Purulent rhinitis in adults and children

When the upper respiratory tract is infected, a whole range of respiratory and ENT diseases develop, one of the symptoms of which is purulent rhinitis – purulent discharge from the nose.

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Epidemiology

Some experts estimate that about 5% of the population of Central Europe suffers from chronic sinusitis.

And statistics from American health services, which studied the epidemiology of chronic rhinosinusitis and its associated complications, cite data from a national survey, according to which this problem worries 12.5-15.5% of the total US population.

However, the accounting of cases diagnosed by doctors using ICD-10 codes as an identifier showed that the prevalence of purulent sinusitis and rhinitis is 2%. This diagnosis is made in women almost eight times more often. The age category of 20-29 years accounts for 2.7% of cases; 50-59 years - 6.6%; over 60 years - 4.8%.

The British Association of Otolaryngologists estimates the overall prevalence of chronic rhinosinusitis among Britons aged 15 to 75 years to be 11-13%.

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Causes purulent rhinitis

In clinical otolaryngology, rhinitis is not only an inflammation of the mucous membranes of the nose (code J31.0 according to ICD-10), which has various etiologies, but also the discharge from it - a runny nose. It can be allergic and vasomotor, infectious and hormonal, professional and medicinal. Depending on the origin, the nature of the discharge from the nose also differs.

The most common form of the common cold (acute rhinitis or nasopharyngitis) is caused by rhinoviruses, influenza viruses, or respiratory syncytial virus (HRSV); the nasal discharge consists of mucin secreted by goblet cells in the nasal mucosa.

Purulent or purulent (from Latin purulen – festering) discharge, which children call “green snot”, appears with a bacterial infection. Acute and chronic purulent rhinitis develop either independently or as a complication of viral rhinitis or acute nasopharyngitis.

The key causes of purulent rhinitis are the inflammatory process induced by a secondary bacterial infection: opportunistic opportunistic bacteria Streptococcus pneumoniae, Haemophilus influenza, Moraxella catarrhalis, Staphylococcus aureus, Streptococcus pyogenes, obligate pathogenic virulent cocci Klebsiella pneumonia, Klebsiella ozaenae and Neisseria meningitidis, as well as Peptostreptococcus anaerobius, Porphyromonas asaccharolytica and bacteroids Prevotella and Fusobacterium.

It is estimated that only 0.5-2% of viral rhinitis are complicated by bacterial ENT diseases, but the exact frequency is unknown: without invasive examination of the sinuses (by puncturing) it is difficult to distinguish a virus from a bacterial infection.

Most often, purulent rhinitis in adults is observed with inflammation of the mucous membranes lining the maxillary (maxillary) paranasal sinuses - chronic sinusitis (maxillary sinusitis), paranasal frontal sinuses - chronic frontal sinusitis, sphenoid sinuses and ethmoid labyrinth - chronic purulent rhinoethmoiditis (which, in turn, is a complication of the chronic form of sinusitis).

All types of such inflammations can be diagnosed by ENT doctors as bacterial purulent sinusitis and rhinitis or infectious rhinosinusitis, since all paranasal sinuses are called paranasal sinuses. With alteration of all paranasal sinuses, pansinusitis is diagnosed, which also gives purulent discharge from the nose.

In severe cases of chronic purulent rhinitis, patients secrete thick, purulent, foul-smelling mucus, which indicates maxillary sinusitis, etiologically associated with chronic periodontal inflammation in root granuloma of the teeth (first molars or second premolars).

Adult nasal neoplasia is a diagnosis of exclusion; if purulent rhinitis (especially unilateral, with blood) continues for months, it may be rhinosporidiosis with bleeding polyps in the maxillary sinus, inverted papilloma, sarcoma or lymphoma. Symptoms of nasal scleroma (rhinoscleroma) and Wegener's granulomatosis may also be accompanied by such a runny nose.

Persistent unilateral purulent rhinitis in a child in 64% of cases is associated with inflammation of the sinuses and impaired drainage. It also occurs at the initial stage of measles and when a foreign body enters the nasal cavity and mechanical obstruction of the nasal passage. In cases of recurrent discharge of purulent snot from both nasal passages, the most common diagnosis is adenoiditis - chronic inflammation of the adenoids. In addition, early nasal polyposis due to genetically determined cystic fibrosis, the presence of benign juvenile angiofibroma of the nasopharynx or functional insufficiency of the ciliary epithelium and impaired nasal mucociliary clearance associated with congenital Kartagener syndrome are not excluded.

