Acute rise in methicillin-resistant Staphylococcus aureus infections in a coastal community

OBJECTIVE

Describe the incidence of head and neck community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections over a 5-year period at a coastal tertiary medical center.

STUDY DESIGN

Retrospective chart review.

SUBJECTS AND METHODS

All patients presenting to the otolaryngology service with cultures taken from head and neck infections between 1999 and 2004 were eligible for inclusion. Statistical analysis was used to determine significance of the changing incidence of isolated organisms over the study period.

RESULTS

CA-MRSA infections rose from 21% to 64% over the 5-year period. The increasing trend in CA-MRSA infections reached statistical significance from 2003 to 2004. All CA-MRSA isolates were resistant to cefazolin and penicillin, but most were sensitive to clindamycin.

CONCLUSIONS

Our data demonstrates a striking increase in the incidence of CA-MRSA. We have tailored our treatment of cutaneous head and neck infections to include empiric treatment for CA-MRSA using clindamycin. Awareness and monitoring of this trend will be important for all practitioners involved in the care of these patients.

Complications in primary and secondary acquired cholesteatoma: a prospective comparative study of 62 ears

OBJECTIVES

This study aimed to compare the clinicopathologic behavior of complications in primary and secondary acquired cholesteatoma and figure out the differences between them.

DESIGN

This was a prospective cross-sectional study.

METHODS

This was a study conducted in a tertiary referral medical college hospital comprising of 62 ears, of which 32 were in the primary acquired cholesteatoma group (PACG) and 30 were in the secondary acquired cholesteatoma group (SACG). We compared the 2 groups with respect to 7 prognostic variables, as follows: age distribution, sex, duration of ear discharge, pathology in the ear, predisposing disease focus in nose and throat, pattern of complications, and microbiology of ear.

OBSERVATION AND RESULTS

The presence of cholesteatoma increased the risk for complications by more than 2 times in PACG, but the presence of granulation tissue did not show the same risk. More than half of the ears with complication contained some or the other predisposing disease focus in the nose or throat. The PACG was 3 times more prone to complications than the SACG in the presence of these foci. They showed a similar pattern of complications. Brain abscess and mastoid infections were the commonest complications.

CONCLUSIONS

The PACG was more prone to complications than the SACG in the presence of cholesteatoma and focus in the nose and throat. Irrespective of the different pathologic origin of the 2 types, the patterns of complications remained the same with no major differences, indicating a common final pathway in the natural course of the disease.

Trigeminal trophic syndrome

Trigeminal trophic syndrome (TTS) is a rare cause of facial ulceration, which is believed to develop after insult to the trigeminal ganglia or other parts of the peripheral/central nervous system in the trigeminal pathway. The pathogenesis of TTS is poorly understood. Developing a better understanding of TTS will allow early recognition and improved treatment. Although the ulcers develop predominantly on the ala nasi, the literature on ulcer locations is limited. In this article, we review the epidemiologic aspects of TTS, expand on our knowledge of the anatomic location of the ulcers, and discuss current theories for its aetiology and briefly review the approaches to its management.

Head and neck manifestations and quality of life of patients with ectodermal dysplasia

OBJECTIVES

Ectodermal dysplasias (EDs) are a group of genetic disorders characterized by deficient ectodermal and mesodermal development. Studies examining resultant otolaryngologic issues are few. The objectives of this study were to delineate the head and neck manifestations and quality of life in EDs.

STUDY DESIGN AND SETTING

For 75 individuals, comprehensive histories were taken and otolaryngologic examinations were performed, and subjects rated their otolaryngologic symptom severity. A validated quality of life instrument (SF-8) was administered.

RESULTS

The majority of subjects had a diagnosis of hypohidrotic ED (72%). Otolaryngologic conditions included otitis media (28%), cerumen impaction (48%), nasal obstruction/crusting (51%), heat intolerance (76%), and eczema (39%). Physical findings included peg teeth/hypodontia (76%), alopecia (41%), nasal crusting (41%), and saddle nose deformity (44%). Quality of life scores were generally high. Overall, health was rated "good to excellent" by 87 percent.

CONCLUSION

Patients with ED frequently experience significant otolaryngologic symptoms, although most patients report a good quality of life.

