YOU ARE NOW CONNECTED TO THE MEDLINE (1994 - 97) FILE. ==THROAT DISORDERS== 1 AUTHOR Schonheyder HC TITLE [Streptococcal tonsillitis: failure of penicillin therapy] SOURCE Ugeskr Laeger 1994 Mar 28;156(13):1931-4 ABSTRACT Group A beta-haemolytic streptococci (GAS) have remained sensitive to penicillin, but penicillin V therapy does not eradicate GAS in 5-30% of cases of GAS tonsillitis. Multiple factors contribute to treatment failure, the foremost among these being lack of compliance with the prescribed therapy, tolerance of GAS towards the killing effect of penicillin, inactivation of penicillin by bacterial beta-lactamases, and absence of bacteriocin-producing non-haemolytic streptococci from the oral flora. The effect of local immunity should be further assessed. It is unlikely that environmental sources of GAS play any significant role. Throat cultures should not routinely be repeated after penicillin treatment. If, in special cases, a new course of treatment is indicated, penicillin V should still be preferred. In the light of modern pharmacological insights, multiple dosing schedules may be desirable in the therapy of GAS tonsillitis. 1 AUTHOR Pospiech L AUTHOR Kuzniar J AUTHOR Rostkowska-Nadolska B AUTHOR Mroz E TITLE [Influence of vapours of paint and toxic dusts on mucous membranes of the upper airways in paint and varnish factory workers] SOURCE Med Pr 1996;47(5):445-53 ABSTRACT Macroscopic, cytologic and bacteriologic conditions of mucous membranes of the upper airways in workers (n = 146) of the Polifarb Factory, Wroclaw, exposed to dusts and solvent vapours used in the paint and varnish production was estimated. In 89% of the workers, pathologic changes in throat mucous membranes were observed. Three types of macroscopic changes were distinguished. In workers with the shortest period of employment, laryngeal oedema congestion alteration was diagnosed, and atrophic changes with medium intensity were observed in workers employed for a long period. It was found that cytologic changes in the nose mucous membrane depended on the duration of exposure. Inflammation cytograms appeared during the first period of exposure to the substances discussed. The longer period of exposure, the more clear features of metaplasia squamous epithelium. The composition of the nose and throat bacterial flora changed according to the length of employment. An increased growth of G(-) genera Enterobacter, Klebsiella, Proteus, Escherichia and Candida fungi was found in workers with long period of employment. 2 AUTHOR Medaglini D AUTHOR Pozzi G AUTHOR King TP AUTHOR Fischetti VA TITLE Mucosal and systemic immune responses to a recombinant protein expressed on the surface of the oral commensal bacterium Streptococcus gordonii after oral colonization. SOURCE Proc Natl Acad Sci U S A 1995 Jul 18;92(15):6868-72 ABSTRACT To circumvent the need to engineer pathogenic microorganisms as live vaccine-delivery vehicles, a system was developed which allowed for the stable expression of a wide range of protein antigens on the surface of Gram-positive commensal bacteria. The human oral commensal Streptococcus gordonii was engineered to surface express a 204-amino acid allergen from hornet venom (Ag5.2) as a fusion with the anchor region of the M6 protein of Streptococcus pyogenes. The immunogenicity of the M6-Ag5.2 fusion protein was assessed in mice inoculated orally and intranasally with a single dose of recombinant bacteria, resulting in the colonization of the oral/pharyngeal mucosa for 10-11 weeks. A significant increase of Ag5.2-specific IgA with relation to the total IgA was detected in saliva and lung lavages when compared with mice colonized with wild-type S. gordonii. A systemic IgG response to Ag5.2 was also induced after oral colonization. Thus, recombinant Gram-positive commensal bacteria may be a safe and effective way of inducing a local and systemic immune response. 4 AUTHOR Heeg P AUTHOR Heizmann W AUTHOR Mentzel H TITLE [Infections caused by Flavobacterium meningosepticum in patients in a neonatal intensive care unit] SOURCE Zentralbl Hyg Umweltmed 1994 Apr;195(4):282-7 ABSTRACT During a period of three and a half months 7 neonates from a neonatal intensive care unit became infected by F. meningosepticum, serotype B. The pathogens could be isolated from the tracheal secretions and--less frequently--from throat swabs, gastric juice and nose swabs. Environmental sampling led to the isolation of F. meningosepticum from the humidification fluid of the respirator, from vaporizers as well as from the artificial ventilation tubing. F. mengingosepticum was found in the water of humidifiers from 3 children, who developed neither a colonization nor an infection. In a number of cases the patients' environment was contaminated with F. meningosepticum prior to colinization or infection. Nearly identical resistance patterns against the antibiotics tested, could be demonstrated for the isolated strains. The primary source of infection could not be identified, it is supposed however that the index patient had been admitted to the hospital nine months before. A strict hygienic policy, like consequently performed hand hygiene, adequate processing of ventilation equipment and application of sterile tubings led to extinction of the infections. During subsequent environmental controls, F. meningosepticum could not be isolated. 