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Medical Forum / Diseases and Disorders / Sinusitis / September 2005Gram negative Pseudomonas stutzeri
Hello, I've had terrible sinus problems for the past several months and a recent gram stain has shown that I have gram negative cocci Pseudomonas stutzeri in my sinuses. My ENT says he's never heard of this strain before and that concerns me. I live in San Diego county. Any opinions on this and how dangerous is this bacteria in the sinuses? Its sensitive (according to the lab) to Septra and some other antibiotics -- but the others are intravenous -- Septra is'nt. Please advise. -RB > Hello, > [quoted text clipped - 4 lines] > My ENT says he's never heard of this strain before and that > concerns me. It's unusual for that strain to infect the respiratory tract. Are you immunocompromised in some way? Or are you already weakened by some other chronic disease?  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. >> I've had terrible sinus problems for the past several months >> and a recent gram stain has shown that I have gram negative >> cocci Pseudomonas stutzeri in my sinuses. >> My ENT says he's never heard of this strain before and that >> concerns me. > It's unusual for that strain to infect the respiratory tract. Are you immunocompromised in some way? No, not that I know of. I'm a 47 yr. old white male, divorced, no smoking, no drugs, workout at the gym, kickboxing, weights, etc. > Or are you already weakened by some other chronic disease? No, only this current sinus problem ... I had sinus surgery two years ago to drain infection from my right maxillary, fix a deviated septum, several laser turbinate reductions and an adenoidecetomy. -RB >>> I've had terrible sinus problems for the past several months >>> and a recent gram stain has shown that I have gram negative [quoted text clipped - 14 lines] > >-RB You might want to repeat the test, and perhaps use a different lab. Sometimes lab tests give false positives due to contamination and other reasons...... > You might want to repeat the test, and perhaps use a different lab. > Sometimes lab tests give false positives due to contamination and other > reasons...... 2 separate specimens (2 different culture tubes) were given to the lab in order to increase the accuracy and 2 different areas of my sinuses were swapped ... 1) inside my nose. 2) Mucous dripping down the back of my throat -- post nasal drip. -RB >> You might want to repeat the test, and perhaps use a different lab. >> Sometimes lab tests give false positives due to contamination and other [quoted text clipped - 4 lines] >of my sinuses were swapped ... 1) inside my nose. 2) Mucous >dripping down the back of my throat -- post nasal drip. I take it that both samples tested positive. You still have the possibility of lab instrument contamination...... > I take it that both samples tested positive. Yes ... one had a high WBC and the other a low WBC. Both positive for stuzeri. > You still have the possibility of lab instrument contamination.... True. I may try another test(s) at a different lab. However, this test was done at a major hospital lab here in San Diego. In the mean time I'm on Septra double-strenght twice a day, for 30 days. (2days, now) How soon before I should start to notice improvement? How dangerous is P. stutzeri in the sinuses? -RB >>I take it that both samples tested positive. > > Yes ... one had a high WBC and the other a low WBC. > Both positive for stuzeri. I hope you won't get angry at me if I ask the following question: Given your own lifestyle, would a test for HIV be in order? I'm still wondering why such a rare bug would infect a person with a healthy immune system. >>You still have the possibility of lab instrument contamination.... > [quoted text clipped - 3 lines] > > How soon before I should start to notice improvement? Sinus infections are typically stubborn. Give it 4-5 days total (that means 2-3 more days from now). And even then, healing may be slow from that point. If you're not seeing any improvement by then, make another appointment with your phyisician. > How dangerous is P. stutzeri in the sinuses? Since it's a rarity for P. stuzeri to infect the respiratory tract (case reports), I don't have a clue how dangerous it is in the sinuses. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. Just wondering. What exactly are your symptoms? David Sacramento, CA > Just wondering. What exactly are your symptoms? Soreness/pain and minor bleeding deep inside the nose along with intermittent sinus pains/pressure above the nose and underneath my eyes. Strange 'snapping' sounds coming from inside my right nasal area at night when I lay down to try to sleep. Many other people I've talked to here in the San Diego area are reporting the same thing including the bleeding, but mine is hangin' in there longer than the other folks ... their symptoms disappeared in about 2 weeks -- mine is, too, but slowly (very slowly) getting better, I think. Since Pseudomonas may be opportunistic, I wonder if it's colonized the areas where my inferior turbinates were burned with the CO2 laser. -RB > I hope you won't get angry at me if I ask the following question: > Given your own lifestyle, would a test for HIV be in order? :::: From what I described, what lifestyle would I be engaging in that :::: is consistant with AIDs exposure? Also, for the past 12 years after :::: divorce, I've always used -condoms- for straight sex, as I am straight. -RB >>I hope you won't get angry at me if I ask the following question: >>Given your own lifestyle, would a test for HIV be in order? > > :::: From what I described, what lifestyle would I be engaging in that > :::: is consistant with AIDs exposure? I didn't know anything about your lifestyle. I was merely asking if whether there's anything in your lifestyle that you know of which might warrant an HIV test. I wasn't being snide. I just don't understand how a very rare bug like that could infect a healthy guy like you say you are. I don't even know where you might have caught it from. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > I didn't know anything about your lifestyle. I was merely asking if whether there's anything in your lifestyle that you know of > which might warrant an HIV test. > I wasn't being snide. I just don't understand how a very rare bug like that could infect a healthy guy like you say you are. I > don't even know where you might have caught it from. No, no ... no problem at all ... absolutely no offense taken whatsoever :) It has to be discussed, it has to be discussed, that's all. If I need to get tested for AIDs then it's gotta be done. If it's time for me to die, I die. Actually, I kinda look forward to death to get out of this disgusting world. A rest in the spirit world might rid me of this sinus disease, hopefully, for when I reincarnate. I've had blood work done a couple years ago when I had sinusitis and my blood looked good -- no signs of Hepatitus, either ... but an AIDs check was not done. I can get one *real* quick if necessary. I haven't ever heard of anyone with AIDs having P. stutzeri in their sinuses, though ... but who knows? Could be. What I'm concerned about is that the CO2 laser burns may have given the bugs a place to live and it's hard to evict them. Maybe some allergies may be a contributing factor, also ... but I'm not sure. The ENT's say to keep sinuses moist with saline solution and I do. -RB I had an AIDs test when I first started with the sinus problems. Its normal to check for that. David Sacramento, CA > I had an AIDs test when I first started with the sinus problems. > Its normal to check for that. The whole problem with my sinuses started about 3 years ago when I was sleeping in someone's house and the heater came on. I was sleeping and I woke up and heard the air coming through the ventilation duct and that's when all hell broke loose in my sinuses. Something very, very bad came out of the duct and I breathed it in and instantly my mouth and tongue turned into dry sandpaper, then sinusitis set in immediately afterwards. No such thing happened while air came through the vent when the air conditioning was on ... breathed it in for the whole summer -- no problem at all. When the heater turned on and I breathed in that air, that was it for me. -RB Do you know if the house contained mold? Possibly the heat dried out the spores and made them airborne. Kathyw > Do you know if the house contained mold? Possibly the heat dried out > the spores and made them airborne. That would still not explain how this bacterium caused his rare infection. Perhaps it was growing in the heating system, like Legionnaire's Disease bugs can grow in air conditioning systems. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. >> Do you know if the house contained mold? Possibly the heat dried out >> the spores and made them airborne. > That would still not explain how this bacterium caused his rare infection. > Perhaps it was growing in the heating system, like Legionnaire's Disease bugs can grow in air conditioning systems. No one else in the house was affected, just me. But then again, I'm not a native of California -- I'm from the east coast, where there is humidity and a change of season. If it was'nt for me insisting on taking the culture kits home with me and doing the swabs MYSELF, the P. Stutzeri would have never been detected ... and THAT's because I woke up at 5:00AM in the morning with all of the blood and mucous in my nose and throat and I was able to aquire a *sufficient* specimen quantity for the labs to work with. I had the same test done from the SAME lab a week earlier, but the incompetent doctor did the swab in his office and did not get