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Atkinson BS, Sandiford NA. Three Episodes of Presumed Culture-Negative Septic Arthritis Following Intramuscular Antipsychotic Injections: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00080. [PMID: 37708327 DOI: 10.2106/jbjs.cc.23.00098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
CASE We present a male patient of low socioeconomic status and Māori ethnicity who experienced 3 episodes of presumed culture-negative septic arthritis of the native hip between ages 43 and 52 years. Each episode occurred within 3 weeks of intramuscular antipsychotic injection into the ipsilateral gluteal muscles. The right hip was involved in 2 presentations and the left hip in 1 presentation. No coexisting infection or underlying immune suppression was identified, and at follow-up 2 years after the last episode, he has no sequelae of septic arthritis. CONCLUSION This report describes 3 episodes of presumed culture-negative septic arthritis after intramuscular antipsychotic injection.
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Affiliation(s)
- Brad S Atkinson
- Orthopaedic Department, Southland Hospital, Invercargill, New Zealand
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2
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Quilling LL, Outerbridge CA, White SD, Affolter VK. Retrospective case series: Necrotising fasciitis in 23 dogs. Vet Dermatol 2022; 33:534-544. [PMID: 36043338 DOI: 10.1111/vde.13113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/12/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Necrotising fasciitis (NF) is a rare, rapidly progressive subcutaneous bacterial infection. Few studies have characterised NF in dogs. HYPOTHESIS/OBJECTIVES To retrospectively describe clinical and laboratory findings, with treatments and outcomes, in dogs with NF. ANIMALS Twenty-three client-owned dogs treated at a veterinary teaching hospital between 1998 and 2021. MATERIALS AND METHODS Medical records and laboratory data from 23 dogs diagnosed with NF were reviewed. RESULTS Male dogs were significantly over-represented (p = 0.003). The most common presenting complaint was sudden lameness. Infection occurred in one or two limbs in 19 of 23 dogs, with right hindlimbs most often affected (13 of 23). Pitting oedema was evident in 14 of 23 dogs. Antibiotic and nonsteroidal anti-inflammatory drugs were administered before presentation in nine and 13 of 23 dogs, respectively. Common clinicopathological abnormalities included hypoalbuminemia, hyponatremia, elevated liver enzymes, elevated creatine kinase, increased bands and lymphopenia. Streptococcus canis was isolated from 18 of 23 dogs. Histopathological features included acute necrosis and severe neutrophilic inflammation. Fifteen dogs were euthanised or died, while surgical intervention led to survival in eight of 23 dogs. CONCLUSIONS AND CLINICAL RELEVANCE Dogs presenting for acute swelling of a limb with oedema should have the diagnosis of NF considered and early surgical intervention might increase survival.
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Affiliation(s)
- Laura L Quilling
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Catherine A Outerbridge
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Stephen D White
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Verena K Affolter
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, California, USA
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3
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Huang J, Xu Q, Liu F, Xiong H, Yang J. Enterobacter cloacae infection of the shoulder in a 52-year-old woman without apparent predisposing risk factor: a case report and literature review. BMC Infect Dis 2021; 21:13. [PMID: 33407223 PMCID: PMC7789740 DOI: 10.1186/s12879-020-05699-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/09/2020] [Indexed: 01/22/2023] Open
Abstract
Background Enterobacter cloacae (E. cloacae) is one of the commensal flora in the human intestinal tract and a prevalent nosocomial pathogen, which rarely causes infectious osteoarthritis in immunocompetent patients without recent trauma or surgery. Here, we report the first case of septic monoarthritis of the shoulder caused by E. cloacae in an immunocompetent patient. Case presentation A 52-year-old female with a 6-year history of right shoulder pain was referred to our emergency department due to fever, acute severe shoulder pain, and swelling. Blood test showed elevated inflammatory markers. The patient denied any recent invasive surgical procedure and trauma. She was misdiagnosed with a frozen shoulder, and the anti-inflammatory painkiller celecoxib for symptomatic treatment was ineffective. Magnetic resonance imaging (MRI) showed a shoulder joint abscess and supraspinatus tendon tear. The joint aspirate culture showed E. cloacae. After late diagnosis, she was treated with levofloxacin and underwent surgical debridement and irrigation. Her follow-up data revealed that she did not suffer from shoulder swelling and severe pain. Conclusion This is a rare case of E. cloacae infected arthritis of the shoulder in an immunocompetent patient with a rotator cuff tear, indicating that even if the symptoms and age of the patients match the characteristics of frozen shoulder, the possibility of septic arthritis should be considered in the presence of fever and increasing inflammatory markers. The cases of our literature review suggest that the patients subjected to invasive procedure may develop a subsequent E. cloacae osteoarticular infection, regardless of being asymptomatic after the procedure.
