Resistance of Pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa

2006 ◽  
Vol 121 (2) ◽  
pp. 118-123 ◽  
Author(s):  
J M Bernstein ◽  
N J Holland ◽  
G C Porter ◽  
A R Maw
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Otitis Externa ◽  
White Cell Count ◽  
Antibiotic Sensitivity ◽  
Response To Treatment ◽  
Reactive Protein ◽  
Intravenous Antibiotics ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa ◽  
Oral Ciprofloxacin

For fifteen years oral ciprofloxacin has been the standard treatment for malignant otitis externa, a sometimes fatal osteomyelitis of the skull base usually caused by Pseudomonas aeruginosa. Resistance to ciprofloxacin is developing. Over a 16-month period, we saw five cases where malignant otitis externa progressed, with the development of cranial nerve palsies in four cases, despite oral ciprofloxacin. Prolonged intravenous antibiotic therapy became necessary. One case was managed largely as an out-patient, but four patients spent many weeks in hospital. Only two cases had diabetes and this was monitored and controlled. Pseudomonas aeruginosa was isolated in four of the five cases, but antibiotic sensitivity to ciprofloxacin was not determined. In one case a later isolate was tested and found to be ciprofloxacin resistant. Progress was monitored by serial C-reactive protein (CRP) and white cell count. For diagnosis and assessing response to treatment we considered serial magnetic resonance imaging or computed tomography more useful than isotope bone scan. There must be a readiness to use intravenous antibiotics, as a response to ciprofloxacin can no longer be assumed. Bacterial isolates must be tested for sensitivity to antibiotics including ciprofloxacin, and further biopsy and culture are essential if treatment fails.

A case of malignant otitis externa following mastoidectomy

1999 ◽  
Vol 113 (12) ◽  
pp. 1095-1097 ◽  
Author(s):  
S. K. Patel ◽  
D. W. McPartlin ◽  
J. M. Philpott ◽  
S. Abramovich
Keyword(s):  
Granulation Tissue ◽  
Cranial Nerve ◽  
Otitis Externa ◽  
Cranial Nerves ◽  
Complete Recovery ◽  
Jugular Bulb ◽  
Intravenous Antibiotics ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa ◽  
Nerve Paresis

AbstractWe present a case of a 63-year-old diabetic male who developed malignant otitis externa following mastoidectomy. Extensive skull base osteomyelitis caused thrombosis of the jugular bulb and subsequent paralysis of cranial nerves VII, IX, X and XII. Hewas treated aggressively with intravenous antibiotics and debridement of granulation tissue in the mastoid bowl with full recovery of the cranial nerve palsies associated with recanalization of the jugular bulb. We believe this is the first reported case of malignant otitis externa to occur following mastoidectomy with complete recovery of the cranial nerve paresis.

scholarly journals Comprehensive management of malignant otitis externa with tuberculosis and cranial nerve paresis in geriatrics

2020 ◽  
Vol 50 (1) ◽  
pp. 77
Author(s):  
Ratna Dwi Restuti
Keyword(s):  
Diabetes Mellitus ◽  
Temporal Bone ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Otitis Externa ◽  
Nerve Palsy ◽  
Geriatric Patients ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa ◽  
Multiple Cranial Nerve