hardly ANY fluid on the swab tip. I told him that I thought nothing would grow on a specimen that small (invisible) and I was *right*. In some cases you will *have* to do a test like this yourself, at home. -RB >No one else in the house was affected, just me. But then again, I'm not a >native of California -- I'm from the east coast, where there is humidity [quoted text clipped - 6 lines] >and I was able to aquire a *sufficient* specimen quantity for the labs >to work with. Good for you. We all can learn from that. Have you had the usual routine tests of immune status such as white blood cell count/morphology, also B12 levels etc? When you have a pathogen that is listed as occuring most often in immunocomprosed individuals, obviously you have to check that angle out, even when you can identify the precipitating event. Many of these bacteria occur everywhere but normally cannot survive the response of the immune system. Another possibility could conceivably be that you have some *other* problerm in the sinuses and that the Pseudomonas stutzeri are riding on top of it. I assume you have had a CT scan and have had it looked at by more than one experienced sinus specialist. > Good for you. > We all can learn from that. Thanks. > Have you had the usual routine tests of immune status such as white blood cell > count/morphology, also B12 levels etc? I'm going to arrange for that to be done. > Another possibility could conceivably be that you have some *other* > problem in the sinuses and that the Pseudomonas stutzeri are riding on top of it. Since I've had sinus surguries and CO2 laser turbinate reductions, it may be possible that the bugs are colonizing those weakened areas. Speculation. > I assume you have had a CT scan and have had it looked at by more than one > experienced sinus specialist. I've had 3 CT scans and one MRI. The first CT scan in early 2003 showed full blown sinusitis and surgery was required to drain it all out of the right maxillary sinus and some other plumbing work. The ENT said nothing grew from that culture!! The second CT scan after the 2003 surgery showed all clear. The third CT scan and MRI done a few months ago show a small amount of inflammation and/or mucosa in the right maxillary sinus. ENT's say it's nothing to be concerned about. Ofcourse, they're the same ENT's who outright *refused* to do a simple culture test of my sinuses ... I had to get a fourth ENT for that and he did'nt do it right. I had to do that one myself and the P. Stutzeri was then detected. This doctor will now *REFUSE* to talk to me. I'm having alot of trouble sleeping now because of the pain snaps and mini-seizures that are occuring in the right side of my head in the turbinate area. Heavy excercise now seems to make the disease worse and the strange snapping and mini-spasms/seizures get worse -- they wake me right up. Visual inspection of the nasal area now shows infammation and there is blood far back in the nose. If it was'nt for tranquilizers I would get no sleep at all. -RB >Since I've had sinus surguries and CO2 laser turbinate reductions, it may be >possible that the bugs are colonizing those weakened areas. By the way, here's what Dr. Grossan saud recently about laser turbinate reductions (and others agree). >Sinus surgery via Laser is simply a gimmick, an advertising term. >If you see an ad promoting sinus surgery by Laser! - [quoted text clipped - 6 lines] >Murray Grossan, M.D. >http://www.ent-consult.com I completely understand your frustration. I had Stenotrophomas cultured twice by an ENT in my area, the first time, a moderate amount and the second time many (after taking Bactrim, which is supposed to be the only reliable antibiotic for it, for a month.) He had never heard of it and what he could see of my sinuses looked fine. He did admit that he couldn't see all of the sinuses. I was also working with an infectious disease doctor in the same area, but since the ENT said everything looked fine, he refused to see me again. I had and still have glu-like transparent to whitish junk that blocks up my sinuses and causes severe pain or when it drains, it is so thick it goes into my lungs and I have trouble breathing. I had to go 6 hours from my home to find an ID doctor to treat this with IV antibiotics (Timentin), but from what I have read, you are supposed to take it 4 times a day and I was only using it twice a day. You're also suppposed to use it with another antibitoic such as the bactrim for this particular bacterium, but he didn't prescribe it. It helped some, but as soon as I stopped using it, it started again. I did get out colored mucus while on the Timentin. He then prescribed nebulized Bactrim, which is helping somewhat also, but I run out of it in a couple of days. He is now insisting my problem is reflux, but I've seen 3 GI specialist that say that even though I have reflux, it is