Ian Olwoch - Academia.edu (original) (raw)

Papers by Ian Olwoch

Research paper thumbnail of The effects of the natural enzyme, Pectinex Ultra SP-L, on human cell cultures and bacterial biofilms in vitro

BMC Microbiology, Oct 2, 2014

Background: Pectinex Ultra SP-L (Pectinex) is a microbial-derived enzyme that is used in the food... more Background: Pectinex Ultra SP-L (Pectinex) is a microbial-derived enzyme that is used in the food industry and that has been shown to inhibit bacterial biofilms. It has been suggested that Pectinex may be useful in the management of biofilm-related bacterial infections and therefore warrants further investigation in this regard. The aim of this study was to investigate the cytotoxicity of Pectinex on cervical adenocarcinoma cells (HeLa), lymphocytes and neutrophils. Cell viability and morphology were assessed using an in vitro spectrophotometric MTT (3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide) assay and polarization-optical transmitted light differential interference contrast microscopy. This study also investigated the antibacterial and antibiofilm actions of Pectinex, alone and in combination with antibiotics, on standard and clinical cultures of Staphylococcus aureus and Pseudomonas aeruginosa. Minimum inhibitory (MIC) and bactericidal (MBC) concentrations were determined using p-iodo-nitrotetrazolium violet staining of bacterial cultures and regrowth of subcultures. Biofilm biomass and cell viability were quantified spectrophotometrically after staining with crystal violet and MTT. Results: The IC 50 (±SEM) of Pectinex was 193.9 (±22.2) PGU/ml for HeLa cells, 383.4 (±81.5) and 629.6 (±62.8) PGU/ ml for fMLP-stimulated and non-stimulated lymphocytes respectively, and 245.9 (±9.4) and 529.7 (±40.7) PGU/ml for fMLP-stimulated and non-stimulated neutrophils, respectively. Induced morphological features characteristic of apoptosis and necrosis included cell membrane blebs and vacuolization in HeLa cells, clumping in lymphocytes, as well as shrunken rounded cells, apoptotic bodies and debris in all cultures. Pectinex (7.42-950 PGU/ml −1) was not bactericidal. In clinical cultures of Staphylococcus aureus, co-administration of Pectinex was associated with a 28.0% increase in both the MIC and MBC of amoxicillin-clavulanate. In clinical cultures of P. aeruginosa, there was an 89.0% and 92.8% increase in the MIC and MBC of ciprofloxacin, respectively. Pectinex ≤ 118.75 PGU/ml −1 and incubation periods ≥ 6 h were associated with increased biomass and cell viability in S. aureus or P. aeruginosa biofilms. Conclusions: Pectinex appeared to antagonize the antibacterial effects of amoxicillin-clavulanate and ciprofloxacin and furthermore demonstrated significant cytotoxicity. It was therefore deemed unsuitable for the management of either planktonic or biofilm phenotypes of S. aureus or P. aeruginosa.

Research paper thumbnail of The effect of Pectinex Ultra SP-L on bacterial biofilms and human cell cultures in vitro

Biofilms are surface-bound bacterial colonies that are held together by a self-produced extracell... more Biofilms are surface-bound bacterial colonies that are held together by a self-produced extracellular polymeric matrix. They are highly resistant to antibiotics and host defence mechanisms, and are known to be the cause of persistent infections. Biofilm-degrading enzymes have been shown to prevent biofilm formation, remove mature biofilm, and enhance the efficacy of antibiotics. This study investigated the antibacterial and antibiofilm actions of the commercial enzyme Pectinex Ultra SP-L (Pectinex), alone and in combination with antibiotics, on standard and clinical cultures of Staphylococcus aureus and Pseudomonas aeruginosa. The cytotoxicity of Pectinex was determined on human cell cultures in vitro. Pectinex (7.42-950 PGU/ml) was not bactericidal, and had no effect on the antibacterial efficacy of amoxicillin-clavulanate and ciprofloxacin in cultures of S. aureus (ATCC 12600) and P. aeruginosa (ATCC 9027), respectively. However, in clinical cultures of P. aeruginosa, Pectinex caused an 89.0% (from 1.0 to 1.89 µg/ml) and 92.8% (from 1.67 to 3.22 µg/ml) increase in the MIC and MBC of ciprofloxacin, respectively. In clinical cultures of S. aureus, both bactericidal indices of amoxicillin-clavulanate were increased by 28.0% (from 2.0 to 2.56 µg/ml). In all bacterial cultures, low concentrations of Pectinex (≤ 118.75 PGU/ml) and prolonged incubation periods (≥ 6 h) were both associated with increased viability and biofilm biomass. Over a short incubation period (≤ 6 h), higher concentrations of Pectinex (237.5-950 PGU/ml) effectively inhibited biofilm formation in P. aeruginosa ATCC (237.5-950 PGU/ml) and clinical (950 PGU/ml) strains but not in S. aureus cultures. Pectinex (237.5-950 PGU/ml) was cytotoxic to HeLa cells, lymphocytes and neutrophils, and induced morphological features that included shrunken rounded cells, blebs, apoptotic iv bodies, cytoplasmic vacuoles and cell debris. The effects at 475 and 950 PGU/ml were comparable to mitomycin C 10 µg/ml and staurosporine 1 µg/ml. Pectinex was shown to either enhance or reduce biofilm biomass and cell viability in cultures of S. aureus and P. aeruginosa. The manifested effects depended on the concentration of the enzyme, the specific bacterial species and strain, and the maturity of the biofilms. Further studies are still needed in order to determine the actions of Pectinex on other clinical pathogens.

