ENT manifestations of tuberculosis: an important aspect of ENT practice.

Tuberculosis involving organs other than the lungs is termed as 'extra pulmonary tuberculosis'. Tuberculosis (TB) remains a worldwide public health problem despite the fact that the causative organism was discovered more than 100 years ago. The present study was conducted to assess different manifestations of tuberculosis affecting the ear, nose and throat (ENT) in patients attending the outpatient department in a total of 520 cases of tuberculosis. One hundred and eight cases were of extra pulmonary tuberculosis. Sixty nine cases had the manifestations of TB in the ENT region. These included patients with tuberculous cervical lymphadenopathy (91.35), laryngeal TB (4.3%), tuberculous otitis media (1.4%), nasal TB (1.4%) and oral tuberculosis (1.4%). Extra pulmonary tuberculosis constitutes about 15-20% of all tuberculosis cases as per WHO survey and it is 20.6% in the present study.

Coagulase-negative staphylococci (CoNS) as a significant etiological factor of laryngological infections: a review.

This review article shows that coagulase-negative staphylococci (CoNS) are widely responsible for laryngological diseases. General characteristics of CoNS infections are shown in the introduction, and the pathogenicity in terms of virulence determinants, biofilm formation and genetic regulation mechanisms of these bacteria is presented in the first part of the paper to better display the virulence potential of staphylococci. The PubMed search keywords were as follows: CoNS and: nares infections, nasal polyps, rhinosinusitis, necrosing sinusitis, periprosthetic joint infection, pharyngitis, osteomyelitis of skull and neck bones, tonsillitis and recurrent tonsillitis. A list of laryngological infections and those related to skull and neck bones was presented with descriptions of the following diseases: rhinosinusitis, necrotizing sinusitis, nasal polyps, nares and nasal skin infections, periprosthetic joint infections, osteomyelitis, pharyngitis, and tonsillitis. Species identification and diagnostic problems challenging for diagnosticians are presented. Concluding remarks regarding the presence of CoNS in humans and their distribution, particularly under the effect of facilitating factors, are mentioned.

[The role of the microbiome in otorhinolaryngology]. / A mikrobiom szerepe a fül-orr-gégészetben.

Our health is highly determined by the diverse microbial community living within our body and upon our skin. Balance among the members of the commensal microbiota is essential for the preservation of health. New generation sequencing is a rapid, sensitive method for determining the whole microbiome without prior hypothesis and also gives information on the resistance and virulence status. Application of this method can help to identify the pathogens contributing to different diseases, and also the protective bacteria inhibiting their growth. Detecting the changes of the microbiome helps to identify new therapeutic targets and establish targeted antibiotic therapy. Broad-spectrum antibiotics also act against the beneficial members of the microbial flora, which may lead to the development of recurrent or chronic disease. Ear, nose and throat infections are the most common infective diseases in humans and the leading cause for antibiotic prescription worldwide. In recent years, many studies using molecular biology methods were performed examining the microbiome of healthy humans and in otorhinolaryngologic diseases. In the present work, the authors review the changes of the microbiological communities in the healthy state and in various pathologic states in the anatomic regions of the ear, nose and throat. Orv Hetil. 2019; 160(39): 1533-1541.

Staphylococcus aureus from ocular and otolaryngology infections are frequently resistant to clinically important antibiotics and are associated with lineages of community and hospital origins.

Staphylococcus aureus is an important human pathogen that causes serious antibiotic-resistant infections. Its population structure is marked by the appearance and dissemination of successful lineages across different settings. To begin understanding the population structure of S. aureus causing ocular and otolaryngology infections, we characterized 262 isolates by antimicrobial sensitivity testing and multilocus sequence typing (MLST). Methicillin-resistant S. aureus were subjected to SCCmec typing and Panton-Valentine leukocidin (PVL) screening. Although we detected a high level of genetic diversity among methicillin-sensitive (MSSA) isolates, (63 sequence types-STs), the population was dominated by five lineages: ST30, ST5, ST8, ST15 and ST97. Resistance to penicillin, erythromycin and clindamycin was common among the major MSSA lineages, with fluctuations markedly impacted by genetic background. Isolates belonging to the predominant lineage, ST30, displayed high rates of resistance to penicillin (100%), erythromycin (71%), and clindamycin (63%). Overall, 21% of the isolates were methicillin-resistant (MRSA), with an apparent enrichment among otitis and orbital cellulitis isolates (>40%). MRSA isolates belonged to 14 STs grouped in 5 clonal complexes (CC), however, CC5 (56.1%) and CC8 (38.6%) dominated the population. Most CC5 strains were SCCmec type II, and resembled the hospital-adapted USA100 clone. CC8 strains were SCCmec type IV, and 86% were positive for the PVL toxin, common features of the community-acquired clone USA300. CC5 strains harboring a SCCmec type IV, typical for the USA800 clone, comprised 15.5% of the population. USA100 strains were highly resistant to clindamycin, erythromycin and levofloxacin (100%), while USA300 strains were frequently resistant to erythromycin (89%) but displayed lower rates of resistance to levofloxacin (39%) and clindamycin (17%). Our data demonstrate that the ocular and otolaryngology S. aureus populations are composed of strains that are commonly resistant to clinically relevant antibiotics, and are associated with the major epidemic clonal complexes of both community and hospital origins.

