Perichondritis of the auricle: bacterial or fungal? (A case series).

BACKGROUND: Suppurative perichondritis of the auricle is a common disease that can easily cause malformations if it develops into an uncontrolled infection. In nearly half of the cases, otolaryngologists cannot identify the pathogens involved. CASE PRESENTATION: In the present work, we described two cases of pyogenic perichondritis, with negative on conventional culture. However, using metagenomic next-generation sequencing (mNGS), we detected fungal infections in the patients and after the patients were given anti-fungal treatment, the patients achieved a good prognosis. CONCLUSIONS: These cases highlighted the possibility that fungi might be the involved pathogens in patients who have had multiple negative bacterial cultures, and mNGS should be applied in these cases. mNGS could be used as a supplement to traditional culture methods.

Antimicrobial susceptibility of bacterial isolates from 33 thoroughbred horses with arytenoid chondropathy (2005-2019).

OBJECTIVE: To describe the prevalence and antimicrobial susceptibility of bacterial isolates cultured from surgical specimens of infected arytenoid cartilage and granulomas. STUDY DESIGN: Retrospective cohort study. ANIMALS: Thirty-three thoroughbred horses. METHODS: Hospital records were retrieved for all horses admitted to a referral hospital for arytenoid chondropathy surgery that had samples submitted for culture and sensitivity between 2005 and 2019. Descriptive analyses were performed. RESULTS: In total, 56 bacterial isolates were obtained. Gram-positive bacteria (58%), Gram-negative bacteria (54%), and anaerobes (33%) were cultured from samples. Fifty-eight percent of horses had multiple bacteria isolated. Streptococcus spp were the most common (32%), followed by Enterobacteriaceae (13%). Bacterial isolates were sensitive to ceftiofur (83%), followed by ampicillin (64%), tetracycline (48%), enrofloxacin (45%), trimethoprim-sulfamethoxazole (41%), and gentamicin (18%). Multidrug resistance (MDR) was present in 44% of bacterial isolates. CONCLUSION: A wide variety of bacteria was cultured, providing evidence that secondary opportunistic infection by common respiratory bacteria is likely a factor in arytenoid chondropathy. Multidrug resistance was higher than what has been previously reported in equine respiratory samples. Trimethoprim-sulfamethoxazole had low effectiveness. CLINICAL SIGNIFICANCE: Because culture and sensitivity testing is not available in the diagnosis of mild to moderate arytenoid chondropathy, the information from this study may allow for more targeted broad-spectrum antimicrobial treatment to limit disease progression when the disease is first identified. The antimicrobial susceptibilities and MDR found in this study emphasize the importance of following current antimicrobial guidelines and highlight the requirement for surgical intervention rather than continued medical treatment in cases that do not resolve with initial antimicrobial therapy.

Staphylococcus aureus osteo-articular infection: usefulness of the determination of daptomycin serum concentration to explain a treatment failure.

We report two cases of treatment failure in patients with osteoarticular infection associated with Staphylococcus aureus bacteremia and receiving daptomycin. Using a published population-pharmacokinetic model and daptomycin blood level in these patients, area under the curve (AUC) was calculated and compared to the pharmacological target. For the first patient, treated with 6 mg/kg every 48 hours due to acute renal failure and then every 24 hours, the AUC was 820 mg×h×L-1, with a minimal concentration of 23.5 mg/L confirming the right dose adjustment and the absence of underdosing. The methicillin-resistant Staphylococcus aureus (MRSA) strain was still susceptible to daptomycin, but it was not sufficient to observe a favorable outcome. For the second patient, treated with 10 mg/kg/d, the steady state residual concentration was 10.4 mg/L, and the calculated AUC value was 550 mg×h×L-1. AUC/MIC values evolved during treatment to be under the cut-off for bactericidal effects (> 800 hours), and the Staphylococcus aureus (SA) strain became daptomycin resistant. This study highlights the inter-individual pharmacokinetic variation leading sometimes to drug underdosing. Drug monitoring should be encouraged in order to avoid treatment failure.

S100A4 deficiency is associated with efficient bacterial clearance and protects against joint destruction during Staphylococcal infection.

