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Colomba C, Garbo V, Boncori G, Albano C, Bagarello S, Condemi A, Giordano S, Canduscio LA, Gallo C, Parrinello G, Cascio A. Streptococcus mitis as a New Emerging Pathogen in Pediatric Age: Case Report and Systematic Review. Antibiotics (Basel) 2023; 12:1222. [PMID: 37508318 PMCID: PMC10376791 DOI: 10.3390/antibiotics12071222] [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: 06/28/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Streptococcus mitis, a normal inhabitant of the oral cavity, is a member of Viridans Group Streptococci (VGS). Generally recognized as a causative agent of invasive diseases in immunocompromised patients, S. mitis is considered to have low pathogenic potential in immunocompetent individuals. We present a rare case of sinusitis complicated by meningitis and cerebral sino-venous thrombosis (CSVT) caused by S. mitis in a previously healthy 12-year-old boy with poor oral health status. With the aim of understanding the real pathogenic role of this microorganism, an extensive review of the literature about invasive diseases due to S. mitis in pediatric patients was performed. Our data define the critical role of this microorganism in invasive infections, especially in immunocompetent children and in the presence of apparently harmful conditions such as sinusitis and caries. Attention should be paid to the choice of therapy because of VGS's emerging antimicrobial resistance patterns.
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Affiliation(s)
- Claudia Colomba
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
- Division of Pediatric Infectious Diseases, "G. Di Cristina" Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy
| | - Valeria Garbo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Giovanni Boncori
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Chiara Albano
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Sara Bagarello
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Anna Condemi
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Salvatore Giordano
- Division of Pediatric Infectious Diseases, "G. Di Cristina" Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy
| | - Laura A Canduscio
- Division of Pediatric Infectious Diseases, "G. Di Cristina" Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy
| | - Cristina Gallo
- Division of Radiology, "G. Di Cristina" Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy
| | - Gaspare Parrinello
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
- Infectious and Tropical Diseases Unit, AOU Policlinico "P. Giaccone", 90100 Palermo, Italy
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Papadopoulos N, Prokopakis EP, Karatzanis AD, Linardakis M, Mourellou E, Symvoulakis EK. Features of ENT Cases in the Emergency Department of a Tertiary Hospital in Greece: A Prospectively Driven Data Collection Study. Healthcare (Basel) 2023; 11:1943. [PMID: 37444776 DOI: 10.3390/healthcare11131943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Primary healthcare is the pillar of a well-functioning healthcare system. General practitioners (GPs) should have a broad skillset to cope with the various conditions they encounter in everyday practice. Ear, nose, and throat (ENT) cases are some of the most common reasons for seeking care. The study aimed to define the frequency and type of ENT disorders seen in the emergency department of a tertiary hospital in Greece. All patients examined by an ENT specialist in the emergency department setting, within a year, were recorded, as well as all referrals from private practice or primary care facilities. From September to December 2021, data were collected from patients who agreed to complete a two-minute survey, namely, the Generalized Anxiety Disorder Scale (GAD-2) questionnaire. During the study year, 4542 cases were documented, from which the most common conditions listed were external otitis (6.9%/314), epistaxis (6.7%/305), and impacted earwax (5.7%/261). The diagnoses that led to hospitalization were 336 and the most common were peritonsillar abscess (16.4%/55), epistaxis (8.0%/27), and facial nerve paralysis (7.4%/25). Referrals from GPs working in the public sector represented more than the half of the total. There was a significant correlation between an increased number of hospital visits and an increased GAD-2 score, in the semester before the current visit (p < 0.001). Referrals to ENT specialists represent around 5% of all cases examined, and about 8% of all visits required hospitalization. Interdisciplinary clinical and research investment into GP training is compulsory to regulate ENT referrals by GPs.
