What are the symptoms of a staph infection in the nose. How is MRSA sinus infection treated. What are the potential complications of untreated nasal staph infections. How can you prevent recurring staph infections in the nasal passages.

Understanding Staph Infections in the Nose

Staphylococcus aureus, commonly known as staph, is a bacterium that naturally resides on the skin and in the nasal passages of many individuals. While typically harmless, these bacteria can cause infections when they enter damaged skin or mucous membranes. Nasal staph infections occur when S. aureus invades the delicate tissues inside the nose, leading to various symptoms and potential complications if left untreated.

Between 20-80% of humans carry S. aureus in their nasal passages without experiencing any adverse effects. However, certain factors can increase the risk of developing a nasal staph infection:

• Nose picking
• Excessive blowing or rubbing of the nose
• Plucking or tweezing nasal hairs
• Damage to the skin inside or around the nose

Understanding the causes and risk factors associated with nasal staph infections is crucial for prevention and early intervention.

Recognizing Symptoms of Staph Infection in the Nose

Identifying the symptoms of a staph infection in the nose is essential for prompt treatment. Common signs include:

• Redness and swelling of the nose
• Crusting around the nostrils
• Boils inside one or both nostrils
• Facial swelling
• Pain
• Fever

Can staph infections in the nose resolve on their own? In some cases, minor staph infections may clear up without intervention. However, more severe infections often require medical treatment to prevent complications and reduce the risk of recurrence.

MRSA: A Serious Form of Staph Infection

Methicillin-resistant Staphylococcus aureus (MRSA) is a particularly concerning strain of staph bacteria. MRSA infections are resistant to many common antibiotics, making them more challenging to treat. When MRSA infects the sinuses, it can lead to a condition known as MRSA sinus infection.

How does MRSA differ from regular staph infections? MRSA infections typically present with similar symptoms to other staph infections but may be more severe and resistant to standard antibiotic treatments. Individuals with weakened immune systems, those who have recently undergone surgery, or people with frequent exposure to healthcare settings are at higher risk for MRSA infections.

Symptoms of MRSA Sinus Infection

MRSA sinus infections may cause additional symptoms beyond those of typical staph infections, including:

• Severe headaches
• Facial pain and pressure
• Nasal discharge
• Reduced sense of smell
• Persistent fever
• Fatigue

Early recognition of these symptoms is crucial for timely diagnosis and appropriate treatment of MRSA sinus infections.

Diagnosis and Treatment Options for Nasal Staph Infections

Diagnosing a staph infection in the nose typically involves a physical examination and may include laboratory tests to identify the specific strain of bacteria causing the infection. In cases of suspected MRSA, additional testing may be necessary to determine antibiotic resistance.

What are the treatment options for nasal staph infections? Treatment approaches may include:

1. Topical antimicrobial medications
2. Oral antibiotics
3. Drainage of boils or abscesses
4. Warm compresses to soothe affected areas

For MRSA sinus infections, healthcare providers may prescribe specialized antibiotics that are effective against resistant strains. In some cases, a combination of treatments may be necessary to fully eradicate the infection and prevent recurrence.

Home Remedies and Self-Care

While medical treatment is often necessary for staph infections, some home remedies and self-care practices can support healing and provide symptom relief:

• Applying warm, damp compresses to affected areas
• Keeping the nasal passages clean and moisturized
• Using over-the-counter pain relievers to manage discomfort
• Getting plenty of rest to support immune function

It’s important to note that these measures should complement, not replace, professional medical care, especially in cases of severe or persistent infections.

Preventing Recurrent Staph Infections in the Nose

Preventing recurrent staph infections is crucial for long-term nasal health. Strategies to reduce the risk of repeat infections include:

• Practicing good personal hygiene
• Avoiding nose picking and excessive nose blowing
• Using nasal antiseptic sprays as recommended by a healthcare provider
• Keeping nasal passages moisturized to prevent cracking and damage
• Avoiding sharing personal items like towels or razors

Are topical treatments more effective than oral antibiotics for preventing recurrent staph infections? According to a 2015 review, topical antimicrobial medications may be more effective than oral antibiotics in preventing recurrence. This is partly due to the potential for lower bacterial resistance to topical treatments.

Potential Complications of Untreated Nasal Staph Infections

Untreated staph infections in the nose can lead to serious complications if the bacteria spread to other parts of the body. Some potential complications include:

Facial Cellulitis

Facial cellulitis is a bacterial infection affecting the deeper layers of skin. Symptoms may include:

• Tenderness and pain in the face
• Skin redness and rash
• Lockjaw
• Fever and chills
• Loss of appetite

Without prompt treatment, facial cellulitis can become life-threatening.

Cavernous Sinus Thrombosis

Cavernous sinus thrombosis (CST) is a rare but serious condition involving a blood clot in the cavernous sinuses. Symptoms of CST include:

• Severe headache
• Swelling around the eyes
• Weakness of eye muscles
• Severe eye pain
• Fever

CST requires immediate medical attention due to its potential life-threatening nature.

