Search Results (402)

Streptococcus pyogenes (GAS) is a leading cause of acute otitis media (AOM) and its complications. This study aimed to evaluate the antimicrobial resistance of all isolated bacterial agents recovered from children with AOM and to perform the emm typing of GAS isolates. Antibiotic susceptibility testing was evaluated according to EUCAST criteria. Phenotyping and genotyping were performed for the macrolide-resistant GAS isolates. All GAS isolates were subjected to emm typing. Among the 103 AOM cases considered, we identified GAS isolates (39.4%), Staphylococcus aureus (26.6%), Haemophilus influenzae (13.8%), Streptococcus pneumoniae (11.7%), Moraxella catarrhalis (7.4%), and Serratia marcescens (1.1%). GAS exhibited 32.4% macrolide resistance and 10.8% clindamycin resistance. The M phenotype and mefE gene (18.9%) were the most common, followed by cMLSB (10.8% with ermB), a combination of mefA and ermB (8.1%), and iMLSB (2.7% with ermA). The most prevalent emm types were emm12 (27.0%), emm1 (21.6%), and emm3 (16.2%). The most common GAS emm types identified among AOM patients in this study are found worldwide and are associated with invasive infections in various countries. This may influence the virulence and invasive potential of these strains. Full article

Background/Objectives: The number needed to vaccinate (NNV) is a metric commonly used to evaluate the public health impact of a vaccine as it represents the number of individuals that must be vaccinated to prevent one case of disease. Traditional calculations may underestimate vaccine benefits by neglecting indirect effects and duration of protection (DOP), resulting in NNV overestimation. This study evaluated the NNV for the pediatric 20-valent pneumococcal conjugate (PCV20) US immunization program, as compared to PCV13, with a unique approach to NNV. Methods: A multi-cohort, population-based Markov model accounting for indirect effects was employed to calculate the NNV of PCV20 to avert a case of pneumococcal disease, invasive pneumococcal disease (IPD), hospitalized non-bacteremic pneumonia (NBP), ambulatory NBP, and otitis media (OM), as well as to prevent antibiotic-resistant cases and antibiotic prescriptions. Results: The mean NNV over a 25-year time horizon to prevent one case of pneumococcal disease was 6, with NNVs of 854 for IPD, 106 for hospitalized NBP, 25 for outpatient NBP, and 9 for OM, 11 for a course of antibiotic, and 4 for resistant disease. The mean NNV per year decreased over time, reflecting the DOP and increasing indirect effects over time. Conclusions: This study presents a novel approach to NNVs and shows that relatively few vaccinations are required to prevent disease. The decrease in NNV over time highlights the necessity of including DOP and indirect effects in NNV calculations, ensuring a more realistic assessment of a vaccine’s impact. Full article

Background: Sudden-onset bilateral mixed hearing loss in adults is an extremely rare condition but challenging to diagnose and treat. Conductive hearing loss is associated with otitis media, while the simultaneous presence of a sensorineural component requires supplementary investigation for possible shared pathophysiological mechanisms. Case Presentation: We report the case of a 41-year-old male who was admitted to our hospital with a 48 h history of bilateral, fast progressive hearing loss following a viral illness. The audiologic testing revealed bilateral severe mixed hearing loss. Tympanometry indicated the presence of middle-ear effusion, and myringotomy confirmed the existence of pressurized serous fluid. Treatment consisted of systemic and intratympanic corticosteroids, antibiotics, and supportive therapy. The patient had an unexpected full recovery of auditory function within one month. Discussion: Multiple hypotheses were considered. We hypothesized the coexistence of unrelated conductive and sensorineural hearing loss or a unifying pathological process. Theories discussed include a direct viral insult to the cochlear structures or even pressure-mediated damage to the basal cochlea due to the simultaneous inward displacement of the oval and round windows. The complete resolution of hearing loss is the indicator of a reversible etiology, possibly due to transient inner ear dysfunction secondary to middle-ear pathology or viral infection. Conclusions: This case illustrates the complexity of diagnosing acute mixed hearing loss. This report emphasizes a rare case of sudden-onset bilateral mixed hearing loss with a complete recovery, contributing valuable insight into under-reported and diagnostically complex presentations. Full article

