[Evaluation of the carriage of Staphylococcus aureus in patients and the personnel of a hemodialysis center for the prevention of infections]

With the aim of improving the prevention of Staphylococcus aureus infections in hemodialysis patients, an evaluation of S. aureus nasal carriage was carried out at the hemodialysis center of CHU-Rouen between the 1st of January, 1991 and the 30th of June, 1991. The S. aureus strains were classified according to their antibiotypes, serotypes and lysotypes. The carriage rate appears to be similar to that of the general population but inferior to what has been previously reported in hemodialysis centers. We report our findings on nasal carriage strains. The risk of infection is low. The standards of hygiene, adopted by hospital personnel, seem to be effective although cross colonization may have possibly occurred. Taking into account the different epidemiologic circumstances encountered in each hemodialysis center it is, therefore, necessary to determine the rate of carriage and identify the personnel at risk (persistent carriers, patients with a previous history of S. aureus septicemia, meti-R strains) in order to implement prophylaxis accordingly to epidemic characteristics of each center.

Blastomycosis in otolaryngology: review of a large series

Blastomycosis is a fungal disease whose signs, symptoms, and roentgenographic findings may suggest pneumonia, cancer, tuberculosis, or other fungal infections. Blastomycosis has a variable clinical course; it primarily affects the lower respiratory tract, although extrapulmonary manifestations are common. To determine the frequency of head and neck manifestations, we reviewed the records of patients with blastomycosis seen at the Mayo Clinic from 1960 to 1990 and found that involvement of the skin and mucosal surfaces, including the larynx, was common. Gross and histopathologic features of the lesions often resemble those of well-differentiated squamous cell carcinoma; thus, overly aggressive therapy may be mistakenly instituted. The clinical features, morphologic findings, and diagnosis of blastomycosis are discussed, and the importance of obtaining and handling specimens correctly is emphasized.

Five cases of mucormycosis in paranasal sinuses

Five cases of mucormycosis are reported, 2 of them suffered from immunosuppression, the other 3 did not. We conclude that a combination of CT and bacteriological findings is useful for the diagnosis of mucormycosis differentially from other diseases. Therapy consisted of paranasal debridement and administration of amphotericin B.

Treatment of canine nasal aspergillosis with enilconazole

Twenty-four dogs with nasal aspergillosis were treated with enilconazole (10 mg/kg bid for 7-14 days) administered topically through tubes surgically implanted into the nasal chambers. Aspergillosis was eliminated in 19 dogs over a median follow-up period of 18 months. Another dog died, but at necropsy there was no evidence of causative fungus. Two of the four dogs that were not cured had infection of periorbital soft tissues. An additional seven dogs received 6 weeks ketoconazole (5 mg/kg bid PO) and enilconazole therapy topically. Six of these dogs were disease-free over a median follow-up period of 35 months. The seventh dog responded to repeated treatment with enilconazole. Twenty-six of the 29 dogs (90%) without extranasal aspergillosis were cured.

Invasive aspergilloma of the skull base

Aspergillus infection originating in the nasal cavity or paranasal sinuses is a rare cause of benign, locally invasive disease affecting the skull base. We describe a case in which extensive disease led to bilateral proptosis and invasion of the anterior cranial fossa.

[Invasive nasosinusal aspergillosis in an immunocompetent patient]

The authors describe a case of invasive nasosinusal aspergillosis in an immunocompetent patient. After a careful bibliographic review, they emphasize that in the present case the diagnosis was made by means of fungal culture as the clinical picture, imaging techniques and histopathological findings were aspecific. The pathogenetic agent resulted Aspergillus tamarii which belongs to the Aspergillus flavus group and is one of the most unusual agents in literature. The treatment of choice, in the invasive form, is surgery that should be as radical as possible followed by a medical therapy. In the present case, after two-phase radical surgery on all the paranasal sinuses, medical treatment with traconazole was employed with excellent local results at a follow-up of one year.

[Rhinofacial entomophthoromycosis due to Conidiobolus coronatus. A report of a case treated successfully with fluconazole]

A case of rhinofacial entomophthoromycosis caused by Conidiobolus coronatus is reported in a 30-years-old male from São Paulo, Brazil. The patient was successfully treated with oral fluconazole in a prolonged regimen. The diagnosis was confirmed by histopathological and mycological data.

Efficacy and safety of cefotiam hexetil in the treatment of ear, nose and throat infections

In 60 patients suffering from acute ear, nose and throat infections the efficacy and safety of cefotiam hexetil (SCE-2174, CAS 61622-34-2) which is a pro-drug of cefotiam was studied. The clinical success rate (improvement/cure) achieved with a daily administration of 600 mg was 90%. In 63% of the cases being evaluable for bacteriological response an eradication of the causative pathogens at the end of the treatment period was found. The majority of the patients tolerated well the compound. Side effects which were possibly, likely or definitely related to the treatment were observed in 12 patients. In 7 of these patients the treatment had to be stopped due to side effects which is equivalent to an intolerance rate of 12%. The data obtained in the present study indicate that cefotiam hexetil is a potent drug for the treatment of acute and acute on top of chronic infections of the upper aerodigestive tract.

