Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Malignant external otitis (MEO) is a disease of the external auditive channel (EAC) due to Pseudomonas aeruginosa which usually involves individuals with diabetes mellitus. It may result in the invasion of the cranial base with cranial neuropathy and a high mortality rate despite therapy. We report the clinical features, diagnostic procedures, evolution and therapy of 8 patients with MEO, seven of which had cranial neuropathy. All patients have diabetes except one who had acquired immunodeficiency syndrome. All had otalgia, otorrhea and headache lasting for several months. Six patients had homolateral (as related to the MEO) facial palsy. One patient with bilateral MEO developed bilateral facial palsy and lesion of the cranial nerves VI (unilaterally) and IX through XII (bilaterally). In all patients P. aeruginosa was cultured from the EAC exudate scintigraphy with 99Tc showed uptake at medium ear and mastoid level in all 8 patients, suggesting a possible osteomyelitis. Scintigraphy with 67Ga was positive in the 6 cases where it was carried out, showing uptake in the soft tissues of the cranial base. Computed tomography was carried out in 6 patients, and it was useful to define the anatomical extent of the disease. The patients received different therapeutic schedules, particularly the combination of a betalactamic and aminoglucoside antibiotics. Follow up was characterized by common recurrences, and one patient died. The importance of early diagnosis and treatment to prevent the extension and recurrence of MEO are discussed. Cranial neuropathy is considered as a poor prognostic finding.
 ...
PMID:[Otitis externa maligna and cranial neuropathy]. 228 52

Malignant external otitis is an invasive pseudomonal infection characteristically afflicting the elderly patient with diabetes mellitus. Therapy has traditionally consisted of the long-term administration of combination parenteral antibiotics, but morbidity and mortality remain substantial despite this therapy. We treated 11 consecutive patients with the oral combination of ciprofloxacin (750 mg twice daily) and rifampin (600 mg twice daily) for 6 to 12 weeks (mean, 8 weeks). Pseudomonas aeruginosa was isolated from ear canal or mastoid, and bone destruction was documented by computed tomography in all patients. Seven patients (64%) had ear irrigation before onset of the infection. Ten patients fulfilled the criteria of both clinical and bacteriologic cure. No serious adverse reaction to either antibiotic was observed. Otalgia and otorrhea responded at a mean of 6 and 4 days, respectively, following the initiation of therapy. The erythrocyte sedimentation rate fell from a mean pretherapy value of 81 mm/h (range, 41 to 138 mm/h) to 18 mm/h (range, 3 to 45 mm/h) after the completion of antibiotic therapy. Minimum inhibitory and bactericidal concentrations established that all organisms were sensitive to ciprofloxacin. Time-kill curve and checkerboard assays failed to demonstrate either synergy or antagonism between ciprofloxacin and rifampin. Serum inhibitory and bactericidal titers showed minimal increase in inhibition and killing of the bacteria with the addition of rifampin. Rifampin did not alter the pharmacokinetics of ciprofloxacin. The successful use of oral antibiotics for this difficult infection may be a major advance. Reduction in antibiotic costs and hospitalization and convenience of oral administration were of notable benefit.
 ...
PMID:Efficacy of oral ciprofloxacin plus rifampin for treatment of malignant external otitis. 234 Jan 32

Malignant external otitis is an infection of the external ear canal, mastoid, and base of the skull caused by Pseudomonas aeruginosa. The condition occurs primarily in elderly patients with diabetes mellitus. Current theories on pathogenesis and anatomic correlations are reviewed. Severe, unrelenting otalgia and persistent otorrhea are the symptomatic hallmarks of the disease, whereas an elevated erythrocyte sedimentation rate is the only distinctive laboratory abnormality. Iatrogenic causes such as administration of broad-spectrum antibiotics and aural irrigation may play a predisposing role in high-risk populations. The disease can result in cranial polyneuropathies (with facial nerve [VII] paralysis being the most common) and death. The mainstay of treatment is administration of antipseudomonal antibiotics for four to eight weeks. Recurrence is common, and mortality remains at about 20 percent despite antibiotic therapy. Given the increasing longevity of diabetic patients, the frequency of this disease is increasing. Internists, family practitioners, and ambulatory care physicians must now be cognizant of the presenting symptoms, while infectious disease specialists and otolaryngologists need to be appraised of strides in diagnosis and therapy. The role of surgery should be minimized. Use of new diagnostic radiologic modalities and new antipseudomonal antibiotics discussed in this review should lead to improved outcome.
 ...
PMID:Malignant external otitis: insights into pathogenesis, clinical manifestations, diagnosis, and therapy. 304 54

