[Ear tuberculosis concomitant with pulmonary localization in an HIV-immunosuppressed patient, in Bamako, Mali]

Introduction/Rationale

Tuberculosis remains a major public health issue. It is an opportunistic pathology, very common in HIV-immunocompromised persons, classifying it at the WHO stage 4. Ear tuberculosis remains a rare and under-diagnosed clinical form. We report here a case of ear tuberculosis concomitant with pulmonary localization in an HIV-immunosuppressed person on triple antiretroviral therapy aged 32 years hospitalized in Bamako (Mali) to discuss the diagnostic and therapeutic difficulties posed by this rare localization.

Description of the case

The patient had a chronic productive cough, otalgia and right chronic purulent otorrhea. The search for acid-resistant bacilli was positive for direct examination in gastric casing fluid and swabbing of the ear pus, confirming the diagnosis of tuberculosis. Anti-tuberculosis treatment instituted for 6 months associated with adjuvants resulted in complete healing of the patient.

Discussion/conclusion

Although rare, ear localization must be actively sought. Etiological treatment must be instituted upon confirmation of the diagnosis to avoid complications and sequelae.

Cerumen microbial community shifts between healthy and otitis affected dogs

Otitis externa is a common multifactorial disease in dogs, characterized by broad and complex modifications of the ear microbiota. The goal of our study was to describe the ear cerumen microbiota of healthy dogs, within the same animal and between different animals, and to compare the cerumen microbiota of otitis affected dogs with that of healthy animals. The present study included 26 healthy dogs, 16 animals affected by bilateral otitis externa and 4 animals affected by monolateral otitis externa. For each animal cerumen samples from the right and left ear were separately collected with sterile swabs, and processed for DNA extraction and PCR amplification of the 16S rRNA gene. Amplicon libraries were sequenced using an Ion Torrent Personal Genome Machine (PGM), and taxonomical assignment and clustering were performed using QIIME 2 software. Our results indicate that the bacterial community of the cerumen in healthy dogs was characterized by extensive variability, with the most abundant phyla represented by Proteobacteria, Actinobacteria, Firmicutes, Bacteroidetes and Fusobacteria. The analysis of both alpha and beta diversity between pairs of left and right ear samples from the same dog within the group of affected animals displayed higher differences than between paired samples across healthy dogs. Moreover we observed reduced bacterial richness in the affected group as compared with controls and increased variability in population structure within otitis affected animals, often associated with the proliferation of a single bacterial taxon over the others. Moreover, Staphylococcus and Pseudomonas resulted to be the bacterial genera responsible for most distances between the two groups, in association with differences in the bacterial community structure. The cerumen microbiota in healthy dogs exhibits a complex bacterial population which undergoes significant modifications in otitis affected animals.

Extended spectrum beta lactamase producing bacteria among outpatients with ear infection at FelegeHiwot Referral Hospital, North West Ethiopia

BACKGROUND

Antibiotic resistant bacteria particularly extended-spectrum beta lactamase (ESBL) producing are of major concern for management of outpatients. They can spread rapidly and are associated with poor patient outcome. However, there is scarcity of information on ear infection with ESBL producing bacteria in Ethiopia. Therefore, this study investigates the prevalence of ear infection with ESBL producing bacteria among outpatients attending Felegehiwot Referral Hospital, Northwest Ethiopia.

METHODS

A hospital based cross-sectional study was conducted from May, 2018 to January, 2019. Demographic and clinical data were collected with face to face interview and were complemented with patient card review. Ear discharge specimens were collected from study participants using swab technique. All ear swab specimens were cultured using standard microbiological techniques. The ESBL producing bacteria were detected by double disc synergy test and interpreted based on Clinical and laboratory Standards Institute Guidelines. Chi-square and fisher's exact tests were calculated to check association between variables.

RESULTS

A total of 236 patients (male = 138 and female = 98) with ear infection took part in the study. The median age of the participants was 20years. Overall, 10 (4.23%, 95%CI; 2.3-7.6%) of patients had ear infection with ESBL producing bacteria. Other chronic illnesses (p = 0.003), history of hospital visit and treatment (p = 0.006) and history of antibiotic use without physician's prescription (p<0.001) had significant association with prevalence of ESBL producing bacteria in ear infection. The proportion of ear infection with ESBL producing P.mirabilis, P.aeruginosa and K.pneumoniae were 4 (1.7%), 3 (1.3%) and 2 (0.8%), respectively. All ESBL producing isolates were MDR (100%). Overall, 58 (43%) species were MDR. P.aeruginosa was the leading MDR isolate 29 (53.7%).For all bacterial isolates of ear infection, ampicillin(93.3%) and amoxicillin-clavulanic acid (58.5%) revealed high level of resistance whereas low resistance rates were observed for ciprofloxacin (5.2%), third generation cephalosporin (11.9-20%) and aztreonam (16.3%).

CONCLUSIONS

Ear infection due to ESBL producing bacteria coupled with high levels of MDR is becoming a growing concern for outpatients in the study area. Regular detection of these bacteria and wise use of antibiotics are needed to stop the spread of this form of resistance.

