Salmonella neck abscess associated with jugular vein thrombosis.

An unusual case of synergistic infection caused by Salmonella paratyphi and anaerobic streptococcus resulting in necrotizing cervical infection associated with deep neck abscess and internal jugular vein thrombosis, is presented. Salmonella acting as an oxygen consumer in the infected tissues, facilitates the growth of anaerobic cocci, hence the development of a devastating soft tissue infection. The precipitating cause was a tonsillar infection developing due to 'post-anginal sepsis'. The aetiopathogenesis of the cervical infection is discussed.     

Methicillin resistant Staphylococcus aureus: is it a problem for nasal surgery?

Methicillin resistant Staphylococcus aureus (MRSA) is becoming ever more prevalent in the UK, and the proportion of MRSA to methicillin sensitive Staphylococcus aureus (MSSA) seems to be increasing. New strains of MRSA are ever developing resistance to antibiotic treatment, increasing morbidity and mortality of infection. Staphylococcus aureus is part of the normal flora of the nose, and MRSA colonizes the nose in infection. However, nasal surgery is rarely complicated by staphylococcal infections, and MRSA infection following nasal surgery is rare. The authors present a literature review of MRSA infection, its relation to the nasal cavity, and infection following nasal surgery.     

啮蚀艾肯菌致鼻咽颅底感染1例报道

目的 总结1例啮蚀艾肯菌引起鼻咽颅底感染的诊疗经验,提高对该菌感染病的认识。方法 回顾性分析1例啮蚀艾肯菌致鼻咽颅底感染患者的病例资料,并结合文献进行讨论。结果 本例患者完善内镜检查、影像学检查以及实验室检查,鼻咽颅底组织2次病理报告均为慢性肉芽肿性炎,经实验室确诊为啮蚀艾肯菌感染,予清创引流、口服抗生素2个月后,患者痊愈,术后随访3个月未复发。结论 鼻咽颅底感染临床少见,临床症状、影像学检查与鼻咽癌相似。啮蚀艾肯菌为罕见致病菌,发病率低。诊治上,需结合病理学、病原学检查明确诊断,及早清创引流、选取合适的抗感染药物。     

Stomatological lesions seen in HIV virus infection. II. Histopathological and ultrastructural studies

Buccal lesions observed in the clinical setting of human immunodeficiency virus (HIV) infection constitute a diverse group of pathological entities. Several are related to the opportunistic infections observed in association with HIV infection. "Hairy leukoplakia" is a recently described benign lesion that is presumably related to infection by Epstein-Barr virus (E.B.V.). Kaposi's sarcoma is seen somewhat frequently in the oral cavity, especially involving the palate of HIV infected patients. We have observed this lesion 19 times in this location. The diagnosis is usually relatively straight-forward. Both vascular inflammatory and more typical sarcomatous morphology sub-types are present. The salivary glands may show an important lymphoplasmocytic infiltration which is unusual in that associated epithelial changes are not observed. The salivary glands seem to be a seat of the lymphocytic infiltration seen in other organs during the course of HIV infection. As for the changes encountered in the lymph nodes in HIV infection, they represent different stages in the evolution of a dynamic process, which progresses from hyperplasia to atrophy of the lymph nodes.     

Biology of human papillomavirus infection and immune therapy for HPV-related head and neck cancers

This article outlines the biology of human papillomavirus (HPV) infection of human mucosa and the cellular pathways that are altered through viral infection. The article provides a conceptual framework with which to understand the 2 major immunologic strategies to address HPV-related diseases: (1) prevention of primary HPV infection through the use of prophylactic vaccines and (2) treatment of established infection and diseases through therapeutic vaccines. Nonimmunologic therapy that targets cellular dysregulation induced by HPV infection is also discussed. The challenges in actualizing these conceptually attractive therapies on both a societal and biological level are examined.     

CT of the paranasal sinuses: study of a control series in relation to endoscopic sinus surgery

A control series of biplane CT scans of the paranasal sinuses, derived from patients examined for orbital tumours, is described. The scans were assessed for the presence of anatomical variants in the middle meatus, said to contribute to meatal stenosis, and for signs of asymptomatic infection revealed by the presence of clouding or mucosal thickening in the sinuses. Of the anatomical variants, only concha bullosa (pneumatisation of the middle turbinate) was associated with a high incidence of infection in the sinuses (85 per cent). Evidence of asymptomatic sinus infection was as high as 39 per cent overall, the highest incidence occurring in the ethmoid cells (28 per cent). Isolated ethmoid clouding on CT was observed in 15 per cent and is likely to be found in as many as one in seven of the adult population in the UK. It is concluded that in the majority of patients clouding confined to a few ethmoid cells shown on CT is without clinical significance. The evidence from the control series did not support the concept that most sinus infection starts in the middle meatus. The presence of a large reservoir of quiescent or chronic sinus infection in the control group suggests that in most instances sinusitis derives from a recrudescence of this pre-existing infection.     

Electronic surveillance of nosocomial infections in head and neck surgery and stapes surgery

BACKGROUND: Nosocomial infection is generally regarded as the most important postoperative complication. Therefore, on 28 December 2002 a German law was implemented requiring the surveillance of postoperative infections in all hospitals. METHODS: The authors propose using stapes and thyroid surgery to monitor the infection rate in a typical Head and Neck Department. A versatile software (CISS) based on MS Word and MS Excel was developed for this purpose. RESULTS: Postoperative infections were retrospectively analyzed for three subsequent years. The present data confirm the results of previous studies that surveillance itself is a powerful tool in reducing the postoperative infection rate. CONCLUSION: The newly developed software provided an easy tool for the collection of infection data. The reported infection rates in stapes and thyroid surgery are representative of ENT clinics in Germany.     

Cervical necrotizing fasciitis with facial nerve paralysis

Necrotizing fasciitis (NF) is a very aggressive infection with associated high mortality. Risk factors of acquiring this infection may include diabetes mellitus, surgery, trauma, and infection. This infection necessitates prompt recognition and aggressive management in order to avoid its unfavourable outcomes. Associated nerve paralysis may indicate the involvement of deeper tissue. The present report highlights a case of cervical NF that was complicated by facial nerve paralysis, a feature that has rarely been reported.     

An update on focal infection of oral origin

Focal infection of oral origin means that an oral infectious focus may have widespread effects. This concept remains controversial since it is difficult to prove the oral origin of germs responsible for an extra-oral infection. Experiments on animal models and clinical studies suggested several physiopathological mechanisms: bacteremia, toxinic and immunological mechanisms. Various operations induce the passage of bacterial flora (transcytosis) and its toxins into the bloodstream: oral care, chewing, or tooth brushing. Bacteremia is worsened by poor oral hygiene or an infection. The germs are usually destroyed by the host's reticuloendothelial system in a few minutes, but the presence of a valvular disease or a weak immune system favors focal infection. Besides infectious endocarditis, this may concern cardiovascular diseases, lung infections, prematurity and hypotrophy, diabetes, prosthetic infections, cerebral abscesses, etc. This update is based on literature review, selected according to its high level of scientific proof, as well as on a selected choice of consensus conferences. The current recommendation is to limit antibiotic prophylaxis to the high bacteremia risk procedures and to patients highly at risk of developing a focal infection.     

Congenital cytomegalovirus infection and sensorineural hearing loss

In a prospective study still in progress, infants with congenital cytomegalovirus (CMV) infection were followed with audiological, ophthalmological, neurological, and psychological tests; 10,328 infants were investigated within a 5-year period (1977-1982) by virus isolation in urine within the first week of life. Fifty (0.5%) had a congenital CMV infection. In this group four children turned out to have total deafness and a fifth possibly a mild hearing disorder. In one case the deafness was associated with severe mental retardation and spastic tetraplegia. The mother of the child had a primary CMV infection in the first trimester. In one of the other cases of severe deafness it could be proven that the mother had had a secondary CMV infection and in further two cases, presumed secondary infections. Prospective serological tests of the mothers would not have revealed more than one of the high risk pregnancies. The value of vaccination against congenital CMV infection is questioned. Screening of newborn infants for congenital CMV infection is recommended in order to reveal infants at high risk for deafness and make an early habilitation possible.     