Rhinosporidiosis

Rhinosporidiosis is the disease resulting from infection by Rhinosporidium seeberi, an organism endemic in the Indian sub-continent, but rarely seen in the United Kingdom. We describe the clinio-pathological features of a case presenting in a 14-year-old female.

Rhinocerebral and nasal zygomycosis in sheep caused by Conidiobolus incongruus

The clinical findings, pathology and mycology of a cluster of 5 ovine cases of rhinocerebral and nasal zygomycosis caused by Conidiobolus incongruus are described. All cases were in Border Leicester or Merino x Border Leicester ewes from a flock pastured in a low-lying paddock adjoining a small tidal river in subtropical Queensland (latitude 28 degrees S). These cases of zygomycosis are believed to be the first infections due to C incongruus recorded in animals other than humans. The disease was subacute in 4 animals with a course of up to several weeks. In these, the primary site of infection was the posterior nasal cavity. The lesions extended to the dorsum of the face between the eyes, to the orbital cavity and to the anterior brain and meninges in the cranial cavity. In one animal, where the anterior nasal cavity was affected and iodine treatment used, the course was longer. The fungal granulomas had numerous foreign body giant cells, neutrophils and eosinophils. Fungal hyphae were thin walled, 6 to 8 microns in diameter, with occasional septa and irregular branching. They were cuffed with a wide zone of necrotic cell coagulum, or with homogeneous eosinophilic Splendore-Hoeppli granules.

Ocular invasion in mucormycosis

The histopathologic findings in a case of ocular invasion in rhinocerebral mucormycosis are described. The findings of hyphae in the inner sclera and marked involvement of the posterior ciliary arteries suggested an arterial route of ocular invasion by fungus. Only five other cases of rhinocerebral mucormycosis with ocular fungal invasion have been reported to our knowledge. All six patients died from the infection. As a group, these cases suggest that the presence of ocular infiltration by fungus may indicate poor prognosis in rhinocerebral mucormycosis.

Cytodiagnosis of rhinosporidiosis

Two clinically suspected cases of nasal rhinosporidiosis were studied cytologically using a wipe out technique. The smears showed the typical spores of the fungus and the cytological diagnosis of rhinosporidiosis was confirmed by excisional biopsy. The smear is recommended as a routine preliminary screening technique in the diagnosis of suspected cases of rhinosporidiosis.

MR imaging in rhinocerebral and intracranial mucormycosis with CT and pathologic correlation

Three cases of mucormycosis, two in diabetics and one in an intravenous drug abuse patient, are presented. Magnetic resonance imaging proved to be useful in all cases, as was computed tomography. In one case, extremely low signal was detected from the fungal mass. It is surmised that this appearance was a result of high concentrations of iron and manganese. The low-signal area simulated air in paranasal sinuses; however, CT displayed a mildly enhancing soft tissue mass and allowed the correct diagnosis to be made. In another patient, pontine infarction was demonstrated by MR. In the third case the MR findings of mucormycosis involving the basal ganglia are shown and correlated with CT. Subsequent imaging studies demonstrated reduction of the mass, corresponding to clinical improvement.

Rhinocerebral mucormycosis: an unusual case presentation

Rhinocerebral mucormycosis is a rapidly fatal fungal disease which involves the nose, paranasal sinuses, orbit and central nervous system. The fungal infection is usually secondary to immunosuppression, diabetic acidosis, or antibiotic, steroid or cytotoxic therapy. It can also occur in patients suffering from burns, malignancy and haematological disorders. Current treatment consists of correction of the underlying disorder, repeated debridement of the wound in combination with intravenous amphotericin B. This paper describes our experience with a case of rhinocerebral mucormycosis. This is an unusual case in which mucormycosis was seen in a young female where no underlying cause was found. She responded to surgical debridement in combination with intravenous amphotericin B.

