Palatine Tonsilloliths and Actinomyces: A Multi-institutional Study of Adult Patients Undergoing Tonsillectomy.

OBJECTIVE: To better characterize associations between Actinomyces and tonsillolith versus nontonsillolith tonsillectomy specimens. STUDY DESIGN: Bi-institutional retrospective case-case study. SETTING: University and county hospital. SUBJECTS AND METHODS: Adult patients with a clinical history of tonsilloliths who underwent tonsillectomy from January 2006 to December 2018 were included. Patients undergoing tonsillectomy for tonsillar hypertrophy and chronic tonsillitis were identified as comparative cases. Similarly, patients with ipsilateral oropharyngeal cancer (OPC) who underwent contralateral tonsillectomy of a normal-appearing tonsil for prophylaxis against a second primary cancer were also included as comparative cases. RESULTS: The study population comprised 134 patients who underwent tonsillectomy: 62 tonsillolith and 72 nontonsillolith (tonsillar hypertrophy, n = 30; chronic tonsillitis, n = 30; normal-appearing contralateral tonsil in patients with ipsilateral OPC, n = 12). Actinomyces was reported in 11% of the patients with tonsilloliths on initial pathology reports but in 95% after re-evaluation (n = 54 of 57). Actinomyces prevalence was significantly higher in patients with tonsilloliths as compared with patients with recurrent tonsillitis (73%, n = 22 of 30, P < .001) and normal-appearing contralateral tonsils in patients with ipsilateral OPC (58%, n = 7 of 12, P < .001). Actinomyces prevalence was not significantly different between patients with tonsilloliths and tonsillar hypertrophy (83%, n = 25 of 30, P = .11). CONCLUSION: The prevalence of Actinomyces in tonsillolith tonsil specimens is high; however, Actinomyces routinely colonizes nontonsillolith tonsil specimens. Therefore, Actinomyces is unlikely to be the primary driver of tonsillolith pathogenesis, and Actinomyces-targeted treatment of tonsilloliths may not be effective. Treatment strategies addressing tonsilloliths should be further investigated.

Biliary antibiotics irrigation for E. coli-induced chronic proliferative cholangitis and hepatolithiasis: A pathophysiological study in rabbits.

BACKGROUND: The gram-negative bacteria secreted endotoxin, Lipopolysaccharide (LPS), plays important roles in the formation and recurrence of hepatolithiasis and chronic biliary inflammation in patients of Southeast Asia. We aimed to elucidate the anti-inflammatory effect and mechanism of local antibiotics irrigation on chronic proliferative cholangitis (CPC) and hepatolithiasis. METHODS: Escherichia coli was injected into rabbit bile ducts to induce CPC. Rabbits were divided into sham operation (SO), povidone-iodine, Metronidazole plus chlorhexidine, ofloxacin, furacillin, Neosporin® G.U., and CPC groups. Local irrigation was performed for 28 days after CPC was established. Residual E. coli and LPS, and the expression of MCP-1, CD14, COX-2, VEGF, IL-6, NF-κB, TNF-α, Fas, TGF-ß1, α-SMA, Collagen-I, ß-glucuronidase, PKC, C-myc, and Mucin 5AC were assessed in bile duct tissues. RESULTS: The residual E. coli and LPS, and expression of MCP-1, CD14, COX-2, IL-6, NF-κB, TNF-α, Fas, TGF-ß1, α-SMA, ß-glucuronidase, PKC, C-myc, and Mucin 5AC in the SO, povidone-iodine, Metronidazole plus chlorhexidine, ofloxacin, and Neosporin® G.U. groups were significantly lower than those in the furacillin and CPC groups (P<0.05). VEGF and Collagen-I levels in the SO, povidone-iodine, metronidazole plus chlorhexidine, and ofloxacin groups were significantly lower than those in the furacillin, Neosporin® G.U., and CPC groups (P<0.05). CONCLUSIONS: LPS affects the pathophysiology of E. coli caused chronic proliferative cholangitis and hepatolithiasis recurrence. Local antibiotics irrigation could prevent chronic proliferative cholangitis and stones formation by decreasing LPS-induced proinflammatory and profibrotic cytokines release. Povidone iodine, metronidazole plus chlorhexidine, and ofloxacin were more effective than Neosporin® G.U. and furacillin.