Prevalence and mechanisms of resistance to fluoroquinolones in Pseudomonas aeruginosa and Escherichia coli isolates recovered from dogs suffering from otitis in Greece

The aim of this study was to investigate the prevalence and the implicated mechanisms of resistance against selected veterinary fluoroquinolones (enrofloxacin, marbofloxacin and pradofloxacin) among 101 Pseudomonas aeruginosa (n=75) and Escherichia coli (n=26) isolates collected from dogs suffering from otitis. Resistance ranged from 32.0% to 48.0% with differences not being considered statistically significant among the three agents or between the two bacterial species. However, individual MICs of pradofloxacin, the latest veterinary fluoroquinolone, were significantly lower than those of enrofloxacin, the oldest one, indicating an increased in vitro potency of the former antimicrobial. Pradofloxacin MIC₉₀ was, additionally, the lowest (8μg/ml), in E. coli, or among the lowest (8μg/ml), in P. aeruginosa isolates. Resistance was in most cases associated with topoisomerase substitutions, with patterns GyrA:V73G in P. aeruginosa and GyrA:S83L+D87N/ParC:S58I+A86V in E. coli being reported for the first time in small animal isolates. Only 6.7% and 15.4% of P. aeruginosa and E. coli otitis isolates, respectively, carried plasmid-mediated quinolone resistance (PMQR) genes, which, moreover, contributed minimally to resistance. Efflux pump activity was additionally detected in resistant E. coli isolates, even those lacking topoisomerase substitutions or PMQR genes. The emergence of resistance in the canine otitis isolates seemed to be associated with previous, prolonged systemic fluoroquinolone administration. In any case, antimicrobial susceptibility testing should guide the selection of systemic FQs for the treatment of canine otitis.

Preventive Effect of Cow's Milk Fermented with Lactobacillus paracasei CBA L74 on Common Infectious Diseases in Children: A Multicenter Randomized Controlled Trial

Background: Fermented foods have been proposed to prevent common infectious diseases (CIDs) in children attending day care or preschool. Objectives: To investigate the efficacy of dietary supplementation with cow’s skim milk fermented with the probiotic Lactobacillus paracasei CBA L74 in reducing CIDs in children attending day care or preschool. Methods: Multicenter, randomized, double-blind, placebo-controlled trial on healthy children (aged 12–48 months) consuming daily 7 grams of cow’s skim milk fermented with L. paracasei CBA L74 (group A), or placebo (maltodextrins group B) attending day care or preschool during the winter season. The main outcome was the proportion of children who experienced ≥1 episode of CID during a 3-month follow-up. Fecal biomarkers of innate (α- and β-defensins, cathelicidin) and acquired immunity (secretory IgA) were also monitored. Results: A total of 126 children (71 males, 56%) with a mean (SD) age of 33 (9) months completed the study, 66 in group A and 60 in group B. At intention to treat analysis, the proportion of children presenting ≥1 CID was 60% in group A vs. 83% in group B, corresponding to an absolute risk difference (ARD) of −23% (95% CI: −37% to −9%, p < 0.01). At per-protocol-analysis (PPA), the proportion of children presenting ≥1 CID was 18% in group A vs. 40% in group B, corresponding to an absolute risk difference (ARD) of −22% (95% CI: −37% to −6%, p < 0.01). PPA showed that the proportion of children presenting ≥1 acute gastroenteritis (AGE) was significantly lower in group A (18% vs. 40%, p < 0.05). The ARD for the occurrence of ≥1 AGE was −22% (95% CI: −37% to −6%, p < 0.01) in group A. Similar findings were obtained at PPA regarding the proportion of children presenting ≥1 upper respiratory tract infection (URTI), which was significantly lower in group A (51% vs. 74%, p < 0.05), corresponding to an ARD of −23% (95% CI: −40% to −7%, p < 0.01). Significant changes in innate and acquired immunity biomarkers were observed only in subjects in group A. Conclusions: Dietary supplementation with cow’s skim milk fermented with L. paracasei CBA L74 is an efficient strategy in preventing CIDs in children.

Mycoplasma Otitis in California Calves

A retrospective study of Mycoplasma otitis in California calves submitted for necropsy between 1993 and 2002 was conducted to characterize the demographic features of the disease and the pathologic findings associated with infection. Sixty-one confirmed cases of Mycoplasma otitis were identified among 20,525 necropsied cattle. All affected animals were calves, ranging in age from 2 weeks to 4 months and with a median age of 1.5 months. Ninety-two percent of the cases were dairy breeds. A higher percent of necropsied calves with Mycoplasma otitis were males (0.45%) than females (0.23%). The proportion of cases that had Mycoplasma otitis increased from 1993 to 2002, and there was a significant ( P < 0.05) seasonal distribution, with the highest proportion in the spring and the lowest in the summer months. Infections involved both the middle and inner ear and were characterized by a suppurative inflammatory response with extensive bony involvement. Three species of Mycoplasma were isolated from the ears: M. bovis, M. bovirhinis, and M. alkalescens. Concurrent pneumonia occurred in 47 cases (77%), and Mycoplasma was isolated from the lungs of 30 of those cases. The increasing proportion of Mycoplasma otitis cases in the past 10 years emphasizes the importance of identifying risk factors that could be modified to lower the incidence of this disease in calves.

