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Tatouli I, Dedes N, Bozikas A, Melliou S, Pavlou MM, Kontogiannis S, Kyrodimos E, Kanioura E, Ntanasis-Stathopoulos I, Dimopoulos MA, Dimopoulos G, Kastritis E, Gavriatopoulou M. Necrotizing Laryngitis in Patients with Hematologic Disease: The First Case-Report Due to PDR Acinetobacter baumannii and Literature Review. Microorganisms 2024; 12:1382. [PMID: 39065149 PMCID: PMC11279041 DOI: 10.3390/microorganisms12071382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Immunocompromised patients with hematologic diseases may experience life-threatening infections with rather uncommon manifestations. Laryngitis has been described as a potential infection in such vulnerable patients and may result in major complications, ranging from impending airway obstruction to total laryngeal necrosis. Immediate laryngoscopy is of paramount importance, as it provides quantification of laryngeal edema and evidence of necrosis. Documentation of the causative pathogen is usually feasible through tissue culture. In the literature, 14 cases of necrotizing laryngitis have already been published. Here, we present the case of a 38-year-old male with a recent diagnosis of multiple myeloma, who received the first cycle of therapy a few days before admission. The patient presented with neutropenic fever, diarrhea, and multiple organ dysfunction. His course was complicated with hemophagocytic lymphohistiocytosis and stridor. A diagnosis of necrotizing laryngitis attributed to Acinetobacter baumannii invasion of the larynx was established. This manuscript highlights that the management of patients with hematologic disease and necrotizing laryngitis should be coordinated in highly specialized centers and clinicians should have a high level of clinical suspicion and act promptly.
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Affiliation(s)
- Ioanna Tatouli
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Nikolaos Dedes
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Andreas Bozikas
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Stamatoula Melliou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Maria-Markella Pavlou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Sofoklis Kontogiannis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Efthymios Kyrodimos
- First Department of Otolaryngology, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.)
| | - Eftychia Kanioura
- First Department of Otolaryngology, Hippocration General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.)
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - George Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.T.); (A.B.); (S.M.); (M.-M.P.); (S.K.); (M.-A.D.); (G.D.); (E.K.)
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2
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Ahmed O, Wahba B, Nissanka-Jayasuriya E, Dhar V, Theokli C. Spindle Cell Carcinoma of the Larynx with Tracheobronchial Aspergillosis: A Rare Coincidence. Indian J Otolaryngol Head Neck Surg 2022; 74:4891-4894. [PMID: 36742790 PMCID: PMC9895263 DOI: 10.1007/s12070-021-02399-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/12/2021] [Indexed: 02/07/2023] Open
Abstract
We herein report a rare coincidence and a possible association between laryngotracheal fungal infection and spindle cell carcinoma of the larynx (SpCC). A 79-year-old gentleman presented to the Emergency Department with manifestations of airway obstruction. Flexible nasendoscopy showed pooling of saliva around the larynx and his neck palpation did not show cervical lymphadenopathy. Further imaging showed bilateral transglottic mass mainly in the subglottis along with right pulmonary nodularity. Percutaneous tracheostomy, panendoscopy and biopsy of the laryngeal mass confirmed a diagnosis of SpCC. A few days later, he was admitted and aspergillus fumigatus was found in a biopsy of his tracheal tissue. To the best of our knowledge, the possible correlation between laryngotracheal aspergillosis and such a rare type of cancer larynx (SpCC) has not been highlighted in the literature.
