Background: Scleroma is a chronic specific granulomatous disease. It is considered endemic in Central America, Egypt, tropical Africa, India, and Indonesia. The most common complaint is nasal obstruction, other symptoms include; rhinorrhea, epistaxis, dysphagia, stridor, and dysphonia. Aim: So our objective was to focus on the various clinical and radiological manifestations of scleroma in an endemic area, with some atypical symptoms and signs, and to alert physicians to suspect scleroma or its complications in any case of unexplained nasal lesion. Material and methodology: Our study included 88 cases who were admitted in our otorhinolaryngology department. They presented with various manifestations of Rhino-pharyngo-laryngo scleroma, out of these patients 16 cases showed atypical presentations. Our diagnosis was based on clinical and radiological examination, aided by bacteriological and pathological examination. Results: Patients with typical rhinoscleroma (72 patients) presented with various nasal and laryngo-tracheal symptoms. 16 patients (18%) presented complaining of various nasal symptoms and signs, which were not suspected to be rhinoscleroma, so our workup was directed to diagnose those patients, and their final diagnosis was reached to be rhinoscleroma, we sub classified those patients according to their presentation. Conclusion: Rhinoscleroma can present clinically with atypical features, so in order to avoid misdiagnosis, it is important to keep in mind these atypical manifestations.Please cite this paper as: Fawaz S, Tiba M, Salman M, and Othman H. Clinical, radiological and pathological study of 88 cases of typical and complicated scleroma. Clin Respir J 2011; 5: 112-121.
Hajj is associated with an increased risk of the transmission of infectious diseases including upper respiratory tract infections (URTIs). It can be a focal point for the emergence, persistence and dissemination of antimicrobial-resistant (AMR) bacteria. The overuse of antibiotics during Hajj can promote the development of antimicrobial resistance. Little information is known regarding the true appropriateness of prescribing antibiotics for treating URTIs during Hajj. Here we studied the rate, patterns and appropriateness of antibiotic prescription among a cohort of pilgrims who were treated for URTIs during the 2018 Hajj season. Adult pilgrims who sought medical services for URTIs [presenting with coryza, runny nose, nasal irritation, nasal congestion, cough, sore throat, headache or fever (even if subjective)] within the Holy sites were enrolled in this study and consented to provide swabs and medical information. A total of 121 pilgrims were enrolled, with the majority (60.3 %) originating from North African Arab countries. Most were male (89.3 %) with a median age of 45 years. Bacterial infections were detected in 7.3 % (n=9) of the URTI cases. The identified bacteria included Haemophilus influenzae (n=6, all resistant to ampicillin), Streptococcus pneumoniae (n=2), Staphylococcus aureus (n=1, resistant to oxacillin) and Moraxella catarrhalis (n=1, resistant to ampicillin and trimethoprim/sulfamethoxazole). The antibiotic prescription rate was 52.1%, most of which was amoxicillin (81 %). The data demonstrated that the proportion of appropriate practices in treating bacterial URTIs in this cohort was 45.5 %. This study highlights the need for implementing laboratory identification of the aetiological agents and related AMR profiles when treating URTIs in Hajj, rather than relying on clinical assessment alone.
AIM:To determine the distribution of vancomycin MIC and the frequency of S. aureus strains with reduced vancomycin susceptibility among Methicillin-Resistant Staphylococcus aureus (MRSA) isolates.METHODS:MRSA isolates (n = 100) were tested for reduced susceptibility to vancomycin using MIC broth microdilution method (BMD), vancomycin screening agar with different vancomycin concentrations with and without casein, and Vitek 2 system.RESULTS:BMD detected (22%) vancomycin-intermediate S. aureus (VISA) and (78%) vancomycin-susceptible S. aureus (VSSA) but couldn’t detect nine (Heterogeneous VISA) (hVISA) isolates (9%) with MIC ≤ 2 µg/ml that grew on screening agar 4 µg/ml or 6 µg/ml. Adding casein to vancomycin screening agar increased detection rate of VISA by 4.5%. Screening agar with 6 µg/ml vancomycin overall detection rate for VISA was 95.45%. Probable ‘pre-hVISA’isolates (17%) showed growth on vancomycin screening agar 2 µg/ml with casein. Vitek 2 system failed to detect any VISA isolates.CONCLUSION:Vancomycin screening agar; 2 µg/ml and (4 and 6 µg/ml) were able to detect; probable “pre hVISA and (hVISA and VISA) isolates respectively based on their BMD MIC values. Decreased vancomycin susceptibility in MRSA isolates might be related to MIC creep. Analysis of vancomycin MIC values over longer periods is recommended to further study this phenomenon and its impact on vancomycin treatment failure.
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