The Journal of Japan Society for Infection and Aerosol in Otorhinolaryngology
Online ISSN : 2434-1932
Print ISSN : 2188-0077
Volume 4, Issue 1
Displaying 1-10 of 10 articles from this issue
Reviews
  • Kazuhiko Minami
    2016 Volume 4 Issue 1 Pages 1-6
    Published: January 20, 2016
    Released on J-STAGE: September 03, 2020
    JOURNAL FREE ACCESS

    Skin-infiltration observed in advanced cancer severely deteriorates patients’ quality of life with symptoms such as bleeding, exudation, odor, and severe pain. Bleeding from skin-infiltration of head and neck cancer often becomes uncontrollable and patients with the symptom likely require long-term inpatient care.

    Mohs’ chemosurgery, was originally developed to treat skin cancer, but has recently been applied to relieve skin-infiltration symptoms in advanced cancer patients. This method improves quality of life of patients with locally advanced, and unresectable skin lesions especially by reducing the likelihood of recurrent bleeding. This section summarizes the procedure and indications of Mohs’ chemosurgery for otolaryngologists, who may not be familiar with the method.

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  • Shin-ichi Yokota
    2016 Volume 4 Issue 1 Pages 7-13
    Published: January 20, 2016
    Released on J-STAGE: September 03, 2020
    JOURNAL FREE ACCESS

    Global spread of antimicrobial resistant bacteria has becoming serious threat. Infectious diseases with resistant bacteria have a higher mortality rate, and their treatments are higher expensive than those with sensitive strains. WHO distributed global report on antimicrobial resistant bacteria and their surveillance on 2014. Since human being developed antibiotics, emergence of antimicrobial resistant bacteria inevitably occurred. Many of guidelines for infectious diseases propose proper use of antibiotics in order to prevent generation and spread of antimicrobial resistant bacteria. Bacteria can remarkably evolve, so antimicrobial resistant bacteria easily generate in the presence of antibiotics. Bacteria acquire the resistance by not only spontaneous mutations in genome but also acquisition of exogenous resistance gene using various mechanisms. This paper summarizes basic knowledge concerning the antimicrobial resistant bacteria, and describes how bacteria acquire skillfully and easily the resistance that are learned from examples of our studies.

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Original Articles
  • Shigehito Mori
    2016 Volume 4 Issue 1 Pages 14-19
    Published: January 20, 2016
    Released on J-STAGE: September 03, 2020
    JOURNAL FREE ACCESS

    In the Department of Otorhinolaryngology, infection control is difficult, because instruments, such as medical units and nebulizers, frequently exposed to the mucosa and mucus are commonly used without thorough disinfection in a large number of patients. However, there is little evidence regarding recent contamination of such instruments. In this study, we quantitatively evaluated bacterial contamination in the mucosa/mucus-exposed areas of such unit peripherals and electric auriscopes, at the external tube ends of nebulizers, in the operation areas of endoscopes, and on the surfaces of head mirrors worn by physicians.

    Only indigenous bacteria at a level lower than on general environmental surfaces were detected in the above areas, excluding the surfaces of head mirrors. No bacteria that may cause airway inflammation such as Streptococcus pneumoniae and Haemophillus influenzae were detected in any area.

    Based on this, the risk of pathogenic infection among patients may be low if the mucosa/mucus-exposed areas of instruments for common use are cleaned/disinfected using intermediate disinfection for individual patients.

    To prevent patient-to-patient infection and protect health care professionals against infection, further evidence should be accumulated, and appropriate guidelines for the prevention of infection must be established.

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  • Yoshihito Tanaka, So Watanabe, Hitome Kobayashi
    2016 Volume 4 Issue 1 Pages 20-23
    Published: January 20, 2016
    Released on J-STAGE: September 03, 2020
    JOURNAL FREE ACCESS

    We report two cases of herpes simplex pharyngitis which were difficult to treat. The patient in case 1 had deglutition difficulty from pharyngeal pain, and also developed pneumonia. Her pharyngitis was subsequently found to be caused by a complication of Behcet’s disease (BD). In case 2, long-term hospitalization was required because of short-term repetition of herpes simplex pharyngitis with meningitis and multiple mono neuropathy.

    In case 1, the patient did not have the herpes simplex virus (HSV) infection as a BD complication. Since neutrophil’s functional abnormality and Th1 cell dysfunction are thought to be the primary pathophysiological mechanism of BD, the worsening of BD might be caused by the patient’s physical constitution and additional stress, such as an HSV infection and pneumonia.

