Extranasal Sites Research Articles

Nasal NK/T Cell Lymphoma (NKTL): A Reported Case

Nasal NK/T cell lymphoma (NKTL), is an aggressive malignancy associated with Epstein Barr virus infection. Nasal NK/T cell lymphoma (NKTL), manifests as a necrotic process affecting nasal or upper aerodigestive structures and, rarely, extra nasal sites such as skin, and the gastrointestinal tract. The diagnosis is confirmed by histological and immunohistochemical analysis of the biopsy. Overall prognosis is poor. However, during the last two decades, advances in its clinicopathologic, genetic and molecular characterization have been achieved, as have changes in the chemotherapy regimens that, in combination with radiotherapy, are significantly improving the survival of these patients, especially in initial stages.

1233. System dynamics modelling for analysis of pre-surgical interventions to reduce surgical infections at a South Indian tertiary care centre

Abstract Background Surgical site infections (SSIs) warrants exploring context-based interventions to minimise their occurrence especially in resource limited settings. Pre-operative interventions are highlighted as important in reducing infections along the surgical pathways. The aim of this study is to investigate whether these interventions can reduce SSIs to inform policy making. Methods A patient centred operational perspective of the entire surgical patients’ pathways including infection management was developed by employing the System Dynamics methodology using the STELLA software. The development process was based on the principles of Group Model building involving healthcare staff, and included: pre-surgery, surgery, post surgery, emergency, re-admission, clinical management, and infection management phases. The model represented (i) categories of patients entering the pathways, (ii) states of patients on the pathways and their evolution over their states, (iii) mix of resources involved in activities, (iv) rules and processes to manage patients, and (v) patients’ exit and discharge routes from the pathways. Literature and policy documents informed also the model building process and the model was validated with the participation of clinical staff involved in the pathways. Results The model was run over a period of 1 year and results regarding the total number of SSIs (TSSIs) and the total number of deaths (TND) following treatment from infections (includes deaths from both SSIs and non-surgical clinical management infections). Three World Health Organization recommended interventions scenarios namely (i) Decolonization of nasal and extranasal sites on hospital admission, (ii) administration of prophylaxis antibiotic 45 minutes before incision, and (iii) skin preparation using Chlorhexidine based alcohol were simulated. TSSIs are reduced from 48 to 33, 36, and 16 under scenarios 1, 2, and 3 respectively (Figure 1) whereas TND are reduced from 35 to 31, 32, and 31 under the same scenarios. Conclusion Pre-operative interventions can be effective in reducing SSIs. Some of these interventions can be successfully implemented in resources limited settings such as the hospital described in this study. Disclosures All Authors: No reported disclosures.

M291 THE NOSE KNOWS: SINONASAL SARCOIDOSIS PRESENTING AS ISOLATED CHRONIC NASAL CONGESTION REFRACTORY TO STANDARD THERAPIES

Sinonasal sarcoidosis is rare, affecting only about 3% of patients with sarcoidosis, and may be difficult to identify without routine use of rhinoscopy. Typically, the presence of symptoms at extra-nasal sites leads to initial consideration of this diagnosis.

Metabolic activity of extranodal NK/T cell lymphoma on 18F-FDG PET/CT according to immune subtyping

Disseminated extranodal NK/T cell lymphoma (ENKTL) is associated with dismal prognosis. Hence, distinct tumor immune microenvironment (TIME) subtypes were proposed to explain their influence on ENKTL progression and help predict treatment response. In this study, we investigated the capacity of FDG PET/CT to discern ENKTL TIME subtypes. A total of 108 pretreatment FDG PET/CT scans of 103 patients with newly diagnosed or relapsed ENKTL were retrospectively analyzed. TIME subtype was determined using three key immunohistochemical markers. SUVmax, MTV and TLG were measured, and metabolic features associated with TIME subtype were statistically extracted. TIME subtype was immune tolerance (IT) in 13.9%, immune evasion A (IE-A) in 56.5%, immune evasion B (IE-B) in 21.3%, and immune silenced (IS) in 8%. The IS group showed the highest SUVmax (15.9 ± 6.4, P = 0.037), followed by IE-A (14.1 ± 7.8), IE-B (10.9 ± 5.6), and IT groups (9.6 ± 5.1). Among 53 with only nasal FDG lesions, 52 had non-IS subtype. Among 55 with extra-nasal FDG lesions, those with IS subtype more often had adrenal (P = 0.001) or testis involvement (P = 0.043), greater MTV (P = 0.005), greater TLG (P = 0.005), and SUVmax located at extra-nasal sites. The presence of 0–2 and 3–4 of these four findings was associated with low probability (2/46) and high probability (6/9) of IS subtype, respectively. Furthermore, patients showing IS subtype-favoring PET/CT pattern had worse overall survival compared to their counterparts. These results demonstrate that FDG PET/CT can help predict immune subtype in ENKTL patients. The different patterns between glycolytic activity and involved site according to TIME subtype might be related to the interplay between tumor cells and immune cells in the tumor microenvironment.

