RESUMEN
Background: Nasopharyngeal polyps are benign and inflammatory masses assumed to arise from the middle ear or the eustachian tube with extension into the pharynx. The most common clinical signs associated with nasopharyngeal polyps include respiratory stertor, dyspnea, and otic discharge. Neurological signs, including head tilt, facial nerve paralysis, and ataxia, might indicate concurrent involvement of the middle or inner ear. The objective of the current report is to describe a case of a feline nasopharyngeal polyp with a concurrent hiatal hernia and megaesophagus, both spontaneously resolved after removal of the polyp. Case: A 6-month-old female intact domestic shorthair cat was presented for evaluation of lethargy, anorexia, and upper respiratory signs, such as stridor, stertor, and dyspnea. A thoracic radiography revealed esophageal dilation caudal to the cardiac silhouette, suggestive of megaesophagus with gaseous filtration. An esophagram confirmed a hiatal hernia and megaesophagus. Computed tomography revealed a nasopharyngeal mass adjacent to the soft palate and a soft-tissue density in the right tympanic bulla. A tentative diagnosis of a nasopharyngeal polyp was made. After the ventral bulla osteotomy, the nasopharyngeal mass was removed by a gentle traction avulsion technique. Six days after the surgery, hiatal hernia and megaesophagus were spontaneously resolved. Based on histopathologic exam, the mass was found to be an inflammatory nasopharyngeal polyp. Two months after surgery, the owner reported that the patient's condition had returned to baseline with a good appetite, and the thoracic radiography was within normal limit. Discussion: For successful treatment of a nasopharyngeal polyp, traction avulsion of the polyp with or without a ventral bulla osteotomy is recommended. However, in patients with otitis media, a ventral bulla osteotomy followed by traction avulsion of the polyp is recommended in order to reduce the rate of polyp recurrence. Common clinical signs of a nasopharyngeal polyp are stertor, stridor, dyspnea, dysphagia, and open-mouth breathing, which are identified in a chronic upper airway obstruction. A hiatal hernia secondary to a nasopharyngeal polyp has not been reported so far. However, a relationship between chronic upper airway obstruction and hiatal hernias has been proposed previously. Moreover, hiatal hernia resolved spontaneously after removal of the nasopharyngeal polyp suggests that the occurrence of the hiatal hernia was secondary to the nasopharyngeal polyp. In addition to the hiatal hernia, megaesophagus was also identified in the present case. Megaesophagus secondary to a chronic upper airway obstruction from a nasopharyngeal obstruction has been reported. However, megaesophagus is also thought to occur secondary to hiatal hernias. Therefore, in the current study, it is unclear whether the megaesophagus was solely a result of the obstructive nature of the nasopharyngeal polyp or a combination of the hiatal hernia and the nasopharyngeal polyp. In conclusion, any cat with clinical signs of an upper airway obstruction and a concurrent hiatal hernia and megaesophagus should be thoroughly investigated for a nasopharyngeal polyp, as well as other gastrointestinal and systemic causes. Furthermore, this case suggests that the prognosis for a concurrent hiatal hernia and megaesophagus is good in cats if the nasopharyngeal polyp is properly removed.
Asunto(s)
Animales , Femenino , Gatos , Osteotomía/veterinaria , Acalasia del Esófago/veterinaria , Pólipos Nasales/veterinaria , Oído Medio/cirugía , Hernia Hiatal/veterinaria , Enfermedades Nasofaríngeas/veterinariaRESUMEN
Los pólipos pilosos nasofaríngeos son tumores benignos poco frecuentes. Se presenta el caso de esta patología en una paciente recién nacida, quien presentó cianosis y dificultad respiratoria por obstrucción de la vía aérea superior, durante las primeras 24 horas de vida. La paciente requirió maniobras de reanimación e intubación endotraqueal. Estudios diagnósticos confirmaron la presencia de una masa en la pared lateral de la faringe. Se realizó la extirpación quirúrgica exitosa con evolución satisfactoria de la paciente
Nasopharyngeal hairy polyps are rare benign tumors. We present a newborn case with a hairy polyp mass causing cyanosis and respiratory distress due to obstruction of the upper airway during the first 24 hours of life. The patient required resuscitation and endotracheal intubation. Diagnostic studies confirmed the presence of a mass in the lateral pharyngeal wall. Surgical treatment and removal of the mass was performed with satisfactory evolution of the patient
Asunto(s)
Humanos , Femenino , Recién Nacido , Pólipos Nasales/diagnóstico por imagen , Resucitación , Pólipos Nasales/cirugía , Enfermedades Nasofaríngeas , Cianosis , Obstrucción de las Vías Aéreas , Intubación Intratraqueal , NeoplasiasRESUMEN
Nasopharyngeal hairy polyps are rare benign tumors. We present a newborn case with a hairy polyp mass causing cyanosis and respiratory distress due to obstruction of the upper airway during the first 24 hours of life. The patient required resuscitation and endotracheal intubation. Diagnostic studies confirmed the presence of a mass in the lateral pharyngeal wall. Surgical treatment and removal of the mass was performed with satisfactory evolution of the patient.
