Actinomycosis: a frequently forgotten disease

Actinomycosis is a rare subacute or chronic, endogenous infection mainly by Actinomyces species, showing low virulence through fimbriae and biofilms. Cervicofacial, thoracic, abdominal, pelvic and sometimes cerebral, laryngeal, urinary and other regions can be affected. Actinomycosis mimics other diseases, often malignancy. Disease risk in immunocompromised subjects needs clarification. Diagnosis is often delayed and 'sulfur granules' are helpful but nonspecific. Culture requires immediate specimen transport and prolonged anaerobic incubation. Imaging, histology, cytology, matrix-assisted laser desorption ionization time-of-flight mass spectrometry and molecular methods improve the diagnosis. Actinomycetes are β-lactam susceptible, occasionally resistant. Treatment includes surgery and/or long-term parenteral then oral antibiotics, but some 1-4-week regimens or oral therapy alone were curative. For prophylaxis, oral hygiene and regular intrauterine device replacement are important.

Antimicrobial resistance and the management of anaerobic infections

Management of anaerobic infections encompasses surgical procedures, antibacterial therapy and adjuncts. At present, metronidazole, penems, beta-lactam/beta-lactamase inhibitor combinations and chloramphenicol have the highest activity against obligate anaerobes. Tigecycline is a promising new agent. Other antibacterials (e.g., nitazoxanide, moxifloxacin, garenoxacin and ramoplanin) and nonantibiotic agents show potential but need further investigation. The patient's characteristics, mixed anaerobic/aerobic infections, infection sites, bacterial resistance patterns, bactericidal activity of agents and their pharmacokinetics, toxicity and influence on the normal flora should be considered. Susceptibility patterns of anaerobes have become less predictable owing to increasing antibacterial resistance. Emergence of highly virulent or multidrug-resistant strains is challenging the current therapy. To counteract these trends, regular resistance surveillance in anaerobes, rational antibiotic use and evaluation of new treatment alternatives are important.

Health care in patients with primary Sjogren's syndrome

The aim of the present study was to define more accurately the necessary health care in patients with the primary Sjogren's syndrome and to compare it to those necessary for patients with another autoimmune disease--rheumatoid arthritis without a concomitant Sjogren's syndrome (Tab. 1, Ref. 5). Full Text (Free, PDF) www.bmj.sk.

Anaerobic bacteria in 118 patients with deep-space head and neck infections from the University Hospital of Maxillofacial Surgery, Sofia, Bulgaria

The aim of this study was to assess the incidence and susceptibility to antibacterial agents of anaerobic strains in 118 patients with head and neck abscesses (31) and cellulitis (87). Odontogenic infection was the most common identified source, occurring in 73 (77.7%) of 94 patients. The incidence of anaerobes in abscesses and cellulitis was 71 and 75.9%, respectively, and that in patients before (31 patients) and after (87) the start of empirical treatment was 80.6 and 72.4%, respectively. The detection rates of anaerobes in patients with odontogenic and other sources of infection were 82.2 and 71.4%, respectively. In total, 174 anaerobic strains were found. The predominant bacteria were Prevotella (49 strains), Fusobacterium species (22), Actinomyces spp. (21), anaerobic cocci (20) and Eubacterium spp. (18). Bacteroides fragilis strains were isolated from 7 (5.9%) specimens. The detection rate of Fusobacterium strains from non-treated patients (32.2%) was higher than that from treated patients (13.8%). Resistance rates to clindamycin and metronidazole of Gram-negative anaerobes were 5.4 and 2.5%, respectively, and those of Gram-positive species were 4.5 and 58.3%, respectively. One Prevotella strain was intermediately susceptible to ampicillin/sulbactam. In conclusion, the start of empirical treatment could influence the frequency or rate of isolation of Fusobacterium species. The involvement of the Bacteroides fragilis group in some head and neck infections should be considered.

