{"title":"一名结核性中耳炎患者合并粘膜奈瑟菌感染","authors":"Tatsuya Hioki , Kazuaki Soejima , Yuki Goto , Makoto Sugiura , Takumi Umemura , Yoshimi Ishihara , Yoshikazu Mutoh , Daisuke Sakanashi , Hiroshige Mikamo","doi":"10.1016/j.joto.2023.10.001","DOIUrl":null,"url":null,"abstract":"<div><p>Tuberculous otitis media (TOM) is a rare manifestation caused by <em>Mycobacterium tuberculosis</em> with low incidence rates among extrapulmonary tuberculosis cases. Diagnosis is often delayed because of the presence of several clinical manifestations and the high prevalence of secondary bacterial infections. Few reports have attributed secondary bacterial infections in patients with TOM to commensal <em>Neisseria</em>. Thus, understanding the pathogenic mechanisms and clinical features of commensal <em>Neisseria</em> is important, considering its recent presentation as an infection-causing pathogen. <em>Neisseria mucosa</em> is a commensal inhabitant in humans and is generally considered non-pathogenic but can cause infection in rare cases. Here, we report an atypical secondary infection caused by <em>Neisseria mucosa</em> in an 81-year-old woman with TOM being treated for pulmonary tuberculosis. Direct purulent otorrhea smear microscopy revealed no acid-fast bacilli using Ziehl-Neelsen staining, whereas the phagocytosis of gram-negative cocci by white blood cells was confirmed using Gram staining. Otorrhea culture revealed the growth of <em>N. mucosa</em>. Subsequently, <em>M. tuberculosis</em> infection in the otorrhea was identified using a culture-based method. Vigilance is critical for the early detection of TOM to prevent further complications. This report raises awareness regarding TOM and provides insight into the pathogenicity of <em>N. mucosa</em> in otitis media.</p></div>","PeriodicalId":37466,"journal":{"name":"Journal of Otology","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1672293023000727/pdfft?md5=1bcb12cc7d3bc58496caba4c61dec3f7&pid=1-s2.0-S1672293023000727-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Co-infection with Neisseria mucosa in a patient with tuberculous otitis media\",\"authors\":\"Tatsuya Hioki , Kazuaki Soejima , Yuki Goto , Makoto Sugiura , Takumi Umemura , Yoshimi Ishihara , Yoshikazu Mutoh , Daisuke Sakanashi , Hiroshige Mikamo\",\"doi\":\"10.1016/j.joto.2023.10.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>Tuberculous otitis media (TOM) is a rare manifestation caused by <em>Mycobacterium tuberculosis</em> with low incidence rates among extrapulmonary tuberculosis cases. Diagnosis is often delayed because of the presence of several clinical manifestations and the high prevalence of secondary bacterial infections. Few reports have attributed secondary bacterial infections in patients with TOM to commensal <em>Neisseria</em>. Thus, understanding the pathogenic mechanisms and clinical features of commensal <em>Neisseria</em> is important, considering its recent presentation as an infection-causing pathogen. <em>Neisseria mucosa</em> is a commensal inhabitant in humans and is generally considered non-pathogenic but can cause infection in rare cases. Here, we report an atypical secondary infection caused by <em>Neisseria mucosa</em> in an 81-year-old woman with TOM being treated for pulmonary tuberculosis. Direct purulent otorrhea smear microscopy revealed no acid-fast bacilli using Ziehl-Neelsen staining, whereas the phagocytosis of gram-negative cocci by white blood cells was confirmed using Gram staining. Otorrhea culture revealed the growth of <em>N. mucosa</em>. Subsequently, <em>M. tuberculosis</em> infection in the otorrhea was identified using a culture-based method. Vigilance is critical for the early detection of TOM to prevent further complications. 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引用次数: 0
摘要
结核性中耳炎(TOM)是由结核分枝杆菌引起的一种罕见表现,在肺外结核病例中发病率较低。由于存在多种临床表现和继发细菌感染的高发病率,诊断往往被延误。很少有报道将TOM患者的继发性细菌感染归咎于共生奈瑟菌。因此,考虑到共生奈瑟菌最近才作为一种致病病原体出现,了解其致病机制和临床特征非常重要。粘膜奈瑟菌是人类的共生菌,通常被认为是非致病菌,但在极少数情况下也会引起感染。在此,我们报告了由粘膜奈瑟菌引起的非典型继发感染,患者是一名 81 岁的女性,因肺结核接受 TOM 治疗。直接脓性耳道分泌物涂片显微镜检查发现,齐氏-奈尔森染色法未发现耐酸杆菌,而革兰氏染色法证实白细胞吞噬了革兰氏阴性球菌。耳道培养显示粘膜上有结核杆菌生长。随后,通过一种基于培养的方法确定了耳道中的结核杆菌感染。警惕性对于早期发现 TOM 以防止进一步并发症至关重要。本报告提高了人们对 TOM 的认识,并对中耳炎粘膜结核的致病性有了深入了解。
Co-infection with Neisseria mucosa in a patient with tuberculous otitis media
Tuberculous otitis media (TOM) is a rare manifestation caused by Mycobacterium tuberculosis with low incidence rates among extrapulmonary tuberculosis cases. Diagnosis is often delayed because of the presence of several clinical manifestations and the high prevalence of secondary bacterial infections. Few reports have attributed secondary bacterial infections in patients with TOM to commensal Neisseria. Thus, understanding the pathogenic mechanisms and clinical features of commensal Neisseria is important, considering its recent presentation as an infection-causing pathogen. Neisseria mucosa is a commensal inhabitant in humans and is generally considered non-pathogenic but can cause infection in rare cases. Here, we report an atypical secondary infection caused by Neisseria mucosa in an 81-year-old woman with TOM being treated for pulmonary tuberculosis. Direct purulent otorrhea smear microscopy revealed no acid-fast bacilli using Ziehl-Neelsen staining, whereas the phagocytosis of gram-negative cocci by white blood cells was confirmed using Gram staining. Otorrhea culture revealed the growth of N. mucosa. Subsequently, M. tuberculosis infection in the otorrhea was identified using a culture-based method. Vigilance is critical for the early detection of TOM to prevent further complications. This report raises awareness regarding TOM and provides insight into the pathogenicity of N. mucosa in otitis media.
期刊介绍:
Journal of Otology is an open access, peer-reviewed journal that publishes research findings from disciplines related to both clinical and basic science aspects of auditory and vestibular system and diseases of the ear. This journal welcomes submissions describing original experimental research that may improve our understanding of the mechanisms underlying problems of basic or clinical significance and treatment of patients with disorders of the auditory and vestibular systems. In addition to original papers the journal also offers invited review articles on current topics written by leading experts in the field. The journal is of primary importance for all scientists and practitioners interested in audiology, otology and neurotology, auditory neurosciences and related disciplines. Journal of Otology welcomes contributions from scholars in all countries and regions across the world.