Research paper thumbnail of Microbiology and antibiotic sensitivity of uncomplicated chronic suppurative otitis media at Dr. George Mukhari Academic Hospital, South Africa

International Journal of Otorhinolaryngology and Head and Neck Surgery, Mar 24, 2021

Chronic suppurative otitis media (CSOM) is a disease frequently encountered by the Otorhinolaryng... more Chronic suppurative otitis media (CSOM) is a disease frequently encountered by the Otorhinolaryngologist. The World Health Organization defines CSOM as chronic inflammation of the middle ear and mastoid air cells characterized by a perforated tympanic membrane and otorrhea for a period of more than two weeks. 1 It is a disease of multiple aetiologies and known for its recurrence and persistence despite adequate treatment at the primary healthcare level. Its importance lies in its consequences on hearing impairment, chronicity, local and central sequalae. It affects different cultural and racial groups in both developing and industrialized countries. 2 Epidemiological studies have reported a high incidence of the disease in children belonging to lower socioeconomic groups. 3 The active form of the disease persists into adulthood in a very small percentage of the affected population. 4

Research paper thumbnail of Microbiology of acute complicated bacterial sinusitis at the University of the Witwatersrand

South African Medical Journal, Jul 26, 2010

The microbiology of bacterial sinusitis has been studied extensively. The most common pathogens c... more The microbiology of bacterial sinusitis has been studied extensively. The most common pathogens cited are aerobes and facultative anaerobes that include Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, Klebsiella pneumoniae, Pseudomonas aeruginosa and S. milleri. 1-9 Anaerobic organisms, isolated from as many as one-third of patients, include Propionibacterium acnes and Peptostreptococcus, Prevotella, Enterobacter, Bacteroides and Fusobacterium species. 9,10 Despite the abundance of published studies there are very few that report on the microbiology of acute complicated sinusitis. 3-8,11,12 Complicated sinusitis is associated with debilitating and potentially life-threatening orbital, intracranial, bone and soft-tissue complications; its treatment is both a medical and a surgical emergency. 3,5,6,11,13,14 At the University of the Witwatersrand, patients with complicated sinusitis are referred to the Department of Otorhinolaryngology where they usually present with any combination of sinus involvement (maxillary, ethmoid, frontal and sphenoid) and one or more associated complications. 3,5,6,11,13,14 A routine clinical assessment and computed tomography scan diagnosis is made before any surgery. Prompt medical treatment, with or without surgery, is then commenced. This entails initial empirical use of antibiotics

Research paper thumbnail of Carcinosarcoma of the nasopharynx: a case report

International Journal of Otorhinolaryngology and Head and Neck Surgery, Aug 23, 2021

On examination, a solid mass was visualized in the right nostril. MRI and CT scans of the brain a... more On examination, a solid mass was visualized in the right nostril. MRI and CT scans of the brain and paranasal sinuses were done. An extensive lobulated mass involving the nasopharynx, maxillary sinuses, ethmoid sinuses, nasal passages, pterygopalatine fossae, infratemporal fossae, sphenoid sinuses, and circumferential encasement of the ABSTRACT Carcinosarcoma is a malignant tumor with a dual histological appearance, a squamous epithelial (sarcomatous), and a mesenchymal component. Carcinosarcomas are characterized by a high recurrence rate, metastatic spread, and high morbidity and mortality. Carcinosarcoma can arise from any squamous epithelial lining but rare in the sino-nasal tract. We are presenting a case of a 19-year-old male with a 3-month history of recurrent epistaxis associated with nasal blockage, anosmia, and bilateral complete loss of vision over a few weeks. Carcinosarcoma of the sino-nasal tract is a rare entity and can mimic any sino-nasal malignancy. The optimal treatment of this disease is controversial and lacks a clear guideline, therefore challenging to the treating oncologists. Carcinosarcoma of the head and neck is a rare and aggressive tumor. It poses diagnostic and treatment challenges.

Research paper thumbnail of The prevalence and impact of otitis media with effusion in children admitted for adeno-tonsillectomy at Dr George Mukhari Academic Hospital, Pretoria, South Africa

International Journal of Pediatric Otorhinolaryngology, Jul 1, 2018

Introduction: Otitis media with effusion (OME) is a leading cause of acquired hearing loss in chi... more Introduction: Otitis media with effusion (OME) is a leading cause of acquired hearing loss in children worldwide. However, previous South African studies have consistently reported the local paediatric OME prevalence to be lower than typically published in international literature. Furthermore, no South African studies have investigated OME in children with adenotonsillar hypertrophy. The objective of this study was to determine the prevalence of OME in children admitted for adeno-tonsillectomy at our institution in Pretoria, South Africa. In addition, the study sought to gauge the impact of OME on quality of life using a validated questionnaire (OM-6). Methods: A cross-sectional, observational study was conducted between July 2015 and May 2016 at the Otorhinolaryngology outpatient department at DGMAH. he study included 109 consecutively sampled children, aged 2-12 years (mean 6.1; 49.7% female). Pneumatic otoscopy and tympanometry were performed on all participants. Adenoid hypertrophy was quantified using he adenoid-nasopharyngeal ratio (ANR) on a lateral post-nasal space radiograph (Fujioka's method). The OM-6 questionnaire was completed for each participant. Pure tone audiometry was performed for participants diagnosed with OME. Results: The prevalence of bilateral OME was 11.9%. For unilateral OME, the prevalence was 22.9% and 16.5%, for the left and right ears, respectively (p > 0.05). The mean hearing loss (SD) was 19.8 dB (9.4). Clinically significant adenoid hypertrophy (ANR ≥ 0.71) was present in 43% of participants. There was no statistically significant (p > 0.05) correlation between the presence OME and adenoid hypertrophy. The mean total OM-6 survey score was 1.67 (SD ± 0.59) in children with OME, and 1.31 (SD ± 0.45) without OME, showing no statistically significant difference (p > 0.05). There was a significant (P < 0.05) correlation between OME and the presence of atopy. Conclusion: Adeno-tonsillar pathology may play an aetio-pathological role in the development of OME. However, this may be due to the presence of biofilms rather than obstructive adenoid hypertrophy, given the lack of a significant (p > 0.05) correlation between adenoid hypertrophy and OME. Whilst OME was not found to impair quality of life in this population group, the validity of the OM-6 in the South African paediatric population requires further investigation.

Research paper thumbnail of A 5-year review of the microbiology of acute complicated bacterial sinusitis at the University of the Witwatersrand

PROFESSOR PC MODI, my supervisor and academic head, for his guidance support and encouragement th... more PROFESSOR PC MODI, my supervisor and academic head, for his guidance support and encouragement throughout the preparation and execution of this study and for his invaluable criticism in the final preparation of this dissertation. All the members of the academic peer review committee of the Department of Neurosciences for their guidance and valuable criticism. DR MRI AHMED, the clinical head of Otorhinolaryngology at the Chris Hani Baragwanath Hospital, for facilitating my access to a wealth of data that was vital to the success of this dissertation. The staff of the: Operating theatres ENT and neurosurgical wards Department of radiology National Health Laboratory Services at the Johannesburg General, Chris Hani Baragwanath, Helen Joseph and Coronation Hospitals for their support in sourcing all the relevant data. My wife JANE, and daughters IRENE and MARGARET, for their patience, encouragement and deep understanding throughout the process of this study.

