SINUSITIS IN 180 CHILDREN INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

The clinical presentations, radiologic and laboratory findings, and tr eatment of and risk factors for acute sinusitis in 180 human immunodef iciency virus-infected children were evaluated retrospectively from ou tpatient visits over a period of 18 months, Acute sinusitis affected 3 9% of our cohort. Most patients presented in the winter months with no nspecific, chronic symptoms (cough and rhinorrhea). Symptoms more spec ific to acute sinusitis were reported less frequently. Imaging studies confirmed the diagnosis of sinusitis in 51% of cases. Maxillary and e thmoid sinuses were most commonly affected, Oral antibiotic monotherap y with a mean duration of 21 days was sufficient for complete resoluti on of symptoms in most. However, 37% of patients had two or more recur rences and were more likely to require multiple antibiotics over a lon ger period, with a greater tendency to relapse. Sinus surgery, includi ng aspiration for culture, was not performed on any of the children. W e found no association between the presence of sinusitis and advanced immunosuppression. CD4 lymphocyte and absolute neutrophil counts in ch ildren with and without sinusitis did not differ, Concurrent allergic rhinitis and asthma/reactive airway disease were identified as predisp osing risk factors for acute sinusitis. Neither monthly intravenous im munoglobulin prophylaxis nor trimethoprim-sulfamethoxazole prophylaxis three times weekly for Pneumocystis carinii pneumonia conferred prote ction against sinusitis.