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Affiliation(s)
- Jingjie Huang
- The Sixth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China.,Department of Orthopedics, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Qiliang Xu
- Department of Orthopedics, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Fuyifei Liu
- Department of Orthopedics, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Hao Xiong
- Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junxing Yang
- Department of Orthopedics, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China.
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Chae MK, Shin SY, Kwak MS, Yoon JY, Kim HI, Cha JM. Fatal Necrotizing Fasciitis Following Uncomplicated Colonoscopic Polypectomy: A Case Report. Clin Endosc 2020; 54:280-284. [PMID: 33302329 PMCID: PMC8039750 DOI: 10.5946/ce.2020.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/09/2020] [Indexed: 11/18/2022] Open
Abstract
Necrotizing fasciitis (NF) is a life-threatening infection that can be caused by various procedures or surgery and may develop in healthy elderly patients. Here, we report a case of a 66-year-old man with diabetes mellitus who underwent colonoscopic polypectomy, without complications. However, he visited the emergency department 24 hours after the procedure complaining of abdominal pain. Abdominopelvic computed tomography revealed multiple air bubbles in the right lateral abdominal muscles. After a diagnosis of NF was made, immediate surgical debridement was performed. However, despite three sessions of extensive surgical debridement and best supportive care at the intensive care unit, the patient died because of sepsis and NF-associated multiple-organ failure. In conclusion, physicians should pay special attention to the possibility of NF if a patient with risk factors for NF develops sepsis after colonoscopic polypectomy.
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Affiliation(s)
- Min Kyu Chae
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang Youn Shin
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ha Il Kim
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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5
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Dincer D, Tanacan E, Cakir Akay GA, Atac GK, Evrin T. Localized
infection and leg ulcer after platelet‐rich plasma injection. Dermatol Ther 2020; 33:e13948. [DOI: 10.1111/dth.13948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Didem Dincer
- Medical Faculty, Department of Dermatology and Veneorology Ufuk University Ankara Turkey
| | - Efsun Tanacan
- Medical Faculty, Department of Dermatology and Veneorology Ufuk University Ankara Turkey
| | - Gul Aslihan Cakir Akay
- Medical Faculty, Department of Dermatology and Veneorology Ufuk University Ankara Turkey
| | - Gokce Kaan Atac
- Medical Faculty, Department of Radiology Ufuk University Ankara Turkey
| | - Togay Evrin
- Medical Faculty, Department of Emergency Medicine Ufuk University Ankara Turkey
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6
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Davis KL, Gonzalez O, Kumar S, Dick EJ. Pathology Associated With Streptococcus spp. Infection in Baboons ( Papio spp.). Vet Pathol 2020; 57:714-722. [PMID: 32744146 DOI: 10.1177/0300985820941496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Streptococcus spp. are a source of morbidity and mortality in captive nonhuman primate populations. However, little is known about the lesions associated with naturally occurring streptococcal infections in baboons (Papio spp.). The pathology database of the Southwest National Primate Research Center was searched for all baboon autopsies from 1988 to 2018 in which Streptococcus spp. were cultured. Baboons on experimental protocol were excluded. The gross autopsy and histopathology reports were reviewed. Archived specimens were retrieved and reviewed as needed for confirmation or clarification. Fifty-six cultures were positive for Streptococcus spp. in 54 baboons with evidence of bacterial infection. Associated gross lesions included purulent exudate, fibrinous to fibrous adhesions, hemorrhage, mucosal thickening, organomegaly, and abscessation. Histologic lesions included suppurative inflammation, abscessation, necrosis, hemorrhage, fibrin accumulation, and thrombosis. Lungs and pleura (n = 31) were the most commonly infected organ followed by the central nervous system (n = 16), spleen (n = 15), soft tissues (n = 12), air sacs, liver, peritoneum, adrenal glands, heart, lymph nodes, uterus, kidneys, biliary system, bones, ears, umbilical structures, mammary glands, pancreas, placenta, and salivary glands. Infections by non-β-hemolytic Streptococcus spp. predominated in the lungs and air sacs; the most common isolate was Streptococcus pneumoniae. Infections by β-hemolytic Streptococcus spp. predominated in the soft tissues and reproductive tract. Naturally occurring β-hemolytic and non-β-hemolytic Streptococcus spp. infections cause morbidity and mortality in captive baboon populations. The lesions associated with streptococcal infection are similar to those reported in human infection. Thus, the baboon may represent an underutilized model for studying Streptococcus spp. as pathogens.