During the years 1972-1985, 50 patients with malignant external otitis (MEO) were seen in our department. All our patients complained of severe earache; they presented initially with an apparently simple external otitis, but failed to improve when the usual measures were adopted. They all presented with granulation tissue in the external ear canal, and five of our patients had multiple cranial nerve involvement. MEO is in effect a severe external otitis which, if untreated, proceeds towards an osteomyelitis of the skull base. MEO is more prevalent in the summer, when external otitis is rampant. In some years, a relatively large number of these patients appear; in others there are none. The reason for this is unknown. In Israel, the disease is more prevalent in Jews than in Arabs. Diabetes was present in 68 per cent of our patients-severe diabetes in 42 per cent, mild diabetes in 26 per cent but 32 per cent of our patients were diabetes-free. The only otological past history in our patients was of a recent traumatic insult to the external ear canal; this was the case in about 8 per cent of them. Today, the treatment of choice of this important disease is local debridement supplemented by appropriate antibiotic treatment for 6-8 weeks. This should include some semi-synthetic penicillin to which pseudomonas aeruginosa is sensitive, combined with an appropriate aminoglycoside. During the earlier years of our encounter with MEO, two of our 10 patients died of it; later on, when we learned better how to treat it, the mortality rate decreased.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Malignant external otitis. 310 45

From 1982 to 1991, we experienced 76 patients with Mycoplasma pneumoniae pneumonia which were confirmed by serologic tests. There were 32 (42%) male and 44 (58%) female patients. One patient had underlying disease of diabetes mellitus while the other patients were in good health. The age ranged from 9 months old to 72 years old. All the patients complained of fever and coughing; 63% had dry cough and 37% had sputum production. Upper respiratory tract complaints such as rhinorrhea, sore throat, or earache were noted in 57% of the patients. Fifty-five percent of the patients had GI symptoms of anorexia, nausea, vomiting, or diarrhea. Other complaints included myalgia/arthralgia (29%), headache (30%), and general malaise (32%). Dyspnea (17%) and chest pain (20%) were occasional complaints. Seventy-one percent of the patients had WBC counts < 10000/cu mm and 29% > 10000/cu mm. The mean value of C-reactive protein (CRP) was 53.1 micrograms/ml, while 16% of the patients had a CRP value above 100 micrograms/ml. Thirty-one percent of the patients were noted to have a transient elevation of serum transaminase. Four different patterns of infiltration were seen in chest radiographic manifestation: 1) peribronchial and perivascular interstitial infiltrates (18.4%), 2) nonhomogeneous patchy consolidations (22.4%), 3) homogeneous acinar consolidations (27.6%), and 4) mixed interstitial and alveolar infiltrates (27.6%). Interstitial infiltration was more commonly seen in pediatric than adult patients (46% vs 20%). Other features of the radiologic manifestation were as follows: unilateral lesions in 80% of patients, single lobe lesions in 77%, lower lobe predominant in 69%, pleural effusion in 7%, and radiographic deterioration in 10%. Mycoplasmal pneumonia should be considered in the differential diagnosis of community-acquired pneumonias.
 ...
PMID:Clinical study of Mycoplasma pneumoniae pneumonia. 832 Jul 55

In the Anglo-Saxon literature, necrotizing otitis in the diabetic patient, known as malignant otitis externa (MOE), represents a specific and in many ways serious entity. We report on our personal experience with 19 cases of MOE with hospitalization and a 9-year follow-up. Our diagnostic criteria are as follows: all our patients are diabetic (with diabetes revealed twice by the MOE). Otalgia is a predominant feature of the clinical picture, with facial palsy being recorded in practically all our patients. A pyocyanic germ was responsible in 16 cases. The use of CT instead of Tc99 scintigraphy enabled the assessment of the extent of the complaint. Surgical treatment (mastoidectomy), recommended for our first patients, is now considered pointless due to its lack of efficacy against an already extensive process, and with the arrival on the market of new families of ATB's, in particular the quinolones. It would appear that this general treatment, combined with local treatment, provides a better control of the evolution of the MOE, which nonetheless carries a high mortality rate estimated at 18%. On the basis of this series, we present the data in the literature, recalling the diagnostic criteria, the value of skull base imaging and the criteria of recovery.
 ...
PMID:[Malignant otitis externa: apropos of 19 cases]. 867 66

Primary care physicians are influential in diagnosing and initiating treatment of most pathologic conditions in patients with a history of hearing loss, chronic ear infection, diabetes, immunosuppression, or otologic symptoms with excessive exposure to sunlight. Lesions of the external ear and the external auditory canal (external acoustic meatus) are significant and common. Patients with such a history should have a thorough basic examination, which can be done with simple tools. Symptoms of hearing loss, otalgia, otorrhea, tinnitus, aural fullness, vertigo, and facial weakness may warrant referral of the patient to an otolaryngologist. The crux of preventing worsening otologic sequelae is early detection and treatment.
 ...
PMID:Pathologic conditions of the external ear and auditory canal. 879 56

