New Sensitization to House Dust Mites in Cefteram-Induced Occupational Asthma: A Case Report

Occupational asthma (OA) can improve after cessation of exposure; however, some patients suffer from persistence or aggravation of their asthmatic symptoms. Here we report a case of a new sensitization to house dust mites during the follow-up period in a 37-year-old female patient with OA induced by cefteram pivoxil powder (cefteram powder). She was previously diagnosed with OA caused by inhalation of cefteram powder. Consequently, she left her job and had been well for 9 subsequent years. She began to experience aggravation of her rhinitis and asthmatic symptoms again several months prior to presentation. Her skin-prick test results had converted to strongly positive responses to two types of house dust mites. The serum levels of eosinophil cationic protein (ECP) and the total and specific immunoglobulin (Ig)E levels against the two types of house dust mites were elevated. An inhalation challenge test with Dermatophagoides farinae was performed, and significant bronchoconstriction (21.1% reduction in the forced expiratory volume in the first second) with asthma symptoms was observed at 10 minutes. To our knowledge, this is the first case demonstrating a new sensitization to house dust mites in a patient with OA caused by cefteram powder. Regular monitoring, including skin-prick tests and measurement of specific serum IgE/ECP levels, may help to screen potential cases.

The Effect of Intensive Therapy Using Nebulized Antibiotics after Endoscpic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are some difficulties and dilemmas in treating patients who show acute recurrent infection or persistent inflammation after sinus surgery. Recently, nebulized antibiotic therapy was recommended as another treatment option for these patients. Our study was to evaluate the effect of nebulized antibiotic therapy in these patients. SUBJECTS AND METHOD: We selected 38 adult patients who had received endoscopic surgery previously. They were patients of the refractory group who have showed persistent purulent rhinorrhea despite treatment for 2 months after sinus surgery and the acute exacerbation group who have showed repeated worsening of their symptoms more than 3 times for 6 months. Cultures were taken from all cases and proper oral antibiotics were used based on their culture results. Oral antibiotics were stopped during the nebulized antimicrobial therapy. Nebulized antibiotics therapy was performed 5 times a week for 4 weeks with cefmenoxime hydrochloride using ultrasonic nebulizer. The symptom score and endoscopic appearance were checked also before and 1, 2 and 3 months after the treatment. RESULTS: In 38 patients, 6 patients were excluded due to follow up loss or voluntary stop of treatment and 32 patients were available. S. aureus, P. aeruginosa and coagulase-negative Staphylococcus were most common organisms in all patients. The symptom score and endoscopic appearance after the treatment showed significant improvement. No complication was found in all cases. CONCLUSION: Nebulized antibiotic therapy might be considered as another therapeutic option for patients with refractory or acute exacerbation of chronic rhinosinusitis after endoscopic sinus surgery.

Effect of Topical Antibiotics to Mouse Model of Acute Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : Administration of antibiotics is an essential modality to treat acute rhinosinusitis. Although intranasal inoculation of antibiotics does not have definite bioavailability, it is a very effective method to treat acute rhinosinusitis. We made a mouse model of rhinosinusitis by inoculation of Streptococcus pneumoniae and administrated time-dependent antibiotics or concentration-dependent antibiotics as a topical manner and investigated their effectiveness. SUBJECTS AND METHOD : Fifty 10-week old male C57BL/6 mice were employed for acute rhinosinusitis model. Mice were inoculated with Streptococcus pneumoniae, and from the 6th to 10th day, we made the negative control group by inoculation of normal saline (Group I), the antibiotics group by inoculation of cefmenoxime & vancomycin (Group II), the ofloxacin & tobramycin group (Group III), and the positive control group (Group IV). On the 11th day, all mice were sacrificed and the effectiveness of antibiotics was evaluated by comparison of nasal lavage colony count and neutrophil count of the sinonasal tissue. RESULTS : Minimum bactericidal concentration (MBC) of each antibiotics was cefmenoxime 20 microgram/ml, ofloxacin 80 microgram/ml, tobramycin 25 microgram/ml, vancomycin 12.5 microgram/ml. By nasal lavage, antibiotics inoculation group (Group II, III) had more decreased bacterial growth than the positive control, and it was statistically significant (p=0.037). Comparision between the group administrated with concentration-dependent antibiotics and time-dependent antibiotics, clusters of neutrophil decreased in two groups compared to positive control revealed that the group administered with concentration-dependent antibiotics had fewer clusters of neutrophil than the group administered with time-dependent antibiotics, and it was statistically significant. CONCLUSION : Local inoculation of concentration dependent antibiotics could be a more effective way to treat acute rhinosinusitis induced by Streptococcus pneumoniae than time dependent antibiotics.

Gonococcal Keratoconjunctivitis in Adult

PURPOSE: Neisseria gonorrhea is usually identified in neonatal conjunctivitis, but rare in adult keratoconjunctivitis. We report a rare case of bilateral gonococcal conjunctivitis combined with keratitis. METHODS: A 29-year-old male with a history of sexual contact with a prostitute 17 days ago referred to our hospital with acute keratoconjunctivitis. Ocular discharge was examined by Gram stain, culture, and sensitivity test to antibiotics, resulting in the identification of penicillin-resistant Neisseria gonorrhea. RESULTS: This patient was treated with intramuscular ceftriaxone for 5 days and topical cefmenoxime 0.5% for 2 weeks. Following 24 hours after antibiotics medication, the clinical symptoms were improved, and follow-up culture was negative. No evidence of serious complication was left in the cornea and conjunctiva. CONCLUSIONS: As adult gonococcal keratoconjuctivitis is relatively rare, the clinical diagnosis may be delayed. When one suspects an adult gonococcal keratoconjunctivitis, immediate gram staining and confirmatory culture for isolation of gram-negative intracellular diplococci are mandatory. It should be remembered that intramuscular ceftriaxone and topical cefmenoxime are an effective treatment for this condition.

Gonococcal Keratoconjunctivitis in Adult

PURPOSE: Neisseria gonorrhea is usually identified in neonatal conjunctivitis, but rare in adult keratoconjunctivitis. We report a rare case of bilateral gonococcal conjunctivitis combined with keratitis. METHODS: A 29-year-old male with a history of sexual contact with a prostitute 17 days ago referred to our hospital with acute keratoconjunctivitis. Ocular discharge was examined by Gram stain, culture, and sensitivity test to antibiotics, resulting in the identification of penicillin-resistant Neisseria gonorrhea. RESULTS: This patient was treated with intramuscular ceftriaxone for 5 days and topical cefmenoxime 0.5% for 2 weeks. Following 24 hours after antibiotics medication, the clinical symptoms were improved, and follow-up culture was negative. No evidence of serious complication was left in the cornea and conjunctiva. CONCLUSIONS: As adult gonococcal keratoconjuctivitis is relatively rare, the clinical diagnosis may be delayed. When one suspects an adult gonococcal keratoconjunctivitis, immediate gram staining and confirmatory culture for isolation of gram-negative intracellular diplococci are mandatory. It should be remembered that intramuscular ceftriaxone and topical cefmenoxime are an effective treatment for this condition.