SIGNIFICANCE

A greater understanding of the otolaryngologic issues in ED should help facilitate diagnosis and improve management.

Nasal symptoms and signs in children suffering from asthma

OBJECTIVE

A link between the upper and lower airways has been convincingly demonstrated both in health and disease. To what extent the nose may be involved in children's asthma, has so far not been thoroughly investigated. In this study, we compared symptoms and signs from the upper airways in children with asthma and in children without to find out more about this.

METHODS

The study group included 27 asthmatic children, the control group 29 age and sex-matched healthy volunteers. The children were investigated by a senior ENT-specialist. Their parents completed questionnaires about symptoms and signs of upper airway disorders. Skin prick tests, total IgE, acoustic rhinometry, and an X-ray of the epipharynx were performed. The data from the groups were compared.

RESULTS

Nasal blockage, mouth breathing, day time sleepiness, apnoeas, itching, sneezing, and hearing impairment were more prevalent in asthmatics compared with controls (p<0.05). For nasal blockage the mean VAS-scores were 52.4 and 30.6 for asthmatics and controls, respectively. For daytime sleepiness the corresponding figures were 34.6 and 23.1. The adenoid-nasopharynx-index was larger, indicating reduced palatal airway in the former compared with the latter (p<0.05).

CONCLUSIONS

As the site of upper airway obstruction in asthmatic children appears to be the epipharynx, the adenoids may play a key-role.

Characterisation of Staphylococcus aureus nasal and skin carriage among patients undergoing haemodialysis treatment

The aim of the study was to investigate the rate of Staphylococcus aureus nasal and skin carriage in patients undergoing haemodialysis. The cultured staphylococcal isolates were subsequently characterized by molecular methods. The study group comprised 43 haemodialysed patients from whom nasal and skin swabs from the vascular access sites were collected. The identification of staphylococcal isolates and antibiotic susceptibility testing were performed on the basis of conventional diagnostic procedures. The staphylococci were further characterized using Pulsed-Field Gel Electrophoresis (PFGE). S. aureus was cultured from 12 (27.9%) patients. Only one (8.3%) patient was colonized with the microorganism both in the anterior nares and the vascular access site representing a single strain, as evidenced by PFGE analysis. Antibiotic susceptibility testing identified one (7.6%) methicillin-resistant S. aureus (MRSA) strain. PFGE typing identified several S. aureus genotypes with the lack of one specific strain responsible for colonization. However, it should be noted that among two (A and D) PFGE patterns genetically indistinguishable and closely related isolates (two isolates for each pattern) were identified. The obtained results revealed a relatively low rate of S. aureus carriage accompanied by low methicillin resistance rate and a significant genetic diversity of cultured isolates with the lack of one predominant strain responsible for colonization.

Rhinologic manifestations of ectodermal dysplasia

BACKGROUND

The Ectodermal Dysplasias (ED) are a group of uncommon genetic disorders characterized by deficient development of tissues derived from ectoderm and mesoderm. Abnormalities of the respiratory epithelium prevent normal mucociliary function. We explored the prevalence and severity of sinonasal features in affected individuals.

METHODS

Thirty-four subjects with ED were evaluated. A focused history and thorough nasal examination including flexible nasopharyngoscopy were performed. Patients and caregivers rated the severity of rhinologic symptoms with a standard scale. Standardized smell tests were also performed.

RESULTS

The study included 21 males and 13 females whose mean age was 18.8 years (range, 4 months to 85 years). The majority (79%) had Hypohydrotic ED. Nearly half of the individuals evaluated reported moderate to severe nasal obstruction. Allergic symptoms were present in 44% of individuals whereas 41% had a history of sinusitis. Nasal concretions were significantly more troublesome in those aged 15 and under (p = 0.028). Eighteen percent had undergone sinonasal surgery. On examination, normal intranasal structures were identifiable in all patients. However, dry mucosae, prominent crusts, and concretions were found in most (79%). A deviated nasal septum was present in 23% of individuals and a saddle nose deformity in 18. Smell tests were normal for age in all subjects.

CONCLUSION

Rhinologic issues are prevalent and problematic in individuals with ED. Management should focus on humidification, nasal debridement, and tailored therapy for allergic rhinitis and sinusitis. Increased awareness of the sinonasal concerns in ED will facilitate diagnosis and improve the care of these patients.

