Purulent Nasal Discharge Research Articles

Clinical study of fungal sinusitis

<p class="abstract"><strong>Background:</strong> Fungal sinusitis is a distinct clinical entity characterized by inflammation of the sinus mucosa caused by fungal infection like aspergillus (fumigatus, niger, flavus), mucormycosis, candida (albicans), scedosporium, pencillium. Mostly immunocompromised patients, farmers, garbage cleaners, and patients on prolonged nasal sprays are affected. There are different types of fungal sinusitis: fungal mycetoma, allergic fungal, chronic indolent and fulminant sinusitis having symptoms like chronic headache and facial swelling with visual impairment. Patients have thick purulent nasal discharge, nasal obstruction, epistaxis, cheek swelling and may be polyposis. Resident bacterial flora probably inhibits colonization by fungi through a number of mechanisms. Thus antimicrobial therapy predisposes to both the overgrowth of normal fungal flora, e.g., Candida species, and growth of opportunists like Aspergillus<sup>1</sup>. Allergic fungal rhinosinusitis is the most common entity. Aspergillosis is the most common fungal infection. Of these aspergillus fumigatus is the most common fungal pathogen. Maxillary sinuses are commonly involved.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study carried out at department of otorhinolaryngology at Kunal Institute of Medical Specialities Pvt Ltd. Evaluation by proper history taking and clinical examination after which the patient is selected for nasal swab, culture and sensitivity. Plain x-ray nose and paranasal sinuses. CT scans nose and paranasal sinuses. Diagnostic nasal endoscopy. </p><p class="abstract"><strong>Results:</strong> Allergic fungal sinusitis was the most common entity found with aspergillosis being the most common organism.</p><p><strong>Conclusions:</strong> Allergic fungal sinusitis was most commonly found in the age group of 20 to 29 years with maxillary sinus most commonly affected. </p>

Acute Myeloid Leukemia in a Dog Chronically Infected with Leishmania spp. and Other Infectious Agents

Background: Rare studies have described the association of hematopoietic tumors and canine visceral leishmaniosis, however the association between the parasitary disease and neoplasia is still not well established in dogs. Thus, the aim of the present study was to report a case of acute myeloid leukemia (AML) in a dog infected by Leishmania spp. and otherinfectious agents.Case: A 8-year-old, male Poodle, was brought to the Veterinary Hospital from Universidade Federal Rural do Semi-Árido. The dog had a history of recurrent tick-borne diseases, such as anaplasmosis, over the previous ten months. On physical examination, pale mucosa, enlargement of popliteal lymph nodes, onychogryphosis, purulent nasal discharge, and bilateralblepharitis with purulent discharge were observed. The dog was skinny and infested with ticks. The blood cell count revealed normocytic, normochromic anemia and leukocytosis (38.000/mm3) with neutrophilia (30.020/mm3). Serum biochemical tests demonstrated hyperproteinemia due to hyperglobulinemia, hypoalbuminemia, and an albumin:globulin ratio of 0.30. The immunochromathographic test for leishmaniasis was negative. The alterations observed in the bone marrow cytological analysis were suggestive of AML, and Anaplasma spp., Hepatozoon spp., and amastigote forms of Leishmania spp. were observed inside bone marrow cells. After diagnosis, a decision to euthanize the animal was made.Discussion: Few studies have demonstrated the presence of hematopoietic neoplasia in dogs chronically and simultaneously infected with multiple pathogens. A case of multiple myeloma in a dog associated with infection by Ehrlichia canis, A. phagocytophilum, L. infantum, and Dirofilaria immitis is described. Another study reported B-cell lymphoma in a dog with E. canis and Histoplasma capsulatum infection. The pathogenesis of AML in the reported dog might be associated with continuous antigenic stimulation and chronic inflammation caused by the infectious agents. The pathological changes in bone marrow caused by Leishmania are well described, and different combinations of hypoplasia, hyperplasia, or dysplasia of all hematopoietic lineages can occur. The inflammation and chronic stimulation of hematopoiesis can lead to an increased risk of changes in the genetic material of the hematopoietic precursor cells. Thus, there is an increased chance of generation of mutated clones, resulting in hematopoietic malignancies. Immunosuppression is a common condition present in numerous types of neoplasia, especially in those with hematopoietic origins, which increases the vulnerability to opportunistic diseases. In humans, the presence of concomitant neoplasia and leishmaniasis is well documented, However, there are very few veterinary medicine studies on the association between neoplasia and canine visceral leishmaniosis. Cases of hematopoietic tumors, such as multiple myeloma, and multicentric, cutaneous, and cardiac lymphomas, have been described in dogs with leishmaniasis. To the best of our knowledge, this is possibly the first report implicating pathogens of the genera Leishmania, Anaplasma and Hepatozoon as contributors in the etiopathogenesis of AML in the studied animal. Based on all clinical and laboratory findings, we theorize that the prolonged antigenic stimulation and chronic inflammationcaused by the infectious agents played a crucial role in the development of leukemia in the dog.Keywords: myeloproliferative disorder, hemoparasites, canine leishmaniasis.