BACKGROUND: Efficient host defense mechanisms are crucial for survival in sepsis and septic arthritis. S100 proteins are reported to have proinflammatory and bactericidal properties. The aim of this study was to investigate the role of S100A4 in staphylococcal arthritis. METHODS: S100A4 knockout mice (S100A4KO) and wild-type counterparts (WT) were intravenously and intra-articularly challenged with Staphylococcus aureus strain LS-1. Clinical and morphological signs of arthritis and sepsis, phagocytosis, bone mineral density (BMD), and bone metabolism were then monitored in S100A4 and WT mice. RESULTS: S100A4KO mice had a lower bacterial load in the kidneys than WT mice (P < .05) but developed more severe clinical signs of arthritis (P < .001) and had higher levels of interleukin 6 and L-selectin (P = .002). S100A4KO mice had fewer morphological signs of synovitis and cartilage/bone destruction following intra-articular instillation of bacteria. S100A4KO mice were protected from loss of BMD and had lower levels of RANKL, MMP3, and MMP9 (P < .05). S100A4 was not bactericidal in vitro. CONCLUSIONS: In staphylococcal infection, S100A4 regulates bacterial clearance as well as systemic and local inflammatory responses.

Laryngeal chondritis as a differential for upper airway diseases in German sheep.

BACKGROUND: Ovine laryngeal chondritis is a rare entity of sheep in the USA, Great Britain, New Zealand and Iceland, but has not been reported in Germany so far. Here, two German cases are reported. CASE PRESENTATION: Two rams showed severe and progressive signs of dyspnea. Endoscopically, a severe bilateral swelling of the larynx was identified in both rams. Due to poor prognosis and progression of clinical signs one ram was euthanized, while the other ram died overnight. In both cases, a necrosuppurative laryngitis and chondritis of arytenoid cartilages was found at necropsy. Fusobacterium necrophorum and Streptococcus ovis were isolated from the laryngeal lesion in one animal. CONCLUSIONS: This is the first report of ovine laryngeal chondritis in continental Europe. This entity should be considered a differential diagnosis for upper airway disease in sheep.

The role of fosfomycin in osteoarticular infection.

Osteoarticular infections include septic arthritis and osteomyelitis, with Gram-positive microorganisms isolated most frequently. In recent years, there has been an increase in the number of resistant strains in this type of infection, which complicates the treatment. Fosfomycin is active against a large percentage of Gram-positive and Gram-negative pathogens, including multidrug-resistant strains, and its properties include low protein binding, low molecular weight and good bone dissemination. In this article, we discuss fosfomycin's activity in vitro, its pharmacokinetic and pharmacodynamic parameters of interest in osteoarticular infections, the experimental models of osteomyelitis and foreign body infection and the clinical experience with these types of infections.

Post-piercing perichondritis.

UNLABELLED: Piercing has become more and more popular among adolescents. The procedure is generally performed by unqualified professionals and carries its risk. Non-sterilized material or inappropiate hygiene increases the possibility of perichondritis and celulitis. The disease is characterized by erythema of the auricula pinna, unbearable pain and fever. Left untreated, the condition progresses with edema along the auricula and abscess formation that may result in ischemic necrosis and a cauliflower anesthetic deformation. The most common bacteria is Pseudomonas aeruginosa. In cases with abscesses, drainage is necessary along with antibiotic therapy guided by cultures and antibiogram. AIM: The aim of this case report was to review the past 10 years of published papers dealing with anatomical aspects of the auricular pinna, the history of piercing and its most common complications. METHODS: A case report of perichondritis after 'high' ear piercing that required surgical treatment and that progressed with no esthetic loss. RESULTS: Theoretical and practical experience based on a review and a report of a case that progressed satisfactorily. CONCLUSIONS: The increased incidence of perichondritis in adolescents should require more elaborated primary prevention measures.

Transcartilaginous ear piercing and infectious complications: a systematic review and critical analysis of outcomes.

OBJECTIVES/HYPOTHESIS: The purpose of this systematic review was to critically analyze infectious complications and treatment following transcartilaginous ear piercing. DATA SOURCES: MEDLINE Pubmed database. REVIEW METHODS: A MEDLINE PubMed database search using free text, including "ear chondritis," "ear perichondritis," "ear cartilage piercing," and "auricle piercing," yielded 483 titles. Based on set inclusion and exclusion criteria, the titles, abstracts, and full text articles were reviewed for inclusion and underwent data extraction. Pooled outcomes are reported. RESULTS: A total of 29 articles met inclusion criteria, including 66 patients. The mean age of the patients was 18.7 ± 7.6 years (range: 11-49), 87.5% female. Ear deformity was more likely to occur following postpiercing perichondritis of the scapha 100% versus the helix 43% (P = 0.003). Mean duration of symptoms prior to patients seeking medical attention was 6.1 ± 4.1 days. Greater than 5 days of symptoms prior to seeking treatment was significantly more likely to result in hospitalization. Pseudomonas aeruginosa accounted for 87.2% infections. Of the patients with Pseudomonas, 92.3% were hospitalized versus 75% of the patients infected with Staphylococcus aureus. Initial oral antibiotics prescribed did not target the cultured bacterium in 53.3% of cases; of these, 87.5% were hospitalized. CONCLUSIONS: Transcartilaginous postpiercing infection may lead to ear deformity and hospitalization. Patients (customers) and practitioners must be aware of optimal treatment strategies to minimize associated morbidity. Scapha piercing and delay in presentation are associated with poorer outcomes. Pseudomonas is the most common bacterial infection. Initial antibiotic selection must be optimized accordingly.

