What physical exam tests distinguish between viral and bacterial Rhinosinusitis?

From the Guidelines

No specific physical exam tests can reliably distinguish between viral and bacterial rhino sinusitis. However, clinicians can look for signs such as purulent nasal discharge, facial pain, and fever, which may suggest bacterial infection 1. The presence of yellow or green nasal discharge for more than 10 days, or worsening symptoms after initial improvement, may also indicate bacterial sinusitis 1.

Key Signs and Symptoms

• Purulent nasal discharge: cloudy or colored nasal discharge
• Facial pain: pain or pressure in the face, particularly in the cheeks or forehead
• Fever: temperature greater than 39°C
• Worsening symptoms: symptoms that worsen after an initial period of improvement In such cases, antibiotic treatment with amoxicillin 500mg three times a day for 5-7 days or azithromycin 500mg on the first day followed by 250mg for the next 4 days may be considered 1. It's essential to note that most cases of rhino sinusitis are viral and will resolve on their own, and overuse of antibiotics can contribute to antibiotic resistance 1. Therefore, a cautious approach to prescribing antibiotics is recommended, and treatment should be individualized based on patient presentation and medical history.

From the Research

Physical Exam Tests for Distinguishing between Viral and Bacterial Rhinosinusitis

There are several physical exam tests and biomarkers that can help distinguish between viral and bacterial Rhinosinusitis, including:

• Measurement of the expression of complement receptors, particularly CR1 (CD35), on neutrophils 2
• Clinical infection score (CIS) point, which incorporates quantitative analysis of complement receptors on neutrophils and standard clinical laboratory data 2
• Pneumonia severity index 3
• Biomarkers such as C-reactive protein (CRP) and procalcitonin 4
• Estimated CRP velocity (eCRPv), which is the ratio between the absolute CRP level upon admission to time from symptom onset 5
• Host-response tests such as the TriVerity test and the MeMed BV test, which measure mRNA and protein levels respectively 6

Biomarkers for Distinguishing between Bacterial and Viral Infections

Biomarkers such as CRP and eCRPv can be used to distinguish between bacterial and viral infections, with higher levels indicating a bacterial infection 5. The MeMed BV test has been shown to have high sensitivity and specificity for distinguishing between bacterial and viral infections 4, 6. The TriVerity test has also been shown to have good diagnostic accuracy for distinguishing between bacterial and viral infections 6.

Limitations of Current Tests

While these tests and biomarkers can be useful in distinguishing between viral and bacterial Rhinosinusitis, there are limitations to their use, including:

• The need for further research and validation to confirm their accuracy and effectiveness 4, 5, 6
• The potential for over-treatment with antimicrobial agents or under-treatment of bacterial infections 3, 4
• The need for prospective impact studies to evaluate the effect of these tests on antibiotic use, safety, and cost effectiveness 6