Efficacy of nasal Staphylococcus aureus eradication by topical nasal mupirocin in patients with perennial allergic rhinitis.

BACKGROUND: Staphylococcus aureus (SA) colonization is frequent in patients with perennial allergic rhinitis (PAR). Mupirocin has well-recognized antistaphylococcal activity, and its nasal formulation is approved for the eradication of SA nasal colonization. OBJECTIVE: To investigate the frequency of SA nasal carriage, its possible influence on AR severity, and nasal mupirocin's role on AR clinical severity. METHODS: Sixty patients, aged 5 to 60 years, with AR were included, and 55 healthy individuals served as a control group. Nasal smear specimens were drawn from both nares. A skin prick test to inhalational allergens and a score-graded clinical evaluation of AR were performed. Carriers of SA were treated with topical nasal mupirocin. RESULTS: The SA carrier (SAC) state was found in 23 (38%) of the patients with AR and in 8 (15%) of the healthy controls (P = .004). Comparing SACs with AR SA noncarriers, nasal symptom scores (SSs) tended to be higher in the SAC group (mean [SD], 11.09 [2.16] vs 8.86 [1.43]; P < .005). Treatment with topical nasal mupirocin diminished the SAC state to 10% (P = .009) but did not change AR clinical severity, as assessed by the SS. CONCLUSIONS: In patients with PAR, the SAC state is more prevalent compared with the healthy population. Topical nasal mupirocin reduces the SAC state but fails to clinically improve PAR, as assessed by the SS.

Fever of unknown origin in Israel.

INTRODUCTION: Fever of unknown origin (FUO) is still a diagnostic challenge for the family physician and the internist. In the last decades a few reports have emphasized a changing pattern in the prevalence of the 3 main categories of FUO: infections, malignancies and collagen diseases. AIMS: a. to find out if the changing pattern among the main diagnoses in patients with FUO is comparable to previous reports. MATERIAL AND METHODS: Medical files of patients that were admitted in two 450 beds rural Israeli hospitals were checked by two physicians. All files of patients with either the diagnosis of FUO, or files of patients with fever that were hospitalized for a week or longer in internal medicine departments were reviewed. RESULTS: 101 files of patients fulfilling the criteria of FUO were found. Surprisingly 54.5% of them had infectious diseases, 7.9% had malignant disease and only 2% had collagen disease. CONCLUSIONS: a. Infectious diseases are still the leading cause of FUO among Israeli patients. b. The prevalence of infectious and malignant diseases is comparable to other studies, however the low rate of connective tissue diseases in our study is unusual. c. The rate of undiagnosed FUO was remarkably high (32.7%), although all these patients recovered during hospitalization and probably had self limited infectious (viral) disease.

Diagnosis and treatment of cervical tuberculous lymphadenitis.

PURPOSE: This study presents the long-term results of treatment of a series of patients with tuberculous mycobacterial lymphadenitis of the head and neck. PATIENTS: Twenty-one patients were seen in a 10-year period. The median age at onset was of 41.2 years (range, 4 to 79 years), and the male-to-female ratio was 11:10. Sixteen patients were of Ethiopian origin, 3 from the former USSR, and 2 were Israeli women (1 of Indian and 1 of Morrocan origin). Symptoms started between 2 weeks and 6 months before presentation (mean, 5.8 weeks). Most patients had negative chest radiographs, a variable response to the tuberculin skin test, and a negative culture for mycobacterial organisms. RESULTS: Fine-needle aspiration (FNA) of the cervical lymph nodes was the most reliable method to confirm the bacteriologic agent causing the lymphadenopathy. Acid-fast bacilli smears of the aspirate were positive in all but 3 patients, whereas histologic examination of the lymph nodes gave diagnostic results in only two thirds of cases examined. All patients were treated with antituberculous chemotherapy. Sixteen patients also underwent surgical excision of their cervical lymph nodes, and all of them showed a complete response to the combined treatment. The remaining patients reacted to chemotherapy alone with complete cure. One patient died of gastric carcinoma, and the only acquired immune deficiency syndrome (AIDS) patient died a year later of cytomegalovirus encephalitis. CONCLUSION: The most reliable indicator of cervical mycobacterial infection is an acid-fast smear from the FNA specimen. Antituberculous chemotherapy, with or without surgical excision of the involved cervical lymph nodes, is the method of choice for treatment of this disease.

Long-term survival of patients with chronic obstructive pulmonary disease following mechanical ventilation.

Fifty patients with chronic obstructive pulmonary disease (COPD) who survived their first artificial ventilation were followed for 15 years. Five-year survival was 30%, median survival 23.5 months, and average survival 44.9 months. Sudden death occurred in 47% of the patients (40% at home and 7% in the hospital). Using multivariate analysis, survival correlated positively and significantly with partial pressure of arterial oxygen (PaO2) on discharge (P less than 0.02), presence of wheezes or rhonchi (P less than 0.02), absence of right heart failure on admission (P less than 0.02), and male sex (P less than 0.05), and negatively with age (P less than 0.03). Sixty percent of the patients were artificially ventilated at least twice. Prognosis was better as the number of ventilations increased after the first ventilation. Our finding that discharge PaO2 was the factor that correlated best with survival suggests that treatment for these patients consist of continuous long-term use of domiciliary oxygen.

Thymic cyst manifesting as subpulmonic fluid.

A 13-year-old girl was hospitalized for further investigation of abdominal pain and pain on the left side of the chest. Laparoscopy and subsequent laparotomy findings were negative. Chest roentgenograms disclosed subpulmonic fluid, the examination of which exposed a sterile mononuclear exudate. Because of these findings and a positive first-strength PPD tuberculin skin test result, the patient received antituberculosis and steroid therapy for six months with no effect. Exploratory thoracotomy revealed a thymic cyst situated in the left subpulmonic area. Thus another possible origin of subpulmonic effusions should be considered.