Staphylococcal adhesion to collagen in intra-articular sepsis.

Ultrastructural studies of the cartilaginous articular surfaces of human and rabbit joints have shown that cartilage is the target substratum for adhesion by Staphylococcus aureus, leading to intra-articular sepsis. Transmission and scanning electron microscope studies demonstrated bacteria in intimate contact with acellular cartilage matrix surfaces, particularly with collagen fibres. Certain strains of Staphylococcus aureus used in these experiments reveal a high binding capacity to collagen that is derived from a cartilage matrix. These studies indicate that the pathogenesis of intra-articular sepsis is based on the ability of certain strains of staphylococci to bind preferentially to a cartilage matrix.

Chondritis attributable to Lactobacillus after ear piercing.

A diabetic patient was admitted with ear pain and purulent discharge after "high ear piercing" by a friend. After investigation she was found to have chondritis, complicated by an abscess. Wound cultures grew Lactobacillus species. Patient responded to parenteral antibiotics without suffering cosmetic deformity. Sterile technique, adherence to post-piercing ear hygiene, and avoiding piercing the auricular cartilage may prevent complications associated with ear piercing. Lactobacillus should be included in the differential of pathogens involved in post-piercing chondritis.

Perichondritis of the auricle.

A search of the literature reveals reports of only 191 cases of auricular perichondritis. The present study includes 15 further cases caused by pseudomonas and proteus. Stroud's excision technique was used in four cases and resulted in marked deformity, repeated debridement, and protracted treatment. Tubal drainage was used in the remaining ears with very good esthetic results. It has been demonstrated in experimental animals and in humans that new cartilage forms in the subperichondrial auricular space in the second postoperative week, being maximum in the fourth week. In the present study tubes were retained two to four weeks to maintain an elevation of the perichondrium from what remains of the auricular cartilage to ensure homogeneous cartilage formation and provide local antibiotic treatment. Hospitalization is required for only two days. The four weeks tubal drainage method should be the method of choice for all cases of perichondritis and the excision method abandoned, even in gram-negative infections. A case of relapsing polychondritis is also presented because it is important to distinguish auricular perichondritis from relapsing polychondritis as the treatment of the latter is not surgical but with steroids.

Hematoma and abscess of the nasal septum in children.

OBJECTIVE: To evaluate the clinical characteristics and treatment outcome of hematoma and abscess of the nasal septum (HANS) in children. DESIGN: Retrospective case series. SETTING: Pediatric tertiary care facility. PATIENTS: Consecutive series of 20 children (age, 2 months to 15 years; mean age, 7 years) who were admitted to the hospital for treatment of HANS after nasal trauma during an 18-year period. INTERVENTIONS: In addition to receiving antibiotics, all patients underwent general anesthetic for incision and evacuation of the collection of blood and pus together with nasal packing. RESULTS: All patients had a history of nasal trauma. The HANS was a consequence of child abuse (2 patients younger than 2 years), minor nasal trauma (14 patients aged 1 to 10 years), and sports injury (4 patients older than 10 years). The diagnosis was made 1 to 14 days (mean, 5.9 days) after the episode of trauma. Nasal obstruction was the most common symptom found and was present in all but 1 patient. Pain, rhinorrhea, and fever occurred in 50%, 35%, and 25% of patients, respectively. Nasal fracture was present in 3 children. Abscess was found at surgery in 12 patients and was universally associated with septal cartilage destruction. Hematoma was present in 8 patients and associated with cartilage destruction in 2 patients. Organisms cultured were Staphylococcus aureus, Streptococcus pneumoniae, and group A beta-hemolytic streptococcus and were obtained from all 12 patients with septal abscess and from 1 patient with septal hematoma. Corrective nasal surgery has been performed in 5 patients, 4 of whom had a history of septal abscess. CONCLUSION: The diagnosis of HANS must be considered in all children who have acute onset of nasal obstruction and a history of recent nasal trauma to minimize the risk of nasal deformity and prevent the development of septic complications.