Ethnopharmacological uses of Sempervivum tectorum L. in southern Serbia: Scientific confirmation for the use against otitis linked bacteria

ETHNOPHARMACOLOGICAL RELEVANCE

Sempervivum tectorum L. (Crassulaceae), known as houseleek, is used in traditional medicine in the treatment of ear inflammation. It can be spread as a pack on wounds, sores, burns, and abscesses and also on painful areas attacked by gout as a refrigerant and astringent. Drinking tea prepared from leaves of S. tectorum is recommended for ulcer treatment. The present study was designed to investigate ethopharmacological use of S. tectorum in the southern Serbia and to further scientifically justify and confirm effectiveness of the leaf juice used in ethnomedicine for ear inflammation, against otitis linked bacteria.

MATERIAL AND METHODS

Ethnopharmacological survey on the use of S. tectorum in southern Serbia was performed using semi structured questionnaires via a face-to-face interview. Chemical composition of the leaf juice regarding phenolic compounds and organic acids was analyzed. Antimicrobial activity was tested on bacteria isolated from ear swabs of the patients suffering from the ear pain (otitis). Anti-quorum-sensing activities of the juice were further investigated on Pseudomonas aeruginosa.

RESULTS

Ethnopharmacological survey revealed the use of S. tectorum in southern Serbia for the treatment of ear pain, warts, cancer, stomachache, ulcer and high blood sugar level with the highest fidelity level (FL) for the ear pain. The phenolic composition of the S. tectorum leaf juice consisted of flavonol glycosides, with kaempferol-3-O-rhamnosyl-glucoside-7-O-rhamnoside as the majority compound. Organic acids composition revealed malic acid as the most dominant one. Antimicrobial and anti-quorum-sensing activities of the juice showed to be promising.

CONCLUSION

Ethnopharmacological use of S. tectorum juice for treating ear pain is justified, since the juice possessed antimicrobial activity towards clinical isolates of bacteria linked to otitis.

Genotyping and antifungal susceptibility testing of multiple Malassezia pachydermatis isolates from otitis and dermatitis cases in pets: is it really worth the effort?

A total of 216 colonies of Malassezia pachydermatis from 28 cases of fungal otitis or dermatitis in pets were genotyped by M13 fingerprinting and tested for antifungal susceptibility. A huge genetic diversity was found (157 M13 types in total), with all animals having a polyclonal pattern of infection (5.4 ± 1.5 genotypes/sample). Furthermore, analysis of molecular variance (AMOVA) revealed that most genetic diversity (44%) was found at the within sample level. In contrast, variability in antifungal susceptibility among isolates from the same sample was less important, with different M13 types displaying in most cases identical or very similar MIC results. Most isolates displayed high in vitro susceptibility to amphotericin B, terbinafine and all azoles tested except fluconazole, for which MIC values were always ≥4 μg/ml and a 26.9% of isolates displayed values ≥32 μg/ml. We conclude that although characterization of multiple yeast isolates results in a considerable increase in laboratory workload and expenses, it may help to get a better understanding of the epidemiology of M. pachydermatis in a given patient population.

[Antibiotic Resistance and Serotype Pattern of Streptococcus pneumoniae Isolated from Children in St. Petersburg in 2010-2013]

The surveillance of the serotype pattern and antibiotic resistance of S. pneumoniae in various geographical regions is required for the validity of rational etiotrophic therapy of pneumococcal infections and the choice of the optimal vaccines for their prophylaxis. 250 S. pneumoniae isolates from children with acute otitis or pneumonia and healthy carriers in St. Petersburg in 2010-2013 were investigated. The analysis of the serotype pattern of the pneumococci showed that 13-valent conjugate vaccine was the most active (86.1% of pneumococci causing pneumonia and 86.4% of pneumococci causing acute otitis). The isolates were higly resistant to beta-lactams and macrolides. By the EUCAST criteria, the decrease in the susceptibility to penicillin, cefotaxime, erythromycin and ceftarolin was observed in 32.4%, 14%, 33.2 and 6% of the isolates respectively. 22.4% of the isolates showed associate resistance to penicillin and erythromycin.. No resistance to moxifloxacin was detected. The frequency of resistance to tetracycline, co-trimoxasole and chloramphenicol in various patients ranged within 30-50%. The prevalence of the antibiotic resistance was mainly characteristic of the isolates serotypes 19A, 19F, 14 and serogroup 6.

[Fever, skin rash and blood bullae of the ears in a middle-aged woman]

A healthcare worker sought medical advice after four days of fever, muscle pains, occipital headache and blocked ears, and was diagnosed with a high CRP level and blood bullae in the outer ear canal. In addition, skin rash appeared during hospital care, and the fever did not seem to go down upon treatment with broad-spectrum antibiotics, during which the CRP rose to a level of 413 mg/L at the highest. Haemorragic bullous otisis was confirmed diagnosis caused by Mycoplasma Pneumoniae.

