Microbiota of the Oropharynx and Endoscope Compared to the Esophagus.

The role of the microflora in the development of esophageal disease is still largely unknown and is being investigated in more detail. Our goal was to determine how the microbiota levels of endoscope and uvular swabs compared to the levels of tissue biopsies along various points of the esophagus. 17 patients with Barrett's esophagus agreed to participate in the study. Biopsies of esophageal mucosa were taken from the (1) proximal esophagus, (2) mid-esophagus, (3) distal esophagus, and (4) Barrett's esophagus. Swabs were also taken from the uvula and the endoscope. Throughout the esophagus, 17 bacterial genera were detected from the samples. The microflora pattern obtained from the uvula and endoscopic swabs did not correlate well with mucosal biopsies along any aspect of the esophagus. There were statistically significant differences in the levels and proportions of bacteria found when comparing the uvula swab to the esophageal biopsies and when comparing the endoscope swab to the esophageal biopsies. Obtaining a simple swab of the uvula or endoscope itself appears to be a poor substitute for tissue biopsy of esophageal mucosa when evaluating microflora patterns. When performing microflora studies of the esophagus, mucosal biopsies should be used for analysis.

Primary tuberculosis of oral cavity: a rare entity revisited.

Oral lesions of tuberculosis though uncommon, are seen both in the primary as well as the secondary stages of the disease. In secondary tuberculosis, the oral manifestations are accompanied by lesions in the lung, lymph nodes, or any other organ system of the body. This can be detected by the usual clinical history and systemic examination. Primary oral tuberculosis may thus present as a diagnostic challenge to the clinician. Amongst the oral lesions also, tongue is the usual site for tubercular infection, with the upper lip and soft palate being the least affected. The authors report two rare cases of children with isolated primary tuberculosis of the lip and uvula. Interestingly, the first case presenting just as a diffuse swelling of the upper lip, and the second as pain in throat with congestion and granulations on the uvula. We suggest a distinct Indian social habit which predisposes to primary lip and uvular tuberculosis, sites not common in the rest of the world. The habit of doing "datoon" i.e. brushing of the teeth with neem twigs in rural India, which at times causes trauma on the palate and thus predisposing to seedling of the wound with mycobacterium tuberculosis.

Pseudomembranous candidosis in nephrotic syndrome: a case report.

A 33-year-old male presented for evaluation of several large, recently discovered white oral lesions of unknown duration. Clinical examination revealed multiple white plaques on the soft palate, uvula, buccal mucosa, and tongue. These lesions could be wiped away, leaving an erythematous base. The lesions were asymptomatic, and the patient did not report difficulty in swallowing. The patient's medical history was noteworthy for several significant diagnoses within the previous 6 months: type 2 diabetes mellitus, mild systolic hypertension, gastroesophageal reflux disease, and adult idiopathic nephrotic syndrome, determined by kidney biopsy to be caused by focal segmental glomerulosclerosis. A provisional diagnosis of pseudomembraneous candidosis was made, and the patient responded to a 14-day course of clotrimazole, administered in 10-mg troches, five times a day. Management of nephrotic syndrome predisposes patients to recurrent fungal infections, and the disease has implications for the selection of systemic antifungal agents.

Upper respiratory tract infections in adolescents.

While upper respiratory tract infections (URTIs) cause much infectious morbidity in infants and young children, adolescents are not immune to infections. Adolescents experience two to four episodes of viral nasopharyngitis annually. In addition to group A streptococcus (GAS), pharyngitis may occur with other streptococci, Arcanobacterium haemolyticum, Epstein-Barr virus, Neisseria gonorrhoeae, and other pathogens. Uvulits, typically in association with GAS, occurs occasionally. Peritonsillar abscess is the most common deep neck space infection seen in adolescents, but retropharyngeal and parapharyngeal abscesses also occur, causing major morbidity. Adolescents experience fewer cases of otitis media than younger children. Rhinosinusitis occurs commonly in adolescents, occasionally leading to chronic sinusitis and serious sequelae such as osteomyelitis. This article reviews the major URTIs likely to be encountered by physicians caring for adolescents. For each entity there is a brief description of the epidemiology, morbidity, microbiology, clinical and laboratory features, treatment, and prevention.

Primary mycobacterial infection of the uvula.

Tuberculosis, and non-tuberculous mycobacterial infections are becoming more common thus it is more likely that otolaryngologists will encounter these conditions. We describe an otherwise well patient, with symptoms and signs from chronic uvular inflammation, who proved to have a primary mycobacterial infection. This is an unique presentation in the literature and reminds clinicians of the need, where uncertainty exists in diagnosis, to consider mycobacterial infections.

Uvulitis caused by anaerobic bacteria.

OBJECTIVE: I present two children with bacteremic uvulitis due to anaerobic bacteria. RESULTS: Fusobacterium nucleatum was recovered from the blood, and Haemophilus influenzae type b was recovered from a surface uvular culture of one patient. beta-Lactamase-producing Prevotella intermedia was isolated for the blood of the other patient. Both patients responded to parenteral, followed by oral, antimicrobial therapy. CONCLUSIONS: These findings illustrate the need to send blood cultures for both aerobic and anaerobic bacteria in patients with uvulitis.

[Vasculitis caused by Pseudomonas: a case report]. / Vasculitis por pseudomona. A propósito de un caso.

Pseudomona vasculitis is an exceptional disease. Only a few cases have been reported, non with oropharyngeal involvement. The case of a 30-year-old, HIV-positive man who suddenly developed septicemia and necrotizing lesions with tissue destruction of the oropharynx is reported. Histological study confirmed vasculitis. Pseudomona aeruginosa was isolated in peripheral blood and in the biopsy of the palatal lesion. Antibiotic treatment produced satisfactory results.

Isolated uvulitis due to Haemophilus influenzae type b.

Infections of the uvula are infrequently recognized and have been previously described only in association with group A streptococcal pharyngitis or Haemophilus influenzae type b epiglottitis. Three cases of H influenzae type b bacteremic uvulitis are described. In suspected cases of H influenzae type b uvulitis, a lateral neck radiograph should be performed and parenteral antibiotics initiated.