Sinus infection with diarrhea


Infections are the hallmark of a primary immunodeficiency. For many patients, a primary immunodeficiency diagnosis is suspected and made only after the patient has had recurrent infections or infections that are uncommon or unusually severe. This section discusses common infections.

Infections in the Patient with Primary Immunodeficiency

Anyone can get an infection, and everyone does. But an infection in a person with a primary immunodeficiency may require different treatment than a similar infection in a person with a normal immune system. For example, the person with a primary immunodeficiency may require a longer course or higher dose of antibiotics than someone who does not have a primary immunodeficiency.

Your primary care provider should be the first point of contact when you are ill. The provider may then want to confer with your immunologist about the management and treatment of a particular infection. Your immunologist needs to know about the infections that you are having, as this knowledge may affect your treatment. For example, antibody deficient individuals who receive immunoglobulin (Ig) therapy may need to have their dose adjusted if they are experiencing frequent “breakthrough” infections.

The goals of medical treatment and supportive care are to reduce the frequency of infections, prevent complications and prevent an acute infection from becoming chronic and potentially causing irreversible organ damage. The patient, family and members of the healthcare team must work together and effectively communicate among each other if these goals are to be accomplished.

A description of several kinds of infections follows. Many other infections including skin infections, deep abscesses, bone infections, meningitis and encephalitis are not covered in this chapter, but these may occur in patients with primary immunodeficiency.

Remember that the suffix “itis” means an inflammation of a particular body part, like tonsillitis or appendicitis. The inflammation is usually caused by an infection, but not always.

Eye Infections

Conjunctivitis – Conjunctivitis, or pink eye, is an inflammation or infection of the lining of the eyelid and of the membrane covering the outer layer of the eyeball (conjunctiva). It can be caused by bacteria, viruses or chemical irritants such as smoke or soap. Conjunctivitis may occur by itself or in association with other illnesses, such as the common cold. The symptoms commonly associated with conjunctivitis are redness and/or swelling of the eyelids, tearing and discharge of mucus or pus. These symptoms are frequently accompanied by itching, burning and sensitivity to light.

In the morning, it is not unusual to find the eyelids “stuck” together from the discharge that has dried while the eyes were closed during sleep. These secretions are best loosened by placing a clean washcloth or cotton ball soaked in warm water on each eye. After a few minutes, gently clean each eye, working from the inner corner to the outer corner of the eye. Meticulous hand washing is necessary for anyone coming in contact with the eye discharge in order to prevent the spread of the infection as conjunctivitis is usually very contagious.

It may be necessary to be seen by a physician if vision is significantly affected or if symptoms persist, in order to determine the type of conjunctivitis. The eye discharge may be cultured to determine if the infection is bacterial or viral. Topical antibiotics (ointment or eye drops) may be prescribed if the infection is bacterial in nature. If the inflammation is caused by an irritant, avoidance of that irritant will be important.

Ear Infections

Otitis Media – Otitis Media is an infection of the middle ear and is usually caused by bacteria or viruses. A small tube called the Eustachian tube connects the middle ear with the back of the throat and nose. In the infant and small child, the tube is shorter and more horizontal than in the adult, and provides a ready path for bacteria and viruses to gain entrance into the middle ear and not drain out. In some infections and allergic conditions, the Eustachian tube may actually swell and close, preventing drainage from the middle ear.

The characteristic symptom associated with otitis media is pain, caused by irritation of the nerve endings in the inflamed ear from inflammatory secretions or changes in ear pressure. A baby or young child may indicate pain by crying, head rolling, or pulling at the infected ear(s). The older child or adult may describe the pain as being sharp and piercing. Restlessness, irritability, fever, nausea and vomiting may also be present. Pressure in the infected eardrum tends to increase when the individual is in a flat position. This explains why pain is often more severe at night, causing the individual to wake up frequently. As fluid pressure increases within the eardrum, pain becomes more severe and the eardrum may actually rupture. The appearance of pus or bloody drainage in the ear canal is an indication of a possible eardrum rupture. Although pain is usually relieved when the eardrum ruptures, the infection still exists.

Whenever an ear infection is suspected, the patient should be seen by a healthcare provider. Antibiotic therapy is usually started in order to cure the infection. Analgesic (pain killing) ear drops may also be prescribed to help with pain. A follow-up examination may be recommended to be sure that the infection has cleared and that no residual fluid remains behind the eardrum. Repeated episodes of otitis media may actually cause hearing impairment or loss.

For children with repeated episodes of otitis media, a procedure called a myringotomy may be recommended. In this procedure a small hole is made in the eardrum and a tube placed in the hole, to promote drainage of fluid from the middle ear and equalize the pressure between the ear canal and middle ear.

Upper Respiratory (Sinus and Throat) Infections

Rhinitis – Rhinitis is a term used to describe an inflammation of the nose. It is usually caused by bacteria, viruses, chemical irritants and/or allergens. Symptoms may include sneezing, difficulty in breathing through the nose, and nasal discharge (rhinorrhea). The nasal discharge may vary from thin and watery, to thick and yellow or green. It is generally accepted that green nasal discharge is a sign of acute infection, but this may not always be the case.

Acute Sinusitis – Sinusitis is an inflammation of one or more of the sinuses. The sinuses are small cavities, lined with mucous membranes, located in the facial bones surrounding the nasal cavities. The purpose of the sinuses is thought to be to decrease the weight of the skull and to give resonance and timbre to the voice. The basic causes of sinusitis are the blockage of normal routes of sinus drainage and infections spread from the nasal passages. Pain, particularly in the forehead and cheekbones, and tenderness over the face in these same areas is characteristic symptoms. In addition, there may be pain in and around the eyes and in the teeth of the upper jaw. The pain and headache associated with sinusitis is typically more pronounced in the morning due to accumulated secretions in the sinuses during sleep. Being in an upright position during the day facilitates sinus drainage and usually provides some temporary relief. Depending on the amount of sinus drainage, there may be cough, throat irritation, bad breath and decreased appetite. Sinusitis may be accompanied by a fever.

