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Cureus Jun 2024, a gram-negative marine bacterium, poses significant health risks through various infections transmitted via contaminated seawater or seafood consumption. This case...
, a gram-negative marine bacterium, poses significant health risks through various infections transmitted via contaminated seawater or seafood consumption. This case report details a 42-year-old male presenting with chronic seropurulent discharge from his ear, ultimately diagnosed with otitis externa caused by . Examination findings and antibiotic sensitivity testing informed the treatment strategy, leading to a successful resolution. The increasing incidence of infections, particularly in warm coastal water, necessitated heightened clinical awareness and appropriate management. As global temperatures rise, proactive measures including patient education and accurate diagnosis become crucial in preventing disease progression and complications associated with infections.
PubMed: 38957264
DOI: 10.7759/cureus.61524 -
BMC Medicine Jul 2024With the global challenge of antimicrobial resistance intensified during the COVID-19 pandemic, evaluating adverse events (AEs) post-antibiotic treatment for common...
Risk of emergency hospital admission related to adverse events after antibiotic treatment in adults with a common infection: impact of COVID-19 and derivation and validation of risk prediction models.
BACKGROUND
With the global challenge of antimicrobial resistance intensified during the COVID-19 pandemic, evaluating adverse events (AEs) post-antibiotic treatment for common infections is crucial. This study aims to examines the changes in incidence rates of AEs during the COVID-19 pandemic and predict AE risk following antibiotic prescriptions for common infections, considering their previous antibiotic exposure and other long-term clinical conditions.
METHODS
With the approval of NHS England, we used OpenSAFELY platform and analysed electronic health records from patients aged 18-110, prescribed antibiotics for urinary tract infection (UTI), lower respiratory tract infections (LRTI), upper respiratory tract infections (URTI), sinusitis, otitis externa, and otitis media between January 2019 and June 2023. We evaluated the temporal trends in the incidence rate of AEs for each infection, analysing monthly changes over time. The survival probability of emergency AE hospitalisation was estimated in each COVID-19 period (period 1: 1 January 2019 to 25 March 2020, period 2: 26 March 2020 to 8 March 2021, period 3: 9 March 2021 to 30 June 2023) using the Kaplan-Meier approach. Prognostic models, using Cox proportional hazards regression, were developed and validated to predict AE risk within 30 days post-prescription using the records in Period 1.
RESULTS
Out of 9.4 million patients who received antibiotics, 0.6% of UTI, 0.3% of URTI, and 0.5% of LRTI patients experienced AEs. UTI and LRTI patients demonstrated a higher risk of AEs, with a noted increase in AE incidence during the COVID-19 pandemic. Higher comorbidity and recent antibiotic use emerged as significant AE predictors. The developed models exhibited good calibration and discrimination, especially for UTIs and LRTIs, with a C-statistic above 0.70.
CONCLUSIONS
The study reveals a variable incidence of AEs post-antibiotic treatment for common infections, with UTI and LRTI patients facing higher risks. AE risks varied between infections and COVID-19 periods. These findings underscore the necessity for cautious antibiotic prescribing and call for further exploration into the intricate dynamics between antibiotic use, AEs, and the pandemic.
Topics: Humans; COVID-19; Anti-Bacterial Agents; Adult; Middle Aged; Female; Aged; Male; Aged, 80 and over; Young Adult; Adolescent; Risk Assessment; Hospitalization; England; SARS-CoV-2; Emergency Service, Hospital; Incidence
PubMed: 38956603
DOI: 10.1186/s12916-024-03480-2 -
American Journal of Clinical Dermatology Jul 2024Palmoplantar pustulosis (PPP), a refractory skin disease characterized by repeated eruptions of sterile pustules and vesicles on palms and/or soles, involves...
BACKGROUND
Palmoplantar pustulosis (PPP), a refractory skin disease characterized by repeated eruptions of sterile pustules and vesicles on palms and/or soles, involves interleukin-17 pathway activation. Brodalumab, a fully human anti-interleukin-17 receptor A monoclonal antibody, is being investigated for use in PPP treatment.
OBJECTIVE
The aim was to assess the efficacy and safety of brodalumab in Japanese PPP patients with moderate or severe pustules/vesicles.
METHODS
A phase 3, randomized, double-blind, placebo-controlled trial was conducted between July 2019 and August 2022, at 41 centers in Japan. Patients aged 18-70 years with a diagnosis of PPP for ≥ 24 weeks, a PPP Area Severity Index (PPPASI) score of ≥ 12, a PPPASI subscore of pustules/vesicles of ≥ 2, and inadequate response to therapy were included. Participants were randomized 1:1 to receive brodalumab 210 mg or placebo, subcutaneously (SC) at baseline, weeks 1 and 2, and every 2 weeks (Q2W) thereafter until week 16. Changes from baseline to week 16 in the PPPASI total score (primary endpoint) and other secondary skin-related endpoints and safety endpoints were assessed.
