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PubMed1985

Pool-associated Pseudomonas aeruginosa dermatitis and other bathing-associated infections.

The growing popularity of heated pools, especially whirlpools and hot tubs, has been accompanied by increasingly frequent outbreaks of an illness produced by Pseudomonas aeruginosa. The illness usually includes folliculitis, pruritic skin rash, and/or otitis externa and occasionally mastitis and systemic symptoms. Although usually self-limited, rare severe cases have been described. Motel and hotel whirlpools are most often implicated as the source of outbreaks. The relative importance of pool conditions and the bacteriology of P. aeruginosa in the pathogenesis of this illness remain to be elucidated. Implementing CDC Guidelines for public spas and hot tubs seem the most reasonable way of reducing the risk of large outbreaks. Prevention of cases arising from home hot tubs or whirlpools will be very difficult and may depend on extensive public education or the development of simple, inexpensive and effective disinfection systems.

Dermatitis↗
PubMed2003

Successful orthotopic liver transplantation after trimethoprim-sulfamethoxazole associated fulminant liver failure.

Trimethoprim-sulfamethoxazole (TMP-SMZ) is one of the most commonly used antibiotics. Although many of its adverse effects are well recognized, TMP-SMZ related hepatotoxicity is considered rare and is usually characterized by cholestasis or mixed hepatocellular-holestatic reactions. In this study, we describe the case of a previously healthy young man with acute fulminant liver failure caused by TMP-SMZ. The patient presented with complaints of 'flu-like' symptoms with myalgia and fever after taking TMP-SMZ for 7 d for otitis externa. The patient subsequently developed fever, worsening jaundice, and a rash on his neck and chest. Liver enzymes peaked on day 3 with alanine aminotransferase (ALT) 11,549, aspartate aminotransferase (AST) 23,289, alkaline phosphatase 245, and total bilirubin 10.3 mg/dL, with a conjugated bilirubin of 8.3 mg/dL, prothrombin time (PT) 60.5 s, partial normalized ratio (PTT) 49 s, and international normalized ratio (INR) 7.5. Of note, acetaminophen level on admission was undetectable. Serology for hepatitis A, B, C, cytomegalovirus, HIV, toxoplasmosis, and blood cultures were all negative. The patient developed hepatic encephalopathy with hallucination on day 4. Laboratory tests revealed a serum ammonia level of 190 U, serum creatinine kinase (CK) 10,466 (42 on admission), serum creatinine 8.2 mg/dL (1.2 on admission), and significant metabolic acidosis. Renal ultrasound was unremarkable. The patient was started on hemodialysis for acute renal failure. Meanwhile, liver transplantation assessment was also initiated. On day 8 post-admission (15 d after taking TMP-SMZ), the patient received a successful orthotopic liver transplant.

Adult↗
PubMed2000

Pseudomonas aeruginosa folliculitis after shower/bath exposure.

BACKGROUND: Pseudomonas aeruginosa folliculitis (PF) can develop after exposure to contaminated water in heated swimming pools, whirlpools, and hot-tubes, or after diving suit dressing. METHODS: We observed and studied 14 cases of PF after shower/bath exposure, an underestimated pathogenic event. Cutaneous and environmental microbiological evaluations were performed. RESULTS: In our cases, the clinical expression of dermatitis was constant, PF being a clinically well recognizable skin infection, presenting with follicular, macular, and papulopustular lesions located on the lateral aspect of the trunk, axillary folds, hips, buttocks, and suprapubic area. In all cases, Pseudomonas aeruginosa was isolated from lesional skin; seven cases were serotyped revealing, in three cases, serotype 0 : 1, in two cases 0 : 8, in one case 0 : 10, and in one case 0 : 11. In three families, Pseudomonas aeruginosa was isolated in the well water. In a further three families, Pseudomonas aeruginosa was isolated from bathroom and kitchen components. CONCLUSIONS: Based on our experience, we suggest that shower/bath exposure should be definitively included amongst the possible pathogenic events causing PF. Pseudomonas aeruginosa is responsible for a number of clinical pictures, e.g. otitis externa, conjunctivitis, toe web intertrigo, green nail syndrome, infection of burns and wounds, and folliculitis. Pseudomonas aeruginosa folliculitis (PF) has been reported to develop as a consequence of exposure to contaminated water in heated swimming pools, whirlpools, and hot-tubes, or related to diving suits and leg waxing.1-4 We observed 14 cases of PF after shower/bath exposure. This is probably an underestimated pathogenic event; to our knowledge, only one case has been reported to date.5 In our patients, the clinical expression of dermatitis was constant, PF being a clinically well recognizable skin condition.

