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PubMed1993

[Case report: suppurative arthritis due to group B Streptococcus in a patient with rheumatoid arthritis].

A 62-year-old woman, who had been diagnosed as having rheumatoid arthritis (RA) with systemic amyloidosis and diabetes mellitus, was admitted to our hospital because of polyarthralgia on October 1, 1987. She had some subcutaneous nodules and rheumatic pleural effusion. Therefore she was treated with 20 milligrams of prednisolone (PSL) daily. On the ninth day after the beginning of steroid therapy, she complained of severe pain and a new swelling in her right knee joint. The knee joint aspirate on arthrocentesis yielded a pure growth of group B Streptococcus (GBS). Blood culture was also positive for GBS. Her suppurative arthritis gradually improved by treatment with penicillin G. However, after the discontinuance of PSL, her pleural effusion deteriorated and she died on January 10, 1988. To our knowledge, there have been no prior reports of group B streptococcal suppurative arthritis complicating RA in Japan.

Arthritis, Infectious↗
PubMedDate not supplied

A systematic review of the effectiveness of ofloxaxin otic solution for the treatment of suppurative otitis media.

The objectives of the study were to determine the effectiveness and incidence of adverse events of ofloxacin otic solution for suppurative otitis media compared with other treatments. All randomized controlled trials and nonrandomized comparative clinical trials published from 1966 to 2000 using ofloxacin otic solution as one of the interventions were reviewed and data were extracted and analyzed. Eleven clinical trials (9 randomized and 2 nonrandomized) enrolling 1,484 adults and children were finally included in the analysis. Five studies employed clear concealment procedure in the allocation of treatment whereas evaluation of outcome was at least single-blinded in 6 trials. The probability of overall cure rate was higher with 0.3% ofloxacin otic solution than with other topical or systemic antibiotics in 9 of the studies analyzed (OR = 2.67; 95% CI = 2.04, 3.50). Resolution of secondary outcome parameters evaluated at least 1 week after treatment was higher with 0.3% ofloxacin otic solution: resolution of otalgia (4 trials; OR = 2.41; 95% CI = 1.2, 4.82); resolution of otorrhea (11 trials; OR = 2.78; 95% CI = 2.12, 3.65), and bacterial eradication rate (6 trials; OR = 3.86; 95% CI = 2.54, 5.87). A subgroup analysis of 4 studies comparing ofloxacin otic solution with antibiotic- and steroid-containing otic solution showed a higher cure rate for ofloxacin otic solution (OR = 2.73; 95% CI = 1.52, 4.90). Another subgroup analysis on 3 studies comparing ofloxacin otic solution with oral systemic antibiotics showed higher resolution of otorrhea with ofloxacin otic solution (OR = 2.78; 95% CI = 2.12, 3.65). Of 4 studies with data on adverse events, the probability of adverse events was lower with ofloxacin otic solution than with other topical antibiotics (OR = 0.28; 95% CI = 0.19, 0.42). Subgroup analysis showed that 0.3% ofloxacin otic solution showed better results in terms of overall cure rate, resolution of otorrhea, otalgia, bacterial eradication rate and incidence of adverse events. Whether due to chronic suppurative otitis media (CSOM) or draining tympanostomy tube, the overall cure rate (CSOM OR = 4.86; with tympanostomy tube OR = 2.13) and resolution of otorrhea (CSOM OR = 4.42; with tympanostomy tube OR = 1.66) were likewise in favor of 0.3% ofloxacin otic solution. The studies included in this meta-analysis showed generally homogenous results in all clinical and laboratory outcomes analyzed, except for the evaluation of adverse events. The authors conclude that 0.3% ofloxacin otic solution is better than other otic antibiotic drops and other oral antibiotics in terms of overall cure rate and resolution of secondary outcome parameters. Estimates on the beneficial effects of ofloxacin otic solution are limited to the period of study included in this review.

Anti-Infective Agents↗
PubMedDate not supplied

Utility of repeat fine needle aspiration in acute suppurative lesions. Follow-up of 263 cases.