Endocarditis

Endocarditis occurs when an infection spreads to the inner lining of the heart chambers and valves. Signs and symptoms may include:

• Fever and chills
• Fatigue
• Aching muscles and joints
• Difficulty breathing
• Nausea and vomiting
• Blood in the urine

Early detection and treatment of endocarditis are crucial to prevent long-term heart damage.

Pneumonia

Pneumonia is an inflammation of the lungs, often caused by bacterial infections. Symptoms of pneumonia include:

• Rapid or shallow breathing
• Breathlessness, even when resting
• Chest pain that worsens when breathing or coughing
• Rapid heartbeat
• Fever and chills
• General malaise
• Loss of appetite

Prompt treatment of pneumonia is essential to prevent respiratory complications.

Sepsis

Sepsis is a life-threatening condition that occurs when the body’s response to infection causes widespread inflammation and organ dysfunction. Symptoms of sepsis can include:

• High fever or low body temperature
• Rapid heart rate and breathing
• Confusion or disorientation
• Extreme pain or discomfort
• Clammy or sweaty skin

Sepsis is a medical emergency that requires immediate hospitalization and intensive treatment.

The Importance of Proper Hygiene in Preventing Staph Infections

Maintaining good personal hygiene is crucial in preventing the spread of staph bacteria and reducing the risk of infections. Key hygiene practices include:

• Washing hands frequently with soap and water
• Keeping wounds clean and covered
• Avoiding touching the face, especially the nose, with unwashed hands
• Regularly cleaning and disinfecting frequently touched surfaces
• Not sharing personal items like towels, razors, or nasal sprays

How effective is hand hygiene in preventing staph infections? Proper hand hygiene has been shown to significantly reduce the transmission of staph bacteria, including MRSA. Regular handwashing, especially before touching the face or nose, can help prevent the introduction of bacteria into vulnerable areas.

When to Seek Medical Attention for Nasal Staph Infections

While minor staph infections may sometimes resolve on their own, it’s important to know when to seek medical attention. Consider consulting a healthcare provider if you experience:

• Persistent or worsening symptoms despite home care
• Fever above 101°F (38.3°C)
• Severe pain or swelling
• Rapid spread of redness or warmth around the affected area
• Development of pus-filled boils or abscesses
• Signs of systemic infection, such as chills, fatigue, or body aches

Early intervention can prevent the progression of staph infections and reduce the risk of serious complications. Don’t hesitate to seek medical care if you’re concerned about a potential staph infection in your nose or sinuses.

Understanding the symptoms, treatment options, and prevention strategies for staph infections in the nose is essential for maintaining nasal health and preventing complications. By practicing good hygiene, recognizing early signs of infection, and seeking prompt medical attention when necessary, individuals can effectively manage and prevent nasal staph infections, including more serious forms like MRSA sinus infections.

Staph infection in nose: Symptoms, treatment, and diagnosis

A staphylococcus, or staph, infection is an infection caused by the bacteria Staphylococcus aureus.

Many people carry Staphylococcus aureus (S.aureus) on their skin or within their nose.

Here we look at the various causes and symptoms of a staph infection in the nose. We also outline the available treatment options for a nasal staph infection, as well as some tips for prevention.

Share on PinterestExcessively blowing or rubbing the nose is a possible cause of a staph infection in the nose.

The bacteria S. aureus cause staph infection.

Between 20–80% of humans carry S. aureus within their nasal passages. Most of the time, the bacteria do not cause any harm. However, if the skin of the nose becomes damaged, the bacteria can enter the wound and cause an infection.

Damage to the surface of the skin may trigger a mild to a moderate staph infection. Damage to the deeper layers of the skin may trigger a severe or even life-threatening staph infection.

Staph bacteria are contagious and can spread to other people through:

• skin-to-skin contact
• sharing personal items, such as toothbrushes, razors, or washcloths
• coughing or sneezing, although these types of transmission are less common

A staph infection in the nose can occur as a result of a scratch, sore, or other types of damage to the skin of the nose.

Some potential causes of a nasal staph infection include:

• nose picking
• excessively blowing or rubbing the nose
• plucking or tweezing nasal hairs

A person who has a nasal staph infection may develop the following symptoms:

• redness and swelling of the nose
• crusting around the nostrils
• boils inside one or both nostrils
• facial swelling
• pain
• fever

In some cases, a staph infection may resolve by itself. In other cases, a person will require treatment to clear the infection and prevent further complications.

Some people may succeed in treating minor nasal infections at home. People can soothe sores and crusting by holding a clean, warm, damp cloth onto affected areas. It is important to wash the cloth afterward to avoid spreading the bacteria.

Some people may develop pus-filled boils inside the nostrils. A doctor will need to drain the boil in order to treat the infection and promote wound healing. This procedure typically involves the use of a local anesthetic.