Research paper thumbnail of Aerosolised ketamine prevents histamine-induced bronchospasm

Medical Science Research, 1994

Research paper thumbnail of The effects of the natural enzyme, Pectinex Ultra SP-L, on human cell cultures and bacterial biofilms in vitro

BMC microbiology, 2014

Pectinex Ultra SP-L (Pectinex) is a microbial-derived enzyme that is used in the food industry an... more Pectinex Ultra SP-L (Pectinex) is a microbial-derived enzyme that is used in the food industry and that has been shown to inhibit bacterial biofilms. It has been suggested that Pectinex may be useful in the management of biofilm-related bacterial infections and therefore warrants further investigation in this regard. The aim of this study was to investigate the cytotoxicity of Pectinex on cervical adenocarcinoma cells (HeLa), lymphocytes and neutrophils. Cell viability and morphology were assessed using an in vitro spectrophotometric MTT (3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide) assay and polarization-optical transmitted light differential interference contrast microscopy. This study also investigated the antibacterial and antibiofilm actions of Pectinex, alone and in combination with antibiotics, on standard and clinical cultures of Staphylococcus aureus and Pseudomonas aeruginosa. Minimum inhibitory (MIC) and bactericidal (MBC) concentrations were determine...

Research paper thumbnail of The management of rhinosinusitis in general practice

South African General Practitioner, 2021

Research paper thumbnail of The two-year survival rate of laryngeal squamous cell carcinoma patients treated at Dr. George Mukhari academic hospital South Africa

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2022

Background: The study was conducted to assess the outcome of patients diagnosed with laryngeal sq... more Background: The study was conducted to assess the outcome of patients diagnosed with laryngeal squamous cell carcinoma (LSCC) treated at a tertiary level hospital in South Africa. The focus was the two-year disease-specific survival (DSS) rate after diagnosis as a measuring tool for the outcomes of the disease.Methods: A retrospective cross-sectional descriptive study was conducted at Dr. George Mukhari academic hospital (DGMAH) from 1 January 2010 to 31 December 2015. The data was collected from files of patients who were identified by clinical laryngeal symptoms, pan-endoscopy and biopsy. A total of 37 files of patients diagnosed as LSCC were included in the study.Results: 166 hospital records were retrieved. After application of inclusion and exclusion criteria, the study excluded 129 files because of benign lesions, malignancies other than SCC on histology report, SCC from upper aero-digestive sites other than the larynx or files with incomplete information. Therefore, 37 record...

Research paper thumbnail of Carcinosarcoma of the nasopharynx: a case report

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Carcinosarcoma is a malignant tumor with a dual histological appearance, a squamous epithelial (s... more Carcinosarcoma is a malignant tumor with a dual histological appearance, a squamous epithelial (sarcomatous), and a mesenchymal component. Carcinosarcomas are characterized by a high recurrence rate, metastatic spread, and high morbidity and mortality. Carcinosarcoma can arise from any squamous epithelial lining but rare in the sino-nasal tract. We are presenting a case of a 19-year-old male with a 3-month history of recurrent epistaxis associated with nasal blockage, anosmia, and bilateral complete loss of vision over a few weeks. Carcinosarcoma of the sino-nasal tract is a rare entity and can mimic any sino-nasal malignancy. The optimal treatment of this disease is controversial and lacks a clear guideline, therefore challenging to the treating oncologists. Carcinosarcoma of the head and neck is a rare and aggressive tumor. It poses diagnostic and treatment challenges.

Research paper thumbnail of The effect of Pectinex Ultra SP-L on bacterial biofilms and human cell cultures in vitro

Biofilms are surface-bound bacterial colonies that are held together by a self-produced extracell... more Biofilms are surface-bound bacterial colonies that are held together by a self-produced extracellular polymeric matrix. They are highly resistant to antibiotics and host defence mechanisms, and are known to be the cause of persistent infections. Biofilm-degrading enzymes have been shown to prevent biofilm formation, remove mature biofilm, and enhance the efficacy of antibiotics. This study investigated the antibacterial and antibiofilm actions of the commercial enzyme Pectinex Ultra SP-L (Pectinex), alone and in combination with antibiotics, on standard and clinical cultures of Staphylococcus aureus and Pseudomonas aeruginosa. The cytotoxicity of Pectinex was determined on human cell cultures in vitro. Pectinex (7.42-950 PGU/ml) was not bactericidal, and had no effect on the antibacterial efficacy of amoxicillin-clavulanate and ciprofloxacin in cultures of S. aureus (ATCC 12600) and P. aeruginosa (ATCC 9027), respectively. However, in clinical cultures of P. aeruginosa, Pectinex caused an 89.0% (from 1.0 to 1.89 µg/ml) and 92.8% (from 1.67 to 3.22 µg/ml) increase in the MIC and MBC of ciprofloxacin, respectively. In clinical cultures of S. aureus, both bactericidal indices of amoxicillin-clavulanate were increased by 28.0% (from 2.0 to 2.56 µg/ml). In all bacterial cultures, low concentrations of Pectinex (≤ 118.75 PGU/ml) and prolonged incubation periods (≥ 6 h) were both associated with increased viability and biofilm biomass. Over a short incubation period (≤ 6 h), higher concentrations of Pectinex (237.5-950 PGU/ml) effectively inhibited biofilm formation in P. aeruginosa ATCC (237.5-950 PGU/ml) and clinical (950 PGU/ml) strains but not in S. aureus cultures. Pectinex (237.5-950 PGU/ml) was cytotoxic to HeLa cells, lymphocytes and neutrophils, and induced morphological features that included shrunken rounded cells, blebs, apoptotic iv bodies, cytoplasmic vacuoles and cell debris. The effects at 475 and 950 PGU/ml were comparable to mitomycin C 10 µg/ml and staurosporine 1 µg/ml. Pectinex was shown to either enhance or reduce biofilm biomass and cell viability in cultures of S. aureus and P. aeruginosa. The manifested effects depended on the concentration of the enzyme, the specific bacterial species and strain, and the maturity of the biofilms. Further studies are still needed in order to determine the actions of Pectinex on other clinical pathogens.

Research paper thumbnail of Microbiology and antibiotic sensitivity of uncomplicated chronic suppurative otitis media at Dr. George Mukhari Academic Hospital, South Africa

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Background: The study was conducted to assess the type and frequency of isolation of different mi... more Background: The study was conducted to assess the type and frequency of isolation of different microorganisms in uncomplicated chronic suppurative otitis media (CSOM) and their antibiotic sensitivity in our institution.Methods: A total of 88 consecutive patients with unilateral or bilateral active, chronic suppurative otitis media attending outpatient department at DGMAH were included in the study after obtaining an informed consent. There were 55 males (62.5%) and 33 females (37.9%) with age range between 6 months and 76 years. Pus swabs were taken through the perforation site and from the promontory after ear mopping under direct vision. Results: Children less than 5 years were more affected (23.9%) than older children 5-10 years (13.6%) and 11-15 years (11.45%). One hundred and six microorganisms were isolated from analysis of cultures obtained from 72 patients. Seven cultures were negative (5.9%), 8 specimens were contaminated (6.7%) and 1 specimen was lost (1.1%). Pseudomonas ...

Research paper thumbnail of The prevalence and impact of otitis media with effusion in children admitted for adeno-tonsillectomy at Dr George Mukhari Academic Hospital, Pretoria, South Africa

International Journal of Pediatric Otorhinolaryngology, 2018

Introduction: Otitis media with effusion (OME) is a leading cause of acquired hearing loss in chi... more Introduction: Otitis media with effusion (OME) is a leading cause of acquired hearing loss in children worldwide. However, previous South African studies have consistently reported the local paediatric OME prevalence to be lower than typically published in international literature. Furthermore, no South African studies have investigated OME in children with adenotonsillar hypertrophy. The objective of this study was to determine the prevalence of OME in children admitted for adeno-tonsillectomy at our institution in Pretoria, South Africa. In addition, the study sought to gauge the impact of OME on quality of life using a validated questionnaire (OM-6). Methods: A cross-sectional, observational study was conducted between July 2015 and May 2016 at the Otorhinolaryngology outpatient department at DGMAH. he study included 109 consecutively sampled children, aged 2-12 years (mean 6.1; 49.7% female). Pneumatic otoscopy and tympanometry were performed on all participants. Adenoid hypertrophy was quantified using he adenoid-nasopharyngeal ratio (ANR) on a lateral post-nasal space radiograph (Fujioka's method). The OM-6 questionnaire was completed for each participant. Pure tone audiometry was performed for participants diagnosed with OME. Results: The prevalence of bilateral OME was 11.9%. For unilateral OME, the prevalence was 22.9% and 16.5%, for the left and right ears, respectively (p > 0.05). The mean hearing loss (SD) was 19.8 dB (9.4). Clinically significant adenoid hypertrophy (ANR ≥ 0.71) was present in 43% of participants. There was no statistically significant (p > 0.05) correlation between the presence OME and adenoid hypertrophy. The mean total OM-6 survey score was 1.67 (SD ± 0.59) in children with OME, and 1.31 (SD ± 0.45) without OME, showing no statistically significant difference (p > 0.05). There was a significant (P < 0.05) correlation between OME and the presence of atopy. Conclusion: Adeno-tonsillar pathology may play an aetio-pathological role in the development of OME. However, this may be due to the presence of biofilms rather than obstructive adenoid hypertrophy, given the lack of a significant (p > 0.05) correlation between adenoid hypertrophy and OME. Whilst OME was not found to impair quality of life in this population group, the validity of the OM-6 in the South African paediatric population requires further investigation.

Research paper thumbnail of Effects of ketamine and salbutamol on histamine- and methacholine-induced contraction of the isolated guinea-pig tracheal chain

Medical Science Research, 1995

Research paper thumbnail of The effects of the natural enzyme, Pectinex Ultra SP-L, on human cell cultures and bacterial biofilms in vitro

BMC microbiology, 2014

Pectinex Ultra SP-L (Pectinex) is a microbial-derived enzyme that is used in the food industry an... more Pectinex Ultra SP-L (Pectinex) is a microbial-derived enzyme that is used in the food industry and that has been shown to inhibit bacterial biofilms. It has been suggested that Pectinex may be useful in the management of biofilm-related bacterial infections and therefore warrants further investigation in this regard. The aim of this study was to investigate the cytotoxicity of Pectinex on cervical adenocarcinoma cells (HeLa), lymphocytes and neutrophils. Cell viability and morphology were assessed using an in vitro spectrophotometric MTT (3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide) assay and polarization-optical transmitted light differential interference contrast microscopy. This study also investigated the antibacterial and antibiofilm actions of Pectinex, alone and in combination with antibiotics, on standard and clinical cultures of Staphylococcus aureus and Pseudomonas aeruginosa. Minimum inhibitory (MIC) and bactericidal (MBC) concentrations were determine...

Research paper thumbnail of Microbiology of acute complicated bacterial sinusitis at the University of the Witwatersrand

South African Medical Journal, 2010

The microbiology of bacterial sinusitis has been studied extensively. The most common pathogens c... more The microbiology of bacterial sinusitis has been studied extensively. The most common pathogens cited are aerobes and facultative anaerobes that include Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, Klebsiella pneumoniae, Pseudomonas aeruginosa and S. milleri. 1-9 Anaerobic organisms, isolated from as many as one-third of patients, include Propionibacterium acnes and Peptostreptococcus, Prevotella, Enterobacter, Bacteroides and Fusobacterium species. 9,10 Despite the abundance of published studies there are very few that report on the microbiology of acute complicated sinusitis. 3-8,11,12 Complicated sinusitis is associated with debilitating and potentially life-threatening orbital, intracranial, bone and soft-tissue complications; its treatment is both a medical and a surgical emergency. 3,5,6,11,13,14 At the University of the Witwatersrand, patients with complicated sinusitis are referred to the Department of Otorhinolaryngology where they usually present with any combination of sinus involvement (maxillary, ethmoid, frontal and sphenoid) and one or more associated complications. 3,5,6,11,13,14 A routine clinical assessment and computed tomography scan diagnosis is made before any surgery. Prompt medical treatment, with or without surgery, is then commenced. This entails initial empirical use of antibiotics