Infections caused by oxacillin-resistant Staphylococcus pseudintermedius are increasingly common in veterinary medicine. The indiscriminate use of antibiotics by pet owners worsens this problem, reducing treatment efficacy and creating the need for alternative therapies. This study aimed to evaluate the inhibitory effect of clove essential oil (Syzygium aromaticum) on both oxacillin-resistant and susceptible S. pseudintermedius. Thirty-five isolates from dogs with otitis externa were analyzed. The bacteria were identified by phenotypic tests and tested for susceptibility to 22 antibiotics using disk diffusion. Resistance genes (mecA and blaZ) were detected using conventional PCR. Among the isolates, 34.28% (12/35) were positive for mecA, and 97.14% (34/35) for blaZ. The essential oil’s efficacy was assessed using broth microdilution to determine its minimum inhibitory concentration (MIC). Clove oil showed an average MIC and minimum bactericidal concentration (MBC) of 6.4 mg/mL, inhibiting both resistant and susceptible isolates. In conclusion, clove essential oil demonstrated in vitro antimicrobial activity against S. pseudintermedius. Full article

Canine otitis externa caused by Pseudomonas aeruginosa is a relevant disease in veterinary medicine. Given P. aeruginosa’s high priority status for the development of new antimicrobials, innovative strategies like bacteriophage therapy are essential. Lytic bacteriophages are viruses with high specificity for their bacterial hosts, making them a promising therapeutic choice in both human and veterinary medicine. This study aimed to evaluate the antimicrobial potential of bacteriophages JG005 and JG024, first characterized in terms of their biofilm-forming ability and antimicrobial susceptibility profile, against P. aeruginosa isolates obtained from dogs with otitis externa,. Bacteriophages titer, host range, and activity were assessed against P. aeruginosa biofilms via microtiter assays using crystal violet and Alamar Blue. JG024 showed lytic activity against 61.2% (n = 30/49) of the isolates, while JG005 showed lytic activity against 38.8% (n = 19/49) of the isolates. Crystal violet quantification showed that JG005 can promote strong microbial suppression of 60% (n = 6/10) and 50% (n = 5/10) of the isolates at a multiplicity of infection (MOI) of 10 and 100, respectively. JG024 presented strong microbial suppression of 20% (n = 2/10) of the isolates regardless of the MOI level tested. These phages show promising potential as an innovative treatment for canine otitis externa caused by P. aeruginosa, but further studies are needed before future clinical use. Full article

Background: Canine pyoderma and otitis externa are prevalent bacterial skin infections in veterinary practice, frequently complicated by the emergence of multidrug-resistant (MDR) pathogens. Objectives: To investigate the frequency, antimicrobial resistance (AMR) profiles, and frequency of MDR bacterial isolates from dogs with pyoderma or otitis externa in Hong Kong. Methods: A retrospective study of bacterial isolates from 215 clinical samples collected from dogs presenting with pyoderma (n = 63) or otitis externa (n = 152) at veterinary clinics across Hong Kong between 2018 and 2022. Bacterial isolates were identified and subjected to antimicrobial susceptibility testing against 13 antimicrobial classes. Results: Staphylococcus spp., particularly S. pseudintermedius, were the most commonly isolated species, followed by Pseudomonas spp. and Proteus spp. High resistance rates were observed for orbifloxacin (61.3% in pyoderma; 76.7% in otitis externa), doxycycline (59.3%; 69.2%), clindamycin (62%; 68.9%), and enrofloxacin (50%; 55.5%). Most isolates were sensitive to ofloxacin, ticarcillin–clavulanate, tobramycin, ciprofloxacin, cefpodoxime, cefuroxime, and cefixime. MDR was detected in 67.5% of pyoderma and 66.8% of otitis externa isolates. Gram-negative bacteria exhibited significantly higher MDR rates than Gram-positive isolates. The multiple antibiotic resistance (MAR) index averaged 0.41 for pyoderma and 0.52 for otitis externa isolates. We found no significant associations between MDR and non-modifiable risk factors (i.e., age, sex, breed, and reproductive status). Conclusions: These findings highlight the critical need for prudent antimicrobial use and continuous surveillance of AMR trends in companion animals. A higher focus should be placed on topical antiseptic therapy, with oral antibiotics used only in exceptional cases and after susceptibility testing. From a One Health perspective, the potential transmission of MDR bacteria between companion animals and humans underscores the importance of a coordinated approach to antimicrobial stewardship across both veterinary and human medicine. Full article