Los pólipos pilosos nasofaríngeos son tumores benignos poco frecuentes. Se presenta el caso de esta patología en una paciente recién nacida, quien presentó cianosis y dificultad respiratoria por obstrucción de la vía aérea superior, durante las primeras 24 horas de vida. La paciente requirió maniobras de reanimación e intubación endotraqueal. Estudios diagnósticos confirmaron la presencia de una masa en la pared lateral de la faringe. Se realizó la extirpación quirúrgica exitosa con evolución satisfactoria de la paciente.
Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Enfermedades Nasofaríngeas/diagnóstico , Pólipos/diagnóstico , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/cirugía , Femenino , Humanos , Recién Nacido , Enfermedades Nasofaríngeas/complicaciones , Enfermedades Nasofaríngeas/cirugía , Nasofaringe/patología , Nasofaringe/cirugía , Pólipos/complicaciones , Pólipos/cirugíaRESUMEN
Neuropathies of pharyngeal branches of glossopharyngeal and vagus are often associated with guttural pouches diseases; however, these branches of injury due to stylopharyngeus muscle compression are not reported. A case was reported of a quarter horse mare, 8 years old, 450 kg, presenting dyspnea and respiratory noise associated with weight loss. Clinical examination observed mixed dyspnea, tachycardia, dysphagia, sialorrhea, lung crackles and submandibular and parotid lymphadenopathy. Endoscopic exam showed right arytenoid chondritis, nasopharyngeal collapse, generalized larynx edema and dorsal displacement of the soft palate. Right guttural pouch evaluation showed swelling in the origin of stylopharyngeus muscle with consequent compression of the XII, X and IX cranial nerves. Tracheotomy, systemic treatment with corticosteroids, beta lactams and aminoglycosides antibiotics were performed. No resolution was observed and, after 16 days, the animal showed clinical worsening, developed pleuropneumonia, uveitis, severe sepsis, acute renal failure and was euthanized. The mixed neuropathy resulted in rapid clinical deterioration of the animal, due to the difficulty in swallowing and consequent associated respiratory processes. This report emphasizes the importance of evaluating stylopharyngeus muscle origin in cases of nasopharyngeal collapse associated with dysphagia in horses, given the possibility that structural changes in this muscle can result in laryngeal neuropathy.(AU)
As neuropatias do glossofaríngeo e vago são frequentemente associadas com enfermidade das bolsas guturais. A ocorrência desta lesão secundária a compressão pelo músculo estilofaríngeo não é reportada. Relata-se o caso de uma égua quarto de milha, 8 anos de idade, 450 kg, apresentando dispneia, ruído respiratório e perda de peso. No exame clínico observou-se dispnéia mista, taquicardia, disfagia, sialorréia, crepitação pulmonar e linfadenopatia submandibular e parotídea. Ao exame endoscópico identificou-se condrite aritenóide direita, colapso nasofaríngeo, edema generalizado da laringe e deslocamento dorsal do palato mole. Na avaliação da bolsa gutural direita identificou-se aumento de volume na origem do músculo estilofaríngeo com consequente compressão dos nervos cranianos XII, X e IX. Foi realizada traqueotomia, tratamento sistêmico com corticosteróides e antibióticos. Nenhuma resolução foi observada, após 16 dias o animal apresentou piora clínica, pleuropneumonia, uveíte, sepse grave, insuficiência renal aguda e foi submetido à eutanásia. A neuropatia mista resultou em rápida deterioração clínica do animal, devido à dificuldade de deglutição e processos respiratórios associados. Salienta-se a importância de se avaliar a origem do músculo estilofaríngeo em casos de colapso nasofaríngeo associado a disfagia em cavalos, dada a possibilidade de que alterações estruturais nesse músculo possam resultar em neuropatia laríngea.(AU)
Asunto(s)
Animales , Trastornos de Deglución/diagnóstico , Enfermedades Nasofaríngeas/veterinaria , Caballos/anomalías , DisneaRESUMEN
Neuropathies of pharyngeal branches of glossopharyngeal and vagus are often associated with guttural pouches diseases; however, these branches of injury due to stylopharyngeus muscle compression are not reported. A case was reported of a quarter horse mare, 8 years old, 450 kg, presenting dyspnea and respiratory noise associated with weight loss. Clinical examination observed mixed dyspnea, tachycardia, dysphagia, sialorrhea, lung crackles and submandibular and parotid lymphadenopathy. Endoscopic exam showed right arytenoid chondritis, nasopharyngeal collapse, generalized larynx edema and dorsal displacement of the soft palate. Right guttural pouch evaluation showed swelling in the origin of stylopharyngeus muscle with consequent compression of the XII, X and IX cranial nerves. Tracheotomy, systemic treatment with corticosteroids, beta lactams and aminoglycosides antibiotics were performed. No resolution was observed and, after 16 days, the animal showed clinical worsening, developed pleuropneumonia, uveitis, severe sepsis, acute renal failure and was euthanized. The mixed neuropathy resulted in rapid clinical deterioration of the animal, due to the difficulty in swallowing and consequent associated respiratory processes. This report emphasizes the importance of evaluating stylopharyngeus muscle origin in cases of nasopharyngeal collapse associated with dysphagia in horses, given the possibility that structural changes in this muscle can result in laryngeal neuropathy.(AU)
