Clinical features and management of Meniere’s disease patients with drop attacks

Abstract

Purpose

The aims of the present study are to investigate the variations in clinical features, including medical history, hearing function, vestibular function, and degree of endolymphatic hydrops (EH), in Meniere's disease (MD) patients with and without drop attacks (DAs), and to examine the efficacy of intratympanic gentamicin (ITG) treatment in alleviating DAs.

Methods

In total, 177 unilateral definite MD patients, including 16 patients with DAs and 161 patients without DAs, were enrolled. The results of hearing test, vestibular-evoked myogenic potentials (VEMPs), and magnetic resonance imaging (MRI) were analyzed. Thirteen patients with DAs received a single ITG treatment and were followed up.

Results

The disease course of MD in the DA group was significantly longer than that in the control group (p = 0.007). MD patients with DAs had significantly greater hearing loss and worse EH than MD patients without DAs (p < 0.05). However, there was no between-group difference in vestibular function. In the study, 92.31% of refractory definite MD patients with DAs achieved satisfactory control of DAs after ITG treatment.

Conclusions

MD patients with DAs tend to suffer from severe hearing loss and a significant degree of EH in the inner ear. However, the vestibular function of MD patients with DAs may not be completely abolished, but be sensitive to stimulating signals. ITG treatment, which helps to decrease vestibular sensitivity, was an effective treatment to control DAs.

http://bit.ly/2BShlUr

Transoral laser microsurgery in early glottic cancer involving the anterior commissure

Abstract

Purpose

Treatment modalities for glottic cancer comprise surgery, (chemo-)radiation, and combined treatment options. Glottic cancer involving the anterior commissure (AC) requires special preoperative assessment and surgical skills, as it is commonly considered a risk factor for local recurrence. The aim of this study is to analyze the oncological effectiveness of transoral laser microsurgery (TLM) in the early glottic cancer involving the AC.

Methods

We retrospectively analyzed the data of all patients with primary, early staged (T1–2) glottic squamous cell carcinoma who were treated between 2004 and 2014. Patients were preferably treated by TLM (rather than open surgical techniques) if appropriated transoral exposure of the endolarynx was ensured. Voice outcomes were not assessed.

Results

186 patients with early glottic cancer were included, 143 were treated by TLM and 43 by other therapy modalities [OT open surgical techniques (n = 32) or primary (chemo-)radiation (n = 11)], respectively. In 84 patients (59%) of the TLM cohort, the AC was involved (OT cohort n = 29 (73%), p = 0.143). The 1-, 3-, and 5-year local control rates after TLM were 91%, 86%, and 81% in patients without AC infiltration and 84%, 74%, and 70% in patients with AC infiltration, respectively, showing no statistical difference (p = 0.180). The 5-year disease-free survival and laryngeal preservation rate (LPR) did not differ with regard to AC infiltration (p = 0.215 and p = 0.261). Comparing the treatment modalities, the 5-year LPR was 90% for TLM and 83% for OT regardless of infiltration of the AC (p = 0,653 and p = 0.267, respectively).

Conclusion

TLM is an effective surgical treatment for early glottic cancer with AC involvement in patients with adequate transoral laryngeal exposure.

http://bit.ly/2R2B1iR

Pasteurella multocida meningitis following mastoidectomy Το P. multocida προκαλεί μια σειρά ασθενειών σε άγρια ​​και εξημερωμένα ζώα, καθώς και σε ανθρώπους. Το βακτήριο μπορεί να βρεθεί σε πουλιά, γάτες , σκύλους, κουνέλια, βοοειδή και χοίρους. Στα πτηνά, το P. multocida προκαλεί ασθένεια της χολέρας των πτηνών ή των πτηνών. μια σημαντική ασθένεια που υπάρχει σε εμπορικά και οικόσιτα σμήνη πουλερικών παγκοσμίως, ιδιαίτερα σμήνη στρώματος και σμήνη πατρικών εκτροφέων. Τα στελέχη P. multocida που προκαλούν τη χολέρα των πτηνών στα πουλερικά συνήθως ανήκουν στους σεροβάρους 1, 3 και