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Affiliation(s)
- Nikolaos Papadopoulos
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Voutes, 71003 Heraklion, Greece
| | - Emmanuel P Prokopakis
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Alexander D Karatzanis
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Manolis Linardakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Voutes, 71003 Heraklion, Greece
| | - Evangelia Mourellou
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Voutes, 71003 Heraklion, Greece
| | - Emmanouil K Symvoulakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Voutes, 71003 Heraklion, Greece
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Orbital complication of acute ethmoiditis: A Tunisian paediatric cross sectional study. Am J Otolaryngol 2020; 41:102320. [PMID: 31732307 DOI: 10.1016/j.amjoto.2019.102320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 10/20/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The anatomical and developmental particularities of sinus cavities in paediatric population lead acute ethmoiditis to be the earliest form of sinusitis in children. Orbital complications are frequent and could lead to visual and neurological impairment. This study investigated the clinical, biological and radiological features of orbital complications. We identified the predictive factors of severe ophthalmological lesions and/or associated cerebral complications of acute ethmoiditis. DESIGN AND METHODS This cross sectional study included all patients identified as having orbital extension of acute ethmoiditis in the database of a single academic paediatric care centre over a period of 14 years. All orbital and cerebral Scans of the included patients were reviewed and the cohort was classified using Chandler's classification as having less severe lesions (Chandler's 1 and 2) or more serious lesions (Chandler's 3, 4 and 5). RESULTS In total, 16 patients (12 girls and 4 boys) were included among 39 consecutives cases of ethmoiditis recessed with a complication rate of 41%. Average consultation delay was 4.88 days. The mean age was 4.37 years. Fever was objectified in 13 cases (81%). Six patients (37.5%) had exophthalmos. Orbital extension spectrum was: stage I (n = 4, 25%), stage II (n = 4, 25%), stage III (n = 6, 37.5%), stage IV (n = 1, 6.5%), stage V (n = 1, 6.5%) and intra cranial extension was associated in two cases. Univariate analysis showed that fever, exophthalmos, ophthalmoplegia, positive CRP, age and white blood cells count were not associated with more severe lesions in the CT scan. Initially, all children received intravenous antibiotic treatment. Association of multiple antibiotics was prescribed in 75% of the cases. With 21.07 days ± 5.51 days as a total treatment duration. Only Four patients underwent surgical treatment. CONCLUSION Orbital complications of ethmoiditis are frequent. No clinical or biological criteria seem to predict the severity of orbital lesions. Both orbital and brain CT scan could help detect eventual complications on time to adapt antibiotic treatment and eventually bring forward surgical intervention.
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Torretta S, Drago L, Marchisio P, Gaini L, Guastella C, Moffa A, Rinaldi V, Casale M, Pignataro L. Review of Systemic Antibiotic Treatments in Children with Rhinosinusitis. J Clin Med 2019; 8:E1162. [PMID: 31382570 PMCID: PMC6723210 DOI: 10.3390/jcm8081162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 01/02/2023] Open
Abstract
Antibiotic treatment in paediatric rhinosinusitis is still a matter of debate, as the current guidelines have been drafted mainly based on clinical studies published before 2013. Recent modifications in the epidemiological basis of the disease might mean that current treatments are not completely adequate considering the evolving microbiological profile of the disease. The present paper reviews the role of systemic antibiotics in children with acute (ARS), chronic (CRS), recurrent (RARS), and complicated acute (CoARS) rhinosinusitis. A total of 14 studies (including 3 prospective non-randomised studies, 8 retrospective studies, and 3 prospective randomised studies) of the 115 initially identified papers were included in this review, corresponding to 13,425 patients. Five papers dealt with ARS, four papers with RARS or CRS, and five papers with CoARS; the remaining papers included patients with either ARS or CRS. Data about the effectiveness of antibiotic treatment in children with ARC, CRS, and CoARS is scarce, as only three randomised controlled trials have been published in the last decade, with contrasting results. There is an urgent need for dedicated controlled trials not only to test the actual clinical benefits deriving from the routine use of systemic antibiotics in different categories of patients but also to compare the effectiveness of various therapeutic protocols in terms of the type of antibacterial molecules and the duration of treatment.
