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1.
J Zoo Wildl Med ; 50(4): 1008-1011, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926538

RESUMO

Curvularia spp. are globally distributed saprophytic fungi, classified in the literature as dematiaceous, or darkly pigmented fungi. These fungi have been increasingly recognized as causing cutaneous, ocular, respiratory, and central nervous system infections in humans, but have been infrequently documented as pathogens in the veterinary literature. A 5-yr-old male Chinese goral (Naemorhedus griseus) presented with bilateral fungal dermatitis of the pinnae, and subsequent pyogranulomatous rhinosinusitis. Clinical signs included epistaxis, mucosanguineous nasal discharge, and dyspnea. Sequential histologic examinations of cutaneous and nasal lesions revealed pyogranulomatous inflammation with extracellular and phagocytized nonpigmented yeasts. Fungal culture and polymerase chain reaction identified Curvularia sp. The absence of pigmentation in tissue in this case suggests that pigmentation may not be a consistent histologic finding for this fungus, emphasizing the importance of molecular identification to prevent misidentification. Despite intensive interventions in this goral, the disease progressed, and was ultimately fatal.


Assuntos
Dermatomiosite/veterinária , Rinite/veterinária , Sinusite/veterinária , Animais , Animais de Zoológico , Antifúngicos/uso terapêutico , Clotrimazol/uso terapêutico , Dermatomiosite/tratamento farmacológico , Dermatomiosite/microbiologia , Griseofulvina/uso terapêutico , Masculino , Rinite/tratamento farmacológico , Rinite/microbiologia , Ruminantes , Sinusite/tratamento farmacológico , Sinusite/microbiologia
2.
Vet Clin North Am Small Anim Pract ; 50(2): 331-357, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31866094

RESUMO

Fungal rhinosinusitis, including sinonasal aspergillosis (SNA) and sino-orbital aspergillosis (SOA), is the most common type of aspergillosis encountered in cats. Other focal forms of aspergillosis including disseminated invasive aspergillosis occur less frequently. SOA is an invasive mycosis that is increasingly recognized and is most commonly caused by Aspergillus felis, a close relative of Aspergillus fumigatus. SNA can be invasive or noninvasive and is most commonly caused by A fumigatus and Aspergillus niger. Molecular methods are required to correctly identify the fungi that cause SNA and SOA. SNA has a favorable prognosis with treatment, whereas the prognosis for SOA remains poor.


Assuntos
Aspergilose/veterinária , Doenças do Gato/microbiologia , Sinusite/veterinária , Animais , Antifúngicos/uso terapêutico , Aspergilose/diagnóstico , Aspergilose/tratamento farmacológico , Aspergilose/microbiologia , Aspergillus fumigatus/isolamento & purificação , Aspergillus niger/isolamento & purificação , Doenças do Gato/diagnóstico , Doenças do Gato/tratamento farmacológico , Gatos , Diagnóstico Diferencial , Sinusite/diagnóstico , Sinusite/tratamento farmacológico , Sinusite/microbiologia
3.
Medicine (Baltimore) ; 98(39): e17365, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574884

RESUMO

RATIONALE: Periorbital cellulitis or an orbital abscess caused by acute sinusitis is a serious acute infectious disease. If not treated in time, serious complications may occur. PATIENT CONCERNS: A 16-year-old girl with a history of right-sided proptosis, periorbital swelling, chemosis, hypophasis, restricted ocular movement in the upward direction, and diminution of vision was referred to our institution. The clinic, computed tomography (CT) and magnetic resonance imaging (MRI) examination indicate right orbital abscess in the upper quadrant and sinusitis. DIAGNOSES: She was diagnosed with orbital abscess, acute sinusitis. INTERVENTIONS: She underwent medical management, transnasal endoscopic surgery and then ultrasound-guided fine needle aspiration (FNA) and catheter drainage. OUTCOMES: She was completely cured without any complications or sequelae. LESSONS: Performance of surgical drainage in a timely manner and administration of effective antibiotic treatment according to bacterial culture can reduce the complications of orbital abscesses. Ultrasound-guided FNA and catheter drainage is a safe, simple, and effective method for the treatment of orbital abscess.


