Methicillin-resistant Staphylococcus aureus superinfection over untreated candidiasis resulting in oronasal fistula

Abstract

with history of wound in mouth, causing nasal regurgitation of food for a period of 4 weeks. Examination revealed, a 3 × 3 cm oval ulcer at the junction of hard and soft palate in the midline, covered with extensive pseudomembrane and associated with foul smell. The ulcer was tender, with well-defined borders and everted margins [Figure 1]. Occlusal radiographs showed evidence of communication with the nasal cavity. Routine blood investigations along with serology (VDRL for syphilis and ELISA for HIV) were negative. Histopathology demonstrated candidal hyphae, while pus culture and antibiogram showed isolated methicillin-resistant Staphylococcus aureus (MRSA). Accordingly, local debridement was done, along with parenteral vancomycin 1 g/day administered 8 hourly and oral fluconazole 150 mg once daily for a week. The patient was referred for surgical management of the fistula after satisfactory healing.

Current insights in the preclinical study of palatal wound healing and oronasal fistula after cleft palate repair

“…Sadhu et al have reported that postoperative infection caused poor palatal wound healing, especially in adults ( Sadhu, 2009 ). A methicillin-resistant Staphylococcus aureus infection with untreated candidiasis leading to poor palatal wound healing has also been reported ( Palla et al, 2019 ). Unfortunately, the studies did not release the relationship between these infections and poor palatal wound healing in detail.…”