Upper respiratory tract involvement of sarcoidosis in the Turkish population

PRINCIPLES AND METHODS

Upper respiratory tract (URT) involvement is rare in sarcoidosis. In this descriptive study, we retrospectively evaluated the clinical and demographic features of 12 (2.19%) patients with URT involvement out of the 546 sarcoidosis patients with follow-up visits at our center within the last 40-year period.

RESULTS

Out of the 546 patients, 12 (2.19%) had upper respiratory tract involvement, 5 (0.91%) had laryngeal involvement, 4 (0.73%) had sinonasal tract involvement, 2 (0.36) patients had salivary gland involvement, and 1 patient had tonsillary involvement. The number of stage 0 subjects among other sarcoidosis patients was significantly lower than that among those with URT involvement.

CONCLUSIONS

URT involvement is rarely diagnosed in patients with systemic sarcoidosis. The most common site for URT involvement among the Turkish population is the larynx, followed by the sinonasal tract.

EBM RATING

C-4.

Yearly incidence of rhinitis, nasal bleeding, and other nasal symptoms in mature women

OBJECTIVES/HYPOTHESIS

To evaluate, by a prospective questionnaire study, the incidence of spontaneous nasal pathology in mature women over a 12-month period, in particular nasal bleeding and the relationships of these symptoms with various factors.

METHODS

Participants were drawn from a sample of 12,735 adult French volunteers participating in a study of antioxidant nutrients ("SU.VI.MAX"); 3500 women aged 50-64 years were randomly selected from good responders in the SU.Vl.MAX population. The responses of 2197 women were analysed.

RESULTS

Nearly 70% of subjects reported at least one episode of rhinitis, with a mean (SD) of 1.88 (2.17) episodes per subject. Rhinitis was related to passive exposure to tobacco smoke (adjusted odds ratio [OR] 1.31, 95% CI 1.05-1.63), menopause (OR 1.47, 95% CI 1.16-1.88), and occupational exposure to vapours or dusts (OR 1.55, 95% CI 1.01-2.37). Nasal bleeding was reported as traces of blood by 16.5% of subjects, and as epistaxis (significant nasal bleeding) by 7.6%. Both symptoms were related to passive exposure to tobacco smoke (OR 1.63, 95% CI 1.22-2.19; OR 1.56, 95% CI 1.05-2.32, respectively) but not to use of systemic or topical medication.

CONCLUSION

A substantial number of mature women experience nasal symptoms during the course of a year. Rhinitis and nasal bleeding were correlated with passive exposure to tobacco smoke.

[The cutaneous leishmaniasis of the face in Gafsa area, Tunisia]

The cutaneous leishmaniasis is a frequent affection in Tunisia. In the Gafsa region it is a endemoepidemic infection. Our prospective study was carried out on 225 cases of cutaneous leishmaniasis of the face collected over two years in the outpatients' department of dermatology at Gafsa hospital. The aim of our study was to know more about the evolutive epidemio-clinical particularities of the cutaneous leishmaniasis of the face. The relative frequency of the cutaneous leishmaniasis of the face for the new patients reached 5%. An equal distribution between the two sexes was noted. The average age of our patients was 24 years old and 6 months old with extremes ranging from 3 months to 77 years. The nodular and ulcerated forms were the most frequent (35.3%), followed by impetiginoid forms (23%), then the lupoid forms (15%). The papular form was quite frequent (13%). Impetiginoid lesions occurred frequently in the child. Lupoid lesions appeared particularly on the nose. The complicated forms: the cutaneuos necrosis or erysipelas of the face appeared after intralesional injections of meglumine antimoniate (Glucantime). The intramuscular meglumine antimoniate was used in 172 patients, among them 47 needed two treatments or more because of a particular resistance of the lesions of the face. The pimple of Gafsa, term initially used for ulcerated skin nodules, was actually characterised by a lesional polymorphism. The prognosis was good however the risk of in aesthetic scar of the face was important.

Seasonal variations in rhino-cerebral Mucor infection

OBJECTIVES

Rhino-orbito-cerebral mucormycosis (ROCM) is an uncommon, potentially lethal infection that occurs mostly in immunocompromised hosts. The seasonal occurrence of ROCM was studied in two of Israel's largest medical centers.