OBJECTIVE: To determine the clinical value of repeat fine needle aspiration (FNA) as a follow-up strategy in the management of patients in India, clinically suspected of having tuberculosis (TB) but showing a cytologic picture of acute suppuration. STUDY DESIGN: Repeat aspirates from 263 patients presenting with lymph node or soft tissue masses were analyzed. The previous FNA of these cases had shown acute inflammatory exudate but no epithelioid granuloma or acid-fast bacilli (AFB). RESULTS: The repeat FNA helped to detect 55% additional cases of TB within a period of 8 weeks; 67% of them were diagnosed in the second and third weeks. Diagnostic yield rose to 59% after the third FNA. AFB were detected in 34 (13.3%) cases that showed a low bacterial load. In addition, nontubercular lesions, such as epidermal inclusion cyst (4), cysticercosis (3), sialadenitis (2) and metastatic carcinoma (8), were diagnosed. CONCLUSION: All cases showing acute suppuration without granulomas or AFB on the first FNA should be reevaluated by follow-up FNA and staining for AFB. This will enhance the diagnostic yield of tuberculosis in developing countries, where molecular diagnostics are too costly or unavailable. This procedure is cost effective as compared to biopsy and culture. In addition to tuberculosis, many unexpected nontubercular lesions may also be unmasked. Repeat FNA reduces sampling and screening errors, improves sensitivity and helps to study the evolution of epithelioid granulomas.

Acute Disease↗
PubMed1992

Aerobic bacteriology of chronic suppurative otitis media without cholesteatoma in children.

Medical management of chronic suppurative otitis media without cholesteatoma in children was shown recently to be efficacious. We undertook a prospective study in order to determine 1) the organisms associated with the disease and their sensitivity to various antibiotics and 2) their association with clinical variables. Pseudomonas was isolated from 84% of the patients, enteric gram-negative bacilli from 32%, Staphylococcus aureus from 20%, streptococci from 14%, and Hemophilus influenzae from 15%. Pseudomonas aeruginosa was the sole isolate in 48 of the 128 patients (38%). The sensitivity of P aeruginosa (78 isolates) was 100% (of isolates) to mezlocillin and ciprofloxacin, 99% to tobramycin and ceftazidime, 97% to piperacillin, 94% to gentamicin, and 78% to ceftriaxone. The isolated organisms and their sensitivity to antibiotics were not associated with age, sex, duration of otorrhea, or the presence of granulation tissue or polyps. We believe that our data may contribute to the appropriate choice of antibiotics when nonsurgical management of chronic suppurative otitis media without cholesteatoma is considered.

Adolescent↗
PubMed2002

Needle aspiration for suppurative cervical lymphadenitis.

In a 10-year prospective study, we used needle aspiration as the treatment of suppurative cervical lymphadenitis that required drainage procedure in 35 consecutive children aged 4 months to 13 years (mean 2.2 years). Twenty-seven patients underwent 1 puncture, 7 patients had 2 punctures, and 1 had 3 punctures. There were no major complications. Patients were followed up for 2-6 months. None required an open drainage of the cervical abscess. There was complete regression of the nodes in all patients within 21 days, with no relapse or scar formation. Needle aspiration seems to be an effective and safe treatment of suppurative cervical lymphadenitis that may avoid open drainage.

Adolescent↗
PubMed2005

Suppurative complications of frontal sinusitis in children.

A retrospective review of children diagnosed and treated for suppurative complications of paranasal sinusitis was undertaken to describe clinical presentation, microbiology, and treatment. This review includes children with subgaleal abscess and osteomyelitis of the frontal bone, subdural empyema, frontal lobe abscess, meningitis, and encephalitis. Staphylococcus aureus and group C beta-hemolytic Streptococcus were isolated agents. All children were treated with intravenous antibiotics with drainage of both the sinus and extracranial and intracranial suppurations. Results of treatment in the series support the opinion that combined aggressive surgical and antibiotic treatment is a preferred method in complicated sinusitis in children.

Adolescent↗
PubMed1993

Therapeutic management of chronic suppurative otitis media with otic drops.

The use of potentially ototoxic topical drugs is controversial. Few experimental reports of audiometric data from human subjects exist. The purpose of this study is to determine if a significant difference between bone conduction hearing sensitivity before and after otic drop treatment for children with chronic suppurative otitis media and patent ventilation tubes exists. A statistical analysis of sensorineural threshold status after treatment of chronic suppurative otitis media with otic drops is presented.

Aminoglycosides↗
PubMed1997

A profile of 100 complicated cases of chronic suppurative otitis media.

A two year study of cases of chronic suppurative otitis media admitted in the Ear, Nose and Throat (ENT) Department of Sir Salimullah Medical College and Mitford Hospital from January 1991 to December 1992 was done. 112 patients of chronic suppurative otitis media (CSOM) were admitted during this two year period, out of which 100 patients (89.3%) presented with different types of complications and only 12 patients (10.7%) presented with no complications. Factors associated with the late presentation of the disorder, including poor socioeconomic conditions and lack of hospital facilities, are identified. Measures to prevent the rate of complications and hearing loss in children are suggested.

Adolescent↗
PubMed1995

Etiology and therapy of chronic suppurative otitis.

