The American Journal of Medical Sciences and Pharmaceutical Research
48
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TYPE
Original Research
PAGE NO.
48-51
10.37547/tajmspr/Volume07Issue02-07
OPEN ACCESS
SUBMITED
16 December 2024
ACCEPTED
18 January 2025
PUBLISHED
20 February 2025
VOLUME
Vol.07 Issue02 2025
CITATION
Daulet Azatbek ugli Jumanov. (2025). Clinical and microbiological features
of pathology of the nose and paranasal sinuses in patients with
community-acquired pneumonia. The American Journal of Medical
Sciences and Pharmaceutical Research, 7(02), 48
–
51.
https://doi.org/10.37547/tajmspr/Volume07Issue02-07
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Clinical and
microbiological features of
pathology of the nose and
paranasal sinuses in
patients with community-
acquired pneumonia
Daulet Azatbek ugli Jumanov
Republic of Uzbekistan, Tashkent Medical Academy, Department of
Otolaryngology, Uzbekistan
Abstract:
This article presents the results of a
comprehensive otolaryngological and microbiological
study of diseases of the nose and paranasal sinuses in
patients with community-acquired pneumonia. These
diseases are closely interconnected, since the upper and
lower respiratory tract are a single whole, have
structures and functions and mechanisms for the
development
of
pathological
conditions.
The
etiopathogenesis of bacterial inflammatory diseases of
the upper and lower respiratory tract is based on the
disruption of the integrity of epithelial cells under the
influence of respiratory viruses. Under the influence of
the general toxic effect of the virus, phagocytosis is
inhibited, immunological protection is disrupted,
resulting in favorable conditions for microbial
colonization in the nasopharynx and further spread of
infections to the paranasal sinuses and lower
respiratory tract. As a result of the clinical and
microbiological study, it was revealed that inflammatory
diseases of the nose and paranasal sinuses such as acute
and chronic rhinosinusitis, allergic and vasomotor
rhinitis, and deviated nasal septum were often
encountered in community-acquired pneumonia. To
determine the nature of the microbial landscape of the
upper and lower respiratory tract, a comparative
microbiological analysis of the nose and sputum was
carried out. The analyzes showed that no significant
difference in pathogenic microflora was detected
between the upper and lower respiratory tract. The
main pathogen in both diseases was Streptococcus
pneumoniae. The correspondence of the pathogenic
microflora of the nasal cavity and lower respiratory tract
when detecting rhinosinusitis in patients with
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The American Journal of Medical Sciences and Pharmaceutical Research
community-acquired
pneumonia
confirms
the
pathogenetic relationship of inflammatory processes
in these organs, as well as the need for parallel
diagnostics, treatment, and prevention.
Keywords:
Upper and lower respiratory tract,
rhinosinusitis,
community-acquired
pneumonia,
microbiological analysis, Streptococcus pneumoniae.
Introduction:
The results of medical statistics
convincingly indicate an increase in the number of
diseases of the nose, paranasal sinuses (PNS) [1,2] and
bronchopulmonary pathology [3]. Close anatomical
and physiological connections between the upper and
lower respiratory tract are the reason that the increase
in the number of rhinosinusitis keeps pace with the
increase in the number of pulmonary diseases [4] and,
in particular, community-acquired pneumonia (CAP).
The incidence of pneumonia in Europe and North
America is 5-10 cases per 1,000 population. Mortality
from severe pneumonia reaches 10% and continues to
grow [3; 5]. Most often, pneumonia occurs in children,
the elderly and in chronic diseases of the respiratory
system. Acute respiratory viral infections (ARVI) are
undoubtedly the main risk factor for community-
acquired pneumonia, acute rhinosinusitis (ARS) and
chronic rhinosinusitis (CRS). They develop at any stage
of the disease if bacterial flora (streptococci,
staphylococci, etc.) joins in. It is known that some
viruses
(influenza,
parainfluenza,
adenovirus,
respiratory
syncytial
virus,
coronavirus,
etc.)
