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BMJ Case Reports Mar 2022A man in his twenties with a history of recurrent sinusitis was urgently referred to the emergency department (ED) by an out-of-hours general practitioner following a...
A man in his twenties with a history of recurrent sinusitis was urgently referred to the emergency department (ED) by an out-of-hours general practitioner following a 2-day history of increasing right eye pain, redness and swelling after a week of coryzal symptoms. He denied visual impairment and any history of recent dental pain or procedures. Initial assessment in ED noted fever, tachycardia and hypotension. Video consultation with ophthalmologist in the ED identified proptosis, periorbital erythema and chemosis with full eye movement solely affecting the right eye. Visual acuity of 6/6 was confirmed in both eyes. After review by the ear, nose and throat (ENT) team, a diagnosis of sinogenic right orbital cellulitis was made, empirical antibiotics started and care transferred to the ENT team for immediate surgical intervention. 48 hours postoperatively, the patient acutely deteriorated, developing ophthalmoplegia and visual acuity of 6/95 in the right eye. Repeat imaging demonstrated a deteriorating picture and urgent surgery was organised at a neighbouring hospital's specialist ENT unit combined with a change to his antibiotics. On day 4, 1 day following transfer, an anaerobic bacterium, was isolated from blood cultures collected on admission. The patient improved clinically following the second surgery and targeted antimicrobial therapy, eventually being discharged 10 days after initial presentation. In addition to , the Anaerobic Reference Unit (Cardiff) identified two further anaerobic bacteria, and This paper presents the first documented case of polymicrobial anaerobic orbital cellulitis secondary to acute bacterial sinusitis. Moreover, this case underpins the importance of broad empirical antibiotics coupled with surgical source control to effectively manage a rare but sight-threatening and life-threatening disease.
Topics: Anaerobiosis; Anti-Bacterial Agents; Base Composition; Humans; Male; Orbital Cellulitis; Phylogeny; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Tomography, X-Ray Computed
PubMed: 35351758
DOI: 10.1136/bcr-2021-248473 -
World Journal of Gastroenterology Nov 2021Immunotherapy has revolutionized the clinical outcomes of intractable cancer patients. Little is known about the intestinal nonpathogenic bacterial composition of...
BACKGROUND
Immunotherapy has revolutionized the clinical outcomes of intractable cancer patients. Little is known about the intestinal nonpathogenic bacterial composition of hepatocellular carcinoma (HCC) patients treated by immunotherapy.
AIM
To determine whether there is a correlation between gut bacterial composition and prognosis in HCC patients.
METHODS
From September 2019 to March 2020, we prospectively collected fecal samples and examined the gut microbiome of 8 advanced HCC patients treated with nivolumab as a second- or third-line systemic treatment. Fecal samples were collected before the start of immunotherapy. Fecal samples of patients with progression during treatment were collected at the time of progression, and fecal samples of patients who showed good response to nivolumab were collected after 5-7 mo as follow-up. Metagenomic data from 16S ribosomal RNA sequencing were analyzed using CLC Genomics Workbench. Microbiome data were analyzed according to therapeutic response.
RESULTS
All 8 patients were male, of which 6 had underlying chronic hepatitis B. A higher Shannon index was found in the responders than in the non-responders after nivolumab therapy ( = 0.036). The unweighted beta diversity analysis also showed that the overall bacterial community structure and phylogenetic diversity were clearly distinguished according to therapeutic response. There was no significant difference in the diversity or composition of the patient gut microbiome according to the immunotherapy used. Several taxa specific to therapeutic response were designated as follows: sp., and for the non-responders; sp. and for the responders. Of note, a skewed ratio and a low ratio can serve as predictive markers of non-response, whereas the presence of species predicts a good response.
CONCLUSION
The current presumptive study suggests a potential role for the gut microbiome as a prognostic marker for the response to nivolumab in treatment of HCC patients.
Topics: Carcinoma, Hepatocellular; Feces; Gastrointestinal Microbiome; Humans; Liver Neoplasms; Male; Nivolumab; Phylogeny; RNA, Ribosomal, 16S
PubMed: 34876793
DOI: 10.3748/wjg.v27.i42.7340 -
Pathogens (Basel, Switzerland) Jun 2021() is known to cause dental, periodontal or sinus infections. To date, the pathogen has only been described in a small number of cases with a severe infection.
BACKGROUND
() is known to cause dental, periodontal or sinus infections. To date, the pathogen has only been described in a small number of cases with a severe infection.
CASE REPORT
We describe the clinical case of a 13-year-old, obese female patient that presented with acute respiratory failure and sepsis. A CT-scan showed extensive bilateral patchy areas, subpleural and peribronchovascular consolidations with surrounding ground-glass opacity, extensive consolidations in the lower lobes of both lungs matching to a severe pneumonia and clinically emerging acute respiratory distress syndrome. Moreover, it showed extensive sinusitis of the right sinus frontalis, maxillaris and right cellulae ethmoidales. was isolated from an anaerobic blood culture obtained at admission. The antibiotic treatment included piperacillin/tazobactam and oral switch to ampicillin/sulbactam plus ciprofloxacin.