Multidrug-resistant CTX-M-15-producing Klebsiella pneumoniae ST231 associated with infection and persistent colonization of dog

Extended spectrum β-lactamase (ESBL)-producing bacterial infections in veterinary medicine are a clinical and epidemiological challenge. We report a case of CTX-M-15-producing Klebsiella pneumoniae infection followed by persistent colonization, in a dog presenting with bilateral purulent nasal discharge and dyspnea. In this regard, 5 broad-spectrum cephalosporin-resistant K. pneumoniae isolates were recovered from infection and surveillance cultures, collected during 1 year and eight months study. Genomic analysis of a representative clone of K. pneumoniae (KpPB76) revealed the presence of the human-associated lineage ST231, whereas resistome data confirmed the presence of genes conferring resistance to aminoglycosides, β-lactams, fluoroquinolones, fosfomycin, phenicols, sulfonamides, tetracyclines and trimethoprim. In the absence of therapeutic options, meropenem therapy was used, contributing to the control of infection during persistent carriage of K. pneumoniae CTX-M-15/ST231. Persistent colonization of companion animals with ESBL-producing bacteria could be result from a variety of situations, including multi introduction from the owner or household family members to pets, or from environmental exposure; whereas colonized animals may serve as an important source for the spread of ESBL-producing strains in the human-animal interface.

Adult acute rhinosinusitis guidelines worldwide: similarities and disparities.

Acute rhinosinusitis (ARS) is a common respiratory infection that poses a major public healthcare burden with respect to antibiotic consumption and related morbidity. Position statements and national ARS guidelines have been published worldwide, aiming to define diagnostic criteria and outline treatment options. Our objective was to analyze the similarities and disparities between such guidelines. We conducted an electronic database search for ARS guidelines using relevant keywords between January 1, 1989, through December 31, 2017. Overall, 25 guidelines from 39 countries were retrieved: 8 from 8 developed countries, and 17 from 31 developing countries. Representative guidelines from developing and developed countries from America, Europe, Africa, Asia, and Oceania were evaluated. We compared the bibliographic data, diagnostic criteria, and treatment recommendations of selected guidelines. In most developed countries, otorhinolaryngological societies published ARS guidelines, whereas the Ministry of Health formulated the guidelines or adopted generic guidelines prepared by an international organization in developing countries. Many similarities in the diagnostic criteria were found, such as purulent nasal discharge and nasal obstruction sensation. In contrast, maxillary culture as a diagnostic tool was mentioned in developed countries, while it was generally ignored in developing countries. The watchful waiting (WW) policy and abstaining from immediate antibiotics was unanimously adopted in developed countries, which was only partly embraced in developing countries. The recommended universal first-line antibiotic therapy is amoxicillin, with or without clavulanic acid, whereas options for second-line and third-line antibiotic therapies varied. ARS guidelines from different countries have many similarities. Specific recommendations are tailored to local epidemiology and healthcare accessibility.