人工耳蜗植入术后感染的因素及其生物学特点研究

目的:分析人工耳蜗植入术后感染的因素及其生物学特点,探讨如何减少术后感染及感染后的治疗措施。方法:回顾性分析2001-07-2011-10期间我院人工耳蜗植入中心接受耳蜗植入的患者发生术后感染的情况。结果:由同一术者完成的316例人工耳蜗植入手术,术后有5例发生感染,外院术后感染转来1例,共6例,均经治疗后痊愈,其中1例术后8年因植入体电极支撑小柱等因素感染取出植入体。结论:人工耳蜗植入术后感染致病菌多为金黄色葡萄球菌、铜绿假单胞菌等。细菌生物膜的形成是人工耳蜗植入术后感染的关键环节,采用化学制剂清除细菌生物膜,能够控制人工耳蜗术后感染,特别是皮瓣感染。人工耳蜗植入术后发生感染时并不一定非要取出植入体。采用积极围手术期干预,积极治疗术后感染,及时采取有效措施,是人工耳蜗植入术后言语康复的有效保障。     

Poststernotomy infections presenting as deep neck abscess

A review of the world literature has failed to reveal any published reports of poststernotomy mediastinitis presenting as a deep neck infection. This article presents two such cases. Since the fascial layers of the mediastinum are a direct continuation of the cervical fascia, a number of potential pathways between the neck and mediastinum exist. Descending infection from the neck into the mediastinum is well documented. The reverse situation, an ascending infection from the mediastinum into the neck, is not described despite the potential natural pathways available for spread of infection. Our proposed mechanism for these two cases is that a surgically created pathway from the mediastinum to the lower neck allows for mediastinitis to point in the intercommunicating fascial spaces of the neck. Recognition of this clinical presentation will allow the surgeon to use prompt intervention for such a serious complication.     

Herpes and the head and neck: the difficulties in diagnosis

A case of primary herpes of the head and neck is presented. The exact source of infection and the precise diagnosis proved difficult to establish, but evidence tended to support a diagnosis of varicella zoster infection as opposed to a herpes simplex infection, though a dual infection was not ruled out. Herpes simplex has specific clinical features which usually make its distinction from varicella zoster clear cut. In this case we relied heavily on laboratory investigations to improve the accuracy of our diagnosis since the clinical characteristics were blurred. Unlike varicella zoster there has been little written about herpes simplex infections specifically affecting the ear, face and neck.     

Etiologic factors in head and neck wound infections

The use of antibiotic prophylaxis does not prevent all postoperative wound infections. The records of 245 patients undergoing major head and neck surgery were reviewed to determine the cause of wound infection which developed in 17 patients. Patients with Stage IV tumors had an increased infection rate as compared to lesser stages (p less than .01). Reconstruction with a myocutaneous flap was associated with an increased infection rate when compared to primary closure or split-thickness skin graft reconstruction (p less than .001). Probable errors in surgical technique were identified in 10 of 17 infected patients. Neither weight loss, diabetes mellitus, prior radiation therapy, nor prior tracheotomy were found to increase the risk of wound infection (p greater than .05). This study lends insight into factors that may potentiate the development of wound infection despite antibiotic prophylaxis. A strategy to minimize postoperative infection is offered.     

Longitudinal investigation of hearing disorders in children with congenital cytomegalovirus

This investigation consisted of a longitudinal study of the effects of congenital cytomegalovirus (CMV) infection on hearing sensitivity in 860 children with documented asymptomatic or symptomatic congenital CMV infection. Of the 651 children with asymptomatic CMV infection, 48 (7.4%) developed sensorineural hearing loss (SNHL), compared to 85 (40.7%) of the children with symptomatic CMV infection. Children in both groups experienced latent effects consisting of delayed onset of loss, threshold fluctuations, and/or progressive loss of hearing. It can be concluded that congenital CMV infection is a leading cause of SNHL in children. The late onset and progression of loss necessitates continued monitoring of hearing sensitivity in this population.     