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Affiliation(s)
- Katelin L Davis
- 311308Purdue University, West Lafayette, IN, USA.,National Cancer Institute, Bethesda, MD, USA
| | - Olga Gonzalez
- Southwest National Primate Research Center, San Antonio, TX, USA
| | - Shyamesh Kumar
- Southwest National Primate Research Center, San Antonio, TX, USA
| | - Edward J Dick
- Southwest National Primate Research Center, San Antonio, TX, USA
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Hovmand N, Byberg S, Larsen MB, Podlekareva D, Buck DL, Hansen BR. Necrotizing fasciitis and meningitis due to Streptococcus pneumoniae serotype 9 N: a case report. BMC Infect Dis 2019; 19:358. [PMID: 31035964 PMCID: PMC6489194 DOI: 10.1186/s12879-019-3969-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022] Open
Abstract
Background Necrotizing fasciitis is a deep infection of the fascia and subcutaneous tissue with a high mortality rate. Meningitis is an infection of the membranes surrounding the brain with a likewise high mortality rate. Streptococcus pneumoniae is the most frequent cause of bacterial meningitis and it is an extremely rare cause of necrotizing fasciitis. Different subcapsular serotypes of S. pneumoniae are known to have diverse virulence. The serotype 9 N is associated with a high risk of death. Case presentation We report a case of a previously healthy 68-year-old female who presented at our clinic with complaints of pain in her left calf since having experienced a very painful leg cramp 3 weeks prior. Within a few hours after admission, she developed fever, neck stiffness and an altered mental state. Concurrently, the pain in her leg worsened. Upon further examination it was found that she suffered from both meningitis and necrotizing fasciitis due to S. pneumoniae, serotype 9 N. The patient survived and avoided leg amputation. Conclusions The patient suffered from two very lethal infections simultaneously. Both of them were caused by S. pneumoniae. We believe that her favorable outcome was, a result of prompt surgical intervention and appropriate antibiotic treatment. Our case underlines the importance of continuous reevaluation of the symptoms and clinical findings in patients with unclear causes of severe illness, especially if the patient’s condition changes.
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Affiliation(s)
- Nichlas Hovmand
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.
| | - Sarah Byberg
- Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Morten Bo Larsen
- Department of Orthopedics, Copenhagen University Hospital, Hvidovre, Denmark
| | - Daria Podlekareva
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - David Levarett Buck
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Birgitte Rønde Hansen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
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8
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Necrotizing Soft Tissue Fasciitis after Intramuscular Injection. Case Rep Surg 2018; 2018:3945497. [PMID: 29854541 PMCID: PMC5964413 DOI: 10.1155/2018/3945497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/10/2018] [Indexed: 11/24/2022] Open
Abstract
Necrotizing soft tissue fasciitis (NSTIs) or necrotizing fasciitis is an infrequent and serious infection. Herein, we describe the clinical course of a female patient who received a diagnosis of NSTIs after gluteus intramuscular injection. We also report the results of our review of published papers from 1997 to 2017. Since now, 19 cases of NSTIs following intramuscular injections have been described. We focus on the correlation between intramuscular injection and NSTIs onset, especially in immunosuppressed patients treated with corticosteroids, suffering from chronic diseases or drug addicted. Intramuscular injections can provoke severe tissue trauma, representing local portal of infection, even if correctly administrated. Otherwise, it is important not to inject drug in subcutaneous, which is a less vascularized area and therefore more susceptible to infections. Likewise, a proper injecting technique and aspiration prior to injection seem to be valid measure to prevent intra-arterial or para-arterial drug injection with the consequent massive inflammatory reaction. Necrosis at the infection site appears to be independent of the drug, and it is a strong additional risk factor for NSTIs.
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9
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Pocinho RM, Antunes L, Pires P, Baptista I. Multifocal septic arthritis, gluteal abscess and spondylodiscitis by Streptococcus dysgalactiae subspecies equisimilis after an intramuscular injection. BMJ Case Rep 2017; 2017:bcr-2017-220336. [PMID: 28724597 DOI: 10.1136/bcr-2017-220336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 63-year-old man, admitted for hand cellulitis and acute kidney injury. A Streptococcus dysgalactiae subsp equisimilis (SDSE) was isolated in blood cultures and despite directed intravenous antibiotherapy, the patient evolved unfavourably, with dorsolumbar spondylodiscitis, multifocal septic arthritis and abscesses. CT also showed densification of the gluteal muscles, multiple air bubbles in the psoas, paraspinal muscles and spinal canal that were associated with an intramuscular injection administered 1 week earlier for a backache. After escalation of the antibiotherapy and intensive supportive measures, the patient showed improvement and was discharged after 8 weeks of antibiotherapy.The incidence of invasive SDSE infections has been growing, especially in immunosupressed patients. In this case, despite no predisposing factor identified, it evolved to severe sepsis. The intramuscular injection, a trivialised but not harmless procedure, was the assumed port of entry, as previously described in another case report.
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Affiliation(s)
- Rita Marques Pocinho
- Department of Medicina 1.2, Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Liliana Antunes
- Department of Medicina 1.2, Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Pedro Pires
- Department of Medicina 1.2, Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Isabel Baptista
- Department of Medicina 1.2, Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal
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10
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Rudkjøbing VB, Thomsen TR, Xu Y, Melton-Kreft R, Ahmed A, Eickhardt S, Bjarnsholt T, Poulsen SS, Nielsen PH, Earl JP, Ehrlich GD, Moser C. Comparing culture and molecular methods for the identification of microorganisms involved in necrotizing soft tissue infections. BMC Infect Dis 2016; 16:652. [PMID: 27821087 PMCID: PMC5100109 DOI: 10.1186/s12879-016-1976-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/26/2016] [Indexed: 12/26/2022] Open
Abstract
Background Necrotizing soft tissue infections (NSTIs) are a group of infections affecting all soft tissues. NSTI involves necrosis of the afflicted tissue and is potentially life threatening due to major and rapid destruction of tissue, which often leads to septic shock and organ failure. The gold standard for identification of pathogens is culture; however molecular methods for identification of microorganisms may provide a more rapid result and may be able to identify additional microorganisms that are not detected by culture. Methods In this study, tissue samples (n = 20) obtained after debridement of 10 patients with NSTI were analyzed by standard culture, fluorescence in situ hybridization (FISH) and multiple molecular methods. The molecular methods included analysis of microbial diversity by 1) direct 16S and D2LSU rRNA gene Microseq 2) construction of near full-length 16S rRNA gene clone libraries with subsequent Sanger sequencing for most samples, 3) the Ibis T5000 biosensor and 4) 454-based pyrosequencing. Furthermore, quantitative PCR (qPCR) was used to verify and determine the relative abundance of Streptococcus pyogenes in samples. Results For 70 % of the surgical samples it was possible to identify microorganisms by culture. Some samples did not result in growth (presumably due to administration of antimicrobial therapy prior to sampling). The molecular methods identified microorganisms in 90 % of the samples, and frequently detected additional microorganisms when compared to culture. Although the molecular methods generally gave concordant results, our results indicate that Microseq may misidentify or overlook microorganisms that can be detected by other molecular methods. Half of the patients were found to be infected with S. pyogenes, but several atypical findings were also made including infection by a) Acinetobacter baumannii, b) Streptococcus pneumoniae, and c) fungi, mycoplasma and Fusobacterium necrophorum. Conclusion The study emphasizes that many pathogens can be involved in NSTIs, and that no specific “NSTI causing” combination of species exists. This means that clinicians should be prepared to diagnose and treat any combination of microbial pathogens. Some of the tested molecular methods offer a faster turnaround time combined with a high specificity, which makes supplemental use of such methods attractive for identification of microorganisms, especially for fulminant life-threatening infections such as NSTI.
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Affiliation(s)
- Vibeke Børsholt Rudkjøbing
- Center for Microbial Communities, Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark
| | - Trine Rolighed Thomsen
- Center for Microbial Communities, Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark.,Life Science Division, The Danish Technological Institute, Taastrup, Denmark
| | - Yijuan Xu
- Center for Microbial Communities, Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark.,Life Science Division, The Danish Technological Institute, Taastrup, Denmark
| | - Rachael Melton-Kreft
- Center for Genomic Sciences, Allegheny-Singer Research Institute, Pittsburgh, USA
| | - Azad Ahmed
- Center for Genomic Sciences, Allegheny-Singer Research Institute, Pittsburgh, USA
| | - Steffen Eickhardt
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bjarnsholt
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Steen Seier Poulsen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Halkjær Nielsen
- Center for Microbial Communities, Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark
| | - Joshua P Earl
- Center for Genomic Sciences, Philadelphia, PA, USA.,Departments of Microbiology and Immunology, Center for Advanced Microbial Processing, Institute for Molecular Medicine and Infectious Disease, Philadelphia, PA, USA.,Departments of Microbiology and Immunology, Philadelphia, PA, USA
| | - Garth D Ehrlich
- Center for Genomic Sciences, Philadelphia, PA, USA.,Departments of Microbiology and Immunology, Center for Advanced Microbial Processing, Institute for Molecular Medicine and Infectious Disease, Philadelphia, PA, USA.,Departments of Microbiology and Immunology, Philadelphia, PA, USA.,Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Denmark.
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11
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Clinical guidelines «Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice». Part I. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:70-82. [DOI: 10.17116/jnevro20151154170-82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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12
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13
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A case of necrotizing fasciitis due to Streptococcus pneumoniae serotype 5 in Saskatchewan. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 19:69-71. [PMID: 19145265 DOI: 10.1155/2008/246468] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Accepted: 09/04/2007] [Indexed: 11/17/2022]
Abstract
Necrotizing fasciitis due to Streptococcus pneumoniae is a rare and grave condition, and only a few cases have been reported. Suggested risk factors include minor trauma, systemic lupus erythematosus, immunosuppression secondary to medication, use of intramuscular anti-inflammatories and alcoholism. A fatal case of pneumococcal necrotizing fasciitis that occurred in a 51-year-old woman with a history of alcohol abuse and oral anti-inflammatory use is presented. Her condition was caused by a multi-etiology outbreak of community-acquired pneumonia, from which S pneumoniae serotype 5 was also isolated. The case description outlines the subtle presentation and rapid clinical progression of this condition. Because serotype 5 antigen is included in the polysaccharide 23-valent pneumococcal vaccine, the present case highlights the importance of pneumococcal immunization programs in Canada.