A sinus infection can be difficult to treat in the patient with a primary immunodeficiency and may require a longer course of antibiotics than would be usually prescribed. Many patients get benefit from the use of daily sinus rinses to keep the sinuses free of accumulating secretions. Repeated or prolonged episodes of acute sinusitis may lead to chronic sinusitis and damage to the mucosal surfaces.

Acute Coryza – Coryza, also known as upper respiratory infection (URI) or the common cold, is an acute inflammation of the upper respiratory tract (nose and throat or nasopharynx). Early symptoms include a dry tickling sensation in the throat, followed by sneezing, coughing and increased amounts of nasal discharge. There may also be symptoms of fatigue and generalized aches and discomfort. A cold is usually caused by a rhinovirus. Symptomatic treatment may bring some relief, but there is no antibiotic currently available that will kill or inactivate a rhinovirus. Taking an antibiotic will not cure a cold any quicker. A cold generally lasts about a week. There is some validity to that old joke that a cold with treatment lasts about seven days and without treatment, a week.

But if your “cold” lasts more than a week and is accompanied by a fever, productive cough and/or difficulty breathing, it may be more than a cold and you should see your primary care provider.

Influenza – Influenza, or “Flu” (a short form of the word “influenza”), is a term that is often used generically to describe the fever, aches, cough, congestion, etc. that we associate with many common respiratory viruses. However, true influenza is caused only by an influenza virus and may be more severe and dangerous than other common respiratory viruses. Flu season is generally in the fall and winter. Flu may occur sporadically or in epidemics. Usually epidemics occur every two to four years and develop rapidly because of the short incubation period of the disease.

The incubation period is the time from when a person is exposed to an infection to the time symptoms appear. Symptoms of the flu include sudden onset of high fever, chills, headache, muscle ache, weakness, fatigue and runny nose. Vomiting and diarrhea may also be present. Sometimes a bacterial infection may develop during or after the flu.

There are anti-viral drugs available to treat the flu, but they must be started shortly (one or two days) after the onset of symptoms in order for them to be effective. There is also some evidence to suggest that these drugs may prevent the flu or decrease its severity if taken after someone has been exposed to the flu. Influenza can be a very serious infection, particularly in someone with a primary immunodeficiency and medical attention should always be sought.

Pharyngitis – Pharyngitis describes an inflammation of the throat (sore throat). It is usually caused by a bacterial or viral infection but may also be caused by simple irritation. Symptoms include a raw or tickling sensation in the back of the throat and there may be difficulty swallowing. Sometimes these symptoms are accompanied by a fever. Sore throats that are caused by streptococcus (strep throat) can cause other diseases such as rheumatic fever or kidney inflammation if they are not treated. If you have a sore throat, you should seek medical attention as a quick test or culture to determine if it is a Strep infection is usually indicated.

Tonsillitis – Tonsillitis is an inflammation of the tonsils. Some people have chronic tonsillar infections, and it may be recommended that the tonsils be removed (sometimes along with the adenoids).

Adenitis or Lymphadenitis – Lymphadenitis, or swollen glands, is an inflammation of the lymph nodes. Lymph nodes are present all over the body, but particularly in the neck, axillae and groin areas. The lymph system functions to help the immune system respond to infection. For example the lymph nodes in the neck can become inflamed as the body is recovering from an upper respiratory infection. This is called reactive lymphadenopathy because it is a normal response, or reaction, to an infection. It is also possible for the lymph nodes to become inflamed because they themselves are infected.

Lower Respiratory Infections

Croup – Croup is a general term used to describe an infection, usually in children, which causes narrowing of the air passages leading to the lungs. Croup can be caused by viruses or bacteria. The child’s temperature may be normal or slightly elevated. The onset of croup may be sudden or occur gradually. In some instances, the onset occurs at night, and the child may awaken with a tight “barking” cough and respiratory distress. Breathing is difficult due to the narrowing of the trachea (windpipe). Croup can be a frightening experience for both the parents and child. Unfortunately, the child’s anxiety may increase the severity of the symptoms. It is important for the parents to remain as calm and as reassuring as possible. Urgent medical attention may be needed. Depending on the severity of symptoms, advice may be sought from the primary care on call provider, and sometimes an emergency room visit is in order.

Acute Bronchitis – Acute bronchitis is an inflammation of the bronchi, which are the major branches off the trachea (windpipe). It often accompanies or follows an upper respiratory infection. Symptoms include fever and cough. At the onset, the cough is usually dry but gradually becomes more productive.

Pneumonia – Pneumonia is an acute infection of the lungs and can be caused by bacteria, viruses and/or fungi. Symptoms include chills, high fever, cough and chest pain associated with breathing. Symptoms of pneumonia should always be reported to the primary care provider. In some people with a primary immunodeficiency, bronchiectasis may develop if there are repeated episodes of pneumonia. Bronchiectasis is an irreversible condition where the airways become widened and scarred. After this occurs, it becomes difficult to clear the airways of mucus and bacteria, which leads to even more serious lung infections.

General Care of Respiratory Infections

Respiratory infections may be merely bothersome, like a cold or more serious like pneumonia. Management of these infections is directed toward the relief of symptoms and the prevention of complications. The primary care provider may recommend a medication to relieve fever and general body aches. Antibiotics may be prescribed to cure infections that are caused by bacteria. Expectorants may be prescribed to liquify (water down) mucus secretions and make them easier to cough up. Decongestants to shrink swollen mucous membranes may also be recommended. Fluids should be encouraged to promote adequate hydration. Drinking a variety of beverages is important. Beverages served with crushed ice can be soothing to a sore throat. Warm beverages, such as tea, may promote nasal drainage and relieve chest tightness. During the acute phase of any of these types of illnesses, there may be a loss of appetite. This is generally short lived. It is usually effective to have small frequent feedings of liquid and light foods. Once the appetite returns, a high caloric, high protein diet, to replace the proteins lost during the acute phase of the illness, might be recommended.

