ro13-9904 and Sinusitis

Streptococcus pneumoniae endocarditis is most commonly associated with pneumonia. It is relatively uncommon disease but its severity makes it clinically relevant. We present a case and review of sinusitis complicated by both pneumococcal endocarditis and cavernous sinus thrombosis. Both endocarditis and dural sinus thrombosis are known complications of facial infections. To our knowledge, this is the first reported case of both S. pneumoniae endocarditis and dural sinus thrombosis complicating sinusitis. A case report and review of the literature is presented.

Topics: Adult; Cavernous Sinus Thrombosis; Ceftriaxone; Endocarditis, Bacterial; Humans; Male; Pneumococcal Infections; Sinusitis

Periorbital cellulitis is a potential sight-threatening complication of sinusitis. The majority of patients improve with medical management. Previous studies have suggested significant variations in practice and lack of evidence regarding the optimal management of this condition.. A prospective study was conducted over a 12-month period at 8 centers in the United Kingdom assessing the management of patients requiring inpatient treatment for periorbital cellulitis secondary to sinonasal infections.. A total of 143 patients were recruited, of whom 40 were excluded. Of the remaining 103 patients, 5 (4.9%) were diagnosed with neurosurgical complications. This resulted in 98 patients admitted with periorbital cellulitis secondary to an upper respiratory tract infection/sinusitis. A total of 72 were children, of whom 12 (16.7%) required surgical intervention; and of 26 adults, 5 (19.2%) required surgery: the most common antimicrobial regimes administered were intravenous ceftriaxone (with or without metronidazole), and co-amoxiclav. The use of both ceftriaxone and metronidazole from admission was associated with the shortest duration of inpatient stay (3.8 days) in comparison to ceftriaxone alone (5.8 days) or co-amoxiclav (4.5 days) and a reduction in number of patients requiring surgical intervention. There was also an association between the early use of intranasal decongestants and steroids and reduction in requirement for surgical intervention.. For a condition where swab and blood cultures are often negative, this study supports the use of ceftriaxone in combination with metronidazole. The administration of intranasal decongestants and corticosteroids correlated with a smaller percentage of those progressing to surgery in those with and without periorbital abscesses.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cellulitis; Child; Drug Therapy, Combination; Humans; Length of Stay; Metronidazole; Nasal Decongestants; Practice Patterns, Physicians'; Prospective Studies; Respiratory Tract Infections; Sinusitis; Steroids; United Kingdom

After an intravenous drip infusion of 1 g or 2 g of ceftriaxone (CTRX), its concentrations in serum and tissue were determined using the bioassay for 18 surgical patients with chronic paranasal sinusitis. 1. The serum levels observed at 75-105, 135-165, 195-225 minutes after an intravenous drip infusion of 1 g, averaged 98 +/- 38, 92 +/- 13 and 73 +/- 13 micrograms/ml, respectively. 2. The tissue levels at 75-105, 135-165, 195-225 minutes after an intravenous drip infusion of 1 g, averaged 27 +/- 13, 27 +/- 7 and 25 +/- 9 micrograms/g. 3. CTRX appears to be a useful drug for the treatment of chronic paranasal sinusitis.

Topics: Adult; Aged; Ceftriaxone; Chronic Disease; Female; Humans; Male; Middle Aged; Sinusitis

Rhinosinusitis-induced brain abscesses are rare but can result in devastating long-term sequalae and mortality; they require a high index of suspicion with early imaging to start early empiric parenteral antibiotic treatment covering aerobes and anaerobes.. Our study was a retrospective analysis on 32 patients who were treated at Oxford University Hospitals for rhinosinusitis-induced brain abscess between February 2013 and June 2020.. Mean age of presentation was 45.83 for adults and 11.14 for children. Subdural collection was the most frequent abscess but 25% of patients had multiple sites of collection; the majority were in the frontal lobe. The most commonly identified pathogens were Streptococcus milleri group and Staphylococcus aureus; 93.75% of the patients were treated with combined Ceftriaxone and Metronidazole for an average of 8 weeks.. In our series most patients received also a prompt and aggressive surgical treatment with combined neurosurgical and ENT procedures in the majority; this was especially important in case of subdural empyema, Streptococcus milleri infection and direct intracranial spread of infection. More than half of the patients were treated with a single surgical procedure. Despite aggressive treatment, one third of patients experienced long-term neurological sequelae; there were no deaths.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Child; Humans; Metronidazole; Retrospective Studies; Review Literature as Topic; Sinusitis; Streptococcal Infections

