Ellerbe D M, Parsons D S, Cook P R
Department of Otolaryngology, Elmendorf USAF Medical Center, Columbia, USA.
Int J Pediatr Otorhinolaryngol. 1997 Sep 18;41(3):363-9. doi: 10.1016/s0165-5876(97)00070-0.
Botryomycosis is a chronic bacterial granulomatous disease often involving the skin and subcutaneous tissue. Head and neck involvement is rare. Botryomycosis presents with clinical and histological features similar to actinomycosis or mycetoma, but the causative organism is usually Staphylococcus aureus. Microscopically the organisms appear to be encapsulated in granules, which are thought to protect them from the effects of standard courses of antibiotics. Botryomycosis usually requires surgical intervention for cure. Major debilitating surgery has been required for most patients, because the infection has been unresponsive to seemingly appropriate medical therapy. We present an 8-month-old male with periorbital botryomycosis. Surgical specimens for diagnosis were obtained, but complete resection would have created debilitating functional and cosmetic defects. The lesion failed to respond to nafcillin alone or combination therapy with hyperbaric oxygen, but showed slow, steady improvement with long-term clindamycin. The patient has been disease free for more than 4 years, with minimal scarring and no functional impairment. Prolonged medical therapy for botryomycosis may be a viable alternative to the traditionally recommended surgical resection, thereby reducing cosmetic and functional morbidity.
葡萄状菌病是一种慢性细菌性肉芽肿性疾病，常累及皮肤和皮下组织。头颈部受累罕见。葡萄状菌病的临床和组织学特征与放线菌病或足菌肿相似，但其病原体通常为金黄色葡萄球菌。在显微镜下，病原体似乎被包裹在颗粒中，这些颗粒被认为可保护它们免受标准疗程抗生素的影响。葡萄状菌病通常需要手术干预才能治愈。大多数患者都需要进行重大的致残性手术，因为感染对看似合适的药物治疗无反应。我们报告一例8个月大患有眶周葡萄状菌病的男性患儿。获取了用于诊断的手术标本，但完整切除会造成致残性的功能和美容缺陷。该病变对单独使用萘夫西林或与高压氧联合治疗均无反应，但长期使用克林霉素后显示出缓慢而稳定的改善。该患者已无病超过4年，瘢痕极小且无功能障碍。对于葡萄状菌病，延长药物治疗可能是传统推荐的手术切除的可行替代方法，从而减少美容和功能方面的发病率。