As neuropatias do glossofaríngeo e vago são frequentemente associadas com enfermidade das bolsas guturais. A ocorrência desta lesão secundária a compressão pelo músculo estilofaríngeo não é reportada. Relata-se o caso de uma égua quarto de milha, 8 anos de idade, 450 kg, apresentando dispneia, ruído respiratório e perda de peso. No exame clínico observou-se dispnéia mista, taquicardia, disfagia, sialorréia, crepitação pulmonar e linfadenopatia submandibular e parotídea. Ao exame endoscópico identificou-se condrite aritenóide direita, colapso nasofaríngeo, edema generalizado da laringe e deslocamento dorsal do palato mole. Na avaliação da bolsa gutural direita identificou-se aumento de volume na origem do músculo estilofaríngeo com consequente compressão dos nervos cranianos XII, X e IX. Foi realizada traqueotomia, tratamento sistêmico com corticosteróides e antibióticos. Nenhuma resolução foi observada, após 16 dias o animal apresentou piora clínica, pleuropneumonia, uveíte, sepse grave, insuficiência renal aguda e foi submetido à eutanásia. A neuropatia mista resultou em rápida deterioração clínica do animal, devido à dificuldade de deglutição e processos respiratórios associados. Salienta-se a importância de se avaliar a origem do músculo estilofaríngeo em casos de colapso nasofaríngeo associado a disfagia em cavalos, dada a possibilidade de que alterações estruturais nesse músculo possam resultar em neuropatia laríngea.(AU)
Asunto(s)
Animales , Trastornos de Deglución/diagnóstico , Enfermedades Nasofaríngeas/veterinaria , Caballos/anomalías , DisneaRESUMEN
Cryptococcus gattii is often associated with pulmonary and systemic infections in humans and animals. In this research we report a case of nasopharyngeal cryptococoma caused by C. gatti in an equine. A 10-year-old mare presented a mass obstructing the oropharynx. Macroscopically the mass was asymmetric, and was attached to the ethmoidal sinuses and obstructed the oropharynx. Histopathological examination of the mass revealed multiple yeast cells ranging from spherical to oval, 4-8m in diameter, with some of them showing narrow base polar budding. Cryptococcus gattii growth in mycological culture (Sabouraud Dextrose Agar) and was L-canavanine-glycine-bromothymol blue Agar positive. The molecular identification confirmed the isolate as C. gattii by means of the amplification of universal primers. C. gattii is considered an emerging fungal agent, as it affects human and animals and does not respond efficiently to commonly established treatments.(AU)
Cryptococcus gattii é frequentemente associada a infecções pulmonares e sistêmicas em humanos e animais. Neste relato descreve-se um caso de criptococoma nasofaríngeo por C. gatti em um equino. Uma égua de 10 anos, apresentou uma massa obstruindo a orofaringe. Macroscopicamente a massa era assimétrica, e estava aderida aos seios etmoidais obstruindo a orofaringe. O exame histopatológico da massa revelou múltiplas células leveduriformes variando de esféricas a ovais, de 4-8m de diâmetro, com algumas delas apresentando brotação polar de base estreita. Cryptococcus gattii foi isolado na cultura micológica (Ágar sabouraud dextrose) e foi positivo no Ágar L-canavanina-glicina-azul de bromotimol. A identificação molecular confirmou o isolado como C. gattii por meio da amplificação de primers universais. O diagnóstico de criptococoma por C. gattii nasofaríngeo foi baseado nos sinais clínicos, achados macroscópicos, lesões histológicas, cultura micológica e Reação em Cadeia da Polimerase. O C. gattii é considerado um agente fúngico emergente, pois acometendo humanos e animais, não respondendo com eficiência aos tratamentos comumente estabelecidos.(AU)
Asunto(s)
Animales , Cryptococcus gattii , Cryptococcus gattii/aislamiento & purificación , Criptococosis/veterinaria , Micosis/veterinaria , Caballos , Enfermedades Nasofaríngeas/veterinaria , Reacción en Cadena de la Polimerasa/veterinariaRESUMEN
Cryptococcus gattii is often associated with pulmonary and systemic infections in humans and animals. In this research we report a case of nasopharyngeal cryptococoma caused by C. gatti in an equine. A 10-year-old mare presented a mass obstructing the oropharynx. Macroscopically the mass was asymmetric, and was attached to the ethmoidal sinuses and obstructed the oropharynx. Histopathological examination of the mass revealed multiple yeast cells ranging from spherical to oval, 4-8m in diameter, with some of them showing narrow base polar budding. Cryptococcus gattii growth in mycological culture (Sabouraud Dextrose Agar) and was L-canavanine-glycine-bromothymol blue Agar positive. The molecular identification confirmed the isolate as C. gattii by means of the amplification of universal primers. C. gattii is considered an emerging fungal agent, as it affects human and animals and does not respond efficiently to commonly established treatments.