In vitro activity of Bulgarian propolis against 94 clinical isolates of anaerobic bacteria

The aim was to evaluate the effect of 30% ethanolic extract of Bulgarian propolis on 94 clinical anaerobic strains. The strains were tested by both agar-well diffusion (wells, 7 mm diameter) and disk-diffusion methods. Only 15% of Clostridium-, 3.3% of other Gram-positive- and 9.1% of Gram-negative anaerobic strains were not inhibited by 30 microL propolis extract per well. Propolis extract was more active than the ethanol (P < 0.001). By 30 microL extract per well, mean inhibitory diameters of the clostridia, other Gram-positive- and Gram-negative anaerobes were 11.5, 13.1, and 11.3 mm, and those by 90 microL were 16, 18.1 and 15.4 mm, respectively. Mean inhibitory diameters of all strains by 30 and 90 microL ethanol were only 8.4 and 9.5 mm. By 30 microL propolis extract per well, inhibitory diameters of 15 mm or more were more common in Gram-positive (32%) than in Gram-negative bacteria (13.6%, P < 0.05). Moist propolis disks inhibited more strains (89.4%) than dried disks (68.1%, P < 0.001). Most (81.8%) Bacteroides fragilis group strains and 75% of clostridial strains were inhibited by moist EEP disks.

CONCLUSION

Bulgarian propolis was active against most anaerobic strains of different genera. In addition to oral pathogens, an activity of propolis against Clostridium, Bacteroides and Propionibacterium species was observed. The results could motivate a higher medical interest and further trials for evaluating the use of bee glue for prophylaxis or treatment of some anaerobic infections such as oral, skin and wound diseases.

[Prosthetic reconstruction after total rhinectomy and due to persistent lupus erythematosus]

A case with histologically verified nasal carcinoma and concomitant lupus erythematosus is presented. Total resection of the nasal pyramid was performed with local postoperative tumor control. The defect of the nose was repaired with silicone prosthesis without special holders, still the support of the spectacles was established. A satisfactory cosmetic effect was achieved.

Primary Sjögren's syndrome complicated with development of non-Hodgkin's lymphoma - a case report and literature review

Primary Sjögren's syndrome (PSS) is an autoimmune disease of the exocrine glands that is presented with progressive ocular and oral dryness, parotid enlargement and often with systemic (extraglandular) manifestations. In patients with PSS the risk of development of non-Hodgkin's lymphoma (NHL) is 44-fold compared to healthy population. The risk is associated with certain characteristics of the disease's course: recurrent changes in the parotid glands, lymph node enlargement, skin vasculitis, peripheral neuropathy, anemia and lymphopenia. According to the morphologic and phenotypic characteristics, B-cell low-grade lymphomas prevail. This communication presents a 65-year-old woman with PSS who developed a follicular type B-cell NHL 21 years after the autoimmune disease had been diagnosed. The analysis of our case and the literature review summarize the characteristics of the course of PSS, histologic variants, and evolution and prognosis of NHL in this kind of patients.

[Diagnostic difficulties in one patient with chronic periostitis of the lower jaw]

The problem of chronic periostitis of the jaws and the difficulties that sometimes arise in differentiation from a tumourous process is briefly discussed. A case of a ten year old child with chronic ossifying periostitis is described that caused considerable differentiation-diagnostic difficulties, mainly because of the X-ray findings of orthopantomography and computer tomography, presenting data suggesting more a tumourous disease of the lower jaw. After the extraction of the sixth tooth of the lower jaw, with a chronic periapical process, and after antibiotic treatment, the disease was healed.

[Necrotic fasciitis of odontogenic origin]

A brief literature review is presented at the beginning of the paper, revealing that the necrotic fasciitis of odontogenic origin in the region of head and face is rarely observed with just a few communications in literature. Proceeding from the fact that term has not been introduced so far in the Bulgarian stomatological literature and that no communications are available about that disease, the author describes a 52-old female patient, affected by severe diabetes. Grave necrotic fasciitis in the infratemporal, temporal, parietal and occipital region advanced after the extraction of lower molars without any pretreatment on the background of the diabetes. The patient was healed by radical necrotomy of the affected fasciae and subcutaneous adipose tissue and via active antibiotic, general tonic and antidiabetic therapy.

[Working model for experimental stomatoscopy]

The authors, for the first time in our country, created working conditions for stomatoscopy on materials and trial-copies to be studied in advance, approaching in type and form to the oral cavity mucosa in norm and pathology. The magnifying possibilities of stomatoscope in observation of working trial-copies are clearly illustrated. Stomatoscopy is recommended as a diagnostic method in pathology of oral cavity mucosa after acquiring the necessary habits and skill, based on the experimental stomatoscopy described.