Assuntos
Abscesso/cirurgia , Drenagem/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Doenças Orbitárias/cirurgia , Sinusite/cirurgia , Abscesso/microbiologia , Doença Aguda , Adolescente , Cateteres , Drenagem/instrumentação , Feminino , Humanos , Doenças Orbitárias/microbiologia , Sinusite/microbiologia
4.
Artigo em Chinês | MEDLINE | ID: mdl-31446729

RESUMO

Objective:Since bacterial infection is one of the common pathogenic factors lead to chronic rhinosinusitis (CRS), our study is designed to investigate the prevalence and antibiotic resistance of nasal colonized bacteria in patients with CRS, and to analyze the correlation between nasal colonized bacteria and pathogenesis of CRS. Method:Nasal vestibule samples collected from 200 patients with CRS were automatically inoculated on to various bacterial culture medium, cultured by WaspLab microbiology automated system, potential pathogenic bacterial colonies grew on agar plates were then examined, identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry, and analyzed their antibiotic-resistant phenotype by antibiotic susceptibility testing. Result:Two hundred and seventy-five bacterial strains of nasal colonization were isolated, including coagulase-negative Staphylococci, Staphylococcus aureus, Streptococcus pneumonia, Moraxella catarrhalis, Haemophilus influenza, Pseudomonas aeruginosa, and Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae. All strains displayed various degrees of antimicrobial resistance among children and adult patients, or among patients with and without endoscopic sinus surgery. Conclusion:The constitution of nasal colonized commensal bacteria in patients with CRS was partially similar to that of pathogenic bacteria causing CRS. They may form a reservoir of antimicrobial resistant pathogens, which would transform into pathogenic bacteria causing CRS under certain conditions. Screening of nasal colonized bacteria may represent an alternative approach for diagnosis and treatment of CRS.


Assuntos
Bactérias/efeitos dos fármacos , Farmacorresistência Bacteriana , Sinusite/microbiologia , Adulto , Criança , Doença Crônica , Humanos , Testes de Sensibilidade Microbiana
6.
Ann Otol Rhinol Laryngol ; 128(12): 1116-1121, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31304771

RESUMO

OBJECTIVES: A shift in the microbiota of chronic rhinosinusitis has been described after radiotherapy to the sinonasal cavity and skull base. There is a paucity of literature characterizing the bacteriology of post radiation sinusitis using next-generation gene sequencing techniques. This study aims to describe and compare the microbial flora of rhinosinusitis after radiotherapy using both culture and molecular techniques for microbial DNA detection. METHODS: The medical records of patients treated with external beam radiation for sinonasal, nasopharyngeal, or skull base malignancy were reviewed at a tertiary care facility. Patients' sinonasal cavities were swabbed for routine culture or brushed for molecular gene sequencing. Swab specimens were processed for standard microbial culture, and brush specimens were sent for gene sequencing at Micro GenX Laboratory (Lubbock, Texas, USA). RESULTS: Twenty-two patients were diagnosed with chronic sinusitis after undergoing radiotherapy. Staphylococcus aureus was the most common organism identified by both culture and gene sequencing, followed by Pseudomonas aeruginosa. Several additional organisms were detected by gene sequencing that were not isolated by routine culture techniques. Gene sequencing identified pathogens differing from culture results in 50% of patients examined. CONCLUSION: The bacteriology of post radiation sinusitis appears to resemble the microorganisms responsible for chronic sinusitis in healthy adults. Next generation gene sequencing techniques may reveal additional organisms responsible for sinusitis and provide complementary results that may impact the medical treatment of post radiation sinusitis.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Microbiota , Lesões por Radiação/microbiologia , Rinite/microbiologia , Sinusite/microbiologia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Pseudomonas aeruginosa/isolamento & purificação , Staphylococcus aureus/isolamento & purificação , Stenotrophomonas maltophilia/isolamento & purificação
8.
Vet Clin Pathol ; 48(2): 300-304, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31210366

