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Gao M, Cheng L, Wang Q, Yang Q, Wang X, Li Y, Hu R, Xu W. Clinical characteristics and prognosis of laryngeal tuberculosis combined with respiratory tuberculosis. Am J Otolaryngol 2024; 45:104115. [PMID: 37979215 DOI: 10.1016/j.amjoto.2023.104115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/08/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE To investigate the clinical characteristics, diagnosis and prognosis of patients with laryngeal tuberculosis (LTB) combined with respiratory tuberculosis. MATERIALS AND METHODS A retrospective analysis was conducted on 134 patients who underwent endoscopy and were eventually diagnosed with LTB. The patients' demographic characteristics, clinical manifestations, endoscopic features, auxiliary examination, imaging examination and prognostic characteristics were analyzed. RESULTS LTB patients had a median age of 45.5 years (range from 12 to 87 years) and a median course of 3.0 months (range from 0.1 to 72 months). The patients' symptoms mainly presented as hoarseness (97.0 %), abnormal sensation of pharyngeal (49.3 %), cough and sputum (41.0 %), pharyngalgia (39.6 %), dysphagia (10.4 %) and dyspnea (8.2 %). The positive rate of tuberculous symptoms was 25.4 %. Endoscopic features showed that the lesions mainly involved the glottis (87.3 %), presenting as unilateral lesions (66.7 %), near-full-length involvement (88.0 %), with mucosal waves significantly reduced (86.3 %), followed by supraglottis (43.3 %), subglottis (24.6 %) and the pharynx (15.7 %). The lesions may present as granulomatous proliferation (66.4 %), ulceration (65.7 %) or swelling and exudation (51.5 %). A total of 75 patients (56.0 %) were finally diagnosed with combined pulmonary tuberculosis (PTB), with a positive chest X-ray rate of 25.6 % and a positive chest CT rate of 71.2 %. A total of 42 patients who received anti-tuberculosis treatment were followed up, and 73.8 % of patients had significant improvement in symptoms. The morphology of the pharyngeal and laryngeal mucosa returned to basically normal (59.4 %) or scar-like (34.4 %). CONCLUSIONS LTB is usually found in middle-aged men, and patients' symptoms are mainly hoarseness, abnormal sensation of pharyngeal, pharyngalgia, cough and sputum, and can be combined with tuberculous symptoms. These lesions mainly involve multiple subregions, mainly in the glottis, and can be combined with pharyngeal involvement. There were various types of lesions. Half of the patients were complicated with PTB, and chest CT was superior to X-ray in the detection of pulmonary lesions. After regular anti-tuberculosis treatment, the symptoms and morphology of the pharyngeal and laryngeal mucosa of most patients were significantly improved.
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Affiliation(s)
- Mengdie Gao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Liyu Cheng
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Qingcui Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Qingwen Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Xiaoyi Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yanru Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Rong Hu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Wen Xu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
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Achache W, Boualam MA, Cassir N, Mimari C, Poitrenaud D, Mezouar S, Mège JL, Drancourt M, Lepidi H. Mycobacterium tuberculosis Resides in Macrophages in Laryngeal Tuberculosis: A Case Report. Pathogens 2023; 12:1413. [PMID: 38133296 PMCID: PMC10745871 DOI: 10.3390/pathogens12121413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/01/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Laryngeal tuberculosis is a rare form of extrapulmonary tuberculosis that questions the natural history of this infection. We report one such case in which a pathological examination of a laryngeal biopsy revealed granulomatous inflammation with caseous necrosis. Further investigations combining immunofluorescence detection of macrophages and in situ hybridization of Mycobacterium tuberculosis indicated the presence of Mycobacterium tuberculosis (M. tuberculosis) in laryngeal granulomatous inflammatory lesions. This observation suggests that the natural history of laryngeal tuberculosis does not differ from that of other forms, guiding early diagnosis in patients with laryngeal lesions to ensure appropriate check-ups and treatment.
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Affiliation(s)
- Wafaa Achache
- MEPHI, Aix-Marseille University, IRD, 13005 Marseille, France (N.C.); (S.M.); (J.L.M.); (M.D.)
