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Moore LR, Skrine RA. Diffuse Dermal Angiomatosis of the Breast Clinically Mimicking Cellulitis and Inflammatory Breast Cancer. Am Surg 2024:31348241256082. [PMID: 38767044 DOI: 10.1177/00031348241256082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
A 40-year-old woman admitted for hyponatremia and anasarca due to decompensated cirrhosis after a recent steroid taper developed extremely painful cutaneous breast lesions clinically mimicking cellulitis and inflammatory breast cancer and was biopsy-diagnosed instead with diffuse dermal angiomatosis (DDA) of the breasts, a rare and painful disease that can be a diagnostic chameleon. This case highlights the importance of early surgical consultation and tissue biopsy to correctly diagnose the etiology of severely painful mastitis and prevent prolonged symptomology and repeated administrations of ineffective treatments. Diffuse dermal angiomatosis should be considered when suspected breast cellulitis is refractory to treatment or there is concern for inflammatory breast cancer, especially in pendulous-breasted women with comorbidities that increase susceptibility to local tissue hypoxia.
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Affiliation(s)
- Lauren R Moore
- Department of Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Robin A Skrine
- Department of Surgery, Geisinger Medical Center, Danville, PA, USA
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2
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Zhou S, Cheng Y, Cheng N, Gong J, Tu B. Early versus delayed appendicectomy for appendiceal phlegmon or abscess. Cochrane Database Syst Rev 2024; 5:CD011670. [PMID: 38695830 PMCID: PMC11064883 DOI: 10.1002/14651858.cd011670.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
BACKGROUND This is an update of a Cochrane review first published in 2017. Acute appendicitis (inflammation of the appendix) can be simple or complicated. Appendiceal phlegmon and appendiceal abscess are examples of complicated appendicitis. Appendiceal phlegmon is a diffuse inflammation in the bottom right of the appendix, while appendiceal abscess is a discrete inflamed mass in the abdomen that contains pus. Appendiceal phlegmon and abscess account for 2% to 10% of acute appendicitis. People with appendiceal phlegmon or abscess usually need an appendicectomy to relieve their symptoms (e.g. abdominal pain, loss of appetite, nausea, and vomiting) and avoid complications (e.g. peritonitis (infection of abdominal lining)). Surgery for people with appendiceal phlegmon or abscess may be early (immediately after hospital admission or within a few days of admission), or delayed (several weeks later in a subsequent hospital admission). The optimal timing of appendicectomy for appendiceal phlegmon or abscess is debated. OBJECTIVES To assess the effects of early appendicectomy compared to delayed appendicectomy on overall morbidity and mortality in people with appendiceal phlegmon or abscess. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, two other databases, and five trials registers on 11 June 2023, together with reference checking to identify additional studies. SELECTION CRITERIA We included all individual and cluster-randomised controlled trials (RCTs), irrespective of language, publication status, or age of participants, comparing early versus delayed appendicectomy in people with appendiceal phlegmon or abscess. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included eight RCTs that randomised 828 participants to early or delayed appendicectomy for appendiceal phlegmon (7 trials) or appendiceal abscess (1 trial). The studies were conducted in the USA, India, Nepal, and Pakistan. All RCTs were at high risk of bias because of lack of blinding and lack of published protocols. They were also unclear about methods of randomisation and length of follow-up. 1. Early versus delayed open or laparoscopic appendicectomy for appendiceal phlegmon We included seven trials involving 788 paediatric and adult participants with appendiceal phlegmon: 394 of the participants were randomised to the early appendicectomy group (open or laparoscopic appendicectomy as soon as the appendiceal mass resolved within the same admission), and 394 were randomised to the delayed appendicectomy group (initial conservative treatment followed by delayed open or laparoscopic appendicectomy several weeks later). There was no mortality in either group. The evidence is very uncertain about the effect of early appendicectomy on overall morbidity (risk ratio (RR) 0.74, 95% confidence interval (CI) 0.19 to 2.86; 3 trials, 146 participants; very low-certainty evidence), the proportion of participants who developed wound infections (RR 0.99, 95% CI 0.48 to 2.02; 7 trials, 788 participants), and the proportion of participants who developed faecal fistulas (RR 1.75, 95% CI 0.36 to 8.49; 5 trials, 388 participants). Early appendicectomy may reduce the abdominal abscess rate (RR 0.26, 95% CI 0.08 to 0.80; 4 trials, 626 participants; very low-certainty evidence), reduce the total length of hospital stay by about two days (mean difference (MD) -2.02 days, 95% CI -3.13 to -0.91; 5 trials, 680 participants), and increase the time away from normal activities by about five days (MD 5.00 days; 95% CI 1.52 to 8.48; 1 trial, 40 participants), but the evidence is very uncertain. 2. Early versus delayed laparoscopic appendicectomy for appendiceal abscess We included one trial involving 40 paediatric participants with appendiceal abscess: 20 were randomised to the early appendicectomy group (emergent laparoscopic appendicectomy), and 20 were randomised to the delayed appendicectomy group (initial conservative treatment followed by delayed laparoscopic appendicectomy 10 weeks later). There was no mortality in either group. The trial did not report on overall morbidity, various complications, or time away from normal activities. The evidence is very uncertain about the effect of early appendicectomy on the total length of hospital stay (MD -0.20 days, 95% CI -3.54 to 3.14; very low-certainty evidence). AUTHORS' CONCLUSIONS For the comparison of early versus delayed open or laparoscopic appendicectomy for paediatric and adult participants with appendiceal phlegmon, very low-certainty evidence suggests that early appendicectomy may reduce the abdominal abscess rate. The evidence is very uncertain whether early appendicectomy prevents overall morbidity or other complications. Early appendicectomy may reduce the total length of hospital stay and increase the time away from normal activities, but the evidence is very uncertain. For the comparison of early versus delayed laparoscopic appendicectomy for paediatric participants with appendiceal abscess, data are sparse, and we cannot rule out significant benefits or harms of early versus delayed appendicectomy. Further trials on this topic are urgently needed and should specify a set of criteria for use of antibiotics, percutaneous drainage of the appendiceal abscess prior to surgery, and resolution of the appendiceal phlegmon or abscess. Future trials should include outcomes such as time away from normal activities and length of hospital stay.