    Some studies have shown that herpes simplex oropharyngitis recurs in short periods with long-term hospitalization as in case 2. Specifically, it is reported that neurologic dysfunction is found in intractable and recurrent cases. There are several reports of herpes simplex encephalitis with herpes simplex pharyngitis but not about recrudesce of meningitis. Risk factors of intractable herpes simplex pharyngitis are; old age, extensive brain complications as observed by magnetic resonance imaging (MRI), and delays in taking antiviral drugs. In this case, old age and multiple mono neuropathy was thought to be risk factors for intractability.

    From these two cases, it is important to check the patients’ complications in treating intractable herpes simplex pharyngitis.

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  • Suguru Furukawa, So Watanabe, Hidenori Kanai, Hitome Kobayashi
    2016 Volume 4 Issue 1 Pages 24-27
    Published: January 20, 2016
    Released on J-STAGE: September 03, 2020
    JOURNAL FREE ACCESS

    Pericoronitis of wisdom tooth may sometimes occur severe inflammation or abscess of the adjacent tissues. We report a rare case of twenty-eight-year-old man diagnosed as infection of the right mandibular wisdom tooth followed by peritonsillar abscess. The patient was treated with dissection of the peritonsillar space and antibiotics administration. Although peritonsillar abscess is thought to occur secondary to peritonsillitis, there have been a few reports of this infection by dental clinics. We should be care of pericoronitis of wisdom tooth as a precursor of peritonsillar abscess.

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  • Masahiro Komori, Masamitsu Hyodo
    2016 Volume 4 Issue 1 Pages 28-34
    Published: January 20, 2016
    Released on J-STAGE: September 03, 2020
    JOURNAL FREE ACCESS

    Introduction: The relationships among the virulence of methicillin-resistant Staphylococcus aureus (MRSA) strains, their antibiotic susceptibility, and the presence of enterotoxin genes have been frequently discussed. The differences between hospital-associated (HA) and community-associated (CA) MRSA strains isolated from the otorrhea of patients with chronic otitis media (COM) were examined to determine which factors influence the prognosis of MRSA-associated COM.

    Materials and Methods: Our study included five strains of both clonal complex (CC) 5 HA-MRSA and CC 8 CA-MRSA as determined by phylogenetic analysis using multilocus sequence typing. The minimum inhibitory concentrations (MICs) of anti-MRSA antibiotics and the presence of toxigenic genes were investigated using the E-test® and Multiplex PCR, respectively. Antibiotic susceptibilities were obtained from chart reviews, and MIC antibiotic breakpoints were evaluated.

    Results: The MIC of vancomycin was >1.5 μg/ml in all strains. The MIC of linezolid was 0.5 to 0.75 μg/ml for the HA-MRSA strains and 2 to 6 μg/ml for the CA-MRSA strains. The MIC of clindamycin was 256 μg/ml for all HA-MRSA strains, 256 μg/ml for a single CA-MRSA strain, and 0.064 to 0.084 μg/ml for the remaining four CA-MRSA strains. The MIC of minocycline was 6 to 12 μg/ml in all HA-MRSA strains and 0.064 to 0.094 μg/ml in all CA-MRSA strains. There were no differences in the MIC of teicoplanin, daptomycin, sulfamethoxazole/trimethoprim, or rifampicin between the HA- and CA-MRSA strains.

    Five to 7 of a total 17 Staphylococcus aureus enterotoxin genes were identified in the HA-MRSA strains. The tsst-1 gene had a prevalence of 40% among the HA-MRSA strains. No toxigenic genes were identified in the CA-MRSA strains. The Panton-Valentine leukocidin gene was not identified in any strains.

    The following differences in antibiotic susceptibility between the HA- and CA-MRSA strains were identified: cefazolin (0% vs. 60%, respectively), flomoxef (60% vs. 100%), cefozopran (60% vs. 100%), meropenem (0% vs. 60%), clindamycin (0% vs. 80%), gentamycin (20% vs. 80%), minocycline (60% vs. 100%), and fosfomycin (20% vs. 100%).

    Conclusions: The MIC of vancomycin was high for both HA- and CA-MRSA strains, and the MIC of linezolid was higher in CA-MRSA strains. More toxigenic genes were identified in HA-MRSA strains than in CA-MRSA strains. In the clinical setting, antibiotic susceptibilities based on chart reviews may help to identify which course of treatment to pursue for different MRSA strains.

