Otitis in Patients With Community-Acquired Bacterial Meningitis: A Nationwide Prospective Cohort Study.

BACKGROUND: Otitis is commonly associated with community-acquired bacterial meningitis, but the role of ear surgery as treatment is debated. In this study, we investigated the impact of otitis and ear surgery on outcome of adults with community-acquired bacterial meningitis. METHODS: We analyzed episodes of adults with community-acquired bacterial meningitis from a nationwide prospective cohort study in the Netherlands, between March 2006 and July 2021. RESULTS: A total of 2548 episodes of community-acquired bacterial meningitis were evaluated. Otitis was present in 696 episodes (27%). In these patients the primary causative pathogen was Streptococcus pneumoniae (615 of 696 [88%]), followed by Streptococcus pyogenes (5%) and Haemophilus influenzae (4%). In 519 of 632 otitis episodes (82%) an ear-nose-throat specialist was consulted, and surgery was performed in 287 of 519 (55%). The types of surgery performed were myringotomy with ventilation tube insertion in 110 of 287 episodes (38%), mastoidectomy in 103 of 287 (36%), and myringotomy alone in 74 of 287 (26%). Unfavorable outcome occurred in 210 of 696 episodes (30%) and in 65 of 696 episodes was fatal (9%). Otitis was associated with a favorable outcome in a multivariable analysis (odds ratio 0.74; 95% confidence interval [CI] .59-.92; P = .008). There was no association between outcome and ear surgery. CONCLUSIONS: Otitis is a common focus of infection in community-acquired bacterial meningitis in adults, with S. pneumoniae being the most common causative pathogen. Presence of otitis is associated with a favorable outcome. Ear surgery's impact on the outcome of otogenic meningitis patients remains uncertain.

Prevalence and genetic diversity of azole-resistant Malassezia pachydermatis isolates from canine otitis and dermatitis: A 2-year study.

Despite previous reports on the emergence of Malassezia pachydermatis strains with decreased susceptibility to azoles, there is limited information on the actual prevalence and genetic diversity of azole-resistant isolates of this yeast species. We assessed the prevalence of azole resistance in M. pachydermatis isolates from cases of dog otitis or skin disease attended in a veterinary teaching hospital during a 2-year period and analyzed the ERG11 (encoding a lanosterol 14-α demethylase, the primary target of azoles) and whole genome sequence diversity of a group of isolates that displayed reduced azole susceptibility. Susceptibility testing of 89 M. pachydermatis isolates from 54 clinical episodes (1-6 isolates/episode) revealed low minimum inhibitory concentrations (MICs) to most azoles and other antifungals, but 11 isolates from six different episodes (i.e., 12.4% of isolates and 11.1% of episodes) had decreased susceptibility to multiple azoles (fluconazole, itraconazole, ketoconazole, posaconazole, ravuconazole, and/or voriconazole). ERG11 sequencing of these 11 azole-resistant isolates identified eight DNA sequence profiles, most of which contained amino acid substitutions also found in some azole-susceptible isolates. Analysis of whole genome sequencing (WGS) results revealed that the azole-resistant isolates from the same episode of otitis, or even different episodes affecting the same animal, were more genetically related to each other than to isolates from other dogs. In conclusion, our results confirmed the remarkable ERG11 sequence variability in M. pachydermatis isolates of animal origin observed in previous studies and demonstrated the value of WGS for disentangling the epidemiology of this yeast species.

We analyzed the prevalence and diversity of azole-resistant Malassezia pachydermatis isolates in a veterinary hospital. A low prevalence of multi-azole resistance (c.10% of isolates and cases) was found. Whole genome and ERG11 sequencing of resistant isolates revealed remarkable genetic diversity.

[Ear tuberculosis concomitant with pulmonary localization in an HIV-immunosuppressed patient, in Bamako, Mali]. / Tuberculose auriculaire concomitante à une localisation pulmonaire chez un patient immunodéprimé par le VIH, à Bamako, Mali.