The human gallbladder microbiome is related to the physiological state and the biliary metabolic profile.

BACKGROUND: The microbial populations of the human intestinal tract and their relationship to specific diseases have been extensively studied during the last decade. However, the characterization of the human bile microbiota as a whole has been hampered by difficulties in accessing biological samples and the lack of adequate methodologies to assess molecular studies. Although a few reports have described the biliary microbiota in some hepatobiliary diseases, the bile microbiota of healthy individuals has not been described. With this in mind, the goal of the present study was to generate fundamental knowledge on the composition and activity of the human bile microbiota, as well as establishing its potential relationship with human bile-related disorders. RESULTS: Human bile samples from the gallbladder of individuals from a control group, without any record of hepatobiliary disorder, were obtained from liver donors during liver transplantation surgery. A bile DNA extraction method was optimized together with a quantitative PCR (qPCR) assay for determining the bacterial load. This allows the selection of samples to perform functional metagenomic analysis. Bile samples from the gallbladder of individuals suffering from lithiasis were collected during gallbladder resection and the microbial profiles assessed, using a 16S rRNA gene-based sequencing analysis, and compared with those of the control group. Additionally, the metabolic profile of the samples was analyzed by nuclear magnetic resonance (NMR). We detected, for the first time, bacterial communities in gallbladder samples of individuals without any hepatobiliary pathology. In the biliary microecosystem, the main bacterial phyla were represented by Firmicutes, Bacteroidetes, Actinobacteria, and Proteobacteria. Significant differences in the relative abundance of different taxa of both groups were found. Sequences belonging to the family Propionibacteriaceae were more abundant in bile samples from control subjects; meanwhile, in patients with cholelithiasis members of the families Bacteroidaceae, Prevotellaceae, Porphyromonadaceae, and Veillonellaceae were more frequently detected. Furthermore, the metabolomics analysis showed that the two study groups have different metabolic profiles. CONCLUSIONS: Our results indicate that the gallbladder of human individuals, without diagnosed hepatobiliary pathology, harbors a microbial ecosystem that is described for the first time in this study. Its bacterial representatives and metabolites are different from those detected in people suffering from cholelithiasis. In this regard, since liver donors have been subjected to the specific conditions of the hospital's intensive care unit, including an antibiotic treatment, we must be cautious in stating that their bile samples contain a physiologically normal biliary microbiome. In any case, our results open up new possibilities to discover bacterial functions in a microbial ecosystem that has not previously been explored.

Primary enterolithiasis with intestinal tuberculosis: rare presentation of a common disease.

Enterolithiasis is the formation of intestinal calculi due to stasis. Tubercular strictures resulting in intestinal stasis provide a favourable environment for enterolith formation. Intestinal tuberculosis occurs commonly in India, but coexistent enterolithiasis has been reported rarely. We are describing three cases of enterolithiasis secondary to tubercular intestinal strictures among female patients in the fourth to fifth decades of life, all of them having pulmonary tuberculosis in the past. All the cases presented with features of subacute intestinal obstruction. X-ray abdomen done for all of them revealed single to multiple round, oval and rectangular, radio-opaque shadows suggestive of stones. Coexistence of enterolithiasis with intestinal tuberculosis may worsen the symptoms of intestinal obstruction and surgery remains the mainstay of treatment. All the patients underwent exploratory laparotomy, resection and anastomosis of the diseased bowel and antitubercular therapy was started. Two patients responded well to the treatment and the third one expired due to cardiac comorbidity.

Screening of different probiotic strains for their in vitro ability to metabolise oxalates: any prospective use in humans?

