Respiratory syncytial virus (RSV) is a major infectious agent causing serious respiratory tract inflammation in infants. However, an effective anti-viral therapy for RSV infection has not yet been developed. RSV upregulates the platelet-activating factor (PAF) receptor, which is a receptor for S. pneumoniae. Clarithromycin (CAM) and Fosfomycin (FOM) significantly suppress RSV-induced adhesion of S. pneumoniae on airway epithelium. Thus, these antibiotics might prevent secondary bacterial infections during RSV infection. In addition, several food materials have potent pharmacological effects on anti-viral infections. Therefore, we investigated the effects of curcumin and humulone on the replication of RSV. We found that curcumin and humulone prevented the expression of RSV/G-protein and formation of virus filaments in RSV-infected nasal epithelial cells. These findings suggest that curcumin and humulone have protective effects against the replication of RSV and that they are useful biological products for the prevention of and therapy for RSV infection.
Nebulizer therapy is still one of the essential treatments employed by ENT practitioners. However, evidence that supports the effectiveness of nebulizer therapy using antimicrobial agents has been considered insufficient. Even in the latest edition of Clinical Guideline for Acute Rhinosinusitis (2010), the recommendation level for nebulizer therapy is “C1”. In our clinic, since we opened in 1994, we have basically stated important factors for nebulizer therapy as follows: (1) It shall not harm patients, (2) it shall be used as effectively as possible, and (3) its procedure shall be simple. As a result of paying attention to these factors, nebulizers used in our clinic have undergone changes over the years. Since 2003, we have mainly used small ultrasonic nebulizers for individual use with consideration of their effectiveness and safety.
Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. This disease mainly affects the mucosa of the nose and nasopharynx. It is endemic in southern India and Sri Lanka, but it is extremely rare in Japan.
We report the fourth case of rhinosporidiosis in Japan. A 35-year-old male from Bangladesh visited our outpatient clinic complaining of throat pain which had persisted for a month. A polypoid mass with white dots was found at the eustachian tuber on the right side of the nasopharynx. Biopsy was performed and a diagnosis of rhinosporidiosis was confirmed by pathological examination. The mass was removed under local anesthesia by bipolar cauterization of the base using a rigid nasal endoscope. There was no recurrence during the follow-up period.
We report a case of invasive aspergillosis which spread from the sphenoid sinus to the pterygopalatine fossa and orbital cavity. A 78-year-old man with diabetes and angina pectoris was admitted to the Cardiovascular Department of Shiga University of Medical Science Hospital for a cardiac catheter test. Because the patient had left temporal pain a month prior to admission, he underwent computed tomography (CT). There was an abnormal shadow on his bilateral sphenoid sinus and a bone defect of the left medial orbital wall. After visiting our department, he started to receive treatment for sphenoid sinusitis with Voriconazole (VRCZ) and Meropenem (MEPM). However, he had no light perception in his left eye, so we performed endoscopic sinus surgery (ESS) on day five. We found a fungus ball in his left sphenoid sinus and a bone defect of the left medial orbital wall. We made a diagnosis of invasive aspergillosis based on the pathological findings of Aspergillus. Although he received intensive antifungal drug therapy, ESS twice, and left orbital exenteration, he died about five months after admission.
There were sixty-nine cases of invasive sphenoid fungal sinusitis from 1988 to 2012 in Japan. Including our case, we analyzed seventy cases. The mortality was 45.7%, but was 22.7% in cases where VRCZ was administered. The most frequent organism was Aspergillus. The average period from symptom awareness to definite diagnosis was 4.2 months. However, the average was 7 months in cases where the patient died. The diagnosis of invasive fungal sinusitis of the sphenoid sinus is very difficult because of poor nasal symptoms and varied imaging findings. Furthermore, the sphenoid sinus is located near the optic canal, orbital cavity, cavernous sinus, and brain, so invasive fungal sinusitis can easily lead to severe complications, such as invasion of surrounding tissue, and frequently results in a lethal outcome. If there is a localized shadow on the sphenoid sinus, the possibility of invasive fungal sinusitis should be considered.
This study aimed to evaluate the efficacy of TBPM-PI in children with refractory otitis media. Sixteen cases of acute otitis media in childhood which were resistant to prior therapy were evaluated. Symptom scores (ear pain, high fever, displeasure) and tympanic membrane scores (rubefaction, swelling, discharge) were evaluated before and after treatment with antimicrobial agents. The cure rate was 87.5%. In addition, TBPM-PI showed favorable antibacterial activities against the isolated pathogens. The results suggest that TBPM-PI is a useful antibiotic in cases of pediatric refractory otitis media.
Mucositis and dysphagia are common complications of chemoradiotherapy (CRT) for head and neck cancer. The importance of oral care, which is one form of supportive care for head and neck cancer patients, has been pointed out. In this study, we examined the effect of oral care on head and neck cancer patients treated with CRT. We investigated 34 patients, all of whom agreed to the purpose of this study, with head and neck cancer treated with CRT between August 2012 and March 2013. The patients included 29 males and 5 females. The average age of all patients was 67.4 years. We counted the total amount of intraoral bacteria over time, and found that oral care not only inhibited intraoral bacterial growth but also decreased the amount of bacteria. Patients with a lot of intraoral bacteria were unable to maintain intraoral moisture by oral self-care, and could not manage the pain of oral mucositis. The management of the amount of intraoral bacteria by oral care tended to reduce the symptoms of oral mucositis.