Cryptococcus gattii é frequentemente associada a infecções pulmonares e sistêmicas em humanos e animais. Neste relato descreve-se um caso de criptococoma nasofaríngeo por C. gatti em um equino. Uma égua de 10 anos, apresentou uma massa obstruindo a orofaringe. Macroscopicamente a massa era assimétrica, e estava aderida aos seios etmoidais obstruindo a orofaringe. O exame histopatológico da massa revelou múltiplas células leveduriformes variando de esféricas a ovais, de 4-8m de diâmetro, com algumas delas apresentando brotação polar de base estreita. Cryptococcus gattii foi isolado na cultura micológica (Ágar sabouraud dextrose) e foi positivo no Ágar L-canavanina-glicina-azul de bromotimol. A identificação molecular confirmou o isolado como C. gattii por meio da amplificação de primers universais. O diagnóstico de criptococoma por C. gattii nasofaríngeo foi baseado nos sinais clínicos, achados macroscópicos, lesões histológicas, cultura micológica e Reação em Cadeia da Polimerase. O C. gattii é considerado um agente fúngico emergente, pois acometendo humanos e animais, não respondendo com eficiência aos tratamentos comumente estabelecidos.
Asunto(s)
Animales , Caballos , Criptococosis/veterinaria , Cryptococcus gattii , Cryptococcus gattii/aislamiento & purificación , Enfermedades Nasofaríngeas/veterinaria , Micosis/veterinaria , Reacción en Cadena de la Polimerasa/veterinariaRESUMEN
El quiste de Thornwaldt es poco común en la nasofaringe, pueden causar síntomas clínicos significativos. Fue descrito por Tornwaldt en 1885. Es una patología poco frecuente, benigna, inducida por persistencia de remanente de notocorda. Los quistes de Thornwaldt son generalmente siempre asintomáticos. El diagnóstico de esta masa suele ser incidental, como parte de un examen endoscópico nasal, o se puede detectar en el examen radiológico. Reportamos este caso de un paciente adulto que presento sintomatología auditiva inicial, secundario a un quiste nasofaríngeo hallado en la rinofibrolaringocospia, requiriendo tratamiento quirúrgico para su resolución.
Thornwaldts cyst is uncommon in the nasopharynx, can cause significant clinical symptoms. It was described by Tornwaldt in 1885. It is a rare, benign pathology induced by persistence of notochord remnant. Thornwaldts cysts are usually always asymptomatic. The diagnosis of this mass is usually incidental as part of a nasal endoscopic examination or that can be detected in the radiological examination. We report the case of an adult patient who presented initial, secondary to nasopharyngeal cyst found in the rinofibrolaringocospia auditory symptoms, requiring surgical treatment for resolution.
Thornwaldt Cisto é raro na nasofaringe, pode fazer com que os sintomas clínicos significativos. Foi descrito por Tornwaldt em 1885. É uma doença rara, patologia benigna induzida restos persistentes de notocorda. Thornwaldt cistos são geralmente sempre assintomática. O diagnóstico desta massa é geralmente incidental como parte de um exame endoscópico nasal ou que pode ser detectado no exame radiológico Reportamos este caso de um paciente adulto que apresento sintomatología auditiva inicial, secundário a um quiste nasofaríngeo achado na rinofibrolaringocospia, requerendo tratamento quirúrgico para sua resolução.
Asunto(s)
Masculino , Humanos , Persona de Mediana Edad , Quistes , Cirugía Endoscópica por Orificios Naturales , Enfermedades Nasofaríngeas/diagnóstico , Enfermedades Nasofaríngeas/patologíaRESUMEN
The aim of this study was to investigate the expression of LRRC4 in nasopharyngeal carcinomas, nasopharyngeal precancerous lesions, and nasopharyngitis as well as the clinical significance of LRRC4. Fifty patients with nasopharyngeal carcinoma were selected as study subjects; 28 patients with chronic nasopharyngitis and 22 patients with nasopharyngeal precancerous lesions served as controls. Immunohistochemical analysis was used to study protein expression of LRRC4; the relation between LRRC4 expression and the clinical stage and histopathological features of nasopharyngeal carcinoma was also analyzed. The LRRC4 expression manifested itself as yellow staining in the cytoplasm or nucleus. LRRC4 was strongly expressed in nasopharyngeal epithelial tissues of patients with chronic nasopharyngitis and in nasopharyngeal precancerous lesions; the rates of positive results were 82.1 and 81.8%, respectively. LRRC4 was weakly expressed in nasopharyngeal carcinoma tissues, at a rate of 10% positive results (P< 0.001); there was no significant difference in the expression of LRRC4 among different clinical stages and pathological grades. Therefore, disappearance of LRRC4 expression is a major feature of nasopharyngeal carcinoma.
