Diagnosis and Management of Fungal Urinary Tract Infections

Fungal urinary infections are becoming more common, particularly in hospital settings with the vast majority caused by Candida species. The ability to differentiate colonization from infection is difficult and treatment decisions are far from straightforward. To date, there is no dependable method for distinguishing colonization from infection, as evidence of funguria does not automatically require treatment. Often, mere modification of predisposing factors is sufficient management. Following a standardized algorithm that categorizes patients with regard to symptoms and risk profiles can aid the clinician in proper workup and treatment and mitigate unnecessary antifungal usage.     

Diagnosis and Management of Necrotizing Fasciitis of the Head and Neck

Necrotizing fasciitis is a rapidly progressing and life-threatening soft tissue infection that often affects the abdominal wall, perineum, or extremities following surgery or trauma. It predominantly occurs in elderly and immunocompromised patients. It is rarely seen in the head and neck region. Necrotizing fasciitis of the head and neck carries high rates of morbidity and mortality. Symptoms usually develop quickly and well-timed diagnosis is critical to optimizing outcome. Diagnosis is based on a combination of clinical history, Gram staining and culture, imaging and surgical exploration. Early and aggressive surgical management and urgent parenteral antibiotic therapy are critical to optimizing outcome.     

The Use of Probiotics in Head and Neck Infections

Recurrent episodes of infections in the upper respiratory tract are very common. The pathogenesis behind these recurrences is still not well understood, but much attention has been paid to the adherence of the microorganisms to epithelial structures and to the protective function of the normal bacterial flora (bacterial interference). Thus, in vitro as well as in vivo studies have shown that both aerobic and anaerobic bacteria of the normal flora in the upper respiratory tract can hinder the growth of pathogens and the establishment of a renewed infection. Studies have shown that lack of interfering bacteria facilitates recurrence of these diseases. Recolonization with interfering alpha-streptococci has been performed successfully in acute streptococcal pharyngotonsillitis, as well as in acute otitis media. The number of recurrences has significantly been lowered in these diseases after recolonization with alpha-streptococci, which is the dominating normal bacteria in the upper respiratory tract. Several mechanisms have been proposed to be responsible for this interaction, such as competition of the adhering sites at the epithelial cells, production of hydrogen peroxide, competition for nutritients, and production of specific growth inhibiting factors such as bacteriocins. Other human components like lactoferrin are also important in the defense against microorganisms, and are important parts of the unspecific and specific immune system.     

Biopsy Procedures for Molecular Tissue Diagnosis of Invasive Fungal Infections

The incidence of invasive fungal infections (IFI) has increased substantially and the epidemiology has changed dramatically in recent years. Candida albicans is still most important, but non-albicans species, Aspergillus species, Glomeromycota (formerly Zygomycetes) and Fusarium species are an increasing cause of IFIs. Due to this growing diversity, the identification of the causative organism to genus and species level is important to perform best and adequate treatment. The early, sensitive and specific detection of IFIs remains challenging and current conventional methods are limited. The golden standard for the definite diagnosis of proven pulmonary infection remains either histopathologic, cytopathologic or direct tissue examination. Invasive procedures are necessary to obtain reliable specimens and biopsies may be taken percutaneously, bronchoscopically, via open surgery or via video-assisted thorascopic surgery. Molecular methods, like PCR or in situ hybridization, are a promising diagnostic tool for rapid and reliable species identification and should be performed in addition to microscopic examination and culture to increase the sensitivity for the diagnosis of IFI. Combining culture, microscopy, serology, and PCR in lung tissues and/or bronchial samples will increase the diagnostic yield by 99%. Here, we give an overview of biopsy procedures for molecular tissue diagnosis of IFI.     

Insights into Nanomedicine for Head and Neck Cancer Diagnosis and Treatment

Head and neck cancers rank sixth among the most common cancers today, and the survival rate has remained virtually unchanged over the past 25 years, due to late diagnosis and ineffective treatments. They have two main risk factors, tobacco and alcohol, and human papillomavirus infection is a secondary risk factor. These cancers affect areas of the body that are fundamental for the five senses. Therefore, it is necessary to treat them effectively and non-invasively as early as possible, in order to do not compromise vital functions, which is not always possible with conventional treatments (chemotherapy or radiotherapy). In this sense, nanomedicine plays a key role in the treatment and diagnosis of head and neck cancers. Nanomedicine involves using nanocarriers to deliver drugs to sites of action and reducing the necessary doses and possible side effects. The main purpose of this review is to give an overview of the applications of nanocarrier systems to the diagnosis and treatment of head and neck cancer. Herein, several types of delivery strategies, radiation enhancement, inside-out hyperthermia, and theragnostic approaches are addressed.     

