Posts filed under ‘Infecciones cabeza y cuello’

Epidemiology, clinical history and microbiology of peritonsillar abscess

Europ J of Clinical Microb & ID V.34 N.3 March 2015

Mazur, E. Czerwińska, I. Korona-Głowniak…


May 11, 2015 at 2:05 pm

Increase in prevalence of Streptococcus pneumoniae serotype 6C at Eight Children’s Hospitals in the United States from 1993 to 2009.

J Clin Microbiol. 2011 Jun;49(6):2097-101.

Green MC, Mason EO, Kaplan SL, Lamberth LB, Stovall SH, Givner LB, Bradley JS, Tan TQ, Barson WJ, Hoffman JA, Lin PL, Hulten KG.


Streptococcus pneumoniae serotype 6C, which was described in 2007, causes invasive disease in adults and children.

We investigated the prevalence of 6C among pediatric isolates obtained from eight children’s hospitals in the United States.

S. pneumoniae isolates were identified from a prospective multicenter study (1993 to 2009). Fifty-seven serotype 6C isolates were identified by multiplex PCR and/or Quellung reaction. Five were isolated before 2000, and the prevalence increased over time (P < 0.000001).

The median patient age was 2.1 years (range, 0.2 to 22.5 years).

Clinical presentations included bacteremia (n = 24), meningitis (n = 7), pneumonia (n = 4), abscess/wound (n = 3), mastoiditis (n = 2), cellulitis (n = 2), peritonitis (n = 1), septic arthritis (n = 1), otitis media (n = 10), and sinusitis (n = 3).

By broth microdilution, 43/44 invasive serotype 6C isolates were susceptible to penicillin (median MIC, 0.015 μg/ml; range, 0.008 to 2 μg/ml); all were susceptible to ceftriaxone (median MIC, 0.015 μg/ml; range, 0.008 to 1 μg/ml). By disk diffusion, 16/44 invasive isolates (36%) were nonsusceptible to erythromycin, 19 isolates (43%) were nonsusceptible to trimethoprim-sulfamethoxazole (TMP-SMX), and all isolates were clindamycin susceptible.

Multilocus sequence typing (MLST) revealed 24 sequence types (STs); 9 were new to the MLST database. The two main clonal clusters (CCs) were ST473 and single-locus variants (SLVs) (n = 13) and ST1292 and SLVs (n = 23). ST1292 and SLVs had decreased antibiotic susceptibility. Serotype 6C causes disease in children in the United States.

Emerging CC1292 expressed TMP-SMX resistance and decreased susceptibility to penicillin and ceftriaxone. Continued surveillance is needed to monitor changes in serotype prevalence and possible emergence of antibiotic resistance in pediatric pneumococcal disease.


January 21, 2014 at 1:51 pm

Panspinal epidural and psoas abscess with secondary cervical disc space infection.

Ulster Med J. 2013 Jan;82(1):23-5.

Shoakazemi A, Amit A, Nooralam N, Abouharb A, Gormley M, McKinstry S.

Psoas and epidural spinal abscesses have been described as relatively rare conditions. The incidence of epidural spinal abscess, however, has doubled in the recent two decades, reaching 1 in 10000 hospital admissions.

Early diagnosis and management of these two pathologies, especially when presenting with insidious and vague symptoms, require a high degree of suspicion. In this case, unusual evolving cervical disc space infection was also noted …


January 15, 2014 at 8:27 am

Indications, efficacy, and safety of intranasal corticosteriods in rhinosinusitis.

World Allergy Organ J. 2012 Jan;5(Suppl 1):S14-7.

Potter PC, Pawankar R.


Allergy Diagnostic and Clinical Research Unit, University of Cape Town, South Africa.


Rhinosinusitis is a significant health problem, causing significant morbidity and resulting in considerable financial cost. Some patients suffer persistent or recurrent symptoms despite receiving optimal medical and surgical treatment. Rhinosinusitis can be acute or chronic, acute often due to viral or bacterial infections and chronic which is classified into chronic with nasal polyposids or chronic rhinosinusitis without nasal polyposis. The disease affects the quality of life significantly and presents a significant burden on health costs globally. The anatomical linkage of the nose with the paranasal sinuses facilitates a common pathology in both organs.

Chronic rhinosinusitis (CRS) has heterogeneous origins, including viruses, bacteria, fungal infections, anatomical abnormalities, polyposis, and aspirin sensitivity. Other conditions such as human immunodeficiency virus acquired immunodeficiency and cystic fibrosis may also be predisposing factors. Nasal polyposis is often associated with increased numbers of Th2 lymphocytes, fibroblasts, goblet cells, mast cells, and eosinophils, with upregulation of IL-13 and the release of specific IgE to staphylococcal enterotoxins.

There is recent evidence that antibiotic treatment may not be as effective as higher doses of intranasal steroids in acute uncomplicated rhinosinusitis, especially in those with allergic disease. The broad inflammatory basis of the pathology of CRS also reveals a cellular infiltrate theoretically suppressed by intranasal corticosteroids. This has been confirmed in recent clinical studies of CRS with or without polyps. A treatment approach based on such studies reported in the European Position Paper on Rhinosinusitis guidelines and a guideline summary are presented.