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14
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Matar VW, Betz P. [Periorbital necrotizing fasciitis: a complication of a dacryocystorhinostomy]. J Fr Ophtalmol 2011; 34:258.e1-5. [PMID: 21411184 DOI: 10.1016/j.jfo.2010.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 09/26/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
Abstract
We report a rare case of periorbital necrotizing fasciitis following a dacryocystorhinostomy procedure. We describe the common features of this rare infection of the skin and subcutaneous tissues and discuss the different management strategies as well as the controversial role of anti-inflammatory medication in treating this condition.
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Affiliation(s)
- V W Matar
- Service d'ophtalmologie, centre hospitalier régional de la Citadelle, 1, boulevard du 12(e) de Ligne, 4000 Liège, Belgique.
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15
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Fascitis necrosante producida por Streptococcus pneumoniae. Med Clin (Barc) 2011; 136:176-7. [DOI: 10.1016/j.medcli.2009.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 11/17/2009] [Accepted: 11/19/2009] [Indexed: 11/24/2022]
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16
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Park SY, Park SY, Moon SY, Son JS, Lee MS. Fatal necrotizing fasciitis due to Streptococcus pneumoniae: a case report. J Korean Med Sci 2011; 26:131-4. [PMID: 21218041 PMCID: PMC3012837 DOI: 10.3346/jkms.2011.26.1.131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Accepted: 08/03/2010] [Indexed: 11/20/2022] Open
Abstract
Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis.
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Affiliation(s)
- So-Youn Park
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - So Young Park
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soo-youn Moon
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jun Seong Son
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Mi Suk Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
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17
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Adigun IA, Nasir AA, Aderibigbe AB. Fulminant necrotizing fasciitis following the use of herbal concoction: a case report. J Med Case Rep 2010; 4:326. [PMID: 20958957 PMCID: PMC2978229 DOI: 10.1186/1752-1947-4-326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 10/19/2010] [Indexed: 12/04/2022] Open
Abstract
Introduction Necrotizing fasciitis is a rare and life-threatening rapidly progressive soft tissue infection. A fulminant case could involve muscle and bone. Necrotizing fasciitis after corticosteroid therapy and intramuscular injection of non-steroidal anti-inflammatory drugs has been reported. We present a case of fulminant necrotizing fasciitis occurring in a patient who used a herbal concoction to treat a chronic leg ulcer. Case presentation A 20-year-old Ibo woman from Nigeria presented with a three-year history of recurrent chronic ulcer of the right leg. She started applying a herbal concoction to dress the wound two weeks prior to presentation. This resulted in rapidly progressive soft tissue necrosis that spread from the soft tissue to the bone, despite aggressive emergency debridement. As a result she underwent above-knee amputation. Conclusion The herbal concoction used is toxic, and can initiate and exacerbate necrotizing fasciitis. Its use for wound dressing should be discouraged.
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Affiliation(s)
- Ismaila A Adigun
- Department of Surgery, University of Ilorin Teaching Hospital, PMB 1459, Ilorin, Nigeria.
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Rodríguez-Peralto JL. Emergency dermatopathology. Int J Surg Pathol 2010; 18:88S-93S. [PMID: 20484269 DOI: 10.1177/1066896910369929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dias AMB, do Couto MCM, Duarte CCM, Inês LPB, Malcata AB. White blood cell count abnormalities and infections in one-year follow-up of 124 patients with SLE. Ann N Y Acad Sci 2009; 1173:103-7. [PMID: 19758138 DOI: 10.1111/j.1749-6632.2009.04872.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of our study was to evaluate the frequency of leukocyte count abnormalities in a large cohort of SLE patients and its association with infection. To make this evaluation, we studied consecutive patients with SLE diagnosis and prospectively followed them in the Coimbra Lupus Cohort. Data about white blood cell count abnormalities and infection during one-year follow-up were obtained. The presence of leukopenia, lymphopenia, and neutropenia was registered for one-year period. Infections were classified as severe or mild. We found that of the 124 patients who were included (91.1% female, mean age 41.2, mean disease duration 11.1), mild infections occurred in 43.5%, and severe in 3.2% of the patients. Twelve percent, 41.1%, and 4.8% of the patients had persistent leukopenia, lymphopenia, and neutropenia, respectively. Fourteen percent received a pneumococcal vaccination. Patients with neutropenia had a significantly higher number of infections (P = 0.033). Thus, our study showed that neutropenia was associated with an increased risk of infection during this one-year follow-up. Infections were frequent, but most of them were mild.