General comfort measures also include rinsing the mouth with plain water at regular intervals. This will relieve the dryness and “bad taste” that often accompanies illness and mouth breathing. A vaporizer may be helpful in increasing room humidity. However, if a vaporizer is used, daily cleaning is imperative to prevent contamination with molds. A coating (such as petrolatum or lip balm) can provide relief and protection to irritated lips and nose. Adequate rest is important. If persistent coughing or post nasal drip interferes with rest, elevation of the head and shoulders with extra pillows during periods of sleep should be attempted. Sometime a cough suppressant can be prescribed at night to prevent interruption of sleep.

Respiratory infections tend to be easily passed from one individual to another. The person who is ill should always be encouraged to cover the mouth and nose when sneezing and coughing. Soiled tissues should be promptly discarded. Frequent hand washing is critical to prevent the spread of the infection. In some cases of bronchitis and pneumonia, coughing and breathing deeply at regular intervals should be encouraged as coughing protects the lungs by removing mucus and foreign particles from the air passages. Deep breathing promotes full expansion of the lungs, reducing the risk of further complications. In some situations, the primary care provider may order chest postural drainage, chest physiotherapy or sinus postural drainage, which are all ways of helping to loosen and clear mucus.

Gastrointestinal (GI) Infections

Diarrhea – Diarrhea is characterized by frequent, loose, watery bowel movements (stools). Diarrhea is a symptom and may indicate an infection or inflammation of the GI tract. Infections may be caused by viruses, bacteria, fungi or parasites. The primary care provider may order stool cultures to determine the cause of the infection. Certain medications may also cause diarrhea. Diarrhea may be mild to severe in nature. Whether it is mild or severe depends on the frequency, the volume and the consistency of the stools. Diarrheal illnesses may be accompanied by fever. In some cases severe diarrhea can cause dehydration. Infants, young children and the elderly are at the greatest risk of serious problems associated with dehydration. Diarrheal illnesses may sometimes be accompanied by vomiting, further increasing risks of dehydration. Signs of dehydration can include:

  • Loss of skin elasticity
  • Dry parched lips, tongue and mucus membranes
  • Thirst
  • Decreased urine output
  • In infants, depressed or sunken fontanelles (soft spots on the head)
  • An appearance of sunken eyes
  • Behavioral changes ranging from restlessness to extreme fatigue and weakness

The general care of diarrhea focuses on the replacement of lost body fluids and salts and the prevention of dehydration. When diarrhea is mild, changes in the diet and increased fluid intake may compensate for fluid losses. The primary care provider may suggest a clear liquid diet, including weak tea, sports drinks, bouillon and “flattened” (without carbonation) soft drinks. As clear liquids are tolerated and the frequency and volume of stools decrease, the diet may be gradually advanced. In case of severe dehydration, hospitalization and intravenous fluids may be necessary.

General comfort measures include coating the rectal area with a petroleum jelly preparation. This will help protect the skin and reduce irritation from frequent diarrheal stools. Soiled diapers and clothing should also be changed immediately. The older child and adult may be encouraged to rinse his or her mouth with water regularly. This helps to relieve mouth dryness and “bad taste” associated with illness and is especially important after vomiting.

In infectious diarrhea, several measures are used to reduce the chances of spreading the illness to other family members. It may be easier for the infected person to use disposable cups, dishes and utensils. Soiled diapers, clothing and linens should be kept separate and washed separately from other family laundry. Bathrooms should be cleaned with a disinfectant solution as often as necessary. Frequent hand washing is essential for everyone.

Bloody diarrhea and diarrhea accompanied by urgency and severe abdominal cramping may be signs of illnesses other than infections. These symptoms should always be reported to the primary care provider. Diarrhea can be caused by many things in addition to infections including certain drugs, malabsorption, inflammatory bowel diseases like ulcerative colitis or Crohns disease, etc., and additional testing may be required to determine its cause.

Other GI Infections

Any of the gastrointestinal organs can become inflamed. Examples of these disorders include hepatitis (liver), gastritis (stomach), pancreatitis (pancreas), cholecystitis (gall bladder) or colitis (large intestine). This inflammation may be caused by infection. Symptoms can include pain, yellowing of the skin and/or eyes (jaundice), diarrhea, nausea or loss of appetite. Medical attention should always be sought for these types of symptoms.

Bloodstream Infections

The blood can become infected with any kind of germ (bacteria, fungus, virus). The general term for this is “sepsis.” These are extremely serious infections usually accompanied by high fever and signs of severe acute illness. It is necessary for the blood to be drawn and cultured to see if infectious organisms are present. Very often, blood stream infections require treatment with intravenous antibiotics.

Infections at Unusual Locations or with Unusual Organisms

Infections that occur with defects in the innate immune system may be quite different from those that affect individuals with defects in T-cells or B-cell/antibody production. For example, children with Chronic Granulomatous Disease (CGD) are usually healthy at birth. The most common CGD infection in infancy is a skin or bone infection with the bacteria Serratia marcescens, an organism that very rarely causes infections in other primary immunodeficiency diseases and any infant with an infection with this particular organism should be tested for CGD.

Infections in CGD may involve any organ or tissue, but the skin, lungs, brain, lymph nodes, liver and bones are the usual sites of infection and abscess formation is common. Infections may rupture and drain with delayed healing and residual scarring. Infection of lymph nodes (under the arm, in the groin, in the neck) is a common problem in CGD, often requiring drainage or surgery along with antibiotics.

