Suhail Amin Patigaroo

Malignant otitis externa with ecthyma gangrenosum and pneumonia in an infant.

Necrotizing (malignant) external otitis, an infection involving the temporal and adjacent bones, is a relatively rare complication of external otitis. Ecthyma gangrenosum is a rare and invasive cutaneous infection caused by pseudomonas in the majority of cases. Pseudomonal pneumonia typically occurs in a patient who is immunocompromised and is found to be the most common cause of hospital acquired pneumonia. We report a rare case of a previously healthy 5 month old infant developing transient neutropenia, presenting to us with malignant otitis externa, ecthyma gangrenosum and pneumonia but without bacteraemia.

Foreign body inhalation in children: clinical presentations and x-ray chest findings -

Background: Foreign body aspiration (FBA) is a medical emergency in children. Delay in diagnosis and treatment can cause complications and even deaths are reported. Objective: The aim of this study was to find out clinical features and x-ray findings in patients with FBA. Materials and Methods: A retrospective analysis was done on all patients less than 15 years of age with the discharge diagnosis of FBA from 2011 to 2014 at SMHS Hospital in Kashmir province. Results: Out of 140 patients with FBA, 87 (62%) were male. The mean age was 48 months. The most common clinical findings were history of chocking (77%), decreased breath sounds (42%), wheezing (38%), cough (20%), respiratory distress (15.5%), and fever. CXR was normal in 46% of patients. Air trapping (emphysema) was the most common radiological finding (29.5%) followed by atelectasis (14%) and consolidations (9.2%) and opaque foreign bodies (5.7%). Gram seeds (pulses) were the commonest foreign body (40%). Bronchoscopic removal of foreign body was done successfully in 133 patients (95%). Conclusion: Although FBA in children diagnosed by history, physical examination and radiographic findings, but this finding may be misleading. Negative X-ray chest should not exclude the diagnosis of FBA in children especially with a strong history of FBA. Early bronchoscopic examination will be safe and lifesaving.

Drift in the bacteriology of chronic suppurative otitis media and methicillin-resistant Staphylococcus aureus as an emerging pathogen: an experience -

Background: Chronic suppurative otitis media (CSOM) is a condition of the middle ear, which is characterized by persistent or recurrent discharge. Many studies done in CSOM have found the predominance of Gram negatives in the ear discharge, with Pseudomonas and Proteus species as the most commonly identified aerobic organisms. Gram positives [Staphylococcus aureus, methicillin-resistant S. aureus (MRSA)] are found but are less common. Objective: To study the aerobic culture and sensitivity results of pediatric patients with CSOM attending the outpatient department, with special emphasis on MRSA. Materials and Methods: One hundred-fifteen pediatric patients with CSOM who fulfilled the inclusion and exclusion criteria were prospectively studied. They showed chronic ear discharge and had not received antibiotics for the previous 7 days. Swabs were taken from the middle ear under microscope and cultured for only aerobic bacteria. The antimicrobial susceptibility testing was performed using an agar disk diffusion method according to the guidelines of Clinical and Laboratory Standards Institute. Result: The male subjects were commonly involved. There were 113 positive cultures for organisms from the 115 patients. The most common organism was Staphylococcus seen in 65% of patients [35% methicillin-sensitive Staphylococcus aureus (MSSA) and 30% MRSA], followed by Pseudomonas sp. 13%, and Escherichia coli in 7%. The majority of Staphylococcus sp. were MSSA (53%), followed by MRSA (44%). Gram positives were seen in 65% of cases, while gram negatives in 31% of cases. We noticed a drift in bacteriology from gram negatives to gram positives. MRSA were sensitive to linezolid, vancomycin, and clindamycin, whereas resistant to azithromycin, cefuroxime, and ciprofloxacin. The majority of MRSA were seen in patients with central perforation with ossicular discontinuity. The percentage of MRSA seen in our study was quite high. Conclusion: In this study, we can see a drift in bacteriology of CSOM from gram negative to gram positive, and MRSA is emerging as an important pathogen in CSOM. Empirical antibiotics should be directed to gram positives, and especially, MRSA should be taken into consideration.

Pediatric Deep Neck Space Abscesses: A Prospective Observational Study

Pediatric patients with deep neck space abscesses were prospectively followed from 2009 to 2011 in SKIMS MC and Peoples care polyclinic. Observational data were collected regarding age, location and size of abscess, source of infection, organism, antibiotic susceptibility, treatment plan, and rate of complications. A brief review of the literature is included to compare our patient population to what has previously been reported in the literature.