METHODS

A total of 36 patients were seen during a 25-year period in this retrospective bi-institutional cohort study. Meteorologic data were obtained and analyzed for a possible linkage of infection with precipitation and temperature.

RESULTS

Twenty-one of the 36 patients (58%) presented between the months of August and October, and 27 patients (75%) presented between the months of August and December. A peak incidence of ROCM was noted in the month of September (13/36 patients; 36%). No association was noted between meteorologic conditions and the incidence of ROCM infection.

CONCLUSIONS

A consistent seasonal peak was observed in ROCM. Heightened awareness is important for early recognition and treatment of this disease.

Staphylococcus aureus and MRSA nasal carriage in general population

OBJECTIVE

Assessment of Staphylococcus aureus (S. aureus) and MRSA nasal carriage in our general population.

DESIGN

Cross-sectional analytical study.

PLACE AND DURATION OF STUDY

A private Pathology Laboratory in Lahore city from January 2002 to December 2003.

MATERIALS AND METHODS

Nasal swabs were obtained from the apparently healthy persons accompanying the patients attending the laboratory. These swabs were inoculated on blood and mannitol salt agar plates and incubated at 37 degrees C. The isolate(s) were identified as S. aureus on the basis of colony morphology, Gram staining, catalase and coagulase tests. Sensitivity to Oxacillin was determined using standard Kirby Bauer technique.

RESULTS

Nasal swabs from 1660 subjects from the community were studied. Out of these samples, a total of 246 (14.82%) samples were positive for growth of S. aureus (nasal carriers of S. aureus). Out of 246 S. aureus isolates, 48 (19.51%) isolates were methicillin resistant S. aureus (MRSA). Nasal carriage was higher in males (15.47%) as compared to females (13.26%), in urban areas (16.99%) as compared to rural areas (11.32%) and in the year 2002 (16.02%) as compared to year 2003 (13.08%). However, the difference was significant only for the urban vs. rural comparison (p<0.05). MRSA isolates were also significantly higher among S. aureus isolates from the nasal cavities of urban subjects (22.98%) as compared to rural ones (11.11%). Maximum nasal carriage was present in the age group upto 9 years (20.23%) with decrease in the age groups 10-19, 20-29 and 30-39 years followed by small rise in the older subjects.

CONCLUSION

The nasal S. aureus carriage as well as methicillin resistance among these isolates are more common in urban community.

Staphylococcus aureus nasal carriage in patients on haemodialysis: role of cutaneous colonization

We performed a prospective study of Staphylococcus aureus nasal carriage in patients on chronic haemodialysis to determine the role of cutaneous colonization in the aetiology of recurrent nasal colonization. From February 2000 to September 2001, 71 patients on chronic haemodialysis in the dialysis unit at a university hospital were screened monthly for S. aureus nasal carriage. Carriers received nasal mupirocin for five days and were tested for nasal and cutaneous carriage two days later and monthly thereafter. Using genotyping results, recurrence was defined as relapse if pretreatment and subsequent nasal isolates were clonally identical; if the isolates were different, it was considered recolonization. Thirty-nine patients (55%) were nasal carriers: 11 initially and 28 during follow-up. Among the mupirocin-treated patients, the eradication of S. aureus nasal carriage rate was 88.5%. Nasal recurrence was documented in 17 patients (43.5%), and S. aureus nasal strains were available for molecular typing in 14 patients with a total of 23 recurrence episodes. On the basis of pulsed-field gel electrophoresis analysis, 16 (70%) recurrence episodes were considered relapses and seven were considered (30%) recolonizations. Among the episodes of relapse, prior cutaneous colonization was detected in only three cases. In haemodialysis patients, the majority of nasal carriage recurrences after mupirocin therapy were due to relapses. Cutaneous colonization does not appear to be relevant in the development of these relapses.