Diagnosis and management of pediatric sinusitis: A survey of primary care, otolaryngology and urgent care providers

ObjectivesThe aims of this project were two-fold: 1) To assess pediatric primary care (PCP), pediatric otolaryngology (ENT) and pediatric urgent care (UC) providers' perception of their adherence to the 2013 American Academy of Pediatrics (AAP) established guidelines for the diagnosis and management of acute bacterial rhinosinusitis (ABRS) in children 1–18 years old and 2) to assess the same providers' practice patterns in the diagnosis and management of pediatric chronic rhinosinusitis (PCRS). MethodA 21-item questionnaire (CVI .9) was designed by th investigators using Survey Monkey®. The survey was emailed to pediatric providers (including physicians and advanced practice providers) in a Midwestern USA healthcare system (94 PCP, 25 UC, 19 ENT providers) from 20 pediatric primary care practices, 1 pediatric UC practice and 1 pediatric otolaryngology practice. ResultsDiagnosis: The following diagnostic criteria are utilized: persistent nasal congestion/cough lasting >10 days (95%), worsening of classic viral URI symptoms at days 5–7 (70%), severe onset and purulent nasal discharge for at least 3 consecutive days (45%). ENT will most commonly culture their patients. ENT providers (57%) approve of a nasal culture being obtained by PCPs. Management: Typically used antibiotics: amoxicillin (72%), Amoxicillin-clavulanic acid (98%), cefdinir (73%), azithromycin (15%). ENT providers will also use clarithromycin and Bactrim more often compared to PCPs. For PCN allergy patients, most providers choose cefdinir. Typical length of antibiotic therapy for providers is 10 days (70%) and 14 days (17%); ENT (21%) prescribes 7 days past any symptom compared to PCP (6%) and UC (5%). Use of adjuvant therapy is variable among the groups. ConclusionThis quality initiative project demonstrates that providers' diagnosis of ABRS is consistent with the 2013 AAP guidelines while variation in clinical management exists for both ABRS and PCRS. This survey demonstrates the need to educate all providers on the current 2013 AAP guidelines and define practice across all settings.

Transmaxillary anchored silicon embedded gauze plug in the post‐operative treatment of a large oromaxillary fistula caused by a supernumerary cheek tooth

SummaryA 9‐year‐old Hungarian sport horse gelding was presented to the clinic in poor condition displaying malodorous bilateral purulent nasal discharge. Oral examination revealed the presence of supernumerary 111 and 211. Bilateral diastema formation between the third maxillary molars and the supernumerary teeth with deep periodontal pockets and massive food impactions were diagnosed endoscopically. Radiography revealed inhomogenous sinus opacities in the left and right paranasal sinuses. Following bilateral oral extractions of the supernumerary cheek teeth and third maxillary molars, bilateral oromaxillary fistula formations were diagnosed (about 17 mm diameter on the right side). Bilateral frontal and right‐sided maxillary trephinations and resection of the right bulla of the maxillary septum were performed. Massive food impactions of the left and right paranasal sinuses were removed under endoscopic control. Repeated trans‐endoscopic sinus lavage was performed post‐operatively. After 2.5 months, the large right‐sided oromaxillary communication was temporarily closed with a transmaxillary anchored, gauze‐cored silicon plug on an outpatient basis. Follow‐up examination after 187 days revealed complete closure of the oromaxillary fistula and absence of sinusitis. In a 1.5‐year follow‐up control, no pathological conditions were found.

Decreased Clinical Severity of Strangles in Weanlings Associated with Restricted Seroconversion to Optimized Streptococcus equi ssp equi Assays.

