Nasopharyngeal tuberculosis: report of four cases and review of the literature.

Even if tuberculosis is a major cause of morbidity and mortality, nasopharyngeal location is unusual and extremely rare. We report four new cases observed with short time interval suggesting a trend towards increased frequency. The diagnosis was confirmed by histological analysis after a biopsy. The evolution was favorable after anti tuberculosis chemotherapy. In the light of those observations and a review of the literature, we will discuss different characteristics of this disease and we will highlight the need of a systematic biopsy in order to confirm diagnosis and exclude undifferentiated carcinoma especially in endemic regions for both diseases.

Brain abscess caused by chronic invasive actinomycosis in the nasopharynx: A case report and literature review.

RATIONALE: Actinomycosis is a rare anaerobic, gram-positive bacterial infection caused by Actinomyces, which is part of the normal flora in the oral cavity and respiratory and female genitourinary tracts. The cervicofacial area is the most common site of involvement, and involvement of the central nervous system is rare. PATIENT CONCERNS: We report a case involving a 51-year-old woman who developed an actinomycotic brain abscess 15 months after the treatment of noninvasive nasopharyngeal actinomycosis, which recurred as an invasive form. DIAGNOSES: Histopathological examination of the surgical specimens revealed actinomycosis. INTERVENTIONS: The patient was treated by surgical drainage of the brain abscess and long-term antibiotic treatment. OUTCOMES: Follow-up brain imaging performed 12 months after surgery showed complete resolution of the brain abscess, and there were no further signs or symptoms of infection. LESSONS: Physicians should be aware of the typical clinical presentations of cervicofacial actinomycosis. Moreover, they should know that actinomycosis may mimic the process of malignancy at various anatomical locations.

Streptococcus pneumoniae burden and nasopharyngeal inflammation during acute otitis media.

Streptococcus pneumoniae (Spn) is a common respiratory pathogen and a frequent cause of acute otitis media (AOM) in children. The first step in bacterial pathogenesis of AOM is the establishment of asymptomatic colonization in the nasopharynx. We studied Spn bacterial burden in conjunction with neutrophil recruitment and inflammatory gene transcription and cytokine secretion in samples of nasal wash collected from normal and otitis-prone children during health, viral upper respiratory infection without middle ear involvement (URI) and AOM. We found no significant associations between otitis-prone status and any of the measured parameters. However, Spn bacterial burden was significantly correlated with neutrophil recruitment, transcription of IL-8, TNF-α and SOD2, and secretion of TNF-α. We also found that transcription of IL-8 and TNF-α mRNA by neutrophils was significantly correlated with the secretion of these cytokines into the nasopharynx. We conclude that Spn bacterial burden in the NP is a major determinant of neutrophil recruitment to the NP and activity during URI and AOM, and that neutrophils are contributors to the secretion of IL-8 and TNF-α in the NP when the Spn burden is high.

Identification of a two-component Class IIb bacteriocin in Streptococcus pyogenes by recombinase-based in vivo expression technology.

Streptococcus pyogenes is a globally prominent bacterial pathogen that exhibits strict tropism for the human host, yet bacterial factors responsible for the ability of S. pyogenes to compete within this limited biological niche are not well understood. Using an engineered recombinase-based in vivo expression technology (RIVET) system, we identified an in vivo-induced promoter region upstream of a predicted Class IIb bacteriocin system in the M18 serotype S. pyogenes strain MGAS8232. This promoter element was not active under in vitro laboratory conditions, but was highly induced within the mouse nasopharynx. Recombinant expression of the predicted mature S. pyogenes bacteriocin peptides (designated SpbM and SpbN) revealed that both peptides were required for antimicrobial activity. Using a gain of function experiment in Lactococcus lactis, we further demonstrated S. pyogenes immunity function is encoded downstream of spbN. These data highlight the importance of bacterial gene regulation within appropriate environments to help understand mechanisms of niche adaptation by bacterial pathogens.

Palatopharyngoplasty for treatment of nasopharyngeal stenosis secondary to extra-laryngeal tuberculosis.

