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International Journal of Surgery Case... Feb 2021Peptoniphilus indolicus is not usually seen in the eye or paranasal sinuses but is a commensal of the human vagina and gut. However, with COVID-19, eye infections and...
BACKGROUND
Peptoniphilus indolicus is not usually seen in the eye or paranasal sinuses but is a commensal of the human vagina and gut. However, with COVID-19, eye infections and other unusual complications are possible with such unsuspected bacteria.
CASE PRESENTATION
The patient is a 76-year-old white male from a nursing home tested positive for COVID-19 and was sent from a nursing facility for left eye drainage and psychiatric evaluation. Upon presentation, the patient was not fully oriented and could not provide a history of the eye drainage. CT scan showed sinusitis with left orbital and periorbital abscess formation, cellulitis, and extensive osteomyelitis. He underwent endoscopic transnasal drainage and orbiotomy. Cultures returned positive for methicillin-resistant Stapholococcus aureus (MRSA), Streptococcus constellatus, and Peptoniphilus indolicus. He was maintained on several days of IV antibiotics and returned to the nursing home. He then presented 2 months later and required enucleation of his globe, due to the presence of multiple scleral perforations in the setting of orbital abscess, as well as removal of necrotic orbital bone.
CONCLUSIONS
Given the concomitant infection with COVID-19 and unusual presentation, the patient's sinus cultures support the notion that COVID-19 can affect the presence of bacteria within certain anatomical regions. Specifically, Peptoniphilus indolicus is not normally found outside of the vagina or gut biome. Avascular, pale mucosa and bone of the nasal cavity was noted during surgery of this COVID-19 infected patient, which is in contrast to the friable and edematous tissue typically found in acutely infected sinuses. Our patient's orbital abscess began to drain spontaneously through the skin, which is rare for orbital abscesses. Also uncommon with orbital abscesses is the need for enucleation, which in this case was deemed necessary given that the abscess had perforated the sclera in multiple locations.
PubMed: 33477076
DOI: 10.1016/j.ijscr.2021.01.043 -
Journal of Otolaryngology - Head & Neck... May 2011This document provides health care practitioners with information regarding the management of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) to enable them... (Review)
Review
This document provides health care practitioners with information regarding the management of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) to enable them to better meet the needs of this patient population. These guidelines describe controversies in the management of acute bacterial rhinosinusitis (ABRS) and include recommendations that take into account changes in the bacteriologic landscape. Recent guidelines in ABRS have been released by American and European groups as recently as 2007, but these are either limited in their coverage of the subject of CRS, do not follow an evidence-based strategy, or omit relevant stakeholders in the development of guidelines and do not address the particulars of the Canadian health care environment.Advances in understanding the pathophysiology of CRS, along with the development of appropriate therapeutic strategies, have improved outcomes for patients with CRS. CRS now affects large numbers of patients globally, and primary care practitioners are confronted by this disease on a daily basis. Although initially considered a chronic bacterial infection, CRS is now recognized as having multiple distinct components (eg, infection, inflammation), which have led to changes in therapeutic approaches (eg, increased use of corticosteroids). The role of bacteria in the persistence of chronic infections and the roles of surgical and medical management are evolving. Although evidence is limited, guidance for managing patients with CRS would help practitioners less experienced in this area offer rational care. It is no longer reasonable to manage CRS as a prolonged version of ARS, but, rather, specific therapeutic strategies adapted to pathogenesis must be developed and diffused.Guidelines must take into account all available evidence and incorporate these in an unbiased fashion into management recommendations based on the quality of evidence, therapeutic benefit, and risks incurred. This document is focused on readability rather than completeness yet covers relevant information, offers summaries of areas where considerable evidence exists, and provides recommendations with an assessment of the strength of the evidence base and the degree of endorsement by the multidisciplinary expert group preparing the document.These guidelines have been copublished in both Allergy, Asthma, and Clinical Immunology and the Journal of Otolaryngology-Head and Neck Surgery.
Topics: Acute Disease; Anti-Bacterial Agents; Canada; Chronic Disease; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Resistance, Bacterial; Drug Therapy, Combination; Evidence-Based Medicine; Female; Humans; Male; Microbial Sensitivity Tests; Practice Guidelines as Topic; Prognosis; Quality Control; Rhinitis; Sinusitis; Treatment Outcome
PubMed: 21658337
DOI: No ID Found -
British Medical Journal Feb 1950
Topics: Chronic Disease; Humans; Sinusitis
PubMed: 15410139
DOI: 10.1136/bmj.1.4650.427 -
Journal of Neuroradiology = Journal de... Sep 2021The incidence of devastating opportunistic coinfections in patients with COVID-19 infection, their imaging features and their morbidity and mortality consequences need... (Review)
Review
BACKGROUND
The incidence of devastating opportunistic coinfections in patients with COVID-19 infection, their imaging features and their morbidity and mortality consequences need to be unraveled.
METHODS
This is a case series presenting the radiologic features and clinical presentation of acute invasive fungal rhino-orbital-cerebral sinusitis (AIFS) in eight hospitalized patients with confirmed COVID-19 infection.