RESUMO

A 6-year-old male neutered Bengal cat was presented to the University of Wisconsin Veterinary Care Hospital with a history of severe chronic rhinitis that was unresolved from kittenhood. In weeks prior to presentation, the cat's upper respiratory signs had significantly worsened and a left-sided facial swelling overlying the left frontal sinus was noted. Skull computed tomography, rhinoscopy, bilateral nasal biopsies, bacterial and fungal cultures of fluid from the left frontal sinus, and cryptococcal fungal antigen testing were performed. The cat was diagnosed with severe chronic rhinosinusitis and determined to have an infection with a mucoid variant of Pseudomonas aeruginosa (P aeruginosa). This case highlights an atypical cytomorphologic appearance of the well-known bacterial pathogen, P aeruginosa, an appearance that could be confused cytologically with other microorganisms, such as septate fungi. Mucoid variants of P aeruginosa are often associated with progressive lung or airway disease in people with cystic fibrosis and have not been previously documented in feline respiratory tract disease. This report also presents a brief review of chronic rhinosinusitis (CRS) in cats and describes a novel interventional treatment approach to feline CRS via sinusotomy and sinus flushing for severely affected cats.


Assuntos
Doenças do Gato/diagnóstico , Infecções por Pseudomonas/veterinária , Pseudomonas aeruginosa/isolamento & purificação , Sinusite/veterinária , Animais , Doenças do Gato/microbiologia , Gatos , Doença Crônica/veterinária , Masculino , Infecções por Pseudomonas/diagnóstico por imagem , Infecções por Pseudomonas/microbiologia , Sinusite/diagnóstico por imagem , Sinusite/microbiologia , Tomografia Computadorizada por Raios X/veterinária
9.
Mycopathologia ; 184(3): 423-431, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31147870

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) with eosinophilic mucin is considered rare in Korea. The object of this study was to categorize CRS patients with eosinophilic mucin into several groups and compared the groups based on their clinicopathological and radiological features. METHODS: In total, 105 CRS patients with eosinophilic mucin from four tertiary medical centers which are located at Chungcheong province of Korea were included for this study. The patients were divided into four groups for analysis, based on the presence or absence of an allergy (A) to a fungus or fungal element (F) in the mucin. The following were the four groups: allergic fungal rhinosinusitis (AFRS, A+F+), AFRS-like sinusitis (A+F-), eosinophilic fungal rhinosinusitis (EFRS, A-F+), and eosinophilic mucin rhinosinusitis (EMRS, A-F-). Their clinical manifestation, the presence of associated disease, radiological finding, treatment, and treatment outcome were reviewed and compared. RESULTS: There were no patients in the AFRS-like sinusitis group, 47 patients were assigned to the AFRS group, 27 to the EFRS group, and 41 to the EMRS group. Patients of AFRS group showed a significantly higher association with allergic rhinitis than did the other groups. The mean total serum IgE level in the AFRS patients was significantly higher than in the EFRS and EMRS patients. In the AFRS group and EFRS group, 67.6% and 74.1% had unilateral disease, respectively, in contrast to the EMRS group (4.9%). The mean Hounsfield unit values of the area of high attenuation in the AFRS patients were significantly higher than those in the other groups. CONCLUSIONS: Significant clinicopathological differences existed among the subgroups of CRS with eosinophilic mucin. AFRS tends to be an allergic response to colonizing fungi in atopic individuals. In EFRS, local allergies to fungi might play a role in the disease. EMRS is thought to be unconnected with fungal allergies, and it showed different form compared with the AFRS and EFRS groups.


Assuntos
Eosinófilos/imunologia , Mucinas/análise , Micoses/microbiologia , Micoses/patologia , Sinusite/microbiologia , Sinusite/patologia , Tomografia Computadorizada por Raios X , Adulto , Doença Crônica , Feminino , Humanos , Imunoglobulina E/sangue , Coreia (Geográfico) , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico por imagem , Estudos Retrospectivos , Sinusite/diagnóstico por imagem , Resultado do Tratamento
10.
Am J Otolaryngol ; 40(4): 609-611, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31109807

RESUMO

The management of invasive fungal sinusitis differs greatly from the management of herpes simplex virus (HSV) of the nose in immunocompromised patients. However, the diagnosis may be uncertain and a delay in treatment can lead to mortality. Here we describe the successful medical management of a series of immunocompromised pediatric patients with HSV lesions of the nose with the initial concern for invasive fungal sinusitis. The diagnosis of HSV herpes was supported by positive polymerase chain reaction (PCR) testing of the nasal lesion. To our knowledge, these are the first cases described in the pediatric literature, emphasizing the need to include this entity on the differential.