Extranodal NK/T cell lymphoma, nasal type: An updated overview.

Extranodal NK/T-cell lymphoma, nasal type (ENKTCL-NT) is an aggressive malignancy associated with Epstein-Barr virus infection, with a geographic and racial predilection for some Asian and Latin American countries. ENKTCL-NT manifests as a necrotic process affecting nasal or upper aerodigestive structures and, rarely, extranasal sites such as skin, and the gastrointestinal tract. ENKTCL-NT was characterized by its poor prognosis irrespective of clinical stage and therapy. However, during the last two decades, advances in its clinicopathologic, genetic and molecular characterization have been achieved, as have changes in the chemotherapy regimens that, in combination with radiotherapy, are significantly improving the survival of these patients, especially in initial stages. For these reasons, we present an overview of the historical background of ENKTCL-NT along with an updated review of its potential etiological factors, clinicopathologic and molecular features, as well as its prognostic models, current treatment protocols, and future directions on potential promising therapeutic approaches.

Rhinosporidiosis with musculoskeletal manifestation: A case series

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It commonly affects young males and involves the mucous membranes of the nose, nasopharynx and eyes. Involvement of extranasal sites including bone has been rarely reported. Involvement of bone without associated mucocutaneous lesions is extremely rare in rhinosporidiosis. We report a case series of three rare cases of Rhinosporidiosis affecting the musculoskeletal system, involving the clavicle, distal interphalangeal joint of little finger, and lower limb Sartorius muscle. Keywords: Rhinosporidiosis, Phalanx, Distal interphangeal joint, Clavicle, Sartorious, Soft tissue.

Human rhinosporidiosis: still an elusive disease

<p>Rhinosporidiosis is a granulomatous infection of the mucous membrane caused by <em>Rhinosporidium seeberi</em>. It usually affects the nasal and nasopharyngeal mucosa but sometimes involve extra-nasal sites such as lips, buccal mucosa, palate, larynx, trachea, lacrimal sac, skin, scalp, penis, urethra, vulva and bone. The natural habitat of this organism is water and the infection probably spreads via trans-epithelial penetration. Histopathological examination confirms the diagnosis. The treatment of choice is complete surgical excision with cauterization of the base but the medical treatment shows limited efficacy. The patient of disseminated rhinosporidosis does not respond to the conventional treatment such as surgical excision and dapsone and with amphotericin B also proved futile result. This infection is usually overlooked, despite <em>R. seeberi</em> being endemic in tropical country like India. Due to the negligence in the diagnosis and taxonomic enigma of rhinosporidiosis, here we discuss the details of its epidemiology, etiopathology, clinical presentations, diagnosis and current treatment. Because rhinosporidiosis is relatively rare, we hope this review article will serve as aid and guide to the medical community for helping further research.</p>

CD20-positive extranodal NK/T cell lymphoma: clinicopathologic and prognostic features.