If a nasal staph infection does not clear up by itself, a person may need to take oral antibiotics or apply topical antimicrobial treatments.

Without treatment, staph infections may recur. This is because S.aureus remains inside the nasal passages.

Prescription antibiotic treatments can reduce numbers of staph bacteria, thereby helping to prevent the staph infection from recurring.

Researchers have been investigating the best treatment to prevent recurrent staph infections. According to a 2015 review, topical antimicrobial medications may be more effective than oral antibiotics. This is because S. aureus may have a lower resistance to topical treatments.

Practicing good personal hygiene may also help to reduce the risk of repeat infections.

If a staph infection enters the bloodstream, it can cause serious complications. We list some potential complications below.

Facial cellulitis

Facial cellulitis is a bacterial infection affecting the deeper layers of the skin. Without treatment, the condition can be life-threatening.

Symptoms of facial cellulitis include:

• tenderness and pain in the face
• rash
• skin redness
• lockjaw
• a fever
• chills
• loss of appetite

Cavernous sinus thrombosis

A cavernous sinus thrombosis (CST) is a blood clot that forms in the cavernous sinuses. This is the hollow space between the brain and the eye sockets.

A CST can develop when an infection in the face or skull spreads to the cavernous sinuses. Although rare, the condition can be life-threatening.

Symptoms of a CST include:

• a fever
• a severe headache
• swelling around the eyes
• a weakness of the eye muscles, resulting in drooping eyelids, or double vision
• severe eye pain

Endocarditis

An infection can sometimes spread to the inner lining of the heart chambers and valves. The medical term for this is endocarditis.

Symptoms of endocarditis include:

• a fever
• chills
• fatigue
• aching muscles and joints
• difficulty breathing
• nausea and vomiting
• blood in the urine

Pneumonia

Pneumonia is the medical term for inflammation of one or both lungs. It typically occurs as a result of infection.

In pneumonia, the tiny air sacs, or alveoli, within the lungs fill with fluid or pus. This makes it difficult for a person to breathe.

Some common symptoms of pneumonia include:

• rapid or shallow breathing
• breathlessness, even when resting
• chest pain that worsens when breathing or coughing
• rapid heartbeat
• a fever
• chills
• feeling generally unwell
• loss of appetite

Sepsis

Sepsis is a potentially life-threatening condition in which the body’s immune system overreacts to an infection. This overreaction leads to a toxic build-up of chemicals within the blood.

Symptoms of sepsis include:

• rapid breathing
• increased heart rate
• a fever
• chills
• feeling confused or disorientated

Toxic shock syndrome

Toxic shock syndrome (TSS) is a rare condition in which staph bacteria release dangerous levels of toxins into the bloodstream. TSS can be life-threatening.

The symptoms of TSS come on suddenly and worsen rapidly. They include:

• a fever
• flu-like symptoms, such as a headache, body aches, and a sore throat
• nausea and vomiting
• diarrhea
• a widespread skin rash that appears similar to sunburn
• a bright red coloring of the lips, tongue, and eye-whites
• difficulty breathing
• fainting
• confusion

There are steps a person can take to reduce their risk of developing or spreading a staph infection of the nose or skin. These include:

• regularly washing hands with soap and clean water
• showering or bathing daily to keep skin clean
• covering any cuts or wounds with sterile bandaids or dressings
• avoiding sharing personal items, such as toothbrushes, razors, and washcloths
• covering the mouth and nose when coughing or sneezing
• disposing of tissues after blowing the nose
• avoiding picking the nose
• using only sterile equipment to pluck or tweeze nasal hair, or avoiding these practices altogether

Some staph infections may resolve by themselves, while others may require treatment.

People should see a doctor if the staph infection:

• is severe
• lasts longer than a week, or keeps coming back
• is getting worse, or spreading to other parts of the face
• causes a skin rash or redness
• causes fever or chills
• causes breathing difficulty, or a change in heart rate

Anyone who has a weakened immune system should see a doctor at the first sign of a staph infection. This includes people who:

• are elderly
• have an autoimmune disease
• are receiving chemotherapy
• have received an organ transplant

Staph bacteria commonly live inside the nose and are usually harmless. However, if the skin of the nose becomes damaged, the bacteria can enter the wound and cause infection.

A person who has a nasal staph infection may develop redness, sores, or crusting around the nostrils. A person may need antibiotics or topical antimicrobial medications to treat the infection.

People should seek treatment if their infection is severe or persistent or accompanied by other symptoms. People who have a weakened immune system should seek treatment as soon as possible to reduce the risk of complications.

Staph infection in nose: Symptoms, treatment, and diagnosis

A staphylococcus, or staph, infection is an infection caused by the bacteria Staphylococcus aureus.

Many people carry Staphylococcus aureus (S.aureus) on their skin or within their nose.

