Short-lasting unilateral neuralgiform headache attacks with conjunctiva injection and tearing presenting as sphenoiditis.

Headaches secondary to paranasal sinus disease are a common problem in otolaryngology practice. However, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCTs) are an extremely rare presentation of sinusitis. We report for the first time an unusual case of acute sinusitis presenting with SUNCTs-like symptoms with radiographically-proven isolated ipsilateral sphenoiditis, without any other intracranial pathologies. This case demonstrates an additional spectrum of acute sinusitis, which should be familiar to the otolaryngologist population.

Fragile X mental retardation protein regulates protein expression and mRNA translation of the potassium channel Kv4.2.

A prominent characteristic of the inherited intellectual impairment disease fragile X syndrome (FXS) is neuronal hyperexcitability, resulting in a variety of symptoms, such as hyperactivity, increased sensitivity to sensory stimuli, and a high incidence of epileptic seizures. These symptoms account for a significant part of the disease pattern, but the underlying molecular mechanisms of neuronal hyperexcitability in FXS remain poorly understood. FXS is caused by loss of expression of fragile X mental retardation protein (FMRP), which regulates synaptic protein synthesis and is a key player to limit signaling pathways downstream of metabotropic glutamate receptors 1/5 (mGlu1/5). Recent findings suggest that FMRP might also directly regulate voltage-gated potassium channels. Here, we show that total and plasma membrane protein levels of Kv4.2, the major potassium channel regulating hippocampal neuronal excitability, are reduced in the brain of an FXS mouse model. Antagonizing mGlu5 activity with 2-methyl-6-(phenylethynyl)-pyridine (MPEP) partially rescues reduced surface Kv4.2 levels in Fmr1 knock-out (KO) mice, suggesting that excess mGlu1/5 signal activity contributes to Kv4.2 dysregulation. As an additional mechanism, we show that FMRP is a positive regulator of Kv4.2 mRNA translation and protein expression and associates with Kv4.2 mRNA in vivo and in vitro. Our results suggest that absence of FMRP-mediated positive control of Kv4.2 mRNA translation, protein expression, and plasma membrane levels might contribute to excess neuronal excitability in Fmr1 KO mice, and thus imply a potential mechanism underlying FXS-associated epilepsy.

Phialemonium infection complicating chronic suppurative otitis media.

Phialemonium infection in humans is rare. We report a 7-year-old healthy boy who presented with chronic otorrhea, which persisted despite adequate antibiotic therapy and four preservative tympanomastoidectomy operations. Following 3 years of intermittent topical antibiotic therapy, cultures eventually grew Phialemonium, which necessitated a more extensive operation, combined with systemic/topical anti-fungal agent to achieve clinical cure.

Duration of rhinovirus shedding in the upper respiratory tract in the first year of life.

BACKGROUND: Current molecular diagnostic methods have detected rhinovirus RNA in a high proportion of asymptomatic infants and children, raising the question of the clinical significance of these findings. This study investigates the prevalence of prolonged rhinovirus RNA presence in the upper respiratory tract of infants during the first year of life. METHODS: In a longitudinal study, infants were followed from birth up to 12 months. Nasopharyngeal specimens were collected monthly (months 1-6 and month 9) and during an upper respiratory infection. Rhinoviruses were detected by quantitative reverse-transcription polymerase chain reaction. Presence of repeated rhinovirus RNA was evaluated by nucleotide sequence analysis. RESULTS: A total of 2153 specimens from 362 infants were studied; 341 distinct rhinovirus infections in 216 infants were identified. Follow-up specimens were available within 30 days for 179 infections, creating the sample set to assess prolonged rhinovirus presence. Of the 179 infections, 46 involved the detection of the same rhinovirus strain in repeated specimens, including 8 events of prolonged presence of the same strain (detected in specimens collected >30 days apart), representing 4.5% of the evaluable rhinovirus infections. There were 26 events in which a rhinovirus strain was replaced by a different strain within a 30-day interval, representing 14.5% of the 179 infections. CONCLUSIONS: Although rhinovirus infections are common in healthy infants, prolonged presence of rhinovirus RNA in the respiratory tract after an upper respiratory infection was uncommon (<5%). Detection of rhinovirus RNA in an infant most likely represents an infection within a 30-day period.

Effect of the 2009 influenza A/H1N1 pandemic on viral respiratory infections in the first year of life.

BACKGROUND: The effect of the 2009 H1N1 influenza pandemic on viral epidemiology of upper and lower respiratory tract infections (URI and LRI) in healthy infants in the first year of life has not been well studied. METHODS: A total of 180 healthy infants were enrolled from birth and monitored for occurrences of URI, LRI and acute otitis media complications until the first acute otitis media episode or between 6 and 12 months of age. Nasopharyngeal specimens collected during acute respiratory illnesses were tested for 18 viruses. RESULTS: Between October 2008 and April 2011, 373 URI episodes, including 20 with LRI, in 139 infants were documented. Viral studies were performed on 189 URI episodes; 87% were positive. Throughout the 31-month period (1386 patient-months), rhinovirus was the predominant virus causing URI (55%); respiratory syncytial virus was the major cause of LRI (64%). Although there was a significant increase in parent-initiated visit rate during the 15-month influenza pandemic as compared with prepandemic and postpandemic periods, only 4 cases of influenza were detected (2 cases during and 2 cases prepandemic and postpandemic). CONCLUSIONS: The 2009 influenza A/H1N1 pandemic had no impact on the overall viral epidemiology of respiratory infections in healthy infants in the first year of life but resulted in increased parent-initiated visits due to respiratory symptoms. Maternal antibody and absence of comorbidity may explain the low influenza burden whereas parental anxiety may explain the increased healthcare visit rate during the pandemic.