Canine otitis externa is a prevalent condition, and inadequate treatment may favor the emergence of multidrug-resistant microorganisms. Drug repurposing provides an alternative approach for the management of this disease. Thus, this study aimed at assessing the antimicrobial and antibiofilm properties of levamisole against bacterial strains recovered from dogs with otitis externa as well as its influence on biofilm growth dynamics during 120 h. A total of 50 clinical bacterial isolates were subjected to analysis. Planktonic bacterial susceptibility to levamisole was assessed by broth microdilution to determine the minimum inhibitory concentration (MIC), the lowest concentration that completely inhibits bacterial growth. The activity against mature biofilms was assessed by determining the minimum biofilm eradication concentration (MBEC). The effect of levamisole on biofilm formation was evaluated at the MIC and at two subinhibitory concentrations, with daily readings recorded at 48, 72, 96, and 120 h. MICs of levamisole ranged from 0.58 to 2.34 mg/mL. Levamisole reduced the biomass of mature biofilms (p < 0.05), with MBEC values ranging from 1.17 to 18.75 mg/mL, and biofilm formation was significantly reduced at the MIC concentration (1.17 mg/mL) for all isolates for 120 h (p < 0.05). Levamisole demonstrated potential as a preventive approach against biofilm-associated bacterial otitis. Full article

Pseudomonas aeruginosa otitis is common in dogs and antibiotic-resistant strains are often isolated. We are unaware of reports evaluating the combination of silver sulfadiazine (SSD) with a biofilm disruptor solution containing Tris-EDTA (tromethamine-ethylenediaminetetraacetic acid) and N-acetylcysteine (Tris-NAC). Forty-eight P. aeruginosa strains from dogs with suppurative otitis were analysed using the agar well diffusion method. A volume of 70 μL of Tris-NAC, a water solution of 10% SSD and their combination in equal amount was pipetted into the designated wells. After incubation, the diameter of the inhibition zone was measured. A synergy experiment using the checkerboard assay was performed to look at any potential synergistic effects of SSD and Tris-NAC against only 10 randomly selected isolates of P. aeruginosa. The samples tested with Tris-NAC + 10% SSD solution, compared with the samples tested with 10% SSD alone, demonstrated significantly higher inhibition zones against P. aeruginosa, p < 0.00001. The checkerboard assay results showed an additive effect between the two compounds. The use of 10% SSD could be evaluated as a therapeutic tool against strains of P. aeruginosa if combined with Tris-NAC. Full article

Purpose: This study aimed to evaluate the immunological response to the 23-valent pneumococcal polysaccharide vaccine (PPV23) in patients investigated for immunodeficiencies due to recurrent infections at EPM-UNIFESP Clinical Immunology outpatient clinic. Methods: This is a longitudinal retrospective study. Data were collected from the medical records of patients between 2012 and 2020. The analyses were developed in two stages: before and after administration of the PPV23 vaccine. Results: A total of 390 patients who received the PPV23 vaccine were selected. Among those who demonstrated an adequate serological response (63.6%), there was a notable decrease in the risk of upper respiratory tract infections (URTI) by 66%, tonsillitis by 74%, otitis by 76%, sinusitis by 49%, and uncomplicated pneumonia (PNM) by 77%. For invasive infections, the risk reduction was 95% for pneumonia with parapneumonic effusion and 93% for meningitis. Conclusions: The study demonstrated a significant decrease in the risk of bacterial infections following the administration of the PPV23 vaccine in this population. Therefore, we recommend including PPV23 in the vaccination schedule following pneumococcal conjugated vaccines for patients with recurrent pneumococcal infections to enhance protection and avoid complications. Full article