Investigation of nasal disease in the cat--a retrospective study of 77 cases

A retrospective study was undertaken to determine the prevalence of different diseases in cats referred for investigation of chronic nasal disease, to identify historical, clinical and diagnostic features which may assist in making a diagnosis, and to provide information pertaining to outcome in these cats. Diagnoses included neoplasia (30 cases), chronic rhinitis (27), foreign body (8), nasopharyngeal stenosis (5), Actinomyces infection (2), nasal polyps (2), stenotic nares (2), and rhinitis subsequent to trauma (1). The most common neoplasia was lymphosarcoma (21 cases), with a median survival of 98 days for cats treated with multiagent chemotherapy. Cats with neoplasia were older on average than the other cats, and were more likely to be dyspnoeic and have a haemorrhagic and/or unilateral nasal discharge than cats with chronic rhinitis. Cats with neoplasia were more likely to have radiographic evidence of nasal turbinate destruction, septal changes, or severe increases in soft tissue density than cats with chronic rhinitis. It was unusual for cats with diseases other than neoplasia to be euthanased as a result of their nasal disease.

Radiographic signs in cats with nasal disease

Radiographic signs in 64 cats that had radiography as part of the diagnostic work-up for suspected nasal disease were reviewed in a blinded fashion. Final diagnoses in these cats were rhinitis in 27, primary nasal neoplasia in 21 and non-nasal disease in 16. The signs with highest predictive value for nasal neoplasia were displacement of midline structures (73%), unilateral generalised soft tissue opacity (70%), unilateral generalised loss of turbinate detail (69%) and evidence of bone invasion (64%). The only radiographic finding that occurred more frequently in cats with rhinitis was a nasal cavity within normal limits, and the predictive value of this sign was only 38%. Radiographic signs in cats with nasal neoplasia are similar to those reported in dogs, whereas the radiographic signs in cats with rhinitis are variable and non-specific, and may be absent.

Influence of heavy traffic, city dwelling and socio-economic status on nasal symptoms assessed in a postal population survey

BACKGROUND

The association between social position, living environment and nasal symptoms is inconsistent. We wanted to test how living environment, occupation and social position were associated with nasal symptoms.

METHODS

In a postal survey study of a random sample of 12,079 adults, aged 20-59 years living in the southern part of Sweden the relationship between nasal symptoms, socio-economic status and environmental factors was analysed.

RESULTS

The response rate was 70% (n = 8469) of whom 33% reported significant nasal symptoms. Nasal discharge, thick yellow discharge, a blocked nose, sneezing and itching were strongly associated with living close to heavy traffic or living in cities. Most of the nasal symptoms provoked by extrinsic factors were more frequently reported among subjects who lived close to heavy traffic and in cities. Apart from thick yellow discharge and nasal symptoms provoked by damp/cold air which were more common in the socio-economic position "low" no relation to the socio-economic group was found. The prevalence of self-reported hay fever was neither affected by site of living nor by socio-economic status. Nasal symptoms evoked by "allergic" factors were linked to asthma but symptoms evoked by non-allergic factors were linked to chronic bronchitis/emphysema CBE.

CONCLUSIONS

To conclude, we found a strong relation between geographical site and the prevalence of self-reported nasal symptoms which emphasizes the environment as a risk factor for nasal symptoms. Only by merging the socio-economic groups into "low" and "middle/high" an association to nasal symptoms was apparent. Nasal symptoms evoked by "allergic" factors were linked to asthma but symptoms evoked by "non allergic factors" were linked to CBE.

The correlation between septal deviation and concha bullosa

OBJECTIVES

To investigate the incidence of concha bullosa (CB) in patients with septal deviation and the correlation between the angle of deviation and degree of pneumatization. Study and design This study was designed as a prospective trial.

METHODS

Computerized tomography scans of the paranasal sinuses of 100 consecutive patients with the chief complaint of nasal obstruction and the diagnosis of septal deviation were taken. CB, sinus diseases, and septal deviation angles were recorded.

RESULTS

Angles of deviation ranged between 3 and 25 degrees (mean, 13.0 +/- 4.1 degrees). The mean of angle of deviation in cases with CB and in cases without CB was 13.0 +/- 4.0 and 13.0 +/- 4.2 degrees, respectively. No statistical difference was found between them (P > 0.05). Pneumatization of the contralateral CB was statistically significantly higher than that of ipsilateral CB (P < 0.05).

