Paracoccus yeei: a Rare Opportunistic Bacterium in a Patient with Parotid Cyst.

BACKGROUND: Parotid cyst is a common problem in patients treated by surgeons. However, Paracoccus yeei was isolated from an aerobic blood culture in a patient with parotid cyst as an unusual etiologic opportunistic agent. METHODS: Since old biochemical identification kits are not able to identify this species, MALDI-TOF MS correctly was recommended to identify this isolate. Its identity was confirmed by sequencing of the 16S rRNA gene. RESULTS: The aligned sequences (16S rRNA gene) were used for a phylogenetic analysis (phylogenetic tree), which was produced using the BLAST pair-wise alignments. The sequence analysis determined that the best matches were with Paracoccus yeei. CONCLUSIONS: Paracoccus yeei has been reported as a rare opportunistic human pathogen, we should actively com-municate to the clinic to improve the real positive rate.

Histological surprise of parotid tuberculosis: about two cases.

Parotid tuberculosis remains a very rare localization in the Department of Otolaryngology and Cervico-Facial Surgery (ENT) sphere. It is presented in the form of a deceptive clinical picture causing confusion with other pathologies of the parotid gland, including tumor pathology. In addition, its lack of knowledge by practitioners increases the risk of missing the diagnosis. Often, the diagnosis is a histological surprise on a piece of excision after an exploratory parotidectomy. However, its treatment is primarily medical if the positive diagnosis is well established. We report medical observation of two new cases aged 44 and 45 respectively, who consult our center for parotid swelling. Radiological examinations were in favor of intraparotid cystic lesions. Both patients benefited from an excision whose histopathological study was in favor of primary parotid tuberculosis. The subsequent evolution was favorable under antituberculous treatment.

Anti-interferon-γ autoantibody-associated disseminated Mycobacterium abscessus infection mimicking parotid cancer with multiple metastases: A case report.

RATIONALE: Among the nontuberculous mycobacteria, Mycobacterium abscessus is a common cause of skin, soft tissue, and bone infections. However, disseminated M. abscessus infection that mimics cancer metastasis with an underlying relatively immunocompetent condition has rarely been reported. PATIENT CONCERNS: A nonsmoking 73-year-old man with an underlying relatively immunocompetent condition reported a 2-month history of a mass in the region of his right parotid gland that had been steadily increasing in size. DIAGNOSES: The head and neck computed tomography showed an avidly enhancing tumor with central necrosis in the right parotid region and lymphadenopathy bilaterally at neck levels II-V (<6 cm) with a necrotic core. The radiologist and otolaryngologist both suspected a diagnosis of right parotid gland cancer with metastasis. INTERVENTIONS: The necrotic tissue was removed surgically, and Mycobacterium culture showed M. abscessus. We collected a blood sample and detected anti-interferon-γ autoantibody. OUTCOMES: After 6 months of anti-M. abscessus treatment, physical examination showed remission of the parotid tumor, and axillary and supraclavicular lymphadenopathy. LESSONS: We report a case of disseminated M. abscessus infection, which involved parotid glands with multiple lymphadenopathies in a person with an underlying relatively immunocompetent condition. Possible underlying mechanisms such as anti-interferon-γ autoantibody-associated immunodeficiency should be considered in a patient with disseminated M. abscessus infection without a known immunocompromised condition.

Parotid tuberculosis.

Parotid gland tuberculosis is an uncommon manifestation of one of the most common infections even in the developing countries, caused by Mycobacterium tuberculosis. There are no specific symptoms or clinical signs of parotid tuberculosis, and such an infection most commonly presents as a slow growing painless parotid mass. Because of its rarity, tuberculosis of parotid gland is often mistaken for a malignant growth, and it most commonly gets diagnosed after superficial protidectomy. Complete cure is possible with standard antituberculous therapy. Most of our knowledge about this rare entity comes from case reports and short case series. The authors encountered three cases of parotid tuberculosis in the last 10 years. This article aims at presenting a comprehensive review of all the available literature and thus providing detailed information and an update on parotid tuberculosis and our experience of three cases.

Atypical mycobacteriosis involving parotid and para-retropharyngeal spaces.

The incidence of retro-parapharyngeal localization of cervical adenitis due to non-tuberculous mycobacteria is very rare. We present a case of an 18-months-old child with an involvement of parapharyngeal and retropharyngeal areas, right parotid and submandibular regions by atypical mycobacteriosis in the CT and MRI scan. The masses were surgically removed and the frozen-section histological exam upheld their atypical mycobacterial origin.

Non tuberculous mycobacterial lesion of the parotid gland and facial skin in a 4year old girl: A proposed treatment strategy.