RESULTS
Of the 126 randomized patients, 50 of 63 in the brodalumab group and 62 of 63 in the placebo group completed the 16-week period. Reasons for discontinuation were adverse event (n = 6), withdrawal by patient/parent/guardian (n = 3), progressive disease (n = 3), and lost to follow-up (n = 1) in the brodalumab group and Good Clinical Practice deviation (n = 1) in the placebo group. Change from baseline in the PPPASI total score at week 16 was significantly higher (p = 0.0049) with brodalumab (least-squares mean [95% confidence interval {CI}] 13.73 [10.91-16.56]) versus placebo (8.45 [5.76-11.13]; difference [95% CI] 5.29 [1.64-8.94]). At week 16, brodalumab showed a trend of rapid improvement versus placebo for PPPASI-50/75/90 response (≥ 50%/75%/90% improvement from baseline) and Physician's Global Assessment 0/1 score: 54% versus 24.2%, 36.0% versus 8.1%, 16.0% versus 0.0%, and 32.0% versus 9.7%, respectively. Infection was the dominant treatment-emergent adverse event (TEAE); the commonly reported TEAEs were otitis externa (25.4%/1.6%), folliculitis (15.9%/3.2%), nasopharyngitis (14.3%/4.8%), and eczema (14.3%/12.9%) in the brodalumab/placebo groups, respectively. The severity of most TEAEs reported was Grade 1 or 2 and less frequently Grade ≥ 3.
CONCLUSIONS
Brodalumab SC 210 mg Q2W demonstrated efficacy in Japanese PPP patients. The most common TEAEs were mild infectious events.
TRIAL REGISTRATION
NCT04061252 (Date of Trial Registration: August 19, 2019).
PubMed: 38954226
DOI: 10.1007/s40257-024-00876-x -
American Journal of Veterinary Research Jun 2024To identify the preferred choices of antimicrobials by veterinarians for addressing infectious diseases in Golden Retrievers across the US.
OBJECTIVE
To identify the preferred choices of antimicrobials by veterinarians for addressing infectious diseases in Golden Retrievers across the US.
ANIMALS
3,044 Golden Retrievers enrolled in the Golden Retriever Lifetime Study.
METHODS
Demographic and veterinary visit data were retrieved from the Morris Animal Foundation Golden Retriever Lifetime Study, following 3,044 Golden Retrievers spanning from 2012 to 2020 collected through questionnaires. The R Studio program was used to clean and analyze the data in which the most common diagnoses were evaluated along with the most frequently used antimicrobials stratified by geographical region within the US.
RESULTS
The most common diagnoses reported and treated with antimicrobials were otitis externa, diarrhea/gastritis, hot spots, and bladder infections. Otitis externa was the most frequently reported medical diagnosis as well as prescribed with antibiotics. The Southern region reported the most antimicrobial use, followed by the Midwest and Northeast. Of the total reported antibiotics prescribed for infectious disease, aminoglycosides were the most frequent (370/1,874 [19.74%]) followed by first-generation cephalosporins, nitroimidazoles, and penicillins.
CLINICAL RELEVANCE
More effort in the prevention of otitis externa in Golden Retrievers may reduce overall antimicrobial usage and promote effective antimicrobial stewardship to combat further antimicrobial resistance.
PubMed: 38889746
DOI: 10.2460/ajvr.23.10.0239 -
Indian Journal of Otolaryngology and... Jun 2024Multidrug resistant strains and fungi add to treatment conundrums in skull base osteomyelitis (SBO). Deep tissue culture in these patients is challenging due to their...