This study aimed to perform ultrasonography of the tympanic bulla in healthy, non-sedated camelids for the first time. In the first step, dissection and sonography in cadaver specimens allowed the essential identification of the anatomical structures of the region of interest. Ultrasonography of the tympanic bulla was then performed on 71 healthy llamas and alpacas, and the length of the visible lateral bulla wall was measured sonographically. The reproducibility of measuring was determined between two examiners. Differences in length and the influences of gender, age, and body condition scores were monitored. A 10 MHz linear probe was positioned in the rostrocaudal and dorsoventral directions caudal to the mandibular ramus and ventral to the base of the ear using a lateral approach. The equipment used proved to be appropriate to visualize the tympanic bulla, the zygomatic bone, the paracondylar process, the external ear canal, and the parotid gland in the cadaver specimens and all live animals. Llamas revealed a significantly longer visible lateral bulla wall than alpacas, but its length was not influenced by gender, body condition score, or age. In alpacas, older females showed a significantly shorter tympanic bulla wall. The intra- and inter-observer reliability yielded a significant agreement. Based on this study’s results, ultrasonography may serve as a non-invasive diagnostic tool for detecting osseous and soft-tissue changes in camelids with otitis media. Full article

A backyard cat with symptoms of otitis was transferred to a veterinary clinic in Central Greece. A sample was obtained and P. aeruginosa was isolated. The strain exhibited an extensively drug-resistant (XDR) profile, as it was non-susceptible to all tested agents except colistin. DNA extraction and whole-genome sequencing (WGS) were performed using a robotic extractor and Ion Torrent technology, respectively. The genome was assembled and screened for resistance and virulence determinants. The isolate belonged to the high-risk clone ST308 with a total of 67 antibiotic resistance genes (ARGs) and 221 virulence factor-related genes being identified. No plasmids were detected. The metallo-beta-lactamase (MBL) bla_NDM-1 gene and 46 efflux pumps were included in the strain’s resistome. Both ARGs conferring tolerance to disinfecting agents and biofilm-related genes were identified, associated with the ability of this clone to adapt and persist in healthcare facilities. This case highlights the risk of relevant bacterial clones spreading in the community and even being transmitted to companion animals, causing challenging opportunistic infections to susceptible individuals, while others may become carriers, further spreading the clones to their owners, other animals and the environment. Full article

Background: Chronic otitis media (COM) with tympanic perforation sometimes requires tympanoplasty. Many factors can interfere with surgical success; however, the histological status of the remaining epithelium of the perforation has not been studied as a risk factor for surgical failure. Methods: This was an observational, longitudinal, and analytical study in patients with COM, candidates for tympanoplasty who met the inclusion criteria, between August and December 2024. Tympanoplasty was performed, and the tympanic ring epithelium was sent for histological analysis. After 30 days, closure or non-closure of the perforation was determined, and the results were collected. Descriptive and analytical statistics were performed according to data distribution using the SPSS 26.0 statistical package. Results: Twenty subjects were included, 80% with tubal dysfunction, 60% with central perforation, and 65% with medium-sized. In total, 13 were successful, and 7 failed. Histopathological analysis revealed dystrophic calcification, chronic lymphocytic infiltrate, histiocytic infiltrate, fibrosis, loose keratin sheets, metaplasia, and spongiosis. The logistic regression model showed an OR of 7.3 for marginal perforation and 3.4 for the OPSS score. Of the patients with surgical failure, 57.4% had epithelial inflammation. Conclusions: epithelial inflammation affected surgical success in more than 50%. Full article