Here we look at the various causes and symptoms of a staph infection in the nose. We also outline the available treatment options for a nasal staph infection, as well as some tips for prevention.

Share on PinterestExcessively blowing or rubbing the nose is a possible cause of a staph infection in the nose.

The bacteria S. aureus cause staph infection.

Between 20–80% of humans carry S. aureus within their nasal passages. Most of the time, the bacteria do not cause any harm. However, if the skin of the nose becomes damaged, the bacteria can enter the wound and cause an infection.

Damage to the surface of the skin may trigger a mild to a moderate staph infection. Damage to the deeper layers of the skin may trigger a severe or even life-threatening staph infection.

Staph bacteria are contagious and can spread to other people through:

• skin-to-skin contact
• sharing personal items, such as toothbrushes, razors, or washcloths
• coughing or sneezing, although these types of transmission are less common

A staph infection in the nose can occur as a result of a scratch, sore, or other types of damage to the skin of the nose.

Some potential causes of a nasal staph infection include:

• nose picking
• excessively blowing or rubbing the nose
• plucking or tweezing nasal hairs

A person who has a nasal staph infection may develop the following symptoms:

• redness and swelling of the nose
• crusting around the nostrils
• boils inside one or both nostrils
• facial swelling
• pain
• fever

In some cases, a staph infection may resolve by itself. In other cases, a person will require treatment to clear the infection and prevent further complications.

Some people may succeed in treating minor nasal infections at home. People can soothe sores and crusting by holding a clean, warm, damp cloth onto affected areas. It is important to wash the cloth afterward to avoid spreading the bacteria.

Some people may develop pus-filled boils inside the nostrils. A doctor will need to drain the boil in order to treat the infection and promote wound healing. This procedure typically involves the use of a local anesthetic.

If a nasal staph infection does not clear up by itself, a person may need to take oral antibiotics or apply topical antimicrobial treatments.

Without treatment, staph infections may recur. This is because S.aureus remains inside the nasal passages.

Prescription antibiotic treatments can reduce numbers of staph bacteria, thereby helping to prevent the staph infection from recurring.

Researchers have been investigating the best treatment to prevent recurrent staph infections. According to a 2015 review, topical antimicrobial medications may be more effective than oral antibiotics. This is because S. aureus may have a lower resistance to topical treatments.

Practicing good personal hygiene may also help to reduce the risk of repeat infections.

If a staph infection enters the bloodstream, it can cause serious complications. We list some potential complications below.

Facial cellulitis

Facial cellulitis is a bacterial infection affecting the deeper layers of the skin. Without treatment, the condition can be life-threatening.

Symptoms of facial cellulitis include:

• tenderness and pain in the face
• rash
• skin redness
• lockjaw
• a fever
• chills
• loss of appetite

Cavernous sinus thrombosis

A cavernous sinus thrombosis (CST) is a blood clot that forms in the cavernous sinuses. This is the hollow space between the brain and the eye sockets.

A CST can develop when an infection in the face or skull spreads to the cavernous sinuses. Although rare, the condition can be life-threatening.

Symptoms of a CST include:

• a fever
• a severe headache
• swelling around the eyes
• a weakness of the eye muscles, resulting in drooping eyelids, or double vision
• severe eye pain

Endocarditis

An infection can sometimes spread to the inner lining of the heart chambers and valves. The medical term for this is endocarditis.

Symptoms of endocarditis include:

• a fever
• chills
• fatigue
• aching muscles and joints
• difficulty breathing
• nausea and vomiting
• blood in the urine

Pneumonia

Pneumonia is the medical term for inflammation of one or both lungs. It typically occurs as a result of infection.

In pneumonia, the tiny air sacs, or alveoli, within the lungs fill with fluid or pus. This makes it difficult for a person to breathe.

Some common symptoms of pneumonia include:

• rapid or shallow breathing
• breathlessness, even when resting
• chest pain that worsens when breathing or coughing
• rapid heartbeat
• a fever
• chills
• feeling generally unwell
• loss of appetite

Sepsis

Sepsis is a potentially life-threatening condition in which the body’s immune system overreacts to an infection. This overreaction leads to a toxic build-up of chemicals within the blood.

Symptoms of sepsis include:

• rapid breathing
• increased heart rate
• a fever
• chills
• feeling confused or disorientated

Toxic shock syndrome

Toxic shock syndrome (TSS) is a rare condition in which staph bacteria release dangerous levels of toxins into the bloodstream. TSS can be life-threatening.