Research paper thumbnail of The effects of the natural enzyme, Pectinex Ultra SP-L, on human cell cultures and bacterial biofilms in vitro

BMC Microbiology, Oct 2, 2014

Background: Pectinex Ultra SP-L (Pectinex) is a microbial-derived enzyme that is used in the food... more Background: Pectinex Ultra SP-L (Pectinex) is a microbial-derived enzyme that is used in the food industry and that has been shown to inhibit bacterial biofilms. It has been suggested that Pectinex may be useful in the management of biofilm-related bacterial infections and therefore warrants further investigation in this regard. The aim of this study was to investigate the cytotoxicity of Pectinex on cervical adenocarcinoma cells (HeLa), lymphocytes and neutrophils. Cell viability and morphology were assessed using an in vitro spectrophotometric MTT (3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide) assay and polarization-optical transmitted light differential interference contrast microscopy. This study also investigated the antibacterial and antibiofilm actions of Pectinex, alone and in combination with antibiotics, on standard and clinical cultures of Staphylococcus aureus and Pseudomonas aeruginosa. Minimum inhibitory (MIC) and bactericidal (MBC) concentrations were determined using p-iodo-nitrotetrazolium violet staining of bacterial cultures and regrowth of subcultures. Biofilm biomass and cell viability were quantified spectrophotometrically after staining with crystal violet and MTT. Results: The IC 50 (±SEM) of Pectinex was 193.9 (±22.2) PGU/ml for HeLa cells, 383.4 (±81.5) and 629.6 (±62.8) PGU/ ml for fMLP-stimulated and non-stimulated lymphocytes respectively, and 245.9 (±9.4) and 529.7 (±40.7) PGU/ml for fMLP-stimulated and non-stimulated neutrophils, respectively. Induced morphological features characteristic of apoptosis and necrosis included cell membrane blebs and vacuolization in HeLa cells, clumping in lymphocytes, as well as shrunken rounded cells, apoptotic bodies and debris in all cultures. Pectinex (7.42-950 PGU/ml −1) was not bactericidal. In clinical cultures of Staphylococcus aureus, co-administration of Pectinex was associated with a 28.0% increase in both the MIC and MBC of amoxicillin-clavulanate. In clinical cultures of P. aeruginosa, there was an 89.0% and 92.8% increase in the MIC and MBC of ciprofloxacin, respectively. Pectinex ≤ 118.75 PGU/ml −1 and incubation periods ≥ 6 h were associated with increased biomass and cell viability in S. aureus or P. aeruginosa biofilms. Conclusions: Pectinex appeared to antagonize the antibacterial effects of amoxicillin-clavulanate and ciprofloxacin and furthermore demonstrated significant cytotoxicity. It was therefore deemed unsuitable for the management of either planktonic or biofilm phenotypes of S. aureus or P. aeruginosa.

Research paper thumbnail of The effect of Pectinex Ultra SP-L on bacterial biofilms and human cell cultures in vitro

Biofilms are surface-bound bacterial colonies that are held together by a self-produced extracell... more Biofilms are surface-bound bacterial colonies that are held together by a self-produced extracellular polymeric matrix. They are highly resistant to antibiotics and host defence mechanisms, and are known to be the cause of persistent infections. Biofilm-degrading enzymes have been shown to prevent biofilm formation, remove mature biofilm, and enhance the efficacy of antibiotics. This study investigated the antibacterial and antibiofilm actions of the commercial enzyme Pectinex Ultra SP-L (Pectinex), alone and in combination with antibiotics, on standard and clinical cultures of Staphylococcus aureus and Pseudomonas aeruginosa. The cytotoxicity of Pectinex was determined on human cell cultures in vitro. Pectinex (7.42-950 PGU/ml) was not bactericidal, and had no effect on the antibacterial efficacy of amoxicillin-clavulanate and ciprofloxacin in cultures of S. aureus (ATCC 12600) and P. aeruginosa (ATCC 9027), respectively. However, in clinical cultures of P. aeruginosa, Pectinex caused an 89.0% (from 1.0 to 1.89 µg/ml) and 92.8% (from 1.67 to 3.22 µg/ml) increase in the MIC and MBC of ciprofloxacin, respectively. In clinical cultures of S. aureus, both bactericidal indices of amoxicillin-clavulanate were increased by 28.0% (from 2.0 to 2.56 µg/ml). In all bacterial cultures, low concentrations of Pectinex (≤ 118.75 PGU/ml) and prolonged incubation periods (≥ 6 h) were both associated with increased viability and biofilm biomass. Over a short incubation period (≤ 6 h), higher concentrations of Pectinex (237.5-950 PGU/ml) effectively inhibited biofilm formation in P. aeruginosa ATCC (237.5-950 PGU/ml) and clinical (950 PGU/ml) strains but not in S. aureus cultures. Pectinex (237.5-950 PGU/ml) was cytotoxic to HeLa cells, lymphocytes and neutrophils, and induced morphological features that included shrunken rounded cells, blebs, apoptotic iv bodies, cytoplasmic vacuoles and cell debris. The effects at 475 and 950 PGU/ml were comparable to mitomycin C 10 µg/ml and staurosporine 1 µg/ml. Pectinex was shown to either enhance or reduce biofilm biomass and cell viability in cultures of S. aureus and P. aeruginosa. The manifested effects depended on the concentration of the enzyme, the specific bacterial species and strain, and the maturity of the biofilms. Further studies are still needed in order to determine the actions of Pectinex on other clinical pathogens.

Research paper thumbnail of Microbiology and antibiotic sensitivity of uncomplicated chronic suppurative otitis media at Dr. George Mukhari Academic Hospital, South Africa

International Journal of Otorhinolaryngology and Head and Neck Surgery, Mar 24, 2021

Chronic suppurative otitis media (CSOM) is a disease frequently encountered by the Otorhinolaryng... more Chronic suppurative otitis media (CSOM) is a disease frequently encountered by the Otorhinolaryngologist. The World Health Organization defines CSOM as chronic inflammation of the middle ear and mastoid air cells characterized by a perforated tympanic membrane and otorrhea for a period of more than two weeks. 1 It is a disease of multiple aetiologies and known for its recurrence and persistence despite adequate treatment at the primary healthcare level. Its importance lies in its consequences on hearing impairment, chronicity, local and central sequalae. It affects different cultural and racial groups in both developing and industrialized countries. 2 Epidemiological studies have reported a high incidence of the disease in children belonging to lower socioeconomic groups. 3 The active form of the disease persists into adulthood in a very small percentage of the affected population. 4

Research paper thumbnail of Microbiology of acute complicated bacterial sinusitis at the University of the Witwatersrand

South African Medical Journal, Jul 26, 2010

The microbiology of bacterial sinusitis has been studied extensively. The most common pathogens c... more The microbiology of bacterial sinusitis has been studied extensively. The most common pathogens cited are aerobes and facultative anaerobes that include Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, Klebsiella pneumoniae, Pseudomonas aeruginosa and S. milleri. 1-9 Anaerobic organisms, isolated from as many as one-third of patients, include Propionibacterium acnes and Peptostreptococcus, Prevotella, Enterobacter, Bacteroides and Fusobacterium species. 9,10 Despite the abundance of published studies there are very few that report on the microbiology of acute complicated sinusitis. 3-8,11,12 Complicated sinusitis is associated with debilitating and potentially life-threatening orbital, intracranial, bone and soft-tissue complications; its treatment is both a medical and a surgical emergency. 3,5,6,11,13,14 At the University of the Witwatersrand, patients with complicated sinusitis are referred to the Department of Otorhinolaryngology where they usually present with any combination of sinus involvement (maxillary, ethmoid, frontal and sphenoid) and one or more associated complications. 3,5,6,11,13,14 A routine clinical assessment and computed tomography scan diagnosis is made before any surgery. Prompt medical treatment, with or without surgery, is then commenced. This entails initial empirical use of antibiotics

Research paper thumbnail of Carcinosarcoma of the nasopharynx: a case report

International Journal of Otorhinolaryngology and Head and Neck Surgery, Aug 23, 2021

On examination, a solid mass was visualized in the right nostril. MRI and CT scans of the brain a... more On examination, a solid mass was visualized in the right nostril. MRI and CT scans of the brain and paranasal sinuses were done. An extensive lobulated mass involving the nasopharynx, maxillary sinuses, ethmoid sinuses, nasal passages, pterygopalatine fossae, infratemporal fossae, sphenoid sinuses, and circumferential encasement of the ABSTRACT Carcinosarcoma is a malignant tumor with a dual histological appearance, a squamous epithelial (sarcomatous), and a mesenchymal component. Carcinosarcomas are characterized by a high recurrence rate, metastatic spread, and high morbidity and mortality. Carcinosarcoma can arise from any squamous epithelial lining but rare in the sino-nasal tract. We are presenting a case of a 19-year-old male with a 3-month history of recurrent epistaxis associated with nasal blockage, anosmia, and bilateral complete loss of vision over a few weeks. Carcinosarcoma of the sino-nasal tract is a rare entity and can mimic any sino-nasal malignancy. The optimal treatment of this disease is controversial and lacks a clear guideline, therefore challenging to the treating oncologists. Carcinosarcoma of the head and neck is a rare and aggressive tumor. It poses diagnostic and treatment challenges.

Research paper thumbnail of The prevalence and impact of otitis media with effusion in children admitted for adeno-tonsillectomy at Dr George Mukhari Academic Hospital, Pretoria, South Africa

International Journal of Pediatric Otorhinolaryngology, Jul 1, 2018

Introduction: Otitis media with effusion (OME) is a leading cause of acquired hearing loss in chi... more Introduction: Otitis media with effusion (OME) is a leading cause of acquired hearing loss in children worldwide. However, previous South African studies have consistently reported the local paediatric OME prevalence to be lower than typically published in international literature. Furthermore, no South African studies have investigated OME in children with adenotonsillar hypertrophy. The objective of this study was to determine the prevalence of OME in children admitted for adeno-tonsillectomy at our institution in Pretoria, South Africa. In addition, the study sought to gauge the impact of OME on quality of life using a validated questionnaire (OM-6). Methods: A cross-sectional, observational study was conducted between July 2015 and May 2016 at the Otorhinolaryngology outpatient department at DGMAH. he study included 109 consecutively sampled children, aged 2-12 years (mean 6.1; 49.7% female). Pneumatic otoscopy and tympanometry were performed on all participants. Adenoid hypertrophy was quantified using he adenoid-nasopharyngeal ratio (ANR) on a lateral post-nasal space radiograph (Fujioka's method). The OM-6 questionnaire was completed for each participant. Pure tone audiometry was performed for participants diagnosed with OME. Results: The prevalence of bilateral OME was 11.9%. For unilateral OME, the prevalence was 22.9% and 16.5%, for the left and right ears, respectively (p > 0.05). The mean hearing loss (SD) was 19.8 dB (9.4). Clinically significant adenoid hypertrophy (ANR ≥ 0.71) was present in 43% of participants. There was no statistically significant (p > 0.05) correlation between the presence OME and adenoid hypertrophy. The mean total OM-6 survey score was 1.67 (SD ± 0.59) in children with OME, and 1.31 (SD ± 0.45) without OME, showing no statistically significant difference (p > 0.05). There was a significant (P < 0.05) correlation between OME and the presence of atopy. Conclusion: Adeno-tonsillar pathology may play an aetio-pathological role in the development of OME. However, this may be due to the presence of biofilms rather than obstructive adenoid hypertrophy, given the lack of a significant (p > 0.05) correlation between adenoid hypertrophy and OME. Whilst OME was not found to impair quality of life in this population group, the validity of the OM-6 in the South African paediatric population requires further investigation.

Research paper thumbnail of A 5-year review of the microbiology of acute complicated bacterial sinusitis at the University of the Witwatersrand

PROFESSOR PC MODI, my supervisor and academic head, for his guidance support and encouragement th... more PROFESSOR PC MODI, my supervisor and academic head, for his guidance support and encouragement throughout the preparation and execution of this study and for his invaluable criticism in the final preparation of this dissertation. All the members of the academic peer review committee of the Department of Neurosciences for their guidance and valuable criticism. DR MRI AHMED, the clinical head of Otorhinolaryngology at the Chris Hani Baragwanath Hospital, for facilitating my access to a wealth of data that was vital to the success of this dissertation. The staff of the: Operating theatres ENT and neurosurgical wards Department of radiology National Health Laboratory Services at the Johannesburg General, Chris Hani Baragwanath, Helen Joseph and Coronation Hospitals for their support in sourcing all the relevant data. My wife JANE, and daughters IRENE and MARGARET, for their patience, encouragement and deep understanding throughout the process of this study.