BACKGROUND: Oxalate is the salt-forming ion of oxalic acid and can generate oxalate salts combining with various cations, such as sodium, potassium, magnesium, and calcium. Approximately 75% of all kidney stones are composed primarily of calcium oxalate (CaOx) and hyperoxaluria, a condition involving high urinary oxalate concentration, is considered a primary risk factor for kidney stone formation, known as nephrolithiasis. Current therapeutic strategies often fail in their compliance or effectiveness, and CaOx stone recurrence is still common. After an initial stone, there is a 50% chance of forming a second stone within 7 years if the condition is left untreated. The potential therapeutic application of some probiotics, mainly lactobacilli and bifidobacteria, in reducing hyperoxaluria in vivo through intestinal oxalate degrading activity is compelling and initial reports are promising. This study was undertaken to screen different Lactobacillus and Bifidobacterium strains for their capacity to degrade oxalate in vitro using reverse-phase high-performance liquid chromatography (HPLC). METHODS: The oxalate-degrading activity of 13 lactobacilli and 5 bifidobacteria was tested using a novel HPLC method after growth in a broth culture added with 10 mM ammonium oxalate. Experiments were repeated 3 times. Oxalobacter formigenes (DSM 4420) was used as positive reference to validate HPLC oxalate-degrading capability assays. RESULTS: Lactobacillus strains were more efficient than bifidobacteria in degrading oxalates. L. paracasei LPC09 (DSM 24243) gave the best result, as 68.5% of ammonium oxalate was converted at the end of incubation, whereas the following best converters belong to the L. gasseri and L. acidophilus species. The relatively low conversion rate observed for most bifidobacteria can probably be attributed to intrinsic oxalate toxicity toward this genus. CONCLUSIONS: Humans lack the enzymes needed to directly metabolise oxalate, and this potentially toxic compound is, therefore, managed using alternative pathways. As oxalate-degrading bacteria are present in the endogenous microbiota of the human intestine, although with significant individual differences, it is possible to hypothesise that the administration of selected oxalate-degrading probiotics could be an alternative and innovative approach to reducing the intestinal absorption of oxalate and the resulting urinary excretion.

Noninvasive aspergillosis as a maxillary antrolith: report of a rare case.

Maxillary antrolithiasis is characterized by masses of tissue of endogenous or exogenous origin that calcify within the maxillary sinuses. Aspergillosis is a fungal disease in which the maxillary sinus is a primary site of infection. Aspergillosis mycetoma, its noninvasive form, is the most prevalent modality of the disease in the maxillary sinuses. In approximately half of the cases reported in the literature, calcification of the fungal mycelia, which later became antroliths, was verified. This article reports a rare case of the accidental discovery of a maxillary antrolith associated with noninvasive aspergillosis in an immunocompetent and asymptomatic 56-year-old woman. The diagnosis and therapeutic procedures used in treating the patient are discussed as well as the probable iatrogenic origin of the fungal pathology.

Chronic rhinorrhea revealing an actinomycotic rhinolithiasis with ectopic tooth.

Intranasal ectopic tooth is a rare nidus for a rhinolith where local infection may be concomitant. No description of the triple association 'actinomycotic rhinolithiasis ectopic tooth' could be found in the medical literature. Classically, the Actinomyces species are sensitive to regimens of penicillin from 6 to 12 months or longer. Immunocompetent patients can benefit from shorter courses of antibiotic therapy, such as ciprofloxacin, with a favourable outcome. The authors describe the case of a 25-year-old man who presented with an actinomycosis chronic discharge revealing actinomycosis associated with rhinolithiasis and ectopic tooth. They attempt to explain the likely mechanism of occurrence of this triple association.

Histoplasmosis.

Histoplasmosis is the most prevalent endemic fungal infection in North America. The clinical spectrum ranges from asymptomatic, self-limited illness to a life-threatening progressive disseminated disease. Chronic manifestations of healed infection can also be problematic. Clinical presentation depends on the infectious load, underlying immune status, and lung function. The preferred diagnostic methods and treatment options vary with clinical scenario and severity of illness. New diagnostic tools and treatment options are now available in clinical practice. We present an overview of this important endemic mycosis with emphasis on diagnosis and treatment recommendations for the different clinical syndromes of histoplasmosis.

Nanobacteria may be linked to testicular microlithiasis in infertility.