The symptoms of TSS come on suddenly and worsen rapidly. They include:

• a fever
• flu-like symptoms, such as a headache, body aches, and a sore throat
• nausea and vomiting
• diarrhea
• a widespread skin rash that appears similar to sunburn
• a bright red coloring of the lips, tongue, and eye-whites
• difficulty breathing
• fainting
• confusion

There are steps a person can take to reduce their risk of developing or spreading a staph infection of the nose or skin. These include:

• regularly washing hands with soap and clean water
• showering or bathing daily to keep skin clean
• covering any cuts or wounds with sterile bandaids or dressings
• avoiding sharing personal items, such as toothbrushes, razors, and washcloths
• covering the mouth and nose when coughing or sneezing
• disposing of tissues after blowing the nose
• avoiding picking the nose
• using only sterile equipment to pluck or tweeze nasal hair, or avoiding these practices altogether

Some staph infections may resolve by themselves, while others may require treatment.

People should see a doctor if the staph infection:

• is severe
• lasts longer than a week, or keeps coming back
• is getting worse, or spreading to other parts of the face
• causes a skin rash or redness
• causes fever or chills
• causes breathing difficulty, or a change in heart rate

Anyone who has a weakened immune system should see a doctor at the first sign of a staph infection. This includes people who:

• are elderly
• have an autoimmune disease
• are receiving chemotherapy
• have received an organ transplant

Staph bacteria commonly live inside the nose and are usually harmless. However, if the skin of the nose becomes damaged, the bacteria can enter the wound and cause infection.

A person who has a nasal staph infection may develop redness, sores, or crusting around the nostrils. A person may need antibiotics or topical antimicrobial medications to treat the infection.

People should seek treatment if their infection is severe or persistent or accompanied by other symptoms. People who have a weakened immune system should seek treatment as soon as possible to reduce the risk of complications.

Septic cavernous sinus thrombosis

Septic cavernous sinus thrombosis (CTS) is one of the life-threatening complications of infections of the face, orbit, ear, paranasal sinuses and oral cavity. The introduction of modern diagnostic methods contributed to the expansion of ideas about the etiology, pathogenesis, clinical manifestations and course of this disease. However, the variety of clinical manifestations, as well as the difficulties in diagnosing this pathology, often prevent the establishment of a correct diagnosis. Therefore, at present, the issues of early diagnosis and effective treatment of TCS remain relevant.

The purpose of the review is to present current data on the etiology of pathogenesis, clinical presentation, diagnosis and treatment of septic thrombosis of the cavernous sinus.

Anatomy. Cerebral veins direct blood to the venous sinuses, which are located between the two layers of the dura mater. The cavernous (cavernous) sinus is located on the sides of the Turkish saddle: the left and right cavernous sinuses are connected with the help of the anterior and posterior intercavernous sinuses, thus forming a circular sinus around the pituitary gland, which causes a rapid spread of infection to the opposite side. The name “cavernous sinus” is due to the large number of connective tissue partitions that permeate its cavity. Blood enters the cavernous sinus from the orbits through the ophthalmic veins and from the anterior part of the base of the brain through the sphenoidal sinus and middle cerebral vein. The question of the presence of valves in the facial veins remains debatable [1]. With thrombosis of the cavernous sinus, the process involves: the oculomotor and trochlear nerve (passing in the upper part of the sinus), the upper branch of the trigeminal nerve (in the outer part of the sinus), the internal carotid artery with the periarterial sympathetic plexus and the abducens nerve (in the posterior part of the sinus). The pituitary gland and the wall of the sphenoid sinus adjoin the inner wall of the cavernous sinus. On the outside, the Gasser knot is closely located. The cavernous sinus is an important regulator of cerebral circulation, the “venous heart”, actively acting on the cerebral venous and arterial circulation [2].

The sinuses of the dura mater play an important role in the circulation of cerebrospinal fluid, since they contain pachyonic granulations, in which CSF is absorbed. This is associated with a high frequency of increased intracranial pressure in patients with sinus thrombosis [3]. From the sinuses, blood enters the internal jugular and vertebral veins, and then through the brachiocephalic veins into the superior vena cava [4]. Part of the venous blood is drained through emissaries – venous graduates located inside the flat bones of the skull and connecting the venous sinuses of the dura mater with the diploic veins and with the external veins of the head [2]. The presence of collaterals between the venous sinuses and connecting veins explains, firstly, the lack of correlation between the severity of the pathological process and neurological symptoms, and secondly, the possibility of complete clinical recovery in cerebral venous thrombosis [3].

Etiology. Currently, the causes of septic sinus thrombosis are divided into [5]:

1. Infectious.

1.1. Local:

– septic injury;

– intracranial infection – abscess, subdural empyema, meningitis;

– regional (local) infection – sinusitis, orbital cellulitis, tonsillitis, stomatitis, skin cellulitis.

1.2. Generalized:

– bacterial – septicemia, endocarditis, tuberculosis;

– viral – measles, hepatitis, herpetic, cytomegalovirus, HIV;

– parasitic – malaria, trichinosis, toxoplasmosis;

– fungal – aspergillosis, cryptococcosis.

Different authors refer to different sources of the first description of this pathology — Dease in 1778 (quoted from [6]), A. Duncan in 1821 [7]. S. Varshney et al. [8] believe that for the first time TCS as a complication of epidural and subdural infection was described by Bright in 1831.

