Allergic Rhinitis
The subjective and objective data of the patient are signs and symptoms of several respiratory conditions leading to several differential diagnoses. Allergic rhinitis is one of the differential diagnoses based on the patient’s subjective and objective data. There is inflammation of the nasal membrane in allergic rhinitis, leading to rhinorrhea, nasal congestion, and sneezing. The condition is also characterized by headache, postnasal drip, eye swelling, and fatigue. The pathophysiology of allergic rhinitis is divided into two stages: early and late allergic responses (Hoyte & Nelson, 2018). The nasal cavity’s regular cleansing and humidifying function in allergic rhinitis are disrupted. Continuous exposure to allergens such as mites or pollens causes the immunoglobulin E to become activated (IgE). There is degranulation of mast cells during the early phase, leading to histamine release. The release of histamine leads to symptoms such as rhinorrhea and sneezing, while other signs, such as watering and redness, occur in the early phase (Hoyte & Nelson, 2018). Other inflammatory mediators such as leukotrienes and eicosanoids are released, increasing vascular permeability. Edema also occurs as a result of inflammatory mediators.
The late phase occurs after hours when a person is exposed to allergens. There is an accumulation of neutrophils, eosinophils, T-lymphocytes, basophils, and monocytes during the late stage. There are also more leukotrienes, cytokines, and prostaglandins, which increase the inflammation process (Hoyte & Nelson, 2018). There is increased edema and remodeling of tissues which leads to nasal congestion. There is fever and yellow discharge during the late phase, indicating that the sinus is infected.
Chronic Sinusitis
The other medical condition with signs and symptoms similar to the objective and subjective data of the patient is chronic sinusitis. Chronic sinusitis involves inflammation of the nasal sinus lasting for at least twelve weeks. Mucosal edema and mechanical obstruction lead to stasis of sections in the sinuses. The stasis of the secretions leads to the growth of pathogens such as viruses or bacteria. Secondary bacterial infections occur due to persistent infection. Untreated acute sinusitis leads to chronic sinusitis due to persistent bacterial infections. The pathophysiology of chronic rhinosinusitis is defined by a wide range of immunological processes and possible etiological factors that includes evidenced by the effector T-cell signature, eosinophilic vs. neutrophilic inflammation, and remodeling profile, according to the current definition. Staphylococcus aureus enterotoxins, which behave as superantigens, may increase inflammation in CRSwNP by activating polyclonal T- and B-cells. The vague clinical presentation of CRS appears to contradict this pathological variety, yet the disease phenotype will be critical in the development and deployment of highly customized therapy. (Kwon & Rourke 2021).
The most likely diagnosis based on the subjective and objective data
The most likely diagnosis based on the subjective and objective data is acute sinusitis. Acute sinusitis refers to short-term inflammation of the sinus. In most cases, the inflammation of the sinus is due to infection of the sinus (DeBoer & Kwon, 2021). Swelling, irritation, and blockage of the sinus lead to inflammation and infection of the sinus leading to sinusitis. The inflammation and edema lead to nasal compression, which causes facial pain. Inflammation in the maxillary sinus makes the maxillary tender (DeBoer & Kwon, 2021). There is also yellow discharge from the nose and headache. The bacterial infection leads to high fevers. The condition lasts less than one month, and in some cases, symptoms disappear within ten days. In this case, the patient presents with facial pain, yellow discharge from the nose, and headache. The symptoms have not persisted for more than a month. There is also fever due to the infection, and the maxillary is tender on palpation. The objective and subjective data of the patient are therefore reassuring signs of acute sinusitis, making it the most appropriate diagnosis.