Infectious diseases of the ear are important in adults due to their incidence and relapses. We carried out a study of aerobic microorganisms on 251 otic exudates from patients diagnosed as having chronic suppurative otitis media without cholesteatoma (119), chronic suppurative otitis media with cholesteatoma (85) and chronic external otitis (47). The microorganisms predominantly isolated were, Pseudomonas aeruginosa, Staphylococcus aureus and other Enterobacteriaceae. 86% of isolates were monomicrobial and 14% of isolates were polymicrobial. In these latter the predominantly isolated microorganisms were also P. aeruginosa, S. aureus, Corynebacterium spp. and Proteus mirabilis. P. aeruginosa was the most commonly isolated and showed the highest percentages of resistance against antimicrobial agents tested. P. aeruginosa was most susceptible to ciprofloxacin and imipenem, but much less susceptible to cefotaxime, moxalactam and trimethoprim-sulfamethoxazole. S. aureus was highly sensitive to amoxicillin/clavulanate, trimethoprim-sulfamethoxazole, rifampin and teichoplanin. 100% of the isolates were resistant to penicillin G and ampicillin.

Adolescent↗
PubMed2003

Labyrinthine fistula: a complication of chronic suppurative otitis media.

A labyrinthine fistula is a frequent complication of long-standing unsafe chronic suppurative otitis media. It is characterized by a slowly progressive erosion of the bony labyrinth. In this paper we present our observations regarding the diagnosis and management in 50 patients with unsafe chronic suppurative otitis media with labyrinthine fistula.

Chronic Disease↗
PubMed2004

Ciliary count in chronic suppurative otitis media: comparative quantitative study between mucosal and squamous types using scanning electron microscopy and image analysis.

The objective of this study was to prove ciliary destruction in the middle-ear mucous membrane in cases of chronic suppurative otitis media (CSOM) and to compare both types of chronic suppurative otitis media with regard to the degree of ciliary destruction and ciliary count using objective quantitative techniques. The mucosa of the anterior mesotympanum over the promontory was sampled in 10 patients with mucosal CSOM and in another 10 patients with squamous type CSOM. Specimens were examined by scanning electron microscopy in combination with image analysis software techniques in order to study the cilia under higher magnifications and to calculate the ciliary area. Five patients with otosclerosis, no history suggestive of otitis media and normal ear drum appearance served as controls. Samples were taken and studied at the Faculty of Medicine of Cairo University. CSOM was found to be associated with significant ciliary destruction and this was more evident in the squamous type than in the mucosal type.

Case-Control Studies↗
PubMed1986

Medical management of chronic suppurative otitis media without cholesteatoma in children.

Tympanomastoid surgery is considered standard management for chronic suppurative otitis media (CSOM) without cholesteatoma, which is unresponsive to ototopical/oral antimicrobial therapy. The following makes this sequence of management less attractive today: 1. potential ototoxicity of ototopical agents; 2. lack of oral antimicrobial agents effective against most common pathogens (e.g., Pseudomonas aeruginosa); 3. frequent occurrence in children who have tympanostomy tubes; and 4. failure of tympanomastoid surgery to eradicate the disease in all cases. We conducted a study in 36 pediatric patients with chronic suppurative otitis media, in which all received parenteral antimicrobial therapy and daily aural toilet (mean duration of treatment = 9.7 days). Thirty-two patients (89%) had resolution of their infection with medical therapy alone; four children required tympanomastoidectomy. Further investigation is needed to understand the etiology, pathogenesis, and most effective methods of management/prevention of CSOM in children.

Adolescent↗
PubMed1991

Aerobic and anaerobic microbiology of acute suppurative parotitis.

Aspirates of pus from acute suppurative parotitis were studied for aerobic and anaerobic bacteria. Bacterial growth was present in 23 specimens. A total of 36 bacterial isolates (20 anaerobic and 16 aerobic and facultative) were recovered, accounting for 1.6 isolates per specimen (0.9 anaerobic and 0.7 aerobic and facultative). Anaerobic bacteria only were present in 10 (43%) patients, aerobic and facultatives in 10 (43%), and mixed aerobic and anaerobic flora in 3 (13%). Single bacterial isolates were recovered in 9 infections, 6 of which were Staphylococcus aureus and 3 were anaerobic bacteria. The predominant bacterial isolates were S. aureus (8 isolates), Bacteroides sp. (6 isolates, including 4 Bacteroides melaninogenicus group), and Peptostreptococcus sp. (5). beta-Lactamase-producing organisms were recovered from 11 (73%) of the 15 specimens tested. This study highlights the polymicrobial nature and importance of anaerobic bacteria in acute suppurative parotitis.

Acute Disease↗
PubMed2006

Chronic cough due to nonbronchiectatic suppurative airway disease (bronchiolitis): ACCP evidence-based clinical practice guidelines.