According to different authors, Staphylococcus aureus is the most common infectious agent found in 70% of cases [9, 10], streptococci are in second place. In recent years, methicillin-resistant Staphylococcus aureus (MRSA) has been detected more frequently [9–12].

Cases of detection of Streptococcus mitis and Staphylococcus lugdunensis are described [13, 14]. St . lugdunensis is a coagulase-negative staphylococcus present on human skin, usually leading to the development of endocarditis, arthritis. R. Matthews et al. [13] found this pathogen in a patient with TCS against the background of right-sided necrotizing maxillary and ethmoidal sinusitis, periorbital cellulitis, and conjunctivitis. Streptococcus mitis – flora of the oropharynx, digestive tract and female reproductive system. S. Kutlu et al. [14] found S . mitis in the cerebrospinal fluid of a patient with intracranial complications resulting from maxillary sinusitis, while the pathogen was not detected in the sinus itself.

In addition, gram-negative and anaerobic flora can also lead to the development of TCS. A case of septic TCS caused by Campylobacter rectus 9 has been described.0009, a gram-negative anaerobic bacterium that causes periodontal disease [15]. Fungi are less common, mainly Aspergillus fumigates , Rhizopus species , m ucormycosis [16–18]. A case of septic TCS caused by tuberculosis infection has been described [19].

Most often, the development of TCS is caused by nasal furuncles (50%), inflammatory processes in the sphenoid and ethmoid sinuses (30%), pathology of the oral cavity and ear (10%) [20—23].

Among the predisposing factors, the most common are hereditary and acquired thrombophilia – pathological conditions characterized by an increased tendency to develop blood vessel thrombosis, which are based on disorders in various parts of the hemostasis and hemorheology system. The most common causes of thrombophilia are antithrombin III deficiency, protein S deficiency, protein C deficiency, factor V Leiden mutation, which leads to an increase in the concentration of factor V in the blood and is clinically manifested by recurrent venous thrombosis and embolism [24]. Less likely factors: plasminogen deficiency [25], plasminogen activator deficiency [26], heparin cofactor II deficiency [27], factor XII deficiency, excess fibrinolysis inhibitor, high levels of histidine-rich plasma glycoprotein, dysfibrinogenemia [28], hyperhomocystenemia [29]. In addition to these factors, other causes of TCS have been identified in women: thrombosis in early pregnancy and while taking oral contraceptives (the risk increases by 4–6 times) [30].

Pathogenesis. Three main mechanisms underlie any thrombosis: damage to the vein wall, slowing of blood flow and changes in the functional state of the hemostasis system. Damage to the wall in the case of septic TCS is due to the action of an infectious agent. First of all, inflammation begins with the vein wall, then the process of adhesion and aggregation of platelets develops in the damaged area with the formation of a primary platelet thrombus. The resulting thrombus is usually tightly fixed on the wall of the inflamed vein, and often the inflammatory process extends to the peri- and paravasal tissue (peri- and paraphlebitis). Further growth of the thrombus is facilitated by the absence of valves in the facial vein, slow blood flow and the presence of numerous septa in the cavity of the cavernous sinus. The spread of a thrombus from the sinuses into smaller vessels causes venous obstruction, creates increased hydrostatic pressure in the proximal veins and capillaries, and contributes to the development of cerebral edema and ischemia, hence, cerebral infarction [31]. At the same time, sinus thrombosis can manifest itself only as edema of the brain substance without the development of a heart attack or does not cause macroscopically detectable damage to the brain substance at all, which explains the greater variability in the prognosis of venous infarcts, in contrast to arterial ones. In the future, thrombi may undergo complete lysis, recanalization with partial restoration of vein patency or fibrous organization [31].

Clinical symptoms. The clinical manifestations of TCS are very diverse and depend on the prevalence of thrombosis, the rate of vein occlusion, the age of the patients, and etiological factors.

The most common initial symptom is headache (in 82% of patients) in combination with papilledema as a manifestation of intracranial hypertension syndrome [31]. Headache is a nonspecific symptom of TCS: it can be of any intensity, diffuse or local, constant or intermittent, with acute, subacute or chronic onset, often accompanied by nausea and vomiting. Phlebitis of the cerebral veins is characterized by increased headaches at night and in a horizontal position, transient swelling and hyperemia under the eyes, noise in the head. Edema of the optic disc is observed in 51% of patients with TCS. It is caused by an increase in intracranial pressure and usually occurs subacutely (in 56% of cases), may be combined with transient bilateral blurred vision [31].

