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Abstract
BACKGROUND Immunosuppressive therapy places pediatric patients at risk of developing life-threatening sinonasal infections. Diagnosis and treatment are challenging owing to nonspecific signs and symptoms. The aim of this study was to present our department's experience with the surgical management of acute rhinosinusitis in immunosuppressed children. METHODS The records of all children with a hematologic or oncologic disease who underwent endoscopic sinus surgery (ESS) for acute rhinosinusitis from January 2005 to May 2014 were reviewed. Data were retrospectively collected on demographics, clinical and imaging characteristics, microbiology, pathology, treatment and outcome. RESULTS Thirty-four-immunosuppressed children underwent ESS for acute rhinosinusitis. Most patients had a fungal infection. Nineteen patients died at the end of follow-up; 10 deaths were infection-related. Facial swelling was the only symptom that correlated with death of infection. Relapse of the underlying disease, bone marrow transplantation, and long duration of neutropenia correlated with infection-related mortality. Fungal infection, and specifically Aspergillus, correlated with death from infection. CONCLUSIONS ESS is a safe and efficient procedure for diagnosing and treating immunosuppressed pediatric patients with acute rhinosinusitis. Early detection and aggressive medical and surgical treatment, with control of underlying risk factors, are crucial to improve outcome.
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Brook I. The role of antibiotics in pediatric chronic rhinosinusitis. Laryngoscope Investig Otolaryngol 2017; 2:104-108. [PMID: 28894828 PMCID: PMC5527363 DOI: 10.1002/lio2.67] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/27/2016] [Accepted: 01/05/2017] [Indexed: 12/31/2022] Open
Abstract
Objectives Presenting the role of antibiotics in pediatric chronic rhinosinusitis based on its pathophysiology and microbiology. Data source Review of the literature searching PubMed for microbiology and treatment of pediatric chronic rhinosinusitis. Results Chronic rhinosinusitis (CRS) is an inflammatory condition of the paranasal sinuses that persists for 12 weeks or longer, despite medical management. The microbiology of rhinosinusitis evolves through several stages. The early phase (acute) is generally caused by a virus that may be followed by an aerobic bacterial infection in 2% to 10% of patients. Aerobic (Staphylococcus aureus) and anaerobic (Prevotella and Fusobacteria) members of the oral flora emerge as predominant sinus cavity isolates. Antimicrobials are one component of comprehensive medical and surgical management for this disorder. Because most of these infections are polymicrobial and many include beta‐lactamase producing aerobic and anaerobic organisms, amoxicillin‐clavulanate is the first‐line regimen for most patients. Clindamycin is adequate for penicillin‐allergic children and is also generally appropriate for methicillin resistant Staphylococcus aureus treatment is administered for at least three weeks and may be extended for up to 10 weeks in refractory cases. A culture preferably from the sinus cavity should be obtained from individuals who have not shown improvement or deteriorated despite therapy. Conclusions Antimicrobial therapy of pediatric chronic rhinosinusitis should be adequate against the potential aerobic and anaerobic pathogens. Level of Evidence 7.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics Georgetown University School of Medicine Washington D.C. U.S.A
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3
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Humphrey JM, Walsh TJ, Gulick RM. Invasive Aspergillus Sinusitis in Human Immunodeficiency Virus Infection: Case Report and Review of the Literature. Open Forum Infect Dis 2016; 3:ofw135. [PMID: 27800523 PMCID: PMC5084715 DOI: 10.1093/ofid/ofw135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/20/2016] [Indexed: 12/28/2022] Open
Abstract
Invasive Aspergillus (IA) sinusitis is a life-threatening opportunistic infection in immunocompromised individuals, but it is uncommon in human immunodeficiency virus (HIV) infection. To gain a better understanding of the characteristics of IA sinusitis in this population, we present a unique case of chronic IA sinusitis in an HIV-infected patient taking antiretroviral therapy and review the literature summarizing published cases of invasive aspergillosis of the paranasal (n = 41) and mastoid (n = 17) sinuses in HIV-infected individuals. Among these cases, only 4 were reported after 1999, and 98% of patients had acquired immune deficiency syndrome. Orbital invasion occurred in 54% of paranasal sinus cases, whereas intracranial invasion was reported in 53% of mastoid sinus cases. The overall mortality was 79%. We also discuss various clinical and immunologic factors that may play a role in the development of IA and consider the changing epidemiology of aspergillosis in the era of effective antiretroviral therapy.