Introduction/Rationale: Tuberculosis remains a major public health issue. It is an opportunistic pathology, very common in HIV-immunocompromised persons, classifying it at the WHO stage 4. Ear tuberculosis remains a rare and under-diagnosed clinical form. We report here a case of ear tuberculosis concomitant with pulmonary localization in an HIV-immunosuppressed person on triple antiretroviral therapy aged 32 years hospitalized in Bamako (Mali) to discuss the diagnostic and therapeutic difficulties posed by this rare localization. Description of the case: The patient had a chronic productive cough, otalgia and right chronic purulent otorrhea. The search for acid-resistant bacilli was positive for direct examination in gastric casing fluid and swabbing of the ear pus, confirming the diagnosis of tuberculosis. Anti-tuberculosis treatment instituted for 6 months associated with adjuvants resulted in complete healing of the patient. Discussion/conclusion: Although rare, ear localization must be actively sought. Etiological treatment must be instituted upon confirmation of the diagnosis to avoid complications and sequelae.

Otomastoiditis por Scedosporium apiospermum. Alucinaciones como efecto adverso del voriconazol / Otomastoiditis due to Scedosporium apiospermum. Hallucinations as an adverse reaction to voriconazol

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In vitro and in vivo efficacy of tea tree essential oil for bacterial and yeast ear infections in dogs / Uso in vitro e in vivo do óleo essencial de Melaleuca (Melaleuca alternifolia) em otites bacterianas e por leveduras

Otitis externa is a common complaint in dogs. Bacteria and yeasts are commonly involved and may perpetuate inflammatory reactions inside the ear canal. Otoscopy, cytological examination of secretion and microbiological culture embody forms of diagnosis. Cytology also has great use in accessing treatment evolution. Therapy usually consists of cleaning ear canals and subsequent use of antibiotics or antifungal products. As some of them may cause hypersensitivity and even ototoxicity, searching for new pharmacological bases is currently necessary and justifies this study, which aimed to evaluate in vitro and in vivo efficacy of tea tree essential oil for bacterial and yeast ear infections in dogs. Twenty-eight dogs from a particular shelter in Cuiabá (Mato Grosso, Brazil), presenting clinical signs of otitis externa, were enrolled in this clinical trial. In all of them, clinical and cytological evaluations, as well as culture and susceptibility testing of the affected ears were carried out. From each dog, one ear was treated with 5% tea tree essential oil lotion and the other with standard otic formulation, according to the type of infection (bacterial, yeast or both). In vitro susceptibility testings of all ear cultures, to the same drugs used in treatment, were also carried out. Culture results showed 62.5% bacterial and fungal infection, 33.9% bacterial infection and 3.6% fungal infection, from the 56 ear samples collected. The most common microorganisms isolated were Staphylococcus intermedius, Staphylococcus aureus, Proteus mirabilis and Malassezia pachydermatis. Gram-positive bacteria were susceptible to gentamycin in 60.5% and resistant in 16.3% of the samples. Five percent tea tree essential oil formulation produced a 5mm clear zone of inhibition around the disks in one of the 63 samples evaluated. Pure (100%) tea tree essential oil formulation produced a 10mm clear zone of inhibition around the disks in four of the 63 samples evaluated, a 9mm zone in three samples, an 8mm zone in 16 samples, a 7mm zone in seven samples, a 6mm zone in two samples and there was no clear zone in 31 samples. Inhibition zones were produced by strains of Staphylococcus intermedius, Staphylococcus hyicus, Corynebacterium sp., Proteus mirabilis and Enterobacter sp. tea tree essential oil ear solution significantly induced remission of clinical signs both in bacterial and yeast ear infections. It also reduced as much Malassezia pachydermatis ear infection as the nystatin solution used in this study, while gentamycin solution showed better antibacterial effect. More studies should be conducted to evaluate in vitro diffusion properties of tea tree essential oil. Good antimicrobial spectrum and the absence of adverse reactions confirm the importance of developing a tea tree formulation as an alternative therapy for ear infections in dogs.(AU)

Otite externa é queixa frequente em cães. Bactérias e leveduras estão comumente envolvidas e podem perpetuar as reações inflamatórias dentro do canal auditivo. Dentre as formas de diagnóstico, encontram-se a otoscopia, o exame citológico da secreção e a cultura microbiológica. Citologia também tem grande utilidade no acesso à evolução do tratamento. A terapia consiste de limpeza dos canais auditivos e posterior utilização de antibióticos ou produtos antifúngicos. Como alguns antimicrobianos utilizados no tratamento podem causar hipersensibilidade e até mesmo ototoxicidade, a busca por novas bases farmacológicas justifica a existência deste estudo, que teve como objetivo avaliar in vitro e in vivo a eficiência do óleo de Melaleuca alternifolia em otites bacterianas e fúngicas de cães. Vinte e oito cães, de um abrigo particular, apresentando sinais clínicos de otite externa, foram incluídos neste estudo clínico. Todos passaram por avaliação clínica, citologia e cultura de material das orelhas afetadas. De cada animal, uma orelha foi tratada com óleo de Melaleuca 5% e a outra com formulação ótica padrão, de acordo com a afecção (bacteriana, fúngica ou mista). As culturas também foram submetidas a testes de susceptibilidade in vitro aos mesmos agentes utilizados no tratamento in vivo. Os resultados da cultura mostraram 62,5% de infecção mista (bacteriana e fúngica), 33,9% de infecção bacteriana e 3,6%, de infecção fúngica a partir das 56 orelhas. Os micro-organismos mais isolados foram Staphylococcus intermedius, Staphylococcus aureus, Proteus mirabilis e Malassezia pachydermatis. As bactérias GRAM-positivas foram sensíveis à gentamicina em 60,5% e resistentes em 16,3% das amostras. A formulação com 5% de óleo essencial de Melaleuca produziu uma zona de inibição de 5mm em torno dos discos em uma das 63 amostras avaliadas. A formulação pura (100%) do mesmo produto produziu uma zona de 10mm de inibição em quatro das 63 amostras analisadas, uma zona de 9 mm em três amostras, uma zona de 8mm em 16 amostras, uma zona de 7mm em sete amostras, uma zona de 6mm em duas amostras e não havia nenhuma zona clara em 31 amostras. Zonas de inibição foram produzidas por estirpes de Staphylococcus intermedius, Staphylococcus hyicus, Corynebacterium sp., Proteus mirabilis e Enterobacter sp. Clinicamente, a formulação com o óleo essencial de melaleuca induziu significativamente uma melhora nas manifestações, tanto nas otites bacterianas quanto nas causadas por leveduras, sendo estatisticamente semelhante ao tratamento com nistatina (nas otites por levedura), mas menos eficaz que a solução de gentamicina nas otites bacterianas. Mais estudos devem ser realizados para avaliar as propriedades de difusão in vitro do óleo essencial de melaleuca. O bom espectro antimicrobiano, a boa resposta clínica e a ausência de reações adversas confirmam a possibilidade de desenvolvimento de formulação ótica com o óleo essencial de melaleuca, como uma alternativa para a terapia de infecções do ouvido em cães.(AU)

First isolation of the Stephanoascus ciferrii in feline otitis in Brazil

Ear infections in cats are uncommon, especially involving yeasts. This report describes the first isolation of the Stephanoascus ciferrii, teleomorph of the Candida genus, in a case of feline otitis in Brazil. The identification and characterization of Stephanoascus ciferrii were confirmed by the Vitek2 System (BioMerieux ®).

Atividade antimicrobiana do oleorresina de copaíba (Copaifera reticulata) frente a Staphylococcus coagulase positiva isolados de casos de otite em cães / Antimicrobial activity of copaiba oil (Copaifera reticulata) against coagulase positive Staphylococcus of canine otitis

The aim of this study was to investigate the antimicrobial activity of the oleoresin Copaifera reticulata Ducke against Staphylococcus coagulase positive (SCP) isolated from otitis externa in dogs. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the oleoresin were determined by broth microdilution method. In addition, we verified the antimicrobial susceptibility profile of the isolates of SCP by agar diffusion method. Eight classes of antimicrobial were used to calculate the multidrug resistance. The chemical composition of the oleoresin was performed by gas chromatography coupled to the mass spectrometry (GC/MS), and β-caryophyllene, β-bisabolene, and (E)-α-bergamotene were the main compounds found. The copaiba oleoresin showed a MIC90 of 0.164mg/mL and a CBM90 of 1.3mg/mL. The multidrug resistance was found in 27% of the strains tested. The results suggest that copaiba oleoresin has bacteriostatic and bactericidal activity even in multidrug-resistant coagulase-positive strains.

O objetivo do presente trabalho foi investigar o potencial antimicrobiano do oleorresina de Copaifera reticulata Ducke em isolados de Staphylococcus coagulase positiva (SCP) provenientes de casos de otite externa em cães. O método de microdiluição em caldo foi utilizado para determinação da concentração inibitória mínima (CIM) e concentração bactericida mínima (CBM) de oleorresina de copaíba. Em adição, foi determinado o perfil de suscetibilidade aos antimicrobianos dos isolados de SCP pelo método de difusão em ágar. Oito classes de antimicrobianos foram usadas para o cálculo de multirresistência antimicrobiana. A determinação da composição química do oleorresina de copaíba foi realizada por cromatografia em fase gasosa acoplada à espectrometria de massas (GC/MS), sendo que β-cariofileno, β-bisaboleno e (E)-α-bergamoteno foram os compostos majoritários. O oleorresina de copaíba demonstrou CIM90 de 0,164mg/mL e CBM90 de 1,31mg/mL. A multirresistência foi verificada em 27% das cepas testadas. Os resultados sugerem que o oleorresina de copaíba exerceu atividade bacteriostática e bactericida mesmo em cepas multirresistentes de Staphylococcus coagulase-positiva.

Atividade antimicrobiana da Terminalia arjuna Wight & Arn.: uma planta etnomedicinal contra patógenos causadores de infecções no ouvido / Antimicrobial activity of Terminalia arjuna Wight & Arn.: an ethnomedicinal plant against pathogens causing ear infection

Infecções de ouvido representam uma das doenças mais comuns do mundo. Diferentes agentes etiológicos são responsáveis por tais infecções. OBJETIVO: Avaliar o potencial antimicrobiano de extratos de folhas e da casca de Terminalia arjuna contra Staphylococcus aureus, Acinetobacter sp., Proteus mirabilis, Escherchia coli, Pseudomonas aeruginosa e Candida albicans - patógenos que causam infecções de ouvido e como esses extratos se comparam às medicações tópicas atualmente disponíveis. MATERIAIS E MÉTODOS: Metanol, etanol, acetona, extratos aquosos (quentes e frios) de folhas e casca da T. arjuna foram testados para avaliação de suas atividades antimicrobianas. RESULTADOS: Dos três solventes orgânicos avaliados, o extrato acetônico das folhas foi o que teve o melhor resultado contra S. aureus. O extrato orgânico da casca exibiu quase o mesmo grau de ação antimicrobiana entre todas as bactérias gram-negativas, exceto contra P. aeruginosa. Entretanto, o extrato aquoso da casca de T. arjuna exibiu boa atividade contra S. aureus. Nenhum dos extratos exibiu atividade antifúngica. CONCLUSÃO: O extrato orgânico obtido a partir da casca e folhas de T. arjuna pode ser usado para tratar infecções bacterianas de ouvido, especialmente aquelas causadas por S. aureus, que exibiu maiores zonas de inibição do que gotas herbáceas; entretanto, ainda necessitamos de estudos mais detalhados - como ensaios in vivo e avaliações de propriedades farmacocinéticas para avaliarmos sua utilidade terapêutica no tratamento de infecções de ouvido.

Ear infection is one of the common diseases occurring throughout the world. Different etiological agents are responsible for ear infections. AIM: To assess the antimicrobial potential of Terminalia arjuna leaves and bark extracts against Staphylococcus aureus, Acinetobacter sp., Proteus mirabilis, Escherchia coli, Pseudomonas aeruginosa and Candida albicans, pathogens causing ear infections and their comparison with locally available ear drops. MATERIALS AND METHODS: Methanol, ethanol, acetone, aqueous (hot and cold) extracts from the leaves and bark of T. arjuna were tested for their antimicrobial activity. RESULTS: Of the three organic solvents evaluated, acetonic leaf extract was found to be best against S. aureus. Organic bark extract showed almost equal inhibition of all tested Gram negative bacteria except P. aeruginosa. However, aqueous extract of T. arjuna bark exhibited good activity against S. aureus. All the extracts were unable to exhibit any antifungal activity. CONCLUSION: Organic extract obtained from the T. arjuna bark and leaves may be used to treat the bacterial ear pathogens especially S. aureus, which has shown greater inhibition zones than the herbal drops, however, we still need more detailed studies as in vivo testing and pharmacokinetics properties for their therapeutic utility in treating ear infections.