DISPATCH

Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 78-80

Pasteurella multocida meningitis following mastoidectomy: A case report and literature review

Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
Department of Medicine, Federal University of Santa Maria, Santa Maria, RS, Brazil

Correspondence Address:

Jamir Pitton Rissardo
Department of Medicine, Federal University of Santa Maria, Santa Maria, RS 

DOI: 10.4103/IJAMR.IJAMR_35_18

Abstract

Pasteurella multocida (PM) is part of the normal nasopharyngeal flora of many animals. The most common PM infections occur in soft tissue, secondary to animal contact. Meningitis is rarely associated. An adult female developed chronic right-sided otorrhea and tympanic membrane perforation. Elective mastoidectomy was performed. On the postoperative day 2, the patient experienced a decreased level of consciousness, headache, nausea, and seizures. Cerebrospinal fluid (CSF) analysis revealed low glucose, high protein, and high cellularity. Blood tests were within normal limits, except for high leukocyte count. Two days after the neurological manifestations, bacteria, identified as PM, grew in the aerobic cultures of CSF and preoperative ear swab. The isolate was sensitive to penicillins. She was started on intravenous penicillin G. The patient had a full recovery. On further questioning, she admitted having a dog, which licks on her face frequently.

Keywords: Mastoidectomy, meningitis, Pasteurella multocida

Introduction

Pasteurella multocida (PM) is a Gram-negative coccobacillus and facultative anaerobe. It is present in the nasopharyngeal flora of domestic pets.^[1] Frequently, PM infections in humans are located in the soft tissue and are associated with animal bites. In rare cases, severe infection, like meningitis, can occur. In this context, it is known that surgical procedures such as mastoidectomy may contribute to meningitis, particularly in a predisposed individual.^[1],[2] To the authors' knowledge, only two cases of mastoidectomy followed by PM meningitis have been reported.^[3],[4] Herein, we report a case of an adult woman who had PM meningitis after mastoidectomy.

Case Report

A 51-year-old female patient presented with chronic right-sided otorrhea and ipsilateral tympanic membrane perforation within 2 months of onset. She was admitted for elective mastoidectomy with tympanoplasty. Her medical history included recurrent ear infections with otorrhea through a tympanic perforation. On neurological examination, conductive hearing loss was observed. The left otoscopy was normal, and right otoscopy showed perforated tympanic membrane with tympanosclerosis. There was no evidence of otorrhea, soft-tissue mass, crusting, or desquamated debris. Her comorbid conditions were dyslipidemia, hypertension, and major depressive disorder. She was in use of sertraline, hydrochlorothiazide, enalapril, and simvastatin.

On the postoperative day 2, the patient experienced a decreased level of consciousness, headache, nausea, and seizures presenting with bilateral tonic-clonic movements and impaired awareness. There was no fever or focal neurological signs. Cranial computed tomography scan showed the mastoidectomy and the absence of mass or hematoma [Figure 1]. Cerebrospinal fluid (CSF) analysis revealed low glucose (5 mg/dL), high protein (114 mg/dL), and high cellularity (158/mm³) with 85% of neutrophils. Blood tests, including glucose level (90 mg/dL), were within normal limits, except for the presence of leukocytosis (20,010/mm³). Initial gram stain of the CSF showed abundant neutrophils and the absence of microorganisms. She was treated empirically for bacterial meningitis with intravenous (IV) ceftriaxone and vancomycin.

Figure 1: Images of computed tomography scan showing the right mastoidectomy, the communication between the right ear and right middle cranial fossa (indicated by the arrow). Coronal (a) and axial (b) views of head computed tomography scan. Axial with brain window (c) and coronal with bone window (d) views of computed tomography scan of the temporal bone Click here to view

Two days after the neurological manifestations, PM grew in the aerobic cultures of CSF and preoperative ear swab. The isolate was sensitive to penicillin. She was started on IV penicillin G 2 million units, every 4 h, for 14 days. After 10 days, the patient had a full recovery.

