidance
of inciting factors like allergens, environmental irritants or
microbes (bacteria, fungi, virus), as well as discussing
treatment options with emphasis on antibiotic resistance
patterns. (GoR D, LoE 5)
53 On a Global Scale
THANKS!
Any questions?
55
References: