Methicillin-resistant Staphylococcus aureus (MRSA) laryngitis may be more common than previously suspected, a new case series suggests.
Given that the signs and symptoms may be subtle and similar to methicillin-sensitive S. aureus (MSSA) laryngitis, "clinicians must have a high index of suspicion for this diagnosis," say researchers Manish Shah and Adam Klein, both from the Emory University School of Medicine in Atlanta, Georgia, USA.
The findings came from a retrospective chart review of all patients with a laryngeal culture-proven diagnosis of S. aureus treated at a large US voice center.
As reported in Laryngoscope, six patients were identified in total, including three patients with culture-proven MRSA laryngitis and three patients with MSSA laryngitis. Five of the patients were male and the median age of all individuals was 56 years.
All had a history of significant current or past tobacco use and all three patients with MRSA were current cigarette smokers. Five of the six subjects had comorbid illnesses, including hyperthyroidism, chronic obstructive pulmonary disease (COPD), hypertension, and diabetes, among others.
In terms of symptoms, all presented with a rough voice and the majority had some degree of vocal fatigue. Some patients reported not being able to project their voice, while others reported that increased efforts were needed to speak.
Common signs on the laryngeal videostroboscopy were mild edema of the vocal cords, thickened vocal fold epithelium, white or yellow crusting, and decreased pliability of the vocal fold mucosa.
"Our findings would suggest that MRSA laryngitis can present with more subtle symptoms and signs than previously suggested," report Shah and Klein.
All six patients underwent an in-office direct laryngeal culture, with three growing MRSA and three growing MSSA. They were each treated with trimethoprim/sulfamethoxazole (TMP-SMX) for various durations. One patient with significant yeast growth was treated concurrently with fluconazole.
In terms of treatment outcomes, one patient with MRSA laryngitis had a subjective and objective improvement with a single 2-week dose of TMP-SMX. One patient, despite improving immediately following a single 4-week course of treatment, had a recurrence requiring a second 12-week course of therapy. The third MRSA patient was lost to follow-up after undergoing a second course of treatment with TMP-SMX.
For those with MSSA laryngitis who were treated, one had a subjective and objective improvement in symptoms, one had an improvement in voice quality, and the third was lost to follow-up.
Prior to the present analysis, just four cases of MRSA laryngitis were reported in the literature. MSSA, on the other hand, is known to be a common cause of bacterial laryngitis.
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