[Suppression of experimental inflammation by anti-fungal agent liranaftate in mice]

To evaluate the anti-inflammatory activity of the thiocarbamate antifungal agent liranaftate, the edema and the neutrophil accumulation detected by the activity of neutrophil marker enzyme, myeloperoxidase (MPO), were examined following application of liranaftate to mouse ears with inflammation induced by phorbol 12-myristate 13-acetate (PMA). Topical 20 microl administration of liranaftate in a dose-range between 1-4% suppressed the increase in ear thickness 6 hr after PMA application dose-dependently. Similarly, it decreased the weight increase of an ear section after 24 hr dose-dependently. More than 1% of liranaftate also suppressed augmentation of MPO activity of the ear section. This and histological observation indicate that liranaftate treatment suppressed neutrophil accumulation in PMA-applied ear lesion. From these results, we discussed that liranaftate might suppress inflammatory symptoms caused by trychophytosis in a clinical condition.

[Fungal infection in the otorinolaryngologic area]

Recent trends of fungal infections of the ear and nose were introduced from the viewpoint of otolaryngologic practice. Aspergillus terreus was the most common pathogen of otomycosis followed by A. niger and A.flavus. Aspergillosis is the most common fungal disease in the paranasal sinuses. Unilateral opacity of the maxillary sinus which contains flecks of calcification was specifically found by CT-study. These two fungal infections are easily treated surgical removal of the fungus ball and establishment of a drainage route to the nasal passage by endoscopic sinus surgery are effective to manage aspergillomas in paranasal sinuses. These two fungal infections usually occurred in immunocompetent patients and the relationship between diabetes mellitus as the underlying disease is not established.

[Upper respiratory tract infections in children caused by atypical bacteria]

It encounters despite solid progress in development of diagnostic methods diagnostics the diseases of upper respiratory tract and ears in children called out by atypical bacteria's on the ground clinical symptoms and their treatment is difficulty still.

AIM

The performance of accessible review of current literature was on the aim of work opinion of the atypical bacteria's part in evocation the infections the upper respiratory tract and ears in children, and performance of characteristic symptoms of clinical diseases these organs the bacteria's also.

CONCLUSIONS

The quoted in work results of investigations do not it let on the unambiguous opinion the atypical bacteria part in contagions of infections the upper respiratory tract and ears in children. It seems however, that Mycoplasma pneumoniae answers first of all for evocation the acute infections of upper respiratory tract; however Chlamydophila pneumoniae plays the larger part in illnesses chronic as well as co-existent pathogen in illnesses sharp. Atypical bacteria can cause upper respiratory tract infections significantly more often than previously thought. These infections often occur in patients with history of respiratory recurrences.

[Is otitis and tonsillitis handled in the same way within normal working hours and out-of-hours?]

BACKGROUND

Several factors influence physicians' prescribing of antibiotics. The purpose of this study is to see whether physicians use diagnostic testing and prescribe antibiotics differently for acute otitis media (AOM) and tonsillitis when they work within normal working hours and out-of-hours.

MATERIAL AND METHODS

The study was a retrospective study of electronic patient records in a 6-month period, from 1.09.1998 to 31.3.1999. All journal notes from the out-of-hours services and the participating general practice clinics were examined. The following variables were recorded: diagnosis, patient age and gender, use of C-reactive protein (CRP) and StrepA testing and treatment.

RESULTS

In the diagnosis of AOM, CRP was used in 8 % of patients cared for out-of-hours and 6 % of those treated during normal working hours. There was no significant difference between the proportion of patients treated with antibiotics out-of-hours (74 %) and within normal working hours (73 %), but individual physicians differed significantly with respect to prescription of antibiotics and use of diagnostic tests. In the diagnosis of tonsillitis, either StrepA antigen test, CRP, or both tests were used in 65 % of patients cared for out-of-hours and in 50 % of those cared for during normal working hours. There was no significant difference in the proportion of patients treated with antibiotics out-of-hours (76 %) or during normal working hours (69 %).

INTERPRETATION

Individual physicians use diagnostic testing and prescribe antibiotics in a similar way within and out-of-hours, but there were significant differences between individual physicians.

Apophysomyces elegans causing acute otogenic cervicofacial zygomycosis involving salivary glands

Zygomycosis is an invasive, life threatening fungal infection that usually affects immunocompromised hosts. In the head and neck region, rhino-orbito-cerebral zygomycosis is more common than the cervicofacial variety. We report the first case of otogenic cervicofacial zygomycosis caused by Apophysomyces elegans involving the salivary glands, an uncommon site of infection. The case began after a trivial trauma in a diabetic patient and despite surgical debridement and liposomal amphotericin B therapy, the patient died due to extensive involvement and metabolic/hemodynamic complications.