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Affiliation(s)
- Shiyi Zhou
- Department of Pharmacy, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yao Cheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Nansheng Cheng
- Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianping Gong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Bing Tu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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3
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Higashi Y, Imafuku S, Tsuruta N, Murotani K. Systemic therapy for psoriasis and the risk of cutaneous infections. J Dermatol 2024. [PMID: 38660962 DOI: 10.1111/1346-8138.17245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
Systemic treatments are important for patients with moderate-to-severe psoriasis; however, they may occasionally cause adverse infectious events. Although the risk of severe infections with psoriatic treatments is well established, little is known about cutaneous infections. Therefore, we studied the frequency of cutaneous infections in patients with psoriasis who underwent biologic treatment. A total of 878 patients (237 females and 641 males) were analyzed in this follow-up survey conducted in 2020 and based on the Western Japan Psoriasis Registry. The observed skin phenotypes were psoriasis vulgaris (83.3%), pustular psoriasis (7.5%), and psoriatic arthritis (28.9%). The most frequently prescribed systemic drug was apremilast (11.3%), followed by ixekizumab (11.0%), risankizumab (10.9%), and secukinumab (10.4%). The incidence of cutaneous bacterial infections was 12 (1.37% of the total patients), with cellulitis being the most common (8/12, 67%). The incidence of viral infections was 11 (1.25%) including the most common, herpes zoster (9/11, 82%); and that of fungal infections was 45 (5.13%) including 33 (73%) and seven (16%) patients with trichophytosis and oral candidiasis, respectively. Multivariate analysis revealed that cutaneous bacterial infections were frequently observed in patients receiving tumor necrosis factor-α (odds raio [OR] 9.917, 95% confidence interval [CI] 2.069-47.572, p = 0.004) and interleukin (IL)-17 (OR 10.798, 95% CI 2.35-49.616, p = 0.002) inhibitor treatments. A history of otitis media and treatment with oral medications (OR 4.50, 95% CI 1.281-15.804, p = 0.019 and OR 3.80, 95% CI 1.141-12.679, p = 0.03 respectively) were associated with a higher ORs for cutaneous viral infections. Furthermore, age and use of IL-17 inhibitors were associated with elevated ORs for fungal infections. In conclusion, our study reveals that systemic therapies may increase the risk of cutaneous viral infections. Therefore, dermatologists should exercise caution in this regard.
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Affiliation(s)
- Yuko Higashi
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shinichi Imafuku
- Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Noriko Tsuruta
- Division of Dermatology, Kitakyushu City Yahata Hospital, Kitakyusyu, Japan
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4
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Yoshikawa H, Uehara T, Yamashita S, Ikusaka M. X-ray-negative Occult Foot Bone Fracture Mimicking Cellulitis. Intern Med 2024; 63:1183. [PMID: 37690848 PMCID: PMC11081898 DOI: 10.2169/internalmedicine.1864-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/30/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
| | - Takanori Uehara
- Department of General Medicine, Chiba University Hospital, Japan
| | - Shiho Yamashita
- Department of General Medicine, Chiba University Hospital, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Japan
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Morris K, Colgan MP, McMahon N, Slattery S. Outcomes from a proof-of-concept specialist lymphoedema clinic in the community. Br J Community Nurs 2024; 29:S14-S18. [PMID: 38578921 DOI: 10.12968/bjcn.2024.29.sup4.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
The Health and Safety Execultive lymphoedema model of care was published in 2018 highlighting the lack of dedicated lymphoedema services in Ireland. This led to the introduction of a proof-of-concept primary care specialist lymphoedema clinic. The clinic was responsible for all patients from their county. A comprehensive dataset was gathered which included the patient's history for 1 year prior to their presentation at clinic and then 6 monthly. A quality of life tool (LymQoL) and a patient satisfaction survey were completed. Completed 1-year data showed a significant reduction in GP and public health nurse visits as well as a reduction in the occurrence of cellulitis and associated hospital admissions. All areas of quality of life were improved and patient satisfaction was either excellent (89%) or very good (11%). The 1-year findings strongly support the roll-out of specialist clinics to all regional health areas.
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Affiliation(s)
- Kay Morris
- Project Manager, National Lymphoedema Services, Ireland
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6
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Vaibhavi D, P N S, Ullalkar N, Amarnath G. Role of Procalcitonin for Early Discrimination Between Necrotizing Fasciitis and Cellulitis of the Extremities. Cureus 2024; 16:e57668. [PMID: 38707041 PMCID: PMC11070177 DOI: 10.7759/cureus.57668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Necrotizing fasciitis (NF) is a grave and life-threatening infection of the soft tissues. It is defined by the gradual necrosis of the fascia and subcutaneous tissue, which spreads along the fascial planes. Cellulitis, a prevalent skin infection, has led to suggestions that procalcitonin could serve as a diagnostic tool to distinguish it from other inflammatory skin conditions that resemble cellulitis. The study aims to assess the procalcitonin (PCT) levels in individuals with NF and cellulitis and determine its effectiveness in early differentiation between these two conditions. Methods After obtaining clearance from the institutional ethical committee, the study was conducted in the Department of General Surgery, Sri Devaraj Urs Medical College, over six months. Informed consent was obtained from all 30 patients included in this study. The study compared PCT levels in patients diagnosed with NF and cellulitis. Statistical analysis was performed using SPSS version 22 software (IBM Corp., Armonk, NY, USA). Results The mean age of subjects was 53.23 ± 8.78 years. Among patients, 21 (70%) were diagnosed with cellulitis and 9 (30%) were diagnosed with NF. The mean PCT levels were 0.34 ± 0.32 and 4.89 ± 1.98 among the cellulitis and NF groups, respectively. There was a significant difference (p<0.05). PCT had a sensitivity of 100% and a specificity of 100%, in differentiating cellulitis and necrotizing fasciitis. Conclusion PCT levels were notably elevated in cases of NF compared to cellulitis. Despite the study's limited sample size, it represents the first report highlighting the value of PCT as an early diagnostic tool for identifying necrotizing fasciitis.
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Affiliation(s)
- D Vaibhavi
- General Surgery, Sri Devaraj Urs Medical College, Kolar, IND
| | - Sreeramulu P N
- Surgery, R L Jalappa Hospital and Research Centre, Kolar, IND
| | - Neha Ullalkar
- General Surgery, Sri Devaraj Urs Medical College, Kolar, IND
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Hageboeck Shepherd K, Colantonio M, Santer M, Mahmud H, Shannon B. Dogs Licks Are Not Benign: Pasturella Multocida Bacteremia From Household Dog. Cureus 2024; 16:e58554. [PMID: 38765386 PMCID: PMC11102085 DOI: 10.7759/cureus.58554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Pasturella (P.) multocida is a gram-negative coccobacilli commonly colonized in the oral, nasopharyngeal, and upper respiratory tracts of animals. Infections due to P. multocida range in severity, and symptoms largely depend on underlying immune status and co-morbid conditions. Widely known, the transmission of P. multocida is commonly thought to occur through biting and skin breakage alone. However, multiple studies have highlighted instances of severe complications secondary to transmission through the passage of P. multocida through animal licking alone without skin disruption. Here, we present a case of a nonagenarian female presenting with septic shock secondary to P. multocida with the source of transmission found to be secondary to the patient's dog licking her chronic leg wounds. We also highlight other instances of similar transmission through a literature review, including common treatment courses. We aim to raise awareness of common transmissions of bacteria, specifically P. multocida, along with broadening differentials when one presents with skin and soft tissue infections.
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Affiliation(s)
| | - Mark Colantonio
- Internal Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Matthew Santer
- Internal Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Haseeb Mahmud
- Internal Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Brooke Shannon
- Internal Medicine, West Virginia University School of Medicine, Morgantown, USA
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8
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Adhikari B, Tellez-Isaias G, Jiang T, Wooming B, Kwon YM. Development of real-time PCR assay for quantitative detection of Clostridium septicum. Poult Sci 2024; 103:103681. [PMID: 38603932 PMCID: PMC11017044 DOI: 10.1016/j.psj.2024.103681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Cellulitis is an important disease in commercial turkey farms associated with significant economic loss. Although the etiology of cellulitis is not fully elucidated, Clostridium septicum (C. septicum) is one of the main causes of this infectious disease. In this study, we report the development of a quantitative real-time PCR (qRT PCR) assay targeting the alpha-toxin gene (csa), which involves a prior 15-cyle PCR using a nested pair of primers to increase the detection sensitivity. Additionally, the TaqMan probe was employed to increase the target-specificity of the assay. The performance of our nested qRT-PCR assay was evaluated using Clostridium isolates from turkey farms, representing both septicum and non-septicum species, as well as sponge swab samples from turkey farms. Our step-by-step development of the assay showed that the csa gene is a suitable target for specific detection of C. septicum strains and that the inclusion of nested PCR step significantly increased the detection sensitivity of the final qRT PCR assay. The performance of the assay was also validated by a high correlation of the threshold cycle numbers of the qRT PCR assay with the relative abundance of C. septicum read counts in 16S rRNA gene microbiota profiles of the C. septicum-containing samples from turkey farms.