Background Streptococcus equi ssp. equi causes characteristic clinical signs that are most severe in young horses, including fever, purulent nasal discharge, and lymph node abscessation in the head region.Hypothesis/ObjectivesClinical, serologic, and microbiologic factors related to unexpectedly mild disease severity in a natural outbreak of strangles in immunologically naïve weanlings were investigated.AnimalsOne‐hundred and twelve warmblood weanlings.MethodsProspective longitudinal observational study of a natural outbreak of strangles. The entire cohort was examined at the peak of the outbreak by deep nasal swabs for culture and quantitative PCR (qPCR) for the presence of S. equi and clinically and serologically in a sequential manner by an optimized ELISA from the index case throughout the outbreak until resolution. Descriptive statistics were calculated and comparisons made using a nondirectional Wilcoxon signed‐rank test.ResultsOutbreak morbidity was 53%, with 9 of 14 horses culture positive and 26 of 53 horses qPCR positive for S. equi lacking clinical signs characteristic of strangles. By resolution, 91 of 112 had seroconverted to Antigen A by ELISA but seroconversion to antigen C (part of the SeM protein) was minimal. Sequencing of the isolates detected no alterations in the SeM protein, but identified a 61 bp deletion in the gene SEQ_0402.Conclusions and Clinical ImportanceAbsence of clinical signs alone in naïve horses may be an insufficient criterion to release horses from strangles quarantine measures. Restricted seroconversion to antigen C may have been associated with decreased clinical severity. The role of a minor gene deletion in SEQ_0402 in the virulence of S. equi warrants further investigation.

Clinico-Haematological Alterations in Goats Affected with Ruminal Acidosis

Ruminal acidosis is one of the most important clinical emergencies in sheep and goats resulting into high mortality rate. In the present study, eight healthy farm goats and 24 goats presented to the TVCC of the college with clinical signs of ruminal acidosis like anorexia, tympany, increased pulse and respiratory rate, reduced body temperature, doughy rumen, enteritis, oliguria, grinding of teeth, purulent nasal discharge, muscle twitching, arched back, dehydration and recumbency with rumen liquor pH below 6 were examined for haematological alterations using autohaematoanalyzer. Among various haematological parameters evaluated from acidotic goats, the mean values of Hb (12.21±0.17 vs. 10.86±0.15 g/dl), TEC (14.28±0.16 vs. 12.04±0.36 ×106/ μl), TLC (13.43±0.11 vs. 11.11±0.27 ×103/μl), PCV (36.91±0.53 vs. 29.88±0.55%), neutrophils (64.54±0.93 vs. 28.13±0.92%), MCV (23.38±0.37 vs. 19.38±1.34 fl) and MCH (7.03±0.08 vs. 6.31±0.25 pg) were found significantly increased, while the mean values of lymphocytes (28.00±0.82 vs. 65.38±0.80%) and MCHC (24.55 ±0.26 vs. 34.88±0.97 g/dl) were decreased significantly from the base values of healthy goats. It was concluded that ruminal acidosis induced due to accidental heavy ingestion of readily fermentable carbohydrate rich grains and food waste significantly altered the haematological profile concurrent with clinical manifestations in goats, and hence can be used to assess the severity of the disease.

Safety and efficacy of pediatric functional endoscopic sinus surgery for the treatment of pediatric chronic rhinosinusitis

ObjectiveThe objective of this article is to evaluate the effectiveness and safety of pediatric endoscopic sinus surgery for the treatment of pediatric chronic rhinosinusitis (CRS).Patients and methodsThis study was of a retrospective observational clinical type and was carried in the tertiary referral center. A total of 90 patients with CRS refractory to medical treatment and operated with endoscopic sinus surgery were included in this study. Computed tomography scan of the nose and paranasal sinuses was done for all patients. Sinonasal outcome test-20 German adapted version was used for preoperative and postoperative symptoms evaluation.ResultsAmong these 90 children, there were 62 males and 28 females, with mean age of 12.5 (7–16) years. A total of 84 (93.3%) patients had CRS without nasal polyps, and CRS with nasal polyps was present in the remaining six (6.7%) patients. Nasal obstruction and purulent nasal discharge were the most reported symptoms. The follow-up period ranged from 6 months to 5 years, with a mean of 3.7 years. The overall success of the procedure was 68.8%. The most significant improvement was noticed by patients with nasal obstruction and purulent nasal discharge (90.3 and 88.8%). The least improvement occurred in patients with hyposmia (36.3%).ConclusionFunctional endoscopic sinus surgery is a safe and effective procedure in children. Proper preoperative selection of patients is mandatory. Limited surgical intervention is needed in children with control of the disease and preservation of the nasal mucosa. Second-look operation may be needed in some cases. Follow-up is essential for success of the procedure.

