Purulent nasal discharge in young children - Tips from Other Journals

Date: Sept, 1991

Purulent nasal discharge is a common clinical symptom, especially in children under three years of age. Wald reviews the differential diagnosis, evaluation and management of purulent nasal discharge in children.

Purulent nasal discharge may be caused by an inflammatory disorder, an immunologic disorder or an intranasal structural abnormality (see table). In children with a clinical illness and associated purulent nasal discharge, the most likely diagnosis is viral upper respiratory tract infection. Specific antimicrobial intervention is not required for transient thickening and discoloration of acute paranasal sinusitis is most likely if the thinkened, colored nasal discharge persists for more than 10 days, without resolution or diminution. Children with paranasal sinusitis typically will have malodorous breath and a cough during the day, which may worsen at night. Fever may or may not be present.

Another cause of purulent nasal discharge is infection with group A streptococci. Although group A streptococcal infection is a known cause of pharyngitis, it may also be associated with a more indolent and less localized illness, characterized by low-grade fever, purulent nasal discharge and cervical adenopathy. Sore throat is not common in this syndrome. The pathologic role of other respiratory bacterial agents in this situation is not known. A throat culture or nasopharyngeal culture for group A streptococci should be performed, and if results are positive, penicillin should be administered.

Adenoiditis, congenital syphilis, pertussis and diphtheria are less common causes of purulent nasal discharge.

Allergic rhinitis is uncommon in infants, but may occur in children two to three years of age. It usually causes sneezing, nasal itching, clear rhinorrhea and ocular symptoms, such as lacrimation and pruritus. Immunodeficiency, structural abnormalities and a foreign body (especially children with a unilateral discharge) are other possible causes of purulent nasal discharge. Polyps are rare in children, except in those with cystic fibrosis.

The role of radiography is controversial. Amoxicillin or an antibiotic with activity against beta-lactamase-producing Haemophilus influenzae or Moraxella catarrhalis should be prescribed in most cases. Allergic symptoms can be treated with systemic antihistamines or decongestants, topical steroids or cromolyn sodium. In children with recurrent purulent nasal discharge (especially when associated with otitis media and lower respiratory tract infection), ciliary dyskinesia or an immunologic disorder should be suspected. (Pediatric Infectious Disease Journal, April 1991, vol. 10, p. 329.)

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