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Affiliation(s)
- Bishnu Adhikari
- Department of Poultry Science, University of Arkansas, Fayetteville, AR 72701, USA; Current address: Research and Development, Aldevron, Fargo, ND 58104, USA.
| | | | - Tieshan Jiang
- Department of Poultry Science, University of Arkansas, Fayetteville, AR 72701, USA
| | | | - Young Min Kwon
- Department of Poultry Science, University of Arkansas, Fayetteville, AR 72701, USA; Cell and Molecular Biology Program, University of Arkansas, Fayetteville, AR 72701, USA
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9
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Özkaçmaz A, Dicle Y, Bayram Y, Parlak M, Akış F, Çallı İ. The Distribution and the Antimicrobial Susceptibility Features of Microorganisms Isolated From the Burn Wounds: A 10-Year Retrospective Analysis. J Burn Care Res 2024; 45:384-397. [PMID: 37847516 DOI: 10.1093/jbcr/irad158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 10/18/2023]
Abstract
In this study, we aimed to evaluate the distribution features and antimicrobial susceptibility test results of the microorganisms isolated from the wounds of pediatric and adult patients with burn. The culture and susceptibility test results of the microorganisms, isolated from the wound swabs of the patients hospitalized in a tertiary-burn care center in 10-year period, were retrospectively screened on the microbiology department databases. Their distribution of isolated microorganisms regarding species and susceptibility test results were compared with previous studies. A total of 367 microorganisms, isolated from the burn wounds of 293 patients (13 ± 18.9 years, F/M: 0.93) (73 adults and 220 pediatric patients), were included in this study. A solitary agent was isolated in 239 (81.6%) patients, while 2 were isolated in 43 (14.7%) and 3 or more agents in 11 (3.8%). From these, 33% of the isolated microorganisms were gram-positive cocci, 61% were gram-negative bacteria, and 6% were Candida spp. The most common isolated microorganisms were Staphylococcus aureus (18.5%), Pseudomonas spp. (16.9%), and Escherichia coli (11.2%), while the least common was Streptococcus spp. (2.5%). Methicillin resistance was 15% among the S. aureus strains. No resistance was observed against levofloxacin, vancomycin, teicoplanin, linezolid, daptomycin, fusidic acid, and tigecycline in S. aureus strains. The highest resistance rates were observed against levofloxacin (64%), tobramycin (64%), pip/tazobactam (63%), imipenem (63%), and the lowest against colistin (5%) and ceftazidime (29%), among Pseudomonas spp. The most common causative agents in burn wound infections and their current antimicrobial susceptibility features should be well identified, in order for prevention of serious complications and optimal management the condition to occur.
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Affiliation(s)
- Ayşe Özkaçmaz
- Department of Microbiology, Faculty of Medicine, Yüzüncü Yıl University, Van 65080, Turkey
| | - Yalçın Dicle
- Department of Microbiology, Faculty of Medicine, Mardin Artuklu University, Mardin 47200, Turkey
| | - Yasemin Bayram
- Department of Microbiology, Faculty of Medicine, Yüzüncü Yıl University, Van 65080, Turkey
| | - Mehmet Parlak
- Department of Microbiology, Faculty of Medicine, Yüzüncü Yıl University, Van 65080, Turkey
| | - Feride Akış
- Department of Microbiology, Cengiz Gökçek Gynecology and Pediatrics Hospital, Gaziantep 27010, Turkey
| | - İskan Çallı
- Department of General Surgery, Faculty of Medicine, Yüzüncü Yıl University, Van 65080, Turkey
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Banbury S, Gebre K, Milgraum DM, Do N, Yan AC. Incomplete Kawasaki disease presenting with a cellulitis-like plaque: Lessons from an unusual presentation. Pediatr Dermatol 2024; 41:359-361. [PMID: 38241186 DOI: 10.1111/pde.15494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/28/2023] [Indexed: 01/21/2024]
Abstract
Kawasaki disease (KD) is an acute small to medium-vessel vasculitis that primarily affects children under the age of 5 years. The cause of KD is unknown, but it is hypothesized to be a systemic inflammatory illness triggered by infections in genetically predisposed individuals. Diagnosis of incomplete KD is made in patients with prolonged fever without a source who do not meet diagnostic criteria but have some findings consistent with KD such as elevated inflammatory markers, transaminitis, and echocardiographic findings. We present a 7-year-old boy who developed 10 days of fevers and rash that began 3 days after his first dose of hepatitis A vaccination and had notable features of a peculiar cellulitis-like plaque and peripheral eosinophilia.
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Affiliation(s)
- Sara Banbury
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kirubel Gebre
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David M Milgraum
- Section of Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ngan Do
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Albert C Yan
- Section of Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Taylor E, Nailor MD, Feider M, Sullivan S, Goodlet KJ. Doxycycline versus cephalexin treatment of presumed streptococcal skin and soft tissue infection among adults presenting to the emergency department. Antimicrob Agents Chemother 2024; 68:e0128223. [PMID: 38169286 PMCID: PMC10848771 DOI: 10.1128/aac.01282-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Among 100 propensity score-matched emergency department patients receiving ≤14 days doxycycline versus cephalexin monotherapy for outpatient treatment of nonpurulent (presumed streptococcal) skin and soft tissue infection, a low rate of 14-day clinical failure was observed [6% each group; odds ratio (OR), 1.34 (0.21-8.69); P = 0.745], defined as hospital admission, i.v. antibiotic therapy, or change in oral antibiotic. Doxycycline may represent a reasonable therapeutic alternative for this indication in regions with low tetracycline resistance.
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Affiliation(s)
- Eric Taylor
- Department of Pharmacy Services, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael D. Nailor
- Department of Pharmacy Services, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michelle Feider
- Department of Pharmacy Services, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
| | - Shannon Sullivan
- Department of Pharmacy Services, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kellie J. Goodlet
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale, Arizona, USA
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12
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Yang F, Malavia M, Chali A, Keeler J. Labial Necrotizing Fasciitis Caused by Pelvic Eggerthia catenaformis Infection. Cureus 2024; 16:e53625. [PMID: 38449955 PMCID: PMC10916910 DOI: 10.7759/cureus.53625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
A patient with comorbid diabetes mellitus, obesity, and hypertension acutely presented to the ED due to labial cellulitis with rapidly progressing symptoms of systemic inflammation. Clinical examination revealed fever and groin pain that was tender to palpation. Initial contrast-enhanced CT scans showed labial cellulitis extending to the inguinal canal, with later CT imaging findings of subcutaneous air indicative of necrotizing fasciitis (NF). Antimicrobial therapy was initiated empirically and later tailored to culture antibiogram. The patient underwent acute surgical abscess drainage and tissue debridement but was transferred to the surgical intensive care unit (SICU) due to postoperative blood loss and hypotension. Two additional surgical procedures were needed before sufficient drainage was achieved, and Eggerthia catenaformis (E. catenaformis) was isolated from all samples. Due to the extent of the infection, the patient was admitted for a total of 16 days, with five days spent in the SICU. They recovered completely due to adequate surgery and antimicrobial therapy for a total of 24 days. Here, we present the third reported case of NF due to E. catenaformiswhile emphasizing timely treatment with empiric antibiotics and surgical intervention.