Against the background of pronounced inflammation, hyperthermia, neutrophilic leukocytosis, accelerated ESR, symptoms of local disturbance of venous outflow appear: exophthalmos, pronounced swelling of the soft tissues of the orbit, cyanosis of the skin in this area, chemosis (edema of the conjunctiva of the eyeball). In the neurological status, there is a picture of the syndrome of the superior palpebral fissure with paresis of the abducens, oculomotor, trochlear nerves and the first branch of the trigeminal nerve. Clinically, this is manifested by ptosis, painful external ophthalmoplegia, impaired sensitivity of the cornea and supraorbital region. The slow development of symptoms observed in some cases with an isolated lesion of III or IV cranial nerves makes it difficult to diagnose.

Quite often, consciousness is disturbed (sometimes with psychomotor agitation), against this background focal brain symptoms occur (paresis or paralysis of the limbs, aphasia, focal or generalized epileptic seizures, etc.). These symptoms occur gradually and are associated with damage to the substance of the brain (infarction or hemorrhage) and progressive cerebral edema.

TCS can be bilateral, in such cases the disease is especially severe, and the process can also spread to adjacent sinuses.

Complications

1. Cerebral edema, formation of infarcts and hemorrhagic complications in 50% of cases [33].

2. Retinal vein thrombophlebitis, purulent meningitis, brain abscess, metastatic lung abscesses, septic pneumonia.

3. Endocrine disorders (hypopituitarism) [34].

4. Status epilepticus.

5. Thromboembolism of the pulmonary artery.

6. Decreased visual acuity.

Diagnostics. Clinical findings of TCS are confirmed by objective methods (CT, MRI, MR angiography). In cases of a clinical picture of cerebral venous thrombosis along the veins and sinuses, a CT or MRI of the brain reveals a zone of ischemia and hemorrhage (foci of increased density in the brain parenchyma). The hypodense zone (edema) of the brain substance persists for several days after the onset of the disease. Visualization of a thrombus in the lumen of the sinus is possible with intravenous contrast enhancement: against the background of a bright functioning lumen of the sinus, areas with a lower density than that of the contrast agent are found in it. The symptom of “empty delta” is the absence of accumulation of a contrast agent in the thrombosed area of ​​the venous sinus. Nonspecific symptoms: hyperdense venous sinus, narrowing of cisterns and / or ventricles due to increased intracranial pressure. A normal CT image is detected in 10–20% of cases with proven TCS [35].

MRI is a more effective method for diagnosing TCS. In the acute stage in the T1 mode, the thrombus in the lumen of the sinus looks like an area isointense with the substance of the brain, in T2 it is hypointense. In the subacute stage, the thrombus has an increased MR signal in all modes. In the chronic stage, the intensity of the signal from the thrombus in T1 decreases, which is associated with fibrosis and possible recanalization of the thrombosed area [36].

MR venography reveals a current hyperintensity defect (MR signal loss) in the sinus [37].

Cerebral angiography is a type of study that is used only when it is impossible to perform an MRI or MR venography, as well as in diagnostically difficult cases. The absence of blood flow through the sinus is recorded in the case of its complete thrombosis. With a long process – the expansion of cortical veins, the formation of additional ways of venous outflow. With lumbar puncture, in 40% of cases, an increase in the pressure of the cerebrospinal fluid is detected without changing its composition. An increase in protein is found in 50% of cases, erythrocytes – in 67%, leukocytes – in 33%, a combination of these changes – in 30-50% [5]. In addition, lumbar puncture is used to reduce headache and prevent visual disturbances in patients with intracranial hypertension.

Given the role of thrombophilia in the pathogenesis of thrombosis, it is necessary to determine prothrombin, partial thromboplastin time, activity and amount of protein C, activity and amount of protein S, antithrombin III and its activity, mutation of factor V Leiden, homocysteine ​​level, fibrinogen and its activity, coagulation factor VIII .

Treatment. First of all, the diseases that caused TCS should be treated. Treatment of septic TCS is carried out in two directions: antimicrobial and thrombolytic therapy. With septic thrombosis, treatment consists in surgical debridement of the focus of infection, the use of broad-spectrum antibiotics that penetrate the blood-brain barrier. Until the etiology of the process is clarified, antimicrobial drugs are prescribed empirically.

The drugs of choice for initial antibiotic therapy are [38]:

1. 3rd and 4th generation cephalosporins: cefotaxime (claforan, oritax) at a dose of 3–12 g/day, ceftriaxone (rocefin) 2–4 g/day, ceftazidime 3–6 g/day, cefoperazone 4– 12 g/day, cefepime 2–4 g/day.

2. An antibiotic of the carbapenem group: meropenem 6 g/day intravenously [23].

3. Glycopeptides: vancomycin 2 g/day [23].

4. Alternative drugs: ampicillin 8-12 g/day; benzylpenicillin 20-30 million units/day; oxacillin 12-16 g/day; gentamicin 12-16 g/day, amikacin 15 mg/kg intravenous drip in 200. 0 ml of saline.