OBJECTIVE: We report a case of a parotid-facial caseating granulomatous infection caused by atypical mycobacteria (Mycobacterium avium) in an immuno-competent child. The size and depth of the lesion and its proximity to the facial nerve present a challenge for a purely surgical treatment strategy. An alternative treatment strategy is developed to avoid severe disfigurement. STUDY DESIGN/SUBJECT: Atypical mycobacterial infection of the parotid region in a 5 year old girl: timeline and definition of a planned combined treatment strategy with antibiotics and surgical excision. RESULTS/CONCLUSION: Cervicofacial infections caused by non-tuberculous mycobacteria (NTM) may present surgical challenges due to the size and depth of the lesion and its proximity to the facial nerve and major vascular structures. Even minor scars are highly visible and poorly tolerated. Close clinical monitoring combined with judicious treatment strategies is necessary for successful treatment and good cosmesis. Recent literature provides insufficient guidance in formulating the best treatment strategy for the individual patient. Comparisons of antibiotic therapy with variations of surgical excision are abundant but poorly formulated. Our case presented with a lesion involving skin, superficial and deep lobe of the parotid gland. Lesion was in immediate proximity to the distribution of the facial nerve through the parotid gland. The risk of surgical damage to the facial nerve in the acute phase of the inflammation and the required extent of skin excision were significant. We decided to start treatment with combination antimycobacterial antibiotics in close cooperation with the pediatric infectious disease specialists. We observed and documented the regress and executed a delayed surgical excision when the lesion was reduced to skin only. In our opinion this was the best treatment strategy that helped us avoid extensive dissection in the vicinity of the facial nerve as well as a parotidectomy. Excision of the involved skin with the deep portion was performed 6.5 months after initial diagnosis.

Parotid abscess in children - A tertiary rural hospital experience.

UNLABELLED: Parotid abscess is a rare complication of acute parotitis in children. Acute parotitis occurs due to infection of intra-parotid or para-parotid lymph nodes or glandular parenchyma of the parotid gland which may progress to parotid abscess. OBJECTIVES: To document the causative organism, clinical behaviour and response to treatment in paediatric parotid abscess. MATERIALS AND METHODS: A retrospective study was done in our tertiary rural hospital from May 2007 to May 2015 to identify and analyse paediatric parotid abscess in 80 unilateral parotitis cases. RESULTS: 7 cases of parotid abscess were identified. 4 cases were diagnosed clinically and in 3 cases ultrasound was done showing heterogenous, hyperechoic, solid and cystic areas. In 2 patients, abscess was extending to the submandibular space. Incision and drainage was done in all patients. The most common bacteria was Methicillin Sensitive Staphylococcus aureus. Escherichia coli was reported in one patient, and was rare in parotid region. 2 patients had House Brackmann grade 2 marginal mandibular nerve palsy, and they recovered within 4½ months. CONCLUSION: Parotid abscess is an uncommon but life-threatening condition in paediatric age group. Poor orodental hygiene was most important predisposing factor. Abscess can be diagnosed clinically and ultrasound scan is also an important diagnostic tool. It is commonly caused by Gram positive cocci and responds well to incision and drainage followed by appropriate antibiotics. No fistula may result if treated early.

Tuberculosis of the parotid gland: histology surprise.

The Parotid gland is rarely involved in tuberculosis, even in endemic countries. We report a case of a 26 year-old woman with no medical history, who presented with a swelling of the parotid lodge. Pathology performed after surgery found a tuberculous parotitis, and the patient received anti-tuberculous regimen with a satisfactory evolution. We discuss both diagnostic and therapeutic modalities for this infection.

Facial extention of ear pathology: infected cholesteatoma causing a parotid abscess.

A man in his early 30s presented with right-sided preauricular swelling and facial oedema. He had a history of acid injury to his right ear as a child resulting in pinna deformity and subsequent blind sac closure of the external auditory canal. Imaging showed abnormal ear anatomy and abnormal density of the right parotid gland. Antibiotic therapy prevented progression but did not resolve the symptoms. Therefore, the infected area was surgically drained. This showed an underlying cholesteatoma, a benign but locally destructive condition where keratinising squamous epithelium grows in the middle ear and mastoid. The infected region was drained and the cholesteatoma was excised. This led to full resolution of the infection. The patient is awaiting a follow-up diffusion-weighted MRI. This case was unusual as the disease had extended beyond the ear and we therefore wish to alert clinicians to cholesteatoma as a possible cause of facial swelling.

Tuberculosis of parotid gland: a rare clinical entity.

Tuberculosis (TB) can affect almost any organ of the body; however, TB of the salivary glands is a rare condition. The purpose of this paper was to report a case of a 14-year-old boy who presented with a painless swelling and discharging sinus in the parotid gland and cervical region on the left side. There was no clinical evidence of systemic signs and symptoms of active TB elsewhere in the body. The combination of clinical suspicion, a positive family history, and the cytological findings confirmed the diagnosis. The patient was successfully treated via antitubercular therapy for six months. This case report suggests that, although primary TB of the parotid gland is an unusual clinical presentation, it should be considered in the differential diagnosis of patients presenting with a parotid gland swelling.

Non-tuberculous mycobacterial infection of the parotid gland in an immunocompetent elderly patient.

We experienced an extremely rare case in which combined antibacterial therapy for a non-tuberculous mycobacteria (NTM) infection of the parotid gland achieved a favourable outcome in an elderly immunocompetent patient. Although a 79-year-old man, who presented with swelling and fistula formation in the left parotid gland region, initially received combined antituberculous therapy due to a positive result of acid-fast staining, the lesion did not respond to these agents. Thereafter, since the culture examination did not detect Mycobacterium tuberculosis or NTM, we excluded tuberculosis and considered the possibility of an NTM infection caused by a rare mycobacterial species. Therefore, we switched to the clarithromycin-based antibacterial treatment for eight consecutive months without a surgical intervention, resulting in the complete disappearance of the lesion and no evidence of recurrence detected for 4 years. This conservative chemotherapy might be a feasible alternative to a surgical intervention for treatment against NTM infections of the parotid gland.