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Affiliation(s)
- Felix Yang
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Mira Malavia
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Ashna Chali
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Jared Keeler
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
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O'Connell R, Rogers R, Brandon I, Del Pilar Bonilla L. A Case Report of Pseudomonas Infection in a Patient With Nasal Septum Perforation, Cocaine Use Disorder, and a Perinuclear Anti-neutrophil Cytoplasmic Antibody (p-ANCA)-Positive Assay. Cureus 2024; 16:e54022. [PMID: 38476784 PMCID: PMC10928456 DOI: 10.7759/cureus.54022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/05/2024] [Indexed: 03/14/2024] Open
Abstract
Nasal septum perforation (NSP) occurs secondary to many underlying etiologies, including facial trauma, drug use, malignancy, infection, or autoimmune disease. We present the case of a 39-year-old female with a past medical history of cocaine use disorder who presented with symptoms concerning facial cellulitis unresponsive to antibiotic therapy. Physical exam and subsequent imaging revealed the presence of NSP. The patient underwent a full workup exploring potential etiologies of NSP in the setting of cocaine use disorder, with lab results indicating Pseudomonas aeruginosa and Pseudomonas putida cellulitis as well as a positive perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) assay. This case highlights the importance of maintaining a broad differential diagnosis for the etiology of NSP and avoiding anchoring bias.
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Affiliation(s)
- Rebecca O'Connell
- Internal Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Richard Rogers
- Family Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Ian Brandon
- Family Medicine, Baptist Health South Florida, Miami, USA
| | - Lorena Del Pilar Bonilla
- Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
- Internal Medicine, Baptist Health South Florida, Miami, USA
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14
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Mukherjee G, Sufcak K, Hames N, Lantis P. Bugs Behind the Bulging Eyeball: Microbiology and Antibiotic Management in Orbital Cellulitis With or Without Subperiosteal Abscess. Clin Pediatr (Phila) 2024; 63:214-221. [PMID: 37752812 DOI: 10.1177/00099228231202158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
The objective of this study is to describe causative pathogens and current antibiotic management among hospitalized children with orbital cellulitis. This retrospective study, performed at a tertiary care children's health system, included patients up to 18 years old who presented with radiographic evidence of orbital cellulitis from 2012 to 2019. Of the 298 patients included in the study, 103 had surgery and an intraoperative culture obtained. A pathogen was recovered in 86 cultures (83.5%). The most common pathogens were Streptococcus anginosus group (26.2%), Streptococcus pyogenes (11.7%), methicillin-susceptible Staphylococcus aureus (10.7%), and Streptococcus pneumoniae (9.7%). Only 8/194 (4.1%) blood cultures returned positive. Median duration of intravenous antibiotics was 4 days and median total duration was 17 days. The most common empiric regimen prescribed was ceftriaxone and clindamycin (64.1%). Despite low incidence of methicillin-resistant S aureus, empiric antibiotics often consisted of 2 antibiotics to ensure coverage for this bacterium.
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Affiliation(s)
- Gargi Mukherjee
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kristine Sufcak
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Nicole Hames
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Patricia Lantis
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta, Atlanta, GA, USA
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15
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Bowhay TR, Tsang T, Wei JCZ, Edwik W, Fridman A, Hubber J, Jo JY, Mckay N, O'Brien C, Osmond-Wallam J, Smythe J, Crump JA, Arnold B. Oral antimicrobial therapy for cellulitis versus outpatient parenteral antimicrobial therapy: a single-centre audit of cellulitis outcomes. Intern Med J 2024; 54:320-327. [PMID: 37461382 DOI: 10.1111/imj.16173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 06/05/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Cellulitis is a common acute skin and soft tissue infection that causes substantial morbidity and healthcare costs. AIMS To audit the impact on cellulitis management, regimen tolerability and outcomes of switching from outpatient parenteral antimicrobial therapy (OPAT) using intravenous (i.v.) cefazolin once daily plus probenecid to oral beta-lactam therapy (OBLT) using oral flucloxacillin plus probenecid. METHODS We undertook a retrospective audit on cellulitis management, regimen tolerability and outcomes at the Dunedin Public Hospital Emergency Department (ED) before and after a change of the local outpatient cellulitis treatment pathway from OPAT using i.v. cefazolin once daily plus probenecid to OBLT using oral flucloxacillin plus probenecid. RESULTS OPAT was used in 97/123 (78.9%) patients with cellulitis before compared to 1/70 (1.4%) after the pathway change (odds ratio (OR), 0.04, P < 0.01). OBLT was used in 26/123 (21.1%) patients with cellulitis before and 69/70 (98.6%) after (OR, 218.8, P < 0.01). Antimicrobial change due to intolerance occurred in 4/123 (3.2%) patients with cellulitis before and 4/70 (5.7%) after (OR, 1.8, P, not significant (NS)) the pathway change. Inpatient admission within 28 days occurred in 15/123 (12.2%) cellulitis patients before and 9/70 (12.9%) after (OR, 1.1, P, NS) the pathway change. CONCLUSIONS Implementation of a change in outpatient cellulitis treatment pathway resulted in a significant change in prescribing practice. Our findings suggest that OBLT was both tolerable and had similar outcomes to OPAT.
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Affiliation(s)
- Thomas R Bowhay
- Dunedin Public Hospital, Te Whatu Ora (Health New Zealand) Southern, Dunedin, New Zealand
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Tiffany Tsang
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jeremy C Z Wei
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Wafa Edwik
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Avi Fridman
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Julia Hubber
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jae Y Jo
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Nicole Mckay
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Catherine O'Brien
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Joe Osmond-Wallam
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - James Smythe
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Brendan Arnold
- Dunedin Public Hospital, Te Whatu Ora (Health New Zealand) Southern, Dunedin, New Zealand
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16
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Dinkar A, Singh J, Yadav M. Leptospirosis Associated Digital Gangrene of Lower Extremities: Two Cases and Review of Literature. Infect Disord Drug Targets 2024; 24:IDDT-EPUB-137642. [PMID: 38265373 DOI: 10.2174/0118715265256882231128074609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Leptospirosis is the most common zoonotic illness worldwide, caused by pathogenic spirochete bacteria called Leptospira. It is clinically presented with mild to moderate in most cases. However, sometimes, the course may be severe with multiorgan dysfunction. CASE PRESENTATION We present two rare cases of leptospirosis with peripheral dry gangrene of the lower extremities. A 25-year-old male, farmer by occupation without any significant past medical history had been diagnosed with a case of leptospirosis that complicated to digital gangrene on 15 days of illness during hospitalization. Another 21-year-old male student was admitted for leptospirosis and developed digital gangrene on 19 days of illness. All clinical findings were resolved on the steroid. CONCLUSION Apart from a high index of suspicion and awareness of unusual manifestations, serology plays a vital role in making an accurate and quick diagnosis to initiate appropriate therapy.
