A case of life-threatening laryngo-epiglottitis is reported, caused by ampicillin-resistant Haemophilus paraphrophilus. Clinicians and microbiologists should be aware of a beta-lactamase-mediated resistance among Haemophilus species other than H. influenzae. (+info)
Isolation rates of Streptococcus pyogenes in patients with acute pharyngotonsillitis and among healthy school children in Iran.
We examined three populations from the Tehran region and the North part of Iran (Gilan), in all more than 5000 individuals, for carriage of Streptococcus pyogenes (group A streptococci; GAS). Children or adults with acute pharyngotonsillitis and healthy school children harboured GAS in 34-1, 20.0 and 21.0%, respectively. Typing of 421 randomly selected isolates showed a predominance of M-types M4, M5, M11, M12, as well as the provisional type 4245; however, many of the isolates were T and M non-typable. Forty-three percent of all strains were opacity factor (OF) negative. The type distribution differed markedly from that reported in 1973-4, when M types 1 and 12 were predominant. (+info)
Analysis of Moraxella catarrhalis by DNA typing: evidence for a distinct subpopulation associated with virulence traits.
Two DNA typing methods, probe-generated restriction fragment length polymorphism analysis and single-adapter amplified fragment length polymorphism analysis, were used to study the genetic relationships among 90 Moraxella catarrhalis strains. Both methods were found to be highly concordant, generating a dendrogram with 2 main branches. The division of the M. catarrhalis population into 2 subspecies was supported by analysis of the 16S rRNA sequences. Both beta-lactamase-positive and beta-lactamase-negative strains were found in all main branches, suggesting horizontal transfer of the beta-lactamase gene. In contrast, 2 virulence traits, complement resistance and adherence to epithelial cells, were strongly associated with 1 of the 2 subspecies. The branch depth suggested that complement-resistant adherent strains diverged from a common ancestor more recently than did complement-sensitive nonadherent strains. These findings suggest the existence of subpopulations of M. catarrhalis that differ in virulence, and they may have implications for vaccine development. (+info)
Cough threshold in reflux oesophagitis: influence of acid and of laryngeal and oesophageal damage.
BACKGROUND: Gastro-oesophageal reflux is often associated with cough. Patients with reflux show an enhanced tussive response to bronchial irritants, even in the absence of respiratory symptoms. AIM: To investigate the effect of mucosal damage (either oesophageal or laryngeal) and of oesophageal acid flooding on cough threshold in reflux patients. PATIENTS: We studied 21 patients with reflux oesophagitis and digestive symptoms. Respiratory diseases, smoking, and use of drugs influencing cough were considered exclusion criteria. METHODS: Patients underwent pH monitoring, manometry, digestive endoscopy, laryngoscopy, and methacholine challenge. We evaluated the cough response to inhaled capsaicin (expressed as PD5, the dose producing five coughs) before therapy, after five days of omeprazole therapy, and when oesophageal and laryngeal damage had healed. RESULTS: In all patients spirometry and methacholine challenge were normal. Thirteen patients had posterior laryngitis and eight complained of coughing. Twenty patients showed an enhanced cough response (basal PD5 0.92 (0.47) nM; mean (SEM)) which improved after five and 60 days (2.87 (0.82) and 5.88 (0.85) nM; p<0.0001). The severity of oesophagitis did not influence PD5 variation. On the contrary, the response to treatment was significantly different in patients with and without laryngitis (p = 0.038). In patients with no laryngitis, the cough threshold improved after five days with no further change thereafter. In patients with laryngitis, the cough threshold improved after five days and improved further after 60 days. Proximal and distal oesophageal acid exposure did not influence PD5. Heartburn disappeared during the first five days but the decrease in cough and throat clearing were slower. CONCLUSIONS: Patients with reflux oesophagitis have a decreased cough threshold. This is related to both laryngeal inflammation and acid flooding of the oesophagus but not to the severity of oesophagitis. Omeprazole improves not only respiratory and gastro-oesophageal symptoms but also the cough threshold. (+info)
99mTc-sulfur colloid gastroesophageal scintigraphy with late lung imaging to evaluate patients with posterior laryngitis.