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Mylle M, Goubau J, Bourgeois M, Vandecasteele SJ. Necrotizing fasciitis due to Streptococcus pneumoniae in a healthy 68-year old man: case report and review of the literature. Acta Clin Belg 2009; 64:452-4. [PMID: 19999397 DOI: 10.1179/acb.2009.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A case of pneumococcal necrotizing soft-tissue infection (NSTI) is described and 16 cases available in literature are reviewed. Pneumococcal NSTI seems to be the consequence of hematogeneous shedding of pneumococci, with frequent involvement of articulations. Furthermore, pneumococcal NSTI present like other NSTI, with a high mortality and the need for a combined surgical and medical therapy.
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Affiliation(s)
- M Mylle
- Internal Medicine, Leuven University Hospital, Herestraat 49, 3000 Leuven, Belgium
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Sepsis requiring intensive care following intramuscular injections: two case reports. CASES JOURNAL 2009; 2:7365. [PMID: 19918523 PMCID: PMC2769353 DOI: 10.4076/1757-1626-2-7365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 07/27/2009] [Indexed: 01/20/2023]
Abstract
Introduction Intramuscular injections can rarely result in serious infectious complications such as abscesses which may progress to bacteraemia and generalized sepsis. These complications are rare, but can be life threatening, as they can lead to multi-organ failure associated with high morbidity and mortality. Case presentation In this report we present two patients who developed life-threatening infections after intramuscular injections. They were admitted to the hospital, had prompt surgical drainage, required ICU admission for severe sepsis, were treated with an early goal-directed therapy protocol and had a good outcome. Conclusion Sepsis is a rare, potentially life-threatening complication after intramuscular injections. Timely surgical drainage followed by appropriate ICU care and early goal directed therapy is crucial and may contribute to a good outcome in these rare cases.
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YAMASHIRO E, ASATO Y, TAIRA K, AWAZAWA R, YAMAMOTO YI, HAGIWARA K, TAMAKI H, UEZATO H. Necrotizing fasciitis caused byStreptococcus pneumoniae. J Dermatol 2009; 36:298-305. [DOI: 10.1111/j.1346-8138.2009.00643.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Garcia-Lechuz JM, Cuevas O, Castellares C, Perez-Fernandez C, Cercenado E, Bouza E. Streptococcus pneumoniae skin and soft tissue infections: characterization of causative strains and clinical illness. Eur J Clin Microbiol Infect Dis 2007; 26:247-53. [PMID: 17372776 DOI: 10.1007/s10096-007-0283-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 01/19/2007] [Indexed: 11/30/2022]
Abstract
Streptococcus pneumoniae is an uncommon cause of skin and soft tissue infections, yet the incidence and clinical significance of its isolation in samples of skin or soft tissues in unselected hospital samples is poorly understood. In the present study, a review was conducted of the records of all patients with skin and soft tissue infections due to S. pneumoniae at a university hospital between January 1994 and December 2005. The isolates were identified by standard methods and were serotyped, and susceptibility testing was performed by the broth microdilution method following the guidelines of the Clinical and Laboratory Standards Institute. During the study period, 3,201 isolates of S. pneumoniae were recovered from several sources. Of these, 69 (2.2%) were from skin and soft tissue samples (69 patients). Complete information could not be obtained for 13 patients. Of the 56 patients remaining, 36 (64.3%) were infected and fulfilled the inclusion criteria. The following types of infections were observed: surgical wound infection (n = 11), burn infection (n = 7), pyomyositis (n = 6), cellulitis (n = 4), perineal or scrotal abscess (n = 3), and other (n = 5). Thirty-one (86%) patients had a favorable outcome, and 5 (13.8%) patients died. Mortality was directly attributable to S. pneumoniae infection in three of the five fatal cases. Of the 39 S. pneumoniae isolates obtained (36 from skin and soft tissues, three from blood cultures), 58.9% were penicillin nonsusceptible, 7.7% were cefotaxime nonsusceptible, and 20.5% were erythromycin resistant. The most frequent serotypes were 3, 19, 11, and 23. Of the overall number of isolates of S. pneumoniae recovered in a general institution, 2.2% involved skin and soft tissues (of which 64% were clinically significant). Mortality due to pneumococcal skin and soft tissue infections was low.
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Affiliation(s)
- J M Garcia-Lechuz
- Department of Clinical Microbiology and Infectious Diseases--HIV, Hospital General Universitario "Gregorio Marañón", Dr. Esquerdo 46, 28007 Madrid, Spain.