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Affiliation(s)
- Anju Dinkar
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Jitendra Singh
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mahima Yadav
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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17
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Shah P, Hanson M, Waller JL, Tran S, Baer SL, Taskar V, Bollag WB. The Assessment of Infection Risk in Patients with Vitiligo Undergoing Dialysis for End-Stage Renal Disease: A Retrospective Cohort Study. Pathogens 2024; 13:94. [PMID: 38276167 PMCID: PMC10821439 DOI: 10.3390/pathogens13010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Vitiligo is an autoimmune condition that causes patchy skin depigmentation. Although the mechanism by which vitiligo induces immunocompromise is unclear, other related autoimmune diseases are known to predispose those affected to infection. Individuals with vitiligo exhibit epidermal barrier disruption, which could potentially increase their susceptibility to systemic infections; patients with renal disease also show a predisposition to infection. Nevertheless, there is little research addressing the risk of infection in dialysis patients with vitiligo in comparison to those without it. A retrospective analysis was performed on patients with end-stage renal disease (ESRD) in the United States Renal Data System who started dialysis between 2004 and 2019 to determine if ESRD patients with vitiligo are at an increased risk of bacteremia, cellulitis, conjunctivitis, herpes zoster, or septicemia. Multivariable logistic regression modeling indicated that female sex, black compared to white race, Hispanic ethnicity, hepatitis C infection, and tobacco use were associated with an enhanced risk of vitiligo, whereas increasing age and catheter, versus arteriovenous fistula, and access type were associated with a decreased risk. After controlling for demographics and clinical covariates, vitiligo was found to be significantly associated with an increased risk of bacteremia, cellulitis, and herpes zoster but not with conjunctivitis and septicemia.
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Affiliation(s)
- Pearl Shah
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (P.S.); (M.H.); (S.T.); (S.L.B.); (V.T.)
| | - Mitchell Hanson
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (P.S.); (M.H.); (S.T.); (S.L.B.); (V.T.)
| | - Jennifer L. Waller
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA;
| | - Sarah Tran
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (P.S.); (M.H.); (S.T.); (S.L.B.); (V.T.)
| | - Stephanie L. Baer
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (P.S.); (M.H.); (S.T.); (S.L.B.); (V.T.)
- Charlie Norwood VA Medical Center, Augusta, GA 30904, USA
| | - Varsha Taskar
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (P.S.); (M.H.); (S.T.); (S.L.B.); (V.T.)
| | - Wendy B. Bollag
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA; (P.S.); (M.H.); (S.T.); (S.L.B.); (V.T.)
- Charlie Norwood VA Medical Center, Augusta, GA 30904, USA
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA
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18
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Subramanyam C, Becker A, Rizzo J, Afzal N, Nong Y, Sivamani R. Visibility of Board-Certified Dermatologists on TikTok. JMIR Dermatol 2024; 7:e46085. [PMID: 38180786 PMCID: PMC10799275 DOI: 10.2196/46085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/13/2023] [Accepted: 10/01/2023] [Indexed: 01/06/2024] Open
Abstract
Tik Tok is an emerging social media platform that provides a novel opportunity for health practitioners such as dermatologists to disseminate accurate health information.
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Affiliation(s)
- Chaitra Subramanyam
- College of Osteopathic Medicine of the Pacific Northwest, Western University of Health Sciences, Lebanon, OR, United States
| | - Alyssa Becker
- John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Julianne Rizzo
- College of Medicine, University of California Davis, Sacramento, CA, United States
| | - Najiba Afzal
- College of Medicine, University of California Davis, Sacramento, CA, United States
| | - Yvonne Nong
- College of Human Medicine, Michigan State University, Flint, MI, United States
| | - Raja Sivamani
- Pacific Skin Institute, Sacramento, CA, United States
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19
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Masarweh OM, Saad-Omer S, Rohr M, Meda N, Brenner N. Methicillin-Resistant Staphylococcus aureus Cellulitis Causing Meningitis From Hematogenous Dissemination: A Case Report. Cureus 2024; 16:e52969. [PMID: 38406170 PMCID: PMC10894443 DOI: 10.7759/cureus.52969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Methicillin-resistant Staphylococcus aureus meningitis is commonly associated with surgical procedures that closely interact with the central nervous system; however, hematogenous spread via bacteremia is rarely reported. Here, we present a case of methicillin-resistant Staphylococcus aureus meningitis as a complication of a diabetic foot infection that disseminated into a bloodstream infection causing infective endocarditis, discitis, vertebral osteomyelitis, and meningitis that was successfully treated with intravenous daptomycin and rifampin.
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Affiliation(s)
- Omar M Masarweh
- Internal Medicine, University of Central Florida, Kissimmee, USA
| | - Suhail Saad-Omer
- Internal Medicine, University of Central Florida, Kissimmee, USA
| | - Michael Rohr
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Neha Meda
- Internal Medicine, University of Central Florida, Kissimmee, USA
| | - Nicole Brenner
- Internal Medicine, University of Central Florida, Kissimmee, USA
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20
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Arora S, Rai V, Tripathi D, Chaudhary SM, Singh A, Chowdary M. Osteomyelitis Masquerading as Cellulitis: A Case Report. Cureus 2024; 16:e53238. [PMID: 38425588 PMCID: PMC10903755 DOI: 10.7759/cureus.53238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Osteomyelitis, a significant global healthcare issue, often results from infections related to open fractures, surgery, or conditions like diabetic foot ulcers. This report describes a case of osteomyelitis in a 62-year-old female with various pre-existing health conditions. The patient initially presented with swelling, pain, and difficulty walking in the right lower extremity, accompanied by systemic symptoms. Despite an initial diagnosis of cellulitis and treatment with ceftriaxone, a subsequent CT scan revealed a pretibial abscess and confirmed osteomyelitis caused by pan-sensitive Escherichia coli. Surgical debridement was performed, and the patient received six weeks of intravenous antibiotics. Hence, a heightened level of suspicion is essential to facilitate a timely diagnosis of osteomyelitis and enhance long-term prognosis. The case underscores the importance of a multidisciplinary approach, including meticulous surgical intervention and tailored antimicrobial therapy, in achieving positive outcomes for osteomyelitis patients.