simultaneously affect the epithelial cells of the upper
and lower respiratory tract [13]. The etiology of
community-acquired pneumonia is directly related to
the opportunistic microflora colonizing the upper
respiratory tract. Of the numerous microorganisms,
only a few with increased virulence are capable of
causing an inflammatory reaction when they enter the
lower respiratory tract. Pneumococcus should be
considered one of these pathogens. Since S.
pneumoniae has more than 90 serotypes with
different antigenic properties, this microorganism can
be present in the nasopharynx for years and can cause
the development of CAP, ARS and otitis media at any
time [3,9]. For some microorganisms, the development
of bronchopulmonary inflammation is not typical [3].
Their isolation from sputum most likely indicates
contamination of the material with the flora of the
upper respiratory tract, and not the etiologic
significance of these microbes. Such microorganisms
include
Streptococcus
viridans,
Staphylococcus
epidermidis, Enterococcus spp., Neisseria spp.,
Candida spp.
It is believed that with almost any ARVI, the paranasal
sinuses are involved in the process to one degree or
another [10,12]. Acute rhinosinusitis is caused by
viruses in 95% of cases; a bacterial process develops 5-7
days after the onset of ARVI [6,7]. Under the influence
of the virus on the ciliated epithelium of the nasal cavity
and paranasal sinuses, the epithelial cells lose cilia, the
epithelium becomes loose, and mucosal edema
develops. As a result of these processes, as well as the
active release of proinflammatory mediators, an
inflammatory reaction develops. The consequence of
this is a violation of sinus aeration, inactivation of
mucociliary clearance, and accumulation of serous
exudate in the lumen of the sinuses. A decrease in the
rate of mucociliary transport allows for an extension of
the contact time of pathogenic bacteria with the
mucous membrane and promotes bacterial infection
[8,12,13].
METHODS
A total of 80 patients with community-acquired
pneumonia who were hospitalized in the pulmonology
department of the multidisciplinary clinic of the
Tashkent Medical Academy were examined. Among the
examined were 32 men and 48 women aged 18 to 65
years (the average age in the group was 45.6 ± 8.75
years). All patients had their complaints and history of
the disease studied in detail, and their general condition
was examined.
The research methods used included endoscopic
examination of the ENT organs, with all formations in
the nasal cavity being carefully examined. To determine
the prevalence of the inflammatory process, all patients
underwent 3D radiography and computed tomography
of the ENT. Particular attention was paid to changes in
the ENT organs and, if necessary, consultation with
other specialists was carried out.
The microbiological characteristics of the upper and
lower respiratory tract in patients with community-
acquired pneumonia were studied using bacteriological
methods. Sterile applicators were inserted into the
middle nasal passage and smears were taken to
determine the pathogenic microflora of the nose and
the UR. Sputum was collected with a spatula in a sterile
container. Analysis of pathological discharge from the
middle nasal passage and sputum was carried out in the
bacteriological laboratory of the multidisciplinary clinic
of the Tashkent Medical Academy. Bacteriological
culture was performed on enriched selective nutrient
media from the company "bio Merieux" (France).
DISCUSSION OF THE RESULTS
3D radiography and computed tomography of the
paranasal sinuses were performed in all 80 patients.
Radiological changes in the paranasal sinuses were
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The American Journal of Medical Sciences and Pharmaceutical Research
recorded with a thickening of the mucous membrane
of more than 6 mm. Radiological changes were
detected in 25 (31.25%) patients. Three patients
showed a total decrease in pneumatization of all
paranasal sinuses: two had right-sided hemisinusitis,
11 had right-sided maxillary ethmoiditis, and 15 had
left-sided maxillary ethmoiditis.
As a result of the study of smears taken from the nasal
cavity, microflora was obtained from the 46th (100%)
patient. A total of 71 microorganisms were identified.