Adequate antibacterial therapy for TCS is a combination of vancomycin and ceftriaxone/ampicillin-sulbactam/piperacillin-tazobactam [8, 12, 23]. Sulbactam and tazobactam are drugs that inhibit the action of β-lactamase and are used in combination with other antibiotics. Given the polymicrobial etiology of sinusogenic TCS, it is necessary to prescribe antianaerobic drugs (eg, metronidazole) [4, 8]. Parenteral antibiotic therapy is long-term, up to 3–4 weeks [21].

Antithrombotic therapy. The use of anticoagulants as the therapy of choice for TCS reduces the risk of fatal outcome and severe disability [12, 39, 40]. The main drug is heparin. Its effectiveness has been proven in controlled studies [41, 42]. Usually, a single initial intravenous administration at a dose of 3000 U is used, then the dose is increased – 25,000-70,000 U / day. The optimal method of therapeutic use of unfractionated heparin (UFH) is continuous intravenous infusion. To achieve the fastest anticoagulant effect, 3000-5000 IU of heparin are initially injected as a bolus, the rest of the daily dose is administered by drip using an infusion pump. For other routes of administration, a single dose of heparin is calculated by dividing the daily dose by the number of injections (8 with fractional intravenous administration with an interval of 3 hours, with subcutaneous administration – 3 with a frequency of 8 hours). Dose selection is carried out under the control of activated partial thromboplastin time (APTT), which should double [41]. Heparin is used until the patient develops positive dynamics of TCS symptoms. Heparin therapy is carried out for a week, then indirect anticoagulants are used for at least 3 months, and subsequently antiplatelet agents. In recent years, low molecular weight heparins (LMWHs) have been used for thrombosis: dalteparin, nadroparin (fraxiparin), enoxaparin (Clexane) [43]. An important feature of all LMWHs is their weaker anticoagulant activity than conventional heparin, and at the same time a more pronounced antithrombotic effect. The advantages of LMWH, compared with UFH, are a lower incidence of hemorrhagic complications, an extremely rare development of thrombocytopenia, a longer duration of action, high bioavailability, and no need for frequent laboratory monitoring. For therapeutic purposes, LMWH is injected twice a day into the anterior abdominal wall. The therapeutic dose of enoxaparin is 1 mg/kg of the patient’s body weight 2 times a day, nadroparin – 0.6-1.0 ml (5700-9500 anti-Ha IU). Synthetic pentasaccharides and direct thrombin inhibitors are considered as alternatives to standard LMWHs. The antithrombotic activity of fondaparinux (arixtra), a result of selective inhibition of factor X mediated by antithrombin III, is administered at doses of 5 to 10 mg by deep subcutaneous injection. A direct thrombin inhibitor, melagatran (Exanta SK) in the form of a solution for subcutaneous injections, at a dose of 3 mg/0.3 ml [43].

Oral anticoagulants are connected for a period of at least 3 months to prevent relapses [44]. For this purpose, warfarin is widely used under the control of indications of the results of the prothrombin test – INR. In the treatment of venous thrombosis, it is recommended to achieve a high level of hypocoagulation (INR 2. 5-3.5). Warfarin is started at 2.5 to 5.0 mg/day once a day. INR control is carried out 6-10 hours after taking the drug. Based on the data obtained, the dose of the drug can be increased. The usual recommended duration of warfarin is 3 months. During the period of gradual withdrawal of indirect anticoagulants, antiplatelet agents are used: pentoxifylline, ticlopidine, clopidogrel. It is also recommended to take aspirin at a dose of 80–100 mg/day; if it is contraindicated, dipyridamole 400 mg/day is recommended [45].

Symptomatic therapy of is mainly aimed at stopping epileptic seizures and normalizing intracranial pressure [44]. With severe intracranial hypertension, intravenous administration of mannitol, mechanical ventilation in the hyperventilation mode can be used. Corticosteroids are not recommended for the treatment of increased intracranial pressure, as their effectiveness has not been proven and they can provoke a thrombotic process [45]. Also, non-steroidal anti-inflammatory drugs should not be used as analgesic and anti-inflammatory therapy during anticoagulant treatment.

Disease prognosis. The outcome of TCS is affected by the severity of the patient’s condition and the timing of diagnosis. Depression of consciousness, deep coma are unfavorable prognostic signs [33]. Hemorrhagic heart attacks, complications in the form of sepsis, poorly controlled epileptic seizures, pulmonary embolism, and the severity of the underlying disease also indicate a poor prognosis.

According to the literature, a complete cure is observed in 52-77% of patients, small residual effects – in 7-29%, pronounced residual effects – in 9-10%, mortality – in 5-33% [20, 46].

Thus, modern ideas about the etiology of the pathogenesis of the disease, data from neuroimaging diagnostic methods and the development of new effective methods of treatment have significantly improved the prognosis of the disease.

The authors declare no conflict of interest.

Methicillin-resistant Staphylococcus aureus of zoonotic origin – a new threat to public health | Vaganova

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