Extranodal natural killer (NK)/T cell lymphoma (ENKTCL) with aberrant CD20 expression is extremely rare. Here, we describe the clinicopathologic features of 11 CD20-positive ENKTCLs from three institutions in China along with a literature review. Membranous expression of CD20 was identified in 1.29% (11/851) of ENKTCLs. CD20-positive ENKTCLs primarily occurred in extra-nasal sites (72.2%, 13/18) rather than in the nasal cavity (27.8%, 5/18). Most evaluated patients (71.4%, 10/14) presented ENKTCL at advanced stage IV. The percentage of CD20-positive tumor cells ranged from 20 to 90%, and the CD20 staining intensity was dimmer in tumor cells than in normal B cells. Among four cases with multiple biopsies, three cases showed discordant expression of CD20 between the disseminated and primary lesions. All evaluated cases were negative for other B cell markers, including PAX5, CD79a, and CD19, except for one case that showed focally positive for CD79a. Patients with CD20-positive ENKTCL more frequently had advanced diseases (stage III/IV: 70% vs 17%, p= 0.001), with older age (median age at diagnosis: 60years vs. 43.5years, p= 0.006) and had inferior outcome (median survival: 18.7moths vs 36.0moths, p= 0.017) compared with CD20-negative cases. Four nonsynonymous single nucleotide variants (C > T) and one stop-gain mutation (C > T) in the exonic region of CD20 gene (MS4A1) were detected in one of seven cases with target region next-generation sequencing. Thus, ENKTCL with aberrant CD20 expression is rare, tends to occur in older patients, and is characterized by a highly aggressive clinical course and poor outcomes. The mechanism underlying the expression of CD20 in ENKTC still remains unknown.

Clinical observation of primary extranasal nasal-type NK/T cell lymphoma treated with P-GEMOX as a first-line regimen

Objective To investigate the clinical efficacy of P-GEMOX (pegaspargase, gemcitabine and oxaliplatin) as a first-line regimen for the treatment of primary extranasal nasal-type NK/T cell lymphoma (NKTCL). Methods The clinical manifestations, treatment response and prognosis of 7 patients with primary extranasal nasal-type NKTCL who underwent P-GEMOX chemotherapy as a first-line therapy in Shenzhen People's Hospital from September 2015 to October 2018 were retrospectively analyzed. Results The median age of 7 patients with primary extranasal nasal-type NKTCL was 41 years old (27-74 years old), which was more commonly found in males (6 cases); the primary and invading extranasal sites included ileocecal, lymph nodes, skin, testis, adrenal gland, central nervous system, etc. The P-GEMOX regimen was used as a first-line therapy, although some patients had a short-term effect, all patients eventually progressed rapidly and died. The overall survival time was 2 weeks to 21 months. Conclusion The short-term efficacy of P-GEMOX as a first-line therapy for the treatment of primary extranasal nasal-type NKTCL is acceptable, but the long-term efficacy is poor. Key words: Lymphoma, NK/T cell; Extranasal; Antineoplastic combined chemotherapy protocols; P-GEMOX regimen

Cutaneous extranodal natural killer (NK) / T - cell lymphoma: A comprehensive clinical features and outcomes analysis of 71 cases

BackgroundThe skin is the common extranasal sites in extranodal natural killer (NK) / T - cell lymphoma, (ENKTL). However, data regarding cutaneous ENKTL are relatively scarce. Thus, we performed a large retrospective study to analyze clinical features and treatment outcomes of cutaneous ENKTL. Patients and methodsSeventy-one patients with cutaneous ENKTL newly diagnosed between 2001 and 2018 were retrospectively analyzed from Sun Yat-sen cancer center. ResultsThe median overall survival (OS) was 15.5 months (95 % confidence interval: 8.0–22.1 months). Age, treatment strategy, and treatment response were independent prognostic factors for cutaneous ENKTL. Patients who could undergo chemotherapy followed by radiotherapy showed a significantly better survival than those treated with chemotherapy alone (p < 0.001). The 3 - year OS rates were 73.9 % for patients who achieved complete response (CR) compared with 10.3 % for patients who did not (p < 0.001). ConclusionWe reported by far the largest series of cutaneous ENKTL, and demonstrated its aggressive clinical behavior and unsatisfying response to the current therapeutic strategies. Further investigations are required for the better understanding and management of this uncommon disease.

