Figure 1 - uploaded by John Molloy
Content may be subject to copyright.
CT Temporal bones showing an opacified mastoid system on the right side with some bony erosion present.
Source publication
Some members of the Non-Tuberculous Mycobacteria family are free living organisms in the environment. They may be pathogenic in the immunocomprimised or in chronic lung disease. We describe a case of a nine year old of Asian descent who presented with clinical mastoiditis where the pathogenic organism was Mycobacterium Gordonae. The decision was ma...
Similar publications
Three derivatives and one structural analogue of diospyrin were synthesized and investigated for their inhibitory activity against Mycobacterium tuberculosis employing the rapid radiometric method in vitro. A novel aminoacetate derivative was found to be more active than the parent compound, the MICs being 50 and 100 mg/L, respectively, for a drug-...
Citations
... Despite this, the incidence of such infections in humans appears to have increased during the study period from one described case in 1995 to 153 cases in 2006 [30] . In addition to immunocompromised patients, infection was also described in a child with mastoiditis who was successfully treated with RIF [31] . Also, other authors state that rifamycins, LZD, and fluoroquinolones are among the most effective antibiotics in the treatment of such infections [32] , which was not the case in our research. ...
Objectives:
Non-tuberculous mycobacteria are opportunistic pathogens that cause disease mainly in immunocompromised hosts. The present study assessed the prevalence of antibiotic resistance among such mycobacteria from domestic and wild animals in Croatia sampled during several years within a national surveillance program.
Methods:
A total of 44 isolates belonging to nine slow-growing species were genotyped and analyzed for susceptibility to 13 antimicrobials often used to treat non-tuberculous mycobacterial infections in humans.
Results:
Most prevalent resistance was to moxifloxacin (77.3%), doxycycline (76.9%) and rifampicin (76.9%), followed by ciprofloxacin (65.4%), trimethoprim-sulfamethoxazole (65.4%), and linezolid (61.4%). Few isolates were resistant to rifabutin (7.7%) or amikacin (6.8%). None of the isolates was resistant to clarithromycin. Nearly all isolates (86.4%) were resistant to multiple antibiotics.
Conclusions:
Our findings suggest substantial risk that human populations may experience zoonotic infections with non-tuberculous mycobacteria that will be difficult to treat using the current generation of antibiotics. Future work should clarify how resistance emerges in wild populations of non-tuberculous mycobacteria.
... Most of our patients presented with the characteristic signs of NTM otomastoiditis, including chronic otorrhea refractory to antibiotic treatment and granulation tissue in the middle ear. The absence of otalgia has been reported to be a typical symptom of NTM otomastoiditis [21,22]. However, otalgia was reported in 31.8% of our patients. ...
Background:
Nontuberculous mycobacteria (NTM) infection has attracted increasing attention in recent years; however NTM otomastoiditis is extremely rare. Surgery combined with antibiotic therapy is the current mainstay of treatment; however, the reported duration of medication still varies. This study aimed to analyze patients with NTM otomastoiditis and establish a more efficient treatment strategy.
Methods:
Medical records and temporal bone images of patients with NTM otomastoiditis were retrospectively analyzed. In addition, a comprehensive review of cases with NTM otomastoiditis in the literature was also performed.
Results:
Twenty-two patients were identified in our institution, and all of the patients had refractory otorrhea. The rates of granulation tissue, otalgia and facial palsy were 90.9%, 31.8% and 9.1%, respectively. Soft tissue attenuation via imaging studies was demonstrated in all of the middle ear cavities, with ossicular chain destruction in five cases. All of the patients received medical treatment, 20 (90.9%) received surgery, and four(18.2%) received revision surgery. The median time to cure was similar between the "prolonged-course" and "standard-course" antibiotic groups (3.0vs.3.3 months, p=0.807). However, the former had a longer median duration of antibiotic therapy (6.0vs.3.0 months, p=0.01). In the literature review, 54 (96.4%) patients received medical treatment, 51 (91.1%) received surgery, and 27 (48.2%) received revision surgery.
Conclusions:
NTM otomastoiditis should be suspected if a patient has chronic refractory otorrhea and ear granulation tissue. Surgery is the mainstay of treatment, and it should be complemented with antibiotics. In those without temporal bone osteomyelitis, antibiotic treatment can be stopped after achieving a dry ear.
... NTM osteomyelitis was rarely reported before the 1980s, but its prevalence seems to have increased recently, refl ected by case reports and large-scale clinical research. Many slow-growing NTM species have demonstrated the ability to cause NTM osteomyelitis, including M. avium-intracellulare complex (MAC) [3,8 -48], M. ulcerans [49 -51], M. marinum [52 -57], M. kansasii [9,33,36,58 -63], M. xenopi [64 -66], M. gordonae [67], M. haemophilium [33,68,69], M. scrofulaceum [45,70], M. szulgai [71 -74], M. longobardum [75], and M. fl avescens [76]. Among the rapidly growing mycobacteria, osteomyelitis can be caused by M. abscessus [3,77 -81], M. fortuitum [82 -94], M. chelonae [5,25,83,95 -104], M. smegmatis [105], M. peregrinum [82], and M. thermoresistibile [106]. ...