Testicular microlithiasis (TM) in infertility is an uncommon pathologic condition of unclear etiology that is characterized by calcium deposits within the seminiferous tubules. Nanobacteria (NB), as novel microorganisms mediating tissue calcification, have been discovered in some diseases. In this study, we hypothesized that NB may participate in the pathogenesis of TM, particularly in infertility. Seventeen infertility patients with TM detected by scrotal color Doppler ultrasonography and 17 infertility patients without TM as controls were enrolled in the study. The NB were isolated and cultured from semen samples and urine samples. After 3 to 6 weeks of culture, 10 of 17 (58.8%) semen samples and 2 urine samples from infertile patients with TM showed the growth of white granular microbes that firmly attached to the bottom of the culture flask and were visible to the naked eye. In the control group, only 1 of 17 (5.9%) semen samples from infertile patients without TM showed the growth of white granular microbes. The cultured microbes were identified by indirect immunofluorescent staining (IIFS), transmission electron microscopy (TEM), and 16s rRNA gene expression. IIFS and TEM revealed NB to be coccoid and 100 to 500 nm in diameter. The BLAST result revealed that the 16s rRNA gene sequence from the cultured microbes was 97% the same as that of the known NB. Our results showed that NB may be linked to the development of TM, which may provide a potential target for the diagnosis and treatment of infertility with TM.

Lacrimal excretory system concretions: canalicular and lacrimal sac.

PURPOSE: To characterize the demographics of patients with dacryolithiasis and to compare patients who have canalicular concretions with patients who have lacrimal sac and duct dacryoliths. DESIGN: Comparative case series study and literature review. PARTICIPANTS: A total of 327 consecutive patients undergoing external dacryocystorhinostomy (DCR) between 1998 and 2008 at the University of Wisconsin-Madison. Fifteen consecutive patients with the diagnosis of canaliculitis during this period were also included. METHODS: The charts of all patients were reviewed for age, sex, laterality, duration of symptoms, history of dacryocystitis, history of lacrimal system intervention, history of smoking, examination findings, result of canalicular probing and irrigation, and histopathologic evaluation of the dacryolith or canalicular concretion. If applicable, the canaliculus involved was noted, as was any history of purulent canalicular drainage or canalicular injury. MAIN OUTCOME MEASURES: Patient demographics, duration of symptoms, history of dacryocystitis, history of smoking, presence of fungi, or Actinomyces on histopathologic evaluation. Findings were compared with prior studies reported in the literature. RESULTS: Of the 327 patients undergoing DCR, 22 (6.7%) had dacryoliths; 11 of 15 patients (73.3%) with canaliculitis had canalicular concretions. Patients with canalicular concretions were older than those with dacryoliths at DCR: 70.6 years versus 51.1 years (P = 0.003). Women made up the majority of both groups: 9 of 11 patients (81.8%) with canalicular concretions and 13 of 22 patients (59.1%) with dacryoliths at DCR (P = 0.26). The mean duration of symptoms was 20.2 months among patients with canalicular concretions and 30.5 months in patients with dacryoliths at DCR (P = 0.66); 1 of 11 patients (9.1%) with canalicular concretions smoked, compared with 9 of 21 patients (42.9%) with dacryoliths at DCR (P = 0.11). Actinomyces was isolated from 10 of 11 canalicular concretions (90.9%) and only 3 of 22 dacryoliths (13.6%) from DCR (P<0.001). In none of the 11 canalicular concretions were fungi identified, compared with 2 of 22 dacryoliths (9.1%) from DCR (P = 0.54). CONCLUSIONS: The demographics of patients with dacryoliths and the histopathology of their concretions vary with the location of the dacryolith in the lacrimal excretory system.

Broncholith caused by donor-acquired histoplasmosis in a lung transplant recipient.

A broncholith is a calcified lymph node that erodes into and partially or completely obstructs the bronchial lumen. The natural history of broncholiths is poorly understood. They are frequently encountered in residents of areas that are endemic for Histoplasma capsulatum and Mycobacterium tuberculum. We report the first case of a broncholith in which the fungus Histoplasma capsulatum was transferred from a donor to a lung transplant (LTx) recipient. Our report highlights the time course of broncholith development and its successful management. We suspect that broncholithiasis and transmission of Histoplasma capsulatum from a donor to the recipient are under-reported in the LTx literature. We hypothesize that histoplasmosis can be transmitted from the donor to the recipient and the duration in the formation of calcification of the lymph node or the broncholith can be anywhere from 2 to 10 months.