Colite necrohemorrágica causada por Entamoeba histolytica em um cão

Background: Intestinal amebiasis with morphological lesions and clinical manifestations is uncommon in dogs. The disease is caused by the protozoan Entamoeba histolytica, which is commonly observed in its natural hosts, humans and some non-human primates. It is occasionally found in the company of animals, usually associated with contact with infected humans. Thus, the objective here is to describe a case of necro-hemorrhagic colitis caused by E. histolytica in a dog infected with the canine distemper virus, in order to characterize the epidemiological and clinicopathological aspects of the disease.Case: An adult, mixed-breed bitch displaying anorexia and ataxia was referred to the veterinary hospital for treatment. Clinical evaluation showed a cachectic animal with 12% dehydration, ocular discharge, and bilateral purulent nasal dis-charge. A clinical diagnosis of distemper was made, and treatment was instituted. The dog’s signs progressed to walking in circles, aimlessly, with lethargy and blindness. After three days of the onset of neurological signs, the dog developed diarrhea with hematochezia. With no improvement noted, we elected to euthanize the dog. At necropsy, edema was present in subcutaneous tissues, and the lungs had yellow areas in the cranio-ventral portions, which the court was flowing purulent discharge. In the large intestine, segmental distention of the distal portion of the descending colon was observed. The segment was approximately 15 cm in length and consisted of irregular reddish areas. There was also slight thickening of the wall with edematous mucosa containing blood clots, fibrin, and multiple areas of ulceration. Microscopically showed necro-hemorrhagic colitis associated with rounded structures, approximately 15 μm in size, containing abundant eosinophilic cytoplasm that was slightly granular or vacuolated. They also contained nuclei and nucleoli that were central or slightly eccentric. These organisms were consistent with amoeba trophozoites. There was also demyelinating encephalitis associated with malacia, corpuscular intranuclear eosinophilic inclusions and / or intracytoplasmic inclusions in ependymal cells, astrocytes, and gemistocytes, characteristic of infection with canine distemper virus. Using immunohistochemistry with polyclonal anti-E. histolytica antibodies in the dilution of 1:1000, trophozoites were immunomarked, confirming the suspected amebiasis.Discussion: The diagnosis of intestinal amebiasis was based on clinical signs and by morphological characteristics on gross and microscopic examination, and was confirmed as E. histolytica by immunohistochemistry. Limited information on theepidemiology and pathological findings of infection with Entamoeba sp. has been reported in the literature, as it is relatively uncommon in pets. Affected animals are usually asymptomatic, but immunosuppression caused by canine distemper virus may have triggered the clinical manifestations of the disease in this dog. Enteritis due Entamoeba sp. should be considered in dogs with chronic weight loss and bloody diarrhea. It should also be included in the differential diagnoses for weight loss and hemorrhagic gastroenteritis, such as canine parvovirus, canine adenovirus 1, Pythium insidiosum, and Giardia sp.

Severely infected pneumoceles of the frontal sinus in patients with mental retardation and brain atrophy treated by endoscopic sinus surgery

We herein present three cases of abnormally expanded frontal sinuses (pneumoceles) with severe infection in patients with mental retardation and brain atrophy. Two patients previously underwent laryngotracheal separation surgery, and bacteriological examinations of purulent nasal discharge revealed infections caused by drug-resistant bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii. As conservative medical treatments were ineffective, all three patients were treated by computed tomography-guided endoscopic sinus surgery. This navigation system is useful for safer surgery in the area of anatomic deformity. The clinical findings, possible etiologies and surgical treatment of these cases are discussed.

