A child presents with unilateral, foul smelling nasal discharge. Most probable cause could be: September 2011
**Core Concept:** Unilateral foul-smelling nasal discharge in a child can be a sign of various conditions affecting the upper respiratory tract, including sinuses, nose, and paranasal sinuses. The most common cause of such discharge is an infective sinusitis, usually due to bacteria or less commonly, viruses or fungi. Septic complications of sinusitis can lead to orbital cellulitis or meningitis, which need urgent attention and management.
**Why the Correct Answer is Right:** The correct answer, 'D', is related to bacterial sinusitis because bacteria are the most common cause of such discharge. Bacterial sinusitis usually develops as a complication of acute or chronic rhinosinusitis. Among the bacteria, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are commonly isolated. The bacteria in question typically involve the maxillary sinus, which is the most commonly affected sinus in children.
**Why Each Wrong Option is Incorrect:**
A. This option is incorrect because viral infections are usually bilateral and cause mild symptoms, whereas bacterial sinusitis presents with unilateral symptoms and foul-smelling discharge.
B. This option is incorrect because fungal infections, such as mucormycosis, are uncommon in children, and the discharge is typically non-purulent.
C. This option is incorrect because orbital cellulitis is a rare complication of sinusitis and does not solely account for the unilateral foul-smelling nasal discharge.
**Why the Correct Answer is Right:** The correct answer, 'D', is right because bacterial sinusitis is the most common cause of unilateral foul-smelling nasal discharge in children. Bacterial sinusitis typically involves the maxillary sinus, which is the most commonly affected sinus in children. This condition usually presents with symptoms like nasal obstruction, headache, facial pain, and fever, along with the discharge mentioned in the question.
**Why Each Wrong Option is Incorrect:**
A. This option is incorrect because viral sinusitis is bilateral and presents with mild symptoms, while bacterial sinusitis causes unilateral foul-smelling discharge.
B. This option is incorrect because mucormycosis is a rare infection caused by fungi and does not typically present as unilateral foul-smelling nasal discharge in a child.
C. This option is incorrect because orbital cellulitis is a complication, not the primary cause, of the unilateral foul-smelling nasal discharge. The primary cause should be identified first, followed by any complications.
**Clinical Pearls:**
1. In clinical practice, it is essential to consider bacterial sinusitis as a differential diagnosis for unilateral foul-smelling nasal discharge in a child.
2. If the discharge persists or is associated with systemic symptoms like fever, headaches, and facial pain, further evaluation and management should be guided by the presence of complications like orbital cellulitis or meningitis.
3. Promptly diagnosing and treating bacterial sinusitis can prevent complications and ensure optimal patient recovery.