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Affiliation(s)
- John M Humphrey
- Division of Infectious Diseases , Weill Cornell Medicine , New York, New York
| | - Thomas J Walsh
- Division of Infectious Diseases , Weill Cornell Medicine , New York, New York
| | - Roy M Gulick
- Division of Infectious Diseases , Weill Cornell Medicine , New York, New York
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Rhinosinusitis in Acute Leukemia Patients Undergoing Allogeneic Stem Cell Transplantation-A Single-Center Experience. Transplant Proc 2016; 48:1797-801. [PMID: 27496494 DOI: 10.1016/j.transproceed.2016.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/22/2016] [Accepted: 03/01/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although rhinosinusitis constitutes a major clinical problem in general population, data on rhinosinusitis in patients undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT) are scarce. Therefore, the aim of the study was to assess the frequency of rhinosinusitis, the impact of rhinosinusitis on post-alloHSCT outcome, and to analyze risk factors potentially predisposing to rhinosinusitis. METHODS Retrospective analysis of acute leukemia patients undergoing alloHSCT. RESULTS A total of 87 patients (49 male), with a median age of 36 years (range, 18-58), transplanted from 1999 to 2010, were enrolled; 61 patients suffered from acute myeloid leukemia (AML) and 26 of acute lymphoblastic leukemia (ALL). Fifteen patients (17.2%) experienced rhinosinusitis before transplantation, among whom 5 (33%) experienced rhinosinusitis after alloHSCT; 22 patients (25.3%), 12 AML and 10 ALL, experienced rhinosinusitis after alloHSCT. The median time to rhinosinusitis was 200 days (range, 1-2,044). 11 patients experienced rhinosinusitis during the 1st 100 days after transplantation, 8 during the 1st 30 days. Post-alloHSCT rhinosinusitis did not affect overall survival of transplant patients (P = .35). In univariate analysis only total body irradiation as part of conditioning (odds ratio [OR], 2.78; 95% CI, 1-7.77) and previous nasal packing (OR, 5.18; 95% CI, 1.22-23.43) were associated with higher incidence of rhinosinusitis. In multivariate analysis, none of the analyzed parameters was shown to have an impact on rhinosinusitis development. CONCLUSIONS Rhinosinusitis is a frequent medical condition in patients undergoing alloHSCT. The overall survival of patients developing rhinosinusitis after HSCT is similar to survival of patients who do not. No risk factors for developing rhinosinusitis could be identified.
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Park AH, Muntz HR, Smith ME, Afify Z, Pysher T, Pavia A. Pediatric Invasive Fungal Rhinosinusitis in Immunocompromised Children With Cancer. Otolaryngol Head Neck Surg 2016; 133:411-6. [PMID: 16143192 DOI: 10.1016/j.otohns.2005.04.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Accepted: 04/22/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES: 1) To determine the factors that predispose towards invasive fungal rhinosinusitis (FS) in immunocompromised children with cancer, and 2) to propose practice guidelines for management of pediatric FS in immunocompromised patients. METHODS: Retrospective chart review of 9 patients who developed invasive FS compared to 8 patients who did not develop invasive FS during the study period. Presenting signs and symptoms, nasal endoscopic findings, radiographs, laboratory studies, histologic and microscopic samples, and outcomes were compared. RESULTS: Seventeen consecutive pediatric immunocompromised patients with hematologic and lymphoid neoplasms underwent nasal endoscopy and biopsy for possible FS. Nine patients were diagnosed with 10 episodes of FS; 1 patient developed FS with different organisms on 2 separate occasions separated by 6 months; 8 patients were not diagnosed with FS. Eight patients had acute myelogenous leukemia (AML); 6 patients had acute lymphoblastic leukemia (ALL); 1 patient had Burkitt's lymphoma, 1 patient had undifferentiated leukemia; and 1 patient had biphenotypic acute leukemia. All patients with FS had an absolute neutrophil count (ANC) 600 or less (range 0-600). All patients with FS had either persistent fevers or sinus symptoms (facial pain, nasal congestion, rhinorrhea). Sinus CT scans were abnormal in all patients with FS and without FS. Two patients with FS had maxillary sinus retention cysts. Operative endoscopic findings were helpful diagnostically when necrosis or ulceration was found. All patients in the non-FS group normalized their ANCs; 2 of the 9 patients in the FS group did not normalize their ANC. These 2 patients died from disseminated FS or from complications due to their immunosuppression. CONCLUSION/SIGNIFICANCE: All patients with FS had either persistent fevers or symptoms localized to the sinuses (facial pain, nasal congestion, or rhinorrhea). Endoscopic examination was helpful when necrosis was detected. We recommend directed biopsies of suspicious lesions, the middle and inferior turbinate, in immunocompromised, neutropenic pediatric patients with cancer who present with either persistent fevers or localizing symptoms to the sinuses. We favor the use of “rush” biopsies over frozen sections because of the better-quality sections and ability to perform appropriate stains.