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Affiliation(s)
- Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20100, Italy.
| | - Lorenzo Drago
- Department of Biomedical Sciences for Health, University of Milan, Milan 20100, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan 20100, Italy
| | - Lorenzo Gaini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy
| | - Claudio Guastella
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy
| | - Antonio Moffa
- Unit of Otolaryngology, University of Foggia, Foggia 71121, Italy
| | - Vittorio Rinaldi
- Unit of Otolaryngology, UOS ORL TI, Campus Bio-medico University, Rome 00128, Italy
| | - Manuel Casale
- Unit of Otolaryngology, UOS ORL TI, Campus Bio-medico University, Rome 00128, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20100, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20100, Italy
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Fabre C, Atallah I, Wroblewski I, Righini CA. Maxillary sinusitis complicated by stroke. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:449-451. [PMID: 30072286 DOI: 10.1016/j.anorl.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Neurological complications of acute sinusitis are exceptional, but potentially serious. CASE REPORT The authors report the case of a 6-year-old diabetic girl who presented with middle cerebral artery ischemic stroke secondary to inflammatory arteritis of the left internal carotid artery in a context of bilateral acute maxillary sinusitis. MRI confirmed ischaemic stroke associated with carotid arteritis and complete obstruction of the maxillary sinuses. A favourable outcome was observed after endoscopic drainage of the sinuses associated with broad-spectrum antibiotic therapy. DISCUSSION This complication was probably due to spread of an infectious inflammatory reaction of the intrapetrosal carotid artery and its branches via the pterygoid venous plexus. To our knowledge, this is the first published case report of maxillary sinusitis complicated by stroke.
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Affiliation(s)
- C Fabre
- Service hospitalo-universitaire d'ORL et chirurgie cervico-faciale, CHU Michalon CS 10217, 38043, Grenoble cedex 9, France.
| | - I Atallah
- Service hospitalo-universitaire d'ORL et chirurgie cervico-faciale, CHU Michalon CS 10217, 38043, Grenoble cedex 9, France; Faculté de médecine, universités des Alpes, Grenoble, France; UGA/UMR/CNRS 5309/Inserm 1209, institut Albert-Bonniot, Grenoble, France
| | - I Wroblewski
- Faculté de médecine, universités des Alpes, Grenoble, France; UGA/UMR/CNRS 5309/Inserm 1209, institut Albert-Bonniot, Grenoble, France; Réanimation et surveillance continue pédiatrique, pôle Couple Enfant, CHU de Grenoble, Grenoble, France
| | - C A Righini
- Service hospitalo-universitaire d'ORL et chirurgie cervico-faciale, CHU Michalon CS 10217, 38043, Grenoble cedex 9, France; Faculté de médecine, universités des Alpes, Grenoble, France; UGA/UMR/CNRS 5309/Inserm 1209, institut Albert-Bonniot, Grenoble, France
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Mardassi A, Mathlouthi N, Mbarek H, Halouani C, Mezri S, Zgolli C, Chebbi G, Mhamed RB, Akkari K, Benzarti S. Complicated sinusitis in children: 18 cases report. World J Otorhinolaryngol 2015; 5:30-36. [DOI: 10.5319/wjo.v5.i1.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 12/01/2014] [Accepted: 12/31/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To precise the clinical characteristics of rhinosinusitis in pediatric population, their complications and therapeutic approaches.
METHODS: All infants younger than 15 years admitted to the Ear, Nose and Throat Department of the Military Hospital of Tunis, Tunisia for a complicated rhinosinusitis between 2006 and 2013 were evaluated. Data related to patients and the disease were collected and analyzed: past medical history, complaints, clinical examination, radiologic findings, therapeutic management and evolution.
RESULTS: Eighteen cases were identified with a mean age of 5.1 years (5 mo to 13 years) (SD ± 3.1). A male preponderance was noted in 72% of the cases. Rhinorrhea and fever were the most common presenting symptoms. Radiological explorations (computed tomography-scan ± magnetic resonance imaging) have been practiced for all of our patients. Orbital involvement was found in 77% of the cases associated with meningitis in 2 cases. Antibiotherapy was prescribed to all our patients. Surgical procedures were performed in 8 cases: endoscopic sinus surgery and/or external drainage of orbital abscess. After an average follow-up period of 2.5 years, 3 of our patients were lost. The ophthalmic sequelae noted in 3 cases (16%) were permanent and caused important functional and social problems. A favourable outcome has been noted in the rest of our patients.
CONCLUSION: Rhinosinusitis can be extremely severe in children requiring urgent radiological imaging and aggressive treatment to avoid orbital and intracranial complications.