6 AUTHOR Wessels MR AUTHOR Bronze MS TITLE Critical role of the group A streptococcal capsule in pharyngeal colonization and infection in mice. SOURCE Proc Natl Acad Sci U S A 1994 Dec 6;91(25):12238-42 ABSTRACT To study the role of the group A streptococcal capsule in pharyngeal colonization, we used two acapsular mutants derived from a type 24 strain of group A Streptococcus by transposon mutagenesis. One mutant had a stable acapsular phenotype due to a transposon-associated chromosomal deletion of essential capsule synthetic genes, while the second mutant could revert to the encapsulated phenotype at a low frequency (< 10(-4)) upon spontaneous excision of the transposon from the capsule-synthesis region of the chromosome. Both acapsular mutants were sensitive to phagocytic killing in vitro and had reduced virulence in mice after intraperitoneal challenge. Mice inoculated intranasally with the stable acapsular mutant rapidly cleared the organisms from the pharynx, and no mice died. In contrast, throat cultures of animals challenged with the revertible mutant yielded many encapsulated revertants, and mortality was similar to that of animals challenged with the parent strain. The rapid emergence of a population of encapsulated revertants in the pharynx implies that the capsule conferred a powerful selective advantage in this environmental niche. Together with the complete avirulence of the stable acapsular mutant, these observations indicate that the hyaluronic acid capsule plays a critical role in colonization and infection of the pharynx by group A streptococci. YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. 1 AUTHOR Hareyama M AUTHOR Nagakura H AUTHOR Tamakawa M AUTHOR Hyodo K AUTHOR Asakura K AUTHOR Horikoshi T AUTHOR Tanaka S AUTHOR Imai K AUTHOR Hattori A AUTHOR Oouchi A AUTHOR Shido M AUTHOR Koshiba H AUTHOR Sakata K AUTHOR Morita K TITLE Retropharyngeal abscess after radiation therapy and cis-platinum, 5-fluorouracil treatment for nasopharyngeal carcinoma with collagen disease: report of two patients and a review of the literature. SOURCE Jpn J Clin Oncol; VOL 26, ISS 3, 1996, P189-93 (REF: 15) ABSTRACT Collagen disease are frequently associated with malignant tumors. Recently, radiotherapy combined with chemotherapy has been recommended for improving the efficacy of treatment for nasopharyngeal carcinoma. Two patients with nasopharyngeal carcinoma complicated by collagen diseases (dermatomyositis in one, and Sjogren's syndrome with mixed connective tissue disease in the other) were given radiotherapy combined with chemotherapy consisting of cis-platinum and 5-fluorouracil. Following this combination therapy, both patients developed retropharyngeal abscess and ulceration of the mucosal membrane on the posterior wall of the oropharynx; there was no tumor cell involvement. Because these injuries were more severe than would have been expected from radiotherapy alone, it is recommended that special attention be paid to combination therapy in patients with nasopharyngeal carcinoma complicated by collagen disease. 5 AUTHOR Dietz A AUTHOR Nollert J AUTHOR Maier H AUTHOR Rudat V AUTHOR Flentje M TITLE [The problem of radiogenic and chemotherapy-induced mucositis of the mouth and and oropharynx exemplified by accelerated radiochemotherapy with carboplatin in patients with inoperable squamous epithelial carcinomas of the head-/neck area. Heidelberg experiences] SOURCE HNO; VOL 43, ISS 7, 1995, P403-13 ABSTRACT Despite numerous treatment measures mucositis of the mouth and pharynx due to radiochemotherapy frequently remains refractory to therapy. In most cases high doses of pain medications are till required. However, mucositis as a strong early reaction may be controllable by limiting cancer therapy. Within the current framework of accelerated radiochemotherapy with carboplatin, 50 patients with inoperable squamous cell carcinomas of the head and neck were followed from 1992 to 1994. Acute toxicity was documented from the first through eighth week after starting therapy. From the fifth week on, the degree of mucositis found was > 3 (WHO scale) in 24 patients. The extent of mucositis in 5 patients required interrupting therapy for 10 days on average. In 14 cases the average stay in hospital had to be prolonged by 10.2 days because of severe inflammation. In all, the average duration of mucositis after the end of the therapy amounted to 9.6 weeks. Twenty patients required bypass feedings with transnasal stomach tubes or percutaneous gastrostomy (PEG) tubes that were later removed. In addition, the incidences of dysphagia, xerostomia, hoarseness, skin reactions, nausea or vomitus and myelotoxicity were recorded. Descriptions of the supportive care concepts used at the University of Heidelberg are given and the supportive care concepts available scientific literature is updated. 