Adult↗
PubMed2002

[Acquired fibrotic atresia of the external auditory canal].

BACKGROUND: There are very few communications on this pathologic entity, which is also called "postinflammatory medial meatal fibrosis" (PIMMF), its etiology and the adequate therapy. Apparently the cause is a chronic inflammation (or chronic ekzema) of the medial part of the external meatus or also a long-lasting otorrhea in chronic otitis media. The stratified epithelium of the eardrum and of the adjacent bony meatus is destroyed and replaced by fibrotic tissue. The lateral part of the auditory canal remains open and has the form of the finger of a glove, it may contain granulations, but often it is lined with a smooth stratified epithelium. A severe conductive hearing loss is the result of this anomaly. PATIENTS: During the last 10 years we operated on 46 patients (52 ears) for this pathology: after retroauricular opening, which allows the best control of the anterior tympanomeatal angle, the fibrotic tissue was removed keeping the lamina propria intact. The bony canal was widened, if necessary. The eardrum and the bony canal were covered with split skin graft from the retroauricular region, then the canal filled with an antibiotic package for 3 weeks. RESULTS: Underneath the fibrotic tissue we detected 3 cholesteatomata of the annular region, so it is important to remember, that the atresia may also cover a dangerous pathology. 6 times a second operation was necessary, besides that, we observed 14 recurrencies. All other patients had a wide epithelialized ear canal, their conductive hearing loss disappeared, and the results were stable over several years. Bacteriological and histological examinations were not helpful to clear up the etiology of this disease. CONCLUSIONS: Surgery is the treatment of choice of the acquired atresia of the external meatus. We suppose that in these patients a individual disposition causes the formation of this excessive fibrosis, which has some similarity with keloid formation.

Adult↗
PubMed2005

[Relapsing polychondritis -- a case report and review of the literature].

PATIENT: A case of a 54-year-old woman with a three month history of recurrent bilateral chondritis of the auricles, cochlear and vestibular inner ear damage and conjunctivitis is described. The diagnosis was based only on clinical criteria (auricular chondritis, conjunctivitis, inner ear damage). Antinuclear antibodies, ANCA and HLA-DR 4 antigen were negative. The only laboratory abnormality was an elevated erythrocyte sedimentation rate. The patient has been treated successfully with Methotrexate 20 mg 1 x /week and Prednisone 15 mg/die for 4 month now. DISCUSSION: The relapsing polychondritis (RP) is a rare, multisystemic and potentially fatal disease. The pathogenesis and optimal therapeutic approach is poorly understood. The disease is characterized by episodic inflammation of cartilage such as auricular, nasal and laryngotracheal. Many other proteoglycan-rich structures like inner ear, eye, kidney and blood vessels, may be involved as well. RP has an equal sex prevalence. The majority of cases appear between 40 and 60 years. Auricular inflammation is the most common feature. Effectiveness of non-steroidal anti-inflammatory drugs, dapsone, immunosuppressive drugs and prednisone has been described. The overall survival rates were 74 % at 5 years and 55 % at 10 in one 1986 series. CONCLUSION: The most common clinical presentation of RP regularly involves ENT-structures. Therefore ENT-specialists should be familiar with this disease. A close interdisciplinary cooperation is essential for therapy and follow-up, because pulmonary and cardiac involvement are limiting prognostic factors.

Audiometry, Pure-Tone↗
PubMed1995

[Dimorphism of cerumen, facts and theory].

¿Dimorphism¿ means the existence of two phenotypic different types of the human cerumen and morphology of the cerumen glands. In this paper, the morphological, biochemical, and functional differences are reviewed. The wet cerumen is better adapted to a hot and humid climate where infections of the outer ear are very frequent and sometimes severe. In a cold and dry climate, the dry cerumen is advantageous. In the moderate climates, both types are equivalent (balanced dimorphism).

