Arruda L K, Mimica I M, Solé D, Weckx L L, Schoettler J, Heiner D C, Naspitz C K
Division of Allergy, Paulista School of Medicine, São Paulo, Brazil.
Pediatrics. 1990 Apr;85(4):553-8.
Thirty-three children with chronic tonsillitis and/or adenoid enlargement and without previous diagnosis of sinusitis were studied regarding the bacterial flora of their maxillary sinuses. Puncture of maxillary sinus was performed at surgery (adenoidectomy and/or tonsillectomy) and aspirates were cultured. Streptococcus pneumoniae was isolated from 8 of 12 (66.7%) patients whose x-rays showed completely opacified maxillary sinus. Streptococcus viridans, Streptococcus faecalis, and Staphylococcus epidermidis were recovered from 6 (28.6%) of the 21 patients with normal maxillary sinus radiographs. Bacterial titers were greater than 10(4) colonies/mL in all but one of the positive cultures. No anaerobic bacteria were isolated. History of bronchial asthma, presence of nasal purulent secretion, elevated blood eosinophils, and elevated serum IgE were found more frequently in children with complete opacification of maxillary sinus. Serum levels of IgG2 were low in 29% of the children, but no correlation was found between low IgG2 levels and positive cultures from maxillary sinus aspirates. We concluded that children with complete radiologic opacification of maxillary sinus had bacterial infection in almost 70% of the cases with symptoms that did not prompt their physicians to consider the diagnosis of sinusitis.
对33例患有慢性扁桃体炎和/或腺样体肥大且既往无鼻窦炎诊断的儿童进行了上颌窦细菌菌群研究。在手术（腺样体切除术和/或扁桃体切除术）时对上颌窦进行穿刺并对吸出物进行培养。在12例X线显示上颌窦完全浑浊的患者中，有8例（66.7%）分离出肺炎链球菌。在21例上颌窦X线片正常的患者中，有6例（28.6%）分离出草绿色链球菌、粪肠球菌和表皮葡萄球菌。除1例阳性培养物外，所有阳性培养物的细菌滴度均大于10⁴菌落/mL。未分离出厌氧菌。在上颌窦完全浑浊的儿童中，支气管哮喘病史、鼻腔脓性分泌物的存在、血液嗜酸性粒细胞升高和血清IgE升高更为常见。29%的儿童血清IgG2水平较低，但未发现低IgG2水平与上颌窦吸出物阳性培养之间存在相关性。我们得出结论，上颌窦影像学完全浑浊的儿童中，近70%的病例存在细菌感染，但其症状未促使医生考虑鼻窦炎的诊断。