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Affiliation(s)
- Albert H Park
- Division of Otolaryngology--Head and Neck Surgery, University of Utah, Salt Lake City, 84132, USA.
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Drozd-Sokolowska JE, Sokolowski J, Wiktor-Jedrzejczak W, Niemczyk K. Sinusitis in patients undergoing allogeneic bone marrow transplantation - a review. Braz J Otorhinolaryngol 2016; 83:105-111. [PMID: 27184506 PMCID: PMC9444742 DOI: 10.1016/j.bjorl.2016.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 02/13/2016] [Accepted: 02/19/2016] [Indexed: 11/08/2022] Open
Abstract
Introduction Sinusitis is a common morbidity in general population, however little is known about its occurrence in severely immunocompromised patients undergoing allogeneic hematopoietic stem cell transplantation. Objective The aim of the study was to analyze the literature concerning sinusitis in patients undergoing allogeneic bone marrow transplantation. Methods An electronic database search was performed with the objective of identifying all original trials examining sinusitis in allogeneic hematopoietic stem cell transplant recipients. The search was limited to English-language publications. Results Twenty five studies, published between 1985 and 2015 were identified, none of them being a randomized clinical trial. They reported on 31–955 patients, discussing different issues i.e. value of pretransplant sinonasal evaluation and its impact on post-transplant morbidity and mortality, treatment, risk factors analysis. Conclusion Results from analyzed studies yielded inconsistent results. Nevertheless, some recommendations for good practice could be made. First, it seems advisable to screen all patients undergoing allogeneic hematopoietic stem cell transplantation with Computed Tomography (CT) prior to procedure. Second, patients with symptoms of sinusitis should be treated before hematopoietic stem cell transplantation (HSCT), preferably with conservative medical approach. Third, patients who have undergone hematopoietic stem cell transplantation should be monitored closely for sinusitis, especially in the early period after transplantation.
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Affiliation(s)
| | - Jacek Sokolowski
- The Medical University of Warsaw, Department of Otorhinolaryngology, Warsaw, Poland.
| | - Wieslaw Wiktor-Jedrzejczak
- The Medical University of Warsaw, Oncology and Internal Diseases, Department of Hematology, Warsaw, Poland
| | - Kazimierz Niemczyk
- The Medical University of Warsaw, Department of Otorhinolaryngology, Warsaw, Poland
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Pipolo C, Turati F, Cressoni P, Farronato G, Angiero F, Garagiola U, Di Pasquale D, Saibene AM, Lenzi R, Felisati G. Prevalence of sinonasal disease in children with Juvenile idiopathic arthritis. Laryngoscope 2014; 125:291-5. [PMID: 25125135 DOI: 10.1002/lary.24881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/04/2014] [Accepted: 07/21/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and is caused by a multitude of well-studied disorders. However, the association between JIA and/or its treatment and sinonasal inflammatory disease (SNID) has never been studied. We therefore investigated this relationship to gain more insight into burdening pathologies connected to JIA. STUDY DESIGN Retrospective evaluation. METHODS A retrospective evaluation according to the Lund-Mackay score of cone-beam computed tomography scans (CBCT) performed in 70 children affected by JIA and compared to CBCT scans of 124 healthy controls was conducted. The prevalence of sinonasal opacification and adenoid hypertrophy in patients affected with JIA was compared with findings obtained in unaffected children. RESULTS JIA was significantly associated with SNID (P = .030). Of patients with JIA, 18.6% had SNID, whereas in children without JIA, only 8.1% had SNID. The odds ratio values were 5.38 (95% confidence interval [CI]: 1.90-15.26) for treated and 0.92 (95% CI: 0.18-4.83) for untreated JIA. No clear difference was found depending on the duration of JIA. No association was found between adenoid hypertrophy and SNID (P = .816). CONCLUSIONS Our data suggest that JIA patients, especially when undergoing immunosuppressive therapy, should be subjected to an ear, nose, and throat evaluation. A prospective study including clinical evaluation would be of the utmost importance to provide evidence on which to base comprehensive healthcare for these patients. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Carlotta Pipolo