Cerumen↗
PubMed1989

[Local treatment of Pseudomonas infection of the ear. A small clinical study].

Infections of the middle and external ear caused by the problem-micro-organism Pseudomonas aeruginosa can be cured by local therapy with Ciprofloxacin and Tutofusin very quickly and without any complications. Drum ruptures caused by ear secretions close up again spontaneously. Tympanon tubes can be left in situ. Function disturbances of the middle and internal ear clear up and the functions return to normal.

Audiometry, Pure-Tone↗
PubMed1998

An epidemic of Malassezia pachydermatis in an intensive care nursery associated with colonization of health care workers' pet dogs.

BACKGROUND: Malassezia species are lipophilic yeasts that are emerging as nosocomial pathogens, particularly in low-birth-weight neonates who receive lipid emulsions. When a cluster of patients with Malassezia pachydermatis infection was identified in an intensive care nursery, we initiated an investigation. METHODS: A case patient was defined as any infant in the intensive care nursery who had a positive culture for M. pachydermatis between October 17, 1993, and January 18, 1995. We conducted a cohort study to identify risk factors for colonization and infection with M. pachydermatis. We collected cultures from the infants and the health care workers and from the health care workers' pets, since this organism has been associated with otitis externa in dogs. RESULTS: Fifteen infants met the case definition: eight with bloodstream infections, two with urinary tract infections, one with meningitis, and four with asymptomatic colonization. The case patients were significantly more likely than the other infants to weigh 1300 g or less (15 of 65 vs. 0 of 419, P<0.001). In a multivariate analysis of infants weighing 1300 g or less, the independent risk factors for colonization or infection with M. pachydermatis were a greater severity of concomitant illness (odds ratio, 19.7; P=0.001), arterial catheterization for nine or more days (odds ratio, 29.5; P=0.027), and exposure to Nurse A (odds ratio, 74.7; P=0.004). In a point-prevalence survey, 9 additional infants, 1 health care worker, and 12 of the health care workers' pet dogs had positive cultures for M. pachydermatis. The isolates from all 15 case patients, the 9 additional colonized infants, 1 health care worker, and 3 of the 12 dogs had identical patterns of restriction-fragment-length polymorphisms. CONCLUSIONS: In this outbreak, it is likely that M. pachydermatis was introduced into the intensive care nursery on health care workers' hands after being colonized from pet dogs at home. The organism persisted in the nursery through patient-to-patient transmission.

Animals↗
PubMed2001

Effects of common topical otic preparations on the morphology of isolated cochlear outer hair cells.

Otic drops are commonly used not only for otitis externa but also for otorrhea in the presence of tympanostomy tube or tympanic membrane perforation. Many studies have demonstrated the ototoxicity of common otic preparations such as Cortisporin otic drops. Recent studies have suggested the use of fluoroquinolone antibiotic drops as an alternative owing to their excellent antimicrobial coverage and no ototoxic effect. The purpose of this study was to assess the relative ototoxicity of four common otic preparations by direct exposure to isolated cochlear outer hair cells (OHCs). OHCs from adult chinchilla cochlea were exposed to standard bathing solution (control), Cortisporin, Cipro HC, Ciloxan, and Floxin. The cells were observed using an inverted microscope, and the images recorded in digital still-frame and video, and analyzed on the Image Pro-Plus 3.0 program. As measured by time to cell death and change in morphology of OHCs, Cortisporin was most toxic to OHCs. Among the fluoroquinolone drops, Floxin was more toxic than Ciloxan or Cipro HC.

Administration, Topical↗
PubMed1977

Common ear diseases: recognition and management.

External otitis is directly related to patient habit patterns. It is easily treated, but the habits must be changed to effect permanent cure. Serous otitis media is the most common cause of conductive hearing loss, and its presence my predispose to development of purulent otitis media. Removal of middle ear fluid may be advisable in persistent serous otitis and is recommended in acute purulent otitis.

Aluminum↗
PubMed1991

Fluoroquinolones. New miracle drugs?