8 AUTHOR Kuratani SC AUTHOR Bockman DE TITLE Inhibition of the development of placodal ganglia, thymus and post-otic pharyngeal epithelium by bis-diamine. SOURCE Anat Rec 1991 Apr;229(4):46A-47A ABSTRACT Congenital anomalies involving derivatives of the post-otic pharyngeal apparatus, including thymus, occur naturally and have also been produced experimentally by the admininstration of chemicals and neural crest ablation. In order to study the mechanism of induction of these anomalies, we administered 100 mg bis-diamine (Fertilysin) intragastrically to rats on days 9 and 10 of gestation (day sperm found = day 0). Bis-diamine was administered in gum tragacanth (1% aqueous). Gum tragacanth was administered alone in controls. Fetuses were harvested on gestation days 13, 14, 15 and 20 and prepared routinely for study of serial histological sections after staining with H&E or localization with HNK-1 antibodies. Controls displayed normal development. After bis-diamine administration, the pharyngeal pouches posterior to pouch 2 failed to develop properly. The thymus and parathyroids failed to develop, although small epithelial nodules sometimes were present. Furthermore, the petrosal and nodose ganglia were missing or reduced in size. The sympathetic system and spinal ganglia developed normally in the experimental animals. These results are interpreted as indicating that bis-diamine inhibits epithelial development in the pharyngeal area, including both ectoderm and endoderm. 12 AUTHOR Hoffman RS AUTHOR Sauter D TITLE Methemoglobinemia Resulting from Smoke Inhalation SOURCE Veterinary and Human Toxicology, Vol. 31, No. 2, pages 168-170, 14 references, 19891989 ABSTRACT Case reports were presented which supported the significance of symptoms occurring in individuals with concomitant poisoning with carboxyhemoglobin and methemoglobin levels, following fire exposure. A 66 year old nonsmoking white female presented with cough and shortness of breath after being removed from a burning dwelling. While her skin and nails were covered with soot, there was no singed nasal hair, erythema or edema of the pharynx or production of carbonaceous sputum. Her symptoms improved following several minutes of oxygen therapy. Arterial blood gas analysis showed a pH of 7.48, a carbon-dioxide tension of 32mmHg, and an oxygen tension of 92mmHg. A carboxyhemoglobin level was 9 percent and the measured oxygen saturation was 72 percent with a methemoglobin level of 19 percent. Two firefighters who had worked in different areas of the fire had carboxyhemoglobin levels of 6 and 12 percent with corresponding methemoglobin levels of 12 and 14 percent, respectively. None of the three were cyanotic, but all were covered with soot. The first patient's carboxyhemoglobin and methemoglobin levels fell to 4 and 17 percent, respectively, after 2 hours of oxygen therapy. The authors conclude that there is some risk for methemoglobinemia to victims of smoke inhalation. The clinical syndrome may be difficult to separate from hypoxia, carbon-monoxide exposure, and cyanide poisoning. It is suggested that treatment with methylene-blue may have brought about a more rapid recovery in these three patients. 16 AUTHOR Midulla M AUTHOR Sollecito D AUTHOR Feleppa F AUTHOR Assensio AM AUTHOR Ilari S TITLE Infection by Airborne Chlamydia trachomatis in a Dentist Cured with Rifampicin after Failures with Tetracycline and Doxycycline SOURCE British Medical Journal, Vol. 294, No. 6574, page 742, 5 references, 19871987 ABSTRACT Three cases of apparent airborne transmission of Chlamydia-trachomatis (CT) were reported. A 29 year old physician experienced ocular burning, pruritus and moderate conjunctival secretion, particularly in the morning. Tests for viruses and bacteria were negative. Ten months later reddening of the glans penis and pruritus of the foreskin were noticed. CT was isolated from the pharynx, conjunctiva, and urethra. Rifampicin at 900 milligram doses per day for 15 days cleared the symptoms, after treatment with tetracycline and doxycycline proved ineffective. At the time the first patient experienced genital symptoms and underwent treatment, his wife, also a physician, began to experience conjunctival burning and reddening, vaginal itching, dispareunia, and leucorrhea. Specimens were positive for CT. Administration of rifampicin was again effective following failure of tetracycline and doxycycline therapy. A 28 year old dentist performed a filling on the first patient while he was on doxycycline therapy. The dentist used surgical gloves, but was exposed to the patient's saliva which was vaporized by the use of the dental drill. Three days later the dentist developed ocular reddening and itching, followed by bilateral purulent conjunctivitis. Treatment similar to that of the other patients was given, with rifampicin proving effective. In all three cases the administration of tetracycline and doxycycline was ineffective. The authors suggest that dentists should use plastic face screens for protection from contaminated aerosol droplets.