Asunto(s)
Enfermedades Nasofaríngeas/metabolismo , Neoplasias Nasofaríngeas/metabolismo , Proteínas del Tejido Nervioso/metabolismo , Adulto , Carcinoma , Femenino , Expresión Génica , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Membrana Mucosa/metabolismo , Membrana Mucosa/patología , Carcinoma Nasofaríngeo , Enfermedades Nasofaríngeas/diagnóstico , Enfermedades Nasofaríngeas/genética , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/genética , Nasofaringitis/diagnóstico , Nasofaringitis/genética , Estadificación de Neoplasias , Proteínas del Tejido Nervioso/genética , Lesiones Precancerosas , Pronóstico , Adulto JovenRESUMEN
The gene glutamate receptor, ionotropic, N-methyl D-aspartate 2A (GRIN2A) is associated with development and neuron viability, and our previous studies showed it to be substantially methylated in nasopharyngeal carcinoma, indicating a link to this disease. The aim of this work was to investigate GRIN2A expression and its clinical significance in nasopharyngeal carcinoma, in contrast to nasopharyngitis and nasopharyngeal precancerous lesions. Fifty patients with nasopharyngeal carcinoma were selected as study subjects, while 28 chronic nasopharyngitis patients and 22 individuals with nasopharyngeal precancerous lesions were used as controls. Immunohistochemical analysis was used to study GRIN2A protein expression, and its relationship with nasopharyngeal carcinoma clinical stage and histopathological features were assessed. GRIN2A appeared as yellow staining in the cytoplasm or nucleus. It was strongly expressed in the nasopharyngeal epithelial tissues of patients with chronic nasopharyngitis and in nasopharyngeal precancerous lesions, the proportions of GRIN2A-positive cells being 82.1 and 72.7%, respectively. However, it was weakly expressed in nasopharyngeal carcinoma tissues, with 28.0% of cells testing positive (P < 0.001). No significant difference in the expression of GRIN2A was observed between different clinical stages and pathological grades. We conclude that weak GRIN2A expression is a major feature of nasopharyngeal carcinoma.
Asunto(s)
Enfermedades Nasofaríngeas/metabolismo , Enfermedades Nasofaríngeas/patología , Neoplasias Nasofaríngeas/metabolismo , Neoplasias Nasofaríngeas/patología , Receptores de N-Metil-D-Aspartato/metabolismo , Adulto , Carcinoma , Femenino , Expresión Génica , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Carcinoma Nasofaríngeo , Enfermedades Nasofaríngeas/genética , Neoplasias Nasofaríngeas/genética , Clasificación del Tumor , Estadificación de Neoplasias , Lesiones Precancerosas , Pronóstico , Receptores de N-Metil-D-Aspartato/genética , Adulto JovenAsunto(s)
Humanos , Masculino , Femenino , Adulto , Arginasa/metabolismo , Artritis Reactiva/microbiología , Artritis Reactiva/virología , Leucocitos Mononucleares/microbiología , Leucocitos Mononucleares/virología , Óxido Nítrico Sintasa de Tipo III/metabolismo , Óxido Nítrico/metabolismo , Artritis Reactiva/complicaciones , Artritis Reactiva/inmunología , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/inmunología , Infecciones Bacterianas/microbiología , Estudios de Casos y Controles , Chlamydia trachomatis/clasificación , Chlamydia trachomatis/aislamiento & purificación , Enfermedades Urogenitales Femeninas/complicaciones , Enfermedades Urogenitales Femeninas/inmunología , Enfermedades Urogenitales Femeninas/microbiología , Enfermedades Urogenitales Femeninas/virología , Enfermedades Gastrointestinales/complicaciones , Enfermedades Gastrointestinales/inmunología , Enfermedades Gastrointestinales/microbiología , Enfermedades Gastrointestinales/virología , Hepacivirus/clasificación , Hepacivirus/aislamiento & purificación , Virus de la Hepatitis B/clasificación , Virus de la Hepatitis B/aislamiento & purificación , Hepatitis/complicaciones , Hepatitis/inmunología , Hepatitis/virología , Leucocitos Mononucleares/inmunología , Enfermedades Urogenitales Masculinas/complicaciones , Enfermedades Urogenitales Masculinas/inmunología , Enfermedades Urogenitales Masculinas/microbiología , Enfermedades Urogenitales Masculinas/virología , Enfermedades Nasofaríngeas/complicaciones , Enfermedades Nasofaríngeas/inmunología , Enfermedades Nasofaríngeas/microbiología , Enfermedades Nasofaríngeas/virología , Cultivo Primario de Células , Streptococcus pyogenes/clasificación , Streptococcus pyogenes/aislamiento & purificaciónRESUMEN
Haemophilus influenzae (Hi) é um microrganismo que faz parte da microbiota transitória da nasofaringe humana e, eventualmente, pode causar doenças em indivíduos suscetíveis. A vacina Hib conjugada além de proporcionar uma proteção direta contra a doença nos vacinados, também reduz a colonização da nasofaringe pelas cepas vacinais. Os estudos de portador de Hi na população permitem a caracterização das cepas circulantes, portanto a identificação correta do microrganismo é de fundamental importância para estimar com acurácia o efeito da vacina. A técnica padrão-ouro para detectar Hi em material clínico é a cultura, um método específico, de sensibilidade variável e que demanda maior tempo para a completa identificação do microrganismo. O uso de técnicas moleculares tem auxiliado na diferenciação de Hi de outras espécies do gênero Haemophilus, devido à alta sensibilidade e especificidade para detectar o agente etiológico. Diferentes ensaios de PCR-TR e PCR foram desenvolvidos para o diagnóstico de Hi utilizando diferentes genes alvo específicos como o gene hpd e o gene fucK. Estes genes são altamente conservados e permite a detecção de Hi capsulado e não capsulado. O principal objetivo deste estudo foi avaliar a acurácia da PCR-TR utilizando o marcador molecular hpd#3 para detectar o Hi na secreção de nasofaringe de crianças saudáveis comparando-a com a cultura. Um total de 410 amostras de secreção de nasofaringe estocadas a -70ºC em meio STGG foi selecionado aleatoriamente para esta avaliação. Pela PCR-TR, 161 (39,2%) amostras foram positivas para o gene hpd e 249 (60,8%) negativas. Pela cultura, 166 (40,5%) amostras foram positivas para Hi e 244 (59,5%) culturas negativas. Sendo assim, a PCR-TR apresentou uma sensibilidade de 90,9% (95% IC: 85,3-94,7) e especificidade de 95,9% (95% IC: 92,4-97,9) quando comparada à cultura para detectar Hi...