Fluoroquinolones are the newest antibiotics for treatment of some infections caused by highly resistant bacteria (eg, Pseudomonas aeruginosa). Clinically sound indications for these drugs include resistant infections of the urinary, intestinal, and respiratory tracts; otitis externa; osteomyelitis; foot infections in diabetic patients; and late infections complicating burns. Fluoroquinolone therapy is not indicated in children younger than 12 years old and patients with foreign bodies, abscesses, pelvic inflammatory disease, or infections requiring a prophylactic antibiotic. Drug interactions with antacids or theophylline may occur.

4-Quinolones↗
PubMed1996

Treatment of vancomycin-resistant Enterococcus faecium infections with an investigational streptogramin antibiotic (quinupristin/dalfopristin): a report of fifteen cases.

New therapies for vancomycin-resistant Enterococcus faecium (VREF) infections are urgently needed. We describe the treatment of 15 patients with VREF infection with quinupristin/dalfopristin (RP 59500), a new injectable streptogramin antibiotic. Primary infections treated were bacteremia (4), urinary tract (4), intraabdominal (5), otitis externa (1), and meningitis (1). Minimum inhibitory concentrations for quinupristin/dalfopristin ranged from 0.5 microgram/ml or less to 2 micrograms/ml, and minimum bactericidal concentrations were greater than 64 micrograms/ml for all VREF isolates tested. Peak serum inhibitory titers following infusion of quinupristin/dalfopristin ranged from 1:8 to 1:64; all bactericidal titers were less than 1:2. Development of resistance to quinupristin/dalfopristin during therapy was not observed. The only drug-related adverse effect noted was phlebitis in 4 patients; all had received quinupristin/dalfopristin by peripheral venous infusion. Three patients had clinical and bacteriologic cures. Relapses occurred in 5 patients with recovery of VREF from infected sites in post-treatment cultures. Ten patients died of severe underlying disease; VREF was believed to contribute directly to the death of only 1 patient. While evaluation of clinical efficacy was complicated by the severity of underlying disease in patients with VREF infection, our experience suggests that quinupristin/dalfopristin is a safe and potentially useful agent for the treatment of VREF infections.

Adult↗
PubMed1997

Pityriasis rubra pilaris: an unusual cutaneous complication of AIDS.

Pityriasis rubra pilaris is an uncommon hyperkeratotic, papulosquamous disorder that has been reported in patients infected by HIV. We recount a case of pityriasis rubra pilaris in an HIV-seropositive man. A 36-year-old man with a history of ulcerative colitis and recurrent otitis externa had diffuse psoriaform erythroderma. He was treated initially with methotrexate and isoretinoin without clinical improvement. Skin examination showed large, erythematous, orange, scaly patches on the upper extremities and thickening of the nail beds. The palms and soles were hyperkeratotic. Skin biopsy revealed changes that were consistent with pityriasis rubra pilaris. Six months before the onset of symptoms, results of an enzyme-linked immunosorbent assay (ELISA) and Western Blot assay for HIV were negative. Six months after symptoms, results of repeat enzyme-linked immunosorbent assay and Western blots for HIV were positive (CD4+ T-cell count = 200 cells/ mm3). Clinical course had been complicated by episodes of Staphylococcus aureus bacteremia, mucocutaneous candidiasis, and development of localized squamous cell carcinoma of the skin. The increased severity of pityriasis rubra pilaris should prompt clinicians to consider coinfection with HIV in patients who have disease that is refractory to treatment. Clinicians also should remain vigilant for the development of squamous cell carcinoma.

AIDS-Related Opportunistic Infections↗
PubMed1998

Postinflammatory acquired atresia of the external auditory canal: treatment and results of surgery over 27 years.

Postinflammatory, acquired atresia of the external auditory meatus is a relatively rare consequence of chronic otitis media or recurrent external otitis with an annual incidence of 0.6 cases per 100,000 inhabitants. Primary and late results after operative treatment of this condition in 53 ears over 27 years are presented. Perioperative findings are described, and an outline of applied surgical technique is given. Six patients had bilateral involvement. The male-to-female ratio was 1:2, median age at surgery was 46 years, and the median follow-up period was 5 years (range, 4 mo to 13 y). In 11% of the cases, recurrent atresia developed. Early operation is recommended, because cholesteatoma behind the atresia was found in 9%. Hearing improvement has been considerable after removal of the atresia with primary closure of airbone gap within 20 dB in 90% of the cases.

