Otomastoiditis caused by non-tuberculous mycobacteria: report of 16 cases, 3 with infection intracranially

2015 ◽  
Vol 129 (7) ◽  
pp. 644-655 ◽  
Author(s):  
L Lundman ◽  
H Edvardsson ◽  
K Ängeby
Keyword(s):  
Antibiotic Treatment ◽  
Relevant Literature ◽  
Mycobacterial Infection ◽  
Mycobacterium Abscessus ◽  
Mycobacterium Fortuitum ◽  
Case Review ◽  
Referral Centre ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Medical Interventions

AbstractObjective:To analyse the clinical presentation, treatment and outcome in patients diagnosed with otomastoiditis caused by non-tuberculous mycobacteria.Methods:A retrospective case review of 16 patients diagnosed with otomastoiditis caused by non-tuberculous mycobacteria from 2000 to 2012 was conducted in a hospital and tertiary referral centre in Sweden. The main outcome measures were microbiology findings, and surgical and medical interventions and outcomes. In addition, the relevant literature was reviewed.Results:In three patients with otomastoiditis, the disease had spread intracranially. The bacteriological findings revealed Mycobacterium abscessus (n = 12), Mycobacterium fortuitum (n = 2) and Mycobacterium avium complex (n = 2). Surgical treatment was undertaken in all but three patients, including exploration of the temporal lobe in one patient. Systemic antibiotic treatment was given to all but one patient. Eight patients healed completely. Eight patients developed hearing loss. Two patients had relapse of the mycobacterial infection several months after the antibiotic treatment had been discontinued.Conclusion:Non-tuberculous otomastoiditis is a severe ear disease with challenging considerations, and should be treated aggressively in order to avoid morbidity.

Single stage, transmastoid approach for otogenic intracranial abscess

2009 ◽  
Vol 123 (11) ◽  
pp. 1216-1220 ◽  
Author(s):  
K P Morwani ◽  
N Jayashankar
Keyword(s):  
Senior Author ◽  
Single Stage ◽  
Research Centre ◽  
Cerebrospinal Fluid Leakage ◽  
Case Review ◽  
Intracranial Abscess ◽  
Referral Centre ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Transmastoid Approach

AbstractObjective:To evaluate the treatment of intracranial abscess of otogenic origin, and to study the outcome measures of single stage treatment of the otogenic focus and drainage of intracranial abscess via a transmastoid approach.Study design:Retrospective case review.Setting:Dr Balabhai Nanavati Hospital and Medical Research Centre, Mumbai, India, an academic tertiary referral centre, and Shri H Bhagwati Municipal General Hospital, Mumbai, India, an academic secondary referral centre.Patients:Seventy-three patients with intracranial abscess secondary to otogenic pathology, confirmed by computed tomographic scanning.Intervention:Single stage treatment of the ear pathology and drainage of intracranial abscess via a transmastoid approach, performed by the senior author (KPM).Results:Of the 73 patients, 12 were lost to follow up and were excluded from the study. Outcomes for the remaining 61 patients were known, and these patients were followed up for at least two years. Adults were more commonly affected by otogenic intracranial abscess than children, with a male preponderance. Otogenic intracranial abscess was associated with both cholesteatomatous (41 per cent) and non-cholesteatomatous ears (59 per cent). All cases were treated with transmastoid drainage of the intracranial abscess and canal wall up or down tympanomastoidectomy, depending on the ear pathology. Two cases developed post-operative cerebrospinal fluid leakage (3 per cent), and another two cases developed meningitis (3 per cent). Five patients had recurrent abscess; two of these patients (3 per cent) died but were included in the study. Three patients had residual abscess, improved with additional management.Conclusion:In this series, the low morbidity and mortality rate, combined with a shorter hospital stay, suggest that single stage, transmastoid drainage of intracranial abscess and concurrent treatment of the otogenic pathology is an effective treatment for otogenic intracranial abscess.