- IHU Méditerranée Infection, 13005 Marseille, France
| | - Mahmoud A. Boualam
- MEPHI, Aix-Marseille University, IRD, 13005 Marseille, France (N.C.); (S.M.); (J.L.M.); (M.D.)
- IHU Méditerranée Infection, 13005 Marseille, France
| | - Nadim Cassir
- MEPHI, Aix-Marseille University, IRD, 13005 Marseille, France (N.C.); (S.M.); (J.L.M.); (M.D.)
- IHU Méditerranée Infection, 13005 Marseille, France
| | - Clémence Mimari
- Service ORL Hôpital de la Conception, 13005 Marseille, France
| | | | - Soraya Mezouar
- MEPHI, Aix-Marseille University, IRD, 13005 Marseille, France (N.C.); (S.M.); (J.L.M.); (M.D.)
- IHU Méditerranée Infection, 13005 Marseille, France
| | - Jean Louis Mège
- MEPHI, Aix-Marseille University, IRD, 13005 Marseille, France (N.C.); (S.M.); (J.L.M.); (M.D.)
- IHU Méditerranée Infection, 13005 Marseille, France
| | - Michel Drancourt
- MEPHI, Aix-Marseille University, IRD, 13005 Marseille, France (N.C.); (S.M.); (J.L.M.); (M.D.)
| | - Hubert Lepidi
- MEPHI, Aix-Marseille University, IRD, 13005 Marseille, France (N.C.); (S.M.); (J.L.M.); (M.D.)
- IHU Méditerranée Infection, 13005 Marseille, France
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Lau RJ, Lackey TG, Samedi V, Fink DS. Nontuberculous Mycobacterial Infection of Larynx and Cervical Trachea. Ann Otol Rhinol Laryngol 2023; 132:1487-1492. [PMID: 36951110 DOI: 10.1177/00034894231161871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVES To present a patient with the first case of NTM (nontuberculous mycobacteria) infection of the larynx extending to cervical trachea, and the first case of subglottic stenosis associated with an NTM infection. METHODS Case report and review of the literature. RESULTS A 68-year-old female with history of prior smoking, gastroesophageal reflux disease, asthma, bronchiectasis, and tracheobronchomalacia presented with a 3-month history of shortness of breath, exertional inspiratory stridor, and hoarseness. Flexible laryngoscopy demonstrated ulceration of medial aspect of right vocal fold and subglottic tissue abnormality with crusting and ulceration extending through the upper trachea. Microdirect laryngoscopy with tissue biopsies and carbon dioxide (CO2) laser ablation of disease completed, and intraoperative culture revealed positive Aspergillus and acid-fast bacilli with Mycobacterium abscessus (type of NTM). Patient began antimicrobial treatment of cefoxitin, imipenem, amikacin, azithromycin, clofazimine, and itraconazole. Fourteen months after initial presentation, patient developed subglottic stenosis with limited extension into the proximal trachea prompting CO2 laser incision, balloon dilation, and steroid injection of the subglottic stenosis. Patient remains disease free without further subglottic stenosis. CONCLUSION Laryngeal NTM infections are exceedingly rare. Failure to consider NTM infection in the differential diagnosis when presented with an ulcerative, exophytic mass in patients with increased risk factors (structural lung disease, Pseudomonas colonization, chronic steroid use, prior NTM positivity) may result in insufficient tissue evaluation, delayed diagnosis, and disease progression.