Nasopharyngeal stenosis is a rare sequela of extra-laryngeal tuberculosis that can adversely impact the quality of life of afflicted patients. Relying solely on the oropharyngeal airway, patients often complain of inspiratory dryness and decreased sensation of airflow as the nasal mucosa and turbinate complex is entirely excluded from the breathing mechanism. Often times, the oropharyngeal inlet can be narrowed as well, limiting the air flow through the oropharyngeal airway. In those circumstances, patients often require tracheostomy for establishment of a reliable airway. We present the unique case of a previously tracheotomized patient with nasopharyngeal stenosis secondary to tuberculosis successfully treated with a modified palatopharyngoplasty to reestablish a patent naso-oropharyngeal airway. During the follow-up period, the patient was decannulated and highly satisfied with his respiratory status. Although rare and more commonly used in the treatment of sleep apnea, palatopharyngoplasty can be a viable option for the treatment of naso-oropharyngeal stenosis and should be kept in the armamentarium of reconstructive craniofacial surgeons.

Tuberculosis of the cavum revealed by acute facial pain.

An 85-year-old woman presented for assessment of recurring episodes of intense hemifacial pain, mimicking trigeminal neuralgia, associated with tinnitus. A necrotic tumour of the cavum with compression of the left Eustachian tube and skull-base invasion was discovered on brain MRI. Although the tumour was initially thought to be malignant, the histopathological findings on the biopsy were compatible with tuberculosis, later confirmed by the cultures. F-18-fluorodeoxyglucose positron emission tomography (PET)/CT showed an intense signal of the cavum, cervical and mediastinal lymph nodes, and also of two small nodules of the apex of each lung. Currently, after 9 months of combined antituberculosis antibiotics, the initial lesion has almost disappeared from both PET scan and MRI. This case highlights the importance of systematically screening for tuberculosis in the assessment of nasopharyngeal tumours.

Two rare cases of head and neck tuberculosis.

Tuberculosis is an infectious disease, which is the leading cause of mortality and morbidity and is still a serious health concern. The fact that extra pulmonary tuberculosis does not have specific examination and radiographic findings and that clinical findings vary depending on the organ in which it is detected cause diagnostic difficulties. The head and neck region is an uncommon site for tuberculosis and tuberculosis can localise in many different places of the head and neck region. In this article, the authors present a case of nasopharyngeal tuberculosis, which clinically mimics nasopharyngeal carcinoma and rare cutaneous tuberculosis of the pinna. A wide knowledge of head and neck tuberculosis, including the disease in the differential diagnosis and carrying out microbiological examinations are necessary for accurate diagnosis.

[Primary nasopharyngeal tuberculosis presenting as durative aural fullness: one case report and literature review].

OBJECTIVE: To study the clinical features, diagnosis and treatments of primary nasopharyngeal tuberculosis. METHOD: A case report was presented, and meanwhile etiopathogenesis and differential diagnosis were also reviewed. RESULT: A biopsy was taken and the histopathological examination showed tuberculosis granuloma with caseous necrosis. After anti-tuberculosis therapy, the symptoms disappeared. CONCLUSION: Not only otologic disorders but also nasopharyngeal diseases need to be considered when aural fullness exists. More importantly, primary nasopharyngeal tuberculosis should be taken as one of the differential diagnosis.

Tuberculosis of nasopharynx masquerading as angiofibroma.

Nasopharyngeal tuberculosis is a rare entity. We present a case of nasopharyngeal tuberculosis in an adolescent male which masqueraded as angiofibroma because of its clinical presentation and radiological features. Histopathology played a critical role in proper management of the case. We report this case because of its atypical presentation and clinical rarity.

Identification of an outer membrane lipoprotein involved in nasopharyngeal colonization by Moraxella catarrhalis in an animal model.

