Background Melioidosis, the infection caused by Burkholderia pseudomallei, is associated with a high case fatality rate, due in part to difficulties in clinical recognition and diagnostic confirmation of the disease. Although head and neck involvement is common in children, specific disease manifestations differ between geographic regions. The aim of this study was to provide a detailed description of melioidosis of the head and neck among children in Sarawak, Malaysia, and determine if fine-needle aspiration of suspected head or neck lesions could improve melioidosis diagnosis. Methods We conducted a retrospective descriptive study of all children aged < 12 years with culture-confirmed melioidosis presenting with head and neck manifestations and admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2020. Fine-needle aspiration of head and neck lesions suspected to be due to melioidosis with inoculation in blood culture bottles (FNA + BCB) was used from the beginning of 2016. Results Of 34 children with culture-confirmed melioidosis, 20 (59%) had an infection involving one or more sites in the head and neck. Of these, 17 (85%) were diagnosed in or after 2016. Cervical lymph nodes were the most common organ or site affected, involved in 19 (95%) children. Clinical presentations of B. pseudomallei lymph node infections were highly variable. Five (25%) children had salivary gland involvement. Lacrimal gland involvement (dacryocystitis) and skin or soft tissue infection (scalp abscess) were less frequent. B. pseudomallei was isolated from the head or neck using FNA + BCB in 15 (75%) children and by standard culture methods of direct plating of pus on agar following incision and drainage in only 2 (10%) children. B. pseudomallei was isolated from non-head or neck specimens or blood in 3 (15%) children. Conclusions Manifestations of pediatric head and neck melioidosis in Sarawak, Malaysia, differ from those of other regions. Fine-needle aspiration, mainly of affected cervical lymph nodes, facilitates B. pseudomallei detection and enables confirmation of melioidosis infections.
Figure 1: Computed tomography scan showing foreign body seen over left frontal sinus. ABSTRACTForeign body in paranasal sinus is rare. Very few cases have been reported of lodgement of foreign body in paranasal sinuses. Garces and Norris reported that 70% of these foreign bodies usually appeared after maxillofacial traumas and 30% appeared during or after dental procedures of maxilla. Foreign bodies are less common in the frontal sinus as compared to maxillary sinus. This is a case of foreign body in frontal sinus in an eighteen-year-old gentleman after a road traffic accident.
Objective: The aim of this study is to investigate the prevalence of sensori-neural hearing loss and ototoxicity in acute myeloid leukemia (AML) patients.Study design: This is a prospective non-randomized study.
A 60-year-old gentleman presented with dyspnoea, hoarse voice and stridor. He had no history suggestive of airway instrumentation or prior laryngeal pathology. Bedside flexible nasopharyngolaryngoscope revealed grossly oedematous bilateral false vocal cord. Computerized tomography scan of the neck with contrast showed rim-enhancing lesions at the paraglottic space and bilateral false vocal cord. A presumptive diagnosis of isolated paraglottic abscess was made. Patient was subjected to tracheostomy, then endoscopic assessment of the larynx. Pus was drained and parenteral antibiotics were commenced. Further assessment revealed improving false vocal cords oedema but right vocal cord palsy was documented. Patient was subsequently discharged well and tracheostomy was successfully decannulated once vocal cords and voice returned to normal. Although occurrence of isolated abscess in the paraglottic region is rare, this disease entity should be considered as a differential diagnosis in the presentation of upper airway obstruction with no prior laryngeal pathology or airway instrumentation.
Tracheostomy is a common procedure in otorhinolaryngology and it is not without its own complications. Tracheoinnominate artery fistula is one of the late complication of tracheostomy. It commonly results in fatality if not detected and treated early. Herein, we present a rare case of a patient with underlying nasopharyngeal carcinoma post radiotherapy, cryotherapy and salvage neck dissection with tracheoinnominate artery fistula as a consequence of tracheostomy who defied statistics and was successfully stented. Objective of this case report is to create awareness regarding the differential diagnosis of massive bleeding from tracheostomy and immediate life saving measures the can be undertakenin addition to theneed to be vigilant in a patient with multiple risk factors that predisposes to the occurrence of tracheoinnominate artery fistula.International Journal of Human and Health Sciences Vol. 03 No. 04 October’19 Page : 238-240
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