OBJECTIVES: To review the role of nonbronchiectatic suppurative airway disease (bronchiolitis) in the spectrum of causes of cough and its management. DESIGN/METHODOLOGY: A MEDLINE search (through May 2004) for studies published in the English language since 1980 on human subjects using the medical subject heading terms "cough," "causes of cough," "etiology of cough," "interstitial lung disease," "bronchiolitis," "bronchiolitis obliterans," "diffuse panbronchiolitis," and "inflammatory bowel disease" was performed. Case series and prospective descriptive clinical trials were selected for review. Any references from these studies that were pertinent to the topic were also obtained. RESULTS/CONCLUSIONS: In patients with cough in whom other more common causes of cough have been excluded, incomplete or irreversible airflow limitation, small airways disease seen on high-resolution CT scan, or purulent secretions seen on bronchoscopy, should suggest nonbronchiectatic suppurative airways disease (bronchiolitis) as a potential primary cause. Successful management depends on the identification of the specific underlying disorder.

Bronchiolitis↗
PubMed1994

[Clinical study of 15 children with acute suppurative thyroiditis].

From 1969 to 1990, 15 children with acute suppurative thyroiditis (AST) were diagnosed in our hospital. Their clinical, laboratory and radiologic findings were reviewed. The characteristic features were as follows: 1) Males to female ratio was 1.5:1. 2) The ages at diagnosis ranged from 3 to 14 years, with a mean age of 6 years. 3) A painful, tender mass in the anterior neck was detected in all cases and fever was detected in 10 cases (67%). 4) The left lobe of the thyroid was affected in 11 cases (73%), whereas the right lobe was affected in the remaining 4 cases. No cases was bilateral. 5) Five cases (33%) were found to be recurrent. 6) Eight pathogenic organisms were identified on culture from 7 cases; among them 3 were due to anaerobic pathogen. 7) Leukocytosis was increased and acute-phase reactant tests were positive in most cases. 8) Thyroid function was found to be normal in all 9 cases examined. 9) Radiologic studies, which included radionuclide thyroid scan, ultrasonography, computed tomography and barium esophagogram, were very helpful for the diagnosis of AST. 10) A barium esophagogram was performed in 9 cases and a fistula originating from the pyriform sinus was found in 4 cases (44%). 11) Three cases (20%) had the complete removal of the fistula as a permanent cure. This report summarizes the clinical features of 15 children with acute suppurative thyroiditis diagnosed in our hospital during the past twenty years.

Acute Disease↗
PubMed1990

Relationship of gingival bleeding, gingival suppuration, and supragingival plaque to attachment loss.

This study evaluated the relationship between the presence of gingival bleeding, gingival suppuration, and supragingival plaque at 3 month appointments to the incidence of probing attachment loss during a 2-year period of maintenance therapy. The data included in this report were taken during the second and third year of maintenance from 75 periodontal patients who had previously received active therapy in an ongoing longitudinal study. The diagnostic sensitivity, specificity, and positive and negative predictive values were calculated for different frequencies of positive responses for each clinical parameter in relation to sites demonstrating greater than or equal to 2 mm probing attachment loss. Gingival bleeding and plaque were not prognosticators and gingival suppuration was a weak prognosticator of attachment loss during a 2 year maintenance period.

Dental Plaque↗
PubMed1985

Rheumatoid arthritis and chronic bronchial suppuration.

Twenty-two patients with rheumatoid arthritis and severe chronic bronchial suppuration are described. In 11 patients the respiratory symptoms appeared after the onset of arthritis at an unusually late age. We discuss causes for the disease association, in particular the possibility that disease modifying drugs in rheumatoid arthritis may predispose to the development of chronic bronchial suppuration; such a possibility requires prospective investigation.

Adult↗
PubMed1982

Candidal suppurative peripheral thrombophlebitis.

Transient candidemia is common with prolonged intravenous therapy. Sustained candidemia, however, usually indicates a persistent focus of infection. A complication of intravenous therapy not previously emphasized is persistent candidemia caused by candidal suppurative peripheral thrombophlebitis. We report six cases that appeared during intravenous therapy: the infection was characterized by a thrombosed peripheral vein at an intravenous site with manifestations for candida septicemia with or without disseminated candidiasis. In two patients, the source of the process was occult; the examination showed only a thrombosed noninflamed vein. In all cases, surgical exploration showed the thrombosed veins to be suppurative with positive cultures for Candida. Special stains, moreover, showed Candida in the luminal clot and the vascular wall. In the five surviving patients, cure was achieved by excision of the affected vein. Four received a short course of amphotericin B and 5-fluorocytosine, and one patient received amphotericin B only.

Adult↗