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Fulltext Invasive rhinocerebral mucormycosis with orbital extension in poorly- controlled diabetes mellitus

Hadzri MH, Azarisman SM, Fauzi AR, Kahairi A

Singapore Med J, 2009 Mar;50(3):e107-9.
PMID: 19352553

Rhinocerebral mucormycosis is an invasive fungal sinusitis with a high mortality rate, especially in immunocompromised patients. A 70-year-old woman, with uncontrolled type 2 diabetes mellitus, presented with a one-month history of non-specific headaches associated with progressive swelling of her left eye. Computed tomography of the brain and orbits showed the extensive involvement of bilateral intranasal sinuses, orbits, extraocular muscle and soft tissues. The diagnosis of invasive mucormycosis was confirmed from a tissue biopsy taken from the internasal septum. Despite the extensive mucormycosis invasion, she was successfully treated with intranasal and systemic amphotericin B and minimal adjunctive intranasal sphenoidotomy.

Matched MeSH terms: Sinusitis/microbiology*
Fulltext The Clinical and Radiological Characterizations of the Allergic Phenotype of Chronic Rhinosinusitis with Nasal Polyps

Abdullah B, Vengathajalam S, Md Daud MK, Wan Mohammad Z, Hamizan A, Husain S

J Asthma Allergy, 2020;13:523-531.
PMID: 33149624 DOI: 10.2147/JAA.S275536

Purpose: The allergic phenotype of chronic rhinosinusitis (CRS) and central compartment atopic disease (CCAD) have been described. The CCAD is a radiological phenotype in patients with CRS that presents as a central mucosal disease due to allergy. The subset of patients having chronic rhinosinusitis with nasal polyps (CRSwNP) has not been well characterized. We aim to describe the clinical and radiological characterizations of patients presenting with the allergic phenotype of CRSwNP.
Patients and Methods: A cross-sectional study at a tertiary hospital was performed. Adult patients diagnosed with CRSwNP who had both allergology and radiological assessments were enrolled. The symptoms of allergic rhinitis, Lund-Kennedy (LK) endoscopic scoring, Lund-Mackay (LM) computed tomography scan of paranasal sinuses (CTPNS) scoring, CCAD features, skin prick test (SPT) and level of specific IgE were assessed. All the patients underwent SPT for house dust mites.
Results: A total of 38 patients were enrolled. Symptoms, endoscopic and CTPNS scores were higher in the allergy and CCAD groups compared to the nonallergy and nonCCAD groups. The symptom of "need to blow nose" was statistically significant in allergy vs nonallergy (p=0.01) and CCAD vs nonCCAD (p=0.02). There were significant differences in the endoscopic scores in both allergy and CCAD (allergy vs nonallergy, p=0.01; CCAD vs nonCCAD, p=0.03), and CT scores in both allergy and CCAD (allergy vs nonallergy, p=0.02; CCAD vs nonCCAD, p=0.02). All patients with CCAD have worse scoring than nonCCAD (LK score, p=0.03; LM score, p=0.02). Patients with allergy have more polypoidal involvement of the middle turbinates (left middle turbinate, p=0.141; right middle turbinate, p=0.074) and CCAD (left middle turbinate, p=0.017; right middle turbinate, p=0.009) than nonallergy and nonCCAD patients.
Conclusion: Allergic phenotype of CRSwNP has a worse clinical and radiological disease burden. Optimal treatment of allergy is essential for a better outcome.

Matched MeSH terms: Sinusitis
Fulltext A fatal case of rhinocerebral mucormycosis