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Affiliation(s)
- Ryan J Lau
- Department of Otolaryngology - Head & Neck Surgery, University of Colorado, Aurora, CO, USA
| | - Taylor G Lackey
- Department of Otolaryngology - Head & Neck Surgery, University of Colorado, Aurora, CO, USA
| | - Von Samedi
- Department of Pathology, University of Colorado, Aurora, CO, USA
| | - Daniel S Fink
- Department of Otolaryngology - Head & Neck Surgery, University of Colorado, Aurora, CO, USA
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Zandvakili A, Kobayashi T, Seligman K, Parsons MG, Ford B, Bayon R, Herwaldt LA. A 58-Year-Old Male With a Chronic Sore Throat. Clin Infect Dis 2023; 77:792-794. [PMID: 37696670 DOI: 10.1093/cid/ciad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Affiliation(s)
- Arya Zandvakili
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Takaaki Kobayashi
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Kristen Seligman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Meredith G Parsons
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Bradley Ford
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Rodrigo Bayon
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Loreen A Herwaldt
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Kaji M, Namkoong H, Nagao G, Azekawa S, Nakagawara K, Tanaka H, Morita A, Asakura T, Kamata H, Uwamino Y, Yoshida M, Fukunaga K, Hasegawa N. Nasopharyngeal Mycobacterium abscessus Infection: A Case Report and Literature Review. Infect Drug Resist 2023; 16:3955-3963. [PMID: 37361939 PMCID: PMC10290463 DOI: 10.2147/idr.s415197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
Background Mycobacterium abscessus (M. abscessus) is a rapidly growing bacterium (RGM) that causes refractory pulmonary and extrapulmonary infections. However, studies investigating pharyngeal and laryngeal M. abscessus infections are limited. Case Presentation A 41-year-old immunocompetent woman complaining of bloody sputum was referred to our hospital. Although her sputum culture tested positive for M. abscessus subsp. abscessus, radiological findings were not indicative of pulmonary infection or sinusitis. Further diagnostic workup, including laryngeal endoscopy and positron emission tomography/computed tomography (PET/CT), confirmed the presence of nasopharyngeal M. abscessus infection. The patient was initially treated with intravenous amikacin, imipenem/cilastatin, azithromycin, and clofazimine for 28 days, after which the patient was provided with amikacin, azithromycin, clofazimine, and sitafloxacin for four months. After the completion of antibiotic therapy, the patient showed negative results on sputum smear and culture and normal findings on PET/CT and laryngeal endoscopy. Whole-genome sequencing of this strain revealed that it belonged to the ABS-GL4 cluster, which has a functional erythromycin ribosomal methylase gene, although it is not a major lineage in non-cystic fibrosis (CF) patients in Japan and Taiwan and in CF patients in European countries. We conducted a literature review and identified seven patients who developed pharyngeal/laryngeal non-tuberculous mycobacterium (NTM) infection. Four of the eight patients had a history of immunosuppressant use, including steroids. Seven of the eight patients responded well to their treatment regimens. Conclusion Patients whose sputum culture tests are positive for NTM and who meet the diagnostic criteria for NTM infection but do not have intrapulmonary lesions should be evaluated for otorhinolaryngological infections. Our case series revealed that immunosuppressant use is a risk factor for pharyngeal/laryngeal NTM infection and that patients with pharyngeal/laryngeal NTM infections respond relatively well to antibiotic therapy.
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Affiliation(s)
- Masanori Kaji
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Genta Nagao
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shuhei Azekawa
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kensuke Nakagawara
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiromu Tanaka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Atsuho Morita
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Clinical Medicine (Laboratory of Bioregulatory Medicine), Kitasato University School of Pharmacy, Tokyo, Japan
- Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Uwamino
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mitsunori Yoshida
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
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Diaz A, Auger S, Cipriani NA, Baird BJ. Right Vocal Cord Paralysis Caused by Histoplasmosis: A Case Report. Ann Otol Rhinol Laryngol 2023; 132:351-355. [PMID: 35450453 DOI: 10.1177/00034894221090334] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Histoplasma capsulatum is a prevalent dimorphic fungus, reaching an exposure rate of 90% in endemic areas such as the Midwest and Central United States. We report an unusual presentation of dysphonia due to right vocal cord paralysis caused by mediastinal lymphadenopathy from histoplasmosis. METHODS A 73-year-old male presented to an otolaryngology clinic with 4 months of hoarseness. Flexible strobolaryngoscopy demonstrated right vocal cord paralysis in lateral position and a full length glottic gap. Computerized tomography (CT) scan showed enlargement of a right paratracheal node. RESULTS A lymph node biopsy was obtained and showed histoplasmosis. He was treated with a 3-month course of pozaconazole. He then received a vocal cord medialization injection 2 months after symptom onset, which produced favorable improvement of his symptoms at 8-month follow up. CONCLUSIONS One other case report in the literature has reported left vocal cord paralysis related to histoplasmosis. This first case of right vocal cord paralysis was extremely unusual and is not often included in the differential diagnosis of vocal cord paralysis.