Colonization of the human nasopharynx by Moraxella catarrhalis is presumed to involve attachment of this bacterium to the mucosa. DNA microarray analysis was used to determine whether attachment of M. catarrhalis to human bronchial epithelial (HBE) cells in vitro affected gene expression in this bacterium. Attachment affected expression of at least 454 different genes, with 163 being upregulated and 291 being downregulated. Among the upregulated genes was one (ORF113) previously annotated as encoding a protein with some similarity to outer membrane protein A (OmpA). The protein encoded by ORF113 was predicted to have a signal peptidase II cleavage site, and globomycin inhibition experiments confirmed that this protein was indeed a lipoprotein. The ORF113 protein also contained a predicted peptidoglycan-binding domain in its C-terminal half. The use of mutant and recombinant M. catarrhalis strains confirmed that the ORF113 protein was present in outer membrane preparations, and this protein was also shown to be at least partially exposed on the bacterial cell surface. A mutant unable to produce the ORF113 protein showed little or no change in its growth rate in vitro, in its ability to attach to HBE cells in vitro, or in its autoagglutination characteristics, but it did exhibit a reduced ability to survive in the chinchilla nasopharynx. This is the first report of a lipoprotein essential to the ability of M. catarrhalis to persist in an animal model.

[Pathogeny and treatment of 50 nasopharyngeal tuberculosis cases].

OBJECTIVE: To analyze the clinical characters and treatment of nasopharyngeal tuberculosis, and to provide a scientific basis for improving clinical diagnosis of nasopharyngeal tuberculosis. METHOD: The clinical materials of 50 patients diagnosed as nasopharyngeal tuberculosis in Guangzhou Chest Hospital were reviewed and analyzed. All the 50 patients were given regular antituberculosis treatment with 3HRZS(E)/9HR(E) for one year, and were treated through nasal spray with combination medication of isoniazid, rifampicin and streptomycin injection solution for 3 months. RESULT: All patients were cured through regular antituberculosis treatment for one year, and no recrudescence cases were found in 2 years of follow-up. CONCLUSION: Nasopharyngeal tuberculosis is rare and the clinical manifestation is atypical. It is extremely easy to cause clinical misdiagnosis. A full understanding of the pathogenesis, timely clinical characters under nasopharyngoscope and histopathological examination results are the keys to diagnosis, and to giving regular antituberculosis treatment to obtain satisfactory curative effect.

[Combination antifungal therapy in hematopoietic stem cell transplantation patients].

Invasive fungal infections are a major cause of morbidity and mortality in hematopoietic stem cell transplantation patients. In recent years, new resistant fungal strains have emerged, requiring physicians to use new generation antifungal drugs or drug combinations. We report a case of invasive Fusarium infection involving the nasopharynx, skin and lungs, following haploidentical hematopoietic stem cell transplantation in an 8-year old patient with recurrent leukemia. The patient was treated with combination antifungal treatment of amphotericin B and voriconazole, as well as supportive care, with the improvement of his symptoms and home discharge. We reviewed the history of combination antifungal therapy. Combination antifungal treatment has been used since 1979, especially in immunocompromised patients. Although randomized controlled trials are lacking, reports favoring combination, especially for invasive mold infections, are increasingly published.

Immunization with DnaJ (hsp40) could elicit protection against nasopharyngeal colonization and invasive infection caused by different strains of Streptococcus pneumoniae.

Increasing mortality, morbidity and economic costs have been paid to pneumococcal diseases every year. Currently, vaccination is the most promising strategy to reduce the occurrence of pneumococcal infection. In this study, we investigated the protective efficacy of immunization with recombinant DnaJ (hsp40) protein against infections of different serotypes of Streptococcus pneumoniae. We demonstrated that mucosal immunization with DnaJ antigen could induce both systemic and mucosal antibodies for DnaJ and stimulate the release of high levels of IL-10, IFN-γ and IL-17A. Moreover, this mucosal vaccination could reduce nasal or lung colonization of pneumococcus and elicit protection against different serotypes of invasive pneumococcal infections. As well, we found that intraperitoneal immunization with DnaJ could also protect against invasive infections caused by different serotypes of pneumococcus, and passive immunization with antibodies specific for DnaJ confirmed that this protection was antibody-mediated. Our results therefore support the potential of DnaJ as a conserved pneumococcal protein vaccine.

