jean robert
Forum Guru
Topics: 161
Posts: 663
|
C
___________________
Great works are performed not by strength, but by perseverance.
|
| pr20
Forum Senior
Topics: 18
Posts: 162
|
D.
|
| Tiff
Forum Guru
Topics: 54
Posts: 562
|
|
| CocaCola
Forum Guru
Topics: 35
Posts: 908
|
e
___________________
There is one thing we can do, and the happiest people are those who can do it to the limit of their ability. We can be completely present. We can be all here. We can give all our attention to the opportunity before us!!!
|
| new_n_lost
Politically InCorrect
Topics: 650
Posts: 6,056
|
E. Gram positive coagulase positive cocci >> Staph Aureus >> MCC of Chronic Sinusitis
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| doc499
Forum Senior
Topics: 5
Posts: 166
|
yeah E NNL
|
| Tiff
Forum Guru
Topics: 54
Posts: 562
|
|
| Tiff
Forum Guru
Topics: 54
Posts: 562
|
I too rationalized choice E, but Staph is less common than something else. There's a better answer.
|
| new_n_lost
Politically InCorrect
Topics: 650
Posts: 6,056
|
 
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| drpkaur
Forum Guru
Topics: 195
Posts: 808
|
d.
|
| Tiff
Forum Guru
Topics: 54
Posts: 562
|
Ok. D & E are incorrect.
Some staphylococci and streptococci can colonize the nares and sinuses. However, in patients with chronic sinus infections, these cocci are isolated less often than gram negative anaerobic bacilli.
|
| Tiff
Forum Guru
Topics: 54
Posts: 562
|
The correct answer is A. (gram negative anaerobic bacilli). A mixture of gram-negative anaerobic bacilli (including Prevotella, Porphyromonas, Fusobacterium, and non-fragilis species of Bacteriodes) and aerobes may be isolated in a sinus puncture specimen from a patient with chronic sinus infection.
|
| new_n_lost
Politically InCorrect
Topics: 650
Posts: 6,056
|
Tiff wrote:
The correct answer is A. (gram negative anaerobic bacilli). A mixture of gram-negative anaerobic bacilli (including Prevotella, Porphyromonas, Fusobacterium, and non-fragilis species of Bacteriodes) and aerobes may be isolated in a sinus puncture specimen from a patient with chronic sinus infection.
U have ought to tell me the source of this question because everywhere i have looked those dont even make the list at all.
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| silver
Forum Guru
Topics: 21
Posts: 770
|
i've never heard of these bacteria
___________________
Everything turns out ok in the end. If it's not ok, then it's not the end.
|
| Tiff
Forum Guru
Topics: 54
Posts: 562
|
Knowing those bacteria I don't believe is what is essential. Just knowing that anaerobic gram negative is common in chronic sinusitis.
However Fusobacterium is one that should be recognized as it does frequently appear in questions.
|
| silver
Forum Guru
Topics: 21
Posts: 770
|
Tiff wrote:
Knowing those bacteria I don't believe is what is essential.
i was basing my answer on the "essential" material i've studied in med. school. and essentially so far every book i've read, essentially says staph. aureus is essentially the mcc of ch. sinusitis.
___________________
Everything turns out ok in the end. If it's not ok, then it's not the end.
|
| Tiff
Forum Guru
Topics: 54
Posts: 562
|
Lippincott Williams & Wilkins - Surgical Recall - under the Head & Neck section lists the causative organisms for chronic sinusitis:
"Usually anaerobes (such as Bacteriodes, Veillonella, Rhinobacterium; also H. influenza, Streptococcus viridan, Staphylococcus aureus, Staphylococcus epidermidis."
(For acute sinusitis: ..."pneumococcus, S. aureus, Group A strep, and H.influenza.")
Minor detail that might be helpful.
|
| CocaCola
Forum Guru
Topics: 35
Posts: 908
|
Bacteria — Both aerobes and anaerobes have been implicated in chronic sinusitis.
Aerobes — In a series of 94 endoscopically-guided ethmoid sinus cultures from 50 adults with chronic sinusitis, the recovered organisms included the following [9]:
Staphylococcus aureus (50 percent)
Gram-negative rods (20 percent)
Haemophilus influenzae (4 percent)
Group A streptococcus (4 percent)
Streptococcus pneumoniae (2 percent)
Corynebacterium diphtheriae (1 percent).
No anaerobes or viruses were found, and only one culture grew fungus.
Mixed anaerobes and aerobes — Anaerobes are believed by some to play a significant role in adult chronic sinusitis [10]. Studies differ in the technique of collecting specimens (meatal swabs versus direct sinus puncture and aspiration versus swabs taken at the time of endoscopic sinus surgery) and the laboratory methods used for the isolation of these organisms.
The incidence of anaerobic bacteria recovered from chronic sinusitis patients ranged from 0 to 56 percent and 25 to 56 percent when good methods for isolating anaerobes were employed [11-13]. In a contemporary multicenter study employing direct antral puncture in 150 patients, aerobes were recovered in 52 percent and anaerobes in 48 percent; most infections were mixed as anaerobes were encountered as the only organisms in only seven cases [11]. Prevotella spp., anaerobic streptococci, and Fusobacterium spp. were the most frequent anaerobes isolated in 31, 22, and 16 percent of specimens, respectively. Although all enrolled patients were supposed to have chronic sinusitis in this report, one potential confounding feature was that some had acute exacerbations of chronic sinusitis and some were listed only as having sinusitis.
