Bacterial Rhinosinusitis is NOT Transmissible Person-to-Person
Bacterial rhinosinusitis itself cannot be transmitted from person to person because it represents a secondary bacterial superinfection of the paranasal sinuses, not a primary contagious disease. The bacteria causing acute bacterial rhinosinusitis (primarily Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis) are typically part of normal nasopharyngeal flora that overgrow when sinus drainage is impaired 1, 2, 3.
Understanding the Pathophysiology
- Bacterial rhinosinusitis develops as a complication of viral upper respiratory infections, not as a directly transmissible bacterial infection 4, 2, 5.
- Most acute rhinosinusitis cases (approximately 90%) are viral in origin and resolve spontaneously within 7-10 days 6, 2.
- Only 0.5-2% of viral upper respiratory infections progress to secondary bacterial rhinosinusitis 2, 7.
- The bacteria involved are usually endogenous organisms already colonizing the patient's upper respiratory tract that proliferate when normal sinus drainage mechanisms are disrupted by viral inflammation 3, 5.
What IS Transmissible
- The preceding viral upper respiratory infection (the common cold) is highly contagious and spreads person-to-person 5.
- Viral rhinitis spreads through respiratory droplets and contaminated fomites, with viruses remaining infectious on hard surfaces for up to 6 hours 1.
- Healthcare workers can acquire respiratory viruses through direct patient contact, handling contaminated secretions, or touching contaminated surfaces 1.
Clinical Implications for Infection Control
Standard respiratory hygiene is appropriate for patients with bacterial rhinosinusitis, but isolation precautions are not necessary because the bacterial infection itself is not contagious 1.
Key infection control measures focus on preventing viral transmission:
- Hand hygiene with soap and water or alcohol-based rubs after any contact with respiratory secretions 1.
- Respiratory etiquette (covering coughs/sneezes, preferably into the elbow) 8.
- Maintaining appropriate distance (at least 3 feet) when feasible 8.
Healthcare setting considerations:
- Healthcare workers with acute upper respiratory symptoms (sneezing, coughing) should avoid caring for high-risk patients (immunocompromised, infants, cardiac patients) to prevent viral transmission 1.
- Contact isolation precautions with gloves and gowns are recommended for viral respiratory infections like RSV, not for bacterial rhinosinusitis 1.
Common Clinical Pitfall
Do not confuse the transmissibility of the initial viral infection with the non-transmissible bacterial complication. Patients often present after the viral phase has passed, when bacterial superinfection has developed. At this stage, they pose minimal transmission risk to others, though they may still shed residual virus 2, 5. The bacterial component represents overgrowth of their own flora in obstructed sinuses, not acquisition of new pathogenic bacteria from another person 3, 5.