Multidrug resistant strains and fungi add to treatment conundrums in skull base osteomyelitis (SBO). Deep tissue culture in these patients is challenging due to their advanced age and co-morbidities. Besides, fungal culture positivity is seen only in 60% of invasive aspergillosis. To determine the efficacy of a minimally invasive test-Serum Galactomannan (sGM)-for diagnosing fungal SBO. Prospective observational study. Thirty- three patients, clinically diagnosed with SBO were included in this study. Baseline ESR (Erythrocyte Sedimentation Rate), CRP (C- Reactive Protein), pain score, and sGM were noted for all patients. Antifungal Voriconazole was initiated on patients if the sGM values were more than 0.8. At the 12th week of treatment, all parameters were repeated and compared with the baseline values. A significant reduction was noted in ESR, CRP, and pain scores at the 12th week of treatment compared to the baseline values in patients with raised sGM values who were started on Voriconazole. For a culture-proven fungal skull base osteomyelitis with a cut-off value of sGM > / = 0.8, the obtained sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 81.82, 36.36, 39.13, 80 and 51.52% respectively. At a cut-off value of sGM > / = 01.6, the values of sensitivity/specificity, PPV, NPV and accuracy were 81.82/72.73%, 60%, 88.89% and 75.76%. Culture-negative patients in SBO with sGM value > 0.8 were more likely to be fungal SBO. An sGM cut-off of 1.6 was observed to give maximum accuracy for diagnosing fungal SBO.
PubMed: 38883534
DOI: 10.1007/s12070-024-04563-5 -
Indian Journal of Otolaryngology and... Jun 2024The demand for ear, nose, and throat (ENT) care significantly contributes to the workload in outpatient departments (OPDs) worldwide, including Thailand. However, the...
Epidemiological Profile of Ear, Nose, and Throat (ENT) Diseases in the Outpatient Department at Thung Song Hospital, a General Hospital in Southern Thailand, from 2016 to 2019.
The demand for ear, nose, and throat (ENT) care significantly contributes to the workload in outpatient departments (OPDs) worldwide, including Thailand. However, the epidemiology of ENT diseases in Thai OPDs has not been thoroughly reported. Therefore, this study aimed to assess and describe the epidemiology of these conditions among patients attending the ENT clinic at Thung Song Hospital, marking the first epidemiological report of southern Thailand. This retrospective, descriptive study spanned four years and observed the number of ENT patients. The comprehensive dataset revealed a total of 34,848 ENT visits and 12,712 new cases within the ENT clinic's OPD, averaging 3,178 case instances annually. Notably, over a quarter of the patients were classified as elderly, aged 60 years or older. Of significance, the prevalence of ENT diseases among females exceeded that of males by more than 15% each year. Specific age groups revealed distinct prevalent conditions: otitis externa was most common among children, benign tumors prevailed in adults, and sensorineural hearing loss was prominent among the elderly. This study endeavor aims to deepen the understanding of the epidemiology of these diseases. Such investigations could guide the refinement of healthcare approaches targeting ENT-related ailments.
PubMed: 38883503
DOI: 10.1007/s12070-024-04560-8 -
Indian Journal of Otolaryngology and... Jun 2024We present a case of a 68-year-old lady with an insidious progressive history of otorrhea, otalgia, and reduced hearing for 3 months. She was treated for malignant...
We present a case of a 68-year-old lady with an insidious progressive history of otorrhea, otalgia, and reduced hearing for 3 months. She was treated for malignant otitis externa and was treated with systemic antibiotic but showed subtherapeutic response to treatment. She underwent examination under anaesthesia and biopsy with tumour debulking of the right ear via posterior auricular approach and histopathological examination revealed squamous papilloma of the external auditory canal. She recovered well after surgery and was asymptomatic during follow-up.
PubMed: 38883461
DOI: 10.1007/s12070-024-04480-7 -
Journal of Pharmacy & Bioallied Sciences Apr 2024This study intended to assess the level of awareness and attitude toward otitis externa (OE) and specific limitations that counter the attempts to uplift the...
OBJECTIVES
This study intended to assess the level of awareness and attitude toward otitis externa (OE) and specific limitations that counter the attempts to uplift the understanding and notion related to OE among the general population of Saudi Arabia.
METHODS
A cross-sectional quantitative study using a questionnaire was done via Google Forms between May 2023 and July 2023. The scoring method was used to determine the participant's awareness or attitude; participants who scored >50% were considered aware or to have a good attitude.
RESULTS
Approximately 52.2% had a good attitude toward the OE, and majority were willing to visit healthcare professionals (81%) to provide care and receive proper education during office visits (80.1%). Of all the participants, 69%, 33.4%, and 30.8% suggested that a lack of awareness, cost, and health insurance, respectively, might prevent patients from seeking a healthcare professional. Only 10.9% of participants demonstrated good awareness (score >13) of outer ear inflammation.
CONCLUSION
The findings indicate a poor level of awareness regarding OE, and a positive attitude toward seeking healthcare, with the majority recommending professional visits and relying on healthcare professionals for information.
PubMed: 38882757
DOI: 10.4103/jpbs.jpbs_1167_23 -
Heliyon Jun 2024The increasing emergence of as the primary causative agent of otitis externa has been noted; however, detailed information regarding the molecular characteristics of...