If the infant has congenital syphilis of the nose or partial atresia of the internal nasal openings (choanae), and if the mother has gonorrhea, purulent rhinitis in the newborn is possible. Read also - Runny nose in a newborn

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Risk factors

In many cases, the appearance of purulent nasal discharge occurs when the immune system is weakened. So purulent rhinitis during pregnancy can occur against the background of physiologically determined gestational immunosuppression. In addition, hormonal changes play an important role in swelling of the nasal mucosa and its congestion during pregnancy.

The following are risk factors:

• getting chlorinated water into the nasal cavity and paranasal sinuses while swimming;
• shift in pH of the mucous membranes of the upper respiratory tract towards increased acidity;
• the presence of foci of persistent infection;
• chronic allergic rhinitis with swelling of the nasal mucosa, creating the preconditions for blocking the excretory ducts of the paranasal sinuses and the addition of a secondary bacterial infection;
• deviation of the nasal septum from its normal anatomical position.

In pediatric practice, attention is paid to common immune dysfunctions: transient hypogammaglobulinemia of infancy and deficiency of immunoglobulin class A (IgA antibodies).

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Pathogenesis

The inflammatory process can be caused by numerous factors, and to date, the pathogenesis of chronic rhinosinusitis and the purulent rhinitis that accompanies this disease remains controversial.

There is more and more evidence confirming the modern hypothesis of the etiology and pathogenesis of chronic inflammatory diseases of all mucous membranes. Its essence is that the balanced interaction of the cells of the mucous membrane of the nasal cavity with the commensal flora - potential pathogens (bacteria, viruses, fungi) is disrupted, and the impact of allergens and/or toxic substances in the environment, classified by specialists as exogenous stress factors, is increased.

The bacteria mentioned above can asymptomatically colonize the nasopharynx, for example, as shown by tests for Staphylococus aureus (nasal swabs for Staphylococcus aureus), asymptomatic carriage is detected in almost a third of adults and at least half of children.

In conditions of immune imbalance, colonizing microorganisms penetrate the mucin barrier and penetrate the upper layer of the mucous epithelium by adhesion. Goblet cells of the mucous membrane begin to function in an enhanced mode. And the developing inflammation is a protective reaction to the invasion of bacterial infection of innate immune cells: C-reactive proteins of blood plasma, mannose-binding lectin (MBL), epithelial receptor M-cells, various chemical mediators (cytokines), mast cells, macrophages, neutrophils, eosinophils, B-lymphocytes of the submucosal lymphoid tissue (producing antibodies).

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Symptoms purulent rhinitis

The first signs of the transformation of normal nasal discharge (which does not go away for two weeks or longer) into purulent discharge are manifested by the fact that they gradually cease to be colorless, turning into a yellow or greenish thick mucous mass (sometimes with a putrid odor).

Indicative symptoms of sinusitis and chronic rhinosinusitis include: nasal congestion with blocked nasal breathing and impaired sense of smell (hyposmia); headache and throbbing pain in the face, the latter of which intensifies when bending over (due to increased pressure in the sinuses).

In acute maxillary sinusitis, the pain is much stronger than in chronic sinusitis (in which pain may be absent). In frontal sinusitis, the pain is localized in the forehead, in rhinoethmoiditis - in the eye socket area closer to the bridge of the nose. Of the general symptoms, the most common are fever and weakness.

Pus can get into the throat, causing coughing. In a child, purulent rhinitis can cause eczema in the nostrils, and maxillary sinusitis (sinusitis) is often accompanied by conjunctivitis and otalgia.

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Complications and consequences

Any inflammatory process with the formation of purulent exudate can have serious consequences and complications.

In the chronic form of purulent rhinitis with inflammation of the paranasal sinuses, pus can accumulate in them, which is fraught with the development of an abscess, which can lead to the spread of purulent inflammation to the membranes of the brain - meningitis.