Mixed flora was obtained from 22 (47.8%) of 46
patients, the maximum number of pathogens in the
association was 3. Gram-positive facultative anaerobes
were identified in 46 (64.7%) strains from among
bacteria, the majority were microorganisms of the
genus Streptococcus and Staphylococcus. 17 (22.0%)
gram-negative facultative anaerobes. Gram-negative
aerobes were identified in the amount of 2 (2.5%)
strains (Neisseria spp.). Fungal flora was isolated from 6
(7.8%) patients, more often isolated in association with
bacterial pathogens.
Microorganisms isolated from patients with rhinosinusitis (n=54)
Microorganisms
Upper respiratory
tract
Lower
respiratory tract
number
%
number
%
Streptococcus pneumoniae
18
39,1
20
43,5
Haemophilus influenza
9
19,5
6
13,0
Staphylococcus aureus
7
15,2
6
13,0
Streptococcus viridans
7
15,2
3
0
Streptococcus pyogenes
5
10,8
7
15,2
Staphylococcus haemolyticus
5
10,8
3
5,5
Staphylococcus epidermidis
4
8,7
2
4,3
Klebsiella pneumonia
4
8,7
6
13,0
Candida spp.
6
11,1
2
4,2
Neisseria spp.
2
4,3
-
0
Proteus mirabilis
1
2,1
-
0
Escherichia coli
2
4,3
2
4,3
Entorococcus faecalis
1
2,1
2
4,3
Total:
71
-
59
-
Bacteriological examination of sputum collected from
46 patients revealed 59 strains of microorganisms. The
results of microbiological examination of sputum
culture are presented in Table 3. The growth of
microorganisms in sputum culture was noted in 36
(78.2%) patients, in 10 (21.7%) patients
microorganisms were not detected. Mixed microflora
was detected in 6 (13.0%) patients, the maximum
number of pathogens in the association was 2. Gram-
positive facultative anaerobes were detected in 41
(69.5%) strains of bacteria, the majority, as in the results
of culture from the middle nasal passage, were
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The American Journal of Medical Sciences and Pharmaceutical Research
microorganisms of the genus Staphylococcus and
Streptococcus. The growth of 11 (18.6%) gram-
negative facultative anaerobes was obtained. Gram-
negative aerobes were detected in the amount of 2
(3.0%) strains (Moraxella catarrhalis). Fungal flora was
isolated from 5 (7.7%) patients, most often isolated in
association with bacterial pathogens.
CONCLUSIONS
Having examined 80 patients with CAP, it is worth
noting a fairly high prevalence of complaints and
symptoms characteristic of inflammatory diseases of
the nasal mucosa, in particular rhinosinusitis. In our
study, 46 (67.5%) patients were found to have
symptoms of ARS and CRS. Radiological changes were
detected in 25 (31.25%) patients.
In many ways, the etiopathogenesis of rhinosinusitis is
similar to CAP. The microflora obtained from sputum
and the middle nasal passage in patients with CP is
almost identical. As a result of the study of smears
taken from the nasal cavity, microflora was obtained in
46 (67.5%) patients, growth was noted in all patients.
A total of 71 microorganisms were identified. During
bacteriological examination of sputum taken from
patients, 59 microorganisms were detected, no growth
was noted in 10 (21.7%) patients. The main pathogen
in acute and chronic rhinosinusitis in patients with CAP
was Streptococcus pneumoniae (39.1% and 43.5%,
respectively).
Thus, based on the data obtained, it can be concluded
that inflammatory diseases of the nose and PNS are
interrelated with CAP. Early diagnosis and parallel
treatment of rhinosinusitis with CAP gives us a quick
and complete recovery of patients and reduces the
development of complications. Timely and effective
treatment of inflammatory diseases of the upper
respiratory tract after an acute respiratory viral
infection is considered one of the preventive measures
for CAP.
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