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Chen Y, Liu B, Chen H, Xie P, Du C, Rui S, Mei H, Duan Z, Armstrong DG, Deng W, Xiao X. Comparison of bacterial species and clinical outcomes in patients with diabetic hand infection in tropical and nontropical regions. Arch Dermatol Res 2024; 316:144. [PMID: 38695894 DOI: 10.1007/s00403-024-02856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/08/2024] [Accepted: 04/07/2024] [Indexed: 05/14/2024]
Abstract
Hand infection is a rare complication in patients with diabetes. Its clinical outcomes depend on the severity of hand infection caused by bacteria, but the difference in bacterial species in the regional disparity is unknown. The purpose of this study was to explore the influence of tropical and nontropical regions on bacterial species and clinical outcomes for diabetic hand. A systematic literature review was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Moreover, the bacterial species and clinical outcomes were analyzed with respect to multicenter wound care in China (nontropical regions). Both mixed bacteria (31.2% vs. 16.6%, p = 0.014) and fungi (7.5% vs. 0.8%, p = 0.017) in the nontropical region were significantly more prevalent than those in the tropical region. Staphylococcus and Streptococcus spp. were dominant in gram-positive bacteria, and Klebsiella, Escherichia coli, Proteus and Pseudomonas in gram-negative bacteria occupied the next majority in the two regions. The rate of surgical treatment in the patients was 31.2% in the nontropical region, which was significantly higher than the 11.4% in the tropical region (p = 0.001). Although the overall mortality was not significantly different, there was a tendency to be increased in tropical regions (6.3%) compared with nontropical regions (0.9%). However, amputation (32.9% vs. 31.3%, p = 0.762) and disability (6.3% vs. 12.2%, p = 0.138) were not significantly different between the two regions. Similar numbers of cases were reported, and the most common bacteria were similar in tropical and nontropical regions in patients with diabetic hand. There were more species of bacteria in the nontropical region, and their distribution was basically similar, except for fungi, which had differences between the two regions. The present study also showed that surgical treatment and mortality were inversely correlated because delays in debridement and surgery can deteriorate deep infections, eventually leading to amputation and even death.
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Affiliation(s)
- Yan Chen
- The Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Bin Liu
- Department of Emergency, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Huan Chen
- Geriatric Medical Center, Bazhong City Central Hospital, Bazhong, 636600, China
| | - Puguang Xie
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Chenzhen Du
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Shunli Rui
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Hao Mei
- Center for Applied Statistics, School of Statistics, Renmin University of China, Beijing, 100872, China
| | - Zixiao Duan
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
| | - Wuquan Deng
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China.
| | - Xiaoqiu Xiao
- The Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
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Chen Y, Liu B, Huan C, Xie P, Du C, Rui S, Hao M, Duan Z, Armstrong DG, Deng W, Xiao X. Comparison of bacterial species and clinical outcomes in patients with diabetic hand infection in tropical and nontropical regions. RESEARCH SQUARE 2024:rs.3.rs-3831828. [PMID: 38260272 PMCID: PMC10802731 DOI: 10.21203/rs.3.rs-3831828/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Purpose Hand infection is a rare complication in patients with diabetes. Its clinical outcomes depend on the severity of hand infection caused by bacteria, but the difference in bacterial species in the regional disparity is unknown. The purpose of this study was to explore the influence of tropical and nontropical regions on bacterial species and clinical outcomes for diabetic hand. Patients and Methods A systematic literature review was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Moreover, the bacterial species and clinical outcomes were analyzed with respect to multicenter wound care in China (nontropical regions). Results Both mixed bacteria (31.2% vs. 16.6%, p=0.014) and fungi (7.5% vs. 0.8%, p=0.017) in the nontropical region were significantly more prevalent than those in the tropical region. Staphylococcus and Streptococcus spp. were dominant in gram-positive bacteria, and Klebsiella, Escherichia coli, Proteus and Pseudomonas in gram-negative bacteria occupied the next majority in the two regions. The rate of surgical treatment in the patients was 31.2% in the nontropical region, which was significantly higher than the 11.4% in the tropical region (p=0.001). Although the overall mortality was not significantly different, there was a tendency to be increased in tropical regions (6.3%) compared with nontropical regions (0.9%). However, amputation (32.9% vs. 31.3%, p=0.762) and disability (6.3% vs. 12.2%, p=0.138) were not significantly differentbetween the two regions. Conclusion Similar numbers of cases were reported, and the most common bacteria were similar in tropical and nontropical regions in patients with diabetic hand. There were more species of bacteria in the nontropical region, and their distribution was basically similar, except for fungi, which had differences between the two regions. The present study also showed that surgical treatment and mortality were inversely correlated because delays in debridement and surgery can deteriorate deep infections, eventually leading to amputation and even death.