[Microbiological diagnosis of upper respiratory tract infections]

Upper respiratory tract (URT) infections are common and account for more medical visits than any other type of infectious disease. Diagnostic procedures for the following syndromes are included in this report: Streptococcal and nonstreptococcal pharyngitis, laryngeal syndromes, otitis, sinusitis, and others caused by unusual and/or uncommon bacteria or fungi, including Lemierre's disease, Vincent's angina, pharyngeal and peritonsillar abscesses, diphtheria, candidiasis, and zygomycoses. Detailed information is provided on specimen collection and processing, selection of laboratory tests, interpretation of findings, reporting results, additional procedures for uncommon infections, and the use of new techniques. All the information included in this article is contained in the Standard Operating Procedures for Clinical Microbiology (http://www.seimc.org/protocolos/microbiologia/).

Scedosporium apiospermum otomycosis

We present a case of Scedosporium apiospermum otomycosis in an immunocompetent 62-year-old woman presumably inoculated as a child in Vietnam. She had life-long recurrent symptoms of chronic otomastoiditis and otorrhea. The organism was identified in an unexpected wound infection after a modified radical mastoidectomy done for chronic otitis media. Treatment consisted of local debridement of necrotic tissue, topical wound care, and long-term systemic antifungals.

Suction clearance and 2% topical miconazole versus the same combination with acidic drops in the treatment of otomycosis

From April 2003 to September 2004, 59 ears from 55 patients received suction clearance and topical miconazole 2% (regimen 1) and in September 2004 to December 2005, 64 ears from 58 patients received the same combinations plus acidic drops [acetic acid 3% (v/ v) in 97% ethanol]. The mean age of patients treated with regimen 1 was 35.76+/-16 years and in regimen 2 was 37.98+/-15 years. Aspergilus sp and Candida sp were seen in 35 (59.3%) and 24 (40.7%) cases treated with regimen 1 and in 43 (67.2%) and 21 (32.8%) cases treated in regimen 2, respectively. Relapse occurred in 2 (3.4%) ears treated with regimen 1, but none in cases treated with regimen 2 (p=0.228). The findings reveal that there were no statistically significant differences between the two regimens and both may be used for the treatment of otomycosis.

Biofilm development by clinical isolates ofMalassezia pachydermatis

Malassezia pachydermatis fungemia has been reported in patients receiving parenteral nutrition. Biofilm formation on catheters may be related to the pathogenesis of this mycosis. We investigated the biofilm-forming ability of 12 M. pachydermatis strains using a metabolic activity plate-based model and electronic microscopic evaluation of catheter surfaces. All M. pachydermatis strains developed biofilms but biofilm formation showed variability among the different strains unrelated to their clinical origin. This study demonstrates the ability of M. pachydermatis to adhere to and form biofilms on the surfaces of different materials, such as polystyrene and polyurethane.

Leczenie grzybic górnych dróg oddechowych i ucha

Fungi, in comparison with other pathogenic factors, have high pathogenicity. The number of fungal species which are able to infect people is over 500. The upper respiratory tract and ear have permanent contact with external environment which makes their ontocenoses open to continuous exchange of microorganisms of which they consist. In etiology of inflammatory processes 21 species which belonging to 3 genera (Zygomycota, Ascomycota, Basidiomycota) of fungi play important role. Administration of antifungal drugs can be: prophylactic, empiric preemptive and therapeutic. Physicians may prescribe antibiotics (mainly pollens: amphotericin B, natamycin and nystatin) and chemiotherapeutics (mainly azoles and fluorpirymidins, pigments, chlorhexidine and chlorquinaldol). In ENT practice topical and systemic drugs can be administrated. Topical lozenges include amphotericin B, clotrimazole, chlorhexidine or chlorquinaldol and oral gels: nystatin and miconazole. Some of drugs are in the form of suspension/solution, which can be used for inhalation, into the sinus, for swabbing or for lavage: amphotericin B, natamycin, nystatin, clotrimazol, flucytosine, miconazole, fluconazole, vorykonazole, caspofungin. It should be underlined that only a few of dugs can be absorbed from the digestive tract: flucytosine, fluconazole, itraconazole, ketoconazole, miconazole, vorykonazole.

Intelligent Bayes Classifier (IBC) for ENT infection classification in hospital environment

Electronic Nose based ENT bacteria identification in hospital environment is a classical and challenging problem of classification. In this paper an electronic nose (e-nose), comprising a hybrid array of 12 tin oxide sensors (SnO₂) and 6 conducting polymer sensors has been used to identify three species of bacteria, Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), and Pseudomonas aeruginosa (P. aeruginosa) responsible for ear nose and throat (ENT) infections when collected as swab sample from infected patients and kept in ISO agar solution in the hospital environment. In the next stage a sub-classification technique has been developed for the classification of two different species of S. aureus, namely Methicillin-Resistant S. aureus (MRSA) and Methicillin Susceptible S. aureus (MSSA). An innovative Intelligent Bayes Classifier (IBC) based on "Baye's theorem" and "maximum probability rule" was developed and investigated for these three main groups of ENT bacteria. Along with the IBC three other supervised classifiers (namely, Multilayer Perceptron (MLP), Probabilistic neural network (PNN), and Radial Basis Function Network (RBFN)) were used to classify the three main bacteria classes. A comparative evaluation of the classifiers was conducted for this application. IBC outperformed MLP, PNN and RBFN. The best results suggest that we are able to identify and classify three bacteria main classes with up to 100% accuracy rate using IBC. We have also achieved 100% classification accuracy for the classification of MRSA and MSSA samples with IBC. We can conclude that this study proves that IBC based e-nose can provide very strong and rapid solution for the identification of ENT infections in hospital environment.