Producción de fosfolipasa y proteinasa en cepas de Malassezia pachydermatis aisladas de perros con otitis y sin otitis / Phospholipase and proteinase production by Malassezia pachydermatis isolated in dogs with and without otitis

Antecedentes. Malassezia pachydermatis forma parte de la microbiota cutánea de perros y gatos. M. pachydermatis se ha asociado frecuentemente a otitis externa y dermatitis seborreicas, sobre todo en el perro, y con menor frecuencia en el gato. M. pachydermatis podría actuar como patógeno cuando existen alteraciones en los mecanismos físicos, químicos o inmunológicos de la piel. Se han identificado diversos factores de virulencia como la capacidad de producir estearasas, lipasas, lipooxigenasas, proteinasas, condroitinsulfatasas e hialuronidasas. Objetivos. Se ha estudiado la actividad fosfolipasa medida a pH 6,3 y la actividad proteinasa medida a pH 6,3 y pH 6,8 (pH de oídos de perros con otitis) de cepas de M. pachydermatis aisladas de perros con otitis y sin otitis. Métodos. Se ha estudiado la actividad fosfolipasa mediante un método semicuantitativo con yema de huevo y la actividad proteinasa mediante un método semicuantitativo con agar albúmina sérica bovina. Se ha realizado el estudio en 96 aislamientos de M. pachydermatis, 43 de ellos aislados de perros sin sintomatología clínica de otitis y 52 aislados de perros con otitis. Resultados. Se observó que el 75,8% de los aislamientos presentaron actividad fosfolipasa a pH 6,3 y el 81% presentaron actividad proteinasa medida a pH 6,3, y el 97,9% a pH 6,8. Se detectó una mayor actividad fosfolipasa en cepas aisladas de perros con otitis. Con respecto a la actividad proteinasa, esta fue mayor a pH 6,8. Conclusiones. Estos hallazgos sugieren que la actividad fosfolipasa podría jugar un papel importante en la invasión de los tejidos del hospedador, por lo menos en la otitis crónica canina. Con respecto a la actividad proteinasa, estos hallazgos podrían ayudar a mejorar la terapéutica de la otitis cuando está implicada M. pachydermatis en el proceso, ajustando a pH bajos los tratamientos aplicados (AU)

Pneumococcal biofilms

Over 60% of bacterial infections (and up to 80% of chronic infections) are currently considered to involve microbial growth in biofilms. This peculiar form of life poses an array of problems in human clinical practice, from infections associated with the implant of prosthetic devices and dental plaque formation to diseases such as cystic fibrosis, otitis media, and endocarditis. Biofilms are also at the basis of a variety of problems in industry. This report describes the biofilms produced by Streptococcus pneumoniae. This bacterium often colonizes the upper airways in humans as a normal commensal, yet it may spread to other areas of the body, causing otitis media, pneumonia, or invasive diseases such as bacteremia and meningitis. The capacity of S. pneumoniae to form biofilms had not been explored until recently. Several newly developed in vitro systems have allowed to test the capacity of S. pneumoniae to form biofilms, and to analyze the influence of several factors, including DNA and proteins-which play a role in the virulence of this «supergerm» in the formation and development of biofilms. In this brief review, we update the knowledge available on pneumococcal biofilm formation and the unusual features of this structure (AU)

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Diagnóstico microbiológico de las infecciones del tracto respiratorio superior / Microbiological diagnosis of upper respiratory tract infections