We present a novel treatment with the use of intraventricular antibiotics delivered through a ventriculostomy in a patient who developed septic cavernous sinus thrombosis after sinus surgery. A 65-year-old woman presented with acute on chronic sinusitis. The patient underwent a diagnostic left maxillary antrostomy, ethmoidectomy, sphenoidotomy and sinusotomy. Postoperatively, the patient experienced altered mental status with episodic fever despite treatment with broad-spectrum antimicrobial therapy. MRI of the brain showed extensive meningeal enhancement with the involvement of the right trigeminal and abducens nerve along with thick enhancement along the right pons and midbrain. MR arteriogram revealed a large filling defect within the cavernous sinus. Intraventricular gentamicin was administered via external ventricular drain (ie, ventriculostomy) every 24 hours for 14 days with continued treatment of intravenous ceftriaxone and metronidazole. The patient improved with complete resolution of her cavernous sinus meningitis on repeat brain imaging at 6 months posthospitalisation.

Topics: Administration, Intravenous; Aftercare; Aged; Angiography; Anti-Bacterial Agents; Cavernous Sinus; Cavernous Sinus Thrombosis; Ceftriaxone; Female; Gentamicins; Humans; Injections, Intraventricular; Magnetic Resonance Imaging; Meningitis; Metronidazole; Sinusitis; Treatment Outcome; Ventriculostomy

Topics: Anti-Infective Agents; Ceftriaxone; Endoscopy; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Middle Aged; Pott Puffy Tumor; Sinusitis; Streptococcal Infections; Streptococcus anginosus; Tomography, X-Ray Computed

Topics: Academies and Institutes; Acute Disease; Adolescent; Amoxicillin; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Clavulanic Acid; Humans; Infant; Pediatrics; Sinusitis

Spondylodiscitis, which is most commonly caused by Staphylococcus aureus, is an uncommon infection in adults. The diagnosis of spondylodiscitis is often delayed by its vague and non-specific presentations. As part of the normal flora in human mouth and sinuses, Streptococcus mitis is a very rare cause of spondylodiscitis. We report a case of thoracic spondylodiscitis caused by S. mitis in a patient with chronic sinusitis. The patient atypically presented with a sharp chest pain that radiated to the back and the imaging studies were initially negative. He failed outpatient pain management and the diagnosis of spondylodiscitis was confirmed by bone biopsy 6 weeks later. Treatment with antibiotics completely alleviated the pain. Increased awareness and a high index of suspicion are essential for early diagnosis of spondylodiscitis with an atypical presentation.

Topics: Anti-Bacterial Agents; Biopsy, Needle; Ceftriaxone; Chest Pain; Chronic Disease; Diagnosis, Differential; Discitis; Emergency Service, Hospital; Humans; Immunohistochemistry; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Middle Aged; Pain Measurement; Severity of Illness Index; Sinusitis; Streptococcal Infections; Streptococcus mitis; Thoracic Vertebrae; Treatment Outcome; Vancomycin

We report a case of a 5-year-old boy with acute disseminated encephalomyelitis as the initial presentation of neuroborreliosis. Parents report an upper-airway infection a few days before the development of acute encephalopathy, mild facial palsy, and seizures. The patient needed mechanical ventilation for 10 days, and after extubation, he presented hypotonia, ataxia, dysarthria, as well as weak gag and cough reflexes. Brain magnetic resonance imaging showed hyperintense lesions on T2- and fluid-attenuated inversion recovery sequences on the right subcortical occipital and parietal region, left posterior arm of the internal capsule, and in the medulla oblongata. Borrelia burgdorferi was identified in the plasma and cerebrospinal fluid by polymerase chain reaction and in the plasma by Western blotting. He was treated with ceftriaxone, methylprednisolone, and human immunoglobulin. Recovery was partial.

Topics: Brain Damage, Chronic; Cefotaxime; Ceftriaxone; Child, Preschool; Coma; Diazepam; Encephalomyelitis, Acute Disseminated; Facial Paralysis; Humans; Immunoglobulins, Intravenous; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Male; Mastoiditis; Methylprednisolone; Portugal; Respiration, Artificial; Respiratory Insufficiency; Respiratory Tract Infections; Seizures; Sinusitis; Vancomycin

Sinusitis can rarely be latent and present directly with intracranial complications. We present the case of an 11-year-old girl who presented with typical features of meningitis. She underwent neuroimaging because of slow improvement and concern for a brain abscess. Despite no history or examination findings suggestive of sinusitis, she was found to have pansinusitis with intracranial extension causing meningitis and epidural abscess.