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Orlando A, Marrone C, Nicoli N, Tamburello G, Rizzo A, Pagliaro L, Cottone M, D'Amico G. Fatal necrotising fasciitis associated with intramuscular injection of nonsteroidal anti-inflammatory drugs after uncomplicated endoscopic polypectomy. J Infect 2007; 54:e145-8. [DOI: 10.1016/j.jinf.2006.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Revised: 08/23/2006] [Accepted: 09/09/2006] [Indexed: 11/26/2022]
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Rosemann T, Joos S, Koerner T, Heiderhoff M, Laux G, Szecsenyi J. Use of a patient information leaflet to influence patient decisions regarding mode of administration of NSAID medications in case of acute low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15:1737-41. [PMID: 16463196 DOI: 10.1007/s00586-006-0068-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Revised: 11/10/2005] [Accepted: 01/10/2006] [Indexed: 10/25/2022]
Abstract
Despite dissuasive recommendations, intramuscular (i.m.) injections of NSAIDS are still a widespread treatment of acute pain in General Practice as well as among orthopaedic physicians. Most physicians argue that patients who are used to receive NSAIDS i.m. would insist on this application mode while being convinced of its therapeutic superiority for pain relief. Therefore, the aim of the study was to find out if patients' decision can be influenced towards an oral application by receiving a simple information leaflet. An information leaflet, providing information about the risks of NSAIDS particularly in case of i.m. application was provided to 161 patients with acute low back pain. Decision in favour or against i.m. application of NSAIDS was documented. Severity of disease was assessed by the Roland Morrison pain questionnaire and visual analogue scale (VAS) at the first visit and again 3-5 days later. From May to December 2004, 161 patients, visiting their GP (13 practices) with acute pain and demanding an injection were included in the study. After reading the information leaflet, 139 of the 161 (86.3%) patients decided for an oral application instead of receiving an injection of NSAIDS as in the past. This effect was statistically significant (P</=0.01). Of the initial 161 patients, 156 could be re-evaluated and no significant differences in the VAS and the Roland Morris Score between the patients with oral and i.m. application mode could be found. Only 2 patients of the 139 who decided for oral application indicated that they would opt for an i.m. injection next time. Our study demonstrates that patients' decision can be influenced even in case of severe pain by providing adequate information on a short information leaflet. The results should help to reduce physicians' fear of losing patients when not following their demand for i.m. injections and therefore enable a safer pain treatment.
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Affiliation(s)
- Thomas Rosemann
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany.
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Abstract
BACKGROUND Injury to the sciatic nerve (SN) is a serious complication of intramuscular injection. AIM The purpose of this paper was to identify factors associated with such iatrogenic injury in adults and measures that nurses may take to prevent it. METHOD A review of the English language literature was undertaken to identify applicable research studies and determine the information that currently is being disseminated on relevant injection procedure. Legal databases were also searched for pertinent court decisions. DISCUSSION The evidence is that injury to the SN is associated with use of the dorsogluteal (DG) site for injection. The choice of site for injection must be based on good clinical judgment, using the best evidence available and individualized assessment of the client. There is wide agreement in the literature that the ventrogluteal site is preferable. If the DG site is chosen, the nurse must have a full appreciation of the anatomy of the site and proximate anatomic structures, be able to accurately identify anatomic landmarks and site boundaries, and administer the injection with meticulous technique. Not only may SN injury resulting from erroneous injection cause client discomfort, morbidity and lasting disability, but it also provides the basis for nursing negligence suits. CONCLUSION The research base for intramuscular injection is limited. Studies on various aspects of the procedure need to be carried out to provide support for clinical guidelines.
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Affiliation(s)
- Sandra P Small
- School of Nursing, Memorial University, St John's, Newfoundland, Canada.
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Balbierz JM, Ellis K. Streptococcal infection and necrotizing fasciitis—implications for rehabilitation: a report of 5 cases and review of the literature. Arch Phys Med Rehabil 2004; 85:1205-9. [PMID: 15241775 DOI: 10.1016/j.apmr.2003.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Five cases are presented of patients who were diagnosed with necrotizing fasciitis secondary to (1) hip disarticulation (in a paraplegic patient); (2) tooth abscess with extensive neck dissection, complicated by sepsis and hypotension with resultant dysphagia and ischemic encephalopathy; (3) below-knee amputation, anoxia, and severe debility; (4) emergent above-knee amputation; and (5) percutaneous endoscopic gastrostomy placement. The latter patient developed abdominal and chest wall necrotizing fasciitis that required skin grafting. Four patients were treated in an acute rehabilitation setting and returned home, and the fifth was rehabilitated in a subacute facility. This report emphasizes the importance of carefully monitoring rehabilitation patients, especially those with impaired sensation.
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Affiliation(s)
- Janet M Balbierz
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132-2119, USA.