Vibrio alginolyticus infections in the Netherlands after swimming in the North Sea

During the summer of 2006, wound infections in bathers caused by Vibrio species were reported from several European countries. In Germany, three people were reported to have developed Vibrio vulnificus infections

Susceptibility of yeast isolates from cattle with otitis to aqueous solution of povidone iodine and to alcohol-ether solution

Lipid-dependent Malassezia species, Candida spp. and Rhodotorula mucilaginosa have been associated with bovine parasitic otitis. This paper evaluated the susceptibility of 63 yeast isolates from cattle with otitis to a povidone iodine aqueous solution (1% and 0.5% v/v) and to an alcohol-ether solution (1:1 v/v). The effectiveness of these antiseptics was assessed using the European suspension test. Products achieving equal to or greater than 5-log reduction in numbers of the challenge organism after 5 min contact are considered to have as acceptable microbicidal effect (ME). The two antiseptic solutions achieved ME greater than 5, when tested at 1 and 5 min contact time, against the majority of yeast strains. The exceptions were alcohol and ether solution against two Candida tropicalis strains. Urea broth macrodilution method was used to determine the minimum inhibitory concentration (MIC), defined as the lowest concentration that resulted in a visually negative urease test or, in the case of Candida spp., turbidity inhibition when compared with that produced by the growth control. Analysis of the results for all 63 isolates showed Malassezia sympodialis and Rhodotorula mucilaginosa to be more susceptible to povidone iodine and Malassezia furfur strains to be less susceptible. Malassezia sympodialis was significantly more susceptible to alcohol-ether solution than other species. This study showed the in vitro efficacy of alcohol-ether solution and povidone iodine and proposes the need for clinical evaluation of the topical treatment and control of bovine otitis with these antiseptics and their effects on the ear microbiota and the ear canal.

[Presumption diagnosis: otomycosis. A 451 patients study]

Otomycosis is a common disease. We try to analyze the causative factors for otomycosis in our environment. Our study includes 451 patients with a presumed diagnosis of otomycosis. The patients were included by ear, nose and throat specialist and general doctors; the diagnosis was confirmed in 24.43% and 16.16% respectively. The most common fungal pathogen found was Aspergillus spp. and Candida sp. The high frecuency of Aspergillus Niger may be because of the diferent ways of gathering samples. The abundance of Candida parapsilosis in the samples that came from general doctors may be because the inadequate treatment with topic antibiotics contributes fungal proliferation. We conclude that the causative factors for otomycosis could be avoided or treated. Treatment with antifungal agents is not enought to ensure complete cure, an furthermore the treatment should be aimed to restore the physiology of the external auditory cannal.

Isolation of Staphylococcus schleiferi from healthy dogs and dogs with otitis, pyoderma, or both

OBJECTIVE

To determine the frequency of isolation and susceptibility patterns of Staphylococcus schleiferi from healthy dogs and dogs with otitis, pyoderma, or both that had or had not received antimicrobial treatment.

DESIGN

Prospective study.

ANIMALS

50 dogs.

PROCEDURE

Dogs were allocated to 1 of 4 groups: healthy dogs (n=13), dogs without otitis but with pyoderma (10), dogs with otitis but without pyoderma (11), and dogs with otitis and pyoderma (16). Bacteriologic culture of ear swab specimens was performed in all dogs. Bacteriologic culture of skin swab specimens was also performed in dogs with concurrent pyoderma. Isolates were identified as S schleiferi subsp schleiferi or S schleiferi subsp coagulans on the basis of growth and biochemical characteristics.

RESULTS

S schleiferi was not isolated from any dogs with pyoderma only. Staphylococcus schleiferi subsp schleiferi was isolated from the ears of 2 healthy dogs, and the skin and ears of 2 dogs and the skin of 1 dog with otitis and pyoderma. Staphylococcus schleiferi subsp coagulans was isolated from the ears of 3 dogs with otitis only, and the ears of 6 dogs and the skin of 2 dogs with otitis and pyoderma. One of the S schleiferi subsp schleiferi isolates from ears, 2 of the S schleiferi subsp coagulans isolates from ears, and 1 of the S schleiferi subsp coagulans isolates from the skin were resistant to methicillin. One methicillin-resistant isolate from the ears and 1 from the skin were also resistant to fluoroquinolones.

CONCLUSIONS AND CLINICAL RELEVANCE

S schleiferi subsp schleiferi was detected in healthy dogs and dogs with otitis and pyoderma. Methicillin-resistant and -susceptible S schleiferi subsp schleiferi and S schleiferi subsp coagulans were detected as the predominant organisms in dogs with otitis.

