Eikenella corrodens. An emerging pathogen in head and neck infections

Eikenella corrodens is a gram-negative, facultative anaerobe that exists as part of the normal oral flora. Its role as a pathogen in human infection has been disputed, but recently its pathogenic potential has been increasingly recognized. A review of the literature reveals the emergence of this organism as a pathogen in human infection. Specific microbiologic characteristics of this organism make it difficult to isolate and evaluate for antibiotic sensitivities. Infections produced by this bacteria are characteristically indolent in nature and are usually associated with oral contamination. Appropriate antibiotic therapy utilizes ampicillin or penicillin. Tetracycline is the drug of choice in the penicillin-allergic patient. Clindamycin resistance is a universal feature. A greater awareness of the pathogenic potential of E corrodens is essential for appropriate recognition and treatment.     

Parotitis associated with Eikenella corrodens in a healthy adult

Eikenella corrodens is a gram-negative, facultatively anaerobic rod that is part of the normal oral flora. Although its pathogenicity was uncertain until recently, E corrodens has been implicated in a variety of human infections, usually in mixed culture, and commonly in patients predisposed by virtue of trauma, malignant neoplasms, antecedent surgery, or parenteral drug abuse. Parotitis due to E corrodens occurred in a healthy 72-year-old woman. Therapy with high-dose intravenous oxacillin sodium had been without effect, but surgical drainage plus antibiotic therapy directed against E corrodens produced prompt resolution.     

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。     

Resistant microorganisms in head and neck infections

The key pathogens most commonly associated with acute infections in the upper respiratory tract include Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes. Antimicrobial resistance amongst these organisms to many of the commonly used agents for treatment continues to evolve. S. pneumoniae is probably the most important pathogen in the respiratory tract and antimicrobial resistance of this organism to many drugs appears to be rising. For some organisms, such as S. pyogenes, resistance to standard therapy such penicillin has not been described. For others, such as M. catarrhalis, beta-lactamase production has become the norm, with over 90% of isolates now producing this enzyme. One of the major drivers of resistance continues to be the overuse and misuse of antibiotics in the community. This is complicated by the fact that most therapy is empiric and the exact etiology of a patient's infection is not known. Despite the fact that the clinical impact of antibiotic resistance on patient outcomes is not always clear, it remains prudent to consider the issue of resistance when selecting therapy for a patient and to continue to strive for appropriate antibiotic use as a means to stem the tide of evolving resistance.     

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.     

Post-operative MRSA infections in head and neck surgery

Purpose

Surgical site infection (SSI) with methicillin-resistant Staphylococcus aureus (MRSA) is a serious post-operative complication, with head and neck cancer patients at greater risk due to the nature of their disease. Infection with MRSA has been shown to be costly and impart worse outcomes on patients who are affected. This study investigates incidence and risks for MRSA SSIs at a tertiary medical institution.

Mycobacterial infections of the head and neck

Mycobacterial infections are grouped into infections caused by M. tuberculosis and those caused by the atypical mycobacterial organisms. Tuberculosis is a systemic disease, with cervical lymphadenitis of the head and neck being the most common extrapulmonary manifestation of the disease. It is important to use imaging, histopathologic examination, and culture to differentiate tuberculosis from atypical mycobacterial infections, because treatments differ. Tuberculosis is best treated as a systemic disease, with anti-tuberculosis medication. The atypical infections can be addressed as local infections and are amendable to surgical therapy.     

Pasteurella infections of the head and neck

Infections caused by Pasteurella occur most frequently after domestic animal bites or scratches and in individuals with agricultural or veterinary contact with animals. A serious Pasteurella infection developed in an agricultural worker following tumor extirpation of a head and neck neoplasm. Review of Pasteurella infections in humans disclosed that 31 of 446 reported infections involved head and neck structures. The most serious of these involved the adjacent central nervous system. Surgical drainage combined with parenteral penicillin remains the treatment of choice in these infections. Aminoglycosides are not effective in treating this organism.     

Fungal infections of the head and neck: an update

Despite the vast literature regarding fungal infections of the head and neck, little has changed in diagnosis or management of these infections except in the nose and sinuses. Three main points regarding fungal involvement in the paranasal sinuses are evident now. First, fungi may be important in a significant percentage of patients with chronic rhinosinusitis. Second, the pathophysiologic mechanism responsible for fungal rhinosinusitis remains unclear. It may represent an allergic IgE response, a cell-mediated reaction, or a combination of the two. Finally, there is certainly a spectrum of disease thus far defined: allergic fungal sinusitis as defined by Bent and Kuhn [35], eosinophilic mucin rhinosinusitis defined by Ferguson [50], and eosinophilic fungal rhinosinusitis as proposed by Ponikau [45]. Fungal infections of the head and neck are panoramic in distribution and pathophysiology. They represent a broad range of disease of which medical science has only recently begun to uncover the surface. As research begins to unravel the complex host defense mechanisms against these pathogens from a cellular and even genetic level, the body of knowledge will continue to increase exponentially and the ability to treat patients suffering from fungal infections will improve.     

Demographics of pediatric head and neck infections in a tertiary care hospital

EDUCATIONAL OBJECTIVE: Discuss potential patterns in the epidemiology of infectious disease of the head and neck. STUDY OBJECTIVES: To investigate patterns in the epidemiology of severe head and neck infections that may reflect the impact of host factors. STUDY DESIGN: Population-based, historic cohort study. METHODS: Information on 1,010, incident head and neck infections occurring over a 5-year period was reviewed for demographics, location, and time of year. A nonparametric Kruskal-Wallis test was used to identify significant differences in the age distributions among the diagnosis groups. A Bonferroni, pair-wise comparison procedure was used for comparison of the average age of first onset of severe head and neck infections. Chi-square test was used to identify any significant association between season of the year and disease. RESULTS: Significant differences were identified in the age distributions among the diagnosis groups (P < .001). The average age of first onset of cellulitis of the neck and retropharyngeal abscess is earlier than peritonsillar abscess, at 2 to 3 years and 13 years, respectively. Parapharyngeal and periapical abscesses and cellulitis of the face occur at approximately age 6. The incidence of parapharyngeal abscess and diseases of the pharynx is decreased during Spring, whereas peritonsillar abscesses and acute periodontitis occurs more often in Spring and Summer. Age does not appear to be related to season of first occurrence. CONCLUSIONS: Head and neck infections are not random occurrences based on exposure alone; host factors are clearly important. Given the lack of correlation with school age, the results cannot be explained on the basis of exposure alone. Developmental patterns of the host immune response may be related to the age differential identified in the current study and are cause for further investigation.     

Nonwound infections following head and neck oncologic surgery

Little information exists regarding the comorbidity of postoperative nonwound infections (NWIs) in patients with head and neck cancer. Prospectively, 225 patients were randomized in a double-blind fashion to receive either clindamycin or ampicillin sodium/sulbactam sodium for prevention of postoperative wound infection. Of the 113 patients receiving clindamycin, 14 developed nonwound infections, compared with 10 of 112 patients receiving ampicillin/sulbactam. A single site of nonwound infection occurred in 21 patients, and 2 sites occurred in 3 patients. The majority of infections were pulmonary (22), followed by urinary tract (3), septic phlebitis (1), and acute sinusitis (1). Gram-negative organisms were isolated more frequently among patients on clindamycin (18) versus ampicillin/sulbactam (6) (P = .014). Risk factors for pulmonary nonwound infection included: longer surgery, a greater than 70 packs per year smoking history, blood transfusion, and hypoalbuminemia (P < .05). Nonwound infections produce significant postoperative morbidity and the predominance of gram-negative organisms isolated from these infections has therapeutic implications.     

Necrotizing soft-tissue infections in the head and neck: A clinicopathological study

The clinicopathological aspects of 15 patients with necrotizing soft-tissue infections in the head and neck are reviewed. Our relatively large series suggests that the disease occurs more frequently than described in the literature. Histological studies showed that tissue superficial and deep to the fascia is frequently involved with the infectious inflammatory process, even in early stages of the disease. These pathologic changes were also found in healthy-appearing tissues at the periphery of the lesions. The early recognition of the disease and the prompt and aggressive surgical and medical therapeutic approach have resulted in far lower mortality rates (7%) than those reported in the literature. Frozen-section examination contributed to the maximal eradication of the pathologic process. This successful outcome was achieved in spite of the adverse associated clinical conditions, such as old age, debilitating disease, or complications, observed in half of the patients.     

Streptococcus milleri: an organism for head and neck infections and abscess

BACKGROUND: Streptococcus milleri, a commensal organism, has the potential to cause significant morbidity. There is a paucity of published data regarding this organism in the head and neck. OBJECTIVES: To identify and assess the presentation, treatment, and outcomes of pediatric patients affected by this pathogen. STUDY DESIGN: Review of the Department of Pathology database at Children's Hospital of Wisconsin, Milwaukee, between 1997 and 1999 identified 26 patients with cultures positive for S milleri group (SMG) bacteria. Retrospective chart analysis examined the demographic data, site of origin of infection, additional organisms cultured, symptoms, treatments, and complications. RESULTS: Sixteen patients had SMG infections involving the head and neck region. Sites of origin included the paranasal sinuses, dental, facial soft tissues, deep neck spaces, peritonsillar region, and a tracheostomy site. The paranasal sinuses were the most common site in 37% (6/16). Streptococcus milleri was the only isolate in 69% (11) of the infections. Significant local extension occurred in 56% (9/16) of the patients and included the orbit, skull base, cranium, and deep neck spaces. All patients had surgical drainage and 15 also received intravenous antibiotic treatment. One complication of osteomyelitis of the frontal bone occurred with resolution after surgical debridement and intravenous antibiotic treatment. CONCLUSIONS: Streptococcus milleri can be an aggressive pathogen in the head and neck with a propensity for abscess formation and local extension of the infection in a pediatric population. Surgical drainage with antibiotics is generally successful in management of the condition. However, emerging penicillin resistance and the ability for local extension require suspicion of incomplete treatment if clinical symptoms persist.     

Complications of space infections of the head and neck.

Life threatening infections of odontogenic or upper airway origin may extend to potential spaces formed by fascial planes of the lower head and upper cervical area. The incidence of these “space infections” has been greatly reduced by modern antibiotic therapy. However, serious morbidity and even fatalities continue to occur. Two cases of deep neck infection, (one of odontogenic and one tonsillar in origin) with subsequent mediastinitis, empyema, pericarditis and ultimate survival are reported. One case of deep neck infection, (of odontogenic etiology) and suppurative thrombophlebitis of the internal jugular vein with ultimate fatal outcome is also reviewed. Review of the literature reveals only one previous case report of a survivor of an odontogenic deep neck infection complicated by mediastinitis, empyema and pericarditis. The anatomy, etiology and treatment of complications of these “space infections” of the head and neck are briefly reviewed.     

Effect of wound infections on head and neck cancer.

There seems to be a consensus in the surgical literature that wound infections after surgery for cancer have a favorable effect on the course of certain malignant diseases. In a review of laryngeal cancer during a 10-year period, the recurrence rate was statistically lower in the group that suffered wound infections than in the group that did not have a wound infection.     

Current management of upper respiratory tract and head and neck infections

The objective of this study is to present the antimicrobial management modalities of treating upper respiratory tract (URT) and head and neck infections. This article discusses the current antimicrobial treatment strategies of URT and head and neck infections. The increasing antimicrobial resistance of many bacterial pathogens has made the treatment of URT and head and neck infections more difficult. This review summarizes the aerobic and anaerobic microbiology and antimicrobials therapy of acute and chronic URT and head and neck infections. These infections include dental (gingivitis, periodontitis, necrotizing ulcerative gingivitis, and periodontal abscess), acute and chronic otitis media, mastoiditis and sinusitis, pharyngo-tonsillitis, peritonsillar, retropharyngeal and parapharyngeal abscesses, suppurative thyroiditis, cervical lymphadenitis, parotitis, siliadenitis, and deep neck infections including Lemierre syndrome. In conclusion, the proper management of these infections requires an accurate clinical and bacteriological diagnosis.     

Indium 111-labeled leukocyte scintigraphy in evaluating head and neck infections.

This retrospective study looked at the role of indium 111-labeled white blood cell (111In WBC) scintigraphy in head and neck infections. The efficacy of 111In WBCs was compared to gallium 67 citrate (67Ga) and technetium Tc99m methylene diphosphonate (99mTc MDP) scintigraphy in detecting and monitoring the resolution of infection. For 22 active infections, the sensitivities for 111In WBC, 67Ga, and 99mTc MDP scintigraphy were 94%, 56%, and 86%, respectively, and the specificities for 111In WBC, 67Ga, and 99mTc MDP scintigraphy were 100%, 43%, and 0%, respectively. For 8 successfully treated infections, all seven 111In WBC studies became negative after therapy, in as short an interval as 1 month. In contrast, all seven 99mTc MDP images remained positive for as long as 6 months after therapy. The seven 67Ga studies had variable results, with four (57%) remaining positive, including two (28%) positive at 6 months after therapy. These results suggest that 111In WBC scintigraphy should be the initial radionuclide imaging tool in detecting active head and neck infections because of its greater accuracy, and its ability to revert to normal much sooner than 67Ga or 99mTc MDP scintigraphs when applied to a subset of patients with resolved infections.