Topics: Bacteroidaceae Infections; Cefotaxime; Ceftriaxone; Child; Combined Modality Therapy; Consciousness Disorders; Diagnostic Imaging; Drug Therapy, Combination; Eikenella; Emergencies; Endoscopy; Epidural Abscess; Female; Fusobacterium Infections; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Meningitis, Bacterial; Metronidazole; Otorhinolaryngologic Surgical Procedures; Peptostreptococcus; Prevotella intermedia; Sinusitis; Staphylococcal Infections; Vancomycin

Orbital cellulitis is a rare complication of strabismus surgery. We report a case of a 4-year-old boy with bilateral orbital cellulitis after uneventful surgery to correct esotropia. Concomitant sinusitis was the likely source of infection. To our knowledge, this is the first case of bilateral orbital cellulitis following strabismus surgery.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Humans; Male; Orbital Cellulitis; Postoperative Complications; Sinusitis; Strabismus; Streptococcal Infections; Streptococcus pyogenes; Tomography, X-Ray Computed

The purpose of this study was to develop a rabbit model of rhinogenic chronic rhinosinusitis (CRS).. New Zealand white rabbits were used and divided into two groups. In group A rabbits, a piece of Merocel (Medtronic-Xomed, Jacksonville, FL) was inserted into one nasal cavity and the other was left undisturbed as control. In group B rabbits, 1 microg phorbol 12-myristate 13-acetate (PMA) was injected into bilateral nasal lateral walls and then a piece of Merocel (Medtronic-Xomed) was inserted into one nasal cavity. At week 2, the Merocel (Medtronic-Xomed) was removed, and computed tomography (CT), nasoendoscopy, and cultures were performed. All examinations were repeated at week 12. Rabbits that had purulent discharge in nasal cavities and sinuses opacification shown in CT scans were diagnosed as having rhinosinusitis. Rabbits with CRS were randomly allocated to receive intravenous ceftriaxone (50 mg/kg/day) for 28 days or nothing. All rabbits with CRS received CT scans, nasoendoscopy, and cultures at week 16.. At week 12, CRS had developed in two controlled nasal cavities, six nasal cavities inserted with Merocel (Medtronic-Xomed), six nasal cavities injected with phorbol 12-myristate 13-acetate (PMA), and seven both PMA-injected and Merocel- (Medtronic-Xomed) inserted nasal cavities. Seven of nine treated CRS sides were clear of opacification after treatment. All non-treated CRS sides had persistent diseases at week 16. There was a significant difference in the CRS incidence (P = .00043) and culture rates (P = .027) between treated and non-treated CRS nasal cavities.. Our study developed a rabbit model of rhinogenic CRS. This model is easily performed and is reversible by treatment.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Chronic Disease; Disease Models, Animal; Endoscopy; Female; Male; Nasal Cavity; Nasal Mucosa; Rabbits; Random Allocation; Sinusitis; Surgical Sponges; Tetradecanoylphorbol Acetate; Tomography, X-Ray Computed

Topics: Adult; Agricultural Workers' Diseases; Bacteremia; Ceftriaxone; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Sinusitis; Streptococcal Infections; Streptococcus equi; Tomography, X-Ray Computed; Virulence

A review of suppurative intracranial complications of sinusitis in children.. Case series review over a two-year period from 1998 to 1999 in a children's hospital, Singapore.. There were seven cases, all male, and age range 9 to 14. Six had subdural empyemas and one had meningitis. The most common presenting symptoms included fever, headache and vomiting. Sinusitis was suspected as the cause in only one patient initially. The intracranial infections were not apparent from the initial brain CT of two patients and were only confirmed later on repeated imaging. Four patients had lumbar punctures without any adverse effects. All seven children had infections involving the frontal, ethmoid and maxillary sinuses and two also had sphenoid involvements. All were treated with high-dose intravenous antibiotics together with drainage of both the intracranial (n=six) and sinus (n=seven) suppurations. Five needed repeated intracranial drainages. Streptococcus species were isolated in five cases. Three patients developed seizures post-operatively which resolved on follow-up. One patient needed a ventriculo-peritoneal shunt for hydrocephalus. All patients had a good Glasgow Outcome Score. The hospital stay ranged from 30 to 89 days with a median of 43 days.. Only males were identified in this review, collaborating the feeling that teenage males are at greatest risk of developing intracranial infections from sinusitis. We recommend that radiologic imaging of the brain for suspected intracranial infection should always include the sinuses as this aids early identification of actual cause. Initial CT imaging may be negative and hence repeated scans are warranted if the index of suspicion is high. The successful outcome of the children in this series supports the opinion that combined aggressive surgical and medical treatment is preferable in this patient population.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Empyema, Subdural; Humans; Male; Meningitis; Metronidazole; Penicillins; Radiography; Retrospective Studies; Sinusitis; Streptococcal Infections; Streptococcus; Treatment Outcome