CONCLUSIONS
We describe the first adolescent with severe systemic infection. Since the pathogen is difficult to culture the systemic virulence remains unclear. This work aims to sensitize health care specialists to consider infection in patients with periodontal or sinusal infection.
PubMed: 34200808
DOI: 10.3390/pathogens10060733 -
The American Journal of Case Reports Mar 2021BACKGROUND Dialister pneumosintes is a suspected periodontal pathogen. It can affect different parts of the body either by hematogenous transmission or regional spread....
BACKGROUND Dialister pneumosintes is a suspected periodontal pathogen. It can affect different parts of the body either by hematogenous transmission or regional spread. Here, we report a case of 30-year-old previously healthy woman diagnosed with mediastinal and neck abscess caused by this pathogen. CASE REPORT A 30-year-old woman presented with a 1-day history of fever, vomiting, and diarrhea. She was on her last dose of a 2-week course of oral antibiotic for suspected dental abscess. On admission, parenteral broad-spectrum antibiotic was started for sepsis of unknown source. Because of intermittent spike of high temperature despite being on an antibiotic, cross-sectional imaging was performed, which revealed a superior mediastinal abscess with extension in the neck. She was referred to the ENT surgeon for incision and drainage of the collection. However, the procedure was complicated by injury to the right internal jugular vein. Her postoperative period was also convoluted with the development of pulmonary embolism, followed by deep vein thrombosis of the right upper limb. Her pus polymerase chain reaction test detected 16s rRNA gene, suggestive of gram-negative anaerobic bacilli, and anaerobic blood culture grew Dialister pneumosintes. After a prolonged course of illness and antibiotic treatment, she recovered well, and now is back to her normal activities. CONCLUSIONS Potential life-threatening complications may develop from periodontal infection by this microorganism. In patients being treated for sepsis of unknown origin, not responding to antibiotic treatment, and with a history of recent periodontal infection, a deep-seated abscess needs to be considered.
Topics: Abscess; Adult; Bacteremia; Female; Humans; RNA, Ribosomal, 16S; Veillonellaceae
PubMed: 33772571
DOI: 10.12659/AJCR.930559 -
World Journal of Gastrointestinal... Sep 2019Impaired anastomotic healing is one of the major complications resulting from radical resection in colorectal cancer (CRC). Accumulating evidence suggests that...
BACKGROUND
Impaired anastomotic healing is one of the major complications resulting from radical resection in colorectal cancer (CRC). Accumulating evidence suggests that intestinal microbiota is correlated with anastomotic healing.
AIM
To explore the microbiota structural shift in margin-surrounding mucosa and evaluate the predictive ability of selected bacterial taxa for impaired anastomotic healing.
METHODS
Margin-surrounding mucosa samples derived from 37 patients were collected to characterize the microbial community structure by 16s rRNA gene sequencing. The patients were divided into two groups according to the healing status of anastomoses: well-healing group ( = 30) and impaired-healing group ( = 7). Statistic differences in bacteria taxa were compared by Wilcoxon test and chi-squared test. The predictive ability of the selected bacterial taxa for the healing status of anastomoses was evaluated by the area under the receiver operator characteristic curve.
RESULTS
Community structure shifts were observed in the impaired-healing group and well-healing group. Six bacterial species were found to be significantly correlated with anastomotic healing, and among these species, , , and were considered as the predictive factors. Taking the known risk factor age into consideration, , , and improved predictive ability for the healing status of anastomoses.
CONCLUSION
These data show that , , and could be considered as supplementary factors in the prediction of anastomosis healing status in patients after CRC radical resection.
PubMed: 31558976
DOI: 10.4251/wjgo.v11.i9.717 -
Microbiology and Immunology Sep 2019Filifactor alocis and Dialister pneumosintes have been associated with the initiation and progression of periodontitis (PE). We determined and compared the frequency of...
Filifactor alocis and Dialister pneumosintes have been associated with the initiation and progression of periodontitis (PE). We determined and compared the frequency of both bacteria in patients with PE, rheumatoid arthritis (RA), and PE/RA simultaneously. Detection was performed by polymerase chain reaction in the subgingival biofilm. Bacteria were more frequent in patients with PE, and clinical periodontal parameters such as pocket depth (PD) and clinical attachment loss (CAL) were significantly higher in patients with PE/RA. F. alocis and D. pneumosintes could influence PD and CAL, hence participating in the initiation and progression of PE in patients with RA.
Topics: Adult; Arthritis, Rheumatoid; Biofilms; Clostridiales; Humans; Mexico; Middle Aged; Periodontitis; Veillonellaceae
PubMed: 31294852
DOI: 10.1111/1348-0421.12727