Osteomyelitis caused by nontuberculous mycobacteria (NTM) can have severe consequences and a poor prognosis. Physicians therefore need to be alert to this condition, especially in immunocompromised patients. Although the pathogenesis of NTM osteomyelitis is still unclear, studies in immunodeficient individuals have revealed close relationships between NTM osteomyelitis and defects associated with the interleukin-12-interferon-γ-tumor necrosis factor-α axis, as well as human immunodeficiency virus infection, various immunosuppressive conditions, and diabetes mellitus. Culture and species identification from tissue biopsies or surgical debridement tissue play crucial roles in diagnosing NTM osteomyelitis. Suitable imaging examinations are also important. Adequate surgical debridement and the choice of appropriate, combined antibiotics for long-term anti-mycobacterial chemotherapy, based on in vitro drug susceptibility tests, are the main therapies for these bone infections. Bacillus Calmette-Guerin vaccination might have limited prophylactic value. The use of multiple drugs and long duration of treatment mean that the therapeutic process needs to be monitored closely to detect potential side effects. Adequate duration of anti-mycobacterial chemotherapy together with regular monitoring with blood and imaging tests are key factors determining the recovery outcome in patients with NTM osteomyelitis.
Resumen
La mastoiditis es una osteítis bacteriana del peñasco que aparece como complicación de una otitis media aguda (OMA) en los lactantes y los niños pequeños. En los niños mayores, este cuadro puede revelar la presencia de un colesteatoma. Los principales microorganismos responsables son Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus y algunas bacterias anaerobias. Debido a su topografía, la infección puede difundirse hacia el exterior, causando un absceso subperióstico, o hacia el cuello, a lo largo del músculo esternocleidomastoideo. Las otras complicaciones extracraneales son la parálisis facial y la laberintitis aguda. La infección también puede difundirse a nivel intracraneal y causar una meningitis, un absceso intracraneal o una trombosis del seno lateral. Las pruebas de imagen permiten confirmar el diagnóstico, buscar una complicación intracraneal o signos sugestivos de un colesteatoma, así como guiar un posible tratamiento quirúrgico. El pronóstico suele ser favorable. El tratamiento consiste en un tratamiento antibiótico solo o asociado a la colocación de un drenaje transtimpánico, un drenaje del absceso subperióstico o una mastoidectomía. Desde hace varios años, la indicación quirúrgica es menos sistemática, pero esto sigue siendo motivo de discusión.
Riassunto
La mastoidite è un’osteite batterica della rocca, che complica l’otite media acuta (OMA) nel lattante o nel bambino piccolo. Nei bambini più grandi, può essere rivelatrice di un colesteatoma. I principali microrganismi causali sono Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus e alcuni batteri anaerobi. Data la sua topografia, l’infezione può diffondersi verso l’esterno, dando origine a un ascesso sottoperiosteo, oppure verso il collo lungo il muscolo sterno-cleido-mastoideo. Le altre complicanze extracraniche sono la paralisi facciale e la labirintite acuta. La diffusione dell’infezione può avvenire anche per via intracranica e portare a meningite, ascesso intracranico o trombosi del seno laterale. La diagnostica per immagini permette di confermare la diagnosi, di ricercare una complicanza intracranica o segni a favore di un colesteatoma e di guidare un eventuale trattamento chirurgico. La prognosi è generalmente favorevole. La gestione consiste in un trattamento antibiotico da solo o associato al posizionamento di un aeratore transtimpanico, al drenaggio dell’ascesso sottoperiosteo o alla mastoidectomia. Negli ultimi anni l’indicazione alla chirurgia è divenuta meno sistematica, ma resta oggetto di discussione.
Background:
Acute mastoiditis remains the commonest intratemporal complication of otitis media in the paediatric population. There has been a lack of consensus regarding the diagnosis and management of acute mastoiditis, resulting in considerable disparity in conservative and surgical management.
Objectives:
To review the current literature, proposing recommendations for the management of paediatric acute mastoiditis and appraising the treatment outcomes.
Method:
A systematic review was conducted using PubMed, Web of Science and Cochrane Library databases.
Results:
Twenty-one studies were included, with a total of 564 patients. Cure rates of medical treatment, conservative surgery and mastoidectomy were 95.9 per cent, 96.3 per cent and 89.1 per cent, respectively.
Conclusion:
Mastoidectomy may be the most definitive treatment available; however, reviewed data suggest that conservative treatment alone has high efficacy as first-line treatment in uncomplicated cases of acute mastoiditis, and conservative therapy may be an appropriate first-line management when treating acute mastoiditis.