The current review represents the proceedings of a session (3 talks) by the authors at the first Middle East-Asia Allergy, Asthma, Immunology Congress in 2009.


November 21, 2013 at 9:29 am

Lesions in the Oral Cavity

N Engl J of Medic Feb.21, 2013 V.368


Jose Narciso Rosa Assunção, D.D.S., Ms.C., and Gustavo Davi Rabelo, D.D.S., Ph.D.

University of São Paulo, São Paulo, Brazil

A 59-year-old man presented with multiple painful ulcers in the oral cavity that had developed over the course of a week. He also noted difficulty swallowing and speaking. Physical examination revealed …





February 22, 2013 at 8:42 am

Rapidly progressing subperiosteal orbital abscess: an unexpected complication of a group-A streptococcal pharyngitis in a healthy young patient.

Head Face Med. 2012 Oct 16;8:28.

Costantinides F, Luzzati R, Tognetto D, Bazzocchi G, Biasotto M, Tirelli GC.


Division of Oral Medicine, Department of Dental Sciences, Piazza dell’Ospitale 1, University of Trieste, Trieste 34100, Italy.




Complications associated to group-A streptococcal pharyingitis include non-suppurative complications such as acute rheumatic fever and glomerulonephritis and suppurative complications such as peritonsillar or retropharyngeal abscess, sinusitis, mastoiditis, otitis media, meningitis, brain abscess, or thrombosis of the intracranial venous sinuses.


We described a case of a 15-year-old patient with a history of acute pharyngodinia early followed by improvise fever and a progressive formation of a diffuse orbital edema, corneal hyperaemia, diplopia and severe decrease of visual acuity.The patient was surgically treated with functional endoscopic sinus surgery (FESS) after the response of a maxillofacial computed tomography scans that showed a pansinusitis complicated by a left orbital cellulites. Numerous colonies of Streptococcus pyogenes were found in the samples of pus and an antibiotic therapy with meropenem was initiated on the basis of the sensitivity test to antibiotics. The patient was finally discharged with diagnosis of left orbital cellulites with periorbital abscess, endophtalmitis and acute pansinusitis as a consequence of streptococcal pharyngitis.


The case highlights the possible unusual complication of a group-A streptococcal pharyingitis in a immunocompetent child and the needing of a prompt surgical and medical approach toward the maxillofacial complications associated to the infection.


December 27, 2012 at 8:56 am

Topical 0.5% Ivermectin Lotion for Treatment of Head Lice

N Engl J of Medic  Nov.1, 2012 V.367 P1687-1693.

David M. Pariser, M.D., Terri Lynn Meinking, Ph.D., Margie Bell, M.S., and William G. Ryan, B.V.Sc.

From the Department of Dermatology, Eastern Virginia Medical School, Norfolk (D.M.P.); Global Health Association of Miami, Coral Gables, FL (T.L.M.); ClinData Services, Fort Collins, CO (M.B.); and Ryan Mitchell Associates, Westfield, NJ (W.G.R.). Address reprint requests to Dr. Ryan at 16 Stoneleigh Park, Westfield, NJ 07090-3306, or at


The emergence of resistance to treatment complicates the public health problem of head-louse infestations and drives the need for continuing development of new treatments. There are limited data on the activity of ivermectin as a topical lousicide.


In two multisite, randomized, double-blind studies, we compared a single application of 0.5% ivermectin lotion with vehicle control for the elimination of infestations without nit combing in patients 6 months of age or older. A tube of topical ivermectin or vehicle control was dispensed on day 1, to be applied to dry hair, left for 10 minutes, then rinsed with water. The primary end point was the percentage of index patients (youngest household member with ≥3 live lice) in the intention-to-treat population who were louse-free 1 day after treatment (day 2) and remained so through days 8 and 15.


A total of 765 patients completed the studies. In the intention-to-treat population, significantly more patients receiving ivermectin than patients receiving vehicle control were louse-free on day 2 (94.9% vs. 31.3%), day 8 (85.2% vs. 20.8%), and day 15 (73.8% vs. 17.6%) (P<0.001 for each comparison). The frequency and severity of adverse events were similar in the two groups.


A single, 10-minute, at-home application of ivermectin was more effective than vehicle control in eliminating head-louse infestations at 1, 7, and 14 days after treatment. (Funded by Topaz Pharmaceuticals [now Sanofi Pasteur]; numbers, NCT01066585 and NCT01068158.)




Topical Ivermectin — A Step toward Making Head Lice Dead Lice?

Olivier Chosidow, M.D., Ph.D., and Bruno Giraudeau, Ph.D.

Head-louse infestation stigmatizes hundreds of millions of people worldwide, predominantly children 3 to 11 years of age of all socioeconomic levels. It is commonly perceived as a sign of poor hygiene, which often engenders excessive management responses (e.g., repeated hair shaving and improper pediculicide use). Medical consequences of infestation can include itching and scratching, which may lead to cutaneous bacterial superinfection (i.e., pyoderma and impetigo) and possible transmission of Bartonella quintana, the trench-fever pathogen that is usually transmitted by body lice and that has been isolated from head lice. The estimated annual direct and indirect cost of head-louse infestation in the United States is $1 billion….



December 6, 2012 at 3:55 pm

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