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Most likely organism in a vaccinated child Sinusitis

2K views 3 replies 4 participants last post by  Mondoshawan 
#1 ·
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 38.5°C (101.3°F) and 39.0°C (102.2°F). 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, 39.0°C (102.2°F); 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
 
#4 ·
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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