Successful treatment of granulomatosis with polyangiitis with hydropneumothorax using corticosteroids and immunosuppressant.

Pneumothorax and pleural effusion is a rare and serious complication of granulomatosis with polyangiitis (GPA). The present study reported a case with a history of sinusitis for 20 years, dry cough for three years and exacerbated purulent nasal discharge and recurrent skin ulcers for two years. The patient experienced sudden difficulty in breathing two months prior to presentation. Lung computed tomography (CT) showed multiple bilateral lung nodules and cavitary nodules as well as right hydropneumothorax. Paranasal sinus CT showed soft tissue infiltration. The cytoplasmic pattern of anti-neutrophil cytoplasmic antibody (c-ANCA) was positive and anti-proteinase 3 (PR3) antibodies, erythrocyte sedimentation rate and C-reactive protein were elevated. After pleural drainage and methylprednisolone pulse treatment, followed by cyclophosphamide and cyclosporine, the patient's symptoms were ameliorated, lungs were re-expanded, and c-ANCA, PR3 and inflammatory markers returned to normal levels.

Antibacterial Activity Of Shin’iseihaito (Xinyiqingfeitang) And its Components Against Methicillin-Resistant Staphylococcus aureus

Objective: Shin’iseihaito (xinyiqingfeitang in Chinese, SSHT), a formula in traditional Japanese Kampo medicine and Chinese medicine comprising nine crude drugs, Gypsum, Ophiopogon Tuber, Scutellaria Root (SR, root of Scutellaria baicalensis), Gardenia Fruit, Anemarrhena Rhizome, Lilium Bulb, Magnolia Flower, Loquat Leaf, and Cimicifuga Rhizome (CR, rhizome of Cimicifuga heracleifolia), is commonly used to treat sinusitis associated with purulent nasal discharge and reddish nasal mucosa. We evaluated anti-bacterial activity of SSHT extract on methicillin-resistant Staphylococcus aureus (MRSA), one cause of bacterial sinusitis. Materials and Methods: Sterile paper disks impregnated with SSHT extract, the combination of crude drugs composing SSHT according to the traditional pharmacological theory, or each component were placed on Mueller-Hinton agar plates inoculated with several strains of MRSA isolated from the patients. The diameter of inhibitory zone was measured after 18–24 h incubation. Results: SSHT extract showed antibacterial activity against 128/190 (66.8%) MRSA clinical isolates. The effect of the extract of SSHT without heat-clearing drugs (SSHT–HC) or without exterior-releasing drugs (SSHT–ER) were significantly lower than that of SSHT extract. Each water extract of SR, Loquat Leaf, Magnolia Flower and CR showed significant anti-MRSA activity, and SR extract exhibited the largest inhibitory zone. Conclusions: SSHT has antibacterial activity against MRSA clinical isolates, and SR mainly contributes to the antibacterial activity of SSHT against MRSA clinical isolates.

Complete response of skull base inverted papilloma to chemotherapy: Case report.

Background:Inverted papilloma (IP) is the most common benign sinonasal neoplasm. Endoscopic techniques, improved understanding of pathophysiology, and novel surgical approaches have allowed rhinologists to treat IPs more effectively, with surgery being the mainstay of therapy. Frontal sinus IP poses a challenge for surgical therapy due to complex anatomy and potentially difficult surgical access.Objectives:We reported a unique case of a massive frontal sinus IP that presented with intracranial and orbital extension, with near resolution after chemotherapy.Methods:A retrospective case review of a patient with a frontal sinus IP treated at a tertiary academic medical center.Results:A 75-year-old male patient presented with nasal obstruction, purulent nasal discharge, and a growing left supraorbital mass. Endoscopy demonstrated a mass that filled both frontal and ethmoid sinuses, with orbital invasion. There also was substantial erosion of the posterior table, which measured 1.73 × 1.40 cm. A biopsy specimen demonstrated IP with carcinoma in situ. The patient was deemed unresectable on initial evaluation and, subsequently, underwent chemotherapy (carboplatin and paclitaxel). The tumor had a dramatic response to chemotherapy, and the patient elected for definitive surgery to remove any residual disease. During surgery, only a small focus of IP was found along the superior wall of the frontal sinus. No tumor was found elsewhere, including at the site of skull base erosion. The final pathology was IP without carcinoma in situ or dysplasia.Conclusion:This was the first reported case of chemotherapeutic “debulking” of IP, which facilitated surgical resection, despite substantial intracranial and orbital involvement. Although nearly all IPs can be treated surgically, rare cases, such as unresectable tumors, may benefit from systemic chemotherapy.