Las infecciones del tracto respiratorio superior se hallan entre las más frecuentes, y generan más consultas médicas que cualquier otro tipo de enfermedad infecciosa. Se incluyen los procedimientos de diagnóstico de los siguientes síndromes: faringitis estreptocócica y no estreptocócica, síndromes laríngeos, otitis, sinusitis y otras infecciones causadas por hongos y bacterias raros y/o poco frecuentes: síndrome de Lemierre, angina de Vincent, abscesos faríngeos y periamigdalares, difteria, candidiasis y zigomicosis. Se incluye información detallada sobre la recogida y procesamiento de las muestras, elección de pruebas de laboratorio, criterios de interpretación, información de (..) (AU)

Upper respiratory tract (URT) infections are common and account for more medical visits than any other type of infectious disease. Diagnostic procedures for the following syndromes are included in this report: Streptococcal and nonstreptococcal pharyngitis, laryngeal syndromes, otitis, sinusitis, and others caused by unusual and/or uncommon bacteria or fungi, including Lemierre's disease, Vincent's angina, pharyngeal and peritonsillar abscesses, diphtheria, candidiasis, and zygomycoses. Detailed information is provided on specimen collection and processing, selection of laboratory (AU)

Otomastoiditis colesteatomatosa crónica por estreptococo de grupo F con fistulización espontánea / Group F chronic cholesteatomatous otomastoiditis with spontaneous fistulization

La otomastoiditis crónica colesteatomatosa es un proceso muy poco frecuente en la infancia y menos aún su fistulización espontánea intracraneal o extracraneal. Las secuelas óticas son siempre importantes, especialmente en los casos de larga evolución. Los patógenos responsables de la otomastoiditis crónica son los mismos que originan la otitis. Cuando se asocia a colesteatoma, es frecuente la presencia de gramnegativos y anaerobios, pero no de estreptococo betahemolítico de grupo F. Se presenta el caso de un niño de 8 años con otomastoiditis crónica colesteatomatosa de larga evolución originada por estreptococo betahemolítico de grupo F que cursó con fistulización espontánea intracraneal y extracraneal

Chronic cholesteatomatous otomastoiditis is a rare entity in childhood, and its spontaneous intra- or extracranial fistulization is even more uncommon. The otologic sequelae are always important, especially when the disease is long standing. The agents causing chronic otomastoiditis are the same as those that can cause otitis. When there is associated cholesteatoma, Gram-negative and anaerobic bacilli are often present, but not group F beta-hemolytic streptococcus. The case of an 8-year-old boy with chronic cholesteatomatous otomastoiditis and spontaneous fistulization caused by group F beta-hemolytic streptococcus is reported

Tres casos de neurosífilis precoz en pacientes infectados por VIH / Three cases of early neurosyphilis in HIV patients

A pesar del relativo control de la enfermedad durante la segunda mitad del siglo XX, la sífilis, como otras enfermedades de transmisión sexual, ha reaparecido con fuerza durante los últimos años en grandes focos urbanos de Europa y Norteamérica. Un porcentaje importante de pacientes con sífilis sufren además infección por virus de la inmunodeficiencia humana (VIH). La asociación de ambas enfermedades puede modificar la evolución clínica de la infección luética y aumentar la incidencia de eventos neurológicos. Presentamos los casos de tres pacientes diagnosticados durante este último año en los que ambas enfermedades coexisten, manifestándose la sífilis con clínica neurológica precoz y afectación oftálmica o cócleo-vestibular. Este reciente brote de sífilis parece traducirse en un aumento de los casos atípicos en nuestra práctica clínica diaria que debemos estar preparados para reconocer y tratar de forma precoz

In spite of the relative control of the disease in the late 20th century, syphilis, like other sexually transmitted diseases, has undergone a strong resurgence in recent years in the large urban centers of Europe and the US. Many patients with syphilis are also HIV+. The association between the two diseases may modify the clinical evolution of syphilis and increase the incidence of neurological disorders. We discuss the cases of three patients diagnosed with both diseases last year, with neurological presentation of syphilis occurring early and ophthalmic or cochlear vestibular involvement. This recent outbreak of syphilis seems to lead to an increase in the number of atypical cases presenting in our daily practice, where we must be prepared for early diagnosis and treatment