The increasing emergence of as the primary causative agent of otitis externa has been noted; however, detailed information regarding the molecular characteristics of these strains in Iran remains scarce. The current study aims to investigate both genotypic and phenotypic attributes of strains implicated in ear infections. In the present work, we analyzed 60 strains isolated from cases of otitis externa over a period of 45 months. The resistance patterns were determined using disk diffusion and microbroth dilution methods. All isolates were confirmed by the polymerase chain reaction assay, and their biofilm production was assessed by a microtiter plate assay. Molecular characterization of the isolates was performed using the staphylococcal cassette chromosome multilocus sequence typing, and staphylococcus protein A typing methods. Overall, the results indicated that 44 out of 60 isolates (73.3 %) were methicillin-resistant . Resistance to mupirocin and vancomycin was observed in 13.3 % and 1.7 % of the tested isolates, respectively. Furthermore, out of the 60 isolates, 56 strains (93.4 %) were classified as positive biofilm strains at different levels. Twelve distinct clonal lineages were identified. The vast majority of isolates belonged to CC30/ST30-MRSA IV/t019 (41.7 %). Among the 31 strong biofilm producers, the majority (64.5 %) belonged to CC30/ST30-MRSA IV/t019 clone. Biofilm negative isolates belonged to CC22/ST22 (2 isolates), CC8/ST585 (one isolate), and CC8/ST8 (one isolate). Our result revealed that about three-quarters of PVL-positive strains belonged to CC30/ST30. Our data confirmed the presence of MSSA strains among CC30/ST30 and CC22/ST22 isolates. The mupirocin resistant isolates (n = 8) belonged to CC8/ST585-MRSA III/t713 (37.5 %), CC8/ST239-MRSA III/t030 (25 %), CC8/ST8-MRSA IV/t008 (12.5 %), CC8/ST239-MRSA III/t037 (12.5 %), and CC22/ST22-MRSA IV/t790 (12.5 %) lineages. The VRSA strain belonged to the CC8/ST8-MRSA IV/t008 lineage, carrying the determinant. iMLS phenotypes (n = 14) were distributed across different lineages, including CC30/ST30-MRSA IV/t019 (21.5 %), CC30/ST30-MSSA/t021 (21.5 %), CC22/ST22-MSSA/t005 (14.3 %), CC8/ST239-MRSA III/t030 (14.3 %), CC22/ST22-MSSA/t1869 (7.1 %), CC22/ST22-MRSA IV/t790 (7.1 %), CC8/ST239-MRSA III/t037 (7.1 %), and CC1/ST772-MRSA IV/t10795 (7.1 %). These findings highlight significant genotypic diversity and high biofilm formation among our isolates. The frequent occurrence of the CC/ST30 clone in strains isolated from otitis externa reflects the emergence of these lineages as a predominant clone in Iran, posing a significant public health concern.
PubMed: 38868027
DOI: 10.1016/j.heliyon.2024.e32002 -
The Veterinary Record Jun 2024There are limited studies that identify diseases associated with head tilt in pet rabbits.
BACKGROUND
There are limited studies that identify diseases associated with head tilt in pet rabbits.
METHODS
This was an observational, retrospective, single-centre study of rabbits with head tilt presented between 2009 and 2020. Descriptive statistics were performed for all cases, whereas univariate and multivariate analyses were only performed for the 36 cases with a final diagnosis.
RESULTS
Seventy-three rabbits met the inclusion criteria. The final diagnoses included Encephalitozoon cuniculi meningoencephalomyelitis (EC) (15/36; 41.7%), otitis media/interna (OMI) (8/36; 22.2%) and concurrent EC and OMI (13/38; 36.1%). Subacute-to-chronic onset was more common in rabbits with OMI than in those with EC (p = 0.018). Previous middle ear surgery (p = 0.046) and a diagnosis of otitis externa (p = 0.004) significantly increased the risk of OMI. Meloxicam was associated with improvement of clinical signs (p = 0.007). Upright ears (p = 0.013), recumbency (p = 0.037) and impaired mentation (p = 0.001) were associated with a higher risk of death/euthanasia. The proportions of residual head tilt (66.7%) and relapse of vestibular signs (42.1%) were high.
LIMITATIONS
This was a retrospective study with cases varying in their investigation and conclusive final diagnoses.
CONCLUSION
OMI and EC were the most common aetiologies of head tilt in pet rabbits in the UK. Meloxicam might be associated with a favourable outcome in affected rabbits. Paired EC serology and a CT scan of the head should be the baseline investigation for head tilt in rabbits.
PubMed: 38831734
DOI: 10.1002/vetr.4267