Maturation sutures for the paediatric tracheostomy – an extra safety measure

2005 ◽  
Vol 119 (12) ◽  
pp. 985-987 ◽  
Author(s):  
M F Craig ◽  
Y Bajaj ◽  
B E J Hartley
Keyword(s):  
Late Complications ◽  
Case Note ◽  
Safety Measure ◽  
Complication Rates ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Fatal Complication ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Case Note Review

Objective: Displacement of the tracheostomy tube in paediatric patients is a potentially fatal complication. We describe an extra safety measure which facilitates tube replacement.Setting: Tertiary referral specialist paediatric centre.Materials and methods: The method involves the placement of sutures between the anterior tracheal wall and skin to hasten the formation of a mature stoma (maturation sutures). We also undertook a retrospective case note review on patients from an academic tertiary referral centre. Thirty-five notes were reviewed. The most common indication for tracheostomy was airway obstruction (65 per cent). Fourteen patients had early and 10 had late complications with three tube displacements occurring. No added complications due to the use of sutures were found.Conclusions: Our complication rates compare well with those in the literature, and we recommend considering the use of such a technique.

Acute mastoiditis in children: contemporary opportunities and challenges

2020 ◽  
Vol 134 (5) ◽  
pp. 434-439
Author(s):  
M Mather ◽  
S Powell ◽  
P D Yates ◽  
J Powell
Keyword(s):  
Sinus Thrombosis ◽  
Acute Otitis Media ◽  
Case Review ◽  
Acute Mastoiditis ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Median Hospital Stay ◽  
Surgical Interventions ◽  
North East ◽  
Median Hospital

AbstractBackgroundMastoiditis is the most common intra-temporal complication of acute otitis media. Despite potentially lethal sequelae, optimal management remains poorly defined.MethodA retrospective case review was conducted of children diagnosed with mastoiditis at a tertiary referral centre, in North East England, between 2010 and 2017.ResultsFifty-one cases were identified, 49 without cholesteatoma. Median patient age was 42 months (2 months to 18 years) and median hospital stay was 4 days (range, 0–27 days). There was no incidence trend over time. Imaging was conducted in 15 out of 49 cases. Surgery was performed in 29 out of 49 cases, most commonly mastoidectomy with (9 out of 29) or without (9 out of 29) grommets. Complications included sigmoid sinus thrombosis (3 out of 49) and extradural abscess (2 out of 51), amongst others; no fatalities occurred.ConclusionA detailed contemporary description of paediatric mastoiditis presentation and management is presented. The findings broadly mirror those published by other UK centres, but suggest a higher rate of identified disease complications and surgical interventions.

scholarly journals 2124. The Epidemiology, Demographics, and Geographical Distribution of Human Non-Tuberculosis Mycobacteria (NTM) Disease in the Endemic Central Florida Region

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S718-S720
Author(s):  
Cristina Vanessa. Garcia ◽  
Greg Matthew E. Teo ◽  
Jamie P Morano ◽  
Beata Casanas ◽  
Sadaf Aslam ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Medical Center ◽  
The United States ◽  
Mycobacterium Abscessus ◽  
Case Review ◽  
Retrospective Case ◽  
Central Florida ◽  
Hospital Facility ◽  
Demographic Distribution ◽  
Living With Hiv

Abstract Background Of the >100,000 people in the United States infected yearly with non-tuberculosis mycobacteria (NTM), Florida has the highest yearly incidence and prevalence of NTM disease. However, little has been documented on the epidemiology and distribution of NTM disease within Central Florida. Methods A retrospective case review study was conducted from January, 2011 to December, 2017 at a large tertiary acute care medical center in Tampa, Florida to identify all NTM infection cases. Demographics (age, sex at birth, ethnicity), comorbidities, HIV testing status, residential zip code, NTM species, and specimen sources were collected. Results Of the 507 isolates, Mycobacterium abscessus group was the most common (45.4%; n = 230), and contained M. abscessus spp. abscessus (34.5%; n = 175), M. abscessus spp. massilense (8.7%; n = 44), and M. abscessus spp. bolletii (1.18%; n = 6). Other rapid growers were M. fortuitum species (6.9%; n = 35) and M. chelonae (2.56%; n = 13). Of the slower growers, M. gordonae (19.9%; n = 101) and M. avium complex (8.28%; n = 42) were the most common. Of the M. avium complex, M. chimera was most common (4.9%; n = 25). Samples were mostly isolated from sputum (51.7%; n = 262), bronchial lavage (26%; n = 132), skin and soft tissue (11%; n = 58), and blood (7.1%; n = 36). Of the 361 unique patients, average age was 59.2 years (12 to 95 years), with 47.6% (n = 172) greater than 65 years of age, and mostly male 57.9% (n = 208). Caucasians represented 73.4% (n = 265) of our cohort, and African Americans and Hispanics represented 16.3% (n = 59) and 6.8% (n = 24), respectively. Most cases were in those residing outside the Tampa Bay metro area 81.2% (n = 293/361). Notable comorbidities included COPD (n = 83), cystic fibrosis (n = 41), lung transplant (n = 40), heart transplant (n = 12), pulmonary fibrosis (n = 12), and renal transplant (n = 7). A total of 145 individuals received HIV testing at the hospital facility, and of these 44 individuals were living with HIV. Conclusion This study identified a diversity of NTM species across a wide geographical and demographic distribution in the endemic Central Florida region. M. abscessus group had the highest prevalence. This is valuable in understanding which populations are at risk for developing NTM infection in this area of Florida. Disclosures All authors: No reported disclosures.