589. Impact of Parents and the Environment on MRSA Transmission in the Neonatal ICU

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) colonization predisposes Neonatal Intensive Care Unit (NICU) infants to subsequent infection. Reservoirs for acquisition remain poorly understood, limiting infection prevention efforts to prevent transmission.MethodsInfants with known MRSA nasal colonization based on hospital surveillance and controls with negative MRSA screening cultures, and their parents, were enrolled in a prospective cohort study. Weekly cultures were collected from infants (4 sites), parents (3 sites), and NICU environmental surfaces (5 sites). Factors associated with MRSA colonization and infection were identified using generalized linear mixed modeling. Whole-genome sequencing (WGS) and pairwise comparisons were performed across entire genomes on 1041 S. aureus isolates using kSNP3. Isolates differing by less than 80 single nucleotide polymorphisms were considered highly related; highly related strains from different sources suggested transmission.ResultsSamples were collected 1–28 (median 7) times from 29 MRSA-colonized infants, 29 controls, 49 mothers, and 21 fathers. Over the study period MRSA colonization was detected in 10 (34%) infants who were not known to be MRSA-colonized based on hospital nasal surveillance cultures. Parent MRSA colonization (OR=11.0; 95% CI: 2.2, 55.0) and environmental MRSA contamination (OR=5.0; 95% CI: 1.6, 15.3) were associated with infant MRSA colonization. Specifically, 87% of infants with an MRSA-colonized parent were MRSA-colonized. MRSA infections occurred in 6 (21%) MRSA-colonized infants and 0 controls (P = 0.05). Infant rectal colonization (OR=15.0; 95% CI 1.6, 140.5) and persistent MRSA colonization (i.e., 3 or more consecutive positive MRSA cultures) (OR=8.4; 95% CI 1.3, 52.5) were associated with MRSA infection. Thirty clusters of highly related isolates were detected, including 12 clusters with highly related isolates from multiple study families (2–6 [median 3] unique families per cluster; Figures 1 and 2).ConclusionOur findings suggest MRSA transmission between infants, their parents, and the environment as well as transmission between patients. Future infection prevention efforts should consider parent and environmental reservoirs, as well as the role of extranasal sites of colonization. Disclosures All authors: No reported disclosures.

Long-term Use of Le Fort I Osteotomy for the Management of Nasopharyngeal Rhinosporidiosis: A Case Series

Rhinosporidiosis is a rare, chronic, granulomatous infection of the mucous membranes that mainly involves the nose and nasopharynx; it occasionally involves the pharynx, conjunctiva, larynx, trachea and, rarely, the skin. The characteristic clinical features of this disease include the formation of painless polyps in the nasal mucosa or the nasopharynx that bleed easily on touch. At our center, excision of the lesion with a Le Fort I osteotomy is carried out in patients (1) in whom two or more previous attempts at excision of biopsy-proven rhinosporidiosis arising from the nasal mucosa was carried out or (2) in whom the rhinosporidiosis arises from the nasophayrngeal mucosa and/or extranasal sites. In this article we retrospectively present 7 cases in which, according to our inclusion criteria, complete excision of the lesion was carried out with a Le Fort I osteotomy. Excellent visualization of the entire maxillary and ethmoidal air cells after the down-fracture of the maxilla helped in the total removal of the lesions. Most of these lesions had multiple points of origin through the nasal, maxillary, and ethmoidal mucosa; the excellent visualization enabled direct cauterization of all these points of origin. The mean follow-up period was 7.96 years, and all patients were disease-free by the time the study was prepared. This article presents details of the treatment protocol and technique followed at our center for the treatment of nasopharyngeal rhinosporidiosis and the details of long-term follow-up. Through this study we hope to prove the efficacy of Le Fort I osteotomy in the definitive management of nasopharyngeal rhinosporidiosis.

Colonization With Methicillin-Resistant Staphylococcus aureus Upon Intensive Care Unit Admission: Incidence and Risk Factors

Background: Since earlier identification of methicillin-resistant Staphylococcus aureus (MRSA)-colonized patients could be helpful for reducing the overall frequency of S.aureus infections, the investigation of persons colonized with MRSA is considered to be a key component of MRSA infection prevention programs, particularly among ICU patients. Objectives: The aim of the present study was to evaluate the prevalence of nasal and extra-nasal carriers of MRSA and risk factors associated with MRSA colonization among adult patients admitted to the ICU. Methods: In a cross-sectional study, 164 adult patients who were admitted to the ICU of a teaching hospital were screened for nasal and extra-nasal carriage of MRSA. In addition, the ICU-hospitalized patients were evaluated for MRSA acquisition during their ICU stay. Results: Out of the 164 patients admitted to the ICU, 12 (7.3%) patients were methicillin-susceptible Staphylococcus aureus (MSSA) carriers, and 12 (7.3%) patients carried MRSA. Four (16.6%) patients were colonized at single or multiple extra-nasal sites based on neg- ative nares screening. Of the 15 remaining patients hospitalized at the ICU, one (6.7%) patient acquired MRSA. The patients colonized with MRSA had more advanced ages (P = 0.008), longer hospital stays before being transferred to the ICU (P > 0.001), more under- lying diseases with chronic obstructive pulmonary disease (COPD) (P = 0.028), and had undergone surgery (P = 0.003). Patients transferred from the surgical wards to the ICU were found to have significantly higher carriage rates of MRSA (P = 0.041). Conclusions: The prevalence of MRSA colonization upon ICU admission at our hospital was relatively high, and routine MRSA screening is suggested, especially for patients who have certain risk factors. In addition, extra-nasal MRSA screenings upon ICU admission will help in the early detection of MRSA.

