Research results obtained over many years on helper and suppressor T-cell functions were reviewed as follows; the role of NK cells in immune responses, immunoregulation by killer molecules, involvement of CD86 (B70) and CD80 (B7) in immunotolerance, and attempts at the human application of immunotolerance by transplantation from the viewpoint of cellular immunology. Based on this latest knowledge, a new research strategy of clinical application enabling the withdrawal of immunosuppressors in patients with organ transplantation is expected.
With the cooperation of the otorhinolaryngological departments at 29 universities in Japan, as well as their 26 affiliated hospitals and practitioners, we conducted the fifth national survey (The first survey conducted by The Japanese surveillance committee, consisting of the Japanese Society of Chemotherapy, Japanese Association for Infectious Disease, and Japanese Society for Clinical Microbiology) to investigate the trends of bacterial isolates and bacterial sensitivity in otorhinolaryngological major infections.
The subjects comprised patients with acute purulent otitis media (185 cases), chronic otitis media (119 cases), acute sinusitis (128 cases), chronic sinusitis (92 cases), acute tonsillitis (116 cases), and peritonsillar abscess (89 cases) who presented to the medical institutions participating in the survey from January 2011 to June 2012. Using specimens obtained from the patients, bacteria were identified by culture and drug sensitivity was measured.
S. pneumoniae and H. influenzae were mainly isolated from patients with acute purulent otitis media and acute sinusitis, and frequency of isolation of S. aureus was decreasing in the recent surveys. Streptococcus spp. (including S. pyogenes) was mainly isolated from patients with acute tonsillitis. Anaerobes (Peptostreptococcus spp., Prevotella spp. and Fusobacterium spp. etc.) were mainly isolated from patients with peritonsillar abscess, and frequencies of isolation of anaerobes in the recent surveys were markedly higher than observed in the former surveys.
Among 112 strains of S. aureus isolated in the present survey, 28 (25.9%) were MRSA. Among 113 strains of S. pneumoniae isolated, 41 (36.8%) were PISP and 14 (12.3%) were PRSP. Among 106 strains of H. influenzae isolated, 38 (35.8%) were BLNAR, and 16 (15.1%) each were BLPAR and BLNAI, respectively. Frequency of isolation of these drug resistant bacteria was higher in patients aged 5 years or younger than in other age groups. Compared with the result of the previous surveys, frequencies of isolation of MRSA, resistant S. pneumoniae (PISP and PRSP), resistant H. influenzae (mainly BLNAR), and ABPC resistant M. catarrhalis are increasing recently.
It is considered necessary to take measures to promote the appropriate use of antibiotics in order to prevent the increase of resistant bacteria.
While leukemia occasionally occurs during the course of severe infection, it can be difficult to differentiate whether leukocytosis is caused by infection or leukemia. We herein present a patient who was brought to our hospital for the first time with disseminated intravascular coagulation (DIC) caused by deep cervical cellulitis. Subsequently, the patient was strongly suspected to have acute leukemia, and was thus transferred to the hematology department.
Actinomycosis is an unusual inflammatory disease caused primarily by Actinomyces israelii. The disease commonly appears as a chronic granulomatous lesion resembling a tumor on the head or neck, so it has been often difficult to distinguish the lesion from a malignant tumor. In this paper, a case of actinomycosis of the neck suspected as hypopharyngeal carcinoma was reported. An 87-year-old man, who was a dialysis patient, visited our hospital with left neck mass.
We suspected hypopharyngeal carcinoma and lymph node metastasis from a study of the CT scan. However, by using both microscopic examination and culture inspection, it was revealed that the patient’s neck abscess was a typical case of actinomycosis. We resected the neck mass under general anesthesia, and made a diagnosis of actinomycosis. It was estimated that the hypopharyngeal lesion was an inflammatory reaction to the abscess. After surgery, we prescribed clarithromycin (CAM) for 8 weeks, and the patient has been shown no sign of recurrence.
Burow’s solution has long been used as a local otological preparation in the treatment of otitis externa and otitis media. To ascertain the antibacterial effect of Burow’s solution on the antibiotic resistant bacteria, it was examined using by the disk method to determine whether the solution has a bactericidal effect on Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae isolated from the patients. They were treated with 13% Burow’s solution. Ultrastructural changes in cells of the strains were examined by scanning electron microscopy (SEM) and transmission electron microscopy (TEM).
The results showed that Burow’s solution had larger average zones of inhibition than the other antibacterial agents (gentian violet). No difference was found in the susceptibilities of the antibiotic sensitive bacteria and resistant bacteria to Burow’s solution. This study suggests that Burow’s solution is an effective antibacterial agent, not only for antibiotic resistant bacteria but also for antibiotics-sensitive bacteria. Therefore, Burow’s solution is considered to be useful for the treatment of otitis. A further study is required to demonstrate whether diluted Burow’s solution is effective in the clinical setting. The microscopic findings show that Burow’s solution is active against this strains, resulting in damage to cell wall.
Aneurysm of extracranial carotid artery unusually occurs, especially pseudoaneurysm caused by infection. Whereas we face this disease rarely, it can be life-threatening with a high mortality rate. We describe 4 cases of infectious pseudoaneurysm of extracranial carotid artery. All of them had been undergoing hemodialysis, so we recognized that hemodialysis was a risk for infectious pseudoaneurysm.
Some authors have mentioned about the immunodeficiency of hemodialysis patients as the cause of infectious pseudoanyeurysms, but the recurrent shunt-puncture and heparization can be also risk factors.
We presented our experienced, 44 year-old female, rare and severe case with lingual tonsillitis and multiple cysts infection of epiglottis which was necessary for receiving the tracheostomy.
The urgent tracheostomy was very useful for the patient. Against the hypertrophy of lingual tonsils and multiple cysts of epiglottis, we adopted lingual tonsillectomy and total removal of epiglottic multiple cysts by using KTP laser equipment.
In conclusion, we, otolaryngologist, should be familiar with the surgical procedure of urgent tracheostomy and will recommend for using the KTP laser against lingual tonsillectomy, because of the effect of bleeding stoppage being high and the operability being good.
Septic pulmonary embolism (SPE) is an uncommon but serious infection which requires early diagnosis and immediate aggressive treatment. We report the case of SPE originating from a masticator abscess. A 74-year-old man with diabetes mellitus and gingivitis visited our hospital complaining of pain and swelling of the left cheek, and trismus in middle of May, 2014. A contrast enhanced computed tomography (CT) showed an abscess in the left masticator space. Intraoral incision and drainage were performed, and antibiotics were administered. Prevotella oris, Parvimonas micra, α-hemolytic streptococcus were isolated from the pus. After 4 days, the patient appeared to be improving clinically. But on the 5th day of admission, he had fever and laboratory tests showed leukocytosis (15,600/μl) and an elevated C-reactive protein (CRP) level (6.5 mg/dl). Although His fever went down in a day, leukocytosis and an elevated CRP level persisted. On the 9th day of admission, a CT revealed pleural effusion and multiple nodular lesions, and SPE was diagnosed. A masticator abscess had disappeared. The blood culture was negative. There were no symptom suggesting respiratory infection such as cough, dyspnea, chest pain nor high fever. Because he remained clinically stable thereafter, appropriate antibiotic treatment was continued. On the 26th day of admission, a CT showed that the lesions had completely disappeared, and a white blood cell (WBC) count and a CRP level returned to the normal range. He recovered well and was discharged from the hospital on the 29th day of admission.