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Review
. 2018 Apr;38(SUPPL. 1):S1-S106.
doi: 10.14639/0392-100X-suppl.1-38-2018.

Emerging and re-emerging infectious disease in otorhinolaryngology

F Scasso  1 , G Ferrari  2 , G C DE Vincentiis  3 , A Arosio  4 , S Bottero  5 , M Carretti  3 , A Ciardo  2 , S Cocuzza  6 , A Colombo  7 , B Conti  8 , A Cordone  1 , M DE Ciccio  2 , E Delehaye  2 , L Della Vecchia  4 , I DE Macina  9 , C Dentone  9 , P DI Mauro  6 , R Dorati  8 , R Fazio  2 , A Ferrari  10 , G Ferrea  9 , S Giannantonio  11 , I Genta  8 , M Giuliani  3 , D Lucidi  11 , L Maiolino  6 , G Marini  3 , P Marsella  11 , D Meucci  5 , T Modena  8 , B Montemurri  11 , A Odone  12 , S Palma  13 , M L Panatta  3 , M Piemonte  13 , P Pisani  7 , S Pisani  8 , L Prioglio  1 , A Scorpecci  11 , L Scotto DI Santillo  1 , A Serra  6 , C Signorelli  14 , E Sitzia  3 , M L Tropiano  5 , M Trozzi  5 , F M Tucci  15 , L Vezzosi  16 , B Viaggi  17
Affiliations
Review

Emerging and re-emerging infectious disease in otorhinolaryngology

F Scasso et al. Acta Otorhinolaryngol Ital. 2018 Apr.

Abstract
in English, Italian

Emerging and re-emerging infectious disease in otorhinolaryngology (ENT) are an area of growing epidemiological and clinical interest. The aim of this section is to comprehensively report on the epidemiology of key infectious disease in otorhinolaryngology, reporting on their burden at the national and international level, expanding of the need of promoting and implementing preventive interventions, and the rationale of applying evidence-based, effective and cost- effective diagnostic, curative and preventive approaches. In particular, we focus on i) ENT viral infections (HIV, Epstein-Barr virus, Human Papilloma virus), retrieving the available evidence on their oncogenic potential; ii) typical and atypical mycobacteria infections; iii) non-specific granulomatous lymphadenopathy; iv) emerging paediatric ENT infectious diseases and the prevention of their complications; v) the growing burden of antimicrobial resistance in ENT and the strategies for its control in different clinical settings. We conclude by outlining knowledge gaps and action needed in ENT infectious diseases research and clinical practice and we make references to economic analysis in the field of ENT infectious diseases prevention and care.

Patologia infettiva emergente e riemergente in otorinolaringoiatria.

Riassunto: La diagnosi e terapia delle infezioni in ambito ORL ha presentato nell’ultimo ventennio crescenti criticità legate ai cambiamenti demografici e alle errate abitudini terapeutiche con la comparsa di nuove infezioni e il ripresentarsi di vecchie credute scomparse. Su queste osservazioni abbiamo voluto fare il punto sulle nuove e vecchie malattie infettive prendendo in considerazione gli aspetti epidemiologici delle infezioni ORL del nuovo millennio da cui emerge l’importanza della prevenzione vaccinale. Si è focalizzata l’attenzione sulle infezioni virali, in particolare HIV EBV e HPV, in tutte le loro manifestazioni ORL con particolare riguardo alla patologia oncologica. Sono state analizzate le modalità di infezione cellulare e i punti chiave che portano alla trasformazione neoplastica. Il problema delle linfoadenopatie granulomatose aspecifiche, tubercolari tipiche e atipiche ha evidenziato l’importanza di protocolli medico-chirurgici variabili ed influenzati dai germi e dalla responsività del soggetto e in questo ambito non è emersa differenza tra popolazione adulta e pediatrica. Si è posta attenzione alle patologie infettive del’infanzia che maggiormente impegnano nella diagnosi e terapia per le possibili gravi complicanze: rinosinusiti, otomastoiditi, papillomatosi laringea. Per quanto riguarda le infezioni batteriche si rileva il problema drammatico dei germi multiresistenti: enterobacteriacee, pseudomonas auriginosa, germi gram positivi analizzando i meccanismi di resistenza; il trattamento di queste infezioni si basa sull’utilizzo mirato di nuove molecole ad alto costo ma trova la migliore chance nella loro prevenzione sia con norme igenico sanitarie che con un utilizzo razionale EBM degli antibiotici. Vengono presentate anche le nuove frontiere dell’antibioticoterapia e le tecnologie di nanomedicina ed infine i non meno importanti effetti di cost-effectiveness.