Evaluation of the Pig-Tailed Macaque (Macaca nemestrina) as a Model of Human Staphylococcus aureus Nasal Carriage.

Staphylococcus aureus nasal carriage is a common condition affecting both healthy and immunocompromised populations and provides a reservoir for dissemination of potentially infectious strains by casual contact. The factors regulating the onset and duration of nasal S. aureus colonization are mostly unknown, and a human-relevant animal model is needed. Here, we screened 17 pig-tailed macaques (Macaca nemestrina) for S. aureus carriage, and 14 of 17 animals tested positive in the nose at one or both screening sessions (8 weeks apart), while the other 3 animals were negative in the nose but positive in the pharynx at least once. As in humans, S. aureus colonization was densest in the nose, and treatment of the nostrils with mupirocin ointment effectively cleared the nostrils and 6 extranasal body sites. Experimental nasal S. aureus colonization was established with 104 CFU/nostril, and both autologous and nonautologous strains survived over 40 days without any apparent adverse effects. A human nasal S. aureus isolate (strain D579, sequence type 398) was carried in 4 of 6 animals for over 3 weeks. Nostrils that did eradicate experimentally applied S. aureus exhibited neutrophilic innate immunity marked by elevated nasal interleukin-1β (IL-1β), IL-8, and monocyte chemotactic protein 1 levels and a 10-fold decreased IL-1 receptor antagonist/IL-1β ratio within 7 days postinoculation, analogous to the human condition. Taken together, pig-tailed macaques represent a physiological model of human S. aureus nasal carriage that may be utilized for testing natural colonization and decolonization mechanisms as well as novel classes of anti-S. aureus therapeutics.

Nasal and extra-nasal methicillin resistant Staphylococcus aureus colonization among hemodialysis patients; is routine culturing of other body sites necessary?

Introduction: Asymptomatic Staphylococcus aureus carriers have become a great concern because of being at risk of subsequent S. aureus infections. The role of nasal S. aureus carriages as an endogenous source for staphylococcal infections especially methicillin resistant S. aureus (MRSA) infections has been known that seems to be contributed to morbidity, mortality, and also the cost of end-stage renal disease management. Besides, many recent studies have demonstrated that extranasal sites may be important unrecognized reservoirs for resistant S. aureus. Objectives: The purpose of the present research was to identify the frequency and factors associated with extra-nasal S. aureus colonization among maintenance hemodialysis patients. Patients and Methods: A total of 179 hemodialysis patients were enrolled in this study. Swab cultures were obtained from anterior nares, posterior pharynx, and the inguinal area. Culture plates were analyzed for the presence of methicillin-resistant or methicillin-susceptible S. aureus using standard microbiological techniques for S. aureus and MRSA. Results: 113 out of 179 patients (63%) were men and 66 (37%) were women with the mean age of 59.8±13.6 years. 36 out of 179 patients (20%) were colonized with S. aureus which 5 patients (2.7%) were colonized with MRSA. Prevalence of extra-nasal S. aureus colonization was 12% ( 22/179 patients), the prevalence of nasal S. aureus colonization was 10% (18/179 patients) and 2.7% of patients (5/179 patients) were colonized with S. aureus in more than one body site. Around 3 out of 5 MRSA colonized patients (60%) were extra-nasal carriers. There was a significant association between type of venous access for dialysis with the extra- nasal colonization (P=0.03) and also an association between underlying disease of diabetes mellitus type 2 with the extra-nasal colonization (P=0.01). Conclusion: This study has emphasized the importance of extra-nasal evaluation along with nasal site sampling as an endogenous risk factor for staphylococcal infections among hemodialysis patients.