The case of a 72-year-old woman suffering from chronic otitis media is presented. This insulin dependent diabetic patient was under steroid therapy for collagenosis and suffered from chronic polysinusitis. After two preceding drainages of the mastoid (antrotomy and mastoidectomy), the patient developed putrid mastoiditis followed by Bezold's abscess, an epidural abscess and thrombosis of the sigmoid sinus. Lateral petrosectomy and drainage of the neck were performed, but the patient again developed an abscess with extension to the lateral skull base, the foramen magnum and the upper cervical spine. After a further operation with extensive drainage and a three-month course of antibiotic treatment with ceftriaxon, the infection finally healed. A germ of the Streptococcus milleri group was identified.

Topics: Aged; Ceftriaxone; Cephalosporins; Chronic Disease; Diabetes Mellitus, Type 1; Epidural Abscess; Female; Humans; Mastoiditis; Neck; Otitis Media; Sinusitis; Skull Base; Streptococcal Infections

Topics: Adolescent; Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Ceftriaxone; Cephalosporins; Clavulanic Acid; Drug Therapy, Combination; Expectorants; Female; Humans; Male; Methylprednisolone; Metronidazole; Middle Aged; Penicillins; Primary Health Care; Sinusitis; Time Factors; Vasoconstrictor Agents

The microbiology of 87 patients admitted to hospital, over a five-year period, with acute sinusitis was retrospectively analysed. Sixty-three patients had one or more of an orbital, intracranial, soft tissue or bony complication. Eighty-four patients had maxillary sinus washouts, while 48 required a surgical procedure to their sinuses, and 33, drainage of an empyema. Streptococcus milleri and Haemophilus influenzae were the commonest organisms isolated from sinus aspirates (44 per cent), with a noticeable absence of Streptococcus pneumoniae (10 per cent). Organisms cultured from intracranial, soft tissue or orbitral empyemas were predominantly Streptococcus milleri (50 per cent) and Staphylococcus aureus (25 per cent) with an absence of Haemophilus influenzae (four per cent) and Streptococcus pneumoniae (four per cent). Ampicillin is an appropriate first line antimicrobial agent in patients with acute complicated sinusitis with the addition of cloxacillin in cases with an empyema. Chloramphenicol or ceftriaxone is used in cases with an intracranial complication.

Topics: Acute Disease; Adolescent; Adult; Aged; Ampicillin; Ceftriaxone; Child; Chloramphenicol; Cloxacillin; Developing Countries; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Retrospective Studies; Sinusitis; South Africa

Children with community-acquired serious otolaryngologic infections are conventionally hospitalized for parenteral antibiotic therapy. However, effective and safe outpatient therapy is desirable since it is less traumatic and less costly. During a 24-month period outpatient parenteral antibiotic therapy, usually once daily i.m. ceftriaxone, was evaluated in 41 children with serious otolaryngologic infections (acute mastoiditis, complicated otitis media, severe external otitis and severe sinusitis with orbital or periorbital involvement). Daily visits and compliant capable parents were considered essential for outpatient management. Diagnosis, plan for management and daily follow-up evaluations were carried out in cooperation by otolaryngology and infectious disease specialists. Nineteen children (45%) were treated initially in the hospital and 22 children (55%) were treated entirely as outpatients. The mean duration of outpatient treatment, using once daily i.m. ceftriaxone was 5.7 days (range 1-13). The overall clinical cure rate was 98% and no serious side effects were observed. One case of sinusitis-orbital cellulitis relapsed during therapy. Most patients and parents returned to normal life activities within 72 h from starting outpatient therapy. Our data suggest that many children with serious otolaryngologic infections can be managed successfully and safely as outpatients by a combined team of otolaryngology and infectious disease specialists.

Topics: Acute Disease; Ambulatory Care; Bacterial Infections; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Injections, Intramuscular; Otitis; Sinusitis