On further questioning, she admitted having a dog which lives inside her house and licks on her face frequently. In the follow-up, investigation for immunosuppression was negative.

Discussion

PM meningitis was first documented in 1925 by Claudius.^[5] Since 1950, about 39 cases have been reported in the English literature. In these cases, the infection was generally associated with cranial surgery or trauma, chronic otitis media, and soft-tissue infection with secondary spread.^[1],[2],[6] History of recent animal contact was reported in 89% of cases.^[2]

There are only a few case reports of PM meningitis following mastoidectomy. We identified two cases after a review of the English literature, and we compared them with the present case [Table 1].^[3],[4] Literature search was performed in Embase, Google Scholar, Lilacs, Medline, Scielo, and ScienceDirect, using a set of terms that included mastoidectomy, meningitis, and PM.

Table 1: Reported cases of Pasteurella multocida meningitis following mastoidectomy Click here to view

In the case reported by Dammeijer and McCombe, PM meningitis occurred after a modified radical mastoidectomy due to recurrent cholesteatoma.^[4] On the other hand, in the study from Pond et al., PM meningitis was associated with a typanomastoidectomy and removal of the incus and malleus with tympanoplasty performed for chronic otorrhea related to tympanic membrane perforation.^[3]

The pathogenesis in PM meningitis following mastoidectomy is probably related with the contiguous spread of the bacteria from a colonized external acoustic meatus, which has contaminated the CSF during the surgery. This hypothesis is based on the preoperative growth of PM in the ear swab, the absence of clinical meningitis signs, and the development of the infection 24 h after the mastoidectomy.^[3],[4]

We agree with the statement of Pond et al.^[3] and Dammeijer and McCombe,^[4] that any patient requiring mastoidectomy should be asked about contact with animals, and in the case of a positive answer, a preoperative ear swab is mandatory since it allows early intervention and prevents possible complications.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 

References

1.	Weber DJ, Wolfson JS, Swartz MN, Hooper DC. Pasteurella multocida infections. Report of 34 cases and review of the literature. Medicine (Baltimore) 1984;63:133-54.
2.	Green BT, Ramsey KM, Nolan PE. Pasteurella multocida meningitis: Case report and review of the last 11 y. Scand J Infect Dis 2002;34:213-7.
3.	Pond ED, El-Bailey S, Webster D. An unusual case of meningitis. Can J Infect Dis Med Microbiol 2015;26:e62-4.
4.	Dammeijer PF, McCombe AW. Meningitis from canine Pasteurella multocida following mastoidectomy. J Laryngol Otol 1991;105:571-2.
5.	Claudius M. The bacteria plague-like. Ugesk Laeger 1925;87:194-5.
6.	Kumar A, Devlin HR, Vellend H. Pasteurella multocida meningitis in an adult: Case report and review. Rev Infect Dis 1990;12:440-8.

Figures

  [Figure 1]
 
 

Tables

  [Table 1]

http://www.ijamhrjournal.org/article.asp?issn=2349-4220;year=2018;volume=5;issue=2;spage=78;epage=80;aulast=Rissardo