Background: Malignant otitis externa is an inflammatory condition of the external ear which has the propensity to spread to the skull base. It can be a difficult entity to treat as clinical presentation varies and response to treatment differs between patients. Purpose: Evaluating the management of malignant otitis externa with complications in geriatric patients who had multiple comorbidities. Case: A 71 years old female with a diagnosis of left malignant otitis externa with complications of multiple cranial nerve palsies (N.VII, IX, X) and comorbidity in the form of diabetes mellitus and chronic kidney disease. The patient underwent subtotal temporal bone resection and petrosectomy. Clinical Question: “Could surgical management of malignant otitis externa with cranial nerve palsies complication in geriatric patients with multiple comorbidities achieve better result than conservative treatment?” Review Method: Literature search using keywords ’malignant otitis externa’ OR ’temporal bone osteomyelitis’ AND ’geriatric’ OR ’elderly’ AND ’multiple cranial nerve palsy’ AND ’diabetes mellitus’ AND ’tuberculosis’ AND ’surgery’ OR ’surgical’ was conducted through Cochrane, Pubmed, and Google Scholar. Result: The search obtained 11 articles published in the last 10 years. Selection based on inclusion and exclusion criteria, 2 studies were found relevant with the topic. Conclusion: Management of malignant otitis externa with complications in geriatric patients with multiple comorbidities requires a multidisciplinary approach to determine the need for surgery intervention.Keywords: malignant otitis externa, cranial nerve palsy, subtotal temporal bone resection, geriatric, diabetes mellitus ABSTRAK Latar belakang: Otitis eksterna maligna adalah suatu kondisi peradangan pada telinga luar yang memiliki kecenderungan untuk meluas hingga ke dasar tengkorak. Penyakit ini menjadi sulit ditangani karena manifestasi klinis yang bervariasi dan respons terhadap pengobatan yang berbeda antara pasien. Tujuan: Mengevaluasi tatalaksana otitis eksterna maligna dengan komplikasi pada pasien geriatri yang memiliki komorbiditas multipel. Kasus: Pasien perempuan 71 tahun dengan diagnosis otitis eksterna maligna telinga kiri dengan komplikasi paresis saraf kranial multipel (n.VII, IX, X) dan penyakit penyerta berupa diabetes melitus dan gagal ginjal kronik. Pasien menjalani operasi reseksi tulang temporal subtotal dan petrosektomi. Pertanyaan klinis: “Apakah tatalaksana pembedahan memberikan hasil yang lebih baik dibandingkan terapi konservatif pada pasien geriatri dengan otitis eksterna maligna disertai paresis saraf kranialis dengan komorbiditas multipel.” Telaah Literatur: Dilakukan menggunakan kata kunci ’malignant otitis externa’ ATAU ’temporal bone osteomyelitis’ DAN ’geriatric’ ATAU ’elderly’ DAN ’multiple cranial nerve palsy’ DAN ’diabetes melitus’ DAN ’tuberculosis’ DAN ’surgery’ ATAU ’surgical’ pada beberapa sumber data seperti Cochrane, Pubmed, dan Google Scholar. Hasil: Didapatkan 11 artikel publikasi 10 tahun terakhir. Berdasarkan kriteria inklusi dan eksklusi diperoleh 2 artikel yang relevan dengan topik. Kesimpulan: Tatalaksana otitis eksterna maligna dengan komplikasi pada pasien geriatri dengan komorbiditas multipel, membutuhkan pendekatan multidisiplin terutama untuk menentukan perlunya dilakukan tindakan pembedahan.

Pseudomonas Bacteremia Precipitated by Ticlopidine-Induced Neutropenia

1996 ◽  
Vol 30 (3) ◽  
pp. 246-248 ◽  
Author(s):  
Sandra M Geletko ◽  
Kathleen M Melbourne ◽  
Dennis J Mikolich
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Febrile Neutropenia ◽  
Blood Cell ◽  
Absolute Neutrophil Count ◽  
Blood Cultures ◽  
Blood Cell Count ◽  
Case Summary ◽  
Serious Infection ◽  
Intravenous Antibiotics ◽  
Oral Ciprofloxacin

OBJECTIVE: To report a case of ticlopidine-induced neutropenia resulting in Pseudomonas bacteremia. CASE SUMMARY: An 83-year-old white man developed febrile neutropenia 5 days after initiation of ticlopidine therapy. At presentation, the patient's white blood cell count was 1.1 × 109/L with an absolute neutrophil count (ANC) of 0. Ticlopidine was discontinued and the patient was treated empirically with ceftazidime, gentamicin, and filgrastim. The patient's blood cultures were positive for Pseudomonas aeruginosa. By day 6 of antibiotic and filgrastim therapy, he was clinically improved and the ANC was 17 040 × 106 cells/L. The filgrastim and intravenous antibiotics were discontinued and oral ciprofloxacin was started. CONCLUSIONS: Ticlopidine-induced neutropenia can occur suddenly and may result in a serious infection, such as bacteremia.