Assuntos
Herpes Simples/diagnóstico , Doenças Nasais/diagnóstico , Aciclovir/administração & dosagem , Adolescente , Adulto , Antivirais/administração & dosagem , Criança , Diagnóstico Diferencial , Feminino , Herpes Simples/patologia , Herpes Simples/terapia , Herpes Simples/virologia , Humanos , Hospedeiro Imunocomprometido , Infusões Intravenosas , Infecções Fúngicas Invasivas/patologia , Leucemia de Células B , Masculino , Doenças Nasais/patologia , Doenças Nasais/terapia , Doenças Nasais/virologia , Seios Paranasais , Reação em Cadeia da Polimerase , Leucemia-Linfoma Linfoblástico de Células Precursoras , Sinusite/microbiologia , Sinusite/patologia , Resultado do Tratamento
11.
BMC Ophthalmol ; 19(1): 117, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109307

RESUMO

BACKGROUND: Rhinosinusitis is a common condition which may present with complications commonly involving the orbit and the intracranial space. Loss of vision in the absence of clinical or radiological signs of involvement of the orbit and intracranium is rare and carries a high morbidity rate. Streptococcus equi subspecies zooepidemicus is not a well-documented cause of paranasal sinus infection. CASE PRESENTATION: We present a case of a 16 year old female patient who had unilateral loss of vision with signs of retrobulbar optic neuritis and no other neurological signs. We isolated an unusual organism- Streptococcus equi subspecies zooepidemicus from the maxillary sinus. Emergency endoscopic sinus surgery and antibiotic treatment resulted in complete reversal of the loss of vision. CONCLUSION: The presence of paranasal sinus disease in association with loss of vision even in the absence of a clear link between the two should be treated as an emergency with surgical drainage and or appropriate antibiotic therapy. In patients presenting with suspected inflammatory orbital involvement, imaging of the orbit and paranasal sinuses should be considered early.


Assuntos
Cegueira/etiologia , Rinite/microbiologia , Sinusite/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus equi/isolamento & purificação , Adolescente , Feminino , Humanos
12.
Acta Otolaryngol ; 139(7): 652-658, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31050570

RESUMO

Background: Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose and the paranasal sinuses, often associated with an infection by Staphylococcus aureus (S. aureus). Disturbance in the function of ion channels is regarded as an etiological factor for pathogenesis of CRS. Aims: The study aims to measure the mRNA expression of the ENaC and CFTR ion channels in nasal epithelial cells (NECs) and to investigate the effect of both the budesonide and S. aureus on these ion channels. Materials and method: NECs biopsies obtained from healthy volunteers and patients with CRS. NECs were infected with S. aureus strains and/or budesonide to study the mRNA expression levels of the ENaC and CFTR ion channels. Results: The mRNA expression level of CFTR was increased while that of ENaC was decreased. S. aureus infection and budesonide treatment induced a significant modulation of ENaC and CFTR ion channels expression. Conclusion: The CFTR and ENaC ion channel physiology are of importance in the pathogenesis of CRS. Exposure to S. aureus infection and treatment with budesonide modulated the mRNA expression of CFTR and ENaC ion channels. Significance: Better understanding of the pathophysiology of CRS.


Assuntos
Budesonida/administração & dosagem , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Regulação da Expressão Gênica , Rinite/genética , Sinusite/genética , Infecções Estafilocócicas/genética , Adulto , Análise de Variância , Estudos de Casos e Controles , Doença Crônica , Canais Epiteliais de Sódio/efeitos dos fármacos , Canais Epiteliais de Sódio/metabolismo , Feminino , Seguimentos , Humanos , Transporte de Íons , Masculino , Pessoa de Meia-Idade , RNA Mensageiro/genética , Valores de Referência , Rinite/tratamento farmacológico , Rinite/microbiologia , Medição de Risco , Transdução de Sinais/genética , Sinusite/tratamento farmacológico , Sinusite/microbiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Regulação para Cima
13.
Eur Arch Otorhinolaryngol ; 276(7): 1975-1980, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30929057