Severe Soft Tissue Infections of the Head and Neck: A Primer for Critical Care Physicians

Patients with severe infections of the potential spaces of the head and neck are commonly managed in the ICU. These infections may present with devastating complications such as airway obstruction, jugular septic thrombophlebitis, lung abscess, upper airway abscess rupture with asphyxiation, mediastinitis, pericarditis, and septic shock. A thorough understanding of the anatomy and microbiology of these infections is essential for proper management of these patients. Retropharyngeal, danger, prevertebral, lateral pharyngeal, and submandibular space infections and their site-specific clinical manifestations, complications, and therapeutic interventions are discussed.     

Mucormycosis of the Head and Neck

Mucormycosis of the head and neck is the most common form of infection by the order Mucorales, accounting for up to half of all cases. About 70% of rhinocerebral cases develop in diabetic patients. Less often, rhinocerebral mucormycosis occurs in solid organ transplant recipients, those with prolonged neutropenia, and those on deferoxamine therapy. Recently, rhinocerebral disease has been increasingly recognized in patients undergoing hematopoietic stem cell transplantation. A growing number of cases have presented as breakthrough infection in patients receiving voriconazole. The mortality rate of rhinocerebral mucormycosis has remained at 30% to 70% despite aggressive therapy. Early initiation of treatment substantially improves outcome, underscoring the need to maintain a high index of suspicion and promptly biopsy potential lesions. Surgical excision of necrotic tissue is essential. Lipid formulations of amphotericin B have become the standard treatment for mucormycosis. Posaconazole is useful as salvage therapy, but cannot be recommended yet as primary therapy.     

Nanomaterials for the Diagnosis and Treatment of Head and Neck Cancers: A Review

Head and neck cancer (HNC) is a category of cancers that typically arise from the nose-, mouth-, and throat-lining squamous cells. The later stage of HNC diagnosis significantly affects the patient’s survival rate. This makes it mandatory to diagnose this cancer with a suitable biomarker and imaging techniques at the earlier stages of growth. There are limitations to traditional technologies for early detection of HNC. Furthermore, the use of nanocarriers for delivering chemo-, radio-, and phototherapeutic drugs represents a promising approach for improving the outcome of HNC treatments. Several studies with nanostructures focus on the development of a targeted and sustained release of anticancer molecules with reduced side effects. Besides, nanovehicles could allow co-delivering of anticancer drugs for synergistic activity to counteract chemo- or radioresistance. Additionally, a new generation of smart nanomaterials with stimuli-responsive properties have been developed to distinguish between unique tumor conditions and healthy tissue. In this light, the present article reviews the mechanisms used by different nanostructures (metallic and metal oxide nanoparticles, polymeric nanoparticles, quantum dots, liposomes, nanomicelles, etc.) to improve cancer diagnosis and treatment, provides an up-to-date picture of the state of the art in this field, and highlights the major challenges for future improvements.     

Fungal Infections of the Bones and Joints

Osteoarticular complications may occur with a variety of invasive fungal infections, and seem to be increasing with growing use of prosthetic joints and as the immunosuppressed patient population increases. Epidemiology, pathogenesis, presentation, and management strategies differ somewhat among the different fungal species. This review focuses on recent developments in diagnostic and management approaches for patients with osteoarticular mycoses, and outlines specific treatment strategies for the different species.     

Diagnosis and Management of Enteroviral Infections of the Central Nervous System

Even with the approaching worldwide eradication of the polioviruses, the nonpolio enteroviruses remain major pathogens of the central nervous system. Our understanding of this important group of viral pathogens has increased dramatically in the past decade. The advent of molecular virology has yielded information that has been vital to the development of molecular diagnostic techniques for the detection of the enteroviruses and for the design of novel antienteroviral drugs. Advances in molecular diagnostics have allowed for a better definition of the diseases they cause and have impacted on patient care. This review discusses recent developments in the diagnosis and treatment of enterovirus infections of the central nervous system, including an overview of the molecular virology of the enteroviruses as it pertains to taxonomy, diagnosis, and treatment.