stenotrophomonas in sinuses

[wilkat]

I have recently had stenotrophomonas cultured twice from my sinuses.  Before that I had  blastomyces cultured.  I was on sporanox for 2 months and bactrim for 1 month.  The first culture showed a moderate amount of growth.
Now a month after taking the bactrim another culture showed heavy growth.  I keep having heavy post nasal drip which is clear to whitish and glue-like and I ache all over.  This alternates with severe pain behind my nose which won't let up until the drainage starts again.  I have been to an ENT twice for both cultures and the enoscopic exam looked great according to him and limited CT scans also were normal.  Because the scans and exams have been fairly normal (I wasn't draining either time I saw him, but had the headache) neither he nor the infectious disease doctor want to treat now. I am feeling terrible. I have tried to find information about this bacteria in the sinuses and it amost always talks in context of chronic sinusitis.  But then I read other reports that say it is nonpathogenic.  I don't understand how I can have both of these cultured out and have "normal" exams and CT scans (limited).  A detailed scan done at NJ in July of '03 showed minimal chronic ethmoid sinusitis and reactive bone formation (I had surgery a few years before that)
Can someone tell me the significance of this stuff in my sinuses?
Is it possible that the infection is in the bone and not showing on CTs?
If this is not the stenotrophomonas, what else could it be?
(I don't have allergies and have GERD controlled with 2 nexiums a day; and I quit smoking a year ago.

[National Jewish]

All symptoms associated with chronic nasal and sinus problems can fluctuate.  Pain and drainage are difficult symptoms to correlate with active sinus disease.  It sounds as if your care has been excellent.  I agree with your treatment, nasal endoscopy with cultures of the mucus and then treatment based on those culture results.
Bacteria and fungus, including stenotrophomonas, can be found in the mucus of patients that have had surgery without always causing symptoms.
Topical antibiotics may be a solution for you. This would be based on your culture results.  Finally, your pain may not be due to sinusitis but from a headache type of condition.

[bactitech]

http://www.emedicine.com/med/topic3457.htm

http://www.cdc.gov/ncidod/eid/vol7no1/valdezate.htm

http://www.ascp.com/public/pubs/tcp/2000/jan/cr_manage.shtml

I am not a doctor, but am a medical technologist, who works on cultures that sometimes grow this organism. The last URL above is posted by a pharmacy group, and goes into treatment in depth.

Hope these URL's help you out somewhat. Good luck to you - you sound very miserable.

[wilkat]

Thanks for the information.  I tried the  last URL and it wouldn't come up, but I do now have a doctor that is willing to treat me.  I still want to see what the people at NJ have to say about this.

[bactitech]

I tried the last URL again and it came up for me. Perhaps their server was down when you tried it.

Good luck. Let us know what you find out.

[wilkat]

I found the URL that I couldn't get up earlier.  I did find an infectious disease doctor who also specializes in chronic sinusitis.  He thinks this is serious enough that he is treating me with an IV antibiotic, Timentin.  He looked at the cultures and the CT scans and has determined that I have osteomyelitis.  He also listened and believed my symptoms that some of the other doctors just seemed to ignore.  I think I failed to mention that the MIC for Bactrim was 40. I had used several nasal antibiotics before, including Bactrim that didn't help at all.  I really don't know much about it, but from what I've read, that seems a little high.  Do you know? I haven't been on the timentin long enough to know if it is going to help, but I seem to be doing a little better.  
Thanks for your input.

[bactitech]

An MIC of 40 for Bactrim is considered sensitive. The number doesn't necessarily mean anything as every antibiotic has a different range. Forty for Bactrim is sensitive; 40 for another drug might be considered resistant. It's totally dependent on which antibiotic, not the number.

Infectious disease docs are the ones to see when the rest of the docs are foundering around in a sea of antibiotics and not quite sure what's going on. These docs deal with antibiotics singly and in combination ALL the time. They are the troops called in when the initial "cavalry" is at a stalemate.

My nephew had a real problem with his throat about 4 years ago. It was sore and closed up to the point that he needed to go to the ER as he couldn't swallow anything and was in danger of not being able to breathe. He was 34 at the time. He went to the local med school where he is an employee. They admitted him and ran him through the internal med rotation, and quite a few residents "had a look" and they came up with exotic ideas as to what was wrong with him. Finally, infectious disease got called in. She took one look at his throat, declared he had a herpes infection (which the lab substantiated later on in the day) and he slowly got better. Her theory was that, for some reason, he hadn't been exposed to this virus as a kid, so had built up no immunity. When he did get an infection, it went gangbusters in his throat and caused quite a havoc. He was finally discharged and his throat gradually returned to normal. As far as I know, this hasn't happened since. He probably has immunity now.

Remember, these docs do an internal medicine gig before they go on to specialize in infectious disease. It is a complicated specialty. Microbiology departments get calls from ID docs all the time for results, special requests on certain isolates, etc.

I'm glad you finally got someone to take you seriously. Steno. maltophilia can be a nasty bug that is very difficult to get rid of. We had a special request from one of our ID docs this weekend to run some extra drugs on an isolate. In vitro results (in the lab) don't necessarily correlate with in vivo (in the body) results with this organism, so it's difficult to treat.

Keep us posted. I'm very curious how you end up and hope things go well for you.