RESUMO

OBJECTIVE: Fungal rhinosinusitis occurs in different forms depending on race and region. While allergic fungal rhinosinusitis is common in Caucasians, fungal ball (FB) is more common in Asians. However, most cases are reported as unilateral, and clinical data on bilateral FB (BFB) are rare. Therefore, the purpose of this study was to analyze and to compare the clinical characteristics of BFB and unilateral FB (UFB) in Koreans. METHODS: We retrospectively analyzed medical records and computed tomography (CT) images of 434 patients diagnosed with FB. The patients were divided into two groups: BFB and UFB. Demographic data, multiple allergen simultaneous test including total or specific immunoglobulin E (IgE) levels, symptoms, CT findings, treatment, and outcomes were analyzed. RESULTS: Among the patients, 26 had BFB and 408 had UFB. Hypertension was noted in 61.5% of the BFB and 39% of the UBF individuals (p = 0.023). While total IgE levels were similar between the two groups, Dermatophagoides pteronyssinus (p = 0.004), Cladosporium (p = 0.017), and Aspergillus-specific IgE positivity (p = 0.025) were significantly higher in the BFB than in the UFB group. Not only symptoms such as postnasal drip (p = 0.013), mucopurulent rhinorrhea (p = 0.009), and foul odor (p = 0.037), but also sphenoid sinus involvement on CT images were more common in the BFB than in the UFB group (p = 0.011). CONCLUSION: Patients with BFB in Korea showed more common hypertension and symptoms of foul odor, mucopurulent rhinorrhea, and postnasal drip with allergy positivity compared to those with UFB. Therefore, understanding clinical characteristics of BFB will allow clinicians to approach BFB more appropriately.


Assuntos
Fungos , Hipertensão/epidemiologia , Micoses , Rinite , Sinusite , Adulto , Comorbidade , Gerenciamento Clínico , Feminino , Fungos/classificação , Fungos/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/epidemiologia , Micoses/microbiologia , Micoses/terapia , República da Coreia/epidemiologia , Estudos Retrospectivos , Rinite/epidemiologia , Rinite/microbiologia , Rinite/terapia , Fatores de Risco , Sinusite/epidemiologia , Sinusite/microbiologia , Sinusite/cirurgia , Sinusite/terapia , Tomografia Computadorizada por Raios X/métodos
14.
J Epidemiol Glob Health ; 9(1): 44-49, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30932389

RESUMO

This study aims to evaluate the antibiotic prescribing rate for acute bacterial rhinosinusitis in community pharmacies and to study the corresponding attitude and behavior of participants. A cross-sectional, nationwide study was conducted using a patient-simulated case of bacterial rhinosinusitis. Descriptive data were reported for the medications prescribed, questions asked, and recommendations made. Bivariate analysis was conducted to identify factors affecting the aforementioned. Out of the 250 community pharmacies visited, 77 (30.8%) prescribed antibiotics, 15 (6%) referred the patient to a physician, and 79 (32%) made the right diagnosis. Amoxicillin/clavulanic acid (69.7%) was the most prescribed antibiotic. The majority of the participants prescribed antibiotics according to guidelines. Overall, 108 (43.2%) participants questioned about symptoms and few questioned about patient age, pregnancy, and history of rhinosinusitis. None counseled about interactions or in case a dose is missed. We concluded that antibiotics are easily prescribed in Lebanese community pharmacies. This misuse should be tackled by legislative authorities to restrict such practices.


Assuntos
Antibacterianos/uso terapêutico , Farmácias/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Doença Aguda , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Estudos Transversais , Feminino , Humanos , Prescrição Inadequada/estatística & dados numéricos , Líbano , Masculino , Rinite/diagnóstico , Rinite/microbiologia , Sinusite/diagnóstico , Sinusite/microbiologia
15.
Laryngoscope ; 129(10): 2230-2235, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30973971