Estudo da colonização na asofaringeana por Streptococcus pneumoniae em crianças com suspeita clínica de pneumonia / Naasofaringeana study of colonization by Streptococcus pneumoniae in children with clinical suspicion of pneumonia

Streptococcus pneumoniae constitui um dos mais importantes patógenos bacterianos do trato respiratório, podendo causar infecções invasivas e não invasivas, levando a altas taxas de morbi-mortalidade, particularmente em crianças menores de cinco anos de idade. A bactéria ganha acesso ao hospedeiro através da colonização da nasofaringe, que representa um importante reservatório para a transmissão deste patógeno na comunidade, contribuindo para a disseminação horizontal de S. pneumoniae entre os indivíduos de uma população. No presente estudo, procuramos caracterizar o perfil de colonização nasofaringeana por S. pneumoniae em pacientes menores de cinco anos de idade com suspeita clínica de pneumonia, atendidos na Unidade de Saúde de São Marcos, Bairro de Pau da Lima, Salvador, no ano de 2009. Um total de 205 swabs foram coletados entre as crianças consideradas elegíveis para o estudo. Os isolados de S. pneumoniae foram identificados através de métodos microbiológicos clássicos e a determinação do sorogrupo/sorotipo foi realizada empregando-se a técnica de Multiplex-PCR. A sensibilidade a sete antimicrobianos foi testada através da técnica de microdiluição em caldo, sendo que os isolados com CIM para penicilina ≥ 0,125 μg/mL foram considerados não-susceptíveis. A técnica de PFGE foi realizada para 26 isolados correspondentes aos sorotipos mais frequentes e associados a não-sensibilidade à penicilina (sorotipos 14, 19F e 23F). Um total de 72 (35,1%) crianças foram diagnosticadas com pneumonia, sendo 39 (54,2%) menores de dois anos de idade. A taxa de colonização geral foi de 50,2%, não havendo diferença entre essas taxas quando se considerou o grupo de crianças confirmadas e suspeitas para pneumonia. Crianças na faixa etária de 36 a 47 meses formaram o grupo com maior risco de ter pneumonia bacteriana (OR: 3.17 [1.29-7.88]). Entre os sorotipos encontrados, o sorogrupo 6 (6A/6B) (17,3%) foi predominante, seguido dos sorotipos 14 (15,4%), 19F (10,6%), sorogrupo 15 (15B/15C) (9,6%), 23F (6,7%) e o sorotipo 19A (6,7%). Os demais sorotipos e sorogrupos compreenderam 33,7%. O padrão de sorotipos foi semelhante aqueles encontrados nos casos de meningite pneumocócica na cidade de Salvador. Um total de 41 isolados (39,8%) apresentaram CIM ≥ 0,125 μg/mL para penicilina e a resistência a SMX-TMP foi identificada em 69,2% dois isolados. A tipagem por PFGE identificou 11 padrões eletroforéticos, sendo que a maioria dos isolados do sorotipo 14 estavam relacionados a clones amplamente disseminados entre os casos de doença pneumocócica (“A” e “GK”). Um total de 50,5% dos isolados foram de sorotipos inclusos na vacina decavalente (PCV10) e considerando os isolados não-susceptíveis à penicilina, esta representatividade foi de 90,2%. O estudo ressalta a importância de um contínuo monitoramento do perfil de sorotipos na colonização nasofaringeana por S. pneumoniae, no período pós-vacina e da necessidade de busca.

[Identification of Staphylococcus aureus in homogenates of hypertrophic adenoid (a preliminary report)]. / Identyfikacja gronkowca zlocistego w homogenatach przerosnietego migdalka gardlowego (doniesienie wstepne).

Standard adenoid swabs were taken from 33 children subjected to adenotomy. The bacterial growth was determined in swabs samples and in homogenates of surgically removed lymphatic tissue. Homogenates were also used for isolation of bacterial DNA. A standard bacteriological examination revealed the presence of Staphylococcus aureus only in 11 children (33%). In stark contrast S. aureus was detected in 20 samples (60%) of homogenized tissue, including all 11 positive swabs specimens. Results of plating were confirmed by molecular test (PCR- polymerase chain reaction). Inconsistent results between swabs and homogenate plating may indicate intracellular localization of S. aureus the tissue of hypertrophic adenoids.