Nurul Suhaili Kamarudin, Rosni Ibrahim, Nur Hanani Ahmad, Siti Norbaya Masri

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):329-331.
MyJurnal

Rhinocerebral mucormycosis is a potentially fatal and progressive angioinvasive fungal infection. It is classically described in patients with uncontrolled diabetes mellitus and hematological malignancies. This report describes a case of progressive rhinocerebral mucormycosis in a patient with poorly controlled diabetes who was on prolonged prednisolone therapy for autoimmune kidney disease. The patient, who was a female, presented to hospital with headache, orbital pain and nasal bridge swelling. Black eschar on nasal mucosae was present on admission. Later, she was started on intravenous fluconazole for the diagnosis of fungal sinusitis. Subsequently, she developed intra- cerebral haemorrhage complicated with transtentorial herniation. Diagnosis of rhinocerebral mucormycosis was later observed by a laboratory finding and the treatment was changed to intravenous amphotericin B. However, the patient succumbed to her illness on the 6th day of hospitalisation. This report discusses the risk factors associated with rhinocerebral mucormycosis as well as the underlying pathogenesis. This report will also highlight the importance of early diagnosis and appropriate treatment for mucormycosis to improve prognosis in patients.

Matched MeSH terms: Sinusitis
Emergence of antibiotic resistant Streptococcus pneumoniae in malaysia

Farida Jamal

Malaysian Journal of Child Health, 1997;9(2):174-177.
MyJurnal

Streptococcus pneumoniae is an important cause of community acquired infections, particularly pneumonia, acute otitis media, sinusitis and exacerbations of chronic bronchitis. Together with Haemophilus influenzae, it is an important cause of childhood meningitis. It is also a major cause of bacterial meningitis among adults. The emergence of Streptococcus pneumoniae resistant to penicillin and other antibiotics in recent years has complicated the management of pneumococcal infections world-wide'. In some areas, penicillin resistant strains have become the predominant pneumococcal isolates2. Multiply resistant strains and those resistant to second and third generation cephalosporins are also increasingly reported'. Treatment of meningitis and acute otitis media caused by such strains is particularly problematic. (Copied from article).

Matched MeSH terms: Sinusitis
Determination of the biofilm formation capacity of bacterial pathogens associated with otorhinolaryngologic diseases in the Malaysian population

Khosravi Y, Ling LC, Loke MF, Shailendra S, Prepageran N, Vadivelu J

Eur Arch Otorhinolaryngol, 2014 May;271(5):1227-33.
PMID: 23880921 DOI: 10.1007/s00405-013-2637-3

This study aims to assess the association between microbial composition, biofilm formation and chronic otorhinolaryngologic disorders in Malaysia. A total of 45 patients with chronic rhinosinusitis, chronic tonsillitis and chronic suppurative otitis media and 15 asymptomatic control patients were studied. Swab samples were obtained from these subjects. Samples were studied by conventional microbiological culturing, PCR-based microbial detection and Confocal Laser Scanning Microscopy (CLSM). Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, coagulase-negative staphylococci (CoNS) and other Streptococcus species were detected in subjects of both patient and control groups. Biofilm was observed in approximately half of the smear prepared from swab samples obtained from subjects of the patient group. Most of these were polymicrobial biofilms. S. aureus biofilm was most prevalent among nasal samples while H. influenzae biofilm was more common among ear and throat samples. Results from this study supported the hypothesis that chronic otorhinolaryngologic diseases may be biofilm related. Due to the presence of unculturable bacteria in biofilms present in specimens from ear, nose and throat, the use of molecular methods in combination with conventional microbiological culturing has demonstrated an improvement in the detection of bacteria from such specimens in this study.

Matched MeSH terms: Sinusitis/microbiology
Practice patterns for chronic respiratory diseases in the Asia-Pacific region: a cross-sectional observational study

Wang Y, Cho SH, Lin HC, Ghoshal AG, Bin Abdul Muttalif AR, Thanaviratananich S, et al.

Int Arch Allergy Immunol, 2018;177(1):69-79.
PMID: 29874659 DOI: 10.1159/000489015

BACKGROUND: Allergic rhinitis (AR), asthma, chronic obstructive pulmonary disease (COPD), and rhinosinusitis are common and little studied in the Asia-Pacific region.

OBJECTIVES: We sought to investigate real-world practice patterns for these respiratory diseases in India, Korea, Malaysia, Singapore, Taiwan, and Thailand.