- Otorhinolaryngology Unit, Head and Neck Department, San Paolo Hospital, University of Milan, Milan, Italy; Department of Epidemiology, Institutes for Research, Hospitalization and Health Care-Mario Negri Institute for Pharmacological Research, Milan, Italy
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Patel ZM. Practice patterns regarding noninvasive rhinosinusitis in the immunosuppressed patient population. ALLERGY & RHINOLOGY 2014; 4:e151-4. [PMID: 24498520 PMCID: PMC3911804 DOI: 10.2500/ar.2013.4.0070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The number of immunosuppressed patients is growing remarkably. Currently, there is no guideline on how treatment of noninvasive sinusitis in these patients may differ from that of the general population, and practice patterns vary widely across the country. The purpose of this survey was to examine practice patterns and management for this patient population. A survey and literature review were performed. The survey was sent to the membership list serve of the American Rhinologic Society. Twelve questions were asked. Four demographic questions were asked about the physicians and their practices. Four questions were asked about the type of immunocompromised patients they saw. Two questions were asked about management in the setting of significant acute and chronic sinusitis. The responses were collected and analyzed using Pearson independent chi-square testing. Of 871 members on the list serve only 89 physicians responded. The majority of responders were sinus and skull base surgeons practicing in an academic setting. There was a large range of geographic location, years in practice, and patient population. Two significant findings related years in practice to management of chronic sinus immunocompromised patients (p = 0.012) and correlated the choice of management option in acute and chronic sinus immunocompromised patients (p = 0.006). There is no standardized method of treating the vulnerable patient population of immunocompromised patients with noninvasive acute and chronic sinusitis and this survey shows the wide range of practice. Clinical research is needed to standardize and optimize treatment for these patients.
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Affiliation(s)
- Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
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9
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Brook I. Amoxicillin-clavulante as the gold standard empirical therapy of acute bacteria rhinosinusitis. Expert Rev Anti Infect Ther 2013; 10:1367-9. [PMID: 23253313 DOI: 10.1586/eri.12.133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Abstract
Acute rhinosinusitis is a common illness in children. Viral upper respiratory tract infection is the most common presentation of rhinosinusitis. Most children resolve the infection spontaneously and only a small proportion develops a secondary bacterial infection. The proper choice of antibiotic therapy depends on the likely infecting pathogens, bacterial antibiotic resistance, and pharmacologic profiles of antibiotics. Amoxicillin-clavulanate is currently recommended as the empiric treatment in those requiring antimicrobial therapy. Isolation of the causative agents should be considered in those who failed the initial treatment. In addition to antibiotics, adjuvant therapies and surgery may be used in the management of acute bacterial rhinosinusitis.