La mastoiditis es una osteitis bacteriana del penasco. Las mastoiditis agudas simples, que complican una otitis media aguda, se observan esencialmente en los lactantes y los ninos pequenos, mientras que las mastoiditis secundarias a un colesteatoma se producen sobre todo en los ninos mayores. La exploracion fisica asociada a la otoscopia con un sistema de aumento permite en la mayoria de los casos establecer el diagnostico de mastoiditis aguda. La mayoria de los casos se deben a Streptococcus pneumoniae, pero otros microorganismos pueden causarla, como Streptococcus pyogenes, Staphylococcus aureus y bacterias anaerobias como Fusobacterium necrophorum. Las complicaciones pueden ser extracraneales: absceso subperiostico, absceso cervical, paralisis facial, laberintitis aguda, o intracraneales: trombosis del seno lateral, absceso intracraneal, meningitis. Las mastoiditis enmascaradas, con timpano normal, suelen manifestarse por estas complicaciones. Las mastoiditis subagudas se caracterizan por la persistencia de signos otoscopicos y de signos infecciosos, a pesar de una antibioticoterapia prolongada. La tomografia computarizada (TC) no permite diferenciar entre una mastoiditis, una otitis media aguda y una otitis serosa, pero es necesaria para buscar una complicacion intracraneal o signos sugestivos de un colesteatoma y para guiar una posible intervencion quirurgica. El pronostico global es bueno, siempre que se administre una antibioticoterapia adaptada al microorganismo responsable, completada con una mastoidectomia si fracasa el tratamiento medico, si se producen complicaciones o si existe un colesteatoma subyacente.
La mastoidite è un’osteite batterica della rocca che complica un’otite media acuta nel neonato e nel bambino piccolo. Nei bambini più grandi, può essere indicativa di colesteatoma. I principali organismi responsabili sono Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus e alcuni batteri anaerobi. Grazie alla sua topografia, l’infezione può diffondersi verso l’esterno, dando un ascesso sottoperiosteo, o verso il collo, lungo il muscolo sternocleidomastoideo. Altre complicanze extracraniche includono la paralisi facciale e la labirintite acuta. La diffusione dell’infezione può anche essere intracranica e produrre una meningite, un ascesso intracranico o una trombosi del seno laterale. Le tecniche di imaging permettono di confermare la diagnosi, di ricercare una complicanza intracranica o dei segni a favore di un colesteatoma e di guidare un eventuale intervento chirurgico. La prognosi è, di solito, favorevole. La gestione consiste nel trattamento antibiotico da solo o associato a un areatore transtimpanico, a un drenaggio dell’ascesso sottoperiosteo o a una mastoidectomia. Negli ultimi anni, l’indicazione alla chirurgia è diventata meno di routine ma rimane aperta al dibattito.
La mastoiditis es una osteítis bacteriana del peñasco que aparece como complicación de una otitis media aguda en los lactantes y los niños pequeños. En los niños mayores, este cuadro puede revelar la presencia de un colesteatoma. Los principales microorganismos responsables son Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus y algunas bacterias anaerobias. Debido a su topografía, la infección puede difundirse hacia el exterior, causando un absceso subperióstico, o hacia el cuello, a lo largo del músculo esternocleidomastoideo. Las otras complicaciones extracraneales son la parálisis facial y la laberintitis aguda. La infección también puede difundirse al nivel intracraneal y causar una meningitis, un absceso intracraneal o una trombosis del seno lateral. Las pruebas de imagen permiten confirmar el diagnóstico, buscar una complicación intracraneal o signos sugestivos de un colesteatoma, así como guiar un posible tratamiento quirúrgico. El pronóstico suele ser favorable. Las medidas terapéuticas consisten en un tratamiento antibiótico solo o asociado a la colocación de un drenaje transtimpánico, un drenaje del absceso subperióstico o una mastoidectomía. Desde hace varios años, la indicación quirúrgica es menos sistemática, pero esto sigue siendo motivo de debate.
To analyse the clinical presentation, treatment and outcome in patients diagnosed with otomastoiditis caused by non-tuberculous mycobacteria.
A retrospective case review of 16 patients diagnosed with otomastoiditis caused by non-tuberculous mycobacteria from 2000 to 2012 was conducted in a hospital and tertiary referral centre in Sweden. The main outcome measures were microbiology findings, and surgical and medical interventions and outcomes. In addition, the relevant literature was reviewed.
In three patients with otomastoiditis, the disease had spread intracranially. The bacteriological findings revealed Mycobacterium abscessus (n = 12), Mycobacterium fortuitum (n = 2) and Mycobacterium avium complex (n = 2). Surgical treatment was undertaken in all but three patients, including exploration of the temporal lobe in one patient. Systemic antibiotic treatment was given to all but one patient. Eight patients healed completely. Eight patients developed hearing loss. Two patients had relapse of the mycobacterial infection several months after the antibiotic treatment had been discontinued.
Non-tuberculous otomastoiditis is a severe ear disease with challenging considerations, and should be treated aggressively in order to avoid morbidity.