Research paper thumbnail of Aerosolised ketamine prevents histamine-induced bronchospasm

Medical Science Research, 1994

Research paper thumbnail of The effects of the natural enzyme, Pectinex Ultra SP-L, on human cell cultures and bacterial biofilms in vitro

BMC microbiology, 2014

Pectinex Ultra SP-L (Pectinex) is a microbial-derived enzyme that is used in the food industry an... more Pectinex Ultra SP-L (Pectinex) is a microbial-derived enzyme that is used in the food industry and that has been shown to inhibit bacterial biofilms. It has been suggested that Pectinex may be useful in the management of biofilm-related bacterial infections and therefore warrants further investigation in this regard. The aim of this study was to investigate the cytotoxicity of Pectinex on cervical adenocarcinoma cells (HeLa), lymphocytes and neutrophils. Cell viability and morphology were assessed using an in vitro spectrophotometric MTT (3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide) assay and polarization-optical transmitted light differential interference contrast microscopy. This study also investigated the antibacterial and antibiofilm actions of Pectinex, alone and in combination with antibiotics, on standard and clinical cultures of Staphylococcus aureus and Pseudomonas aeruginosa. Minimum inhibitory (MIC) and bactericidal (MBC) concentrations were determine...

Research paper thumbnail of The management of rhinosinusitis in general practice

South African General Practitioner, 2021

Research paper thumbnail of The two-year survival rate of laryngeal squamous cell carcinoma patients treated at Dr. George Mukhari academic hospital South Africa

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2022

Background: The study was conducted to assess the outcome of patients diagnosed with laryngeal sq... more Background: The study was conducted to assess the outcome of patients diagnosed with laryngeal squamous cell carcinoma (LSCC) treated at a tertiary level hospital in South Africa. The focus was the two-year disease-specific survival (DSS) rate after diagnosis as a measuring tool for the outcomes of the disease.Methods: A retrospective cross-sectional descriptive study was conducted at Dr. George Mukhari academic hospital (DGMAH) from 1 January 2010 to 31 December 2015. The data was collected from files of patients who were identified by clinical laryngeal symptoms, pan-endoscopy and biopsy. A total of 37 files of patients diagnosed as LSCC were included in the study.Results: 166 hospital records were retrieved. After application of inclusion and exclusion criteria, the study excluded 129 files because of benign lesions, malignancies other than SCC on histology report, SCC from upper aero-digestive sites other than the larynx or files with incomplete information. Therefore, 37 record...

Research paper thumbnail of Carcinosarcoma of the nasopharynx: a case report

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Carcinosarcoma is a malignant tumor with a dual histological appearance, a squamous epithelial (s... more Carcinosarcoma is a malignant tumor with a dual histological appearance, a squamous epithelial (sarcomatous), and a mesenchymal component. Carcinosarcomas are characterized by a high recurrence rate, metastatic spread, and high morbidity and mortality. Carcinosarcoma can arise from any squamous epithelial lining but rare in the sino-nasal tract. We are presenting a case of a 19-year-old male with a 3-month history of recurrent epistaxis associated with nasal blockage, anosmia, and bilateral complete loss of vision over a few weeks. Carcinosarcoma of the sino-nasal tract is a rare entity and can mimic any sino-nasal malignancy. The optimal treatment of this disease is controversial and lacks a clear guideline, therefore challenging to the treating oncologists. Carcinosarcoma of the head and neck is a rare and aggressive tumor. It poses diagnostic and treatment challenges.

Research paper thumbnail of The effect of Pectinex Ultra SP-L on bacterial biofilms and human cell cultures in vitro

Biofilms are surface-bound bacterial colonies that are held together by a self-produced extracell... more Biofilms are surface-bound bacterial colonies that are held together by a self-produced extracellular polymeric matrix. They are highly resistant to antibiotics and host defence mechanisms, and are known to be the cause of persistent infections. Biofilm-degrading enzymes have been shown to prevent biofilm formation, remove mature biofilm, and enhance the efficacy of antibiotics. This study investigated the antibacterial and antibiofilm actions of the commercial enzyme Pectinex Ultra SP-L (Pectinex), alone and in combination with antibiotics, on standard and clinical cultures of Staphylococcus aureus and Pseudomonas aeruginosa. The cytotoxicity of Pectinex was determined on human cell cultures in vitro. Pectinex (7.42-950 PGU/ml) was not bactericidal, and had no effect on the antibacterial efficacy of amoxicillin-clavulanate and ciprofloxacin in cultures of S. aureus (ATCC 12600) and P. aeruginosa (ATCC 9027), respectively. However, in clinical cultures of P. aeruginosa, Pectinex caused an 89.0% (from 1.0 to 1.89 µg/ml) and 92.8% (from 1.67 to 3.22 µg/ml) increase in the MIC and MBC of ciprofloxacin, respectively. In clinical cultures of S. aureus, both bactericidal indices of amoxicillin-clavulanate were increased by 28.0% (from 2.0 to 2.56 µg/ml). In all bacterial cultures, low concentrations of Pectinex (≤ 118.75 PGU/ml) and prolonged incubation periods (≥ 6 h) were both associated with increased viability and biofilm biomass. Over a short incubation period (≤ 6 h), higher concentrations of Pectinex (237.5-950 PGU/ml) effectively inhibited biofilm formation in P. aeruginosa ATCC (237.5-950 PGU/ml) and clinical (950 PGU/ml) strains but not in S. aureus cultures. Pectinex (237.5-950 PGU/ml) was cytotoxic to HeLa cells, lymphocytes and neutrophils, and induced morphological features that included shrunken rounded cells, blebs, apoptotic iv bodies, cytoplasmic vacuoles and cell debris. The effects at 475 and 950 PGU/ml were comparable to mitomycin C 10 µg/ml and staurosporine 1 µg/ml. Pectinex was shown to either enhance or reduce biofilm biomass and cell viability in cultures of S. aureus and P. aeruginosa. The manifested effects depended on the concentration of the enzyme, the specific bacterial species and strain, and the maturity of the biofilms. Further studies are still needed in order to determine the actions of Pectinex on other clinical pathogens.