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Affiliation(s)
- Omar Ahmed
- East Kent Hospitals University NHS Foundation Trust, Aldington, TN257GQ UK
| | - Basim Wahba
- East Kent Hospitals University NHS Foundation Trust, Aldington, TN257GQ UK
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Cairo, Giza, Egypt
| | | | - Vikram Dhar
- East Kent Hospitals University NHS Foundation Trust, Aldington, TN257GQ UK
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3
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Villemure-Poliquin N, Chénard-Roy J, Lachance S, Leclerc JE, Lemaire-Lambert A. Necrotizing epiglottitis with necrotizing fasciitis in a child: A case report and review of literature. Int J Pediatr Otorhinolaryngol 2020; 138:110385. [PMID: 33152976 DOI: 10.1016/j.ijporl.2020.110385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 11/15/2022]
Abstract
Necrotizing epiglottitis (NE) is a rare but extremely serious variant of acute bacterial epiglottitis. So far, it has been reported mostly in immunocompromised adults and only seldomly in the pediatric population. We describe the case of a 15-month-old immunocompetent child who presented to our tertiary referral center with necrotizing epiglottitis. This manuscript emphasizes the need for rapid recognition and surgical management of this unusual condition, as well as the importance of laryngeal preservation when facing overwhelming necrosis around the laryngeal cartilaginous framework. A review of the literature using MEDLINE, Embase and Web of Science databases was performed to discuss the epidemiology, bacteriology, treatment and prognosis of NE.
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Affiliation(s)
- Noémie Villemure-Poliquin
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, Quebec, Canada.
| | - Jade Chénard-Roy
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, Quebec, Canada
| | - Sophie Lachance
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, Quebec, Canada
| | - Jacques E Leclerc
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, Quebec, Canada
| | - Anthony Lemaire-Lambert
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, Quebec, Canada
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4
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Richardson C, Muthukrishnan PT, Hamill C, Krishnan V, Johnson F. Necrotizing epiglottitis treated with early surgical debridement: A case report. Am J Otolaryngol 2018; 39:785-787. [PMID: 30064927 DOI: 10.1016/j.amjoto.2018.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 07/24/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Necrotizing supraglottitis is a rare but potentially morbid infection most often seen in immunocompromised patients. All reported cases have utilized intravenous antibiotic therapy as the mainstay of treatment and many have had associated morbidities. METHODS We describe a case of a 50-year-old previously healthy female who presented with necrotizing epiglottis and was treated with immediate surgical debridement followed by directed antibiotic therapy. RESULTS Our patient rapidly recovered with no further invasive interventions. On follow up she had no further complications or functional deficits. CONCLUSIONS Although uncommon, providers should be aware of the potential benefits of early debridement when treating patients with similar pathology. Early surgical intervention should be considered to avoid local tissue loss, airway interventions, and long-term sequelae.
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Affiliation(s)
- Clare Richardson
- Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center - Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, United States of America.
| | - Prashanth Thalanayar Muthukrishnan
- Department of Pulmonary and Critical Care Medicine, MetroHealth Medical Center, 2500 Metrohealth Dr, Cleveland, OH 44109, United States of America.
| | - Chelsea Hamill
- Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center - Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, United States of America.
| | - Vidya Krishnan
- Department of Pulmonary and Critical Care Medicine, MetroHealth Medical Center, 2500 Metrohealth Dr, Cleveland, OH 44109, United States of America.
| | - Freedom Johnson
- Department of Otolaryngology, MetroHealth Medical Center, 2500 Metrohealth Dr, Cleveland, OH 44109, United States of America.
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5
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Wisniowski-Yáñez A, Ramírez-Anguiano J, Rosado-Canto R, Valdivia-Cayoja A, Pérez-Gutiérrez T, Cuellar-Rodriguez J. Aspergillus infection of the larynx in a solid organ transplant recipient. Transpl Infect Dis 2018; 20:e12900. [PMID: 29668122 DOI: 10.1111/tid.12900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/28/2018] [Accepted: 03/17/2018] [Indexed: 11/27/2022]
Abstract
Primary laryngeal aspergillosis is a rare condition. Only a few cases have been reported in the past years. Most of them have been reported in healthy patients or with a mild immunocompromised state. We report a case of primary laryngeal aspergillosis in a solid organ transplant recipient (SOT), an infection not previously described in this population; we reviewed the published literature in all populations.
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Affiliation(s)
- Andrea Wisniowski-Yáñez
- Department of Infectious Diseases, Mineral Metabolism and Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jaqueline Ramírez-Anguiano
- Department of Otorhinolaryngology, Mineral Metabolism and Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rodrigo Rosado-Canto
- Department of Nephrology, Mineral Metabolism and Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Adolfo Valdivia-Cayoja
- Department of Infectious Diseases, Mineral Metabolism and Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Teresa Pérez-Gutiérrez
- Department of Infectious Diseases, Mineral Metabolism and Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jennifer Cuellar-Rodriguez
- Department of Infectious Diseases, Mineral Metabolism and Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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6
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Chen C, Natarajan M, Bianchi D, Aue G, Powers JH. Acute Epiglottitis in the Immunocompromised Host: Case Report and Review of the Literature. Open Forum Infect Dis 2018; 5:ofy038. [PMID: 29564363 PMCID: PMC5846294 DOI: 10.1093/ofid/ofy038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/14/2018] [Indexed: 11/14/2022] Open
Abstract
We present a case of acute epiglottitis in a 16-year-old with severe aplastic anemia. He was admitted with a history suggestive of a severe upper airway infection and an absolute neutrophil count of 0 per cubic millimeter. Despite his immunocompromised state, he presented with the classical signs and symptoms of epiglottitis. We review here the presentation and comorbidities of immunocompromised patients with epiglottitis. In addition, the appropriate choice of empirical antibiotic therapy is important for the management of epiglottitis in immunocompromised patients, especially in the post-Haemophilus influenza type B vaccination era. In our patient, Enterobacter cloacae was isolated from endoscopically directed throat cultures, and treatment was successful without the need for intubation. The current literature suggests that in immunocompromised patients, particularly those who are neutropenic, there is a potentially wide range of organisms, both bacterial and fungal, that may play a role in the pathology of acute epiglottitis.
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Affiliation(s)
- Cheng Chen
- University of Cambridge, Cambridge, United Kingdom
| | - Mukil Natarajan
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - David Bianchi
- National Institute on Deafness and Communication Disorders, National Institutes of Health, Bethesda, Maryland
| | - Georg Aue
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - John H Powers
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, Maryl
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7
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Swiss T, Cervantes SS, Hinni M, Lott DG. Invasive fungal laryngopharyngitis resulting in laryngeal destruction with complete laryngotracheal separation: Report of a case. EAR, NOSE & THROAT JOURNAL 2017; 96:E33-E36. [PMID: 28122110 DOI: 10.1177/014556131709600105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As the treatment of hematopoietic cancers evolves, otolaryngologists will see a higher incidence of opportunistic infections. We discuss a case of invasive fungal disease that invaded the larynx, pharynx, trachea, and pulmonary parenchyma after chemotherapy. The patient, a 46-year-old woman, presented 1 week after undergoing induction chemotherapy. Her initial symptoms were odynophagia and dysphagia. Despite encouraging findings on physical examination, her health rapidly declined and she required an urgent tracheotomy and multiple operations to address spreading necrosis. Because of her inability to heal, she was not a candidate for laryngectomy, so she was treated with conservative management. The patient was then lost to follow-up, but she returned 5 months later with laryngeal destruction and a complete laryngotracheal separation. While noninvasive fungal laryngitis is routinely encountered, its invasive counterpart is rare. The literature demonstrates that some cases completely resolve with medical therapy alone but that surgery is necessary in others. We recommend surgical debridement of all necrotic tissue.
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Affiliation(s)
- Tyler Swiss
- Midwestern University-Arizona College of Osteopathic Medicine, 19555 N. 59th Ave., Glendale, AZ 85308, USA.
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8
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Sengör A, Willke A, Aydin O, Gündes S, Almaç A. Isolated Necrotizing Epiglottitis: Report of a Case in a Neutropenic Patient and Review of the Literature. Ann Otol Rhinol Laryngol 2016; 113:225-8. [PMID: 15053207 DOI: 10.1177/000348940411300311] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Isolated necrotizing epiglottitis (INE) is an unusual condition that may develop in immunocompromised patients. Only 3 cases of INE have been reported in the English-language literature; this is the fourth case, one in a 27-year-old woman who had neutropenia due to cytomegalovirus infection. Stenotrophomonas maltophilia and Candida albicans were isolated from the culture of necrotic material. The features of INE are discussed here by reviewing the literature and by examining the characteristics of this case.
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Affiliation(s)
- Atilla Sengör
- Department of Otorhinolaryngology-Head and Neck Surgery, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
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9
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Lake JA, Ehrhardt MJ, Suchi M, Chun RH, Willoughby RE. A Case of Necrotizing Epiglottitis Due to Nontoxigenic Corynebacterium diphtheriae. Pediatrics 2015; 136:e242-5. [PMID: 26055849 DOI: 10.1542/peds.2014-3157] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 11/24/2022] Open
Abstract
Diphtheria is a rare cause of infection in highly vaccinated populations and may not be recognized by modern clinicians. Infections by nontoxigenic Corynebacterium diphtheriae are emerging. We report the first case of necrotizing epiglottitis secondary to nontoxigenic C diphtheriae. A fully vaccinated child developed fever, poor oral intake, and sore throat and was found to have necrotizing epiglottitis. Necrotizing epiglottitis predominantly occurs in the immunocompromised host. Laboratory evaluation revealed pancytopenia, and bone marrow biopsy was diagnostic for acute lymphoblastic leukemia. Clinicians should be aware of aggressive infections that identify immunocompromised patients. This case highlights the features of a reemerging pathogen, C diphtheriae.
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Affiliation(s)
| | - Matthew J Ehrhardt
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
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10
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Durell J, Taha R, Pipi G, Oko M. Aspergillus epiglottitis in a non-immunocompromised patient. BMJ Case Rep 2011; 2011:2011/feb24_1/bcr1120103485. [PMID: 22707579 DOI: 10.1136/bcr.11.2010.3485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors present a case that highlights an atypical example of a fungal epiglottis in an otherwise well adult patient with no medical history of fungal infection or an immunocompromised state. As current medical literature presents this fungus as only manifesting in the immunocompromised, the authors suggest, by this case report, that fungal pathogens be considered as a potential cause of epiglottitis in non-immunocompromised patients.
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Affiliation(s)
- J Durell
- ENT SHO, Department of ENT, Pilgrim Hospital, Boston, UK.
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11
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Abstract
We report a case of an acute necrotizing supraglottitis in a healthy patient. Only seven cases of necrotizing epiglottitis/supraglottitis have been reported in medical literature; all in immunocompromised patients. The features and characteristics of necrotizing epiglottitis are discussed with review of all previously reported cases.
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Affiliation(s)
- J Klcova
- Royal Blackburn Hospital, Lancashire, UK
| | | | - P Morar
- Royal Blackburn Hospital, Lancashire, UK
| | - A Belloso
- Royal Blackburn Hospital, Lancashire, UK
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12
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Necrotizing epiglottitis in an infant: an unusual first presentation of human immunodeficiency virus infection. Pediatr Infect Dis J 2009; 28:164-6. [PMID: 19106777 DOI: 10.1097/inf.0b013e318187a869] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We describe the case of a 4-month-old infant presenting with severe respiratory distress secondary to necrotizing epiglottitis, who was subsequently diagnosed with human immunodeficiency virus infection. Additionally, we review the existing literature on this rare condition with a focus on the potential underlying pathogenesis.
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13
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Necrotizing epiglottitis and hemophagocytic lymphohistiocytosis. Int J Pediatr Otorhinolaryngol 2009; 73:119-25. [PMID: 19062109 DOI: 10.1016/j.ijporl.2008.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 09/05/2008] [Accepted: 09/09/2008] [Indexed: 11/20/2022]
Abstract
With the introduction of vaccination for haemophilus influenza, the epidemiology of epiglottitis in children has changed. Classic childhood epiglottitis is now rare, and unusual forms of the disease may be seen. Nectrotizing epiglottitis is an extremely rare form of epiglottitis. Only four cases of nectrotizing epiglottitis have been previously reported, and all cases were in immunocompromised adult patients. Hemophagocytic lymphohistiocytosis is a rare condition characterized by high fevers, hepatosplenomegaly, and cytopenias caused by an abnormal proliferation and activation of macrophages. We report the first case of a previously healthy 5-year-old male presenting with acute onset of airway distress and pancytopenia. Subsequent airway evaluation led to the diagnosis of nectrotizing epiglottitis, and he was simultaneously diagnosed with infection-induced hemophagocytic lymphohistiocytosis. The patient recovered with intubation and antibiotics. Follow-up direct laryngoscopy revealed an epiglottis remnant with approximately 50% loss of epiglottic tissue. The presentation and pathophysiology of this unusual manifestation of epiglottitis and hemophagocytic lymphohistiocytosis will be reviewed. In the post-haemophilus influenze vaccination era, the pediatric otolaryngologist must be familiar with unusual forms of epiglottitis and its associated manifestations.
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14
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Cullis JO, Hyde RD. Acute epiglottitis in immunocompromised patients--a report of two cases. CLINICAL AND LABORATORY HAEMATOLOGY 2008; 13:379-82. [PMID: 1773592 DOI: 10.1111/j.1365-2257.1991.tb00302.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J O Cullis
- Department of Haematology, Southampton General Hospital, Shirley
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15
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Abstract
We report an 8-year-old boy who developed a life-threatening acute epiglottitis during induction chemotherapy for acute promyelocytic leukemia. He survived the infection with emergency tracheostomy, treatment with broad spectrum antibiotics and amphotericin, and the use of granulocyte-macrophage colony stimulating factor. No organism was identified. A literature review identified 18 cases of acute epiglottitis in cancer patients. Sixteen of them were suffering from hematologic malignancies and three patients had received bone marrow transplantation. Unlike the usual case of epiglottitis, the majority (15 out of 18) of affected patients were adults and none of the infections was associated with Haemophilus influenzae. Streptococcus pneumoniae and Candida albicans were the most frequently identified pathogens. Early recognition and aggressive supportive care are required for successful management.
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Affiliation(s)
- Anselm C W Lee
- Department of Paediatrics, Tuen Mun Hospital, New Territories, Hong Kong, China.
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16
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Ogawa Y, Nishiyama N, Hagiwara A, Ami T, Fujita H, Yoshida T, Suzuki M. A case of laryngeal aspergillosis following radiation therapy. Auris Nasus Larynx 2002; 29:73-6. [PMID: 11772495 DOI: 10.1016/s0385-8146(01)00115-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Primary laryngeal aspergillosis is extremely rare. It is commonly seen as a part of a systemic infection involving the respiratory system in an immunocompromised host. Differential diagnosis is important, as the clinical symptoms are similar to those of malignant laryngeal disease. We describe a 73-year-old man with a history of hoarseness. He had a history of radiotherapy for laryngeal squamous cell carcinoma and had a history of diabetes. Direct laryngoscope and biopsy confirmed the diagnosis of aspergillus. We cauterized the lesion with a CO(2) laser. In the present case, irradiation seemed to have played a more important role in the onset of this disease rather than diabetes.
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Affiliation(s)
- Yasuo Ogawa
- Department of Otorhinolaryngology, Hachiouji Medical Center of Tokyo Medical University, 1163 Tate Hachiouji-shi, Tokyo 193-0944, Japan.
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17
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Kraus M, Gatot A, Leiberman A, Nash M, Fliss DM. Acute necrotizing epiglottitis resulting in necrotizing fasciitis of the neck and chest. Otolaryngol Head Neck Surg 2001; 124:700-1. [PMID: 11391269 DOI: 10.1177/019459980112400624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M Kraus
- Department of Otolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
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18
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Stevens DA, Kan VL, Judson MA, Morrison VA, Dummer S, Denning DW, Bennett JE, Walsh TJ, Patterson TF, Pankey GA. Practice guidelines for diseases caused by Aspergillus. Infectious Diseases Society of America. Clin Infect Dis 2000; 30:696-709. [PMID: 10770732 DOI: 10.1086/313756] [Citation(s) in RCA: 604] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/1999] [Indexed: 11/03/2022] Open
Abstract
Aspergillosis comprises a variety of manifestations of infection. These guidelines are directed to 3 principal entities: invasive aspergillosis, involving several organ systems (particularly pulmonary disease); pulmonary aspergilloma; and allergic bronchopulmonary aspergillosis. The recommendations are distilled in this summary, but the reader is encouraged to review the more extensive discussions in subsequent sections, which show the strength of the recommendations and the quality of the evidence, and the original publications cited in detail. Invasive aspergillosis. Because it is highly lethal in the immunocompromised host, even in the face of therapy, work-up must be prompt and aggressive, and therapy may need to be initiated upon suspicion of the diagnosis, without definitive proof (BIII). Intravenous therapy should be used initially in rapidly progressing disease (BIII). The largest therapeutic experience is with amphotericin B deoxycholate, which should be given at maximum tolerated doses (e.g., 1-1.5 mg/kg/d) and should be continued, despite modest increases in serum creatinine levels (BIII). Lipid formulations of amphotericin are indicated for the patient who has impaired renal function or who develops nephrotoxicity while receiving deoxycholate amphotericin (AII). Oral itraconazole is an alternative for patients who can take oral medication, are likely to be adherent, can be demonstrated (by serum level monitoring) to absorb the drug, and lack the potential for interaction with other drugs (BII). Oral itraconazole is attractive for continuing therapy in the patient who responds to initial iv therapy (CIII). Therapy should be prolonged beyond resolution of disease and reversible underlying predispositions (BIII). Adjunctive therapy (particularly surgery and combination chemotherapy, also immunotherapy), may be useful in certain situations (CIII). Aspergilloma. The optimal treatment strategy for aspergilloma is unknown. Therapy is predominantly directed at preventing life-threatening hemoptysis. Surgical removal of aspergilloma is definitive treatment, but because of significant morbidity and mortality it should be reserved for high-risk patients such as those with episodes of life-threatening hemoptysis, and considered for patients with underlying sarcoidosis, immunocompromised patients, and those with increasing Aspergillus-specific IgG titers (CIII). Surgical candidates would need to have adequate pulmonary function to undergo the operation. Bronchial artery embolization rarely produces a permanent success, but may be useful as a temporizing procedure in patients with life-threatening hemoptysis. Endobronchial and intracavitary instillation of antifungals or oral itraconazole may be useful for this condition. Since the majority of aspergillomas do not cause life-threatening hemoptysis, the morbidity and cost of treatment must be weighed against the clinical benefit. Allergic bronchopulmonary aspergillosis (APBA). Although no well-designed studies have been carried out, the available data support the use of corticosteroids for acute exacerbations of ABPA (AII). Neither the optimal corticosteroid dose nor the duration of therapy has been standardized, but limited data suggest the starting dose should be approximately 0.5 mg/kg/d of prednisone. The decision to taper corticosteroids should be made on an individual basis, depending on the clinical course (BIII). The available data suggest that clinical symptoms alone are inadequate to make such decisions, since significant lung damage may occur in asymptomatic patients. Increasing serum IgE levels, new or worsening infiltrate on chest radiograph, and worsening spirometry suggest that corticosteroids should be used (BII). Multiple asthmatic exacerbations in a patient with ABPA suggest that chronic corticosteroid therapy should be used (BIII). Itraconazole appears useful as a corticosteroid sparing agent (BII). (ABSTRACT TRUNCATED)
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Affiliation(s)
- D A Stevens
- Dept. of Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128-2699, USA.
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Abstract
Infections caused by Aspergillus species consist of many different disease presentations, ranging from relatively benign asthma in atopic disease to life-threatening systemic invasive infections. The spectrum of disease manifestations is determined by a combination of genetic predisposition, host immune system defects, and virulence of the Aspergillus species. For the purposes of this discussion, we will address three principal entities: invasive aspergillosis, both primary and disseminated, pulmonary aspergilloma, and allergic bronchopulmonary aspergillosis. Amphotericin B is the standard of treatment for severe Aspergillus infections, despite the fact that mortality in these patients remains high. Alternative therapies such as combination regimens and itraconazole also have efficacy against Aspergillus infections. We discuss the role of current therapies, the potential role of drugs in development, and the results of ongoing research with combination and immunotherapies. Copyright 2000 Harcourt Publishers Ltd.