controlled through my medication. So I've been to 2 ENTs since then. One said my sinuses are condemned because I have osteitis. I just recently saw the original ENT that did my surgery in 1999 (8 hours away). He also said that I probably have osteitis and was supposed to contact me yesterday about a plan of action because he is going to be out of town next week. He did a culture, but said that if it is osteitis, it might not culture anything. He did not call back. My medical bills are getting tremendous even with good insurance. I'm afraid they are going to quit paying. I mentioned the mold, because, even though I've had sinusitis a long time, I didn't get these strange "bugs" cultured out (also blastomyces and serratia marcescens, all unusual to be found in the sinuses), I had a massive exposure to mold in the school where I worked after a remediation which wasn't properly done. Not everyone responds to mold in the same way. It can make some people extremely ill and more susceptible to sinusitis and not affect another person. BTW, I am also immunocompetent, been tested for HIV, even though there was no reason to do so, but I had been on prednisone and numerous antibotics beforehand which can also predispose to weird superinfections. I hope your current medication works. Make sure you stay on it long enough for it to work. Also, did the ENT do deep endoscopic sinus cultures? It has been my experience that these are more reliable than results obtained from the drainage. Kathyw >I completely understand your frustration. I had Stenotrophomas > cultured twice by an ENT in my area, the first time, a moderate amount [quoted text clipped - 7 lines] > causes severe pain or when it drains, it is so thick it goes into my > lungs and I have trouble breathing. Does salt water irrigation help? > I hope your current medication works. Make sure you stay on it long > enough for it to work. Also, did the ENT do deep endoscopic sinus > cultures? They all refuse to do this. (4 ENTs and an allergist) > It has been my experience that these are more reliable than > results obtained from the drainage. I'm sure they are, but I don't know what to do. The worst thing for me is not being able to sleep due to the recently developed 'mini-seizure'-'spasms' in my head (right sinus) at night while sleeping or when beginning to fall alseep. I even went and got a CPAP machine and breath through my mouth with it (full face mask) and the mini-seizures still wake me up, though not as bad as without the machine. If only I knew what I actaully have ... I'll have to have some more blood work done, as folks here are suggesting. -RB The saline rinse helps to clear the secretions when the mucus is draining. When it is not, then I have the tremendous pain and pressure. Nothing helps then. I just have to take Lortabs and wait it out and eventually start on another antibiotic which I hate. I used to have electrical zap sensations in my head when I would try to sleep, but don't have them anymore. It is possilbe that you have infection in the bone. It doesn't show up as "sinusitis" on CT scan. Try to find an ENT who will look carefully at the bony structure on CT scans. I know that's easier said than done. Sometimes it is a diagnosis of exclusion. But it takes an ENT who is willing to listen to symptoms and not rely soley on "objective" findings. That's hard these day. Most of my experiences has been: If they don't see it, it's not there. >The saline rinse helps to clear the secretions when the mucus is >draining. When it is not, then I have the tremendous pain and [quoted text clipped - 11 lines] >findings. That's hard these day. Most of my experiences has been: If >they don't see it, it's not there. U. Penn. (Dr. David Kennedy at al). believe in surgery that removes much of the fine bony structure of the ethmoid sinuses to eliminate infection in the bone. So he could possibly try a consultation there. I know that that route did not work out for you though....... > The saline rinse helps to clear the secretions when the mucus is > draining. When it is not, then I have the tremendous pain and > pressure. Nothing helps then. I just have to take Lortabs and wait it > out and eventually start on another antibiotic which I hate. ::: I used to have electrical zap sensations in my head when I would try to ::: sleep, but don't have them anymore. That's EXACTLY what I've got when I try to sleep ... what is that? I have to space-out on Valium and Vodka and Neurontin to sleep. Otherwise, those electrical seizure-like evil things wake me up. It's on the right side ... sometimes travels over to the right ear. (the more I excersize, the more they occur, I think) > It is possilbe that you have infection in the bone. It doesn't show up > as "sinusitis" on CT scan. Try to find an ENT who will look carefully [quoted text clipped - 3 lines] > findings. That's hard these