Haemophilus influenzae (Hi) colonizes the human nasopharynx and eventually can cause diseases in susceptible individuals. The Hib conjugate vaccine provides direct protection against the diseases and also reduces nasopharyngeal colonization by vaccine strain. Hi carriage studies allow the knowledge of circulating strains and the accurate identification of the microorganism is important to estimate the effect of the vaccine. Culture is the gold standard method to detect Hi in clinical samples, this is a specific method, with variable sensitivity and demand more time for the complete identification of the microorganism. The use of molecular techniques has helped in differentiating Hi from other species of the Haemophilus spp. due to the high sensitivity and specificity to detect the etiologic agent. Different RT-PCR and PCR assays were developed for the diagnosis of Hi using several biomarker genes such as hpd and fucK gene. These genes are highly conserved and are present in encapsulated and non-encapsulated Hi strains, allowing the detection of both variants. The aim of this study was to evaluate the accuracy of RT-PCR to detect Hi in nasopharyngeal samples of healthy children vaccinated against Hib comparing it with the culture. A total of 410 nasopharyngeal swabs stored at -70°C in STGG medium were randomly selected to evaluate RT-PCR assay targeting protein D (hpd#3). Considering the 410 nasopharyngeal swabs, 161 (39.2%) samples were positive for Hi and 249 (60.8%) had negative RT-PCR. By culture, 166 (40.5%) samples were positive for Hi and 244 (59.5%) were negative. Thus, the hpd#3 RT-PCR showed a sensitivity of 90.9% (95% CI: 85.3 - 94.7) and a specificity of 95.9% (95% CI: 92.4 - 97.9) when compared to culture to detect Hi in nasopharyngeal swabs. The results showed no significant difference (McNemar's chi-square = 0.64 p>0.5) between RT-PCR and culture and the Kappa coefficient showed an excellent agreement (0.873) between the two techniques...
Asunto(s)
Humanos , Niño , Amplificación de Genes , Enfermedades Nasofaríngeas/diagnóstico , Haemophilus influenzae , Portador Sano , Reacción en Cadena de la Polimerasa , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
Introduction: Juvenile nasopharyngeal angiofibroma is a rare, highly vascular, and histologically benign tumor, generally observed in male adolescents. It shows very aggressive behavior due to local invasiveness and is associated with various symptoms. Juvenile nasopharyngeal angiofibroma originates in the sphenopalatine forame, causing epistaxes and nasal obstruction. Objective: To retrospectively describe our experience in the diagnosis and treatment of patients with juvenile nasopharyngeal angiofibroma. Scientific drawing: Retrospective, descriptive study conducted after approval from the Ethics Committee of the Federal University of Sergipe (protocol 0114.0.107.000 -11). Methods: We analyzed findings in 20 patients who underwent surgery between 2004 and 2011. Factors analyzed include patient age and gender, symptoms, stages, treatment, length of surgery, intraoperatory bleeding, postoperative need for nasal tampons, hospitalization time, complications, and tumor recurrence. Results: Patients were aged 10-29 years. All patients were treated surgically, including 17 who underwent endoscopic surgery. The mean operation time was 120 min, and the mean bleeding volume was 300 mL. Seventeen patients required clamping of the external carotids and tumor embolization. Conclusion: Endoscopic surgery alone or with other conventional techniques was safe for the treatment of angiofibromas of different stages...