We report here a case of rhinogenic intracranial complications associated with influenza. A 14-year-old patient visited the Department of Pediatrics at our hospital with a 38-degree fever and joint pain. He was diagnosed with influenza A and prescribed antivirals; however, five days later, vomiting and left upper limb paralysis occurred, and the patient was emergency transported to our hospital. Cranial magnetic resonance imaging (MRI) was conducted, and a signal was detected in the right frontal cortex on FLAIR imaging. The patient was subsequently diagnosed with influenza encephalopathy and prescribed Peramivir, Edaravone, and Glycerol, and received a combination of steroid pulse therapy and antibiotics. Although his fever had dropped by the next day, his neurological symptoms worsened. The patient was therefore transferred to our hospital’s pediatric department the following day. Based on computed tomography and MRI findings, he was diagnosed with right acute sinusitis and multiple subdural abscess. The multiple nature of his lesions rendered drainage difficult, and so the patient was administered an antibiotic treatment regimen instead. The paranasal sinus was first cleaned via endoscopic sinus surgery under general anesthesia, during which outflow of yellow pus was observed at the opening of the frontal sinus. The nasofrontal fossa was widely opened, and the sinus was washed. Approximately one month after surgery, subdural abscesses had disappeared from imaging findings. The patient was discharged from the hospital two months after surgery. At discharge, relatively high brain dysfunction was observed. In cases with rhinogenic intracranial complications, endoscopic sinus surgery is believed to be minimally invasive. Therefore, performing early surgery and controlling infection sources are important.
Descending necrotizing mediastinitis (DNM), which is caused by a downward spread of a deep neck infection, is a rare complication that can be secondary to peritonsillar abscess or dental infection. Between January 2006 and April 2013, we treated 7 cases of descending necrotizing mediastinitis in our department and in the general intensive care unit at our hospital. Four cases of DNM arose from the inferior pole of a peritonsillar abscess, two cases from the superior pole of a peritonsillar abscess, and one case from a retropharyngeal abscess. Usually peritonsillar abscess occurs in the superior pole of the tonsil. However, in our series of DNM patients, inferior pole peritonsillar abscess was the most common underlying cause. This may be explained by the fact that the diagnosis can be relatively delayed and a lower abscess of the tonsil can easily reach the mediastinum due to gravity. One patient died of sepsis and the other 6 patients are surviving without complications.
It is essential for patient survival to perform aggressive surgical neck drainage.
According to data of the Health, Labor and Welfare Ministry, ear tuberculosis constituted 0.09% (21 cases) of all newly diagnosed tuberculosis patients in Japan in 2011. Only 3 cases of pediatric (0 to 14 years old) ear tuberculosis have been registered over the last decade. We present a case of a 7-year-old boy presented with unilateral aural discharge who was initially diagnosed with acute otitis media. He developed a paradoxical reaction of cervical lymph node swelling after 6 months of anti-tuberculosis treatment.
We should take into account the possibility of tuberculosis as a differential diagnosis of intractable otitis media. It is also important for clinicians to recognize paradoxical reactions during anti-tuberculosis treatment.
We report a rare case of tuberculous otitis media that was difficult to diagnose. The patient was a 24-year-old Chinese woman working at a factory in Japan. Her chief complaint was left hearing loss and otorrhea. She had no family or past history of tuberculosis (TB) infection. She became aware of the hearing loss about three months previous, and was diagnosed with left acute otitis media at a nearby ENT clinic the following month. After tympanostomy, her condition temporarily improved. However, the symptoms gradually worsened and she was admitted to the ENT department of the General Hospital. She received antibiotic treatment (FMOX · GRNX) and was put on a steroid tapering schedule. She was referred to our hospital because of recurrence of otorrhea about 2 weeks later. On admission, the perforation of the tympanic membrane was located in the anterior quadrant, and ear discharge was transparent. The bacteriological examination, acid-fast stain test, and TB-PCR for otorrhea were negative. The chest X-p was normal, and a temporal bone CT scan revealed fluid density in her middle ear and mastoid. Her laboratory findings were normal. She was treated with antibiotic medication (ABPC / SBT) and ear irrigation. The otorrhea subsided in 2 weeks. After 12 days from discharge, we received a report that M. tuberculosis was detected in the culture results of the ear discharge on admission.
Tuberculous otitis media is difficult to diagnose in the early stages, and TB may not be detected by the PCR method if there is a small amount of M. tuberculosis. Moreover, the use of fluoroquinolones delays the diagnosis of TB. However, fluoroquinolones are used frequently in the treatment of otitis media. When we encounter refractory otitis media in everyday practice, we should keep in mind the possibility of tuberculous otitis media.