[The peculiar features of epidemiology and clinical course of syphilis encountered in the otorhinolaryngological practice under the present-day conditions]. / Osobennosti épidemiologii i klinicheskogo techeniia sifilisa v otorinolaringologicheskoi praktike v sovremennykh usloviiakh.

The article was designed to report the available information about the main characteristics of epidemiology and pathomorphism of syphilis. It describes the process of development and clinical symptoms of syphilis, both classical and undergoing modification, under the present-day conditions, with special reference to the distinctive features and peculiarities of ENT organ lesions with the underlying syphilitic etiology.

[The peculiar features of the microbial paysage and the problems of antibacterial therapy of the inflammatory ENT diseases in the patients presenting with diabetes mellitus]. / Osobennosti mikrobnogo peizazha i problemy antibakterial'noi terapii vospalitel'nykh zabolevanii LOR-organov u bol'nykh sakharnym diabetom.

This article is focused on the peculiar features of the ENT microbial paysage in the patients presenting with diabetes mellitus. We have examined a total of 310 patients including 145 suffering from the pyoinflammatory ENT diseases and concomitant diabetes mellitus. The study has demonstrated that the microbial biocenoses of the ENT organs in the diabetic patients are dominated by the potentially pathogenic and transitory microflora whereas the saccharolytic microflora and the non-fermentative bacteria (pseudomonades) concentrate in the foci of ENT inflammation. The spectrum of microorganism that occur in the areas of inflammation are shown to depend on the quality of compensation of diabetes mellitus.

Antimicrobial treatment of ENT infections.

ENT infections are the most common childhood infections and the leading causes of antibiotic prescriptions. These infections are mainly due to viruses and most of them (even if bacterial species are implicated) resolve spontaneously. Therefore, the first message is to not prescribe antibiotics in the following situations: common cold, non-streptococcal pharyngitis, laryngitis, non-purulent otitis media, etc. For sore throat/pharyngitis, the antibiotic treatment decision is based mainly on the use of group A streptococcus rapid diagnostic tests. For otitis media, only purulent forms occurring in children less than 2 years of age and most severe situations in older children should be treated with antibiotics. Amoxicillin is the first-line treatment for the vast majority of ENT infections requiring antibiotic treatment. Severe ENT infections (mastoiditis, epiglottitis, retro- and parapharyngeal abscesses, and ethmoiditis) are therapeutic emergencies requiring in most cases hospitalization and intravenous antibiotics.

[The post-streptococcal diseases in the clinical practice].

The authors describe various clinical forms of streptococcal infections, the pathogenetic mechanisms underlying these conditions, and peculiarities of their clinical picture. Also considered are the modern methods employed for laboratory diagnostics of streptococcal infections. The probability of the risk of development of post-streptococcal diseases in the children is evaluated. Measures for the prevention of these conditions are proposed.

Infecciones por micobacterias en otorrinolaringología: revisión de la literatura / Mycobacterial infections in otolaryngology: review

Las micobacterias constituyen un grupo de bacilos aeróbicos no capsulados y no móviles, algunos de los cuales son patógenos causantes de graves enfermedades en los mamíferos incluyendo tuberculosis y lepra. Chile, a pesar de pertenecer al grupo de países de baja prevalencia de tuberculosis en América, presentó un enlentecimiento en la curva de descenso de incidencia. Así mismo, se ha visto un aumento de micobacterias atípicas tanto en muestras pulmonares como extrapulmonares respecto a décadas anteriores. Por otra parte, las infecciones por micobacterias adquieren importancia en otorrinolaringología dado que la tuberculosis de cabeza y cuello representa alrededor del 10% a 35% de los casos de tuberculosis, siendo su localización más frecuente los ganglios linfáticos. La siguiente revisión abarcará los cuadros de infecciones por micobacterias en otorrinolaringología, sus manifestaciones clínicas, diagnóstico y tratamiento.