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Prakash PK, Biswas M, ElBouri K, Braithwaite PA, Hanna FW. Pneumococcal necrotizing fasciitis in a patient with Type 2 diabetes. Diabet Med 2003; 20:899-903. [PMID: 14632714 DOI: 10.1046/j.1464-5491.2003.00984.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Necrotizing fasciitis (NF) is a rare and often fatal soft-tissue infection involving the superficial fascial layers of the extremities, abdomen or perineum. Progression to septic shock can occur very rapidly with its associated high morbidity and mortality. NF is usually caused by beta haemolytic streptococci; less often a poly-microbial isolate is the cause. It typically occurs in patients with some degree of immune dysfunction. We present a case of severe pneumococcal necrotizing fasciitis in an obese patient with Type 2 diabetes. There was no history of trauma or evidence of diabetes-related complications. The initial presentation was with features of septic arthritis of the left knee, which subsequently progressed to NF. Differentiation from cellulitis is often difficult in the early stages. Invasive pneumococcal infections are extremely rare, with only a few reported in the literature. Moreover, our case highlights the need to consider other differential diagnoses (and to look out for complications) in patients with diabetes, especially if there is little clinical response to the initial treatment.
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Affiliation(s)
- P K Prakash
- Department of Diabetes and Endocrinology, Prince Charles Hospital, Merthyr Tydfil, UK.
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Kuncir EJ, Tillou A, St Hill CR, Petrone P, Kimbrell B, Asensio JA. Necrotizing soft-tissue infections. Emerg Med Clin North Am 2003; 21:1075-87. [PMID: 14708819 DOI: 10.1016/s0733-8627(03)00089-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
It has been more than 130 years since NSTIs were first described. Despite the development of various classification systems and progress in surgical management, these infections continue to have high mortality and pose enormous diagnostic and therapeutic challenges. For optimal outcome, treatment involves rapid institution of appropriate antibiotic coverage and early wide surgical debridement. Recovery requires aggressive resuscitation, postoperative nutritional support and wound care that is similar to the care of burn patients in many respects. The entire therapeutic process requires a well-prepared and coordinated team of health care professionals including EPs, general, orthopedic, and other specialist surgeons, infectious disease consultants, specially trained nursing staff, and physical therapists.
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Affiliation(s)
- Eric J Kuncir
- Trauma Service A, Division of Trauma and Surgical Critical Care, University of Southern California, Keck School of Medicine, LAC - USC Medical Center, 1200 North State Street, Room 10-750, Los Angeles, CA 90033-4525, USA
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Abstract
Necrotizing soft tissue infections are characterized by necrosis of skin and associated structures. Despite advances in the diagnosis and treatment of these infections, the mortality remains high. There have been increasing reports of necrotizing fasciitis caused by group A Streptococcus over the past decade. Recent information supports the role of superantigens in the pathogenesis of this infection. The approach to management requires expeditious evaluation with early surgery and appropriate antimicrobial agents. Limited data suggest that surgical debridement may be delayed in selected patients until the patient is stable by the use of intravenous immunoglobulin, which can neutralize superantigens.
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Affiliation(s)
- Thomas M. File
- Northeastern Ohio Universities College of Medicine, Rootstown, OH, and Summa Health System, 75 Arch Street, Suite 105, Akron, OH 44304, USA.
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Kwak EJ, McClure JA, McGeer A, Lee BC. Exploring the pathogenesis of necrotizing fasciitis due to Streptococcus pneumoniae. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2003; 34:639-44. [PMID: 12374351 DOI: 10.1080/00365540210147985] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Monobacterial necrotizing fasciitis is a rare form of soft tissue infection usually caused by the group A beta-hemolytic Streptococcus. Soft tissue infection is an uncommon clinical manifestation of invasive disease due to Streptococcus pneumoniae. We describe 3 cases of pneumococcal necrotizing fasciitis and explore potential pathogen-specific mechanisms of pathogenesis. The clinical characteristics of necrotizing fasciitis due to S. pneumoniae and group A beta-hemolytic Streptococcus appear to overlap. The similarities include predominant occurrence in elderly adults with underlying chronic illness, predilection for lower extremity infection, progression to toxic shock-like syndrome and a high case fatality rate. No DNA fragments corresponding to speA, speB or speC were amplified by PCR from the 3 pneumococcal isolates. Western immunoblot revealed no evidence of SpeA, SpeB or SpeC protein expression. Evaluation for protease production and cytotoxicity was unrevealing. The similar clinical presentation of pneumococcal necrotizing fasciitis to the disease caused by the group A beta-hemolytic Streptococcus has important therapeutic implications. The molecular mechanisms underlying the pathogenesis are unclear. Prospective population-based studies are required to define the epidemiology of this infection.
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Affiliation(s)
- Eun J Kwak
- Department of Medicine, University of Ottawa, Ontario, Canada
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Ben M'Rad M, Brun-Buisson C. A case of necrotizing fasciitis due to Streptococcus pneumoniae following topical administration of nonsteroidal anti-inflammatory drugs. Clin Infect Dis 2002; 35:775-6. [PMID: 12203181 DOI: 10.1086/342323] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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