CONCLUSION

Septal deviation does not appear to give rise to the formation of CB, but augments the pneumatization of the middle turbinate depending on the degree of deviation angle.

[Oto-rhino-laryngology and geriatrics in the Ivory Coast]

Geriatrics medicine develops more and more as a specialized branch of medicine. We report a prospective study of 69 cases of geriatric patients hospitalized in the ENT department of Treichville's teaching hospital from 1996 till 2001. The frequency of hospitalization was estimated at 6.5%. The cohort consisted of 48 males (69.5%) and 21 females (30.5%) with an overall average age of 66.5 years. The majority of the patients lived in the city of Abidjan (61%) with a low socio-economic level (54%). 50.7% were married and 75.4% lived in a house-bold of several persons. The main lesions were at the level of the larynx (36.2%) and nose and sinuses (21.7%) cancers (52%) were more frequent. The patients were little dependent (84%), however 11.6% presented with psychological troubles. Associated pathologies were identified in 18.8% of case. The age, dependence and pathology determined the average duration of stay and the mode of exit. Mortality, of tumoral cause (cancer of the larynx), was estimated at 11.6%. An improved service requires a mutli-disciplinary approach an ORL-based presentative programme and prospective multicentre studies.

Ocular, nasal, dermal and general symptoms among commercial airline crews

OBJECTIVE

To study symptoms among a commercial cabin crew, in relation to personal risk factors, perceived psychosocial work environment, occupation, and work on intercontinental flights, with exposure to environmental tobacco smoke (ETS).

METHODS

A standardized questionnaire (MM 040 NA) was mailed in February-March 1997 to all Stockholm aircrew on duty in a Scandinavian flight company ( n=1,857), and office workers from the same company ( n=218). During this time, smoking was allowed only on intercontinental flights. The participation rate was 81% ( n=1,513) of the aircrew, and 77% ( n=168) of the office group. Statistical analysis was performed by multiple logistic regression analysis, keeping age, gender, atopy, current smoking, occupation, and perceived psychosocial work conditions simultaneously in the model.

RESULTS

The most common symptoms among the aircrew were fatigue (21%), nasal symptoms (15%), ocular symptoms (11%), dry or flushed facial skin (12%), and dermal hand symptoms (12%). The aircrew had more nasal (odds ratio (OR) = 3.12), throat (OR=5.75), and dermal symptoms on the face (OR=2.03), and hands (OR=3.68), than the office workers. The aircrew with a history of atopy had an increase of most symptoms (OR=1.5-3.8), but age, gender, or smoking was not associated with symptoms. Perceived stress due to excess of work was associated with fatigue (OR=7.33), feeling heavy-headed (OR=9.52), headache (OR=5.10), and facial dermal symptoms (OR=3.75), while those crew with better work control and work satisfaction had less fatigue. For most symptoms, there were no differences between different categories onboard, but pilots had fewer ocular (OR=0.28) nasal (OR=0.52), and dermal hand symptoms (OR=0.39). Airline crew that had been on an intercontinental flight the previous week had more complaints of fatigue (OR=1.87), heavy-headedness (OR=1.89), and difficulties concentrating (OR=3.22).

CONCLUSION

There was an association between symptoms and work stress, lack of influence on working conditions, atopy, and work on intercontinental flights where smoking was allowed. In view of the increase of civil aviation, the working conditions for aircrews need further attention.

A long-term study of 277 cases of equine sinonasal disease. Part 1: details of horses, historical, clinical and ancillary diagnostic findings

The clinical and ancillary diagnostic findings in equine sinnasal disease were studied. The diagnoses in 277 referred (1984-1996) cases of equine sinonasal disease included the following (% all cases): 67 cases (24.2%) primary sinusitis, 61 (22.0%) dental sinusitis, 37 (13.4%) sinus cysts, 22 (7.9%) sinonasal neoplasia, 21 (7.6%) progressive ethmoid haematoma, 17 (6.1%) sinonasal trauma, 13 (4.7%) sinonasal mycosis, 11 (4.0%) rostral maxillary cheek tooth infection, 7 (2.5%) sinonasal polyps, 7 (2.5%) cases of nasal epidermal inclusion cysts and 14 (5.1%) miscellaneous sinonasal disorders. Many disorders showed similar clinical signs including nasal discharge (present in 88% of all cases) and facial swelling (46%). Most disorders were chronic, with a median duration of signs of 12 weeks (range 3 days- 6 years) prior to referral. Sinus cysts and sinonasal neoplasia were significantly (P<0.05) more frequently associated with gross distortion of the nasal passages and facial bones than the other sinonasal disorders. Endoscopic changes were detected per nasum in 91% of cases, but contributed to the exact diagnosis in only 20%. Radiography revealed abnormalities in 81% of cases but was diagnostically useful in only 36%. Sinoscopy was diagnostically useful in 70% of the 61 cases where used.