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  • Yuki Fujiwara, Hirotaka Hara, Kazuma Sugahara, Hironori Fujii, Yosuke ...
    2016 Volume 4 Issue 1 Pages 35-38
    Published: January 20, 2016
    Released on J-STAGE: September 03, 2020
    JOURNAL FREE ACCESS

    The Kawasaki disease is an acute febrile disease to appear most commonly on infants. The diagnostic criteria of the Kawasaki disease is based on clinical manifestations in the definitive diagnosis, therefore it is very difficult to diagnose in early period of onset. Especially, the findings of neck lymphadenopathy and low density area at the retropharyngeal space need to be differential diagnose in particular other infectious diseases. In this report, we present a case of the Kawasaki disease that needed to be differential diagnosed with peritonsillar abscess.

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  • Shohei Fujimoto, Yuko Kataoka, Shin Kariya, Akiko Sugaya, Kazunori Nis ...
    2016 Volume 4 Issue 1 Pages 39-42
    Published: January 20, 2016
    Released on J-STAGE: September 03, 2020
    JOURNAL FREE ACCESS

    Abstract: Shewanella is a gram-negative rod bacterium found particularly in the sea; it is widespread in freshwater, soil, and oilfields, but it is rarely separated from human infection. There are two types of Shewanella strain: S. algae and S. putrefaciens. Bacillemia, spondylodiscitis, meningitis, and brain abscess caused by these bacteria have been reported. We report a rare case of middle ear infection caused by S. putrefaciens after sea bathing. A 13-year-old boy was treated for otitis media since he was approximately 4-years-old. On June 15, 20XX, he swam in the sea, and a week later, he complained of pain in the left year; he then consulted a family doctor. He was treated with antimicrobial agents by both oral and intravenous infusion and also with left myringotomy twice, ventilation tube therapy, and ear drops of OFLX. However, his condition did not improve. We suggested the destruction of auditory ossicles using CT on July 30, 20XX. S. putrefaciens was detected from the bacterial culture examination of the left otorrhea. He was then referred to our hospital for surgery on August 5, 20XX. We suspected otogenic complications as the antimicrobial agents did not work and cholesteatoma because CT revealed shadows in the middle ear cavity. We then performed an emergency surgery on the same day and found that a granuloma filled the mastoid antrum and that cholesteatoma spread from the epitympanum through the mastoid antrum inlet. Post surgery, he was treated with CPFX by intravenous infusion for 8 days; his condition improved and he was discharged. These results suggest that cholesteatoma should be considered in patients with otitis media who show resistance to antimicrobial agents. Furthermore, surgery should be considered to investigate the CT or local findings.

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  • Satoru Kodama, Masashi Suzuki
    2016 Volume 4 Issue 1 Pages 43-47
    Published: January 20, 2016
    Released on J-STAGE: September 03, 2020
    JOURNAL FREE ACCESS

    Abstract: Primary ciliary dyskinesia (PCD) a rare disease with abnormalities of the ciliary structure and function, which causes impaired mucociliary clearance. Patients with PCD present with rhinosinusitis, otitis media with effusion, recurrent lower respiratory tract infections, and bronchiectasis. The diagnosis of PCD is sometimes difficult due to the absence of the specific clinical and laboratory signs. Herein, we described two cases of PCD, which clinically presented with refractory sinusitis to various antibiotics treatment. Our cases of PCD were treated by endoscopic sinus surgery (ESS). The diagnosis of PCD was confirmed by the demonstration of ciliary structure anomalies with electron microscopy. The incidence of lower respiratory infections decreased postoperatively. To date, fundamental treatment for PCD has not been established yet. Early diagnosis and appropriate management for lower respiratory infections are important to prevent irreversible lung damage and the progression of PCD.

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  • Ichiro Tojima, Ryoko Taniguchi, Takeshi Shimizu
    2016 Volume 4 Issue 1 Pages 48-53
    Published: January 20, 2016
    Released on J-STAGE: September 03, 2020
    JOURNAL FREE ACCESS

    We report four cases of pediatric orbital complications caused by acute rhinosinusitis in our hospital from January 2004 to December 2014. Clinical characteristics such as age, gender, affected sinus, pathogenic bacteria, eye symptoms, and hospital days were evaluated. Two cases were diagnosed as orbital cellulits, which were successfully treated with intravenous antibiotics. Remaining two cases were diagnosed as subperiosteal abscess of orbital cavity with external opthalmoplegia and no visual acuity. Subperiosteal abscesses were located in superior lesion and inferomedial lesion of orbital cavity, respectively. In both cases, conservative treatments including intravenous antibiotics successfully improved eye symptoms without surgical interventions.

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