Another group employed polymerase chain reaction (PCR) and standard anaerobic culture methods on 64 specimens obtained at the time of endoscopic sinus surgery to assess the role of anaerobes in chronic sinusitis [12]. Anaerobes were cultured in five percent of cases compared to 19 percent of specimens by PCR. A second study using PCR techniques found both aerobes and anaerobes in approximately 50 percent of specimens from patients with chronic sinusitis [14].
Anaerobes appeared to play a significant role in chronic sinusitis in one study. Sixty-two patients with either chronic sinusitis or an acute exacerbation of chronic sinusitis (AECS) had cultures obtained using inferior meatal antrostomy and had their specimens transported to the laboratory in a sealed syringe or an anaerobic transport tube [15]. Cultures yielded aerobes only in 25 and 27 percent, anaerobes only in 34 and 37 percent, and mixed cultures in 41 and 37 percent, respectively from the chronic compared to AECS groups. The predominant anaerobic bacteria in both groups were Peptostreptococcus subspecies, Fusobacterium subspecies, anaerobic gram-negative bacilli, and Propionibacterium acnes. The predominant aerobic bacteria were Enterobacteriaceae and S. aureus in both groups and S. pneumoniae additionally in the AECS group.
The differences in the rate of isolation of anaerobic bacteria between the two studies is most likely due to the specific transport of specimens and short time between collection and inoculation of the specimen (ie, generally shorter than 60 minutes for the syringes and < three hours for the anaerobic transport tube) in the later study.
------------------------------------------------------------------------- ----------------
The above is from Up To Date
I guess the answer depends on what reference you use!
I still think the best answer is Staph aureus!
___________________
There is one thing we can do, and the happiest people are those who can do it to the limit of their ability. We can be completely present. We can be all here. We can give all our attention to the opportunity before us!!!
|
| new_n_lost
Politically InCorrect
Topics: 650
Posts: 6,056
|
CocaCola wrote:
I still think the best answer is Staph aureus!
Agree.
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| Tiff
Forum Guru
Topics: 54
Posts: 562
|
Coca Cola - not to defend the qbank and the opinion of question writers....
You posted some material: "Aerobes — In a series of 94 endoscopically-guided ethmoid sinus cultures from 50 adults with chronic sinusitis, the recovered organisms included the following [9]:
Staphylococcus aureus (50 percent)
Gram-negative rods (20 percent)
Haemophilus influenzae (4 percent)
Group A streptococcus (4 percent)
Streptococcus pneumoniae (2 percent)
Corynebacterium diphtheriae (1 percent).
No anaerobes or viruses were found, and only one culture grew fungus. "  Perhaps no anaerobes found since the test involved testing for aerobes as it implies above that they differentiated aerobes.
Is this data from an up to date unknown source consistent with the remainder of the information posted? The remainder of the information says that in one study anaerobes appeared less, another says anaerobes appear more. That's not very convincing.
Here's some material.
http://archotol.ama-assn.org/cgi/content/full/132... "This study demonstrates that the organisms isolated from patients with AECS were predominantly anaerobic and were similar to those generally recovered in patients with chronic sinusitis. However, aerobic bacteria that are usually found in acute infections (eg, S pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis) can also emerge in some of the episodes of AECS. "
http://www.pubmedcentral.nih.gov/articlerender.fc... "Aspirates from 26 acutely and 17 chronically infected ethmoid sinuses were studied. Thirty-seven aerobes and 10 anaerobes were recovered from isolates from patients with acute sinusitis. Streptococcus pneumoniae and Haemophilus influenzae were predominant. Twenty-seven aerobes and 41 anaerobes were found in isolates from patients with chronic sinusitis. The predominant isolates were anaerobic gram-negative bacilli and Peptostreptococcus spp."
http://www.sciencedirect.com/science?_ob=ArticleU... " The normal oropharyngeal flora contained aerobic and anaerobic bacteria that can cause respiratory infections including sinusitis. Some of these bacteria can interfere with the growth of potential pathogens and may play a role in preventing infections. Anaerobic bacteria emerge as pathogens as the infection becomes chronic. This may be the result of the selective pressure of antimicrobial agents that enable resistant anaerobic organisms to survive, and from the development over time of conditions appropriate for anaerobic growth, which include the reduction in oxygen tension and an increase in acidity within the sinus cavity. Anaerobes were isolated in acute maxillary sinusitis of odontogenic origin and in over half of the patients with chronic sinusitis whenever proper techniques for their cultivation were employed. These organisms were also recovered in acute sinusitis that was associated with dental infections. The predominant isolates were pigmented Prevotella and Porphyromonas, Fusobacterium and Peptostreptococcus spp.
From the materials I've read, there have been some close calls, but anaerobes predominate. Becuase of these close calls I think there had to be a reason for the making of this question. But then again, you do not need to agree.  
|
| CocaCola
Forum Guru
Topics: 35
Posts: 908
|
Hi Tiff,
"Up To Date" is a database used by hospitals that gives you a compliation of current journal articles regardling your chosen subject... it doesn't give answers just gives the current thoughts and studies, hence the different opinions stated in my above post...
I don't dispute that anaerobes may be the prodominant microbe found in many sinuses with chronic inflammation... but until it becomes overwhelming opinion I would stick with S. aureus...
by the way thanks for the discussion - its the best way to learn
___________________
There is one thing we can do, and the happiest people are those who can do it to the limit of their ability. We can be completely present. We can be all here. We can give all our attention to the opportunity before us!!!
|
| Tiff
Forum Guru
Topics: 54
Posts: 562
|
Agree
|
|
| |
| | | | | | | | | | | | | | | | | | | | | | |