scholarly journals Atypical presentations of malignant otitis externa

2010 ◽  
Vol 124 (11) ◽  
pp. 1205-1208 ◽  
Author(s):  
Z Vourexakis ◽  
M-I Kos ◽  
J-P Guyot
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Skull Base ◽  
Diagnostic Criteria ◽  
Otitis Externa ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Diabetic Patients ◽  
Malignant Otitis Externa ◽  
Life Threatening ◽  
Atypical Presentations

AbstractIntroduction:Malignant otitis externa is a life-threatening infection of the skull base. Its presentation is not always typical.Case reports:We report three cases of malignant otitis externa which illustrate the diversity of its clinical manifestations and the difficulties in its diagnosis.Discussion:The perception of malignant otitis externa as an infection caused by Pseudomonas aeruginosa in diabetic patients is not always correct. The adoption of diagnostic criteria could be helpful in identifying atypical cases.

scholarly journals Pyomyositis of the pectineus muscle in an adolescent male

2017 ◽  
Vol 99 (7) ◽  
pp. e216-e218 ◽  
Author(s):  
J Hiddema ◽  
S Hassan ◽  
N Mangat ◽  
N Siddiqui
Keyword(s):  
White Cell Count ◽  
Normal Function ◽  
Adolescent Male ◽  
Reactive Protein ◽  
Intravenous Antibiotics ◽  
Tropical Areas ◽  
Widespread Availability ◽  
Magnetic Resonance Imaging Mri ◽  
Irritable Hip

The ‘irritable hip’ continues to pose a challenge for clinicians. Even with predictive clinical algorithms, decision making can be difficult. Emergency treatment is required if septic arthritis is suspected. Other differential diagnoses such as transient synovitis, pyomyositis of the pelvic girdle muscles and osteomyelitis must be considered in order to help guide appropriate investigations and allow early treatment. We report the case of a 13-year-old boy presenting to our institution with an acutely painful left hip but still able to weight bear. Despite a fever and raised inflammatory markers, the clinical examination did not correspond to that of an infected hip joint. Urgent magnetic resonance imaging (MRI) confirmed pyomyositis of the pectineus muscle. To our knowledge, this is the first reported case in the literature. The child was treated with seven days of intravenous antibiotics. There was a good clinical response as well as normalisation of the C-reactive protein level and white cell count. The patient was discharged home with a further week of oral antibiotics. Follow-up MRI at two weeks demonstrated a dramatic reduction in the inflammation of the pectineus. At the clinic follow-up appointment, the child was asymptomatic and back to normal function. Pyomyositis is typically found in tropical areas but its rates in temperate climates have been rising. It usually affects large groups of muscles such as the quadriceps and gluteal muscles. MRI is the gold standard investigation. If diagnosed early, the condition can be treated successfully with intravenous antibiotics alone. Given the widespread availability of MRI, we recommend its increased use to distinguish between pyomyositis and other paediatric hip pathologies.

Relapsing malignant otitis externa successfully treated with ciprofloxacin

1988 ◽  
Vol 102 (10) ◽  
pp. 872-876 ◽  
Author(s):  
G. A. J. Morrison ◽  
C. M. Bailey
Keyword(s):  
Cranial Nerve ◽  
Otitis Externa ◽  
Diabetic Control ◽  
Cranial Nerve Involvement ◽  
Parenteral Antibiotic ◽  
Malignant Otitis Externa ◽  
Oral Ciprofloxacin ◽  
Antibiotic Agents ◽  
Ear Drops ◽  
Antibiotic Courses

AbstractTwo cases are presented, both patients with advanced maligant otitis externa.The antibiotic ciprofloxacin has strong anti-pseudomonal activity. It was given orally for six months to both patients, following administration of the traditional parenteral antibiotic courses, and in each case the disease has been extinguished. We therefore recommend that the management of patients shown to have malignant otitis externa should include strict diabetic control, regular local aural toilet, gentamicin ear drops and a six week course of parenteral antipseudomonal antibiotic agents (usually gentamicin and azlocillin) together with metronidazole to cover any anaerobic element in the infection. This regimen should be followed by a six month course of oral ciprofloxacin (750 mg b. d.). Indium scans should be used to monitor recovery. We believe that this regimen can significantly reduce the morbidity and mortality of patients suffering from malignant otitis externa with cranial nerve involvement.