RESUMO

OBJECTIVE: In the pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwNP), Aspergillus fumigatus (A. fumigatus) can upregulate IL-33 from human sinonasal epithelial cells (SNECs), which then activates innate lymphoid cells causing release of IL-13, an important driver of allergic inflammation. However, the mechanism by which A. fumigatus mediates the induction of IL-33 expression remains to be elucidated. The objectives of this study were to determine the specific fungal component(s) and the receptor responsible for mediating the A. fumigatus induced increase in IL-33 expression in SNECs from patients with CRSwNP. METHODS: SNECs from CRSwNP patients were cultured and stimulated with various fungal components in the absence or presence of 4-(2-Aminoethyl)benzenesulfonyl fluoride hydrochloride, an irreversible serine protease inhibitor, or GB83, a reversible protease activated receptor 2 (PAR2) inhibitor. IL-33 expression was evaluated using quantitative real-time polymerase chain reaction (qRT-PCR). PAR2 expression was examined in inflamed mucosa from nonatopic control and CRSwNP patients. RESULTS: Elevation of IL-33 expression in primary SNECs was found in response to fungal protease but not fungal cell wall components. PAR2 expression was elevated in inflamed mucosa from CRSwNP patients in comparison to controls. The A. fumigatus fungal protease-mediated elevation in IL-33 expression by human SNECs was serine protease- and PAR2-dependent. CONCLUSION: These data suggest that serine protease activity of A. fumigatus is capable of inducing IL-33 expression in CRSwNP SNECs via PAR2, a potential therapeutic target in the treatment of CRSwNP. LEVEL OF EVIDENCE: NA Laryngoscope, 129:2230-2235, 2019.


Assuntos
Aspergillus fumigatus/imunologia , Interleucina-33/metabolismo , Pólipos Nasais/microbiologia , Receptores Acoplados a Proteínas-G/imunologia , Rinite/microbiologia , Sinusite/microbiologia , Células Cultivadas , Doença Crônica , Células Epiteliais/imunologia , Células Epiteliais/microbiologia , Feminino , Humanos , Imunidade Inata , Linfócitos/imunologia , Linfócitos/microbiologia , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/imunologia , Mucosa Nasal/microbiologia , Pólipos Nasais/imunologia , Seios Paranasais/imunologia , Seios Paranasais/microbiologia , Rinite/imunologia , Sinusite/imunologia
16.
BMJ Case Rep ; 12(4)2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30967452

RESUMO

A 33-year-old man presented to the emergency department with a right-sided facial paralysis and maxillary division (V2, trigeminal nerve) paraesthesia. He had been suffering with upper respiratory tract symptoms in the preceding 2 months, including rhinorrhoea, fever and headache. The patient was otherwise fit and immunocompetent. Urgent radiological investigation revealed extensive fungal sinusitis with sphenoid sinus dehiscence and skull base osteitis. The patient underwent emergency endoscopic sinus surgery revealing concretions and debris in the ethmoid and sphenoid sinuses. He was commenced on systemic antifungal therapy and made a full recovery with resolution of his cranial neuropathies. The fungus Schizophyllum commune was isolated and is a rare cause of fungal sinusitis, but with the potential for invasive disease in immunosuppressed individuals.


Assuntos
Doenças Ósseas Infecciosas/etiologia , Doenças dos Nervos Cranianos/etiologia , Micoses/complicações , Osteíte/etiologia , Sinusite/complicações , Adulto , Antifúngicos/uso terapêutico , Doenças Ósseas Infecciosas/complicações , Doenças Ósseas Infecciosas/microbiologia , Fluconazol/uso terapêutico , Humanos , Imagem por Ressonância Magnética , Masculino , Micoses/diagnóstico , Micoses/microbiologia , Micoses/terapia , Osteíte/microbiologia , Schizophyllum/isolamento & purificação , Sinusite/diagnóstico , Sinusite/microbiologia , Sinusite/terapia , Base do Crânio/diagnóstico por imagem , Base do Crânio/microbiologia , Base do Crânio/patologia , Tomografia Computadorizada por Raios X
17.
BMC Infect Dis ; 19(1): 310, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953465