Sinonasal Sarcoidosis: A Case Report

Sarcoidosis is a chronic granulomatous disease of unknown etiology which principally affects the lower respiratory tract & lungs. Sarcoidosis in the head & neck region is infrequent. Isolated sino nasal sarcoidosis without pulmonary involvement is rare.Case: An 18 years old male patient presented with the complaints of nasal blockage, purulent nasal discharge which was occasionally blood stained for 6 months, deformity of nose, swelling of face & lips for 4 months & watering of eyes for same duration. Endoscopy of nose revealed intra nasal mucosal thickening which was friable & bleeds on touch. The diagnosis of sino nasal sarcoidosis was made by histopathological examination of nasal biopsy specimen.Conclusion: Sino nasal sarcoidosis is a disease of diagnostic challenge to the clinician as its mimicking clinical features may be misleading & cause delay in definitive diagnosis. In the current case report, we presented a case of sino nasal sarcoidosis presenting as chronic rhino sinusitis.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.648-650

Guttural pouch empyema caused by Corynebacterium pseudotuberculosis in a pregnant mare

SummaryDuring medical management of mild colic in a 12‐year‐old Quarter Horse, mid‐gestation mare, unilateral purulent nasal discharge from the right nostril was noted. Endoscopic examination revealed guttural pouch empyema. Culture was positive for Corynebacterium pseudotuberculosis and negative for Streptococcus equi ssp. equi. A synergistic haemolysis inhibition titre of 1024 was consistent with C. pseudotuberculosis infection. Treatment included serial lavages and local infusion of antibiotics into the guttural pouches along with a 6‐week course of oral trimethoprim–sulfamethoxazole and rifampicin. Overall, no additional sites of infection were identified and the mare responded well to treatment, delivering a healthy, full‐term foal. This case emphasises that C. pseudotuberculosis, although uncommon, should be considered as a differential for guttural pouch empyema.

Combined assessment of clinical and patient factors on doctors' decisions to prescribe antibiotics.

BackgroundAntibiotic overprescription is a worldwide problem. Decisions regarding antibiotic prescription for respiratory tract infections (RTIs) are influenced by medical and non-medical factors.MethodsIn family medicine practices in Białystok, Poland, family medicine residents directly observed consultations with patients with RTI symptoms. The observing residents completed a questionnaire including patient data, clinical symptoms, diagnosis, any prescribed antibiotic, and assessment of ten patient pressure factors.ResultsOf 1546 consultations of patients with RTIs, 54.26 % resulted in antibiotic prescription. Antibiotic prescription was strongly associated with rales (OR 26.90, 95 % CI 9.00–80.40), tonsillar exudates (OR 13.03, 95 % CI 7.10–23.80), and wheezing (OR 14.72, 95 % CI 7.70–28.10). The likelihood of antibiotic prescription was increased by a >7-day disease duration (OR 3.94, 95 % CI 2.80–5.50), purulent nasal discharge (OR 3.87, 95 % CI 2.40–6.10), starting self-medication with antibiotics (OR 4.11, 95 % CI 2.30–7.30), and direct request for antibiotics (OR 1.87, 95 % CI 1.30–2.80). Direct request not to prescribe antibiotics decreased the likelihood of receiving antibiotics (OR 0.34, 95 % CI 0.27–0.55).ConclusionWhile clinical signs and symptoms principally impact prescribing decisions, patient factors also contribute. The most influential patient pressure factors were starting self-medication with antibiotics, and directly requesting antibiotic prescription or no antibiotic prescription. Interventions aiming to improve clinical sign and symptom interpretation and to help doctors resist direct patient pressure could be beneficial for reducing unnecessary antibiotic prescribing.