Human papillomavirus in larynx

OBJECTIVES: The core of the present clinical and basic research knowledge of laryngeal human papillomavirus (HPV) infection is described. STUDY DESIGN: Review. METHODS: A computer-aided search of MEDLINE database supplemented by hand searches of key journals was conducted. RESULTS: One of the tumor-promoting factors in the larynx is the HPV found both in normal laryngeal epithelium and in laryngeal tumors. The most important manifestation of laryngeal HPV infection is laryngeal papillomatosis, a rare disease caused by HPV types 6 and 11. In laryngeal carcinogenesis, the role of HPV remains uncertain. The means of transmission of HPV are partly unknown, and the course of laryngeal HPV infection is unpredictable and variable. Treatment of laryngeal papillomatosis is based on surgery, especially on CO2 laser and shaver. Alpha-interferon is the drug of choice in patients whose response to surgery is poor. However, neither interferon nor other antiviral drugs are able to eradicate the virus from laryngeal mucosa. Little is known about immunological mechanisms involved in laryngeal HPV infection, but in defense against HPV cellular immunity is considered a more important mechanism than humoral immunity. A good experimental model of HPV infection is lacking in which the entire viral life cycle can take place. Organotypic cell cultures (collagen rafts) are useful, but the rate-limiting step in this method is the difficulties in culturing HPV-positive epithelial cells. CONCLUSIONS: Although laryngeal papillomatosis is clinically well defined, the mechanisms and treatment modalities of laryngeal HPV infection need further investigations.     

Complicated otitis media caused by Fusobacterium necrophorum

Fusobacterium necrophorum is implicated as an aetiological agent in a variety of necrotic diseases, such as Lemièrre's syndrome (LS) in humans. LS was initially described as septic thrombophlebitis of the internal jugular vein secondary to an acute oropharyngeal infection. Other primary sources of infection include parotitis, otitis media, sinusitis, odontogenic infection and mastoiditis. In the pre-antibiotic era LS carried a high mortality. This has been reduced as a result of the widespread use of antibiotics, but there is still a definite morbidity and mortality associated with infection with this virulent organism. We report three cases of complicated otitis media caused by Fusobacterium necrophorum. The patients were treated successively with intravenous metronidazole and surgery.     

晚期鼻咽癌同步放化疗患者营养状况监测及院内感染分析

目的：观察鼻咽癌同步放化疗患者治疗前后的营养状况和院内感染情况,探讨预防感染的有效措施。方法：对82例鼻咽癌接受同步放化疗的患者治疗前后的营养状况以及院内感染和治疗情况进行回顾性分析。结果：同步放化疗前后患者营养状况,包括体重、血红蛋白及血清白蛋白之间差异有统计学意义。82例患者中发生院内感染者63例（76．83％）;口鼻、咽部黏膜感染者76例（92．68％）;黏膜感染伴有皮肤带状疱疹者2例（2．44％）;肺部感染者3例（3．66％）;败血症1例（1．22％）。共分离病原菌39株,病原菌其中革兰阴性菌最为多见,共23株（58．97％）;其次真菌12株（30．77％）;革兰阳性菌3株（7．69％）;带状疱疹病毒1株（2．56％）。结论：晚期鼻咽癌同步放化疗患者治疗期间应做好营养监测和营养支持,加强饮食指导和干预以减少其不良反应的发生,提高患者的躯体耐受性及生活质量。同期放化疗期间院内感染以口咽黏膜感染革兰阴性菌发生率最高,应重视咽拭子培养,必须加强口腔护理并合理用药。     

Focal infection? Did you say focal infection ... focal infection and uveitis

A chronic seat of infection more often than not situated in the E.N.T. area is responsible for remote pathological symptoms commonly called focal infection. The eye may be a target organ, where focal infection appears in the form of a uveitis. Four clinical observations are reported as demonstration. The transmission mechanism operates through an immune phenomenon from bacterial antigens which engender reactions of hypersensitivity. The E.N.T. specialist must be aware of these symptoms and seek a pharyngeal, sinusal or latent buccodental infection.     

Laryngeal carcinoma — or is it laryngeal blastomycosis?

A patient is described who was evaluated for persistent hoarseness. Although an initial diagnosis of squamous cell carcinoma of the larynx was made, review of the pathology slides revealed pseudoepitheliomatous hyperplasia, acanthosis, and what appeared to be a fungal infection. After a detailed work-up was initiated the patient was treated successfully with ketoconazole for a blastomycosis infection of the larynx. The literature relative to blastomycosis infections of the respiratory larynx is reviewed. The authors emphasize that patients who show evidence of acanthosis and pseudoepitheliomatous hyperplasia along with the diagnosis of squamous cell carcinoma should be suspected as having a potential fungal infection.