Asunto(s)
Humanos , Masculino , Niño , Adolescente , Adulto Joven , Angiofibroma/cirugía , Angiofibroma/diagnóstico , Angiofibroma/terapia , Enfermedades Nasofaríngeas/etiología , Embolización Terapéutica , Epistaxis/terapia , Nasofaringe/fisiopatología , Procedimientos Quirúrgicos Otorrinolaringológicos/métodosRESUMEN
Introducción: Las infecciones respiratorias agudas constituyen un importante problema de salud pública, en este caso reconocidas como la principal causa de morbilidad pediátrica y frecuente motivo de utilización de los servicios de salud. Objetivo: Identificar las características epidemiológicas y clínicas de las infecciones producidas por los nuevos virus respiratorios emergentes y convencionales en las muestras de secreciones nasofaríngeas. Método: Se realizó un estudio epidemiológico, descriptivo, en niños menores de 15 años ingresados en el hospital pediátrico docente Luis Ángel Milanés Tamayo de Bayamo, Granma, en el periodo comprendido del 1ro de Diciembre del 2010 al 31 de diciembre del año 2011. El universo estuvo constituido por 144 pacientes con el diagnóstico de Infección Respiratoria Aguda, con toma de exudado nasofaríngeo y la muestra 119 casos con aislamientos virales positivos. Resultados: Predominó el grupo de edad 1 a 4 años con un 47,08 por ciento, y el sexo masculino con 55,46 por ciento. Las neumonías y bronconeumonías resultaron los diagnósticos más frecuentes con 28 y 26 casos respectivamente. Los virus respiratorios emergentes encontrados en las muestras fueron los metapneumovirus y el bocavirus Humano con 12 casos cada uno de ellos. Conclusiones: Los niños menores de 5 años, con diagnósticos de neumonías, bronconeumonías y rinofaringitis aguda catarral fueron los más afectados. El virus de la Influenza A H1N1 y los rinovirus se aislaron con mayor frecuencia en el grupo de 1 a 4 años y el virus sincitial respiratorio en los menores de un año.(AU)
The Acute Respiratory Infections constitute an important problem of public health, in this case they are recognized like the main cause of pediatric morbility and the frequent reason for its application in health services. Objective: To identify the epidemiologic and clinical characteristics of the infections produced by the new respiratory, emergent and conventional viruses in the samples of nasopharyngeal secretions. Method: it was realized a descriptive, epidemiologic study in children under 15 years, hospitalized in General Luis Ángel Milanés Tamayo Teaching Pediatric Hospital in Bayamo, Granma, in the period between December 1rst, 2010 to December 31, 2011. The universe was constituted by 144 patients with the diagnostic of Acute Respiratory Infection, with nasopharyngeal exudates and the sample had 119 cases with positive viral isolations. Results: The group of age between 1 to 4 years with 47, 08 per cent and the male sex with 55, 46 per cent prevailed. The pneumonias and Bronchopneumonias were the most frequent diagnostics with 28 and 26 cases. The emergent respiratory viruses found in the samples were the Metapneumovirus and the Human Bocavirus with 12 cases each one. Conclusions: The children under 5 years with diagnostics of pneumonias, Bronchopneumonias and the Acute Catarrhal Rhinopharyngitis were the most affected. The virus of the Influenza A H1N1 and the Rhinovirus isolated with greater frequency in the group of 1 to 4 years and the Respiratory Sincitial virus in children under a year.(EU)
Asunto(s)
Humanos , Masculino , Femenino , Infecciones por Virus Sincitial Respiratorio/microbiología , Enfermedades Nasofaríngeas/microbiología , Virus Sincitiales Respiratorios/aislamiento & purificación , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Niño , Metapneumovirus/aislamiento & purificación , Bocavirus Humano/aislamiento & purificaciónRESUMEN
La miasis es la infestación de animales vertebrados y humanos con larvas de dípteros, las cuales, por lo menos durante un cierto periodo de tiempo, se alimentan de tejidos vivos y muertos, líquidos corporales o alimentos ingeridos del hospedero. La miasis bucal es una condición rara no reportada en nuestro medio frecuentemente, y se describe asociada a factores como la pobre higiene oral, nivel socioeconómico bajo, alcoholismo e indigencia. Se presentó el caso de un paciente de 83 años, masculino, de color de piel blanca, con antecedentes de cardiopatía isquémica e hipertensión arterial, quien luego de una pérdida accidental por el bosque, estuvo obligado a dormir al aire libre sin ningún tipo de protección, durante tres noches, y a beber agua estancada. Llegó al cuerpo de guardia del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, en Matanzas, con un cuadro de disnea, lesiones linguales y del paladar, así como expectoración sanguinolenta con abundantes larvas. Se decide llevar al quirófano para la limpieza mecánica de las lesiones presentes(AU)
The myiasis is the infection of vertebrate animals and humans with insects' larvae that, during certain period of time, feed on the living and death tissues, body fluids or the foods eaten by the host. The buccal myiasis is a rare condition that is not frequently reported in our settings. We describe it associated to factors like poor oral hygiene, low socioeconomical level, alcoholism and destitution. We present the case of a male, white patient, aged 83 years old, with antecedents of ischemic heart disease and arterial hypertension, who, after an incidental lost in the woods, had to sleep outdoors without any protections, during three days and to drink stagnant water. He arrived at the emergency unit of the University Clinico-Surgical Hospital Comandante Faustino Perez, in Matanzas, with clinical features of dyspnea, lingual and palatal lesions, and also bloody expectoration with plentiful larvae. We decided to carry up a surgery to clean mechanically the lesions he had(AU)
Asunto(s)
Humanos , Masculino , Anciano de 80 o más Años , Miasis , Enfermedades Nasofaríngeas , DípterosRESUMEN
La miasis es la infestación de animales vertebrados y humanos con larvas de dípteros, las cuales, por lo menos durante un cierto periodo de tiempo, se alimentan de tejidos vivos y muertos, líquidos corporales o alimentos ingeridos del hospedero. La miasis bucal es una condición rara no reportada en nuestro medio frecuentemente, y se describe asociada a factores como la pobre higiene oral, nivel socioeconómico bajo, alcoholismo e indigencia. Se presentó el caso de un paciente de 83 años, masculino, de color de piel blanca, con antecedentes de cardiopatía isquémica e hipertensión arterial, quien luego de una pérdida accidental por el bosque, estuvo obligado a dormir al aire libre sin ningún tipo de protección, durante tres noches, y a beber agua estancada. Llegó al cuerpo de guardia del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, en Matanzas, con un cuadro de disnea, lesiones linguales y del paladar, así como expectoración sanguinolenta con abundantes larvas. Se decide llevar al quirófano para la limpieza mecánica de las lesiones presentes.