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Affiliation(s)
- Sanjiya Arora
- Internal Medicine, Sub-Divisional Hospital (SDH) cum Civil Hospital, Fatehabad, IND
| | - Vikramaditya Rai
- Orthopedics, Dr. Rajendra Prasad Government Medical College & Hospital, Kangra, IND
| | | | - Sachin M Chaudhary
- Internal Medicine, Gujarat Cancer Society (GCS) Medical College, Hospital and Research Centre, Ahmedabad, IND
| | - Ajay Singh
- Internal Medicine, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, IND
| | - Mohitha Chowdary
- Internal Medicine, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, IND
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21
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Momin RI, Baer SL, Waller JL, Young L, Tran S, Taskar V, Bollag WB. Atopic Dermatitis and the Risk of Infection in End-Stage Renal Disease. Medicina (Kaunas) 2023; 59:2145. [PMID: 38138248 PMCID: PMC10744789 DOI: 10.3390/medicina59122145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/24/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Atopic dermatitis (AD), also known as eczema, is a common chronic inflammatory skin condition affecting 16.5 million adults in the United States. AD is characterized by an impaired epidermal barrier that can predispose individuals to infection. End-stage renal disease (ESRD) is also commonly complicated by infections due to chronic vascular access and immune-system dysfunction, possibly related to uremia. Multiple studies have reported that renal disease is a common comorbidity in adults with atopic dermatitis. The aim of this study was to determine whether AD is a risk factor for certain infections in patients with ESRD. Materials and Methods: Using the United States Renal Data System, a retrospective cohort analysis was conducted on adult ESRD patients initiating dialysis between 2004 and 2019 to investigate associations between infections and AD in this population. Results: Of 1,526,266 patients, 2290 were identified with AD (0.2%). Infectious outcomes of interest were bacteremia, septicemia, cellulitis, herpes zoster, and conjunctivitis. In all infectious outcomes except for conjunctivitis, patients with the infectious outcomes were more likely to carry a diagnosis of AD. After controlling for demographic and clinical covariates, AD was associated with an increased risk of cellulitis (adjusted relative risk (aRR) = 1.39, 95% confidence interval (CI) = 1.31-1.47) and herpes zoster (aRR = 1.67, CI = 1.44-1.94), but not with bacteremia (aRR = 0.96, CI = 0.89-1.05), septicemia (aRR = 1.02, CI = 0.98-1.08), or conjunctivitis (aRR = 0.97, CI = 0.740-1.34). Conclusions: Overall, after controlling for demographic and clinical covariates and adjusting for person-years-at-risk, AD was associated with an increased risk for some, but not all, infections within the population of patients with ESRD.
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Affiliation(s)
- Rushan I. Momin
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (R.I.M.); (S.L.B.); (J.L.W.); (S.T.); (V.T.)
| | - Stephanie L. Baer
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (R.I.M.); (S.L.B.); (J.L.W.); (S.T.); (V.T.)
- Charlie Norwood Department, Veterans Affairs Medical Center, Augusta, GA 30904, USA
| | - Jennifer L. Waller
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (R.I.M.); (S.L.B.); (J.L.W.); (S.T.); (V.T.)
| | - Lufei Young
- School of Nursing at UNC Charlotte, University of North Carolina Charlotte, Charlotte, NC 28223, USA
| | - Sarah Tran
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (R.I.M.); (S.L.B.); (J.L.W.); (S.T.); (V.T.)
| | - Varsha Taskar
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (R.I.M.); (S.L.B.); (J.L.W.); (S.T.); (V.T.)
| | - Wendy B. Bollag
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (R.I.M.); (S.L.B.); (J.L.W.); (S.T.); (V.T.)
- Charlie Norwood Department, Veterans Affairs Medical Center, Augusta, GA 30904, USA
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22
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Sarathi S, Brahma A, Das PK, Mahapatra A, Behera B. Edwardsiella tarda Causing Fishbone Injury Cellulitis Leading to Sepsis in a Case of Hematological Malignancy-A Rare Report and Review of Literature. J Lab Physicians 2023; 15:602-607. [PMID: 37780878 PMCID: PMC10539073 DOI: 10.1055/s-0043-1770930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/18/2023] [Indexed: 10/03/2023] Open
Abstract
Edwardsiella tarda ( E. tarda ), a gram-negative bacillus, a member of order Enterobacterales , is typically a fish pathogen frequently isolated from fresh and brackish water environments. It is very rarely implicated in human infections such as gastroenteritis (most common), cellulitis, gas gangrene, hepatobiliary infections, peritonitis, empyema, and meningitis. Bacteremia/sepsis caused by E. tarda can be fatal in humans, although very rare (<5%). To date, very few cases of E. tarda sepsis have been reported worldwide including India. We report a rare case of cellulitis caused by E. tarda following fishbone injury in a patient with underlying hematological malignancy leading to sepsis.
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Affiliation(s)
- Sushree Sarathi
- Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Anupam Brahma
- Department of Hematooncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prabodha Kumar Das
- Department of Hematooncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ashoka Mahapatra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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23
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Yavuz L, Alhammadi M, Musa R, Hamdi M, Aldirawi M. A Rare Infection of Chromobacterium violaceum in an Immunocompetent Patient: A Case Report. Cureus 2023; 15:e51148. [PMID: 38283453 PMCID: PMC10811561 DOI: 10.7759/cureus.51148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/30/2024] Open
Abstract
Chromobacterium violaceum is a motile gram-negative bacillus. It lives in water and soil and rarely causes infection in immune-competent patients. It does not respond to the classical treatment and can cause a rapid and progressive illness. Hence, it should be considered in severe infection. Physicians are not generally aware of this organism as a possible cause of infection, and this increases the risk of mortality. Here, we described a case of a 17-year-old previously healthy girl who had severe necrotic cellulitis that progressed and spread rapidly over a few days despite the treatment with antibiotics. It started after a few days of swimming in a swimming pool. She was treated successfully with a broad spectrum of antibiotics and discharged home.
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Affiliation(s)
- Lemis Yavuz
- Department of Pediatrics, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Moza Alhammadi
- Department of Pediatrics, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Rehab Musa
- Department of Pediatrics, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Moataz Hamdi
- Department of Pediatrics, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | - Mohammed Aldirawi
- Department of Pediatrics, Al Jalila Children's Speciality Hospital, Dubai, ARE
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24
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Sheth MA. Fifth-Generation Cephalosporins Is Not Spared From Drug-Induced Liver Injury. Cureus 2023; 15:e50268. [PMID: 38196441 PMCID: PMC10775736 DOI: 10.7759/cureus.50268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/11/2024] Open
Abstract
Ceftaroline fosamil is a fairly new parenteral cephalosporin antibacterial approved by the US Food and Drug Administration (FDA) for use in the treatment of acute bacterial skin and skin structure infections (ABSSSI). Drug-induced liver injury (DILI) is an important side effect profile to consider with antibiotic use. This case reports DILI in a previously healthy individual associated with a widely used antibiotic, ceftaroline, after only two doses. Discontinuation of the ceftaroline resulted in a resolution of DILI in a three-week period. Ceftaroline-induced liver injury is highlighted in this case report, along with a discussion of how we excluded other potential factors that can cause liver injury with the use of the Roussel Uclaf Causality Assessment Method (RUCAM) score. We also explained why other causes like hemochromatosis, Wilson's disease, celiac disease, and thyroid disease were unlikely.
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Affiliation(s)
- Monish A Sheth
- Internal Medicine, Baylor College of Medicine, Temple, USA
- Internal Medicine, Baylor Scott & White Medical Center - Temple, Temple, USA
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25
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Fernández Vecilla D, Aspichueta Vivanco C, Ugalde Zárraga E, Díaz de Tuesta Del Arco JL. Wound infection caused by Pasteurella canis and Neisseria animaloris after a dog bite. Rev Esp Quimioter 2023; 36:635-637. [PMID: 37772341 DOI: 10.37201/req/035.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Affiliation(s)
- D Fernández Vecilla
- Domingo Fernández Vecilla, Clinical Microbiology and Parasitology. Hospital Universitario de Basurto. Avenida Montevideo nº18, Gurtubay pavilion, 3rd floor. Postal code: 48013, Bilbao (Basque country). Spain.
