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Old 03-28-2012
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Bacteria Most likely organism in a vaccinated child Sinusitis

A 5-year-old boy is brought to the physician, because of a 10-day history of cough, bilateral nasal discharge, and nasal congestion. He has also been febrile, with a temperature ranging between 38.5C (101.3F) and 39.0C (102.2F). There has not been any vomiting, diarrhea, or earache. He has been otherwise well and has received all recommended vaccinations. Vital signs are as follows: blood pressure (BP), 96/65 mm Hg; pulse, 110 beats/minute; temperature, 39.0C (102.2F); and respirations, 24 breaths/minute. There is a thick, purulent nasal discharge bilaterally, along with a mild erythema of the nasal mucosa. Otoscopic examination demonstrates a translucent, pearly grey tympanic membrane and presence of the light reflex. What organism is a sinus aspirate culture is most likely to grow ?

A. Aspergillus species
B. Haemophilus influenzae
C. Moraxella catarrhalis
D. Staphylococcus aureus
E. Streptococcus pneumoniae
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Old 03-28-2012
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e) strep pneumo?
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Old 04-01-2012
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Could it be E?
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Old 04-01-2012
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From Emedicine, the most common pathogens in pediatric sinusitis:
  • Streptococcus pneumoniae - 20-30%
  • Nontypeable Haemophilus influenzae - 15-20%
  • Moraxella catarrhalis - 15-20% (not as common in adults)
  • Streptococcus pyogenes (beta-hemolytic) - 5%

So I think you all are right with E. Adult sinusitis has a more complicated ecology, it seems - some sources give the above, but others add coagulase-negative Staph, Corynebacterium spp, Fusobacterium, Staph aureus, and all sorts of things as being equally common...
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