RESUMO

BACKGROUND: Early diagnosis of acute invasive fungal rhinosinusitis (AIFRS) is vital to improving outcomes in immunocompromised patients. This study evaluated the impact of a systematic protocol with nasal endoscopy and biopsies to early detect AIFRS in immunocompromised patients. Additionally, we compared the accuracy of frozen-section biopsy and culture with formalin-fixed paraffin-embedded (FFPE) biopsy. METHODS: Retrospective cohort in a Tertiary Referral Hospital. Patients with the suspected diagnosis of AIFRS were evaluated following a standardized protocol, including serial nasal endoscopies and biopsies when necessary. The sensitivity and specificity of frozen-section biopsy and culture were also compared with FFPE. RESULTS: The mortality rate related to AIFRS of this standardized cohort (13/43) was 30.2%. Better outcomes were observed in patients with disease limited to the turbinates and in those with higher peripheral neutrophils count. Frozen-section biopsy positivity correlated with FFPE findings for fungi detection (p-value < 0.0001), with a sensitivity of 90.6%, specificity of 72.7%, and accuracy of 86.0%. CONCLUSION: Implementation of this standardized protocol was related to a considerably low mortality rate among patients with suspected AIFRS at our Institution. Frozen-section biopsy revealed high accuracy to diagnose AIFRS. The current protocol including frozen-tissue biopsy improved the evaluation and survival rates of immunocompromised patients with presumed AIFRS.


Assuntos
Biópsia/métodos , Endoscopia/métodos , Infecções Fúngicas Invasivas/diagnóstico , Rinite/diagnóstico , Sinusite/diagnóstico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Diagnóstico Precoce , Feminino , Secções Congeladas , Humanos , Hospedeiro Imunocomprometido , Lactente , Infecções Fúngicas Invasivas/microbiologia , Infecções Fúngicas Invasivas/mortalidade , Masculino , Pessoa de Meia-Idade , Nariz , Inclusão em Parafina , Estudos Retrospectivos , Rinite/microbiologia , Rinite/mortalidade , Sensibilidade e Especificidade , Sinusite/microbiologia , Sinusite/mortalidade , Taxa de Sobrevida
18.
Int J Pediatr Otorhinolaryngol ; 121: 50-54, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30861428

RESUMO

OBJECTIVES: The aim of this study was to analyze the rate of admissions, the rate of serious complications (postseptal orbital complications and surgery) and the bacterial etiology of acute rhinosinusitis in hospitalized children under five years old in Stockholm County, eight years after the introduction of the pneumococcal conjugate vaccine (PCV). The secondary aim was to compare this period with the period four years prior to the vaccine's introduction. METHODS: This was a population-based, descriptive observational study with retrospectively collected data from 1 July 2008 to 30 June 2016 in Stockholm County. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed and compared to the pre-PCV period of 2003-2007. RESULTS: A total of 215 children were admitted, for a yearly incidence of 18.8 per 100 000 children (22.8 for boys, 14.6 for girls). Computer tomography-verified postseptal orbital complications occurred in 29 cases (13.5%) and surgery was necessary in nine (4.2%). Pathogens other than Streptococcus pneumoniae were found in the cases with postseptal complication or surgery (Streptococcus pyogenes in four, Haemophilus influenzae in three and Staphylococcus aureus in one case). In comparison to the four years pre-PCV, the incidence of admission decreased from 43.81 to 20.31 and 17.45 per 100 000/year for the two four-year periods after vaccine introduction. The incidence of CT-verified postseptal complication increased slightly from 1.51 to 2.34 and 2.74 per 100 000/year. The incidence of surgeries increased marginally but continued to be very low, from 0.22 to 0.54 and 1.03 per 100 000/year. CONCLUSIONS: Complications due to acute rhinosinusitis in children living in Stockholm County continues to be very rare after the introduction of pneumococcal vaccine. Hospitalization has decreased for children under five years old after PCV introduction, but the incidence or postseptal complications and surgery in the same population increased slightly. Predominantly bacteria other than Streptococcus pneumoniae was found. There is a need of larger studies to determine trends, and a need of prospective studies to elucidate the bacterial etiology, of serious complications due to acute rhinosinusitis in children.