Visceral nodular cartilaginous metaplasia in rockfishes (Sebastes spp.) in the eastern North Pacific Ocean.

Multiple, discrete, nodular foci of cartilaginous metaplasia were found in the spleens and kidneys of rockfishes taken from the northeastern Pacific Ocean during a survey to determine the incidence and the nature of diseases in these animals. These nodules sometimes occurred in association with granulomatous inflammation and distinct granulomas. Many of these fish were infected by Ichythophonus spp. or acid-fact bacteria (presumably Mycobacteria spp.). Some of the metaplastic foci contained encapsulated accumulations of eosinophilic vesicles and basophilic granular debris, described by other authors as "cysts of unknown etiology," which have been observed at different sites in a variety of temperate and tropical fish species.

Chondritis of the ear: a late sequela of deep partial thickness burns of the face.

Chondritis of the ear is a late sequela of deep partial thickness burns of the face. It is the purpose of this article to describe two patients who came to the emergency department 21 days and 35 days after sustaining deep partial thickness burns of the face from explosions. The patients were hospitalized for incision and drainage of the infected wound that included excision of the infected cartilage complemented by systemic antibiotic therapy.

Outbreak of Pseudomonas aeruginosa infections caused by commercial piercing of upper ear cartilage.

CONTEXT: Sporadic infections following ear piercing are well documented, but common-source outbreaks are rarely recognized. OBJECTIVE: To investigate reports of auricular chondritis subsequent to commercial ear piercing. DESIGN, SETTING, AND SUBJECTS: Outbreak investigation by Oregon public health agencies, including cohort study of persons pierced at a jewelry kiosk in August-September 2000, environmental sampling, and molecular subtyping of isolates. Confirmed cases had Pseudomonas aeruginosa cultured from ear wounds. Suspected cases had signs and symptoms of external ear infection, including drainage of pus or blood for at least 14 days. MAIN OUTCOME MEASURES: Risk factors for infection and comparison of bacterial isolates by molecular subtyping. RESULTS: From 186 piercings in 118 individuals, we identified 7 confirmed P aeruginosa infections and 18 suspected infections. Confirmed cases were 10 to 19 years old. Most were initially treated with antibiotics ineffective against Pseudomonas. Four were hospitalized, 4 underwent incision and drainage surgeries (1 as an outpatient), and several were cosmetically deformed. Upper ear cartilage piercing was more likely to result in either confirmed or suspected infection than was lobe piercing (confirmed: RR undefined, P<.001; suspected: RR, 3.6; 95% confidence interval, 1.5-8.5). All persons with confirmed infections had their ear cartilage pierced with an open, spring-loaded piercing gun. Patient isolates were indistinguishable by molecular subtyping, and matching isolates were recovered from a disinfectant bottle and nearby sink. At least 1 worker admitted sometimes spraying the disinfectant on the ear studs before piercing. CONCLUSIONS: Ear cartilage piercing is inherently more risky than lobe piercing. Clinicians should respond aggressively to potential auricular chondritis and consider Pseudomonas a possible cause pending culture results.

High ear piercing--a dangerous craze.

Ear piercing is a primitive tradition among the human being. It reflects the culture of many religions, tribes, and communities, predominately adopted by the females. We reported a sixteen years old girl with painful swelling of both pinnas for last one month following piercing the pinna. She was treated locally by general practitioner without significant improvement. On examination frank abscess were detected in both pinna. Under general anesthesia incision drainage and deep curettage was done. She was treated with ciprofloxacin 750 mg 12 hourly for 2 weeks and recovery was uneventful. After one month she developed unsightly cauliflower ear. With this report we want to sensitize our community regards the risk of transmission of needle prick diseases and deformity of pinna following ear piercing

[Laryngeal chondro-radionecrosis]. / Condrorradionecrosis laríngea.

Laryngeal chondroradionecrosis is a complication following radiotherapy for laryngeal tumours that may appear many years after the treatment. We present the case of a 78 year old man, that come to the Accident and Emergency department with a prelaryngeal mass and hemoptysis. He had been treated 17 years before with radiotherapy for a vocal cond carcinoma. Posteriorly the lesion did a cutaneous fistula with complete laryngeal exposition and torpid evolution. Post-radiotherapy necrosis in the larynx is a serious complication though not a common one. A tumour recurrence needs to be excluded and even in this case a total laryngectomy is mandatory as it will end in total loss of laryngeal function.