Burkholderia cepacia complex nasal isolation in immunocompetent patients with sinonasal polyposis not associated with cystic fibrosis

Burkholderia Cepacia Causes Frontal Mucopyocele with Anterior Cranial Fossa Extension: A Novel Case Report

Introduction:

Burkholderia cepacia complex (Bcc) is a group of gram-negative bacilli that have rarely been isolated in the ear, nose and throat region in immunocompetent patients. Bcc show resistance to most available antibacterial drugs.

Case Report:

We present the case of an immunocompetent 31-year-old male reporting a pulsating headache with right supraorbital swelling associated with exophthalmos. A brain CT scan showed an expansive giant cystic lesion occupying the right frontal sinus, extending to the anterior cranial fossa. Management and outcome: drainage with the resecting of the floor of the frontal sinus from the orbital plate of the ethmoid bone to the nasal septum (Draf IIb) was performed with wide marsupialization of the mucopyocele. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was used to identify the isolate. MRI 1 and 12 months after surgery showed complete lesion removal. The patient was followed for 12 months with complete recovery of symptoms.

Conclusion:

Paranasal sinuses disease with cranial expansion and orbital complications constitutes an emergency. For the first time in the literature, Bcc was isolated in the frontal sinus, extending into the anterior cranial fossa, in an immunocompetent patient. An endoscopic surgical approach with microbiological identification and management by appropriate antibacterial drug treatment seems to be the key to success.

Burkholderia gladioli sinonasal infection

INTRODUCTION

Burkholderia gladioli are non-fermenting, Gram-negative, rod-shaped aerobic bacteria that were first identified as a plant pathogen. Most of the B. gladioli infections reported in the literature have involved immunocompromised adults and newborn infants. B. gladioli in humans is often associated with a poor prognosis.

CASE REPORT

We describe the first case of sinonasal infection due to B. gladioli and Staphylococcus aureus in an immunocompetent patient who had recently travelled to the Congo.

DISCUSSION

As in the few other reported cases involving immunocompetent patients, the appropriate approach to this multidrug-resistant B. gladioli infection was a combination of surgery and antibiotics chosen in the light of an antibiogram.

Burkholderia cepacia complex isolation in non-polypoid chronic rhinosinusitis

PURPOSE

Burkholderia cepacia complex (Bcc) infections of the head and neck have been infrequently reported in immunocompetent patients, while their association with cystic fibrosis is quite well known. One of the main problems associated with Bcc is their intrinsic resistance to most clinically-available antimicrobials. Bcc has already been isolated in sinonasal polyposis, while here we report for the first time on its isolation in patients with chronic rhinosinusitis (CRS) but no nasal polyposis.

MATERIALS AND METHODS

Thirty-four consecutive surgically-treated CRS patients without cystic fibrosis were recruited.

RESULTS

Bcc was isolated in 4 cases of CRS without polyposis, and in another case in sinonasal polyposis. All tested Bcc strains isolated in non-polypotic CRS were resistant to ciprofloxacin, amikacin, ertapenem, amoxicillin/clavulanate, cefotaxime, and gentamicin.

CONCLUSIONS

The novel finding of Bcc species in CRS without polyposis as well suggests that the mechanism by which these bacteria adhere to the epithelium of the upper respiratory tract may be important in the host's colonization.

Burkholderia cepacia complex infection in a case of sinonasal polyposis recurrence without cystic fibrosis

Burkholderia cepacia complex (BCC) has been rarely isolated in infections of the ear, nose and throat region in immunocompetent patients without cystic fibrosis. There is only one previous study in literature that reported BCC isolation in immunocompetent patients with sinonasal polyposis. We describe herein a rare case of multiresistant sinonasal infection by BCC in an immunocompetent patient with recurrent sinonasal polyposis. BCC seems to be a potentially emerging bacterial pathogen of sinonasal structures in patients with polyposis, also after FESS.