Manubrio-stapedioplasty: new surgical technique for malleus and incus fixation due to tympanosclerosis

2015 ◽  
Vol 129 (6) ◽  
pp. 587-590 ◽  
Author(s):  
L Sennaroglu ◽  
V Gungor ◽  
G Atay ◽  
S Ozer
Keyword(s):  
Glass Ionomer Cement ◽  
Glass Ionomer ◽  
Case Review ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Hearing Results ◽  
Conductive Hearing ◽  
Ionomer Cement ◽  
New Surgical Technique

AbstractObjective:This paper reports the authors' technique of manubrio-stapedioplasty using glass ionomer cement for malleus and incus fixation due to tympanosclerosis.Methods:A retrospective case review was conducted of five patients with conductive hearing loss (mean pre-operative air–bone gap of 42.75 dB) treated in a tertiary referral centre. The hearing results of a manubrio-stapedial bone cement ossiculoplasty technique, utilised on the five patients, were analysed. All cases were Wielinga and Kerr tympanosclerosis classification type 2 (attic fixation of the malleus-incus complex with a mobile stapes). The incus and head of the malleus were removed in all patients, and the manubrium was directly connected to the head of the mobile stapes using glass ionomer cement. Patients were evaluated in terms of pre- and post-operative audiometric results; hearing gain and post-operative air–bone gap were the main outcome measures.Results:Mean post-operative air–bone gap was 5.25 dB. Four patients had an air–bone gap of less than 10 dB; the remaining patient had an air–bone of 12.50 dB.Conclusion:Manubrio-stapedioplasty is an effective method for ossicular reconstruction in cases of malleus and incus fixation due to tympanosclerosis.

scholarly journals 1640. A Clinical Audit and Cost Analysis of Tuberculosis Management at a Tertiary Referral Centre in the Republic of Ireland

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S810-S810
Author(s):  
James A O’Connell ◽  
Eoghan de barra ◽  
Samuel McConkey
Keyword(s):  
Hospital Admissions ◽  
Treatment Success ◽  
Diagnostic Delay ◽  
Mycobacterial Infection ◽  
High Rate ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Tertiary Referral Centre ◽  
Illness Onset ◽  
Productivity Losses