Malassezia Baillon, emerging clinical yeasts

The human and animal pathogenic yeast genus Malassezia has received considerable attention in recent years from dermatologists, other clinicians, veterinarians and mycologists. Some points highlighted in this review include recent advances in the technological developments related to detection, identification, and classification of Malassezia species. The clinical association of Malassezia species with a number of mammalian dermatological diseases including dandruff, seborrhoeic dermatitis, pityriasis versicolor, psoriasis, folliculitis and otitis is also discussed.

Association between phospholipase production by Malassezia pachydermatis and skin lesions

An evaluation was made of the phospholipase activities of Malassezia pachydermatis strains isolated from healthy dogs versus those from dogs with dermatitis and otitis. A high percentage of strains of M. pachydermatis obtained from lesion sites (93.9%) produced phospholipase, compared to the strains obtained from healthy skin of the same dog with localized lesions (41.4%) and healthy dogs (10.6%).

[Species affiliation of staphylococci isolated in purulent infections]

The microflora was studied of the clinical material taken from those patients presenting with different pyo-septic diseases. It has been ascertained that a key role in the etiology of the above diseases must be referred to gramme-positive micro-organisms--to coagulase-negative staphylococci among their number. Of these, S. haemolyticus and S. epidermidis were found with high frequency.

Malassezia species in skin diseases

Since the taxonomic revision carried out in 1996, enlarging the genus Malassezia to comprise seven different species, a number of studies have investigated from different points of view -- mycological, molecular and immunological -- the relationships of these species with the pathologies associated with lipophilic yeasts, as well as its presence in healthy skin. From these studies, it now appears clear that Malassezia globosa is the main species associated with pityriasis versicolor, which is the only cutaneous disease in which the involvement of Malassezia is undisputed. Nevertheless, this species can also be found in normal skin, in which the predominant species is Malassezia sympodialis. In the remaining dermatological disorders related to Malassezia, the role of these yeasts is controversial. In seborrhoeic dermatitis, atopic dermatitis and folliculitis, several studies have focused on the immunological aspects that could explain the pathogenic mechanism. In other diseases, such as confluent and reticulate papillomatosis, neonatal pustulosis, otitis and onychomycosis, the presence or significance of Malassezia is still a matter of dispute.

Otomycosis: prevalence, clinical symptoms, therapeutic procedure

Local lesions observed in otitis, create favourable conditions for the growth of fungi and development of mycoses both in the external and middle ear, as well as in post-operative cavities, especially in cases of open-type surgery. The objective of this study was: (1) to determine the prevalence of mycotic infections in inflammatory conditions of the ear; (2) to evaluate the relationship between the presence of fungi and clinical symptoms of inflammation; and (3) to construct a model of therapeutic procedure. The study concerned 345 individuals, including 295 patients (381 ears) who presented with symptoms of otitis. The mycological examinations revealed presence of fungi in 30.4% cases (116 ears). Positive culture results were obtained predominantly in patients with post-operative suppuration (52.8%). Otomycosis was more often associated with fungi of the genus Candida (3/5) than with fungi of the genus Aspergillus (2/5). The analysis of symptoms in otomycoses showed that in bacteria-induced otitis, pruritus, discharge, post-operative defective hearing and headaches are most common; the analysis of signs showed that reddened epidermis and lining of the tympanic cavity are statistically more frequent. The therapeutic protocol adopted in otomycoses yields good results: 89%--complete cure.

Serum antibodies to Malassezia yeasts in canine atopic dermatitis

Significant numbers of humans with atopic dermatitis develop Malassezia-specific IgE. Immediate skin-test reactivity to Malassezia has been demonstrated in atopic dogs. The aim of this study was to compare the serum IgG and IgE response to Malassezia in atopic dogs with and without clinical evidence of Malassezia dermatitis and/or otitis, nonatopic dogs with clinical evidence of Malassezia dermatitis and/or otitis and healthy dogs. Cytology was used to diagnose clinically significant Malassezia dermatitis and otitis. Contact plate cultures confirmed the validity of this technique. Reproducible enzyme-linked immunosorbent assays for Malassezia-specific IgG and IgE in canine serum were established. Atopic dogs had significantly higher serum IgG and IgE levels than either healthy dogs or nonatopic dogs with clinical evidence of Malassezia dermatitis and/or otitis. There was no significant difference in IgG and IgE levels between atopic dogs with and without clinical evidence of Malassezia dermatitis and/or otitis. The implications of these findings in the pathogenesis and management of canine atopic dermatitis are discussed.

The significance of nasal carriage of Staphylococcus aureus as risk factor for human skin infections

The present study was designed to investigate the significance and the relationship between nasal carriage of Staphylococcus aureus and staphylococcal skin infections. Thirty-one S. aureus strains, isolated from 12 patients with chronic and recurrent skin infections, one patient with septicemia and one patient with otitis externa were studied. The staphylococcal strains were isolated from the site of infection and from the anterior nares of each patient. The identity of both strains of each pair could be demonstrated by determination of phenotypic properties and by genotyping of the isolates. The phenotypic properties included hemolytic activities, antibiotic resistance data, and the production of enterotoxins. The identity was additionally confirmed by phage-typing, by determination of the size and the number of repeats of the X region of spa gene, by determination of gene polymorphisms of coa gene and by macrorestriction analysis of the chromosomal DNA of the isolates by pulsed-field gel electrophoresis. The present results showed an identity of the S. aureus obtained from anterior nares and from skin infection of each patient indicating the importance of nasal carriage of these bacteria for development of human skin infection.