day. Most of my experiences has been: If > they don't see it, it's not there. Understood. -RB I have no idea what the electric zaps are. Mine started after my mold exposure and this lastest bout of sinus infections that started over 3 years ago. They occurred often at first and gradually became less and less. One time my body jerked so bad that it almost knocked me out of bed. I haven't had one since I was on IV antibiotics; don't know if that had anything to do with it or not. As Don said, you can send your CT scans to Dr. Kennedy and he will look at them and let you know if he thinks it is in the bone and surgery would help. I sent mine and it took a long time, but I eventually talked to the receptionist or nurse and was told I wasn't a candidate for surgery. I evenually got the scan back. I sent it on a CD so it was easier to mail and return. The ENT that I saw last week said that the osteitis that I have is too close to the brain to do surgery. He said he would put me back on IV antibiotics, but I haven't heard back from him yet. The contact information is: David W. Kennedy, M.D., F.A.C.S. Professor and Director Division of Rhinology Department of Otorhinolaryngology: Head and Neck Surgery Vice Dean for Professional Services and Senior Vice President University of Pennsylvania Health System 215-662-6971 I did have the address, but can't find it. You can call the above number and get it. I don't know if he is still doing it or not, but maybe someone there would. Also, for a fee, you can have doctors from the Cleveland Clinic do an evaluation without going there. The web address is: http://www.clevelandclinic.org/myappointment/ >I have no idea what the electric zaps are. Mine started after my mold > exposure and this lastest bout of sinus infections that started over 3 > years ago. They occurred often at first and gradually became less and > less. One time my body jerked so bad that it almost knocked me out of > bed. I haven't had one since I was on IV antibiotics; don't know if > that had anything to do with it or not. How long did the zaps last for ... a few days, weeks? Were you able to sleep when they happened? I don't understand why it 'waits' until trying to sleep before it happens. I can feel it starting when I lay down because I start getting these kinda little tissue pressure pops in the nose and then it escalates into these zapping-like mini seizures. It seems like something is infected near a nerve path, but I'm not sure. I'm starting to feel tired and fatigued alot, too. -RB My electric zaps lasted for about 3 years, off and on. I didn't have them every night. It only happened when I went to sleep, not just lying down and was more like an electric shock went through my entire head. I wouldn't be able to go back to sleep for a while, but it usually didn't happen again after the first one. No one could tell me what was causing it. Do you get this every night? It does sound like something is going on in the turbinate area. I don't know if we were having the same type of sensation or not. > My electric zaps lasted for about 3 years, off and on. I didn't have > them every night. It only happened when I went to sleep, not just [quoted text clipped - 4 lines] > something is going on in the turbinate area. I don't know if we were > having the same type of sensation or not. Not every night, so far ... but heavy excersize seems to trigger it. I does sound like we are/were having something similar occuring. Unfortunately, for me, if it's happeneing on a particular night it will occur numerous times -- robbing me of my sleep and it's definately on the right side -- then it kinda branches out to the right ear. I've been on double-strength Septra now for 8 days and the bleeding in the nose and sinus pains haved reduced by 90%. If I could legally get away with it, I would find the ENT's who refused to culture test me and break their arms and legs with a baseball bat ... the bastards deserve to rot in hell. I had to find the P. Stuzeri myself ... fk'g UNBELIEVABLE. -RB I understand exactly how you feel. My horror stories with ENTs could fill a book. But you need to concentrate on trying to get better now. If the Septra is working, you probably need to take it for an extended period of time. If you quit taking it too soon, it could lurk around and become more resistant and difficult to get rid of. Kathyw I'm not a doctor but what you describe with the zaps and pain sounds like Trigeminal neuralgia. Check it out. > I'm not a doctor but what you describe with the zaps and pain sounds like > Trigeminal neuralgia. Check it out. Trigeminal neuralgia would'nt account for the bleeding in the inferior turbinate area ... which appears to be responding to antibiotics. I think the P. Stutzeri in my sinuses may be producing symptoms similar to TN. (I hope) -RB
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