[Human nasal myiasis due to Oestrus ovis]

One case of human nasal myiasis caused by second and third instar larvae of Oestrus ovis was observed in Lille (North France). Oestrosis is a common myiasis of sheep and goats in Mediterranean and Tropical countries. The authors examine the oestrosis pathogenesis in the usual host (sheep) or in humans, and analyse the epidemiology, the symptomatology and the treatment of human oestrosis.

Nasal, eye, and skin irritation in dockyard painters

OBJECTIVES

To determine whether the risk of irritant symptoms in painters is related to their exposure to paint.

METHODS

The prevalences of skin, eye and nasal symptoms were compared in 260 United Kingdom and 109 Chinese dockyard painters, 539 British community controls, and 255 Chinese dockyard controls, relative to their exposure to paints.

RESULTS

Painters showed an excess of irritant symptoms compared with controls. Adjusted relative risks (RRs) (95% confidence interval (95% CI) were: for skin irritation 1.58 (1.19 to 2.08) in British painters and 2.68 (1.73 to 4.09) in Chinese painters; for eye irritation, 1.41 (0.98 to 2.05) and 3.01 (1.90 to 4.76); and for nasal irritation, 1.53 (1.10 to 2.14) and 6.73 (3.53 to 12.82), respectively. Exposure duration-response relations were found for these symptoms; the risks decreased with time after exposure ended.

CONCLUSIONS

Irritant symptoms occur more often in dockyard painters than in controls, and this is likely to be a response to exposure to paint.

Prevalence of Pneumonyssoides caninum infection in dogs in Sweden

A prospective study of 474 dogs, 145 cats, and 66 wild red foxes submitted for necropsy to the Departments of Pathology at the National Veterinary Institute and the Swedish University of Agricultural Sciences, Uppsala, Sweden, was conducted to examine for the presence of Pneumonyssoides caninum, the canine nasal mite. Pneumonyssoides caninum (P. caninum) was found in 95 (20%) of the dogs but in none of the cats or foxes. The median number of P. caninum mites per infected dog was 13 (range, 1 to 250). Dogs older than 3 years of age were more often infected with P. caninum than younger dogs, and large-breed dogs were more often infected than small-breed dogs. No sex predisposition was found.

Laryngeal and nasal involvement in pemphigus vulgaris

BACKGROUND

The presence of lesions of pemphigus vulgaris in the larynx and nasal cavity has been reported in individual case reports. However, the frequency with which these sites are involved is not known.

OBJECTIVE

Our purpose was to investigate the incidence of laryngeal and nasal disease involvement in patients with pemphigus vulgaris.

METHODS

This was a retrospective analysis conducted in a referral private practice in an academic department of dermatology. A total of 53 sequential patients with pemphigus vulgaris diagnosed by clinical, histologic, and immunofluorescence criteria were selected on the basis of having been treated by one of us (J. C. B.) during most of their illness. Patients' charts were reviewed for documentation of laryngeal and nasal symptoms, ear/nose/throat evaluation, and response to treatment.

RESULTS

Twenty-six (49%) of the patients complained of laryngeal or nasal symptoms at some time during the course of their disease. Twenty-one patients had laryngeal symptoms and 12 had nasal symptoms. More than 80% of patients with laryngeal or nasal symptoms had evidence of pemphigus involvement based on ear/nose/throat examination or rapid response to increased doses of corticosteroids, and 2 patients had candidiasis confirmed by fungal culture.

CONCLUSION

These observations indicate that laryngeal and nasal symptoms are common in pemphigus vulgaris. In the majority of cases, this appears to be a result of involvement with the disease or with candidiasis.