Elastase deficiency phenotype of Pseudomonas aeruginosa canine otitis externa isolates

Pseudomonas aeruginosa veterinary isolates were assayed for elastase and total matrix protease activity. The elastase activity of canine ear isolates was much less than that of strain PAO1 and that of all other veterinary isolates (P < 0.0001). The results indicate that canine ear isolates have a distinct elastase phenotype.

Comparison of serotyping, ribotyping and pulsed-field gel electrophoresis for distinguishing group A Streptococcus strains isolated in Albania

Conventional serotyping for T antigens, rRNA gene restriction fragment length polymorphism analysis (ribotyping) and pulsed-field gel electrophoresis were compared for distinguishing among group A streptococci isolated in Albania between 1980-1982 and in 1995. A total of twelve serotypes were identified among seventy GAS strains. Ribotyping revealed eight and eleven distinct patterns after digestion with HindIII and PvuII, respectively. Twenty-three strains of serotype T12 were subdivided in 10 ribotypes and 11 strains of T2 serotype were differentiated in 5 ribotypes. By comparison, PFGE generated 37 patterns after SmaI digestion. The index of discrimination, using the Hunter-Gaston formula, was applied to assess the value of these methods for interpretation of the epidemiological data. For serotyping the value of index was 0.85. The ribotyping system revealed an ID of 0.83 when the combination HindIII and PvuII was used. This index reached 0.97 for PFGE. The methods used were useful to subtype the isolates of GAS.

Proteinase, phospholipase, hyaluronidase and chondroitin-sulphatase production by Malassezia pachydermatis

The production of four functional enzyme categories was investigated in 30 strains of Malassezia pachydermatis isolated from dogs with otitis or dermatitis. The most appropriate reading intervals for these assays were determined with the aid of statistical comparisons. All strains produced proteinase and chondroitin-sulphatase; hyaluronidase and phospholipase were produced by all skin isolates (15/15) and 14 out of 15 ear canal isolates. Strains from ear canals did not differ significantly as a group from skin strains in quantitative production of any of the four enzymes; production of proteinase and chondroitin-sulphatase in particular was markedly uniform.

Anaerobic infections in children

Anaerobic bacteria commonly cause infection in children. Anaerobes are the most predominant components of the normal human skin and mucous membrane bacterial flora, and are therefore a common cause of bacterial infections of endogenous origin. Because of their fastidious nature, they are difficult to isolate from infectious sites and are often overlooked. Anaerobic infections can occur in all body sites, including the central nervous system, oral cavity, head and neck, chest, abdomen, pelvis, skin, and soft tissues. Anaerobic bacteria colonize the newborn after delivery and have been recovered from several types of neonatal infections. These include cellulitis of the site of fetal monitoring, neonatal aspiration pneumonia, bacteremia, conjunctivitis, omphalitis, and infant botulism. The lack of directing adequate therapy against these organisms may lead to clinical failures. Their isolation requires appropriate methods of collection, transportation, and cultivation of specimens. Treatment of anaerobic infection is complicated by the slow growth of these organisms, by their polymicrobial nature, and by the growing resistance of anaerobic bacteria to antimicrobials. Antimicrobial therapy is often the only form of therapy required, whereas in other cases it is an important adjunct to a surgical approach. Because anaerobic bacteria generally are recovered mixed with aerobic organisms, the choice of appropriate antimicrobial agents should provide for adequate coverage of both types of pathogens.

Phenotypic and phylogenetic characterization of a new Corynebacterium species from dogs: description of Corynebacterium auriscanis sp. nov

Six strains of a previously undescribed catalase-positive coryneform bacterium isolated from clinical specimens from dogs were characterized by phenotypic and molecular genetic methods. Biochemical and chemotaxonomic studies revealed that the unknown bacterium belonged to the genus Corynebacterium sensu stricto. Comparative 16S rRNA gene sequencing showed that the six strains were genealogically highly related and constitute a new subline within the genus Corynebacterium; this subline is close to but distinct from C. falsenii, C. jeikeium, and C. urealyticum. The unknown bacterium from dogs was distinguished from all currently validated Corynebacterium species by phenotypic tests including electrophoretic analysis of whole-cell proteins. On the basis of phylogenetic and phenotypic evidence, it is proposed that the unknown bacterium be classified as a new species, Corynebacterium auriscanis. The type strain of C. auriscanis is CCUG 39938(T).

Malassezia pachydermatis: a review

Malassezia pachydermatis is of importance in both veterinary and human medicine. Its taxonomic status and physiological characteristics are now better understood. Skin disease associated with this lipophilic yeast is now commonly recognized, especially in dogs. However, further studies are required to elucidate the mechanisms which allow this yeast to proliferate and induce disease. Skin colonization is common in pet carnivores which consequently constitute a source of M. pachydermatis for susceptible humans. In the future, the development of efficient typing systems should allow better understanding of the transmission mechanisms.