Posts filed under ‘Infecciones cabeza y cuello’

Primary cervical osteomyelitis.

J Chin Med Assoc. 2013 Nov;76(11):640-7.

Tsai CE1, Lee FT, Chang MC, Yu WK, Wang ST, Liu CL.



Cervical osteomyelitis accounts for only 3-11% of all cases of spinal osteomyelitis, and the diagnosis may be delayed. The characteristics of different pathogens causing cervical osteomyelitis are not fully understood, and there are few established guidelines for treatment.


The cases of six patients who presented with primary cervical osteomyelitis in the orthopedic department between January 2002 and March 2012 were retrospectively reviewed. All patients had been treated with anterior decompression, instrumentation, and autograft fusion. Data about preoperative and postoperative symptoms, neurological function, pain, C-reactive protein (CRP) levels, and the results of plain film and magnetic resonance imaging were reviewed.


Intraoperative cultures revealed Staphylococcus aureus in three patients, Propionibacterium acnes in two, and Mycobacterium tuberculosis in one. The mean duration between symptoms and diagnosis was 7.2 weeks (range, 3-12 weeks). Three patients with S. aureus infections had relatively higher preoperative CRP levels (mean, 173 mg/L) than did the patients with P. acnes infections or tuberculosis (mean, 5.5 mg/L). However, bony destruction was less severe in patients with S. aureus infections than in those patients with P. acnes and tuberculosis. All CRP levels returned to normal in 12 weeks, and all six patients had a final stable cervical alignment and fusion. Ultimately, neurological function and pain score improved in all patients.


Cervical osteomyelitis caused by S. aureus has an acute onset, higher CRP level, shorter duration from onset to diagnosis and thus causes less bony destruction. By contrast, cervical osteomyelitis caused by P. acnes and tuberculosis has an indolent course, a low or even normal CRP level, a longer duration from onset to diagnosis, and produces more severe bony destruction. Anterior decompression, instrumentation, and autograft fusion can be successfully used to treat primary cervical osteomyelitis. However, a mesh cage can also be a good alternative to an autograft.


July 3, 2017 at 3:21 pm

Treatment of cervicofacial actinomycosis: a report of 19 cases and review of literature.

Med Oral Patol Oral Cir Bucal. 2013 Jul 1;18(4):e627-32.

Moghimi M1, Salentijn E, Debets-Ossenkop Y, Karagozoglu KH, Forouzanfar T.

Author information

1Department of Oral and Maxillofacial Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherland.



Actinomycosis is a chronic suppurative granulomatous infection caused by the Actinomyces genus. Orocervicofacial actinomycosis is the most common form of the disease, seen in up to 55% of cases. All forms of actinomycosis are treated with high doses of intravenous penicillin G over two to six weeks, followed by oral penicillin V. Large studies on cervicofacial actinomycosis are lacking. Therefore proper guidelines for treatment and treatment duration are difficult to establish. The aim of this study is to establish effective treatment and treatment duration for orocervicofacial actinomycosis.


A Pubmed and Embase search was performed with the focus on treatment and treatment duration for cervicofacial actinomycosis. The hospital records of all patients presenting to our department with head and neck infection from January 2000 to December 2010 were reviewed, retrospectively. The following data were collected: age, gender, clinical presentation, aetiology, duration of symptoms, microbiological findings, treatment, and duration of treatment. The treatment and treatment duration is subsequently compared to the literature.


The literature search provided 12 studies meeting the inclusion criteria. All studies were retrospective in nature. Penicillin or amoxicillin/clavulanic acid are the preferred antibiotic regimens found in the literature. Most of our patients were treated with a combination of penicillin G 12 million units/day and metronidazol 500 mg 3/day, most commonly for a duration of 1 – 4 weeks, being shorter than the 3 – 52 weeks reported in the literature.


When actinomycosis is suspected, our review has shown that a surgical approach in combination with intravenous penicillin and metronidazol until clinical improvement is seen, followed by oral antibiotics for 2 – 4 weeks is generally efficient.


January 14, 2016 at 11:45 am

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

Human papilloma virus: a new risk factor in a subset of head and neck cancers.

J Cancer Res Ther. 2011 Jul-Sep;7(3):251-5

Bisht M, Bist SS.


Department of Pharmacology, Himalayan Institute of Medical Sciences, Himalayan Institute Hospital Trust University, Jolly- Grant, Dehradun, India.


Head and neck cancer is the sixth most common malignancy worldwide. Tobacco smoking and alcohol consumption are two well known behavioral risk factors associated with head and neck cancer. Recently, evidence is mounting that infection with human papilloma virus, most commonly human papilloma virus-16 is responsible for a subset of head and neck squamous cell carcinoma especially tumors of tonsillar origin. The molecular pathway used by human papilloma virus to trigger malignant transformation of tissue is different from that of other well known risk factors, i.e. smoking and alcohol, associated with squamous cell carcinoma. Apparently, these subsets of patients with human papilloma virus positive tumor are more likely to have a better prognosis than human papilloma virus negative tumor. Considering this fact, the human papilloma virus infection should be determined in all oropharyngeal cancers since it can have a major impact on the decision making process of the treatment.


October 24, 2012 at 3:52 pm

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