Streptococcal gangrene of the head and neck: a case report and review of the literature.

Necrotizing bacterial infections that occur in the head and neck are exceedingly rare and are often associated with a group A beta-hemolytic streptococcus (Streptococcus pyogenes). The disease is associated with soft tissue necrosis and vascular thrombosis. There appears to be an increasing incidence of hyperaggressive beta hemolytic streptococcal infections associated with high mortality rates. We report the survival of an otherwise healthy patient who developed a flu-like illness followed by a rapidly progressive toxic systemic illness associated with subtotal facial soft tissue necrosis down to bone. The recent literature related to this necrotizing bacterial infection is reviewed. Otolaryngologists must be aware of this entity since survival depends upon aggressive early wound management and high-dose intravenous antibiotics.

Staphylococcus aureus nasal carriage in patients with rhinosinusitis.

Toxic shock syndrome has been associated with rhinologic surgery and medical devices, and it has been linked to a circulating exotoxin of a toxogenic strain of Staphylococcus aureus. One hundred forty patients with rhinosinusitis were studied. Nasal cultures were obtained. The microbiological characteristics are described. The carrier rate for Staphylococcus aureus was 35%. Thirty percent of patients selected for surgery were Staphylococcus aureus carriers. Toxin-capable isolates were identified in 40% of those tested. Users of cocaine, topical decongestants, and steroid sprays had a statistically higher rate of Staphylococcus aureus carriage compared to nonusers. It is hoped that by identifying the population at risk and defining the factors associated with the development of toxic shock syndrome, a cogent policy of prevention can be established.

Otogenic Münchausen syndrome.

Münchausen syndrome is uncommon in otolaryngology. Self-induced otitis externa has rarely been reported, and nothing is known concerning the true incidence of feigned vertigo. We present a patient who has been hospitalized several times and who has undergone ear surgery and treatment at different institutions along the eastern seaboard. She has suffered complications of therapy, including a profound sensorineural hearing loss, and was referred to us for surgical treatment of bizarre intractable otitis externa. The infection failed to respond to medical treatment and was ultimately found to be self-inflicted. Despite psychotherapy, the patient continues to seek further treatment at still other hospitals. This entity must be considered whenever a thorough evaluation fails to yield a reasonable organic diagnosis.

Antibiotic prophylaxis in vascular and interventional radiology: a rational approach.

The current medical and surgical literature was reviewed to determine the rationale for the use of prophylactic antibiotics during surgical procedures. Specifically, the experimental basis for the timing and duration of administration of the antibiotics was considered, and the expected pathogens in each type of surgery were cataloged. High-risk patient groups were identified. The risk of infectious complications during interventional radiologic procedures was reviewed, and appropriate choices of drugs were determined by analogy to the corresponding surgical procedures.

Toxic shock syndrome in nasal surgery: a physiochemical and microbiologic evaluation of Merocel and NuGauze nasal packing.

A prospective comparison of the microbiologic safety of Merocel versus NuGauze nasal packing in 119 surgical patients is presented. Presurgical and postsurgical nasal cultures were obtained, analyzed, and compared. The importance of a preoperative nasal culture isolate of Toxic Shock Syndrome Toxin Number 1 (TSST-1) producing Staphylococcus aureus in predicting postoperative toxigenic S. aureus isolation and Toxic Shock Syndrome symptomatology is demonstrated. An in vitro comparison of the ability of NuGauze and Merocel to amplify TSST-1 production was performed.