Abstract Background Ireland is a low tuberculosis (TB) incidence country. Effective TB services are important in the efforts to meet WHO End TB Targets. A dedicated TB clinic was established in our tertiary referral centre in 2018. Our aim is to describe the patients with TB attending our service and evaluate the care provided to them in terms of cost and clinical effectiveness. Methods We performed a retrospective review of patients attending our service from 01/07/2018-31/12/2019. We included patients who were referred for assessment of symptoms of active tuberculosis. We collected data on patients risk factors for TB, time from illness onset to diagnosis and resources utilized (including hospital admissions, outpatient appointments, investigations and drug treatment). We estimated the productivity losses due to TB in our cohort following the Hanover Consensus. Using national TB notifications data we used our estimate treatment cost and productivity losses to estimate the total national cost of TB in Ireland in 2019. Results Fifty-four patients were assessed for TB in our clinic. Most patients (68.5%) referred had a diagnosis of TB made, 5.6% had a non-tuberculosis mycobacterial infection and the remainder had no mycobacterial infection diagnosed. Over half (51.4%) of patients with TB had respiratory TB. The most prevalent risk factor was being from a country of high TB incidence (59.5% of TB patients). Five patients (13.5%) had drug resistance. Patients were referred most frequently from the emergency department (54.1%). The median time from symptom onset to diagnosis was 14.1 weeks (IQR 5.3-30) in patients with respiratory TB compared to 25.9 weeks (IQR 6.3-55.9) in patients with non-respiratory TB. Out of 35 patients who remained within our service 97.1% (34/35) completed treatment and 2.9% (1/35) are still on treatment. We estimate that the median cost of managing a case of TB in our centre was €6088 (€1,003-17,588). The estimated cost of managing all 267 cases of TB in Ireland in 2019 was €9,048,380 which incurred productivity losses of €791,421. The total cost of TB to Ireland in 2019 was €9,839,801. Conclusion Our clinic had a high rate of treatment success. Interventions to reduce diagnostic delay and cost are needed. Disclosures All Authors: No reported disclosures

Pre-operative overnight pulse oximetry to predict high dependency unit intervention in children undergoing adenotonsillectomy for obstructive sleep apnoea

2014 ◽  
Vol 128 (4) ◽  
pp. 360-364 ◽  
Author(s):  
K A Lightbody ◽  
A J Kinshuck ◽  
A J Donne
Keyword(s):  
Pulse Oximetry ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
High Dependency Unit ◽  
Referral Centre ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
High Dependency ◽  
Obstructive Sleep ◽  
Case Note Review

AbstractBackground:Post-operative high dependency unit beds are often requested for patients undergoing adenotonsillectomy for obstructive sleep apnoea. This study evaluated the utilisation of high dependency unit beds for such cases at our institution, a paediatric tertiary referral centre.Method:A retrospective case note review of patients admitted to the high dependency unit following adenotonsillar surgery for obstructive sleep apnoea, over a two-year period, was performed.Results:Sixty-six cases were identified. Thirty-nine patients underwent pre-operative overnight pulse oximetry; of these, 30 patients had desaturations noted. Seventeen patients had significant post-operative desaturations. These were predicted in all 11 patients who had undergone pre-operative pulse oximetry. The remaining six had not undergone pre-operative pulse oximetry. Nineteen patients required high dependency unit care; eight had experienced post-operative desaturations.Conclusion:High dependency unit care may be required following adenotonsillectomy for obstructive sleep apnoea. In this study, pre-operative overnight pulse oximetry had 100 per cent sensitivity in predicting post-operative desaturations, and may therefore aid the appropriate utilisation of high dependency unit beds for patients undergoing adenotonsillectomy for obstructive sleep apnoea.

scholarly journals Non-tuberculous Mycobacterial Infection of the Musculoskeletal System Detected at Two Tertiary Medical Centres in Henan, China, 2016–2020

2021 ◽  
Vol 12 ◽  
Author(s):  
Qiong Ma ◽  
Rende Chen ◽  
Enhui Yang ◽  
Youhua Yuan ◽  
Yongfu Tian ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Median Duration ◽  
Musculoskeletal System ◽  
Granulomatous Inflammation ◽  
Mycobacterial Infection ◽  
Mycobacterium Abscessus ◽  
Diagnostic Methods ◽  
Mycobacterium Fortuitum ◽  
Specific Symptoms

Non-tuberculous mycobacterial (NTM) infection of the musculoskeletal system is rare but poses a grave threat to public health. These infections yield non-specific symptoms that remain undetected until the development of the later stages of the disease. In this study, we performed a retrospective review of 25 cases of musculoskeletal NTM infection at two tertiary medical centres over a 5-year period to determine the clinical features and improve the current clinical diagnosis and treatment. The most common mycobacterial species detected were Mycobacterium fortuitum in eleven patients, Mycobacterium abscessus in eight patients, Mycobacterium houstonense in three patients, Mycobacterium avium in two patients, and Mycobacterium smegmatis in one patient. The sites of infection included the limbs and joints, most commonly the knee (ten patients) and foot (six patients). The median duration from the onset of symptoms to diagnosis was 2.5 months (0.8–13.5 months). Deep sinus tracts extending to the surgical site were observed in 60% of the patients (15/25), and granulomatous inflammation and granulomatous inflammation with necrosis occurred in 60% of the patients (15/25). All patients underwent surgical treatment for infection control, and all patients, except one, received antimycobacterial therapy based on drug sensitivity assays. The median duration of the antimicrobial chemotherapy was 5 months (range: 3–20 months). At the final follow-up, 24 patients presented with absence of recurrence and one patient succumbed owing to heart failure after debridement. Our findings highlight the importance of vigilance and improvements in the diagnostic methods for musculoskeletal NTM infection. Aggressive surgical treatment and antimycobacterial drug treatment can help achieve satisfactory results.