Assuntos
Abscesso/epidemiologia , Celulite Orbitária/epidemiologia , Doenças Orbitárias/epidemiologia , Rinite/epidemiologia , Sinusite/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Admissão do Paciente/tendências , Vacinas Pneumocócicas , Estudos Retrospectivos , Rinite/microbiologia , Rinite/terapia , Sinusite/microbiologia , Sinusite/terapia , Suécia/epidemiologia , Vacinas Conjugadas
19.
Artigo em Inglês | MEDLINE | ID: mdl-30873390

RESUMO

Background: Pseudomonas aeruginosa causes severe chronic respiratory diseases and is associated with recalcitrant chronic rhinosinusitis (CRS). P. aeruginosa exoproteins contain virulence factors and play important roles in the pathogenicity of P. aeruginosa, however their role in CRS pathophysiology remains unknown. Methods: We isolated P. aeruginosa clinical isolates (CIs) and obtained clinical information from 21 CRS patients. Elastase activity of the CIs was measured at different phases of growth. Primary human nasal epithelial cells (HNECs) were cultured at air-liquid interface (ALI) and challenged with P. aeruginosa exoproteins or purified elastase, followed by measuring Transepithelial Electrical Resistance (TEER), permeability of FITC-dextrans, western blot, and immunofluorescence. Results: 14/21 CIs had a significant increase in elastase activity in stationary phase of growth. There was a highly significant strong correlation between the in vitro elastase activity of P. aeruginosa CIs with mucosal barrier disruption evidenced by increased permeability of FITC-dextrans (r = 0.95, p = 0.0004) and decreased TEER (r = -0.9333, P < 0.01) after 4 h of challenge. Western blot showed a significant degradation of ZO-1, Occludin and ß-actin in relation to the elastase activity of the exoproteins. There was a highly significant correlation between the in vitro elastase activity of P. aeruginosa CIs and CRS disease severity (for log phase, r = 0.5631, p = 0.0097; for stationary phase, r = 0.66, p = 0.0013) assessed by CT imaging of the paranasal sinuses. Conclusion: Our results implicate P. aeruginosa exoproteins as playing a major role in the pathophysiology of P. aeruginosa associated CRS by severely compromising mucosal barrier structure and function.


Assuntos
Células Epiteliais/microbiologia , Elastase Pancreática/metabolismo , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/metabolismo , Sinusite/microbiologia , Fatores de Virulência/metabolismo , Adulto , Idoso , Células Cultivadas , Doença Crônica , Células Epiteliais/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/fisiopatologia , Pseudomonas aeruginosa/isolamento & purificação , Sinusite/fisiopatologia
20.
Curr Allergy Asthma Rep ; 19(4): 21, 2019 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-30859336

RESUMO

PURPOSE OF REVIEW: Staphylococcus aureus (S. aureus) is correlated with the development of persistent severe inflammatory disease of the upper airway including chronic rhinosinusitis with nasal polyps (CRSwNP). The presence of S. aureus is associated with atopic disease including allergic rhinitis and atopic dermatitis and is associated with poor outcomes. RECENT FINDINGS: Several different strains of S. aureus generate different toxins and gene products that can account for organism pathogenicity. S. aureus bacteria and its antigens shape the bacterial and fungal microbiome and the mucosal niche which generates host responses that can account for inflammation. The multiple disease phenotypes and molecular endotypes seen in CRSwNP can be characterized by T-helper cell environment within the inflammatory milieu, the presence of epithelial barrier dysfunction, aberrant eicosanoid metabolism, poor wound healing, and dysfunctional host-bacteria interactions which lead to recalcitrant disease and worse surgical outcomes. Understanding the pathomechanisms that S. aureus utilizes to promote nasal polyp formation, prolonged tissue inflammation, and bacterial dysbiosis are essential in our efforts to identify new therapeutic approaches to resolve this chronic inflammatory process.


Assuntos
Pólipos Nasais/microbiologia , Rinite Alérgica/microbiologia , Sinusite/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/patogenicidade , Antígenos de Bactérias/imunologia , Doença Crônica , Enterotoxinas/imunologia , Humanos , Pólipos Nasais/diagnóstico , Pólipos Nasais/imunologia , Rinite Alérgica/diagnóstico , Rinite Alérgica/imunologia , Sinusite/diagnóstico , Sinusite/imunologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/imunologia , Staphylococcus aureus/imunologia , Superantígenos/imunologia
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