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Ben Abdallah Chabchoub R, Kmiha S, Turki F, Trabelsi L, Maalej B, Ben Salah M, Abdelhédi Gargouri L, Boukédi A, Ben Halima N, Mahfoudh A. [Septic cavernous sinus thrombosis following ethmoiditis: a case report]. Arch Pediatr 2013; 21:66-9. [PMID: 24290188 DOI: 10.1016/j.arcped.2013.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 06/03/2013] [Accepted: 10/25/2013] [Indexed: 11/26/2022]
Abstract
Acute ethmoiditis is a rare infection of ethmoidal cells. The pathognomonic sign is an edema of the internal corner of the eye. Imaging may be necessary to verify the absence of orbital or endocranial complications. Thrombophlebitis of the cavernous sinus is a serious complication of this infectious process. We report the case of an 11-year-old boy who presented with ethmoiditis complicated with thrombophlebitis of the cavernous sinus, with right hemiplegia and left Bell palsy sequelae. Early diagnosis of this disorder and urgent therapy are essential. Treatment is based on the antibiotic therapy.
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Affiliation(s)
| | - S Kmiha
- Service de pédiatrie urgences et réanimation pédiatrique, CHU Hédi-Chaker, Sfax, Tunisie
| | - F Turki
- Service de pédiatrie urgences et réanimation pédiatrique, CHU Hédi-Chaker, Sfax, Tunisie
| | - L Trabelsi
- Service de pédiatrie urgences et réanimation pédiatrique, CHU Hédi-Chaker, Sfax, Tunisie
| | - B Maalej
- Service de pédiatrie urgences et réanimation pédiatrique, CHU Hédi-Chaker, Sfax, Tunisie
| | - M Ben Salah
- Service de pédiatrie urgences et réanimation pédiatrique, CHU Hédi-Chaker, Sfax, Tunisie
| | - L Abdelhédi Gargouri
- Service de pédiatrie urgences et réanimation pédiatrique, CHU Hédi-Chaker, Sfax, Tunisie
| | - A Boukédi
- Service de pédiatrie urgences et réanimation pédiatrique, CHU Hédi-Chaker, Sfax, Tunisie
| | - N Ben Halima
- Service de pédiatrie urgences et réanimation pédiatrique, CHU Hédi-Chaker, Sfax, Tunisie
| | - A Mahfoudh
- Service de pédiatrie urgences et réanimation pédiatrique, CHU Hédi-Chaker, Sfax, Tunisie
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[Unilateral isolated partial third nerve palsy and sphenoiditis in a child: A case report]. J Fr Ophtalmol 2012; 35:348-52. [PMID: 22475536 DOI: 10.1016/j.jfo.2011.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 11/18/2011] [Accepted: 11/22/2011] [Indexed: 11/24/2022]
Abstract
We report a case of unilateral mydriasis associated with sphenoid sinusitis and mucocele in a child. An 11-year-old girl with a history of unilateral mydriasis was referred for ophthalmologic examination. She complained of a mild headache over the past four days. The right pupil was dilated and nonreactive to light. The left pupil was normal and reactive. There was no ptosis or other focal neurological deficit. She was orthotropic. Visual acuity in both eyes, ocular motility and fundi were normal. Magnetic resonance imaging (MRI) showed a sphenoid sinus mucocele with sphenoiditis. The diagnosis was partial third nerve palsy without ophthalmoplegia. Treatment with antibiotics was initiated and led to complete resolution of the mydriasis. Sphenoid sinus mucoceles are relatively rare. Failure to diagnose and treat can lead to serious neurologic sequellae such as third nerve palsy, compressive optic neuropathy, cavernous sinus thrombosis, meningitis or brain abscess. Head imaging by reconstructed CT and MRI can lead to the diagnosis of mucocele. Isolated unilateral mydriasis as a sign of third nerve palsy may be caused by a slowly enlarging lesion. In a child with isolated unilateral mydriasis, head MRI should be performed to rule out a compressive lesion of the oculomotor nerve.
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Thrombophlébite du sinus caverneux nosocomiale à Staphylococcus aureus multirésistant. À propos d’un cas. Arch Pediatr 2011; 18:529-32. [DOI: 10.1016/j.arcped.2011.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 01/12/2011] [Accepted: 02/11/2011] [Indexed: 11/22/2022]
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