Non-Tuberculous Mycobacterial Infections Related to Peritoneal Dialysis

2017 ◽  
Vol 38 (2) ◽  
pp. 147-149 ◽  
Author(s):  
Hiroyuki Inoue ◽  
Naoki Washida ◽  
Kohkichi Morimoto ◽  
Keisuke Shinozuka ◽  
Takahiro Kasai ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Mycobacterial Infection ◽  
Mycobacterium Abscessus ◽  
Mycobacterium Fortuitum ◽  
Mycobacterium Chelonae ◽  
Exit Site Infection ◽  
Mycobacterial Infections ◽  
Tunnel Infection ◽  
Multi Agent ◽  
Catheter Replacement

Most infections related to peritoneal dialysis (PD) are caused by common bacteria, and non-tuberculous mycobacteria are rare. The clinical characteristics and prognosis of PD patients with non-tuberculous mycobacterial infections were investigated at our hospital. Non-tuberculous mycobacteria were detected in 11 patients (exit-site infection, tunnel infection, and peritonitis in 3, 5, and 3 patients, respectively). Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus were identified in 4, 2, and 2 patients, respectively. Most patients with peritonitis or tunnel infection required catheter removal. During the study period (2007 – 2017), peritonitis occurred in 44 patients, including 3 patients (6.8%) with non-tuberculous mycobacterial peritonitis. When non-tuberculous mycobacterial infection occurs, multi-agent antibiotic therapy, unroofing surgery, and/or catheter replacement should be performed to prevent peritonitis.

scholarly journals Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study

2015 ◽  
Vol 172 (3) ◽  
pp. 243-250 ◽  
Author(s):  
L A Behan ◽  
M Sherlock ◽  
P Moyles ◽  
O Renshaw ◽  
C J T Thompson ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Plasma Sodium ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Significant Incidence ◽  
Cranial Diabetes Insipidus ◽  
Vasopressin Analogues

Context and objectivePatients with cranial diabetes insipidus (CDI) are at risk of developing both hypernatraemia and hyponatraemia, due to the condition itself or secondary to treatment with vasopressin-analogues or during administration of i.v. fluids. We aimed to assess the frequency and impact of dysnatraemias in the inpatient (INPT) and outpatient (OPT) setting in desmopressin-treated CDI, comparing those with normal thirst with those with abnormal thirst.DesignThe study included 192 patients with cranial diabetes, who were identified from the Beaumont Pituitary Database, a tertiary referral centre. Retrospective case note audit was performed and the clinical and biochemical information of 147 patients with CDI were available for analysis.ResultsA total of 4142 plasma sodium measurements for 137 patients with normal thirst, and 385 plasma sodium measurements for ten patients with abnormal thirst were analysed. In those with normal thirst, the most common OPT abnormality was mild hyponatraemia (pNa+ 131–134 mmol/l) in 27%, while 14.6% had more significant hyponatraemia (pNa+ ≤130 mmol/l). Of those patients with normal thirst, 5.8% were admitted due to complications directly related to hyponatraemia. Compared with patients with normal thirst, those with abnormal thirst were more likely to develop significant OPT hypernatraemia (20% vs 1.4%, P=0.02) and significant INPT hyponatraemia (50% vs 11.1%, P 0.02).ConclusionOPT management of CDI is complicated by a significant incidence of hyponatraemia. In contrast, OPT hypernatraemia is almost exclusively a complication seen in adipsic CDI, who also had more frequent INPT hyponatraemia. CDI associated with thirst disorder requires increased physician attention and patient awareness of potential complications.

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