A 51-Year-Old Man With Hoarseness of Voice.

CASE PRESENTATION: A 51-year-old nonsmoking man presented to his general practitioner with a primary complaint of 4 months of progressive hoarseness, and was subsequently referred to an otolaryngologist. He had no relevant medical or surgical history. He did not take any chronic medications or supplements. He was born in the Dominican Republic and moved to New York City when he was 36 years old. He worked in construction. In his spare time, he would return to his home country. The patient was a lifelong nonsmoker and reported no alcohol consumption. He denied shortness of breath, cough, sputum expectoration, fevers, chills, and night sweats.

Unusual extra-podal fungal mycetoma with black grains in a Senegalese child.

Mycetoma remains endemic in the tropical and subtropical regions of the "mycetoma belt" including Senegal. It affects more commonly young men in the age group of 20 to 40 years. The foot represents the most commonly affected site. The most common extra-podal localizations are leg, knee, buttocks, hand and arm. We report an exceptional case of cervical fungal mycetoma that occurred in a 13-year-old Senegalese child. He consulted for a cervico-submandibular tumefaction with multiple sinuses and black grains discharge evolving since 6 years, associated to laryngeal dyspnoea. Mycological examination with culture isolated Madurella mycetomatis. Cervical CT Scan showed bone and soft tissue invasion. Terbinafine alone was administered. During the evolution, tracheotomy was performed following the aggravation of the laryngeal disorders. Death from severe sepsis occurred after 8 months of evolution. The particularities of our case are the occurrence of fungal mycetoma in a child, the cervical localization and the difficulties of therapeutic management largely due to the diagnostic delay.

Post-transplantation laryngeal actinomycosis.

A case of laryngeal actinomycosis occurred after bone marrow transplantation was reported. The patient was a 14-year-old girl who had a history of bone marrow transplantation for the treatment of acute lymphocytic leukemia 4month before the onset of the disease. She was referred to our hospital complaining persistent sore throat since 2weeks ago. Fiberscopic observation proved the presence of white tumor-like mass on her right arytenoid of the larynx. As CT image demonstrated that the mass was localized at the arytenoid region with central low-density area surrounded by granulation tissue, we underwent biopsy under local anesthesia. Excision of the mass proved it to be a soft granulation including sulfur granules. Oral administration of amoxicillin 750mg per day was initiated as a postoperative medication. On day 17, histological study confirmed that the tumor-like mass was Actinomyces granuloma, and therefore amoxicillin administration continued. The medication was effective to subside the disease and the arytenoid lesion healed on day 31. Amoxicillin was further administered until day 70 to prevent recurrence. At 6month after the biopsy, she was free from the disease.

[Microflora of laryngeal mucosa in the healthy subjects and the patients presenting with non-specific post-intubation laryngeal granuloma].

This comparative study was designed to determine the qualitative and quantitative composition of microflora of laryngeal mucosa in the healthy subjects and the patients presenting with non-specific post-intubation laryngeal granuloma. The secondary objective was to measure the sensitivity of the isolated microorganisms to antibiotic therapy. The quantitative characteristic and the species composition of the microbial associations in laryngeal mucosa were investigated in 40 healthy subjects and 72 patients presenting with non-specific post-intubation laryngeal granuloma. The mean age of the participants of the study varied from 31 to 69 years. The total microbial population density in the healthy subjects was 2.672±614 CFU/ml compared with 21.514±2.382 CFU/ml in the patients. The healthy subjects were found to carry streptococci in 87.5% of the cases, staphylococci and neisseria in 60.0% and 42.5% of the cases respectively. As many as 77.8%, 83.3%, and 90.3% of the patients with non-specific post-intubation laryngeal granuloma were carriers of these microorganism respectively. The dominant microorganisms in the mucous membrane of the larynx in these patients were N. flavescence (17.6%), S. aureus (9.01%), S. pneumonia (7.3%), and S. pyogenes (6.0%).The staphylococci isolated from the mucous membrane of the larynx of the patients presenting with non-specific post-intubation laryngeal granuloma exhibited the highest sensitivity to cephalosporin antibiotics (cefuroxime, cefprome or ceftriaxone) and fluoroquinolone (levofloxacin) antibiotics (100, 100, 91.7 and 96.7% respectively).