Background: Children with Down syndrome (DS) are at high risk for a broad spectrum of otorhinolaryngologic (ENT) disorders, including hearing impairment, obstructive sleep apnea (OSA), dysphagia, and language delay. These conditions often coexist and interact with the neurodevelopmental and anatomical features of DS, requiring early identification and coordinated management. Despite the clinical burden, ENT involvement in DS remains under-characterized and inconsistently addressed in care pathways. Methods: A narrative review was conducted to provide an integrative overview of ENT manifestations in pediatric patients with DS. A literature search was performed in PubMed, Scopus, and Web of Science, covering studies published between 1979 and 2025. Articles were included if they addressed ENT disorders in children with DS and met clinical relevance criteria. A total of 45 studies were selected and analysed by study design, focus, and contribution to diagnostic or therapeutic frameworks. Results: The majority of included studies were observational in nature, covering key domains such as conductive hearing loss, chronic otitis media with effusion, sleep-disordered breathing, and feeding/swallowing dysfunction. Several articles emphasized the importance of early audiologic and polysomnographic screening. Gaps in standardization and accessibility of multidisciplinary ENT care were consistently reported. A proposed framework for integrated evaluation is discussed. Conclusions: ENT manifestations in pediatric DS are frequent, multifactorial, and clinically impactful. A multidisciplinary, anticipatory model of care is essential for timely diagnosis and targeted intervention. This review highlights the need to formalize ENT pathways within comprehensive care protocols for children with DS. Full article

This review studies the potential relationship between the pathogenesis of allergic rhinitis (AR) and otitis media with effusion (OME) in both adults and children, applying the modified Bradford Hill criteria. While AR and OME are distinct conditions, several epidemiological and experimental studies suggest a significant association, primarily through allergic mechanisms such as Th-2 immune responses, Eustachian tube dysfunction, and inflammatory mediators in the middle ear. Given the substantial diversity and, in many instances, the “low quality” of related studies when assessed against the standards of modern evidence-based medicine, employing a structured framework like the modified Bradford Hill criteria is beneficial for investigating and establishing causality. This approach, which allows a wide range of diverse studies to be classified as direct, mechanistic, or parallel evidence, supports the notion that management of the allergic immune response may improve OME outcomes, although the inconsistencies among studies require further research. Despite current guidelines recommending against the use of antiallergic medications, the application of the above criteria suggests that proper diagnosis and treatment of allergic rhinitis should be strongly considered in adults and children with OME. Full article

Background: Primary ciliary dyskinesia (PCD) is a rare hereditary disorder caused by defective motile cilia, predominantly affecting the respiratory system. Conductive hearing loss (CHL) due to chronic otitis media with effusion (OME) is a typical feature of PCD, particularly in childhood. However, the underlying mechanisms contributing to sensorineural hearing loss (SNHL) in patients with PCD remain unclear. Methods: We present the case of a 52-year-old male with a clinical diagnosis of PCD, confirmed by the presence of situs inversus, chronic respiratory symptoms, and ultrastructural ciliary defects. Results: Despite a history of recurrent acute otitis media (AOM), the patient developed severe bilateral SNHL, a relatively uncommon and poorly understood manifestation of PCD. Genetic testing revealed a pathogenic SH3TC2 variant, a gene classically associated with Charcot–Marie–Tooth disease type 4C (CMT4C), raising the possibility of an alternative or contributory genetic etiology for the patient’s auditory dysfunction. Conclusions: This case highlights the importance of comprehensive audiological and genetic evaluations in PCD patients, particularly those presenting with progressive or atypical HL. The presence of a pathogenic SH3TC2 mutation suggests a potential neuropathic component to the patient’s HL, underscoring the need for further research into the intersection between ciliary dysfunction and genetic neuropathies. Early identification and intervention are critical to optimizing auditory outcomes and quality of life in affected individuals. Full article