METHODS: This cross-sectional observational study enrolled adults (age ≥18 years) presenting to general practitioners (GP) or specialists for physician-diagnosed AR, asthma, COPD, or rhinosinusitis. Physicians and patients completed study-specific surveys at one visit, recording patient characteristics, health-related quality of life (QoL), work impairment, and healthcare resource use. Findings by country and physician category (GP or specialist) were summarized.

RESULTS: Of the 13,902 patients screened, 7,243 (52%) presented with AR (18%), asthma (18%), COPD (7%), or rhinosinusitis (9%); 5,250 of the 7,243 (72%) patients were eligible for this study. Most eligible patients (70-100%) in India, Korea, Malaysia, and Singapore attended GP, while most (83-85%) in Taiwan and Thailand attended specialists. From 42% (rhinosinusitis) to 67% (AR) of new diagnoses were made by GP. On average, patients with COPD reported the worst health-related QoL, particularly to GP. Median losses of work productivity for each condition and activity impairment, except for asthma, were numerically greater for patients presenting to GP vs. specialists. GP prescribed more antibiotics for AR and asthma, and fewer intranasal corticosteroids for AR, than specialists (p < 0.001 for all comparisons).

CONCLUSIONS: Our findings, albeit mostly descriptive and influenced by between-country differences, suggest that practice patterns differ between physician types, and the disease burden may be substantial for patients presenting in general practice.

Matched MeSH terms: Sinusitis
Fulltext Antimicrobial drug use in primary healthcare clinics: a retrospective evaluation

Shamsuddin S, Akkawi ME, Zaidi ST, Ming LC, Manan MM

Int J Infect Dis, 2016 Nov;52:16-22.
PMID: 27639454 DOI: 10.1016/j.ijid.2016.09.013

OBJECTIVES: To examine the appropriateness of antibiotics prescribed for acute infection based on the Malaysian national antibiotic guidelines and the defined daily dose (DDD) system of the World Health Organization (WHO). This study also aimed to describe the factors influencing the drug use pattern and to investigate the procurement patterns of antibiotics in the primary healthcare setting.
METHODS: A retrospective cohort follow-up study of randomly selected patients from all patients who received any antibiotic between January and December 2013 was conducted at three primary healthcare clinics in Selangor State of Malaysia. For each patient, the following information was recorded: name of the antibiotic, frequency and dose, and Anatomical Therapeutic Chemical (ATC) group. The defined daily dose per 1000 inhabitants per day was calculated for each antibiotic. The national antibiotic guidelines were used to assess the appropriateness of each antibiotic prescription.
RESULTS: A total of 735 patients were included in the study. The five most used antibiotics were amoxicillin (1.36g, 35.2%), cloxacillin (0.68g, 26.3%), erythromycin (0.32g, 22.3%), bacampicillin (0.13g, 7.2%), and cephalexin (0.11g, 6.9%). Respiratory tract infections were the most commonly treated infections, and the doctors' preferred antibiotic for the treatment of these infections was amoxicillin. More than 18% of all amoxicillin prescriptions were deemed inappropriate according to the national antibiotic guidelines. In terms of procurement costs, USD 88885 was spent in 2011, USD 219402 in 2012, and USD 233034 in 2013 at the three primary healthcare clinics, an average of USD 180440 per year for the three clinics.
CONCLUSIONS: This study reports the antibiotic usage at three primary healthcare clinics in Klang Province. The most prescribed antibiotic was amoxicillin in capsules (250mg), which was mainly prescribed for respiratory infections. Although the national antibiotic guidelines state that amoxicillin is a preferred drug for acute bacterial rhinosinusitis, this drug is also being prescribed for other disease conditions, such as acute pharyngitis and acute tonsillitis. This result shows that current practice is not following the current antibiotic guidelines, which state that phenoxypenicillin should be the preferred drug.
KEYWORDS: Antibiotic guideline; Defined daily dose; Drug utilization study; Prescribing pattern; Upper respiratory tract infection
Study site: Klinik Kesihatan Anika, Klinik Kesihatan Pandamaran, Klinik Kesihatan Bukit Kuda, Kelang, Selangor, Malaysia

Matched MeSH terms: Sinusitis