Adolescent↗
PubMed2001

Bone-anchored hearing aid quality of life assessed by Glasgow Benefit Inventory.

OBJECTIVE/HYPOTHESIS: The bone-anchored hearing aid (BAHA) is a well established mode of treatment and many studies show the audiological benefit, but none has assessed the benefit to the quality of life of patients. This study uses the validated Glasgow Benefit Inventory to quantify the changes in quality of life. STUDY DESIGN: Retrospective questionnaire study. METHODS: Sixty consecutive patients receiving treatment with BAHA were enrolled in the study. The male/female ratio was 1.26 to 1; mean patient age was 45 years. The most common indication was hearing loss secondary to mastoid disease and surgery followed by congenital atresia and chronic discharge from the ear. RESULTS: The response rate was 85%, which is high and adds weight to the results. The general benefit score was +34 (range, +27-+48), which is comparable to middle ear surgery but just below benefit from cochlear implantation. The social benefit was +21 (range, +12-+37) with only +10 (range, +2-+26) for the physical score. This pattern mirrors that reported for other ear interventions. Maximum benefit was noted in patients with congenital atresias followed by discharging mastoid cavities. CONCLUSION: This study is the first to demonstrate significant quality of life benefit from BAHA surgical intervention as measured by the Glasgow Benefit Inventory.

Adolescent↗
PubMed2001

Determination of ototoxicity of common otic drops using isolated cochlear outer hair cells.

OBJECTIVES: Otic drops are commonly used not only for otitis externa, but also for otorrhea in the presence of tympanostomy tubes or tympanic membrane perforations. Many studies have demonstrated the ototoxicity of common otic preparations such as Cortisporin otic drops (Monarch Pharmaceuticals, Bristol, TN). The purpose of this study was to assess the relative ototoxicity of common otic preparations by direct exposure to isolated cochlear outer hair cells (OHCs). METHODS: OHCs from adult chinchilla cochlea were exposed to standard bathing solution (control), acetic acid, Acetasol HC (Alpharma USPD Inc., Baltimore, MD), Gentacidin (CIBA Vision Ophthalmics, Atlanta, GA), and Tobradex (Alcon, Fort Worth, TX). The cells were observed using an inverted microscope, and the images were recorded in digital still-frame and video, and analyzed on the Image Pro-Plus 3.0 program (Media Cybernetics, Silver Spring, MD). RESULTS AND CONCLUSIONS: As measured by time to cell death and change in morphology of OHCs, acetic acid with or without hydrocortisone was most toxic to OHCs. Cortisporin was more cytotoxic than gentamicin and Tobradex.

Acetic Acid↗
PubMed2004

Protective effect of corticosteroid against the cytotoxicity of aminoglycoside otic drops on isolated cochlear outer hair cells.

OBJECTIVES: Otic drops are commonly used not only for otitis externa but also for otorrhea in the presence of tympanic membrane perforation or tympanostomy tube. Many studies demonstrated the ototoxicity of aminoglycoside. In our previous study, we observed that gentamicin (GM), when activated with liver extract, demonstrated significant cytotoxicity. The purpose of this study was to assess the protective effect of corticosteroid against the cytotoxicity of GM and tobramycin drops using isolated cochlear outer hair cells (OHCs) in vitro with liver extract. METHODS: OHCs from adult chinchilla cochleae were exposed to standard bathing solution, liver extract alone, and aminoglycoside otic drops with and without corticosteroid and liver extract. All experiments were performed at an osmolality of 305 +/- 5 mOsm, at room temperature, and for up to 60 minutes. The images of OHCs were recorded using an inverted microscope and analyzed on the Image Pro-Plus 3.0 program. Time to cell death and change of cell length were measured and analyzed. RESULTS: The time to cell death and percent change in cell length observed was significantly longer in the GM + liver extract + dexamethasone group than the GM + liver extract group (P <.05). The Tobradex + liver extract group showed an insignificant increase in percent change of cell length (P >.05) and significantly increased time to cell death than the tobramycin + liver extract group (P <.05). CONCLUSION: This study demonstrated that dexamethasone significantly reduced aminoglycoside cytotoxicity.

Aminoglycosides↗