Further workup based on the latest clinical practice guidelines
Based on the latest clinical guidelines for acute sinusitis, Radiography, nasal endoscopy, computed tomography, and allergy and immune function tests are among the procedures available. In recent years, radiographic imaging has been recommended to accurately diagnose acute sinusitis (DeBoer & Kwon, 2021). Imaging is done after a thorough examination and history taking. Radiographic imaging of the sinus may reveal thickening of the mucosa or show sinuses filled with fluid. May also reveal blockage of the sinus during radiographic imaging (DeBoer & Kwon, 2021). Allergy tests should also be conducted to rule out allergic rhinitis as the condition’s cause. The discharge can be cultured in the laboratory to identify the organism causing the condition—further workup. Laboratory tests, including white blood cell count, should help diagnose. Patients with suspected complications of acute sinusitis need to be taken for a CT scan (Wyler & Mallon, 2019). CT scan helps to visualize the sinuses to identify signs that cause complications. Multiple chronic diseases such as asthma, cystic fibrosis, immunocompromised status, and ciliary dyskinesia are identified as modifying rhinosinusitis therapy. The guideline is designed for all Providers who are likely to diagnose and treat adults with rhinosinusitis, and may use it in any situation where an adult with rhinosinusitis is recognized, monitored, or treated. This recommendation does not apply to individuals under the age of 18 or those with severe rhinosinusitis of any age. (Wyler & Mallon, 2019).
The treatment plan for Mary based on the latest clinical practice guidelines
In most people, the signs and symptoms of acute sinusitis disappear within ten days. The cause of the condition depicts the treatment option. Acute sinusitis due to bacterial infection is treated using antibiotics. According to the Infectious Disease Society of America, guidelines for Acute Bacterial Rhinosinusitis Amoxicillin with clavulanate is recommended as first-line therapy for 10 to 14 days in children and 5 to 7 days in adults. If symptoms do not improve or worsen after 3 to 5 days of therapy, it is considered a treatment failure. Amoxicillin with or without clavulanate is recommended as first-line treatment by the American Academy of Pediatrics Clinic Practice guideline for diagnosing and managing Acute Bacterial Sinusitis in Children Aged 18 Years. The length of therapy is unknown; however, they recommend continuing medication for another seven days after symptoms have subsided. If symptoms do not improve or worsen after 72 hours of therapy, it is considered a therapeutic failure. If the patient is unable to accept oral fluids, ceftriaxone 50mg/kg might be given. If the patient is able to take oral fluids the next day and improves, the patient can then begin an oral antibiotic course. A third-generation cephalosporin with clindamycin (for adequate coverage of non-susceptible S. pneumonia) or doxycycline might be therapeutic options for individuals allergic to penicillin. The effectiveness of third-generation cephalosporins alone against S. pneumoniae is varied. Fluoroquinolones are another option, although they come with a higher risk of side effects. In youngsters, doxycycline and fluoroquinolones should be administered with care. Nasal sprays manage acute sinusitis due to viral infections or other infections (DeBoer DL,et,al.2021).Should not use decongestants and steroid nasal sprays for more than three days. A person with acute sinusitis should take extra fluids and have enough rest. Can treat high fevers with acetaminophen tablets. Pain can be treated with either ibuprofen or acetaminophen (Ziegler, Patadia & Stankiewicz, 2018). The nasal cavity can be irrigated with a saline solution, especially in children. Nasal irrigation with saline can be done for more than five days. Patients with allergies can be treated with immunotherapy.
References
DeBoer DL, Kwon E. Acute Sinusitis. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547701/
DeBoer, D. L., & Kwon, E. (2021). Acute Sinusitis. PubMed; StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/31613481/
Hoyte, F. C. L., & Nelson, H. S. (2018). Recent advances in allergic rhinitis. F1000Research, 7. https://doi.org/10.12688/f1000research.15367.1
Kwon, E., & O’Rourke, M. C. (2020). Chronic Sinusitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441934/
Wyler, B., & Mallon, W. K. (2019). Sinusitis Update. Emergency Medicine Clinics of North America, 37(1), 41–54. https://doi.org/10.1016/j.emc.2018.09.007
Ziegler, A., Patadia, M., & Stankiewicz, J. (2018). Neurological Complications of Acute and Chronic Sinusitis. Current Neurology and Neuroscience Reports, 18(2), 5. https://doi.org/10.1007/s11910-018-0816-8
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