Evaluation of the pig-tailed macaque (Macaca nemestrina) as a model of human Staphylococcus aureus nasal carriage

Abstract Staphylococcus aureus (SA) nasal carriage is a common condition effecting both healthy and immunocompromised populations, and provides a reservoir for dissemination of potentially infectious strains by casual contact. Factors regulating the onset and duration of nasal SA colonization are mostly unknown, and a human-relevant animal model is needed. Here, we screened 17 pig-tailed macaques (Macaca nemestrina) for SA carriage, and 14 of 17 animals tested positive in the nose at one or both screening sessions (8 weeks apart), while the other three animals were negative in the nose but positive in the pharynx at least once. Similar to humans, SA colonization was densest in the nose, and treatment of the nostrils with mupirocin ointment effectively cleared the nostrils and 6 extra-nasal body sites. Experimental nasal SA colonization was established with 104 CFU/nostril, and both autologous and non-autologous strains survived over 40 days without any apparent adverse effects. A human nasal SA isolate (D579/ST398) was carried in 4 of 6 animals for over three weeks. Nostrils that did eradicate experimentally applied SA exhibited neutrophilic innate immunity marked by elevated nasal IL-1β, IL-8, and MCP-1, and a 10-fold decreased IL-1RA:IL-1β ratio within 7 days post-inoculation, analogous to the human condition. Taken together, pig-tailed macaques represent a physiological model of human SA nasal carriage with utility for testing natural colonization and decolonization mechanisms, and novel classes of anti-SA therapeutics.

Cessation from smoking improves innate host defense and clearance of experimentally inoculated nasal S. aureus

Abstract Staphylococcus aureus (SA) nasal carriage is transient in most humans and usually benign, but dissemination of SA to extranasal sites causes the majority of clinical infections, and SA is a major cause of serious infections in the U.S. A better understanding of innate nasal decolonization mechanisms is urgently needed, as are relevant models for studying SA clearance. Here, we screened a population of healthy smokers for nasal SA carriage, and compared participants’ abilities to clear experimentally applied nasal SA before and after completion of a smoking cessation program. We determined that cigarette smoking increases mean nasal SA load (2.6×104 CFU/swab) compared to healthy non-smokers (1.7×103 CFU/swab) and might increase the rate of SA nasal carriage in otherwise healthy adults: 22 of 99 smokers carried SA at the screening visit, while only 4 of 30 non-smokers screened positive during the same time period. Only 6 of 19 experimental inoculation studies in active smokers resulted in SA clearance within the month of follow-up, while in the cessation group, 6 of 9 subjects cleared nasal SA and carriage duration averaged 21±4 days. Smoking cessation associated with enhanced expression of SA-associated IL-1β and G-CSF in nasal fluids. Participants who failed to clear SA exhibited higher nasal SA load and elevated nasal interleukin-1 receptor antagonist (IL-1RA) expression at the pre-experiment study visits. We conclude that smokers exhibit higher SA load than non-smokers, and that innate immune pathways including G-CSF expression and signaling through the IL-1 axis are important mediators of nasal SA clearance.

Cessation from Smoking Improves Innate Host Defense and Clearance of Experimentally Inoculated Nasal Staphylococcus aureus.

Staphylococcus aureus nasal carriage is transient in most humans and usually benign, but dissemination of S. aureus to extranasal sites causes the majority of clinical infections, and S. aureus is a major cause of serious infections in the United States. A better understanding of innate nasal decolonization mechanisms is urgently needed, as are relevant models for studying S. aureus clearance. Here, we screened a population of healthy smokers for nasal S. aureus carriage and compared the participants' abilities to clear experimentally applied nasal S. aureus before and after completion of a smoking cessation program. We determined that cigarette smoking increases the mean nasal S. aureus load (2.6 × 104 CFU/swab) compared to the load observed in healthy nonsmokers (1.7 × 103 CFU/swab) and might increase the rate of S. aureus nasal carriage in otherwise-healthy adults: 22 of 99 smokers carried S. aureus at the screening visit, while only 4 of 30 nonsmokers screened positive during the same time period. Only 6 of 19 experimental inoculation studies in active smokers resulted in S. aureus clearance within the month of follow-up, while in the cessation group, 6 of 9 subjects cleared nasal S. aureus and carriage duration averaged 21 ± 4 days. Smoking cessation associated with enhanced expression of S. aureus-associated interleukin-1β (IL-1β) and granulocyte colony-stimulating factor (G-CSF) in nasal fluids. Participants who failed to clear S. aureus exhibited a higher nasal S. aureus load and elevated nasal interleukin-1 receptor antagonist (IL-1RA) expression at the preexperiment study visits. We conclude that smokers exhibit higher S. aureus loads than nonsmokers and that innate immune pathways, including G-CSF expression and signaling through the IL-1 axis, are important mediators of nasal S. aureus clearance.