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Affiliation(s)
- Yan Chen
- the First Affiliated Hospital of Chongqing Medical University
| | - Bin Liu
- Chongqing University Central Hospital
| | | | | | | | | | | | | | | | | | - Xiaoqiu Xiao
- the First Affiliated Hospital of Chongqing Medical University
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Varela K, Brown JA, Lipton B, Dunn J, Stanek D, Behravesh CB, Chapman H, Conger TH, Vanover T, Edling T, Holzbauer S, Lennox AM, Lindquist S, Loerzel S, Mehlenbacher S, Mitchell M, Murphy M, Olsen CW, Yager CM. A Review of Zoonotic Disease Threats to Pet Owners: A Compendium of Measures to Prevent Zoonotic Diseases Associated with Non-Traditional Pets: Rodents and Other Small Mammals, Reptiles, Amphibians, Backyard Poultry, and Other Selected Animals. Vector Borne Zoonotic Dis 2022; 22:303-360. [PMID: 35724316 PMCID: PMC9248330 DOI: 10.1089/vbz.2022.0022] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Kate Varela
- One Health Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer A. Brown
- National Association of State Public Health Veterinarians
- Indiana Department of Health
| | - Beth Lipton
- National Association of State Public Health Veterinarians
- Seattle & King County Public Health
| | - John Dunn
- National Association of State Public Health Veterinarians
- Tennessee Department of Health
| | - Danielle Stanek
- National Association of State Public Health Veterinarians
- Florida Department of Health
| | | | - Helena Chapman
- Division of Infectious Diseases and Global Medicine, University of Florida College of Medicine
- American Association for the Advancement of Science at NASA Applied Sciences
| | - Terry H. Conger
- U.S. Department of Agriculture Animal (USDA) and Plant Health Inspection Service (APHIS) Veterinary Services
| | | | | | - Stacy Holzbauer
- Minnesota Department of Health
- CDC Preparedness and Response Career Epidemiology Field Officer Program
| | | | | | | | | | - Mark Mitchell
- Louisiana State University School of Veterinary Medicine, Veterinary Clinical Sciences
| | - Michael Murphy
- Food and Drug Administration Center for Veterinary Medicine
| | - Christopher W. Olsen
- AVMA Council on Public Health
- Department of Pathobiological Sciences, University of Wisconsin-Madison School of Veterinary Medicine
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Lautenbach M, Tenbrock A, Bock M, Millrose M, Kim S, Eisenschenk A. [Osteitis/Osteomyelitis of the Hand and Wrist]. HANDCHIR MIKROCHIR P 2021; 53:282-289. [PMID: 34134160 DOI: 10.1055/a-1394-6332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Osteomyelitis of the hand and wrist is uncommon compared to the infections of the long bones but not rare. There is poor evidence on many answers to questions concerning this disease. This includes careful consideration of the prevalence, pathogenesis, microbiology, diagnostic methods and the conservative, medical and surgical treatment. The emergence of the disease can subdivided in post-traumatic, postoperative, spread from contiguous infections and hematogenous. The individual patient-specific risk must be considered. Early diagnosis and correct management are essential to preserve bony structures and the articular function of the hand. A two-step surgical procedure is usually necessary, but uncertainties about the optimal treatment are still existing. Satisfactory control rates of the infection and successful bone reconstructions can be achieved. But complications, a limited range of motion and amputations of finger parts can still not be avoided in all cases.
