SINUSITIS IN CHILDREN INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - CLINICAL CHARACTERISTICS, RISK-FACTORS, AND PROPHYLAXIS

The clinical presentation, radiological and laboratory evaluation, tre atment, and risk factors of sinusitis in a cohort of 376 human immunod eficiency virus (HIV)-infected children from a placebo-controlled clin ical trial of intravenous immunoglobulin (MG) as prophylaxis for infec tions were examined. Ninety-five episodes of sinusitis were described in 60 patients; one-third of the patients had two or more episodes. Si nusitis episodes were commonly associated with nonspecific, chronic sy mptoms (67.4%, persistent nasal discharge; 54.7%, nocturnal or persist ent cough), whereas symptoms more specific to acute sinusitis were les s frequent (17.9%, headache or facial pain; 9.5%, periorbital swelling ; 25.3%, temperature of greater than or equal to 102 degrees F; 9%, to tal white blood cell count of >15,000/mm(3)). The sinuses primarily in volved were the maxillary sinus (85.9%) and the ethmoidal sinus (42.3% ); 36% of episodes involved two or more sinuses. Preceding respiratory infections did not appear to increase the risk of sinusitis, and CD4( +) lymphocyte counts in children with and without sinusitis did not di ffer. Neither monthly IVIG prophylaxis nor three times weekly trimetho prim-sulfamethoxazole prophylaxis for Pneumocystis carinii pneumonia d ecreased the risk of sinusitis. Sinusitis in HIV-infected children is most often subacute and recurrent. Evaluations of new modalities for p rophylaxis for sinusitis are needed.