Sinusitis Case and a Combination of Dehydration and Allergy.

Lily is relatively healthy for a 57 year old. Except for the blood pressure which is slowly creeping up due to her age, her baseline blood investigations are within normal limits. She is slightly obese though with a BMI of 30 (normal 23-25 for Malaysian). She needs to exercise to shed off her excess weight. On a positive note,she seldom suffers from any infection.

She travelled to Singapore last week and had a rather spicy dish the evening of her arrival for which she developed bouts of heavy diarrhoea early the next morning. She started to feel off color and the hotel air-conditioning was also not helpful as it made her throat dry. After feeling slightly better at midday, she went to a hair salon in a shopping mall and had her hair permed for almost four hours with only a glass of water.

                                     Lily's favourite hot and spicy "Mee Rebus" (noodle casserole)

On her visit to the restroom of the mall, she was inundated by the smell of cigarette's smoke but according to her she could not see anyone smoking. Now Lily is allergic to cigarette smoke and she could feel as if the smoke had gone through her nose and down to her throat. Her eyes and nose became watery and itchy and she coughed and sneezed incessantly . The shopping mall is,by the way, fully air-cond.

Then Lily, with her hair well couiffered, decided to visit her family friend and later they went for dinner. She remembered eating fried rice and drinking only tea. When she was about to leave, she was besieged by a discomfort in her throat as if the secretions had thickened in parts and was painful.

That was on 12 Dec 2009 and the next morning she somehow felt a bit better and only ate bland food. On the way back home on the plane, three days later, she started again to feel sick and her nose had become congested and secretion thick and yellowish-green and yet she did not feel feverish.By the fourth and fifth day of the initial throat pain, Lily had full-blown sinusitis, an inflammation of the nasal passages and throaty productive coughs signalling the start of her misery.

She was seen on 15 Dec and was started on a course of antibiotics when her condition did not improve the following day. The purulent secretions only receded and became clear on 19 Dec, after 72 hours of treatment. She was advised to continue the antibiotics for seven days. Throughout her ordeal, there was no fever.

Sinusitis, in this case was most probably initiated by the dehydration Lily suffered from the diarrhoea, the hotel air-conditioning, the mall and salon air-conditioning and the compressed cabin air of the aircraft. Then the allergic reaction due to the cigarette smoke. All these factors had altered the normal state of her sinus, rendering it more susceptible to secondary infection by micro-organisms prevalent in the nasal passages.

It is important to avoid getting dehydrated when you travel. it is also not smart to eat spicy foods on account of possible diarrhoea. Avoid prolonged stay in air-cond areas if you are already dehydrated or drink plenty of fluid. Fresh air is best.

For her indiscretion with food during travel and the unfortunate encounter with the smoke allergen in an enclosed area, Lily was off sick for three days, effectively lowering her work productivity. She had looked forward to a year without sick leave and she thought she was going to achieve it as there are only 19 days before 2009 ends.