Cryptococcosis in cats: clinical and mycological assessment of 29 cases and evaluation of treatment using orally administered fluconazole

Twenty-nine cats with naturally occurring cryptococcosis were evaluated prior to commencing oral fluconazole therapy (25-100 mg every 12 h). Affected cats ranged from 2 to 15 years-of-age. Male cats (19; 66%) and Siamese cats (5; 21%) appeared to be over-represented in comparison to the hospital's cat population. Mycotic rhinitis was observed in 24 (83%) of the cases, although nasal cavity involvement was subtle in four animals. Disease of the skin and subcutaneous tissues was present in 15 cases (52%) and amongst these the nasal plane (seven cats) and bridge of the nose (seven cats) were most commonly involved. Primary infection of the central nervous system was not encountered, although one cat developed meningoencephalitis and optic neuritis as a sequel to longstanding nasal cavity disease. Antibodies against the feline immunodeficiency virus (FIV) were detected in eight cats (28%), and these cats tended to have advanced and/or disseminated disease. There was a tendency for cats to develop cryptococcosis during the Australian summer. Organisms were cultured from 27 cases. Cryptococcus neoformans var. neoformans was isolated from 21 cats, while C. neoformans var. gattii was identified in the remaining six. The response to oral fluconazole was excellent in this series, which included many cats with advanced, longstanding or disseminated disease. The fungal infection resolved in all but one advanced case which died after only 4 days of therapy. A dose of 50 mg per cat, given every 12 h, produced a consistently good response without side effects. Lower doses were effective in some cases, while 100 mg every 12 h was required to control the infection in one cat. Serum fluconazole levels obtained during chronic dosing (50 +/- 18 mg l-1, mean +/- SD; 50 mg per cat every 12 h) were highly variable (range 15-80 mg l-1). Concurrent FIV infection did not impart an unfavourable prognosis, although affected cats often required prolonged courses of therapy.

Nasofacial zygomycosis

Zygomycosis is an uncommon polymorphic fungal disease. One clinical subtype, nasofacial zygomycosis, is caused by infectious exposure to the organism Conidiobolus coronatus. A case affecting the nose and lips of a 42-year-old Malay man is reported here. The clinicopathologic features and management of this disease are described, and its differential diagnosis is discussed.

Post-surgical nasal cellulitis outbreak due to Mycobacterium chelonae

An outbreak of post-rhinoplasty nasal cellulitis due to Mycobacterium chelonae in a secondary care centre is described. A case-control study demonstrated that the use of inadequately sterilized surgical equipment in the Otorhinolaryngology Department was a risk factor. The causal organism was cultured from the equipment, from the surface of the operating theatre lamp, adhesive tape and from two of the hospital's general water tanks. Introduction of effective instrument sterilization methods, monitored with biological controls, the use of new air filters and cleansing and disinfection of hospital water tanks, were sufficient to control the outbreak. The antimicrobial susceptibilities of the causal organism were consistently different from those previously reported in M. chelonae.

Nasal and retrobulbar mass in a cat caused by Pythium insidiosum

Nasal and retrobulbar infection caused by the Oomycete Pythium insidiosum is described in a cat. The diagnosis was established on three criteria. The staining of broad, sparsely septate hyphal elements in biopsy tissue using a fluorescein-labelled antiglobulin specific for P. insidiosum, detection of antibodies to P. insidiosum by an immunodiffusion test, and isolation of the aetiological agent in pure culture from the biopsy tissue. Treatment with ketoconazole for 6 weeks resulted in clinical improvement, but proptosis of the left eye slowly appeared after the discontinuation of treatment. This case represents a new host for P. insidiosum, namely, a domestic, shorthaired cat, from North Carolina, U.S.A.

[Phinocerebral mucormycosis--report of a case]

Rhinocerebral mucormycosis is a rare and fatal deep fungus infection occurring in debilitated patients. Its reports have been recently increased because of the increase of such conditions as uncontrolled diabetics, leukemia, and cancer. A 60-year-old male suffering from continuous headache and fever was diagnosed as meningitis, and repeated culture of cerebrospinal fluid was negative. Antibiotic therapy was ineffective. CT scan revealed brain abscess in the right frontal lobe and bone defect over the right posterior ethmoidal sinuses. Both maxillary and ethmoidal sinuses were operated on 38 years ago. The patient was suspected to have rhinologic brain abscess. We intended to remove the source of infection in the right posterior ethmoidal sinuses beneath the base of the skull and to repair the defect of dura mater. The operation was tried on the 6th hospital day. There was a cyst in the posterior ethmoidal sinuses and an intact denuded dura mater over the cyst. The causative organism was not detected by smear test, bacteriological and fungal culture. He relapsed into lethargy, and died on the 21st hospital day due to the vast cerebral infarction. Autopsy revealed rhinocerebral mucormycosis. The literature on this disease was also reviewed and discussed.

[A case of entomophthoromycosis caused by Conidiobolus coronatus]

The authors report a case of entomophthoromicosis caused by Conidiobolus coronatus, a saprophytic fungus that belongs to the class Zygomycetes (Phycomycetes in the past). Our patient was from a rural area. The paranasal sinuses had been drained surgically and a polyp was removed from his nasal cavity. He had a deformity in the face and nasal obstruction. His general condition and immunological status were normal except for epistaxis since childhood. The diagnosis was made clinically by the appearance of the lesion and confirmed by the mycological and histopathological findings. The therapeutic response was slow but with total resolution of the lesion.