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Sinusite aguda e suas complicações na criança : uma revisão da literatura
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A sinusite aguda é uma patologia frequente na idade pediátrica. Ocorre, na sua maioria, em contexto de uma infecção viral do trato respiratório superior, com um quadro clínico auto-limitado e resolução espontânea. No entanto, alguns episódios virais evoluem para sinusite bacteriana aguda. A sua elevada prevalência na população e a dificuldade na distinção entre etiologia viral e bacteriana nos cuidados primários, com possíveis erros de tratamento e desenvolvimento de complicações, motivou esta revisão de literatura. A sinusite tem diversos factores de risco, locais e sistémicos, que influenciam o curso da doença e a escolha do tratamento. O diagnóstico etiológico é, na sua maioria, feito com base na apresentação clínica da criança, tendo em conta a duração, a gravidade e a evolução dos sinais e sintomas. O diagnóstico é essencialmente clínico, reservando os exames imagiológicos, como a TC ou RMN, para o estudo das complicações, sinusites crónicas, agudas resistentes ao tratamento médico adequado, suspeita de tumores e candidatos a cirurgia. O tratamento é, maioritariamente, médico, com antibioterapia e medidas adjuvantes. A maioria das sinusites agudas curam com o tratamento médico. No entanto, algumas infecções disseminam-se, por via directa ou hematogénea. As complicações da sinusite são mais frequentes na idade pediátrica e incluem complicações orbitárias, as mais comuns, intracranianas e ósseas, com particularidades epidemiológicas, clínicas, diagnósticas e de tratamento, que serão abordadas nesta revisão. O seu reconhecimento precoce e avaliação multidisciplinar é essencial para um bom prognóstico. A evolução dos métodos diagnósticos, a abordagem agressiva com antibioterapia endovenosa e cirurgia, permitiu uma diminuição drástica nas taxas de mortalidade, que estas complicações implicavam. Apesar do aumento de conhecimento sobre a sinusite, continuam a existir complicações com impacto importante na qualidade de vida das crianças.
Acute sinusitis is a common disease in children. The majority occurs in the context of an upper respiratory viral infection, with a self-limited clinical condition, which resolves by itself. However, a few of the viral infections can evolve to bacterial acute sinusitis. Its high prevalence and the difficulty to differentiate the viral from the bacterial infections, which may result in treatment errors and the in development of complications have motivated this literature review. Sinusitis has many risk factors, local and systemic, that influence the disease course and the treatment choice. Most of the etiological diagnosis is made by the child’s clinical presentation, based on the symptoms and signs’ duration, severity and evolution. The diagnosis is primarily clinical, and the imaging tests, such as CT and MRI, should be reserved to study the complications, chronic sinusitis, treatment resistant acute sinusitis, suspected tumors and surgery candidates. Treatment is primarily medical, with antibiotics and adjuvant therapy. Most acute sinusitis are cured by the medical treatment. However, there can be direct or vascular spread from some sinus infections. Sinusitis complications are more common in children and include orbital, the most common, intracranial and osseous complications. Each with its epidemiological, clinical, diagnostic and treatment characteristics, which will be addressed in this review. Its early recognition and multidisciplinary evaluation is essential for a good prognosis. The evolution of the diagnostic methods and the aggressive approach with intravenous antibiotics and surgery have drastically reduced the mortality rates of these complications. Despite increased knowledge about this disease, complications continue to exist with a significant impact on children’s quality of life.
Acute sinusitis is a common disease in children. The majority occurs in the context of an upper respiratory viral infection, with a self-limited clinical condition, which resolves by itself. However, a few of the viral infections can evolve to bacterial acute sinusitis. Its high prevalence and the difficulty to differentiate the viral from the bacterial infections, which may result in treatment errors and the in development of complications have motivated this literature review. Sinusitis has many risk factors, local and systemic, that influence the disease course and the treatment choice. Most of the etiological diagnosis is made by the child’s clinical presentation, based on the symptoms and signs’ duration, severity and evolution. The diagnosis is primarily clinical, and the imaging tests, such as CT and MRI, should be reserved to study the complications, chronic sinusitis, treatment resistant acute sinusitis, suspected tumors and surgery candidates. Treatment is primarily medical, with antibiotics and adjuvant therapy. Most acute sinusitis are cured by the medical treatment. However, there can be direct or vascular spread from some sinus infections. Sinusitis complications are more common in children and include orbital, the most common, intracranial and osseous complications. Each with its epidemiological, clinical, diagnostic and treatment characteristics, which will be addressed in this review. Its early recognition and multidisciplinary evaluation is essential for a good prognosis. The evolution of the diagnostic methods and the aggressive approach with intravenous antibiotics and surgery have drastically reduced the mortality rates of these complications. Despite increased knowledge about this disease, complications continue to exist with a significant impact on children’s quality of life.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Sinusite aguda Complicações da sinusite aguda Pediatria Otorrinolaringologia