Evaluation and management of nosocomial sinusitis in Intensive Care Unit patients for pyrexia of unknown origin: Case report and review of literature

Abstract

Background: Diagnosing nosocomial sinusitis (NS) in Intensive Care Unit, ICU, is difficult as the patient is usually on ventilator and the usual clinical signs and symptoms of acute or chronic rhinosinusitis cannot be confirmed from the patient. Aim: Authors want to highlight that nosocomial sinusitis as the cause of fever in ICU patients should be explored. A detailed review of literature on evaluation and management of nosocomial sinusitis is also presented in this article. Findings: In this article, we emphasize how to evaluate and diagnose nosocomial sinusitis in ICU patients using a case of a 38-year old patient who was treated for nosocomial sinusitis. Nosocomial sinusitis can be treated successfully in most of the patients if it is diagnosed early and managed properly. Hence, an index of suspicion should be kept for nosocomial sinusitis in a case of pyrexia of unknown origin in ICU settings. Conclusion: Nosocomial sinusitis in ICU setting presenting with fever needs to be diagnosed early in patients having risk factors for this entity and should be managed aggressively to prevent life threatening complications like ventilator-associated pneumonia and sepsis. Early endoscopic clearance of all the sinuses along with culture sensitivity-based antibiotics should be the standard management protocol in all such cases.

Keywords: Nosocomial sinusitis, management, ICU, pyrexia