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Tarkan O, Karagün B, Ozdemir S, Tuncer U, Sürmelioğlu O, Cekiç E, Kara K. Endonasal treatment of acute invasive fungal rhinosinusitis in immunocompromised pediatric hematology-oncology patients. Int J Pediatr Otorhinolaryngol 2012; 76:1458-64. [PMID: 22795740 DOI: 10.1016/j.ijporl.2012.06.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 05/30/2012] [Accepted: 06/03/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Acute invasive fungal rhinosinusitis (AIFR) is an aggressive fungal infection in immunocompromised patients with high mortality rates. The aim of this study is to present our experiences on endonasal treatment in immunocompromised pediatric hematology-oncology patients with AIFR. METHODS Thirteen pediatric hematology-oncology patients treated for AIFR between March 2006 and December 2011 were analyzed retrospectively. We reviewed the following data for all patients: age, gender, predisposing disease, initial symptoms, pathological diagnosis, microbiological results, laboratory findings, surgical procedure, number of operations and treatment outcomes. RESULTS Nine of 13 patients with lesions confined to sinonasal cavity were operated with endoscopic approach. Open surgery was performed in four patients, three of them had palatal and buccal lesions and one had facial skin involvement. Endoscopic approach was also used for sinonasal lesions of these four patients. A total of 7 patients died: 4 patients with progression of the underlying disease, 2 patients with sepsis and 1 patient due to renal failure. Survival rate in surgically treated patients was found 46% (6/13 patients). CONCLUSIONS Endonasal endoscopic approach is both feasible and efficient technique, also enables excellent local control with less morbidity compared to open surgery. This approach is suitable for patients who are diagnosed in the early stages of AIFR and also presents a less traumatic option for patients with poor health status. Open surgical procedure should be preferred in patients with disease extending out of the sinonasal cavity.
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Affiliation(s)
- Ozgür Tarkan
- Çukurova University, Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery, Adana 01330, Turkey.
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12
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Brook I. Anaerobic bacteria in upper respiratory tract and head and neck infections: microbiology and treatment. Anaerobe 2011; 18:214-20. [PMID: 22197951 DOI: 10.1016/j.anaerobe.2011.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 12/09/2011] [Accepted: 12/11/2011] [Indexed: 11/26/2022]
Abstract
Anaerobes are the predominant components of oropharyngeal mucous membranes bacterial flora, and are therefore a common cause of bacterial infections of endogenous origin of upper respiratory tract and head and neck. This review summarizes the aerobic and anaerobic microbiology and antimicrobials therapy of these infections. These include acute and chronic otitis media, mastoiditis and sinusitis, pharyngo-tonsillitis, peritonsillar, retropharyngeal and parapharyngeal abscesses, suppurative thyroiditis, cervical lymphadenitis, parotitis, siliadenitis, and deep neck infections including Lemierre Syndrome. The recovery from these infections depends on prompt and proper medical and when indicated also surgical management.
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Affiliation(s)
- Itzhak Brook
- Departments of Pediatrics and Medicine, Georgetown University School of Medicine, Washington, DC 20016, USA.
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Finkelstein A, Contreras D, Pardo J, Cruz JP, Gonzalez C, Constanza Beltrán M, Fonseca X. Paranasal sinuses computed tomography in the initial evaluation of patients with suspected invasive fungal rhinosinusitis. Eur Arch Otorhinolaryngol 2011; 268:1157-1162. [DOI: 10.1007/s00405-011-1561-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 02/25/2011] [Indexed: 11/24/2022]
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Affiliation(s)
- Itzhak Brook
- Georgetown University School of Medicine, Washington, DC, USA.
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Abstract
OBJECTIVE Sinonasal mucormycosis is a rare fulminant disorder that typically affects immunocompromised patients. This article focuses primarily on the clinical manifestations and the importance of early diagnosis and treatment of this disease. PATIENTS AND METHODS Four pediatric cases of sinonasal mucormycosis encountered over an 8-year-period in our institution are reported. The initial presenting symptoms, physical examination, computed tomography, intraoperative, and histopathologic findings are described. The underlying immunosuppressive diseases are also outlined. RESULTS The most common signs and symptoms were fever, rhinorrhea, facial erythema and edema, and very pale nasal mucosa. Despite these manifestations, the diagnosis of sinonasal mucormycosis was delayed, except in one child. Computed tomography scan findings were nonspecific and did not correlate well with surgical and pathologic findings. Treatment consisted in a combination of antifungal agents, multiple aggressive surgical debridements, and control of the underlying disease. In the postoperative course, 1 child died of the disease, 1 developed a persistent unilateral blindness, 1 was lost to follow-up, and the last 1 was cured with no sequelae. CONCLUSIONS Sinonasal mucormycosis in the immunocompromised pediatric population is an uncommon but potentially fatal disease. A high index of suspicion is of utmost importance to decrease its related morbidity and mortality.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics, Georgetown University School of Medicine, 4431 Albemarle Street, NW, Washington, DC 20016, USA.
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Abstract
Sinusitis is one of the most common complaints resulting in physician visits in the United States. An antecedent viral infection of the upper respiratory tract is the most common presentation. Despite its prevalence, most cases resolve spontaneously. Only a small proportion develops a secondary bacterial infection that will benefit from antimicrobial therapy. This article discusses the microbiology and pathogenesis of acute and chronic bacterial sinusitis. The role anaerobic bacterial in chronic and recurrent sinusitis is emphasized, and appropriate antimicrobial regimens are discussed.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics and Medicine, Georgetown University School of Medicine, 4431 Albemarle St. NW, Washington, DC 20016, USA.
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19
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Brook I. Microbiology and Principles of Antimicrobial Therapy for Head and Neck Infections. Infect Dis Clin North Am 2007; 21:355-91, vi. [PMID: 17561074 DOI: 10.1016/j.idc.2007.03.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The principles of antimicrobial management for head and neck infections include establishing an accurate clinical and microbiologic diagnosis and treating the patient initially with an empiric antimicrobial regimen based on predicted likelihood of success and reduced potential for resistance. Subsequent adjustments may be required based on clinical response and available culture results. This article summarizes the aerobic and anaerobic microbiology of selected acute and chronic infections of the head and neck and the approaches to antimicrobial therapy.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics and Medicine, Georgetown University School of Medicine, 4431 Albemarle St. NW, Washington, DC 20016, USA.
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Knipping S, Holzhausen HJ, Koesling S, Bloching M. Invasive aspergillosis of the paranasal sinuses and the skull base. Eur Arch Otorhinolaryngol 2007; 264:1163-9. [PMID: 17534639 DOI: 10.1007/s00405-007-0336-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 05/01/2007] [Indexed: 11/24/2022]
Abstract
Invasive aspergillosis (IA) originating from the paranasal sinuses can cause an intracranial growth mainly along the skull base and larger vessels. This study reports our experience in the diagnosis and treatment of a series of patients with IA. A retrospective chart review of four patients with chronic invasive intracranial aspergillosis was performed. Clinical signs, physical examinations, radiographs, histological samples, and outcome were demonstrated. The patients demonstrated different symptoms like exophthalmus, ophthalmoplegia, loss of vision, and hypaesthesia of the ophthalmic and maxillary nerve. Computed tomography and MRI revealed extensive sino-orbital and skull base lesions. The patients were treated with aggressive endonasal debridement, intravenous antifungal agents and daily irrigations with antimycotic suspensions. Furthermore, we applied hyperbaric oxygenation. Two patients died from complications due to subarachnoidal hemorrhage and accompanied complications respectively. Despite the high mortality rate patients with an invasive aspergillosis can be effectively treated in some cases by an early and rigorous treatment schedule using all surgical and conservative therapeutic options.
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Affiliation(s)
- Stephan Knipping
- Department of Otorhinolaryngology Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Magdeburger Str 12, Halle/Saale, Germany.
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Affiliation(s)
- Chang-Keun Kim
- Department of Pediatrics, Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, Korea
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Abstract
Sinusitis remains one of the most prevalent but clinically challenging disease processes in pediatrics. Lack of appropriate culture evidence makes the diagnosis difficult, and increasing microbial resistance presents a therapeutic dilemma. This article examines causative factors, appropriate diagnostic measures, and effective medical and surgical treatment options for sinusitis in the pediatric population.
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Affiliation(s)
- Michael Zacharisen
- Section of Allergy and Immunology, Medical College of Wisconsin, Suite 411, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Abstract
The growing resistance to antimicrobial agents of all respiratory tract bacterial pathogens has made the management of sinusitis more difficult. The upper respiratory tract including the nasopharynx serves as the reservoir for pathogenic bacteria that can cause respiratory infections including sinusitis. During a viral respiratory infection, potential pathogens can relocate from the nasopharynx into the sinus cavity, causing sinusitis. Establishment of the correct microbiology of all forms of sinusitis is of primary importance, because it can serve as a guide for choosing the adequate antimicrobial therapy. This article summarizes the current information regarding the microbiology of all forms of sinusitis and approaches to antimicrobial therapy.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics, Georgetown University School of Medicine, 4431 Albemarle Street NW, Washington, DC 20016, USA.