The First Case of Endoscopic Transnasal Removal of an Ectopic Molar Tooth from the Pterygomaxillary Fossa: A Low Morbidity Approach

Ectopic teeth erupted in the maxillary sinus (MS) or Pterygomaxillary Fossa (PF) are rarely reported. Though often asymptomatic, patients with ectopic teeth in the MS or PF may suffer from facial pain/numbness, purulent nasal discharge, facial edema, epiphora, and haemoptysis. Caldwell-Luc procedure is traditionally performed to remove ectopic teeth from the sinus, though several side effects and complications have been reported. The maxillary facial pain and numbness following such procedure can be extremely bothersome. This paper reports the case of a young woman suffering from maxillary facial pain and swelling due to an ectopic molar tooth in the PF and related maxillary sinusitis. Tooth removal and MS cleaning were carried out through a transnasal endoscopic approach. The postoperative course was uneventful. The patient did not complain any facial pain or numbness. We conclude that transnasal endoscopy is a painless and easy approach for the removal of ectopic teeth from the PF thanks to the low morbidity of intranasal antrotomy and advantages of endoscopic vision.

Canine Staphylococcus pseudintermedius sinonasal infection in human hosts

Staphylococcus pseudintermedius is a gram-positive bacterium commonly found as part of the normal skin and nasal flora of healthy dogs. It may act as an opportunistic pathogen in dogs, but has also been shown to colonize the nasal mucosa of humans. We report 4 cases of chronic rhinosinusitis (CRS) refractory to aggressive medical management with cultures that grew S. pseudintermedius, with clinical improvement only after initiating culture-directed therapy. Retrospective review of 4 patients with CRS treated at a tertiary academic medical center with sinonasal cultures growing S. pseudintermedius. All 4 patients are dog owners and had clinical diagnoses of CRS. Three of the 4 patients had a diagnosis related to immune dysfunction (sarcoidosis, Crohn's disease, history of lymphoma). After undergoing endoscopic sinus surgery, each patient was treated with aggressive medical therapy but continued to have purulent nasal discharge. Sinonasal cultures repeatedly grew S. pseudintermedius in all cases, with 3 patients' dogs also having had concurrent S. pseudintermedius wound infections of the ear and leg with similar antibiotic susceptibilities. Treatment with culture-directed therapy improved the infections in all cases. Opportunistic pathogens have a propensity to exacerbate infection in CRS patients with immune dysfunction. We report the first case series of sinonasal S. pseudintermedius infection in humans. Though a rare cause of disease, pathogens such as S. pseudintermedius from nonhuman hosts should be considered in the management of CRS patients refractory to medical therapy.

Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention.

Acute respiratory tract infection (ARTI) is the most common reason for antibiotic prescription in adults. Antibiotics are often inappropriately prescribed for patients with ARTI. This article presents best practices for antibiotic use in healthy adults (those without chronic lung disease or immunocompromising conditions) presenting with ARTI. A narrative literature review of evidence about appropriate antibiotic use for ARTI in adults was conducted. The most recent clinical guidelines from professional societies were complemented by meta-analyses, systematic reviews, and randomized clinical trials. To identify evidence-based articles, the Cochrane Library, PubMed, MEDLINE, and EMBASE were searched through September 2015 using the following Medical Subject Headings terms: "acute bronchitis," "respiratory tract infection," "pharyngitis," "rhinosinusitis," and "the common cold." Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected. Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis (for example, persistent fevers, anterior cervical adenitis, and tonsillopharyngeal exudates or other appropriate combination of symptoms) by rapid antigen detection test and/or culture for group A Streptococcus. Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis. Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39°C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening). Clinicians should not prescribe antibiotics for patients with the common cold.