The aim of this study was to use gastroesophageal and pulmonary scintigraphy to evaluate the prevalence of gastroesophageal reflux and airway involvement among patients with posterior laryngitis. METHODS: The study included a total of 201 patients (131 females, 70 males; age range, 15-77 y; mean age +/- SD, 49 +/- 16 y). All patients had posterior laryngitis documented by laryngoscopy and symptoms such as a dry cough, painful swallowing, and hoarseness. A control population of 20 healthy volunteers (13 females, 7 males; age range, 19-74 y; mean age, 53 +/- 13 y) was also evaluated. After a 12-h fast, all subjects underwent gastroesophageal scintigraphy through administration of 300 mL orange juice labeled with 185 MBq 99mTc-sulfur colloid. After 18 h, planar anteroposterior thoracic images were acquired with the subjects supine. RESULTS: Sixty-seven percent of patients (134/201) had scans positive for gastroesophageal reflux; of these, 30 (22%) had distal reflux and 104 (78%) had proximal reflux. In addition, the scans of 31 patients were positive for proximal reflux-associated pulmonary uptake. The frequency, duration, and degree of reflux episodes were significantly greater in patients with proximal reflux than in patients with distal reflux (P < 0.001). The 67 patients in whom reflux was not detected had diseases or reflux-associated cofactors that could account for laryngeal symptoms. No statistically significant difference in symptoms or esophageal motility parameters could be identified among the patient groups, but patients with proximal reflux had significantly prolonged gastric emptying times compared with healthy volunteers. CONCLUSION: Most patients with posterior laryngitis had detectable proximal gastroesophageal reflux. Exposure of the proximal part of the esophagus to acid, by setting the stage for microaspiration of gastric material into the larynx, remains a major cause of damage to the laryngeal mucosa. Slowed gastric emptying may be a predisposing factor. Moreover, symptoms such as a dry cough, painful swallowing, or hoarseness may not be reliable predictors of the presence of gastroesophageal reflux or of associated airway involvement. (+info)
Maximizing outcome of extraesophageal reflux disease.
Gastroesophageal reflux disease (GERD) accompanied by regurgitation and aspiration has been suggested as the cause of many conditions, but the strongest evidence exists for a relationship between asthma and GERD and posterior laryngitis and GERD. The exact mechanism of the tracheopulmonary damage has not been determined, but studies show that proton pump inhibitor therapy can ameliorate to some extent the laryngeal symptoms in laryngitis as well as asthma symptoms, asthma medication use, and lung function. Antireflux surgery appears to be more effective than antireflux medication in asthma patients with GERD symptoms. The role of tracheopulmonary damage in patients with chest pain is less clear, and the difficulty lies in determining which patients have gastroesophageal etiology. (+info)
Detection of Chlamydia pneumonia DNA in nasopharyngolaryngeal swab samples from patients with rhinitis and pharyngolaryngitis with polymerase chain reaction.
OBJECTIVE: To assess the prevalence of Chlamydia pneumomia DNA in patients with otolaryngic disease. METHODS: PCR assay was used to detect Chlamydia pneumonia specific Pst I 474 fragment DNA in swabs from patients with acute or subacute pharyngolaryngitis or rhinitis and sinusitis. C. pneumonia specific antibodies in sera were also assayed with microimmuno-fluoresence (MIF). RESULTS: About 28% (49/175) of the patients were PCR positive and 25.7% (45/175) were MIF antibodies positive. The accordance rate of the two methods was 91.8%. CONCLUSION: It is suggested that the C. pneumonia infection was common in this group of patients and the C. pneumonia Pst I 474 specific PCR was sensitive and specific for detecting C. pneumonia in pharyngolaryngitis or rhinitis and sinusitis. (+info)
A cotton rat model of human parainfluenza 3 laryngotracheitis: virus growth, pathology, and therapy.
Parainfluenza virus type 3 (PIV3) infection led to laryngotracheitis in cotton rats. Laryngeal virus titers peaked at 10(5.0)-10(6.0) plaque-forming units (pfu)/g of tissue from days 2 through 5 after inoculation with 10(5.5) pfu of PIV3. Lymphocytic and neutrophilic inflammatory infiltrates were present in the subglottic and proximal tracheal regions, whereas respiratory epithelial cells were blunted with loss of cilia. Topical therapy with moderate doses of triamcinolone acetonide, an anti-inflammatory glucocorticoid, greatly reduced the extent of lesions. Interferon-gamma messenger RNA production was increased by infection and was suppressed by the highest dose of glucocorticoid. Topical glucocorticoid therapy, with or without concurrent topical immunotherapy with antibody to PIV3, did not lead to a rebound of viral replication. (+info)