sinusitis crÓnica
TRANSCRIPT
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SINUSITIS CRÓNICA
TRATAMIENTO MEDICO O QUIRURGICO?
Dra. Ma. Antonia Rivera Gómez
Clínica de Inmunología, Asma y Alergia
Hospital General de Pachuca
CMICA
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La Rinosinusitis es un grupo de desórdenes que involucran
la Inflamacion de la mucosa nasal y senos paranasales.
La Sinusitis cambia su termino a Rinosinusitis, porque
esta siempre precedida por inflamación nasal o Rinitis.
AAACI-SLAI-EAACI
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La prevalecia va en aumento del .2% al .4% en
Diagnostico de Consulta externa
(Datos del National Ambulatory Medical Care Survey)
La Rinosinusitis ae presenta en 13,6 millones de pacietes externos
Cuando se asocia a enfermedades comorbidas
la exacerbacion de estas afecta a 90 milllones de
pacientes,1 de cada 3 americanos
Tuker R.Respiratory Diseased Sinusistis
Clin.American Practice 2006:4:929
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Clasificacion de Sinusitis
Clin,infect,dis 2005 30(2) 337-397
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Clasificacion Actual
Rinosinusitis Aguda : Bacteriana
Rinosinusitis Cronica sin/con Polipos
Rinosinusitis Alergica
Rinosinusitis Micotica
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Sinusitis Aguda
• Procesos infeccioso
• Viral
• Bacteriano (+1000ucf)
• Mediadores inflamatorios
Cuando el meato medio se encuentra lleno
de fluido viscoso, un soplido nasal puede
propulsar hasta 1 ml de material en el Seno
Maxilar.
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Rinosinusitis InfecciosaRinosinusitis Infecciosa
• El fluido nasal,drena a SPN,
provocando inflamacion y/o
infeccion
• Resultado, edema de la
mucosa,engrosamiento de
moco por exocitosis de
mucina,infiltracion celular
Clin,infect,dis 2005 30(2) 337-397
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Especies cultivadas en 50 ninos
Clin,infect,dis 2005 30(2) 337-397
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Bacterias en RSA en ninos
Clin,infect,dis 2005 30(2) 337-397
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Rinosinusitis Aguda en adultos
adquirida en comunidad
Clin,infect,dis 2005 30(2) 337-397
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Bacterias en RSA en adultos
Clin,infect,dis 2005 30(2) 337-397
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Bacteriologia en RSC en adultos de 17 a 76 anos
Revision Rincon de Alergia
Dr. Juan Carlos Ivancevich
Buenos Aires Argentina
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Osteitis: Inflamacion, remodelacion
Superantigenos;Bacterias que activan
exotoxinas activando cel T hasta
30%.
Abs anti-superantigeno
Biofilm;Organizacion de microorganismos
rodeados de glicocalix,formando una
superficie biologica artificial
Fisiopatologia
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Rinosinusitis Alergica Micotica
Alergia al Hongo
Gran Produccion de mucina
eosinofilica que contiene hifas
micoticas
Poliposis Nasal
Rx Caracteristica
Inmunocompetencia
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RINOSINUSITIS ALERGICA MICOTICA
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RSAM
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La mucina alergica es moco verde viscoso
Polipos y abundantes eosinofilos
Hifas Micoticas con laminas de eosinofilos
y cristales de Charcot- Leyden
Se puede cultivar el hongo en un 60%
RSC AM
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RSC Micotica Invasiva
• Invasion x mas de 12 sem.
• Forma granulomatosa
• No granulomatosa
• Aspergillus,Mucor,Alternaria
• Candida
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B
CPIgE
CC
IL-3, IL-5, IL9, IL-13, IL-25, GM-CSF
Treg. IFg, IL 10, IL25,
REGULACION
Amy l.Wagelie-Steffen MD.Arthur F.Biologic
Therapies for the
treatment of Asthma. Clin Chest Med 27
(2006) 133-147
CCR3
Respuesta Alergica
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RINOSINUSITIS ALERGICA
• RSA bacteriana
• RSC sin polipos
• NEUTROFILOS
• RSC con polipos
• EOSINOFILOS
IL5 - Eotaxina
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• IgE especifica derivada de
superantigenos de estafilococo
• Lesion endotelial x mediadores
• Hiperrespuesta de IL5-Eotaxina
• Respuesta Celular
Rinosinusitis Cronica
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Factores no infecciosos o
Inmunologicos en RSC
• Hipoactividad de vias
nerviosas autonomas
• Irritacion por RGE
• Defectos Mucociliar
• Enfermedad Respiratoria
asocida a aspirina
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Ddx Celular de Rinosinusitis
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Ddx Rinosinusitis
Displasia Epitelial
Alteraciones Neurologicas(Medicamentos)
Alt.Olfativas
Hormonales
Anatomicas
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Polipos Nasales
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