Pneumonia is also a common problem in CGD. Pneumonias due to the fungus Aspergillus may come on very slowly, initially only causing fatigue, and only later causing cough or chest pain. Fungal pneumonias often do not cause fever. In contrast, bacterial infections (Staphylococcus aureus, Burkholderia cepacia complex, Serratia marcescens, Nocardia) usually come on very quickly with fever and cough. Nocardia in particular causes high fevers and lung abscesses that can destroy parts of the lung.

With CGD it is particularly important to identify infections early and treat them completely, usually for a long period of time, so it is critical to seek medical attention early. If pneumonia is found it is very important to figure out exactly which microorganism is the cause, which may require a biopsy, usually done with a needle or a bronchoscope and not surgery. Treatment may require many weeks.

Liver abscesses occur in about a third of patients with CGD. It can start as fever and fatigue but may also cause mild pain over the right upper abdomen. Staphylococcus aureus causes most liver abscesses. Abscesses can also develop in the brain or bones (osteomyelitis) and can involve the spine, particularly if a fungal infection in the lungs spreads into it.

Treatment of Infections

There are many “anti-infective” drugs: antibacterial, antifungal, antiviral and anti-parasitic. The term “antibiotic” usually refers to a drug that fights bacterial infections. Anti-infective drugs are very specific. Different infections require different treatment. While penicillin is an excellent antibacterial antibiotic, it does not kill every kind of bacteria and has no effect at all on a virus or a fungus. An infection can only be cured if it is treated with the right drug. Every infection does not necessarily need to be treated with an antibiotic or an anti-infective. The body has many defenses and mechanisms to fight off and kill infections. These defenses are present, even in people with immunodeficiencies. For example, the skin and mucus membranes are the first line of defense against many infections. Phagocytes (germ killing white blood cells) usually work very well in people with antibody disorders just as antibodies are produced and work effectively in people with certain phagocyte problems. Some infections are mild and will resolve on their own, even in someone with primary immunodeficiency.

Sometimes prophylactic (or preventive) antibiotics may be prescribed for patients with some immunodeficiencies. For example, people with CGD usually receive daily antibiotics to protect them against certain kinds of infections. People with cellular immune defects may take antibiotics to protect them against a particular kind of pneumonia. Prophylactic antibiotics are not, however, routinely recommended for all people with primary immunodeficiencies. There can be risks associated with antibiotic therapy. For example drug-resistant organisms can develop or severe diarrhea can occur if normal body, non-pathogenic organisms are killed by an antibiotic. Only your immunologist can determine if prophylactic antibiotics are appropriate for you.

It is always important to try and determine the cause of a particular infection in someone with a primary immunodeficiency. In order to determine what the “right” drug is, it may be necessary to get a culture. For example, if you have a respiratory infection with a cough, sputum that is coughed up can be sent to the lab to identify what the infecting agent is and its sensitivity to different antimicrobial agents. Cultures can be obtained on any type of drainage or body fluid. Sometimes, a biopsy of a tissue needs to be done. This involves taking a sample of a particular tissue and testing it to see if infection is present. For example, during a colonoscopy, tiny samples of the tissue from the intestinal wall are taken and examined by the pathologist to determine if an infection or other kind of inflammation is present.

Summary of Infections

While infections of all kinds (acute, chronic, frequent or recurrent) are always going to be problematic for people with primary immunodeficiencies, it is important to remember that prevention and early intervention are always the best approaches. A healthy lifestyle that includes adequate rest, nutrition and exercise can go a long way to preventing infections. Similarly, a common sense approach to prevention that includes such measures as frequent handwashing and avoiding others who are ill can also be highly effective. However, once symptoms of an infection are present, seeking medical care in a timely manner is critical so that infections can be diagnosed early and treated appropriately, thereby preventing complications.

Excerpted from the IDF Patient & Family Handbook for Primary Immunodeficiency Diseases FIFTH EDITION Copyright 2013 by Immune Deficiency Foundation, USA. This page contains general medical information which cannot be applied safely to any individual case. Medical knowledge and practice can change rapidly. Therefore, this page should not be used as a substitute for professional medical advice.

Sinus Infection (Sinusitis)

Español: Infección de los senos paranasales (sinusitis)

Stuffy nose that just isn’t getting better? You might have a sinus infection, also called sinusitis

Antibiotics are not needed for many sinus infections, but your doctor can decide if you need an antibiotic.


Sinus infections happen when fluid builds up in the air-filled pockets in the face (sinuses), which allows germs to grow. Viruses cause most sinus infections, but bacteria can cause some sinus infections.

Sinus Infection

When you have a sinus infection, one or more of your sinuses becomes inflamed and fluid builds up, causing congestion and runny nose.


When you have a sinus infection, one or more of your sinuses becomes inflamed and fluid builds up, causing congestion and runny nose.

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Risk Factors

Several factors can increase your risk of getting a sinus infection:

  • A previous cold
  • Seasonal allergies
  • Smoking and exposure to secondhand smoke
  • Structural problems within the sinuses (such as growths on the lining of the nose or sinuses, known as nasal polyps)
  • A weak immune system or taking drugs that weaken the immune system


Common symptoms of sinus infections include:

  • Runny nose
  • Stuffy nose
  • Facial pain or pressure
  • Headache
  • Mucus dripping down the throat (post-nasal drip)
  • Sore throat
  • Cough
  • Bad breath

baby icon See a doctor right away if your child is younger than 3 months old and has a fever of 100.4 °F (38 °C) or higher.

When to Seek Medical Care

See a doctor if you have:

  • Severe symptoms, such as severe headache or facial pain.
  • Symptoms that get worse after initially improving.
  • Symptoms lasting more than 10 days without improvement.
  • Fever longer than 3-4 days.

You should also seek medical care if you have had multiple sinus infections in the past year.

This list is not all-inclusive. Please see a doctor for any symptom that is severe or concerning.