Malignant otitis externa: case series

2010 ◽  
Vol 124 (8) ◽  
pp. 846-851 ◽  
Author(s):  
T Ali ◽  
K Meade ◽  
S Anari ◽  
M R ElBadawey ◽  
I Zammit-Maempel
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Otitis Externa ◽  
Nerve Palsy ◽  
Case Series ◽  
Case Review ◽  
Retrospective Case ◽  
North East ◽  
Malignant Otitis Externa

AbstractBackground:In the light of current concerns regarding ciprofloxacin resistance and the changing face of malignant otitis externa, we reviewed cases of malignant otitis externa treated in our centre, in order both to evaluate the current epidemiology of the condition and to assess the status of drug resistance in our patient population.Method:Retrospective case review of all malignant otitis externa cases managed in a tertiary referral centre in the north-east of England between 2000 and 2009.Results:Forty-one patients were identified, but the required data were available for only 37 cases. Patients' ages ranged from 51 to 101 years (median, 81 years). Diabetes was present in 51 per cent of patients (19/37), facial nerve palsy in 40 per cent (15/37) and multiple cranial nerve palsy in 24 per cent (9/37). Pseudomonas aeruginosa was the most commonly isolated organism (54 per cent), sensitive to ciprofloxacin in all cases.Conclusions:The incidence of cranial nerve palsy in our study was higher than in previous reports. The incidence of diabetes and Pseudomonas aeruginosa in our cohort was much lower than previously reported. The Pseudomonas aeruginosa strains isolated were all sensitive to ciprofloxacin, despite recent reports on emerging resistance.

scholarly journals Synchronous Malignant Otitis Externa and Squamous Cell Carcinoma of the External Auditory Canal

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
R. Y. Chin ◽  
T. B. V. Nguyen
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
External Auditory Canal ◽  
Otitis Externa ◽  
Concomitant Treatment ◽  
The Third ◽  
Intravenous Antibiotics ◽  
Malignant Otitis Externa ◽  
Synchronous Tumour

Objectives. To discuss the management of a squamous cell carcinoma in the presence of malignant otitis externa.Study Design. We present only the third reported case in the literature of a synchronous tumour with malignant otitis externa in the literature.Methods. A case report and review of malignant otitis externa and squamous cell carcinomas of the external auditory canal are discussed.Results. A 66-year-old female is presented here with a 2-month history of a painful, discharging left ear refractory to standard antibiotic therapy. Computerised tomography, magnetic resonance imaging, technetium 99 m, and gallium citrate Ga67 scans were consistent with malignant otitis externa. Biopsy in the operating theatre revealed a synchronous squamous cell carcinoma of the external auditory canal. Primary resection of the tumour and surrounding tissues was performed with concomitant treatment with intravenous antibiotics.Conclusions. This is only the third case to be reported in the literature and highlights several important diagnostic and management issues of these two rare conditions. Both conditions may present in a similar manner on clinical assessment and radiological investigations. Aggressive management with surgical resection and treatment with appropriate intravenous antibiotics is necessary to give the best chance for cure.

scholarly journals A Case of Transient, Isolated Cranial Nerve VI Palsy due to Skull Base Osteomyelitis

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Brijesh Patel ◽  
Anas Souqiyyeh ◽  
Ammar Ali
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Facial Pain ◽  
Otitis Externa ◽  
Skull Bone ◽  
Topical Antibiotics ◽  
Skull Base Osteomyelitis ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa ◽  
The Common

Otitis externa affects both children and adults. It is often treated with topical antibiotics, with good clinical outcomes. When a patient fails to respond to the treatment, otitis externa can progress to malignant otitis externa. The common symptoms of skull bone osteomyelitis include ear ache, facial pain, and cranial nerve palsies. However, an isolated cranial nerve is rare. Herein, we report a case of 54-year-old female who presented with left cranial nerve VI palsy due to skull base osteomyelitis which responded to antibiotic therapy.

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