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Affiliation(s)
- Ashley Diaz
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Samuel Auger
- Section of Otolaryngology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Nicole A Cipriani
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Brandon J Baird
- Section of Otolaryngology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
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Fritsche TR, Anderson JL, Bassi D, Hall MC, Boyle TR, Meece JK. Direct Tissue PCR and Genotyping for Species Identification in a Case of Laryngeal Blastomycosis. EAR, NOSE & THROAT JOURNAL 2021; 102:NP157-NP160. [PMID: 33683980 DOI: 10.1177/0145561321991342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Otolaryngologic manifestations of infection with Blastomyces species are extremely rare and restricted geographically to recognized endemic regions. Here, we describe a case of laryngeal blastomycosis that presented as slowly progressive dysphonia. While a preliminary diagnosis was made using routine histopathology, a species identification of Blastomyces dermatitidis was made using polymerase chain reaction amplification and rapid genotyping without the need for fungal culture. All symptoms resolved following 1 month of antifungal therapy. Rapid molecular differentiation of B dermatitidis from Blastomyces gilchristii provides important insights into pathogenesis given recent recognition of differences in clinical spectra.
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Affiliation(s)
- Thomas R Fritsche
- Division of Laboratory Medicine, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Jennifer L Anderson
- Integrated Research and Development Laboratory, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Deepa Bassi
- Division of Laboratory Medicine, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Matthew C Hall
- Department of Infectious Diseases, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Timothy R Boyle
- Department of Otolaryngology, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Jennifer K Meece
- Integrated Research and Development Laboratory, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
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Zang J, Tian Y, Jiang X, Lin XY. Appearance and morphologic features of laryngeal tuberculosis using laryngoscopy: A retrospective cross-sectional study. Medicine (Baltimore) 2020; 99:e23770. [PMID: 33371143 PMCID: PMC7748357 DOI: 10.1097/md.0000000000023770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
Laryngeal tuberculosis (LTB) is highly contagious and can cause permanent laryngeal damage. Therefore, correctly identifying laryngoscopic LTB lesion locations, sizes, and morphologic features are essential for LTB diagnoses. This study aimed to explore the appearance and morphologic features of LTB and correlated these features with clinical symptoms.We retrospectively analysed 39 LTB patients in our hospital between January 2013 and December 2019. Medical records, including clinical presentation, lesion appearance (locations, sizes, and morphology), complementary examination results, and histopathologic features were summarized and analysed.In this patient cohort, dysphonia and sore throat were the two most common clinical symptoms. In LTB patients with extensive lesions, ulcerative lesions were most common, and the proportion of cases with concurrent pulmonary tuberculosis (86.4%, P = .033) infection was higher, as were the positive rates of sputum smears (72.7%, P = .011) and cultures (86.4%, P = .002) than patients without concurrent pulmonary TB and with more localized and exophytic lesions. The histopathologic features of LTB-related ulcerative lesions included fewer granulomas and more areas with caseous necrosis. These lesions were more likely to have acid-fast bacilli detected with a Ziehl-Neelsen stain than exophytic lesions that rarely showed detectable bacilli.A complete knowledge regarding the visual and morphologic features of LTB on laryngoscopy is needed for the early detection and diagnosis of LTB. Our study revealed the lesion sites, sizes, and morphologic features of LTB. These parameters were also correlated with patient clinical symptoms. Future studies are needed to support and expand the results of this retrospective study.
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Affiliation(s)
- Jian Zang
- Department of Otolaryngology, The First Affiliated Hospital, China Medical University, Shenyang
| | - Ying Tian
- Department of Otolaryngology, The First Affiliated Hospital, China Medical University, Shenyang
| | - Xuejun Jiang
- Department of Otolaryngology, The First Affiliated Hospital, China Medical University, Shenyang
| | - Xu-Yong Lin
- Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
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