RESULTS
Our patient cohort presented with symptoms of the invasive fungal disease within 12-35 days from their initial presentation with COVID-19 infection. The cross-sectional imaging features of AIFS associated with COVID-19 infection do not differ from those reported in the literature for AIFS associated with other risk factors, yet our patients had features of aggressive late-stage forms with high morbidity and mortality rate.
CONCLUSION
AIFS is a possible encounter in patients with COVID-19 patients and radiologists should be familiar with its imaging features.
Topics: COVID-19; Humans; Mucormycosis; SARS-CoV-2; Sinusitis; Tomography, X-Ray Computed
PubMed: 34087330
DOI: 10.1016/j.neurad.2021.05.007 -
Evidence Report/technology Assessment... Oct 2000
Review
Topics: Acute Disease; Anti-Bacterial Agents; Child; Evidence-Based Medicine; Humans; Randomized Controlled Trials as Topic; Sinusitis; Ultrasonography
PubMed: 11089497
DOI: No ID Found -
Le Infezioni in Medicina Dec 2012Acute sinusitis is a common upper respiratory tract infection worldwide, which can be severely complicated if inappropriate treatment is applied. The aim of this study... (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVES
Acute sinusitis is a common upper respiratory tract infection worldwide, which can be severely complicated if inappropriate treatment is applied. The aim of this study was to assess and compare efficacy of cefuroxime and co-amoxiclav in the treatment of acute sinusitis in an Iranian sample population.
METHODS
A randomized clinical trial, comparing the efficacy of two oral antibiotics, cefuroxime and co-amoxiclav in the treatment of acute sinusitis, was conducted in 2007. A total of 99 patients were enrolled in the study. The clinical diagnosis of acute sinusitis was based on association of suborbital pain, purulent rhinorrhea and purulent discharge on the middle nasal meatus. All patients were also radiographically examined and their diagnoses were confirmed. Patients were randomly assigned to either receive 10 days of treatment with cefuroxime 250 mg twice daily (n=57) or receive co-amoxiclav 500/125 mg three times daily (n=42). Patients responses to treatment were assessed during and at the end of the treatment.
RESULTS
A satisfactory clinical outcome (cure or improvement of symptoms) was found in 86% (49/57) and 71.4% (30/42) of the clinically evaluable patients treated with cefuroxime or co-amoxiclav, respectively (p >0.05).
CONCLUSIONS
The findings of this study suggest that cefuroxime (twice daily) is comparably effective as co-amoxiclav (three times a day) in the treatment of patients with acute sinusitis.
Topics: Acute Disease; Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Cefuroxime; Child; Female; Humans; Iran; Male; Middle Aged; Single-Blind Method; Sinusitis; Young Adult
PubMed: 23299064
DOI: No ID Found -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Feb 2021The aim of this study is to explore the diagnosis, clinical manifestations and surgical treatment experience of acute sinusitis complicated with orbital subperiosteal...
The aim of this study is to explore the diagnosis, clinical manifestations and surgical treatment experience of acute sinusitis complicated with orbital subperiosteal abscess. The clinical data of 11 patients with acute sinusitis complicated by orbital subperiosteal abscess from 1 year and 8 months to 50 years were retrospectively analyzed, including clinical manifestations, imaging manifestations, bacteriological examinations, surgical methods and therapeutic effects. All patients were given antibacterial drugs, glucocorticoids, and surgery. All 11 patients had unilateral lesions. The imaging examinations all supported the appearance of orbital subperiosteal abscess. Nine patients underwent nasal endoscopic sinus opening+SPOA incision and drainage, 2 patients underwent nasal endoscopic sinus opening+ultrasound guided abscess puncture. Eyelid swelling and exophthalmia of all patients were alleviated when discharged. Ten of the 11 patients had no visual acuity change, and one patient had light perception only when she came to the hospital and recovered to 0.05 when discharged, there was no change in visual acuity after 3 months follow-up. The bacterial cultures of nasal secretion or pus were positive in 7 cases, the main pathogenic bacteria were Staphylococcus aureus(3 cases, includes one case of MRSA), Streptococcus anginosus(2 cases), and Streptococcus intermedius(2 cases). Rhinogenous orbital subperiosteal abscess has a rapid onset and progresses quickly. Once an abscess is formed, patients with poor conservative treatment should choose surgical treatment as soon as possible. The most common surgical method is nasal endoscopic sinus opening+SPOA incision and drainage. If the abscess is located above or above the eyeball, puncture or incision and drainage should be combined with ultrasound guidance.