The myiasis is the infection of vertebrate animals and humans with insects' larvae that, during certain period of time, feed on the living and death tissues, body fluids or the foods eaten by the host. The buccal myiasis is a rare condition that is not frequently reported in our settings. We describe it associated to factors like poor oral hygiene, low socioeconomical level, alcoholism and destitution. We present the case of a male, white patient, aged 83 years old, with antecedents of ischemic heart disease and arterial hypertension, who, after an incidental lost in the woods, had to sleep outdoors without any protections, during three days and to drink stagnant water. He arrived at the emergency unit of the University Clinico-Surgical Hospital Comandante Faustino Perez, in Matanzas, with clinical features of dyspnea, lingual and palatal lesions, and also bloody expectoration with plentiful larvae. We decided to carry up a surgery to clean mechanically the lesions he had.
Asunto(s)
Humanos , Masculino , Anciano de 80 o más Años , Dípteros , Enfermedades Nasofaríngeas , MiasisRESUMEN
Streptococcus pneumoniae constitui um dos mais importantes patógenos bacterianos do trato respiratório, podendo causar infecções invasivas e não invasivas, levando a altas taxas de morbi-mortalidade, particularmente em crianças menores de cinco anos de idade. A bactéria ganha acesso ao hospedeiro através da colonização da nasofaringe, que representa um importante reservatório para a transmissão deste patógeno na comunidade, contribuindo para a disseminação horizontal de S. pneumoniae entre os indivíduos de uma população. No presente estudo, procuramos caracterizar o perfil de colonização nasofaringeana por S. pneumoniae em pacientes menores de cinco anos de idade com suspeita clínica de pneumonia, atendidos na Unidade de Saúde de São Marcos, Bairro de Pau da Lima, Salvador, no ano de 2009. Um total de 205 swabs foram coletados entre as crianças consideradas elegíveis para o estudo. Os isolados de S. pneumoniae foram identificados através de métodos microbiológicos clássicos e a determinação do sorogrupo/sorotipo foi realizada empregando-se a técnica de Multiplex-PCR. A sensibilidade a sete antimicrobianos foi testada através da técnica de microdiluição em caldo, sendo que os isolados com CIM para penicilina ≥ 0,125 μg/mL foram considerados não-susceptíveis. A técnica de PFGE foi realizada para 26 isolados correspondentes aos sorotipos mais frequentes e associados a não-sensibilidade à penicilina (sorotipos 14, 19F e 23F). Um total de 72 (35,1%) crianças foram diagnosticadas com pneumonia, sendo 39 (54,2%) menores de dois anos de idade. A taxa de colonização geral foi de 50,2%, não havendo diferença entre essas taxas quando se considerou o grupo de crianças confirmadas e suspeitas para pneumonia. Crianças na faixa etária de 36 a 47 meses formaram o grupo com maior risco de ter pneumonia bacteriana (OR: 3.17 [1.29-7.88]). Entre os sorotipos encontrados, o sorogrupo 6 (6A/6B) (17,3%) foi predominante, seguido dos sorotipos 14 (15,4%), 19F (10,6%), sorogrupo 15 (15B/15C) (9,6%), 23F (6,7%) e o sorotipo 19A (6,7%). Os demais sorotipos e sorogrupos compreenderam 33,7%. O padrão de sorotipos foi semelhante aqueles encontrados nos casos de meningite pneumocócica na cidade de Salvador. Um total de 41 isolados (39,8%) apresentaram CIM ≥ 0,125 μg/mL para penicilina e a resistência a SMX-TMP foi identificada em 69,2% dois isolados. A tipagem por PFGE identificou 11 padrões eletroforéticos, sendo que a maioria dos isolados do sorotipo 14 estavam relacionados a clones amplamente disseminados entre os casos de doença pneumocócica (A e GK). Um total de 50,5% dos isolados foram de sorotipos inclusos na vacina decavalente (PCV10) e considerando os isolados não-susceptíveis à penicilina, esta representatividade foi de 90,2%. O estudo ressalta a importância de um contínuo monitoramento do perfil de sorotipos na colonização nasofaringeana por S. pneumoniae, no período pós-vacina e da necessidade de busca.