Mycobacteriums are a group of aerobic non-capsuled and non-mobile bacillus some of which can cause diseases in mammals such as tuberculosis and leprosy. Chile, despite belonging to the group of countries with low prevalence of tuberculosis in America, presented a slowing in the decline in incidence curve. At the same time there has been an increase in atypical mycobacterium in pulmonary and extrapulmonary samples, comparedto past decades. On the other hand infections by mycobacterium become important because the head and neck tuberculosis accounts for about 10%-35% of cases of tuberculosis, the most common site being the lymph nodes. The following review will cover mycobacterial infections in otolaryngology clinical manifestations, diagnosis and treatment.

[Infectious ENT emergencies]. / Les urgences infectieuses ORL.

Extremely serious diseases associated with very poor prognosis, especially in this context of undermedicalization and poverty. The aim of this case study was to determine the etiologies of these emergencies and to discuss their therapeutic management. Retrospective-descriptive study conducted over a 5-year period, a total of 52 clinical records were included. These infections accounted for 0.33% of our consultations. The average age of our patients was 23 years. Young age, inappropriate treatments and some ENT disorders were found to be contributing factors. The reasons for consultation were varied, depending on the site of infection; however, two clinical signs were constant: pain and fever. Adenophlegmon, peritonsillar phlegmon, cellulitis were our main etiologies together with streptococcus and staphylococcus which were the commonest causative bacteria. Empirical antibiotic therapy was used as first-line therapy, in particular third-generation cephalosporin + aminoglycoside + imidazole combination. Clinical course was marked by local and systemic complications. The evolution of diagnostic and therapeutic ENT emergencies management plans still encounters complications due to patient delay in seeking consultation.

ENT mucormycosis. Report of 4 cases.

OBJECTIVES: Mucormycosis is an opportunist infection usually affecting immunocompromised patients. It is rare and often fatal. The pathogen is filamentous fungus of the mucorales order. Studies discuss the clinical, diagnostic and therapeutic aspects of ENT mucormycosis, insisting on early clinical diagnosis, laboratory data not being contributive within satisfactory time limits. MATERIAL AND METHODS: A retrospective study included 4 patients with ENT mucormycosis diagnosed over a 13-year period, from January 2000 to December 2012. RESULTS: The study included 2 male and 2 female patients, aged from 3 to 77 years. Two patients were diabetic. There were 2 cases of sinonasal mucormycosis and 2 of otologic involvement. Diagnosis was founded on anatomopathologic and mycologic examination. A fatal issue occurred in 1 case with otocerebral involvement. CONCLUSIONS: Otorhinolaryngologic mucormycosis is a rare fungal infection, which needs to be borne in mind. Rhinocerebral lesions are the most common clinical manifestations. Involvement of the ear is very rare. Diagnosis is often difficult, but should be as early as possible. Treatment, initiated urgently, associates antifungal treatment, surgical resection and control of risk factors. The prognosis remains in all cases severe.

[Persistent infections in the children presenting with chronic ENT diseases: the potential of etiotropic therapy].

The objective of the present study that involved 176 children at the age varying from 2 to 12 years presenting with chronic ENT diseases was etiological diagnostics and etiotropic therapy of these pathologies taking into consideration the duration of the disease of less than one year (n=72), from 1 to 2 years (n=54), and over 2 years (n=50). The bacteriological method was employed to identify microflora from the upper respiratory tract and the molecular-biological methods for the detection of Epstein-Barr virus DNA, cytomegalovirus, and 6 types of human herpes virus in the blood and saliva. All the children were treated with the recombinant interferon preparations given for 1-1.5 months. For 41% of the children this treatment was combined with antibacterial therapy followed by immunocorrective therapy with interferon inducers (in 79.4% of the patients) or bacterial lysates (20.6%). The study revealed the predominant role of types 4, 5, and 6 type herpes viruses in the development of chronic ENT pathologies in the children with the gradual lowering of activity of these infections over 2 years. Staphylococcus aureus and Streptococcus pyogenes as well as fungi of the genus Candida were the commonest bacterial and fungal pathogenic agents isolated from the naso- and oropharynx of the children suffering from chronic ENT pathology.The effectiveness of etiotropic therapy was shown to decrease with time, from 78% during 1 year after the onset of the disease to 30% within the next 2 years.

