Use of Dipstick Assay and Rapid PCR-DNA Analysis of Nasal Secretions for Diagnosis of Bacterial Sinusitis in Children With Chronic Cough

Song, Charles; Chorath, Jeena; Pak, Youngju; Redjal, Nasser

In children, acute sinusitis is usually defined as symptoms lasting less than 30 days, chronic sinusitis longer than 90 days, and subacute sinusitis in between these 2 ranges. 13 Acute sinusitis is associated with sinus pressure, purulent nasal drainage, cough, and the presence of PPB. 13, 14 In chronic and subacute sinusitis, protracted cough may play a more prominent role than nasal symptoms. 13, 15 The pathology of subacute sinusitis may resemble acute sinusitis, 14 while chronic sinusitis may involve inflammatory processes in association with various microbes including SA, especially in patients with nasal polyposis. 14-16 Among group 1 patients, 9 patients had chronic and 13 patients subacute symptoms (data not shown). Once we made the clinical diagnosis of bacterial sinusitis based on the previously mentioned criteria (group 1A), we sought to identify the predominant bacteria associated with the condition. Although asymptomatic children may be colonized by PPB in the middle meatus, 17 the presence of these PPB in the nasal cavity of patients diagnosed with clinical sinusitis may reveal the pathogens. Lee et al. reported a study of 31 adults with acute sinusitis in which 61% of nasopharyngeal and 48% of middle meatal samples grew PPB and that the concordance rate between the 2 sites was 84%. 18 We wanted to increase the sensitivity of microbial identification by employing DNA-based molecular diagnostics. Recent studies indicate that molecular diagnostic approaches yield much more accurate results with regard to diversity and quantities of microbes present in the sinus and nasal cavities. [19] [20] [21] [22] [23] Once the PCR results were reported, we classified these bacteria into different categories depending on their pathogenic potential. SP, HI, and MC were classified as PPB since these have been established as predominant pathogens for acute and subacute sinusitis by previous studies. 12, 24 SE is reported to be a commensal bacterium in the nasal cavity. 25 Although CP was characterized as pathogenic in some studies, 26 it was reported to be part of natural microbiota of the nares and throat. 27 DP has not been reported to cause sinusitis. 28 SA was classified separately because of its presence in the nasal and sinus cavities of asymptomatic subjects [29] [30] [31] and patient with sinusitis. 32, 33 Rhinovirus and Parainfluenza Virus were the only viruses identified and classified as potentially pathogenic viruses (PPV) since it is well known to cause upper respiratory symptoms. As seen in Tables 2 and 3 , the presence of PPB as a dominant species in the nasal cavities correlated with the clinical diagnosis of bacterial sinusitis (P < .002) indicating that dominance of microbes over others is an important element of pathogenesis. 34 The presence of a PPB in group 1B, 2, and 3 is not surprising because it is known to inhabit the nasal cavities of asymptomatic subjects. 17 The nondominance of these PPB along with other clinical features should enable the clinicians to separate these groups from the ones with bacterial sinusitis (1A). Group 1A may represent a combination of recurrent acute, subacute, and chronic sinusitis with bacterial infections. These PPB are also reported to be the most common pathogens associated with acute otitis media 33 and protracted bacterial bronchitis. 6, 7 It is possible that these patients may indeed have simultaneous sinusitis and protracted bacterial bronchitis since antibiotic treatment stops cou