Bacteriology of Sinusitis in the Immunocompromised Hosts

Sinusitis occurs in a wide range of immunocompromised hosts including neutropenics, diabetics, patients in critical care units, and patients infected with HIV.

Fungal and P. aeruginosa are the most common forms of sinusitis in neutropenic patients. Aspergillus spp. is frequently the causative organism, although mucor, rhizopus, alternaria, and other molds have been implicated (50). Fungi and S. aureus, streptococci and gram-negative enterics are the most common isolates in diabetics (51). The organisms most commonly isolated in nosocomial sinusitis are gram-negative enteric bacteria (such as P. aeruginosa, K. pneumoniae, Enterobacteriaceae, P. mirabilis, and S. marcescens) streptococci and staphylococci (52) and anaerobic bacteria (53). The causative organisms in patients with HIV infection included P. aeruginosa, S. aureus, streptococci, anaerobes, and fungi (Aspergillus, Cryptococcus, and Rhizopus) (54). Refractory parasitic sinusitis caused by Microsporidium, Cryptosporidium, and Acanthamoeba has also been described in these with advanced immunosuppression. Other etiologic agents include cytomegalovirus, atypical mycobacteria, and Mycobacterium kansasii (47).

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