Presentation, diagnosis and management of neck abscesses in children.

UNLABELLED: The aim of the study was to analyze the presenting signs and symptoms, diagnostic procedures, clinical course, pathogenic organisms and management of neck abscesses in children. MATERIALS AND METHODS: This retrospective medical records review comprised of 51 pediatric cases referred because of neck abscess from 2001 to 2014. Medical records of the patients were reviewed for demographic data, clinical presentation, treatment before referral, localization of the abscess, imaging evaluation, medical and surgical treatment, bacteriological data and complications. RESULTS: Average age of the patients was 4.9 years. 18 (35%) of the children were below one year of age. The submandibular was the most common area involved (41,2%). Contrast-enhanced computed tomography (CECT) was performed in 45% of patients mainly with deep neck abscesses. All CECT scans showed the fluid collections. In all but one of the patients treated surgically and diagnosed with ultrasound and/or CECT surgical intervention revealed presence of pus. The most common pathogen was Staphylococcus aureus- SA (78% of all isolates) of which 24% were methicillin resistant Staphylococcus aureus - MRSA. Clindamycin resistance was detected in 28% of all SA isolates and in 67% (4/6) of all MRSA isolates. All MRSA isolates were sensitive to vancomycin. CONCLUSIONS: CECT is reliable imaging technique for diagnosing deep neck abscesses in children. Infants with neck abscesses are at higher risk of having MRSA as offending pathogen which should be taken into consideration when considering empiric treatment. Vancomycin is recommended as empiric antibiotic therapy in newborns with neck abscess.

Deep Neck Infection: A Review of 130 Cases in Southern China.

The study aims to present our experience of the clinical course and management of deep neck infection and try to determine if the characteristics of this kind of infection were similar between the children and adults in southern China.Patients diagnosed with deep neck infection in the Division of Otolaryngology in the First Affiliated Hospital of Sun Yat-sen University between January 2002 and December 2011 were screened retrospectively for demographic characteristics, presenting symptoms, antibiotic therapy before admission, the history of antibiotics abuse, leucocyte count, etiology, bacteriology, disease comorbidity, imaging, treatment, complications, and outcomes.One hundred thirty patients were included and 44 (33.8%) were younger than 18 years old (the children group), 86 patients (66.2%) were older than 18 years old (the adults group). Fever, trismus, neck pain, and odynophagia were the most common symptoms in both groups. Forty children (90.9%) and 49 adults (57.0%) had been treated with broad-spectrum antibiotic therapy before admission. Thirty one children (70.5%) and 24 adults (27.9%) had a history of antibiotics abuse. In children group, the site most commonly involved was the parapharyngeal space (18 patients, 40.9%). In adults group, the site most commonly involved was multispace (30 patients, 34.9%). In children group, the most common cause was branchial cleft cyst (5 patients, 11.4%) and the cause remained unknown in 31 patients (70.5%). In adults group, the most common cause was pharyngeal infection (19 patients, 22.2%). All of the 27 patients with associated disease comorbidity were adults and 17 were diabetes mellitus (DM). Streptococcus viridans was the most common pathogen in both children and adults groups. Eighty six (66.2%) underwent surgical drainage and complications were found in 31 patients (4 children, 27 adults).Deep neck infection in adults is easier to have multispace involvement and lead to complications and appears to be more serious than that in children. Understanding the different characteristics between the children and adults with deep neck infection may be helpful in accurate evaluation and proper management.

Nationwide surveillance of 6 otorhinolaryngological infectious diseases and antimicrobial susceptibility pattern in the isolated pathogens in Japan.