Other conditions can cause symptoms similar to a sinus infection, including:

  • Seasonal allergies
  • Colds


Your doctor will determine if you have a sinus infection by asking about symptoms and doing a physical examination.

Antibiotics are not needed for many sinus infections. Most sinus infections usually get better on their own without antibiotics. When antibiotics aren’t needed, they won’t help you, and their side effects could still cause harm. Side effects can range from minor issues, like a rash, to very serious health problems, such as antibiotic-resistant infections and C. diff infection, which causes diarrhea that can lead to severe colon damage and death.

However, in some cases, antibiotics are needed. Talk to your doctor about the best treatment for your illness.

For some sinus infections, your doctor might recommend watchful waiting or delayed antibiotic prescribing.

  • Watchful waiting: Your child’s doctor may suggest watching and waiting to see if your child needs antibiotics. This gives the immune system time to fight off the infection. If your child doesn’t feel better after 2–3 days of rest, extra fluids, and pain relievers, the doctor may write a prescription for an antibiotic.
  • Delayed prescribing: Your child’s doctor may give an antibiotic prescription but suggest that you wait 2–3 days to see if your child is still sick before filling it.

How to Feel Better

Below are some ways you help relive sinus pain and pressure:

  • Put a warm compress over the nose and forehead to help relieve sinus pressure.
  • Use a decongestant or saline nasal spray.
  • Breathe in steam from a bowl of hot water or shower.

Ask your doctor or pharmacist about over-the-counter medicines that can help you feel better. Always use over-the-counter medicines as directed.

Vomiting and Diarrhea

What is it?

Like fever, vomiting and diarrhea are not illness themselves, but are common symptoms of many other common illnesses of childhood. The most common cause of vomiting and diarrhea in children is a stomach or intestinal infection, typically caused by a virus, but occasionally can be caused by a bacteria or parasite. These viruses are contagious, so typically other children or family members will have it as well. Other illnesses that can cause vomiting and diarrhea include:

  • Strep throat infection
  • Urinary tract infection
  • Respiratory or sinus infection
  • Meningitis
  • Ear infection
  • Appendicitis
  • Reyes syndrome
  • Milk or food allergy
  • Side effects from oral medications (usually antibiotics)

What are the symptoms?

The following signs indicate a need to contact the child’s physician:

  • Stomach contents or diarrhea with blood or bile in them. Bile is a bright yellow green color.
  • Severe abdominal pain
  • Strenuous, repeated vomiting
  • Swollen abdomen
  • Lethargy or severe irritability
  • Convulsions or seizures
  • Inability to drink adequate amounts of fluid
  • Vomiting following a head injury
  • Moderate to severe dehydration (see below) or continued vomiting or watery diarrhea with a mild diarrhea
Condition Symptom
Mild dehydration
  • Restless / fussy
  • Acts hungry or thirsty all the time
  • Urinates less frequently than unusual, requires fewer diaper changes. Urine will have a strong odor and will be darker yellow than normal.
Moderate dehydration
  • Has decreased interest in play
  • Eyes are sunken with few tears
  • Child’s mouth is dry with little or no saliva
  • Has not urinated in 8 hours or has urinated fewer than
  • 3 times in 24 hours
Severe dehydration
Severe dehydration is a medical emergency. Call 911 or emergency services immediately
  • Lack in interest in playing and extreme sleepiness (the child may be so sleepy that he or she is difficult to wake up)
  • Eyes are very sunken and without tears
  • Mouth and tongue are very dry
  • Drinks poorly/unable to drink
  • No urination in 12 hours

How can I treat vomiting and diarrhea?

It is important to prevent dehydration. Make sure your child drinks plenty of fluids when they are sick (even though they may not be thirsty) such as an oral rehydration solution. Nursing mothers should continue to breastfeed. If your child is suffering from diarrhea, avoid sugar-based beverages such as sports drinks, soda, or juices. The sugar can draw water into the intestines and away from the rest of the body, making the diarrhea worse and increasing the risk of dehydration. Additionally, these beverages may not contain electrolytes that need to be replenished.

Oral-rehydration suggested scheduled:

Age Amount Timing
Less than 2 ½ cup Every hour
Older than 2 Up to 1 cup Every hour
If vomiting – even if your child vomits after drinking the fluid part if it will stay down 1-2 teaspoons Every 1-2 minutes. Once the child is doing better increase to bigger sips spread 5 minutes apart

Once nausea and vomiting have subsided you can resume a normal diet such as breastfeeding, formula (½ strength for 2 days), or solid foods (avoid high fat foods)

Important additional information

  • When a toddler vomits, it is important to make sure he or she has not swallowed medications, household liquids, or other poisons. Look around the house for empty containers and spills. There may be pills in your child’s vomit or the vomit may have an unusual appearance, color, or odor.
  • Do not give your child anti-diarrheal medications unless your physician tells you too.

The following are examples of over-the-counter (OTC) products that can be used to treat the symptoms of vomiting and diarrhea:

Symptom relief Helpful medications Active ingredients* to look for in generic and name brand OTC products
Dehydration Oral rehydration products** Oral electrolyte solution
Example: Pedialyte®

* Active ingredients: ingredients in a medication that produce a therapeutic response

** Oral rehydration solutions are helpful medications for keeping your child hydrated however, they will not stop diarrhea

Note: This information is intended to provide readers with health information. The information provided is not a substitute for consultation with a healthcare provider. Brand names included on this Web page are provided for examples only. Their inclusion does not mean that they are endorsed by Blue Cross and Blue Shield of North Carolina.

You know the symptoms: nasal congestion, facial pressure, pain, fever, too much mucus. Ugh. It’s probably another sinus infection.

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But is your infection caused by a virus or bacteria — and does it really matter?

It does, says otolaryngologist Raj Sindwani, MD. Doctors treat viral and bacterial sinus infections differently. Here is what you need to know about both kinds of infection and how to treat them.