Keywords: Bacterial resistance; EBV; HIV; HPV; Mycobacteriosis; Nanomedicine.

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Figures

FIG. 3.1.
FIG. 3.1.
HPV positive tonsillar carcinoma.
FIG. 3.2.
FIG. 3.2.
Overexpression of p16 protein in tonsillar carcinoma.
FIG. 3.3.
FIG. 3.3.
CT picture of lymph node metastases from HPV positive tonsillar carcinoma.
FIG. 3.4.
FIG. 3.4.
MR picture of lymph node metastases from HPV positive tonsillar carcinoma.
FIG. 5.1.
FIG. 5.1.
Histological section of lymphoepithelial cysts of the parotid from HIV.
FIG. 6.1.
FIG. 6.1.
A: I stage B: II stage C: III stage D: IV stage according to the classification of Penn.
FIG. 6.2.
FIG. 6.2.
Age distribution of children affected from cervical Non Tuberculous Mycobacteria infection recorded at Bambino Gesù Hospital in the period 2008-2017.
FIG. 7.1.
FIG. 7.1.
Algorithm for the diagnosis and evaluation of patients with peripheral lymphadenopathy (from Mohseni et al., 2014 , mod.).
FIG. 7.2.
FIG. 7.2.
Algorithm for the diagnosis and evaluation of pediatric patients with peripheral lymphadenopathy suspicious to mononucleosis-like syndrome (from Chiappini et al., 2015 , mod.).
FIG. 7.3.
FIG. 7.3.
Algorithm for the diagnosis and evaluation of pediatric patients with peripheral lymphadenopathy without local flogosis (from Chiappini et al., 2015 , mod.).
FIG. 7.4.
FIG. 7.4.
Evaluation of suspected incomplete Kawasaki disease Clinical criteria are: changes in extremities (acute: erythema of palms, soles; edema of hands, feet; subacute: periungual peeling of fingers, toes in weeks 2 and 3), polymorphous exanthem, bilateral bulbar conjunctival injection without exudate, changes in lips and oral cavity (erythema, lips cracking, strawberry tongue, diffuse injection of oral and pharyngeal mucosae), cervical lymphadenopathy (>1.5 cm diameter, usually unilateral) (from Newburger et al., 2004 , mod.).
FIG. 8.1.
FIG. 8.1.
Decisional algorithm evidence based scheme for therapy in children with acute rhinosinusitis (from Clement, 2007 , mod.).
FIG. 8.2.
FIG. 8.2.
Preseptal orbital cellulitis.
FIG. 8.3.
FIG. 8.3.
Orbital abscess in ethmoid-maxillary sinusitis.
FIG. 8.4.
FIG. 8.4.
Graded implementation of precision medicine in chronic rhinosinusitis.
FIG. 8.5.
FIG. 8.5.
Balloon dilation of access to frontal sinus.
FIG. 8.6.
FIG. 8.6.
Mucormycosis in patients with ALL.
FIG. 8.7.
FIG. 8.7.
Mucormycosis: endoscopic and histological detection.
FIG. 8.8.
FIG. 8.8.
Flow-chart of treatment of otogenic thrombosis of the sigmoid sinus proposed by the Audiology and Otosurgery Unit of the Pediatric Hospital Bambino Gesù.
FIG. 8.9.
FIG. 8.9.
Marked obstruction of the respiratory space in a case of massive laryngeal papillomatosis.
FIG. 8.10.
FIG. 8.10.
Anterior commissure synechia resulting from surgical treatment of laryngeal papillomatosis.
FIG. 8.11.
FIG. 8.11.
Surgical treatment of laryngeal papillomatosis with Microbrewer.
FIG. 8.12.
FIG. 8.12.
Use of Coblator in treatment of laryngeal papillomatosis.
FIG. 10.1.
FIG. 10.1.
Evolution of antibiotic resistance. The bars show the time lapse from introduction of a clinical antibiotic up to the first described clinical case of resistance, highlighting (red bars) the rapid development of the latter for various classes of antibiotics (from Schmieder et al., 2012 , mod.).
FIG. 10.2.
FIG. 10.2.
New nanomaterials and nanostructures studied as vehicles of antibiotics and antimicrobial substances.
FIG. 10.3.
FIG. 10.3.
Different action mechanisms of metallic Nps.
FIG. 10.4.
FIG. 10.4.
Nanofibrous matrices seen with the naked eye (a) and internal structure of the matrix (b). Made of fibres of nanometric dimensions seen through a scanning electron microscope (SEM).
See this image and copyright information in PMC

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