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Affiliation(s)
- Martin Lautenbach
- Krankenhaus Waldfriede Berlin; Abteilung Handchirurgie, obere Extremität und Fußchirurgie, Zentrum für Orthopädie und Unfallchirurgie, Rheumaorthopädie
| | - Arne Tenbrock
- Krankenhaus Waldfriede Berlin; Abteilung Handchirurgie, obere Extremität und Fußchirurgie, Zentrum für Orthopädie und Unfallchirurgie, Rheumaorthopädie
| | - Markus Bock
- Krankenhaus Waldfriede Berlin; Abteilung Handchirurgie, obere Extremität und Fußchirurgie, Zentrum für Orthopädie und Unfallchirurgie, Rheumaorthopädie
| | - Michael Millrose
- BG Unfallklinik Murnau; Abteilung für Unfallchirurgie und Sporttraumatologie
| | - Simon Kim
- Ernst-Moritz-Arndt Universitat Greifswald; Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin
| | - Andreas Eisenschenk
- Unfallkrankenhaus Berlin; Abteilung für Hand-, Replantations- und Mikrochirurgie
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Minato S, Sukegawa K, Onuma K, Otake Y, Iida R, Takaso M. Polymicrobial Extensor Tenosynovitis Including Mycobacterium chelonae Caused by a Dog Bite: A Case Report. JBJS Case Connect 2021; 11:e20.00608. [PMID: 33543870 DOI: 10.2106/jbjs.cc.20.00608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A nonimmunocompromised 77-year-old man was bitten in the hand by his dog; redness, swelling, and exudate developed. Despite debridement and medications administered at another hospital, his symptoms did not improve. He was referred to us after 3 months. Debridement and negative-pressure wound therapy was performed. Cultures were positive for multiple bacterial organisms, including Mycobacterium chelonae. Polymicrobial extensor tenosynovitis including M. chelonae was diagnosed. Clarithromycin was given for 7 months based on drug sensitivity. His symptoms did not recur. CONCLUSION Mycobacterium chelonae infections after dog bites are rare; however, mycobacterial culture tests are important, especially if tissue shows granulomatous inflammation.
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Affiliation(s)
- Sayoko Minato
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara-shi, Kanagawa, Japan
| | - Koji Sukegawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara-shi, Kanagawa, Japan
| | - Kenji Onuma
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara-shi, Kanagawa, Japan
| | - Yuya Otake
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara-shi, Kanagawa, Japan
| | - Riyo Iida
- Kitasato University Hospital, Clinical Training Center, Sagamihara-shi, Kanagawa, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara-shi, Kanagawa, Japan
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Lowell DL, Jean-Claude JM, Fuchs L. Infectious Tenosynovitis of the Tibialis Anterior Due to Mycobacterium chelonae After Intravenous Heroin Injection. J Foot Ankle Surg 2021; 59:413-417. [PMID: 32131013 DOI: 10.1053/j.jfas.2019.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/03/2019] [Accepted: 08/18/2019] [Indexed: 02/03/2023]
Abstract
Mycobacterium chelonae is a ubiquitous Gram-positive, acid-fast, non-spore-forming bacterium commonly encountered in nature associated with aquatic animals, soil, and water, including tap water. Nontuberculous mycobacterial tenosynovitis infections caused by M. chelonae in the lower extremity are uncommon, leading to a paucity of literature documenting the diagnosis and treatment of such cases. This report is of a 65-year-old male patient who was found to have an M. chelonae infection along the tibialis anterior tendon after injecting himself with heroin into the dorsal foot veins. This review covers the diagnosis and treatment as well as a case report on the outcome of infectious tenosynovitis of the tibialis anterior associated with M. chelonae. To date, this is the only reported case of tibialis anterior infectious tenosynovitis caused by M. chelonae after intravenous heroin injection.
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Affiliation(s)
- Danae L Lowell
- Program Director, Cleveland VA Podiatric Medicine and Surgery Residency, Reconstructive Rearfoot/Ankle Surgery, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH.
| | - Jessie M Jean-Claude
- Chief of Surgery, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Lisa Fuchs
- Postgraduate Year 3, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
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Abstract
Mycobacterial hand infections are uncommon. These infections have an indolent course and are marked by variable and nonspecific presentations, often leading to diagnostic and treatment delays. The pathogens involved in mycobacterial hand infections include Mycobacterium tuberculosis complex, atypical mycobacteria, and M leprae. Initial treatment involves a combination of long-term antibiotics and surgical débridement to cure the infection. Reconstructive procedures aid in restoring hand function lost secondary to the disease.
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Affiliation(s)
- Abdo Bachoura
- The Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107, USA
| | - David S Zelouf
- The Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107, USA.
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Watch Out for Wild Animals: A Systematic Review of Upper Extremity Injuries Caused by Uncommon Species. Plast Reconstr Surg 2017; 140:1008-1022. [PMID: 29068939 DOI: 10.1097/prs.0000000000003754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Across the world, many species of nondomesticated animals dwell among humans in metropolitan areas. Rare animal bites pose a dilemma for hand surgeons, as they often result in operative injuries and recalcitrant infections. The authors treated an 85-year-old man who experienced severe cellulitis of the index finger following an opossum bite. This case prompted a systematic review of upper extremity injuries caused by species other than dogs, cats, snakes, and insects. METHODS The authors conducted a systematic review of PubMed and Scopus databases to identify relevant articles published between 1980 and 2016. Two reviewers critically appraised the studies that met inclusion and exclusion criteria. RESULTS The hand infection in the man who sustained an opossum bite at the authors' institution was successfully treated with targeted antibiotic therapy, hand elevation, and splinting. Seventy-one articles met inclusion criteria for and were included in this systematic review. The vast majority of existing articles represent level IV and level V evidence. The relevant literature suggests that the majority of hand infections attributable to animal bites and stings are polymicrobial. CONCLUSIONS Injuries secondary to aquatic animals appear to be the most frequently described in the literature, and hot water immersion should be used for the majority of envenomation attributable to aquatic species. Infections can often be treated with an aminopenicillin antibiotic combined with a beta-lactamase inhibitor. Given the variability in presentation and potential for sequelae such as soft-tissue necrosis and systemic reactions, hand surgeons should approach such upper extremity injuries with a high degree of caution.
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Gherman-Ciolac C, Patel A, Budha S, Macve J, Buch H. A Case of Disseminated Sepsis Caused by an Unusual Microorganism in a Patient With Diabetes. Clin Diabetes 2017; 35:112-115. [PMID: 28442828 PMCID: PMC5391810 DOI: 10.2337/cd16-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | | | - Joanna Macve
- Microbiology, New Cross Hospital, Wolverhampton, West Midlands, UK
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Bezos J, Álvarez-Carrión B, Rodríguez-Bertos A, Fernández-Manzano Á, de Juan L, Huguet C, Briones V, Romero B. Evidence of disseminated infection by Mycobacterium avium subspecies hominissuis in a pet ferret (Mustela putorius furo). Res Vet Sci 2016; 109:52-55. [DOI: 10.1016/j.rvsc.2016.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/31/2016] [Accepted: 09/16/2016] [Indexed: 01/19/2023]
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Mentré V, Bulliot C. A Retrospective Study of 17 Cases of Mycobacteriosis in Domestic Ferrets ( Mustela Putorius furo) between 2005 and 2013. J Exot Pet Med 2015; 24:340-349. [PMID: 32288684 PMCID: PMC7106324 DOI: 10.1053/j.jepm.2015.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
From 2005 to 2013, 17 ferrets were diagnosed with mycobacteriosis at the authors’ practices. Clinical findings included ocular, respiratory, and digestive abnormalities. Diagnosis was based on histopathology, specific histochemical stains, and/or on polymerase chain reaction. All bacteria identified belonged to the nontuberculous Mycobacterium complex. Several treatment protocols were attempted, frequently based on the use of enrofloxacin. In all, 3 ferrets were considered cured. Mycobacteriosis in ferrets is a polymorphous disease with diverse clinical presentations. It is also likely an underdiagnosed disease in pet ferrets, which appear to be particularly susceptible to environmental sources. Mycobacteriosis should be included in the differential diagnosis for ocular, respiratory, and gastrointestinal diseases; in particular, it should be differentiated from systemic coronavirus infection.
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Affiliation(s)
- Véronique Mentré
- Clinique Vétérinaire de la Patte d'Oie, Montigny les Cormeilles, France
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12
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Bi S, Hu FS, Yu HY, Xu KJ, Zheng BW, Ji ZK, Li JJ, Deng M, Hu HY, Sheng JF. Nontuberculous mycobacterial osteomyelitis. Infect Dis (Lond) 2015; 47:673-85. [PMID: 25915177 PMCID: PMC4714132 DOI: 10.3109/23744235.2015.1040445] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/29/2015] [Indexed: 11/15/2022] Open
Abstract
Osteomyelitis caused by nontuberculous mycobacteria (NTM) can have severe consequences and a poor prognosis. Physicians therefore need to be alert to this condition, especially in immunocompromised patients. Although the pathogenesis of NTM osteomyelitis is still unclear, studies in immunodeficient individuals have revealed close relationships between NTM osteomyelitis and defects associated with the interleukin-12-interferon-γ-tumor necrosis factor-α axis, as well as human immunodeficiency virus infection, various immunosuppressive conditions, and diabetes mellitus. Culture and species identification from tissue biopsies or surgical debridement tissue play crucial roles in diagnosing NTM osteomyelitis. Suitable imaging examinations are also important. Adequate surgical debridement and the choice of appropriate, combined antibiotics for long-term anti-mycobacterial chemotherapy, based on in vitro drug susceptibility tests, are the main therapies for these bone infections. Bacillus Calmette-Guerin vaccination might have limited prophylactic value. The use of multiple drugs and long duration of treatment mean that the therapeutic process needs to be monitored closely to detect potential side effects. Adequate duration of anti-mycobacterial chemotherapy together with regular monitoring with blood and imaging tests are key factors determining the recovery outcome in patients with NTM osteomyelitis.