No less serious is the danger of the formation of blood clots in the venous collectors (cavernous sinuses) of the dura mater of the brain.

There is also a risk of permanent loss of smell (anosmia) and vision problems due to inflammation of the tissues of the periorbital region.

Diagnostics purulent rhinitis

Bacterial acute and chronic sinusitis with swelling and inflammation of the tissues lining the sinuses can be difficult to distinguish from viral rhinitis. Therefore, to identify specific pathogens of purulent rhinitis, not only general and biochemical blood tests are necessary, but also bacterial culture - an analysis of mucus from the nose. In case of sinusitis, an analysis of the contents of the paranasal sinuses is done, which is taken during their puncture.

Instrumental diagnostics uses rhinoscopy, radiography of the nose and paranasal sinuses, ultrasound and CT examination of the paranasal sinuses.

Based on the results of the tests and taking into account the data obtained during the instrumental examination, differential diagnostics is carried out. More information on this issue in the article - Diseases of the paranasal sinuses

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Treatment purulent rhinitis

When prescribing treatment for purulent rhinitis, ENT doctors set a goal: to stop the inflammatory process and relieve symptoms.

To relieve inflammation in purulent rhinosinusitis, systemic corticosteroids (Prednisolone and Methylprednisolone) can be prescribed, but only in short courses (to avoid the development of side effects). According to a 2013 Cochrane review, these drugs give a positive result quite quickly - especially in acute sinusitis aggravated by nasal polyps. However, there are not enough randomized controlled trials to include them in the treatment regimen for purulent nasal discharge.

There are many drugs of this pharmacological group for intranasal use, most often budesonide is used (Benacort solution and powder for inhalation, Tafen nasal spray) - twice a day.

Antibiotics for purulent rhinitis should be used in cases of proven bacterial etiology of the disease. In pediatric practice, as experts from the European Academy of Paediatrics believe, antibiotic therapy should be prescribed only if purulent rhinitis in a child lasts more than two weeks.

The list of drugs of choice, effective against most strains of bacteria, includes: Amoxiclav or Augmentin (amoxicillin + clavulanate), Azithromycin, Gentamicin, Tobramycin, Ciprofloxacin, Cefuroxime, Clarithromycin, Roxithromycin. For more information on their method of use, side effects and contraindications, see the publication - Antibiotics for a runny nose

Streptocide was previously used for purulent rhinitis, but this sulfonamide drug is not currently used due to bacteria developing resistance to its action. In addition, pus reduces the bacteriostatic properties of streptocide.

For nasal congestion, systemic antihistamines are used, as well as vasoconstrictor nasal drops with decongestants - naphazoline (drops Naphthyzinum), oxymetazoline (drops Nazivin, Sanorin, aerosol Noxprey, etc.) or tramazoline (Lazarin, Rinospray, Adrianol). More details in the materials: Drops for a runny nose and Drops for sinusitis, as well as - How to treat nasal discharge

ENT doctors recommend a very good remedy for purulent snot - washing the nose with salt, or more precisely, isotonic saline or physiological solution. What else can be used to carry out this procedure, in more detail in the article - Means for washing the nose

How physiotherapy treatment is carried out can be found in the publication - Physiotherapy for rhinitis

Traditional medicine suggests using the following for instillation into the nose:

• antiseptics Collargol and Protargol, which contain colloidal silver, “forgotten” by doctors;
• homemade drops from a tablespoon of aloe juice and a teaspoon of liquid honey;
• Kalanchoe juice mixed with boiled water;
• propolis diluted in water (0.3 g per half glass);
• a mixture of kernel and eucalyptus oils (4:1).

Herbal treatment can also be quite effective if you rinse your nasal cavity daily with a decoction of chamomile or calendula, diluted with water (3:1) or juice from sorrel leaves; put plantain juice or St. John's wort infusion into your nose.

Prevention

To prevent a common cold from turning into a purulent one, it is necessary to treat it correctly. And, of course, strengthen the body's defenses by taking vitamins, hardening, and eating only healthy foods. In general, the recommendations are the same as for preventing colds.

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Forecast

In this case, the prognosis will be favorable if you do not let the disease progress and begin its treatment on time - at the stage of common rhinitis.

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