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Affiliation(s)
- Tom M. Chiller
- Division of Infectious Diseases, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA
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Beust L, Godey B, Le Gall F, Grollier R, Le Clech G. Primary aspergillosis of the larynx and squamous cell carcinoma. Ann Otol Rhinol Laryngol 1998; 107:851-4. [PMID: 9794614 DOI: 10.1177/000348949810701007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary laryngeal aspergillosis is exceptionally rare, and only five cases have been reported in the literature. We present here two cases of invasive laryngeal aspergillosis without tracheobronchopulmonary extension and without any generalized immune deficit. Aspergillosis developed after local radiotherapy for a squamous cell carcinoma and preceded a recurrence of the tumor. The relationships between the clinical features, the histopathology, and the etiology of laryngeal aspergillosis and squamous cell carcinoma are discussed. We recommend that following treatment of laryngeal aspergillosis, these rare patients should systematically be investigated for a squamous cell carcinoma or a recurrence thereof.
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Affiliation(s)
- L Beust
- Department of Otolaryngology-Head and Neck Surgery, Rennes University Hospital, France
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Sriskandabalan P, Roy RB. Aspergillus infection of the epiglottis in a HIV positive patient. Genitourin Med 1996; 72:431-2. [PMID: 9038641 PMCID: PMC1195733 DOI: 10.1136/sti.72.6.431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
Acute epiglottitis has become a disease of adults, probably as a result of immunization of children against Haemophilus influenzae. This article is a review of the literature on epiglottitis, including signs and symptoms, investigation, differential diagnosis, and treatment in the emergency department. The microbiology is discussed and the importance of prophylaxis in exposed persons is stressed.
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Affiliation(s)
- M J Carey
- Veterans Affairs Medical Center, Seattle, WA 98144, USA
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Richardson BE, Morrison VA, Gapany M. Invasive Aspergillosis of the Larynx: Case Report and Review of the Literature. Otolaryngol Head Neck Surg 1996; 114:471-3. [PMID: 8649885 DOI: 10.1016/s0194-59989670221-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- B E Richardson
- Department of Otolaryngology, University of Minnesota, Minneapolis, USA
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Abstract
Primary infection of the larynx with Aspergillus spp. is rare. It is more commonly seen as part of a wider infection involving the respiratory system in an immunocompromised host. In noncompromised patients laryngeal aspergillosis may represent colonization rather than invasion requiring no systemic anti-fungal treatment. The diagnosis is important as the presenting symptoms are suggestive of malignant laryngeal disease. We present a 62-year-old man with a short history of hoarseness. Direct laryngoscopy and biopsy confirmed the diagnosis of aspergillosis. Clinical presentation, diagnosis and the important pathological characteristics of this infection are discussed.
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Goldsmith AJ, Schaeffer BT. Necrotizing epiglottitis in a patient with procainamide-induced neutropenia. Am J Otolaryngol 1994; 15:58-62. [PMID: 7510934 DOI: 10.1016/0196-0709(94)90042-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- A J Goldsmith
- Department of Otolaryngology and Communicative Disorders, Long Island Jewish Medical Center, New Hyde Park, NY
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Berlinger NT, Freeman TJ. Acute airway obstruction due to necrotizing tracheobronchial aspergillosis in immunocompromised patients: a new clinical entity. Ann Otol Rhinol Laryngol 1989; 98:718-20. [PMID: 2675730 DOI: 10.1177/000348948909800911] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Two immunocompromised patients with severe neutropenia developed acute airway obstruction due to Aspergillus mycetoma formation in the trachea and main bronchi. The mycetomas caused transmural necrosis of the airway. In one patient, the necrosis extended through the bronchus intermedius into the pulmonary artery, resulting in a fatal hemorrhage during bronchoscopy.
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Affiliation(s)
- N T Berlinger
- Department of Otolaryngology, University of Minnesota, Minneapolis
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