Viral or bacterial?

Most sinus infections are viral. How can you tell, based on symptoms, whether your infection is viral or bacterial?

“You can’t,” says Dr. Sindwani.

“Symptoms like bad breath, yellow or green mucus, fever and headache are not reliable signs of a bacterial infection,” he says. “They can be present with viral infections, too. Even your doctor can’t tell if your infection is viral or bacterial based solely on symptoms or an exam.”

Instead, your doctor looks at symptom duration to determine the source of your infection. A viral sinus infection will usually start to improve after five to seven days. A bacterial sinus infection will often persist for seven to 10 days or longer, and may actually worsen after seven days.

4 steps you can take

Whether your sinus infection turns out to be viral or bacterial, you can help to ease your symptoms early on with supportive care:

  1. Use saline spray two to three times per day in each nostril.
  2. Use a nasal decongestant such as Afrin®, but not longer than three days.
  3. Drink eight 8-ounce glasses of fluid per day.
  4. Get plenty of rest.

If your symptoms aren’t improving after one week, it’s important to see your doctor. If your doctor suspects a bacterial infection, you’ll probably need to take an antibiotic to clear up the infection and prevent further complications.

Note: Antibiotics won’t help a viral infection, and taking an antibiotic unnecessarily can do more harm than good. You risk possible side effects and increase your chances of developing antibiotic resistance, which can make future infections harder to treat, says Dr. Sindwani. So it’s important to wait and see how long your symptoms last.

What to do for chronic sinusitis

If you’re suffering from chronic sinusitis (nasal congestion, drainage, facial pain/pressure, and a decreased sense of smell lasting 12 weeks or longer) you should see your doctor, says Dr. Sindwani.

Your doctor will swab your nose to collect mucus. Culturing it in a laboratory will reveal which type of bacteria is causing the infection so the right antibiotic can be prescribed.

Treat early sinus infection symptoms with rest, hydration and over-the-counter sprays and decongestants. But don’t look for an antibiotic unless your illness extends beyond a week, he says. Then check in with your doctor for a prescription and let him or her know if your condition worsens.

Top 7 Post Nasal Drip Causes

1. Sinusitis

Sinusitis occurs when mucus builds up in the nasal passage, causing swelling and inflammation in areas surrounding the nasal passage. Symptoms of sinusitis include headache, runny nose, nasal congestion, and post nasal drip.

Sinusitis can be caused by viruses, bacteria, fungi, and air pollutants. People at highest risk for developing sinusitis are those who have nasal polyps, weakened immune systems, allergies, and previous respiratory infections such as the common cold.

2. Common Cold

This common viral infection of the nose and throat is characterized by symptoms of sneezing, runny nose, nasal congestion, post nasal drip, fever, and body ache. Adults typically experience between two and three colds per year, but children experience them even more frequently. The common cold tends to clear on its own within seven to 10 days.

Cold viruses can spread through exposure to sneezes and coughs from those already infected. Cold viruses can also spread by touching someone who has a cold or by touching surfaces that contain the virus, such as doorknobs, railings, and elevator buttons. You can lower your risk for the common cold by avoiding contact with infected people, exercising regularly, and eating healthy foods that boost immunity.

3. Influenza

Also known as the flu, influenza is a contagious respiratory infection caused by influenza viruses that infect the throat, nose, and lungs. Early symptoms of the flu are similar to those of the common cold, but they tend to develop more abruptly. Common flu symptoms include sore throat, post nasal drip, muscle aches, dry cough, fatigue, and a fever over 100.4 degrees F (38 C).

Flu viruses can spread through the air when someone talks, sneezes, or coughs, and they can be picked up from surfaces touched by people who already have the flu. These viruses can then transfer to the eyes, nose, and mouth. Risk factors for the flu include obesity, pregnancy, a weakened immune system, and chronic illnesses such as asthma or diabetes.

4. Allergic Rhinitis

An allergy occurs when the immune system reacts abnormally to something that is usually harmless to other people, such as pet dander, dust mites, and perfumes. Breathing in substances you’re allergic to can cause inflammation in the nasal and sinus passages as the body reacts to the offending substance. Common symptoms of allergic rhinitis include post nasal drip, headache, sore throat, watery eyes, and coughing.

Common triggers of allergic rhinitis are pollen, animal dander, mold, and dust mites. Avoiding these allergens and reducing your exposure are the best ways to prevent allergic rhinitis, but you can treat symptoms with antihistamines, decongestants, and nasal corticosteroid sprays.

5. Pregnancy Rhinitis

Rising estrogen levels have been shown to stimulate the body’s histamine production. During pregnancy, a woman’s estrogen levels rise to help facilitate a healthy uterus, placenta, and growing baby. As a result, pregnant women are often more susceptible to congestion, post nasal drip, runny nose, ear infections, and sinus infections.

When experienced during pregnancy, these symptoms are commonly known as pregnancy rhinitis. Fluctuations in estrogen levels can cause women who are not pregnant to experience these same symptoms before and after their menstrual periods. Pregnant women can lower their risk for developing rhinitis by drinking plenty of water, keeping the head elevated while sleeping, and avoiding exposure to known allergy triggers such as pet dander and secondhand smoke.

6. Certain Foods

Dairy and spicy foods are common triggers of post nasal drip. Dairy intake has been linked to congestion, runny nose, and post nasal drip in some individuals — particularly those who suffer from asthma. Chili powders and hot peppers contain a compound known as capsaicin, which can irritate the mucous membranes in the mouth and cause post nasal drip. Other foods found to trigger post nasal drip include curry, ginger, and garlic.

Avoiding foods that trigger post nasal drip is the best way to prevent symptoms. Keeping a food journal can help you identify which foods trigger your post nasal drip.

7. Medications

Certain medications, including over the counter cold medicine, have been linked to post nasal drip and other rhinitis symptoms, which commonly include sneezing, cough, runny nose, and stuffy nose. Medications that can trigger post nasal drip are ibuprofen, aspirin, and high blood pressure medications such as ACE inhibitors and beta blockers. Evidence suggests that ACE inhibitors boost histamine production, causing inflammation, cough, post nasal drip, and other related symptoms.

People who use medications that trigger or worsen post nasal drip can talk to their doctors about other effective therapies that don’t cause symptoms. For example, acupuncture can reduce painful symptoms such as headache, arthritis, and neck pain, and it doesn’t lead to post nasal drip or other rhinitis symptoms.

Possible Health Conditions Related to Post Nasal Drip

  • Bacterial infection: Post nasal drip is a symptom of many bacterial infections and often occurs alongside symptoms of sneezing, vomiting, fatigue, diarrhea, and fever.
  • Viral infection: Post nasal drip is a sign of viral infections such as the common cold, which also produces symptoms of fever, cough, sore throat, stomach cramps, and diarrhea.
  • Gastroesophageal reflux disease (GERD): With this digestive disease, stomach acid flows back into the esophagus to irritate its lining. GERD produces symptoms that include nausea, heartburn, belching, dry cough, and post nasal drip.

Questions Your Doctor May Ask About Post Nasal Drip

  • Do you suffer from allergies?
  • What other symptoms do you experience aside from post nasal drip?
  • How long have you experienced post nasal drip?
  • What medications do you currently take?
  • Do you notice that certain foods trigger post nasal drip?

Post Nasal Drip May Also Be Known as

  • Upper airway cough syndrome
  • Post nasal drip syndrome


3,888 Possible Causes for Diarrhea, Sinusitis

  • Diabetes Mellitus

    Abstract Proprotein convertase 1/3 (PC1/3) deficiency is a very rare disease characterized by severe intractable diarrhea in the first years of life, followed by obesity and Key words Aretaeus of Cappadocia Diabetes Galen Soranus of Ephesus Diarrhea urinosa Dipsakon This is a preview of subscription content, log in to check access. However, the drug commonly causes GI adverse effects (eg, dyspepsia, diarrhea), which for most people recede with time.

  • Microsporidiosis

    Diarrhea was self-limited, and the spores cleared from the stools in all HIV-non infected travelers, but showed a chronic course in the HIV-infected one. ., shortness of breath, sinusitis, and diarrhea with wasting. Untreated, microsporidiosis has been documented as a cause of death. Microsporidia may infect the intestine, liver, gallbladder, biliary tract (the tubes that connect the liver and gallbladder with the small intestine), cornea, sinuses, muscles

  • Cystic Fibrosis

    Field M, Semrad CE : Toxigenic diarrheas, congenital diarrheas, and cystic fibrosis: disorders of intestinal ion transport. Annu Rev Physiol 1993; 55 : 631–655. 12. The impact of sinusitis on the cystic fibrosis population is significant. Approximately 20% of patients will eventually require surgical treatment of their sinuses. European descent, it has been proposed that CF heterozygotes have a survival advantage when infected with Vibrio cholerae or Escherichia coli, the toxins of which induce diarrhea

  • Upper Respiratory Infection

    : If associated with a URI, diarrhea suggests a viral etiology Fever: Can be caused by EBV infections and influenza Bacterial pharyngitis This may be difficult to distinguish data suggest that previous history of acute sinusitis influences the composition of the NP microbiota, characterized by a depletion in relative abundance of specific taxa Less common symptoms include reduced ability to smell, headache, shortness of breath, sinus pain, itchy and watery eyes, nausea, vomiting, diarrhea, bad breath, and body aches

  • Microscopic Polyangiitis

    Individuals with gastrointestinal (GI) disease exhibit nausea, emesis, diarrhea, abdominal pain, and bloody stools. ., sinusitis) frequently seen in people affected by GPA. Digestive tract: Abdominal pain, nausea, vomiting, and diarrhea may occur. Stools may contain blood. Nerves: People may have tingling, numbness, or weakness in a limb.

  • Hypogammaglobulinemia

    During these episodes, her diarrhea was associated with cramping abdominal pains. Infections of the lungs (pneumonia), ear (otitis) and sinuses (sinusitis) are most frequently reported. Recurrent or chronic upper and lower respiratory tract infections leading to bronchiectasis, chronic sinusitis or cor pulmonale are not common.

  • Congenital Acquired Immune Deficiency Syndrome

    Recurrent or chronic diarrhea. Usually affecting ears, sinuses and lungs. 21. Acquired Immunodeficiency Syndrome/AIDS 22. What is HIV/AIDS? (diarrhea that may come and go) oral thrush (a fungal infection in the mouth that is characterized by white patches on the cheeks and tongue) constant or recurring ear infections

  • Primary Immune Deficiency Disorder

    Gastrointestinal disorders, primarily manifesting in form of diarrhea, may bother up to 50% of PIDD patients. Wiskott-Aldrich Syndrome • X-linked condition • Incidence: 4:10,00,000 • Severe eczema, recurrent infections, Bloody diarrhea, chronic otitis • T cells appear bald 😕 The most common symptoms are recurring infections involving the ears, sinuses, nose, bronchi (breathing tubes), and lungs (respiratory tract).

  • Acquired Immunodeficiency Syndrome

    recent CD4 count, four months before admission, was 19) and hepatitis C who presented to the Emergency Department complaining of one week of persistent nausea, vomiting, and diarrhea retroviral syndrome Clinical Stage 1 Asymptomatic Persistent generalized lymphadenopathy Clinical Stage 2 Moderate unexplained weight loss ( Recurrent respiratory infections (sinusitis Keywords: non-human primate, chronic diarrhea, aids, hiv, siv Abstract: Diarrhea is the pathophysiological reaction of hosts gastrointestinal tract to a variety of external

  • Viral Upper Respiratory Tract Infection

    More severe viral upper respiratory infections also cause vomiting, nausea, diarrhea and abdominal pain, as well as myalgia, fatigue or malaise- more frequent in influenza OBJECTIVE: Differentiating acute bacterial sinusitis from viral upper respiratory tract infection (URI) is challenging; 20% to 40% of children diagnosed with acute sinusitis Other side effects such as stomach upset, nausea vomiting, diarrhea or decreased appetite may occur.

  • Sinusitis

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    Medically reviewed by Last updated on Sep 24, 2019.

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    • Sinusitis is an inflammation (swelling) of the lining of your sinuses. Sinuses are hollow spaces inside the skull that are located behind the bones of your forehead, cheeks, and eyes. They are lined by mucous membranes that contain cilia (small hairs). Cilia helps mucus drain into the nose through small openings called ostia. With sinusitis, the ostia may be blocked or the cilia may not be working properly, preventing mucus from draining properly. Germs, such as bacteria and viruses, grow in the mucus causing an infection. Sinusitis may be acute, subacute, chronic, or recurrent. Acute sinusitis signs and symptoms last less than four weeks. Subacute sinusitis lasts from four to 12 weeks, while chronic sinusitis lasts longer than 12 weeks. Recurrent sinusitis happens when you have three or more episodes of acute sinusitis in one year. Sinusitis usually starts during or just after a cold. Sinusitis may also be caused by diseases, such as cystic fibrosis, and infections near your sinuses, such as an ear or gum infection. Problems with the structure of your sinuses or nose, such as polyps (growths), and allergies may also cause sinusitis.

    • Sinusitis is diagnosed based on symptoms present and how long you have had them. Sinusitis is usually considered when symptoms have not improved after seven days. You may feel pain, pressure, or swelling around the forehead, cheeks, or eyes. You may have a headache or face pain that is worse when you lean forward, fever, chills, or other cold symptoms. Discharge from your nose may be thick and yellow or green-colored. You may also have a dry cough or tooth pain. You may have an endoscopy, culture, computerized tomography (CT) scan, magnetic resonance imaging (MRI), or x-rays of the sinuses to diagnose sinusitis. Treatment includes antibiotic medicines to fight infection, and medicines to treat fever and headache. Sinus surgery may be done if the sinusitis does not improve with medicines or you have an obstruction. Diagnosing and treating sinusitis as soon as possible may relieve your symptoms and improve your quality of life.


    You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.


    Treatment for sinusitis may cause unpleasant side effects. Some medications may cause nausea (upset stomach), vomiting (throwing up), or diarrhea (loose stools). You may also have an allergic reaction to an antibiotic. Left untreated, acute sinusitis may lead to chronic sinusitis. Germs causing your sinusitis, such as bacteria, may spread to other parts of your body. This may lead to meningitis or cause an abscess (pus) to form inside the skull, brain, or around the eyes. Meningitis is an inflammation of the lining of the brain and spinal cord. Ask your caregiver if you are worried or have questions about your sinusitis, care, or treatment.


    A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.


    An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.


    You may need any of the following:

    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    • Decongestant: A decongestant is medicine that relieves congestion, such as that of mucus membranes. It should not be used for longer than three days.
    • Medicines to treat pain, swelling, or fever: These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease or a history of bleeding in your stomach.
    • Steroids: This medicine may be given to decrease inflammation.


    You may need any of the following:

    • Culture: This is a test that may help caregivers learn which type of germ is causing your sinus infection. A sample of the cells from the mucus discharge of your nose may be sent to a lab for tests.
    • Endoscopy: This test uses a scope to see the inside of your sinuses. A scope is usually made of a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures. During an endoscopy, caregivers may look into your nose where the sinuses drain. Caregivers will look for polyps, tumors, and any other condition that may be causing your sinusitis. Samples may be taken from the inside of your sinuses and sent to a lab for tests.
    • Imaging tests:
      • Computerized tomography scan: This test is also called a CT scan. A special x-ray machine uses a computer to take pictures of your sinuses. Dye may be given before the pictures are taken. The dye may help sinus disease, a structure problem, or other problems, such as polyps, show up better in the pictures. Tell your caregiver if you are allergic to shellfish (lobster, crab, or shrimp), as you may also be allergic to this dye.
      • Magnetic resonance imaging scan: This test is called an MRI scan. During the MRI, pictures are taken of your sinuses. An MRI may also be taken of your nose, face, and skull. You will need to lie still during a MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury.
      • Ultrasound: This is a test that uses sound waves to look inside your nose and sinus area. Pictures are shown on a TV-like screen. Your caregiver may do an ultrasound to better see your sinuses and look for an infection.
      • X-rays: You may need to have x-rays of your nose, face, and sinuses taken. This will help your caregiver know if you have problems in any of these areas. You may need more than one x-ray.
    • Sinus puncture: A needle may be inserted into your sinuses to get fluid and tissue samples. This may show what kind of germ is infecting your sinuses. The fluid and tissue samples will be sent to a lab for tests.
    • Other tests: You may have blood or other tests, such as a sweat test, if you have chronic sinusitis. These tests may be used to check for an immune system problem or a genetic problem, such as cystic fibrosis.

    Treatment options:

    • Functional endoscopic sinus surgery: This surgery uses an endoscope, which is a long, bendable tube with a light and video camera at the end. Functional endoscopic sinus surgery (FESS) may be done if your sinusitis does not respond to medicine. Fungi, polyps, tumors, or damaged tissue may be removed from your sinuses to improve mucus drainage. Ask your caregiver for more information about FESS.
    • Gum and tooth problems: Problems with your gums and teeth may be treated by another caregiver, called a dentist.
    • Steam inhalation: Inhaling steam from a vaporizer or a warm cup of water may help you breathe easier and loosen dry mucus.

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    The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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