Differential Diagnosis for Throbbing Facial Pain
The patient's symptoms of throbbing facial pain, nasal congestion, purulent nasal discharge, sore throat, and nonproductive cough, along with the physical examination findings, suggest an infection involving the sinuses. The most likely causal organisms can be categorized as follows:
- Single Most Likely Diagnosis
- Streptococcus pneumoniae: This bacterium is a common cause of community-acquired pneumonia and sinusitis, especially in adults. The patient's symptoms of facial pain, purulent nasal discharge, and lack of transillumination over the left maxillary sinus are consistent with acute bacterial sinusitis, for which Streptococcus pneumoniae is a leading cause.
- Other Likely Diagnoses
- Haemophilus influenzae: Although less common than Streptococcus pneumoniae, Haemophilus influenzae can cause sinusitis, especially in patients with underlying conditions or those who have not been vaccinated against H. influenzae type b.
- Moraxella catarrhalis: This bacterium is another common cause of respiratory infections, including sinusitis, particularly in adults. It is often considered in the differential diagnosis for community-acquired sinusitis.
- Do Not Miss Diagnoses
- Staphylococcus aureus: While less common as a cause of acute sinusitis, Staphylococcus aureus can lead to more severe infections, including orbital cellulitis or intracranial complications, especially if the infection spreads from the sinuses. It is crucial to consider this organism, especially if the patient does not respond to initial treatment or if there are signs of complications.
- Rare Diagnoses
- Streptococcus pyogenes (group A): Typically associated with pharyngitis, Streptococcus pyogenes can occasionally cause sinusitis, but it is a less common cause compared to the other organisms listed.
- Anaerobic bacteria: These can be considered in cases of chronic sinusitis or in patients with a history of sinus surgery or trauma, but they are less likely in this acute presentation.
Each of these organisms has a different implication for treatment, with Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis often being susceptible to a variety of antibiotics, while Staphylococcus aureus may require more targeted therapy due to potential resistance patterns.