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Pasteurella multocida meningitis following mastoidectomy: A case report and literature review Jamir Pitton Rissardo, Ana Letícia Fornari Caprara International Journal of Advanced Medical and Health Research 2018 5(2):78-80 Pasteurella multocida (PM) is part of the normal nasopharyngeal flora of many animals. The most common PM infections occur in soft tissue, secondary to animal contact. Meningitis is rarely associated. An adult female developed chronic right-sided otorrhea and tympanic membrane perforation. Elective mastoidectomy was performed. On the postoperative day 2, the patient experienced a decreased level of consciousness, headache, nausea, and seizures. Cerebrospinal fluid (CSF) analysis revealed low glucose, high protein, and high cellularity. Blood tests were within normal limits, except for high leukocyte count. Two days after the neurological manifestations, bacteria, identified as PM, grew in the aerobic cultures of CSF and preoperative ear swab. 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In this article, we do not aim to provide an exhaustive coverage of every approach. Instead, we provide an overview of the following eight major suicide prevention interventions: awareness programs, screening, gatekeeper training, access to means restriction, follow-up care, hotlines, media strategies, pharmacotherapeutic and psychotherapeutic approaches. The evidence base and components of each approach are described to facilitate replication. The best practice elements are synthesized from each approach and presented to aid program development and practice. Although a number of approaches hold promise, there are difficulties in ascertaining the effective elements under each of them. Innovative research designs are needed to address this knowledge gap as it will facilitate optimal allocation of resources for suicide prevention. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLES Healthcare-seeking behavior for infectious diseases in a community in Bangladesh  p. 52 Md Shafiqul Islam Khan, Jannatul Ferdous Ani, Bithika Rani, Shafaet Jamil Apon, Fahmida Rashid, Tanjil Islam Yead, Musammet Rasheda Begum, Sukanta Chowdhury DOI:10.4103/IJAMR.IJAMR_38_18   Background: Healthcare-seeking behavior is associated with the severity of infectious diseases, particularly in low-income countries. We need better understanding about the current healthcare-seeking behavior of rural people in low-resource settings. This study aimed to describe the healthcare-seeking behavior of rural people for infectious diseases and identify the associated factors. Methods: We conducted a cross-sectional survey in a rural community in Bangladesh. We interviewed a total of 450 persons to collect data on demographics, household income, household expenditure, and healthcare-seeking behavior. We performed a descriptive analysis to summarize the demographic characteristics and multivariate logistic regression analysis to identify the association between healthcare-seeking behavior and variables of interest. Results: Among the study participants, 42% went to the health facilities, 30% went to the pharmacy, 14% went to the nonregistered doctors, 1% went to the traditional healers, 1% went to the spiritual healer, and 2% took self-treatment. Proximity of the health-care facilities (prevalence ratio [PR] 1.97, 95% confidence interval [CI]: 1.55–2.49) and number of clinical symptoms (PR 1.23, 95% CI: 1–1.52) were significantly associated with the care-seeking behavior. Conclusions:Healthcare-seeking behavior for infectious diseases among rural people in Bangladesh was poor. Information obtained from this study could be useful to develop, design, and improve health-care systems in low-resource settings. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Assessment of the level of knowledge and universal cross-infection control practices against lassa fever among health workers in Sokoto, Nigeria: A hospital survey during lassa fever outbreak in Nigeria p. 57 Catherine Fidelis, Johnson Olajolumo DOI:10.4103/IJAMR.IJAMR_11_18   Introduction: Lassa fever (LF) is an endemic West African viral hemorrhagic fever which presents acutely and is often fatal. This study assessed the level of knowledge about LF among the health workers in Sokoto State and also examined their cross-infection control practices against LF during ongoing outbreaks in health facilities in Nigeria. Methods: Data obtained from a total of 298 health workers in five hospitals in Sokoto metropolis, Nigeria, were used for this study. The study tool was a 25-item questionnaire. Data obtained were analyzed using the SPSS version 20 Software. Results: Three-tenth of the participants were within the age bracket of 26–30 years. About 54% were men, 54.4% were nursing officers, and 75.2% of the participants had practice ≤10 years. All of the surveyed medical doctors and dentists were aware of the ongoing LF outbreak in Nigeria. All of the dentists and medical laboratory scientists surveyed accurately identified the virus as the cause of LF. Only the dentists accurately identified Mastomys natalensis rodents as the vector for LF, and its transmission from person-person. Less than 20% of the participants in each occupational category did not know the universal precaution measures against infections, and about 12% of the respondents wore their personal protective equipment outside the surroundings of their duty posts. It was observed that more than 50% of the participants were below 60% on a scale of 1%–100% regarding their cross-infection and control practices. Conclusion: The findings obtained from this study revealed a very low level of knowledge about LF and very poor universal cross-infection control practices against LF among the health workers in Sokoto City, Nigeria. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Recipient hemovigilance at a tertiary care hospital in Southern India: A cross-sectional study p. 66 Vikram Kumar Gente, Abhishekh Basavarajegowda, Rajendra Kulkarni, Debdatta Basu DOI:10.4103/IJAMR.IJAMR_33_18   Introduction: Information on incidence of various transfusion reactions could help in early recognition as well as management and could also help to institute adequate measures to make blood transfusion as safe as possible. The primary objective of the present study was to determine the frequency and types of adverse transfusion reactions in patients who required blood component transfusion. Methodology: This was a cross-sectional, observational study conducted over a period of 22 months from September 2014 to June 2016 in the Department of Transfusion Medicine, JIPMER. All patients admitted to the wards of various specialty departments who were transfused with blood components and reported to have transfusion reaction during or after transfusion of blood components were included in the study. Results:A total of 90,758 components were issued during the study period, and 137 transfusion reactions were reported which accounted for 0.15% of total transfusions. Febrile nonhemolytic transfusion reaction (46.7%) was the most common reaction followed by allergic reaction (31.3%). Among different blood components, packed red blood cells (82%) were most commonly associated with transfusion reactions. Conclusion: Transfusion reactions unless serious are grossly underreported either due to lack of attributing the adverse event to transfusion or because the milder reactions are usually managed and unreported as the staff are too often used to having them, especially in chronically transfused patients. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta DISPATCHES Human immunodeficiency virus-associated neurocognitive disorder masquerading as psychiatric illness p. 71 Jitender Aneja, Navratan Suthar, Gopal K Bohra, Pawan Garg DOI:10.4103/IJAMR.IJAMR_31_18   Human immunodeficiency virus-1 (HIV-1)/acquired immunodeficiency syndrome (AIDS) has been shown to be associated with a constellation of neuropsychiatric disorders. The presence of depressive symptoms may obscure the evaluation of cognitive manifestation of a neurodegenerative disorder like dementia associated with AIDS. Further, it is uncommon to see catatonia in association with HIV/AIDS. In this report, we present a case who had an array of psychiatric syndromes as the initial manifestation of AIDS. The subsequent management issues are also dealt with. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta A case report of dyskeratosis congenita associated with both psychosis and mood disorder p. 75 Vigneshvar Chandrasekaran, Gopinath Sathyanarayanan, Vikas Menon, Balaji Bharadwaj DOI:10.4103/IJAMR.IJAMR_5_18   Dyskeratosis congenita (DC) is a rare heritable skin disorder with progressive bone marrow failure. Psychiatric manifestations could also be a presentation of this rare skin condition. Although it has been associated with psychiatric manifestations, there is a dearth of information regarding mood symptoms in this condition. We report a 41-year-old male who had presented with predominant psychotic followed by affective symptoms and was diagnosed with DC and comorbid organic delusional and mood disorder. He was also worked up for other physical manifestations of DC. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Pasteurella multocida meningitis following mastoidectomy: A case report and literature review p. 78 Jamir Pitton Rissardo, Ana Letícia Fornari Caprara DOI:10.4103/IJAMR.IJAMR_35_18   Pasteurella multocida (PM) is part of the normal nasopharyngeal flora of many animals. The most common PM infections occur in soft tissue, secondary to animal contact. Meningitis is rarely associated. An adult female developed chronic right-sided otorrhea and tympanic membrane perforation. Elective mastoidectomy was performed. On the postoperative day 2, the patient experienced a decreased level of consciousness, headache, nausea, and seizures. Cerebrospinal fluid (CSF) analysis revealed low glucose, high protein, and high cellularity. Blood tests were within normal limits, except for high leukocyte count. Two days after the neurological manifestations, bacteria, identified as PM, grew in the aerobic cultures of CSF and preoperative ear swab. The isolate was sensitive to penicillins. She was started on intravenous penicillin G. The patient had a full recovery. On further questioning, she admitted having a dog, which licks on her face frequently. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta