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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6480
Experience:  14 years as clinician in the field of Family Practice
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Hello Doctors, Im so glad that you have this site! Im

Resolved Question:

Hello Doctors,

I'm so glad that you have this site!

I'm really getting frustrated with chronic sinus infections. Some have been MRSA or strep, but the majority are Serratia. I work with children in an outpatient facility, which is affiliated with a hospital. I seem to cycle, getting sinus infections about every 6 to 8 weeks. I'm concerned about being on all the antibiotics. I'm usually on Cipro for Serratia. (I've been on Levaquin, but have heard that it can cause cardiac problems, so I'm a little leery. I had some type of vasal vagel(?) reaction with I was on it before, as my pulse got low (in 50s). Went to the ER, and they didn't think it was anything serious.) I had also heard that Cipro doesn't usually get to the nares (nostrils?) in treating Serratia, and that an antibacterial should be applied inside the nose. I need to get back to putting Bactroban ointment in my nostrils 2 to 3 times a week, but I'm not sure that it has made a major difference. I also need to irrigate more regularly, and an ENT told me that putting Baby Shampoo in with the saline rinses often helps to eliminate infections. (I often get pinkish mold in the tub and sink, which I've heard is Serratia, so I need to get to clean even more frequently.)

A doctor once suspected that I had CVIS (CVID?) due to the frequent sinus infections. Some blood work a few years ago revealed low immunoglobin levels, which went back to normal after a medication that can cause that problem was discontinued, so I didn't meet the criteria for the diagnosis. I'm on one of the medications again, so I'm wondering if I should get immunoglobin levels checked again, and/or get another opinion from another ENT and/or see an infectious disease specialist. (Johns Hopkins didn't believe, for the most part, in doing sinus cultures, but I would think that with my history, I would need them. (I have had some negative cultures.)

I apologize for the length of this. I'm so frustrated and concerned about all these infections.

Thank you for any advice that you can provide! I really appreciate it!

Suzanne
Submitted: 8 months ago.
Category: Health
Expert:  Anthony Bray, MD replied 8 months ago.

Anthony Bray, MD : Hello!
Anthony Bray, MD : From your history it sounds that one major factor that increases your risk of sinus infection is anatomical in nature. The sinus surgery does alter the normal anatomy and not uncommonly may be associated with increased risk...
Anthony Bray, MD : With your report of increased thick mucus noticed to one side this could relate to risk-- I agree with you on this-- I would advise trying daily Mucinex ( guafenicin) with plenty if fluid to help keep mucus thin-- should be a factor in your favor ....
Anthony Bray, MD : I would advise that you request the " pneumonia shot" from your doctor --- Pnuemovax 23 -- this boosts your immunity to pneumococcus bacteria which you do not report as problem but is actually statistically most common cause of sinus infections and ear infections in children ....
Anthony Bray, MD : get annual flu shot.... Similar strategy ... Post- flu infections are common and working with children YOU WILL BE EXPOSED!!
Anthony Bray, MD : take a probiotic --- yogurt / Activia or other... Secretarial is gram negative bacteria and is poissible to be harbored in GI tract... Probiotic helps to be part if your immune protection...
Anthony Bray, MD : Bactrian to nares is good idea but this is mainly protection vs staph germs as the lower nares are common for colonization of staph germs...
Anthony Bray, MD : three times a week take a bath in 2 and 1/2 inches of water with 1/2 cup bleach added --- this helps to cleanse strep and staph colonizing bacteria off the skin--- helpful to reduce risk OF recurrent MRSA
Anthony Bray, MD : Hibiclens soap for occasional use -- antibacterial soap to use on skin in occasion -- maybe especially if you change a young child's diaper--- this is same soap used in surgical scrubs...
Anthony Bray, MD : Frequent use of anti- bacterial hand cleanser at work may be helpful to you...
Anthony Bray, MD : I feel that you need not really worry about Cipro or Levaquin unless you had specific cardiac conduction concerns ...
Anthony Bray, MD : The screen shows you typing but I am not seeing anything that you have said--- I may switch to Q and A mode if you have submitted responses as I can not see them so far.....
Anthony Bray, MD : I hope that this is helpful for you! Let me know if you have further questions! I will be happy to get back with you!
Customer:

I'm so sorry. I guess I was waiting for your complete response. I appreciate all of your advice. I have been working on a lot of the preventative measures, but have not tried the tub. Should there be anymore workup or concern regarding chronic Serratia?

Anthony Bray, MD : if my answer has been helpful and to your satisfaction then please remember to leave positive feedback, that would be much appreciated! Thank you and best regards!
Anthony Bray, MD : Anthony Bray MD
Customer:

I'm not sure if my last question came through. I'm concerned specifically about the Serratia bacteria and wonder if I need more tests. Thanks!

Anthony Bray, MD : Well I would suspect your GI tract as a place this type bacteria could hide ... Urinary tract also possible...
Anthony Bray, MD : it could be repeat exposure to children passing it back and forth too...
Anthony Bray, MD : I think the probiotic may help... Depends on the source of the source of course ....
Customer:

I have no cardiac condition that is known, so that makes me feel better about Cipro and Levaquin. Do you think that I should also see an infectious disease doctor? Isn't it kind of unusual to keep getting Serratia, as I've heard that this isn't a likely bacterium. Working with children doesn't help,either, I know.

Anthony Bray, MD : right well if you continue to have these frequent infections then I would favor repeat of your CBC and white count differential plus immunoglobulin levels ... It sounds that low immunoglobulin level was once found but repeat normal so it might relate to this...
Customer:

Thank you! I hope that I can decrease these infections.

Customer:

Take care.

Anthony Bray, MD : If you continue to have frequent recurrences then consulting infectious disease specialist may be helpful... The culture results by ENT are the main point with your situation though ...
Customer:

The only other question is I'm curious as to whether a lot of patients with chronic sinusitis have Serratia this frequently? A lot of my concern is related this specific bacterium.

Anthony Bray, MD : it could be if recurrent Serratia bacteria that a more prolonged course of antibiotic with proven effectiveness such as 2" days for example may take care of this for you... It could be that this atypical bacteria is being harbored by one or more of the children that you work with though...
Anthony Bray, MD : young children will increase your risk of respiratory infections though -- especially fall/winter ...
Customer:

I'm sorry - what was this about 2" days with prolonged course of antibiotics? I see different children every day, but am in close quarters with them. I 'm actually trying to get another type of job.

Anthony Bray, MD : No not this one specifically. I have seen cases of patients with recurrent infections that do seem to have repeats with same pathogen though --- pseudomonas/ MRSA/ pneumococcus/ klebsiella as other examples...
Anthony Bray, MD : 20 days -- did I type 2" days??? - maybe typo...
Anthony Bray, MD : Sometimes finding right antibiotic but carrying it longer than the typical ten days will help...
Customer:

I was getting MRSA regularly, but not as often now. I guess that was 20 days. I'm actually on Cipro now for 4 weeks, and I'm not sure that it is the best medication for Serrati(?).

Anthony Bray, MD : Well most often this would kill Serratia but we have to test for bacterial resistance each time we obtain culture... Recurrent use or prolonged use can lead to resistance ... We have to watch for this if course...
Anthony Bray, MD : The " best" depends on culture results which are specific to a given bacteria population...
Customer:

That's true. I want to try to avoid these infections, in the first place, and will more regularly use these recommendations.

Anthony Bray, MD : ok good luck to you!! I hope that you feel better and stay free from this problem ... Let me know if you have further questions !!
Customer:

Thank you so much for all of your help! Take care.

Anthony Bray, MD : Thank you! Best regards XXXXX XXXXX!!
Anthony Bray, MD : Let me k ow if you have further questions.. I will be happy to get back with you anytime !!
Customer:

I really do appreciate it. I guess I just go on Just Answer and ask for you?

Customer:

Thanks so much, again!

Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6480
Experience: 14 years as clinician in the field of Family Practice
Anthony Bray, MD and 6 other Health Specialists are ready to help you
Expert:  Anthony Bray, MD replied 8 months ago.
Hello!

This is Dr. Anthony Bray from
Justanswer.com. We spoke yesterday with regard to your concerns regarding recurrent sinus infections. Thank you for using our service! Thank you also for your positive feedback!

I welcome you to return in the future and ask me other health/ medical questions. You may reach me specially by addressing me ( Dr. Bray ) on the main site. You may also reach me by going to my profile page on the site and typing your question or comment on this page.

My profile page is

http://www.justanswer.com/medical/expert-anthonybraymd/

Just type comment or question in the box on this page...

Thank you again and best regards!!

Anthony Bray MD

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