Research paper thumbnail of Microbiology and antibiotic sensitivity of uncomplicated chronic suppurative otitis media at Dr. George Mukhari Academic Hospital, South Africa

International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021

Background: The study was conducted to assess the type and frequency of isolation of different mi... more Background: The study was conducted to assess the type and frequency of isolation of different microorganisms in uncomplicated chronic suppurative otitis media (CSOM) and their antibiotic sensitivity in our institution.Methods: A total of 88 consecutive patients with unilateral or bilateral active, chronic suppurative otitis media attending outpatient department at DGMAH were included in the study after obtaining an informed consent. There were 55 males (62.5%) and 33 females (37.9%) with age range between 6 months and 76 years. Pus swabs were taken through the perforation site and from the promontory after ear mopping under direct vision. Results: Children less than 5 years were more affected (23.9%) than older children 5-10 years (13.6%) and 11-15 years (11.45%). One hundred and six microorganisms were isolated from analysis of cultures obtained from 72 patients. Seven cultures were negative (5.9%), 8 specimens were contaminated (6.7%) and 1 specimen was lost (1.1%). Pseudomonas ...

Research paper thumbnail of The prevalence and impact of otitis media with effusion in children admitted for adeno-tonsillectomy at Dr George Mukhari Academic Hospital, Pretoria, South Africa

International Journal of Pediatric Otorhinolaryngology, 2018

Introduction: Otitis media with effusion (OME) is a leading cause of acquired hearing loss in chi... more Introduction: Otitis media with effusion (OME) is a leading cause of acquired hearing loss in children worldwide. However, previous South African studies have consistently reported the local paediatric OME prevalence to be lower than typically published in international literature. Furthermore, no South African studies have investigated OME in children with adenotonsillar hypertrophy. The objective of this study was to determine the prevalence of OME in children admitted for adeno-tonsillectomy at our institution in Pretoria, South Africa. In addition, the study sought to gauge the impact of OME on quality of life using a validated questionnaire (OM-6). Methods: A cross-sectional, observational study was conducted between July 2015 and May 2016 at the Otorhinolaryngology outpatient department at DGMAH. he study included 109 consecutively sampled children, aged 2-12 years (mean 6.1; 49.7% female). Pneumatic otoscopy and tympanometry were performed on all participants. Adenoid hypertrophy was quantified using he adenoid-nasopharyngeal ratio (ANR) on a lateral post-nasal space radiograph (Fujioka's method). The OM-6 questionnaire was completed for each participant. Pure tone audiometry was performed for participants diagnosed with OME. Results: The prevalence of bilateral OME was 11.9%. For unilateral OME, the prevalence was 22.9% and 16.5%, for the left and right ears, respectively (p > 0.05). The mean hearing loss (SD) was 19.8 dB (9.4). Clinically significant adenoid hypertrophy (ANR ≥ 0.71) was present in 43% of participants. There was no statistically significant (p > 0.05) correlation between the presence OME and adenoid hypertrophy. The mean total OM-6 survey score was 1.67 (SD ± 0.59) in children with OME, and 1.31 (SD ± 0.45) without OME, showing no statistically significant difference (p > 0.05). There was a significant (P < 0.05) correlation between OME and the presence of atopy. Conclusion: Adeno-tonsillar pathology may play an aetio-pathological role in the development of OME. However, this may be due to the presence of biofilms rather than obstructive adenoid hypertrophy, given the lack of a significant (p > 0.05) correlation between adenoid hypertrophy and OME. Whilst OME was not found to impair quality of life in this population group, the validity of the OM-6 in the South African paediatric population requires further investigation.

Research paper thumbnail of Effects of ketamine and salbutamol on histamine- and methacholine-induced contraction of the isolated guinea-pig tracheal chain

Medical Science Research, 1995

Research paper thumbnail of The effects of the natural enzyme, Pectinex Ultra SP-L, on human cell cultures and bacterial biofilms in vitro

BMC microbiology, 2014

Pectinex Ultra SP-L (Pectinex) is a microbial-derived enzyme that is used in the food industry an... more Pectinex Ultra SP-L (Pectinex) is a microbial-derived enzyme that is used in the food industry and that has been shown to inhibit bacterial biofilms. It has been suggested that Pectinex may be useful in the management of biofilm-related bacterial infections and therefore warrants further investigation in this regard. The aim of this study was to investigate the cytotoxicity of Pectinex on cervical adenocarcinoma cells (HeLa), lymphocytes and neutrophils. Cell viability and morphology were assessed using an in vitro spectrophotometric MTT (3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide) assay and polarization-optical transmitted light differential interference contrast microscopy. This study also investigated the antibacterial and antibiofilm actions of Pectinex, alone and in combination with antibiotics, on standard and clinical cultures of Staphylococcus aureus and Pseudomonas aeruginosa. Minimum inhibitory (MIC) and bactericidal (MBC) concentrations were determine...

Research paper thumbnail of Microbiology of acute complicated bacterial sinusitis at the University of the Witwatersrand

South African Medical Journal, 2010

The microbiology of bacterial sinusitis has been studied extensively. The most common pathogens c... more The microbiology of bacterial sinusitis has been studied extensively. The most common pathogens cited are aerobes and facultative anaerobes that include Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, Klebsiella pneumoniae, Pseudomonas aeruginosa and S. milleri. 1-9 Anaerobic organisms, isolated from as many as one-third of patients, include Propionibacterium acnes and Peptostreptococcus, Prevotella, Enterobacter, Bacteroides and Fusobacterium species. 9,10 Despite the abundance of published studies there are very few that report on the microbiology of acute complicated sinusitis. 3-8,11,12 Complicated sinusitis is associated with debilitating and potentially life-threatening orbital, intracranial, bone and soft-tissue complications; its treatment is both a medical and a surgical emergency. 3,5,6,11,13,14 At the University of the Witwatersrand, patients with complicated sinusitis are referred to the Department of Otorhinolaryngology where they usually present with any combination of sinus involvement (maxillary, ethmoid, frontal and sphenoid) and one or more associated complications. 3,5,6,11,13,14 A routine clinical assessment and computed tomography scan diagnosis is made before any surgery. Prompt medical treatment, with or without surgery, is then commenced. This entails initial empirical use of antibiotics