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Affiliation(s)
- Sheng Bi
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Fei-Shu Hu
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Hai-Ying Yu
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Kai-Jin Xu
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Bei-Wen Zheng
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Zhong-Kang Ji
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jun-Jie Li
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Mei Deng
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Hai-Yang Hu
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Ji-Fang Sheng
- From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou, China
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13
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Wang ML, Vosbikian MM, Abboudi J, Beredjiklian PK. Treatment of a Chronic Multidrug-Resistant Cutaneous Mycobacterium chelonae Infection of the Hand with Wide Debridement and Skin-Grafting: A Case Report. JBJS Case Connect 2014; 4:e102. [PMID: 29252770 DOI: 10.2106/jbjs.cc.n.00067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE We present a case of a healthy thirty-seven-year-old woman with a chronic cutaneous Mycobacterium chelonae infection of the hand recalcitrant to antibiotics and excisional biopsies. She was treated with wide excision of the lesion and staged full-thickness skin-grafting. At the sixth-month follow-up, she reported no activity limitations and demonstrated full painless digital motion without evidence of recurrent infection. CONCLUSION The technique presented offers the advantage of early digital range of motion with temporary soft-tissue coverage prior to definitive coverage with a full-thickness skin graft while laboratory analysis is performed.
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Affiliation(s)
- Mark L Wang
- Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107
| | - Michael M Vosbikian
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, 1025 Walnut Street, Room 516 College, Philadelphia, PA 19107.
| | - Jack Abboudi
- Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107
| | - Pedro K Beredjiklian
- Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107
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14
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Pengas IP, Assiotis A, Kokkinakis M, Khan WS, Meyers P, Arbuthnot J, Mcnicholas MJ. Knee Osteochondritis Dissecans Treated by the AO Hook Fixation System: A Four Year Follow-Up of an Alternative Technique. Open Orthop J 2014; 8:209-14. [PMID: 25067976 PMCID: PMC4110397 DOI: 10.2174/1874325001408010209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 03/09/2014] [Accepted: 03/11/2014] [Indexed: 11/22/2022] Open
Abstract
Surgical fixation is recommended for stable osteochondritis dissecans (OCD) lesions that have failed nonoperative management and for all unstable lesions. In this study we set out to describe and evaluate an alternative method of surgical fixation for such lesions. Five knees with unstable OCD lesions in four male adolescent patients with open physes were treated with the AO Hook Fixation System. The outcome was evaluated both clinically and with three separate outcome systems (IKDC 2000, KOOS, Lysholm) at one and a mean four year follow-up. We demonstrated excellent clinical results in all patients. At four years, all scoring systems demonstrated statistically significant improvement when compared to the preoperative status. Our study suggests that the AO Hook Fixation System is an alternative method of surgical intervention with comparable medium term results with other existing modes of fixation and the added biomechanical advantage of the absence of distracting forces during hardware removal.
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Affiliation(s)
- Ioannis P Pengas
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK ; Department of Orthopaedics and Trauma Surgery, Warrington Hospital, Lovely Lane, Cheshire, WA5 1QG, UK
| | - Angelos Assiotis
- Department of Orthopaedics and Trauma Surgery, Central Middlesex Hospital, Acton Lane, London, NW10 7NS, UK
| | - Michail Kokkinakis
- Department of Orthopaedics and Trauma Surgery, Evelina Childrens Hospital, Guy's & St Thomas Hospital NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Wasim S Khan
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - Paul Meyers
- Department of Orthopaedics and Trauma Surgery, Warrington Hospital, Lovely Lane, Cheshire, WA5 1QG, UK
| | - James Arbuthnot
- Department of Orthopaedics and Trauma Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Michael J Mcnicholas
- Department of Orthopaedics and Trauma Surgery, Aintree University Hospital, Liverpool, Merseyside L9 7AL, UK
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Raval P, Khan W, Haddad B, Mahapatra AN. Bite injuries to the hand - review of the literature. Open Orthop J 2014; 8:204-8. [PMID: 25097675 PMCID: PMC4112338 DOI: 10.2174/1874325001408010204] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 04/05/2014] [Accepted: 04/10/2014] [Indexed: 11/22/2022] Open
Abstract
Patients presenting to the emergency department with bite injuries to the hand sustain them through a number of causes including domesticated as well as stray animal bites, and human bites commonly sustained as a result of violence. The nature of the injuries sustained can be very deceptive. A small tooth mark on the exterior can be a fulminant infection in the tissues deeper down. Tendon injuries, fractures of the metacarpals and phalanges and management of the wound are critical issues faced by a surgeon in dealing with such patients. Similarly the less common bite injuries to the hand, often with disastrous and sometimes fatal complications, do also present to the emergency department. A high incidence of suspicion is needed in dealing with these injuries effectively. In our article we discuss the common as well as uncommon causes of bite injuries to the hand and their management. In addition to reviewing the literature to ascertain the management of such injuries, we also discuss interesting and rare case reports.
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Affiliation(s)
- Pradyumna Raval
- Department of Orthopaedic Surgery, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Wasim Khan
- University College London Institute of Orthopaedics & Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Behrooz Haddad
- University College London Institute of Orthopaedics & Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, UK
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16
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Walsh TL, Baca V, Stalling SS, Natalie AA, Veldkamp PJ. Mycobacterium avium-intracellulare pulmonary infection complicated by cutaneous leukocytoclastic vasculitis in a woman with anorexia nervosa. Infection 2013; 42:559-63. [PMID: 24363210 DOI: 10.1007/s15010-013-0574-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 12/13/2013] [Indexed: 11/29/2022]
Abstract
A 53-year-old Caucasian woman with a history of anorexia nervosa developed a bilateral lower extremity rash comprised of palpable red to violaceous, sub-centimeter papular lesions that increased in quantity rapidly. She also noted a 2-month history of non-productive cough. Imaging modalities revealed a thin-walled cavitary lesion in the right lung apex and scattered nodular opacities. Acid fast bacilli (AFB) were found in sputum and subsequently identified by culture as Mycobacterium avium-intracellulare (MAI). Punch biopsies of her skin lesions yielded a histological diagnosis of small-to-medium vessel vasculitis. Stains and cultures for organisms were negative. Her skin lesions resolved quickly after the initiation of antimicrobial therapy for MAI. Hypersensitivity vasculitis associated with an atypical mycobacterial infection is unusual. The postulated underlying mechanism is the deposit of immune complexes and not the bacillus itself. While cutaneous leukocytoclastic vasculitis (CLV) due to MAI is certainly a rare entity, it should be entertained in patients with vasculitic skin lesions and a concomitant pulmonary disease.
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Affiliation(s)
- T L Walsh
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Falk Medical Building, Suite 3A, 3601 Fifth Avenue, Pittsburgh, PA, 15213, USA,
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17
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Nukui Y, Nakamura H, Ishioka H, Miyamoto H, Okamoto A, Kazumi Y, Yotsuyanagi H, Moriya K, Hatakeyama S. Synovitis of the wrist caused by Mycobacterium florentinum. Infection 2013; 42:437-40. [PMID: 24264693 DOI: 10.1007/s15010-013-0561-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022]
Abstract
Mycobacterium florentinum is a newly identified, rare, slow-growing species of nontuberculous mycobacteria (NTM). Here, we report a case of M. florentinum-induced synovitis of the wrist in an immunocompromised Japanese patient. M. florentinum was identified by sequence analysis of the rpoB, hsp65, and 16S rRNA genes. The M. florentinum strain in this study could not be differentiated from certain M. triplex strains by the hsp65 or 16S rRNA sequences alone, because they occasionally shared more than 99 % sequence identity. The isolated M. florentinum strain was only susceptible to clarithromycin and amikacin. Initially, the patient was treated with clarithromycin, levofloxacin, and ethambutol, and then with clarithromycin, levofloxacin, and rifampicin. To our knowledge, M. florentinum-induced synovitis has not been previously reported. Our results suggest that, in addition to other well-known pathogenic NTM, the recently identified M. florentinum strain should be considered as a possible cause of synovitis. Moreover, we should be cautious when identifying M. florentinum because this strain closely resembles M. triplex in genotype.
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Affiliation(s)
- Y Nukui
- Department of Infection Control and Prevention, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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18
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Hsiao CH, Cheng A, Huang YT, Liao CH, Hsueh PR. Clinical and pathological characteristics of mycobacterial tenosynovitis and arthritis. Infection 2013; 41:457-64. [DOI: 10.1007/s15010-013-0403-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 01/01/2013] [Indexed: 02/02/2023]
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