Mycobacterium fortuitum as a cause of mastoiditis and wound infection.

Mycobacterium fortuitum is uncommonly pathogenic for man. When implicated, this organism usually infects soft-tissue structures. Therapy necessitates surgical excision and prolonged antimicrobial therapy. A patient had a mastoiditis and wound infection due to this organism. Her successful treatment included radical debridement and prolonged therapy with several antimicrobials. The necessity for including mycobacteria in the differential diagnosis of ear, nose, and throat diseases is emphasized by our experience. The complexities of management of these infections are reviewed.

Aspergillosis of the nose and paranasal sinuses.

Aspergillosis of the nose and paranasal sinuses should not be considered an innocuous disease. In a review of 103 cases, other than in the Sudan, the mortality rate was 16 per cent. Intracranial extension of the fungus from the nose and sinuses carries a grave prognosis. Although aspergillosis occurs frequently in patients debilitated from other diseases, this is not always the case, and most deaths in the review series occurred in otherwise healthy individuals. The authors present eight cases of their own.

Sinusitis of the maxillary antrum.

Twenty-four adults with clinical evidence of sinusitis were studied by 65 needle punctures of the maxillary antrum. Fourteen of 15 sinuses with normal transillumination and 19 of 26 that were dull had normal aspirates, whereas 24 of 24 that were opaque had abnormal aspirates (P less than 0.001). Marked mucosal thickening as determined radiologically (Water's view) was associated with abnormal aspirates whereas lesser mucosal thickening was not (P less than 0.001). In acute sinusitis, there was a strong correlation between high aspirate leukocyte counts (greater than 1000 per cubic millimeter) and infection as manifested by bacterial titers of greater than 10(5) per milliliter or the isolation of virus fungus (P greater than 0.001). Anterior-nasal-swab cultures correlated poorly with direct aspirate culters. Organisms frequently recovered from the sinus included Haemophilus influenzae, Strepto coccus pneumoniae, and anaerobic bacteria. Rhinovirus was recovered twice. Antibiotics were usedful in patients with acute sinusitis if the organism was sensitive in vitro (P less than 0.001).