Our knowledge of chronic suppurative otitis media is scanty in Ethiopia. This hospital-based study was, thus, conducted prospectively over a period of 2 years among children visiting a tertiary facility in Addis Ababa. Demographic, clinical, audiometric and microbiological data were collected using a preformed questionnaire. A total of 391 patients constituting 0.6% of the hospital patient population and 22.3% of those seen at the ear, nose, and throat clinic had chronic suppurative otitis media. Most (82.1%) of them were from Addis Ababa, the male to female ratio was 1.6:1, and their median age at presentation was 5.9 years. Otorrhoea had started before the age of 2 years in 269 (68.8%), was bilateral in 215 (55.0%), recurrent in 285 (72.9%), and continuous in 106 (27.1%). Otalgia was reported in only 18%. Hearing loss was the major presenting symptom and the loss was moderate to severe (grades 2 and 3) in 32 (69.6%) and slight (grade 1) in 14 (30.4%) of the ears tested audiometrically. Malnutrition, nasopharyngitis, measles, HIV infection, tuberculosis, diabetes mellitus, neoplastic diseases, and structural abnormalities were common antecedents. Serious complications included systemic infections, otogenic meningitis, mastoiditis, and tetanus. A total of 106 bacterial isolates were cultured from ear discharges of 80 patients. Proteus species were the commonest, accounting for 40 (37.7%) followed by Staphylococcus aureus, Pseudomonas aeruginosa, and Gram negative enterics. All isolates were highly resistant to the commonly used antibiotics including penicillin, ampicillin, amoxycillin, trimethoprim-sulfamethoxazole, and chloramphenicol. Augmentin, gentamicin, and kanamycin were the only drugs to which most of the pathogens were sensitive. Marked improvement on the discharge was achieved in 64% of the 116 patients who complied with treatment. Awareness about the health implications of the disease seemed to be lacking in among the caretakers. Selective use of antibiotics and continuous aural cleansing need to be promoted. More elaborate epidemiological studies will be required to define the magnitude of the problem and identify optimal therapeutic modalities of suppurative ear disease in Ethiopia.
 ...
PMID:Chronic suppurative otitis media in a children's hospital in Addis Ababa, Ethiopia. 1196 74

Necrotizing (malignant) external otitis, an infection involving the temporal and adjacent bones, is a relatively rare complication of external otitis. It occurs primarily in immunocompromised persons, especially older persons with diabetes mellitus, and is often initiated by self-inflicted or iatrogenic trauma to the external auditory canal. The most frequent pathogen is Pseudomonas aeruginosa. Patients with necrotizing external otitis complain of severe otalgia that worsens at night, and otorrhea. Clinical findings include granulation tissue in the external auditory canal, especially at the bone-cartilage junction. Facial and other cranial nerve palsies indicate a poor prognosis; intracranial complications are the most frequent cause of death. Diagnosis requires culture of ear secretions and pathologic examination of granulation tissue from the infection site. Imaging studies may include computed tomographic scanning, technetium Tc 99m medronate bone scanning, and gallium citrate Ga 67 scintigraphy. Treatment includes correction of immunosuppression (when possible), local treatment of the auditory canal, long-term systemic antibiotic therapy and, in selected patients, surgery. Family physicians and others who provide medical care for immunocompromised patients should be alert to the possibility of necrotizing external otitis in patients who complain of otalgia, particularly if they have diabetes mellitus and external otitis that has been refractory to standard therapy. Susceptible patients should be educated to avoid manipulation of the ear canal (i.e., they should not use cotton swabs to clean their ears) and to minimize exposure of the ear canal to water with a high chloride concentration. Appropriate patients should be referred to an otolaryngologist.
 ...
PMID:Necrotizing (malignant) external otitis. 1557 Oct 53

Malignant externa otitis is a rapidly progressive infection of the external ear canal, mastoid and the base of the skull caused by Pseudomonas aeruginosa in elderly diabetics and other immunosuppressive conditions. Thirteen cases of malignant externa otitis seen in the E.N.T. Dept University College Hospital, Ibadan between 1988 and 1997 were reviewed. The mean age was 62 years and the mean duration of diabetes was 14 years. The most frequent symptoms were otalgia 13 (100%) and otorrhoea 12 (92%). The complications include multiple cranial neuropathy 11 (85%), meningitis (31%), brain abscess (8%), and infratemporal abscess 1 (8%). There were 8 deaths (62%) showing that this is still a dangerous condition in our environment. The problems identified were late presentation of cases and inavailability of facilities for prompt control and monitoring of patients. It is hoped that the outlook of the disease can be improved if there are corrected.
 ...
PMID:Behavioural pattern of malignant otitis external: 10-year review in Ibadan. 1451 Jan 33


1 2 3 Next >>