Topics: Abscess; Anti-Bacterial Agents; Drainage; Female; Humans; Orbital Cellulitis; Orbital Diseases; Retrospective Studies; Sinusitis
PubMed: 33540993
DOI: 10.13201/j.issn.2096-7993.2021.02.008 -
Frontiers in Cellular and Infection... 2022Acute exacerbations (AE) in chronic rhinosinusitis (CRS) are a common and important clinical issue. However, relatively little is known regarding the underlying... (Review)
Review
BACKGROUND
Acute exacerbations (AE) in chronic rhinosinusitis (CRS) are a common and important clinical issue. However, relatively little is known regarding the underlying microbiology that drives exacerbations or how it relates to the microbiome of CRS. The purpose of this study is to examine the literature to characterize the microbiome associated with acute exacerbations in a chronic rhinosinusitis setting. Understanding this disease process may facilitate targeted antibiotic therapy, reduced antibiotic resistance, and offer more effective disease control and treatment efficacy.
OBJECTIVE
To characterize the microbiome associated with acute exacerbations of chronic rhinosinusitis (AECRS).
METHODS
We conducted a systematic review of the literature on Medline, Embase, and Web of Science databases from January 1990-June 2021 to identify studies related to AE in CRS. Exclusion criteria include non-English, non-human studies, and case reports. Studies without culture or PCR data were also excluded.
RESULTS
Fourteen studies were identified which provided detailed data regarding sinus microbiome in AECRS patients. In these patients, a total of 1252 individual isolates were identified. While common acute pathogens were identified in high frequencies in the sinonasal cultures (), the predominant bacteria were (including methicillin-sensitive ) and Patient characteristics that may represent higher risk phenotypes were not consistently collected in the studies. Discussion of antimicrobial sensitivities and/or resistance were included in 7/14 studies.
CONCLUSIONS
This systematic review identifies the predominant microbiology species that may contribute to AECRS. Further studies are needed to understand the pathogenic role of bacteria and viruses in AECRS and to identify associated comorbidities and patient phenotypes that may predispose to AE. The optimal treatment regimen for AECRS remains unclear.
Topics: Anti-Bacterial Agents; Bacteria; Chronic Disease; Humans; Rhinitis; Sinusitis; Staphylococcal Infections
PubMed: 35402317
DOI: 10.3389/fcimb.2022.858196 -
Rhinology Jun 2016Management of rhinosinusitis during pregnancy requires special considerations. (Review)
Review
BACKGROUND
Management of rhinosinusitis during pregnancy requires special considerations.
OBJECTIVES
1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations.
METHODS
The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea.
RESULTS
Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations.
CONCLUSIONS
The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence.
Topics: Administration, Intranasal; Adrenal Cortex Hormones; Anti-Bacterial Agents; Cerebrospinal Fluid Rhinorrhea; Cesarean Section; Chronic Disease; Delivery, Obstetric; Disease Management; Female; Humans; Leukotriene Antagonists; Nasal Polyps; Otorhinolaryngologic Surgical Procedures; Paranasal Sinuses; Practice Guidelines as Topic; Preconception Care; Pregnancy; Pregnancy Complications, Infectious; Rhinitis; Sinusitis
PubMed: 26800862
DOI: 10.4193/Rhino15.228 -
RMD Open Feb 2024To determine whether antecedent sinusitis is associated with incident rheumatic disease.
OBJECTIVES
To determine whether antecedent sinusitis is associated with incident rheumatic disease.
METHODS
This population-based case-control study included all individuals meeting classification criteria for rheumatic diseases between 1995 and 2014. We matched three controls to each case on age, sex and length of prior electronic health record history. The primary exposure was presence of sinusitis, ascertained by diagnosis codes (positive predictive value 96%). We fit logistic regression models to estimate ORs for incident rheumatic diseases and disease groups, adjusted for confounders.
RESULTS
We identified 1729 incident rheumatic disease cases and 5187 matched controls (mean age 63, 67% women, median 14 years electronic health record history). After adjustment, preceding sinusitis was associated with increased risk of several rheumatic diseases, including antiphospholipid syndrome (OR 7.0, 95% CI 1.8 to 27), Sjögren's disease (OR 2.4, 95% CI 1.1 to 5.3), vasculitis (OR 1.4, 95% CI 1.1 to 1.9) and polymyalgia rheumatica (OR 1.4, 95% CI 1.0 to 2.0). Acute sinusitis was also associated with increased risk of seronegative rheumatoid arthritis (OR 1.8, 95% CI 1.1 to 3.1). Sinusitis was most associated with any rheumatic disease in the 5-10 years before disease onset (OR 1.7, 95% CI 1.3 to 2.3). Individuals with seven or more codes for sinusitis had the highest risk for rheumatic disease (OR 1.7, 95% CI 1.3 to 2.4). In addition, the association between sinusitis and incident rheumatic diseases showed the highest point estimates for never smokers (OR 1.7, 95% CI 1.3 to 2.2).
CONCLUSIONS
Preceding sinusitis is associated with increased incidence of rheumatic diseases, suggesting a possible role for sinus inflammation in their pathogenesis.
Topics: Humans; Female; Middle Aged; Male; Autoimmune Diseases; Case-Control Studies; Rheumatic Diseases; Arthritis, Rheumatoid; Sinusitis
PubMed: 38388169
DOI: 10.1136/rmdopen-2023-003622