RESUMO
BACKGROUND: Petrous apex aspergillosis is an uncommon and dangerous condition, with only four previously reported cases. As with other forms of petrous apicitis, the clinical symptoms are often non-specific and this contributes to diagnostic delay. This paper presents the first reported case of Aspergillus petrous apicitis associated with an intracranial or nasopharyngeal abscess. CASE REPORT: A 72-year-old man with chronic otorrhoea developed neuralgic headaches and progressive lower cranial nerve palsies despite antibiotic therapy. Imaging revealed petrous apicitis, a temporal lobe abscess and nasopharyngeal abscess. Analysis of biopsy tissue indicated invasive aspergillosis. The patient recovered on a protracted course of voriconazole in addition to medium-term antibiotic therapy. CONCLUSION: Invasive fungal disease should be considered early in the course of skull base osteomyelitis that is clinically unresponsive to empirical broad spectrum antibiotics. This paper highlights the role of tissue biopsy in diagnosis, and the efficacy of voriconazole therapy without the need for radical surgery.
Assuntos
Abscesso/diagnóstico , Imunocompetência , Petrosite/diagnóstico , Inibidores de 14-alfa Desmetilase , Abscesso/complicações , Abscesso/tratamento farmacológico , Idoso , Antifúngicos/uso terapêutico , Aspergillus , Doenças dos Nervos Cranianos/diagnóstico por imagem , Doenças dos Nervos Cranianos/patologia , Diagnóstico Tardio , Humanos , Imageamento por Ressonância Magnética , Masculino , Neuroaspergilose , Petrosite/complicações , Petrosite/tratamento farmacológico , Pirimidinas/uso terapêutico , Radiografia , Base do Crânio/diagnóstico por imagem , Triazóis/uso terapêutico , VoriconazolRESUMO
Opsonic antibody activity against Moraxella catarrhalis was determined in sera from children with otitis media. The antibody was determined with a new assay utilizing outer membrane antigen-coated latex beads. Antigen-coated beads opsonized in heat-inactivated pooled human serum phagocytosed 47.5 +/- 36.1 beads per 100 neutrophils compared to 15.6 +/- 10.2 beads per 100 neutrophils opsonized in hypogammaglobulinemic serum (p < .025). Antigen-coated beads opsonized in homologous sera from 11 children with M. catarrhalis otitis media demonstrated increased opsonic activity in convalescent sera (34.6 +/- 27.1) compared to acute sera (15.5 +/- 6.7; p < .05). These data suggest that infection with M catarrhalis is associated with the development of opsonic antibody.