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Subramanian P, Bhosale NK, Easow JM, Chandramouli C, Chenthil KS. Ochrobactrum intermedium septicemia. J Infect Dev Ctries 2023; 17:1636-1640. [PMID: 38064389 DOI: 10.3855/jidc.17185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/10/2023] [Indexed: 12/18/2023] Open
Abstract
Ochrobactrum species are emerging Gram-negative, non-fermenting bacteria with low virulence. Infection with the Ochrobactrum species is commonly nosocomial and has been reported in patients with indwelling medical devices and implants. Among the species of Ochrobactrum infecting humans, Ochrobactrum anthropic and Ochrobactrum intermedium are the commonest ones. We present a case of septicemia caused by Ochrobactrum intermedium in a 75-year-old patient with lower limb cellulitis. This report describes the epidemiology, clinical manifestations, laboratory diagnosis, antibiotic susceptibility pattern, and treatment of Ochrobactrum infections.
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Affiliation(s)
- Pramodhini Subramanian
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
| | - Namrata K Bhosale
- Department of Microbiology, Vinayaka Mission's Medical College and Hospital, Vinayaka Mission's Research Foundation (Deemed to be University), Karaikal, Puducherry, India
| | - Joshy M Easow
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
| | - Chandni Chandramouli
- Department of Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
| | - K S Chenthil
- Department of Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India
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Li F, Wu M, Wu P, Tang D. Foam sclerotherapy for patients with Klipple-Trenaunary syndrome complicated by frequent cellulitis of lower extremity: A case report. Medicine (Baltimore) 2023; 102:e36011. [PMID: 37986390 PMCID: PMC10659712 DOI: 10.1097/md.0000000000036011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023] Open
Abstract
RATIONALE Klipple-Trenaunary Syndrome (KTS) complicated by frequent cellulitis of lower extremity seriously affects a patient quality of life. The hemodynamic characteristics of the disease are still unclear. Direct skin incision or puncture to remove malformed veins at the lesion site carries the risk of non-healing of the surgical incision. Our aim is to explore initial management strategies based on the hemodynamic characteristics of this disease. PATIENT CONCERNS A 29-year-old Manchu man was affected by KTS from childhood, characterized by an increase of the circumference and superficial varicose veins of the lower extremity. In the past 5 years, he suffered from frequent cellulitis in the left leg every 15 days or so. DIAGNOSES KTS complicated by frequent cellulitis of lower extremity. INTERVENTIONS The clinical and hemodynamic characteristics of KTS were evaluated by Doppler ultrasonography (DUS) combined with CT venography (CTV), and foam sclerotherapy and postoperative elastic bandage compression were performed accordingly. OUTCOMES Based on evaluations, the reason for frequent cellulitis was the continuous increase of venous hypertension in the calf caused by the malformed superficial vein and its penetrating vein. After 3 operations, the patient had no recurrence of cellulitis of the leg. Follow-up for 1 year showed no recurrence of left leg cellulitis. LESSONS This report emphasizes that foam sclerotherapy can significantly improve the clinical symptoms of KTS, such as cellulitis, and provide a safe skin environment for the implementation of other surgical methods, based on the evaluation of the pathological characteristics of KTS by DUS combined with CTV.
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Affiliation(s)
- Fandong Li
- Department of Vascular Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mengtao Wu
- Department of Vascular Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Peng Wu
- Department of Vascular Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Dianjun Tang
- Department of Vascular Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Pearce J, Hadcocks L, Mansour S, van Zanten M, Jeffery S, Gordon K, Ostergaard P, Mortimer P, Macallan DC. Profound and selective lymphopaenia in primary lymphatic anomaly patients demonstrates the significance of lymphatic-lymphocyte interactions. Front Immunol 2023; 14:1279077. [PMID: 38022535 PMCID: PMC10656747 DOI: 10.3389/fimmu.2023.1279077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The lymphatic system has a pivotal role in immune homeostasis. To better understand this, we investigated the impact of Primary Lymphatic Anomalies (PLA) on lymphocyte numbers and phenotype. Methods The study comprised (i) a retrospective cohort: 177 PLA subjects from the National Primary Lymphatic Anomaly Register with clinical and laboratory data, and (ii) a prospective cohort: 28 patients with PLA and 20 healthy controls. Patients were subdivided using established phenotypic diagnostic categories and grouped into simplex (localised tissue involvement only) and systemic (involvement of central lymphatics). Further grouping variables included genital involvement and the likelihood of co-existent intestinal lymphangiectasia. Haematology laboratory parameters were analysed in both cohorts. In the prospective cohort, prospective blood samples were analysed by flow cytometry for markers of proliferation, differentiation, activation, skin-homing, and for regulatory (CD4+Foxp3+) T cells (Treg). Results In patients with PLA, lymphopaenia was frequent (22% of subjects), affected primarily the CD4+ T cell subset, and was more severe in subjects with systemic versus simplex patterns of disease (36% vs 9% for lymphopaenia; 70% vs 33% for CD4+ cells). B cells, NK cells and monocytes were better conserved (except in GATA2 deficiency characterised by monocytopaenia). Genital oedema and likelihood of concomitant intestinal lymphangiectasia independently predicted CD4+ T cell depletion. Analysing CD4+ and CD8+ T cells by differentiation markers revealed disproportionate depletion of naïve cells, with a skewing towards a more differentiated effector profile. Systemic PLA conditions were associated with: increased expression of Ki67, indicative of recent cell division, in naïve CD4+, but not CD8+ T cells; increased levels of activation in CD4+, but not CD8+ T cells; and an increased proportion of Treg. Skin-homing marker (CCR10, CLA and CCR4) expression was reduced in some patients with simplex phenotypes. Discussion Patients with PLA who have dysfunctional lymphatics have a selective reduction in circulating lymphocytes which preferentially depletes naïve CD4+ T cells. The presence of systemic disease, genital oedema, and intestinal lymphangiectasia independently predict CD4 lymphopaenia. The association of this depletion with immune activation and increased circulating Tregs suggests lymphatic-lymphocyte interactions and local inflammatory changes are pivotal in driving immunopathology.