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García Rodríguez JA, García Sánchez JE, Gobernado Serrano M, Mensa Pueyo J, Lorente Guerrero J, Ortega del Alamo P, Sabater Mata de la Barata F, Tomás Barberán M. Diagnóstico y tratamiento antimicrobiano de las sinusitis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2003; 54:449-62. [PMID: 14567080 DOI: 10.1016/s0001-6519(03)78435-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J A García Rodríguez
- Departamento de Microbiología, Hospital Universitario Po. San Vicente, 108, 37007 Salamanca.
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25
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Evans P, Miser WF. Sinusitis and Pharyngitis. Fam Med 2003. [DOI: 10.1007/978-0-387-21744-4_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Florence E, Bottieau E, Lynen L, Colebunders R. Patients with HIV infection and fever: a diagnostic approach. Acta Clin Belg 2002; 57:184-90. [PMID: 12462794 DOI: 10.1179/acb.2002.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Fever is a common sign among patients with HIV infection and frequently leads to a medical consultation. It is generally caused by infections. The type of infection depends on the stage of the disease. Opportunistic infections occur only in the presence of severe immunodeficiency. A systematic approach will identify most causes of fever. Since the incidence of opportunistic infections has dramatically decreased with the use of highly active antiretroviral treatments, other causes of fever including immune restoration disease, neoplasm and drug-fever should be considered.
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Affiliation(s)
- E Florence
- Departement Klinische Wetenschappen, Instituut voor Tropische Geneeskunde, Antwerpen, België
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Brook I. Bacterial contamination of saline nasal spray/drop solution in patients with respiratory tract infection. Am J Infect Control 2002; 30:246-7. [PMID: 12032501 DOI: 10.1067/mic.2002.119955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study evaluated the potential for bacterial contamination of saline nasal spray/drop solution after 3 days of clinical use in patients. Twenty patients with upper respiratory infection used the saline as a spray, and 20 patients used the solution as drops. Bacterial growth was present in 18 (907%) solution containers of the spray group and in 3 (157%) solution containers of the drops group (P <.005). Twenty isolates were recovered from the spray group and 3 from the drops group. The predominate isolates included Staphylococcus aureus, Staphylococcus epidermidis, alpha Streptococcus species, Pseudomonas aeruginosa, Escherichia coli, and Proteus spp. This study demonstrates the contamination of nasal saline-dispensing solution used as a spray with micro-organisms that are part of the normal skin and nasal flora and gram-negative organisms of potential enteric origin. These data support the use of nasal saline-dispensing solution as drops, rather than as spray. They also illustrate the risk for crossinfection if a nasal solution is used by more than 1 patient.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics, Georgetown University School of Medicine, Washington, DC, USA
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Brook I, Frazier EH. Correlation between microbiology and previous sinus surgery in patients with chronic maxillary sinusitis. Ann Otol Rhinol Laryngol 2001; 110:148-51. [PMID: 11219522 DOI: 10.1177/000348940111000210] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aspirates of 108 chronically inflamed maxillary sinuses were processed for aerobic and anaerobic bacteria. There were 295 bacterial isolates: 109 aerobic and facultative, and 186 anaerobic. The predominant aerobic isolates were Staphylococcus aureus (17 isolates), alpha-hemolytic streptococci (14), Pseudomonas aeruginosa (12), Moraxella catarrhalis (10), and Haemophilus spp (8). The predominant anaerobes were Peptostreptococcus spp (61), Prevotella spp (45), Fusobacterium spp (15), and Propionibacterium acnes (14). Analysis of the medical histories revealed a correlation only between the microbial results and previous sinus surgery. Pseudomonas aeruginosa and gram-negative aerobic bacilli (GNAB) were more often isolated in patients who had surgery (9 of 33 patients had P aeruginosa and 17 had GNAB) than in patients who did not have surgery (3 of 75 had P aeruginosa and 7 had GNAB; p < .001). Anaerobes were isolated more often in patients who did not have surgery (69 of 75 patients) than in those who had previous surgery (21 of 33 patients; p < .001). These findings illustrate the unique microbiological features of chronic maxillary sinusitis that persist after sinus surgery.
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Affiliation(s)
- I Brook
- Department of Pediatrics, Navy Hospital, Bethesda, Maryland, USA
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