The Japanese Three Academic Societies Joint Antimicrobial Susceptibility Surveillance Committee has conducted a nationwide surveillance on antimicrobial susceptibility patterns and rates of isolation in 6 otolaryngological diseases. The surveillance program was conducted in the otorhinolaryngological departments of 29 universities, and their 26 affiliated hospitals. Patients suffering from acute otitis media, chronic otitis media, acute nasal sinusitis, chronic nasal sinusitis, acute tonsillitis, and peritonsillar abscess between January 2011 and June 2012 were investigated. The collected swab or incision samples were cultivated for microbial identification, and the drug susceptibility of detected bacteria was measured at the Kitasato University Research Center for Infections and Antimicrobials. The surveillance focused on three gram-positive bacteria (Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus), three gram-negative bacteria (Haemophilus influenzae, Moraxella Catarrhalis, and Pseudomonas aeruginosa), and three anaerobic bacteria (Peptostreptococcus spp., Prevotella spp., and Fusobacterium spp.). Bacterial susceptibility to 39 antimicrobial drugs was investigated. We compared bacterial isolation ratio of each disease in this surveillance from those of past 4 times surveillance which we performed formerly, and we also compared percentage of main drug resistant strains from those of past 4 times surveillance. The age composition between this time and former surveillances was not statistically significant by student-t test. We were unable to completely resolve the rise in resistant bacteria, such as methicillin-resistant S. aureus, penicillin-resistant S. pneumoniae, penicillin-intermediate resistant S. pneumoniae, beta-lactamase non-producing ampicillin-resistant H. influenzae, beta-lactamase producing ampicillin-resistant H. influenzae, and beta-lactamase producing amoxicillin clavulanic acid-resistant H. influenzae. We suggest promoting the proper usage of antimicrobial drugs in order to avoid the spread of these bacteria.

Update on disorders and treatment of the guttural pouch.

The most common disorders of the equine guttural pouches are empyema, tympany, mycosis, and temporohyoid osteoarthropathy. Diagnosis of these conditions is made primarily by imaging with endoscopy, radiographs, computed tomography, and/or MRI. Medical treatment with anti-inflammatories, antimicrobials, and/or antifungals may be successful in some cases, but many of these disorders necessitate surgical intervention. Direct surgical approaches to the guttural pouch are difficult because of their complex anatomy and relationship with important structures, thus precipitating a move toward minimally invasive procedures when possible.

In defence of 'dye therapy'.

Worldwide, healthcare is facing enormous problems with the continuing rise of drug-resistant infectious diseases. In view of the scarcity of new antimicrobial agents and the withdrawal of many pharmaceutical houses from the fray, alternative approaches are required. One of these is photoantimicrobial chemotherapy, which is highly effective across the range of microbial pathogens and does not suffer from resistance. However, there is a lack of uptake of this approach by healthcare providers and the pharmaceutical industry alike. It is seldom recalled that, unlike anticancer photodynamic therapy, the development of photoantimicrobial agents has evolved from the antiseptic 'dye therapy' in common use until the widespread introduction of the penicillin class in the mid-1940s. Cationic biological dyes such as methylene blue, crystal violet and acriflavine were effective in local wound therapy and today provide a sound basis for light-activated antimicrobial therapeutics. It is proposed that such 'safe' dyes are introduced as locally administered photoantimicrobials, especially in order to conserve valuable conventional antibacterial drugs.

Biofilms en otorrinolaringología / Biofilms in otolaryngology

Según el Instituto de Salud de los Estados Unidos de Norteamérica «un porcentaje superior al 60% de todas las infecciones microbianas están originadas por biofilms», afirmación que puede parecernos sorprendente, pero basta que consideremos que infecciones tan comunes como las del tracto genitourinario, las producidas por el catéter, las del oído medio en los niños, la formación de la placa dental y la gingivitis son originadas por biofilms, para que esta afirmación parezca más realista. Los biofilms son conglomerados de células que viven inmersas en una matriz propia de exopolisacárido con una organización estructural y funcional compleja, resultado de una comunicación continua entre ellas. La estructura de dicha biopelícula les confiere protección contra los antibióticos y las defensas del organismo, por lo que son los responsables de innumerables infecciones recalcitrantes en todo el cuerpo humano y particularmente en oídos, senos paranasales, amígdalas y adenoides. Actualmente se investigan nuevos tratamientos que puedan ser eficaces para erradicarlos (AU)

According to the National Institute of Health of the USA, "more than 60% of all microbial infections are caused by biofilms". This can surprise us, but it is enough to consider that common infections like those of the genito-urinary tract, infections produced by catheters, middle ear infections in children, the formation of dental plaque and gingivitis are caused by biofilms, for this statement to seem more realistic. At present this is one of the subjects of great interest within medicine, particularly in otolaryngology. Bacteria have traditionally been considered to be in a free state without evident organisation, partly perhaps by the ease of studying them in this form. Nevertheless, the reality is that, in nature, the great majority of these germs form complex colonies adhered to surfaces, colonies that have received the name of biofilms. These biofilms are more common than previously thought and almost all of the people have been in contact with them in the form of infections in the teeth or humid, slippery areas. New treatments that can eradicate them are currently being investigated (AU)