Series of Atypical Rhinosporidiosis: Our Experience in Western Part of West Bengal.

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It usually presents as sessile or pedunculated granular polyp, red in colour with multiple yellowish pin-head sized dots. Atypical presentations due to involvement of extra-nasal sites may produce diagnostic dilemma. Very high incidence of rhinosporidiosis and that too with atypical presentations in the rural western part of West Bengal, encourages us to undertake this study. The present study was conducted in a tertiary care hospital in the rural western part of West Bengal from July 2013 to December 2016. Patients presenting with rhinosporidiosis in extra-nasal sites and with atypical presentations were included in the study. Rhinosporidiosis confined to nose and patients who lost follow up were excluded from the study. All patients were treated with wide excision and cauterization of base. Among total 114 patients of rhinosporidiosis, 16 had atypical presentations (14.04%). Nine patients (56.25%) presented with a mass hanging in the oropharynx, some mimicking oropharyngeal malignancy. Two patients (12.50%) presented with acute respiratory distress and stridor. One patient (6.25%) presented with disseminated rhinosporidiosis with involvement of the skin, subcutaneous tissue, muscle, bone, penis and urethra. Recurrence was noted in only two patients (12.50%) in nasopharynx. This chronic disease may present with different acute presentations. Proper clinical eye may avoid pre-operative biopsy which may lead to extensive bleeding. Recurrence can be reduced with meticulous and complete removal. Regular post-operative follow-up with endoscopy is must to detect and treat early recurrence.

The prognostic role of level of involved regional lymph node in patients with stage II extranodal nasal-type NK/T-cell lymphoma of the upper aerodigestive tract

Objective This study aimed to evaluate the prognostic value of regional lymph node spread in patients with stage Ⅱ nasal-type NK/T-cell lymphoma of the upper aerodigestive tract (UADT-NKTCL). Methods From 1987 to 2013, a total of 97 patients with newly-diagnosed stage Ⅱ UADT-NKTCL were retrospectively reviewed. Primary tumors were located in the nasal cavity (n=52) or extranasal UADT sites (n=45). The majority of patients were treated with primary radiotherapy. Sixty-five patients were treated with combined modality therapy (CMT), and 32 patients were treated with radiotherapy alone (n=27) or chemotherapy alone (n=5). The Kaplan-Meier method was used to calculate the survival rate, and the log-rank test was used for survival difference analysis and monovariate prognostic analysis. The Cox regression model was used to multivariate prognostic analysis. Results The 5-year overall survival (OS) and progression-free survival (PFS) rates for all stage Ⅱ patients were 57% and 49%, respectively. The presence of a lower neck lymph node (defined as extension below the caudal border of the cricoid cartilage) was significantly associated with poor outcomes on univariate analysis and maintained significance on multivariate analysis. The median survival for patients with lower neck lymph node was 19.3 months and the 2-, 5-years OS rates were 28% and 11%(P=0.000). For stage Ⅱ patients, CMT significantly improved survival. The 5-year OS and PFS rates were 64% and 52% for CMT, compared with 40.4%(P=0.006) and 42% for single modality therapy (P=0.088). Conclusion The level of regional lymph node is a powerful prognostic factor for stage Ⅱ UADT-NKTCL.The involvement of low neck lymph node is significantly associated with poorer survival outcomes. Key words: Extranodal nasal-type NK/T-cell lymphoma/radiotherapy; Extranodal nasal-type NK/T-cell lymphoma/chemotherapy; Prognosis