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Affiliation(s)
- Julian Pearce
- Lymphovascular Research Unit, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, United Kingdom
- Dermatology and Lymphovascular Medicine, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Linda Hadcocks
- Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
| | - Sahar Mansour
- Lymphovascular Research Unit, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, United Kingdom
- Dermatology and Lymphovascular Medicine, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
- South West Thames Regional Centre for Genomics, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Malou van Zanten
- Lymphovascular Research Unit, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, United Kingdom
| | - Steve Jeffery
- Lymphovascular Research Unit, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, United Kingdom
| | - Kristiana Gordon
- Dermatology and Lymphovascular Medicine, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Pia Ostergaard
- Lymphovascular Research Unit, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, United Kingdom
| | - Peter Mortimer
- Lymphovascular Research Unit, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, United Kingdom
- Dermatology and Lymphovascular Medicine, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Derek C. Macallan
- Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
- Infection and Immunity Clinical Academic Group, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
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Yin R, Jiang J, Wang Y, Jin Y, Qian E, Yue C, Jiang C, Wang M, Xu K, Zhou X, Hou W. Comparing Oral Versus Intravenous Antibiotics Administration for Cellulitis Infection: Protocol for a Systematic Review and Meta-Analysis. JMIR Res Protoc 2023; 12:e48342. [PMID: 37921834 PMCID: PMC10656654 DOI: 10.2196/48342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Cellulitis is defined as an infection of the skin that is usually characterized by localized but poorly demarcated areas of erythema, swelling, and pain. Erysipelas is a subtype of cellulitis that is characterized by a more superficial infection, often involving the face. Because gram-positive bacteria are the most common infective agent, beta-lactam antibiotics such as cephalosporins are commonly used. However, guidelines and physician preference vary widely as different antibiotic options and routes of administration exist, in addition to the fact that most cases are treated empirically without microbiological lab guidance. This lack of standardization in evidence, guidelines, and physician practice prompted this systematic review and meta-analysis of both randomized trial data and cohort studies to aggregate the currently available evidence for the optimal routes of antibiotic administration in cellulitis treatment. OBJECTIVE The primary objective of our review is to compare the efficacy of oral versus intravenous antibiotic administration for cellulitis infections, thereby providing clinicians with evidence-based guidelines for treatment. METHODS We will search MEDLINE, Embase, and CENTRAL through Ovid as well as Web of Science and CINAHL for all available literature comparing different routes of antibiotic administration in the treatment of cellulitis and erysipelas. We will perform title and abstract as well as full-text screening in duplicate according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines and then extract the relevant data using a prepiloted data sheet. The primary outcome for our review is the duration of infection resolution, and secondary outcomes such as incidence of sepsis, mortality, hospital admission, and Clostridium difficile infection. We will assess the risk of bias in our included studies using the RoB 2.0 (revised tool for Risk of Bias in randomized trials) and ROBINS-I (Risk of bias in non-randomized studies for interventions) tools, with a final quality assessment using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework and a sensitivity analysis to examine heterogeneity. RESULTS We will publish the final results of our systematic review in a peer-reviewed academic journal. This project received no funding or financial assistance. Data analysis is currently underway, and the results are expected to be submitted for publication in late November 2023. CONCLUSIONS To our knowledge, this will be the most up-to-date review of the best available evidence comparing different routes of antibiotic administration for cellulitis. Because of the vast selection of antibiotic options available and the empirical nature of the treatment, we anticipate heterogeneity within our data but nonetheless hope to provide aggregated evidence on the efficacy of intravenous versus oral administration of antibiotics in cellulitis treatment. We hope the results from this study will better inform physician practices in the future for cellulitis infections. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/48342.
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Affiliation(s)
- Raymond Yin
- Faculty of Science, University of Western Ontario, London, ON, Canada
| | - Jingyi Jiang
- Faculty of Science, University of Toronto, Toronto, ON, Canada
| | - Yiyang Wang
- College of Life Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Yuhao Jin
- Faculty of Science, University of Western Ontario, London, ON, Canada
| | - Eric Qian
- Emory University, Atlanta, GA, United States
| | - Chenyang Yue
- Faculty of Science, York University, Toronto, ON, Canada
| | - Coco Jiang
- Faculty of Science, University of Toronto, Toronto, ON, Canada
| | - Michelle Wang
- Faculty of Science, University of Toronto, Toronto, ON, Canada
| | - Kylie Xu
- Faculty of Science, Dawson College, Montreal, QC, Canada
| | - Xiaoyuan Zhou
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Winston Hou
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Hailu Wondafrash A, Laifa Lima U, Abebe D, Negash KS. Incidence and Causes of Cellulitis Among Patients at Tupua Tamasese Meaole Hospital in Upolu, Samoa in 2019. Cureus 2023; 15:e48318. [PMID: 38058333 PMCID: PMC10697806 DOI: 10.7759/cureus.48318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE To study the incidence and causes of cellulitis in patients who visited the only tertiary hospital in Samoa, i.e., Tupua Tamasese Meaole (TTM) Hospital, in 2019. METHOD Of the total of 14,198 patients who presented to TTM Hospital in 2019, a chart review of all 258 patients who presented with cellulitis was conducted. All charts with the final primary admitting diagnosis of cellulitis were extracted. No exclusion criteria were employed, and raw data were analyzed manually. RESULTS Of the 14,198 patients who sought care at TTM Hospital in 2019, 258 patients received care for cellulitis. This represents an incidence rate of 1.8%. Most patients were male (62.4%). Those in the age group of 41 to 80 years old accounted for 79.5% of the total. The leg (94.6%) was the major site of infection. Of those who had blood cultures drawn, 76.4% had negative results. Of the 56 patients with positive microbial growth, Staphylococcus and Streptococcus species accounted for a combined total of 71.4% of the cases. The mainstay of antibiotic treatment was flucloxacillin alone or in conjunction with other antibiotics (92.2%). Of the many comorbidities affecting patients, diabetes (44.2%) was the most prevalent. Hospital admission, ranging from three to 10 days was needed in 63.5% of patients. CONCLUSION The incidence rate of cellulitis at TTM in 2019 was 1.8%, which was marginally higher than noted in other parts of the world. Male patients and people over the age of 40 years are affected the most. The leg is affected the most mainly by Staphylococcus and Streptococcus species. Flucloxacillin is the main antibiotic used to treat cellulitis at the TTM Hospital. From the data analyses, it is inferred that a large proportion of patients who presented had moderate to severe cellulitis.
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Affiliation(s)
| | - Uila Laifa Lima
- Department of Medicine, Oceania University of Medicine, Apia, WSM
| | - Degu Abebe
- Department of Medicine, Oceania University of Medicine, Apia, WSM
| | - Kidus S Negash
- Department of Medicine, Hayat Medical College, Addis Ababa, ETH
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Cucka B, Biglione B, Xia J, Tan AJ, Chand S, Rrapi R, El Saleeby C, Kroshinsky D. Complicated Cellulitis is an Independent Predictor for Increased Length of Stay in the Neonatal Intensive Care Unit. J Pediatr 2023; 262:113581. [PMID: 37353147 DOI: 10.1016/j.jpeds.2023.113581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/23/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To assess cellulitis in the neonatal intensive care unit (NICU) setting and identify risk factors for its disease severity and whether cellulitis influences length of stay (LOS). STUDY DESIGN In this retrospective study, patients with cellulitis were identified using the electronic health record while admitted to the NICU at Massachusetts General for Children from January 2007 to December 2020. Demographic and clinical data were extracted from patient records. Two multivariable logistic regression models were constructed to assess for independent predictors for increased LOS (≥30 days) and complicated cellulitis in the hospital. RESULTS Eighty-four patients met the study criteria; 46.4% were older than 14 days at the time of diagnosis of cellulitis, 61.9% were non-White, and 83.3% were born prematurely; 48.8% had complicated cellulitis as defined by overlying hardware (41.7%), sepsis (7.1%), requirement for broadened antibiotic coverage (7.1%), bacteremia (4.8%), and/or abscess (3.6%). The mean hospital LOS was 58.5 ± 36.1 days SD, with 72.6% having a LOS greater than 30 days. Independent predictors of increased LOS were extreme prematurity (<28 weeks' gestation) (OR: 14.7, P = .03), non-White race (OR: 5.7, P = .03), and complicated cellulitis (OR: 6.4, P = .03). No significant predictors of complicated cellulitis were identified. CONCLUSIONS This study identifies complicated cellulitis in the NICU as an independent predictor of increased hospital LOS in neonates. Implementation of strategies to mitigate the development of cellulitis may decrease LOS among this high-risk population.
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Affiliation(s)
- Bethany Cucka
- Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Bianca Biglione
- Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Joyce Xia
- Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Alice J Tan
- Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Sidharth Chand
- Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Renajd Rrapi
- Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Chadi El Saleeby
- Divisions of Hospital Medicine and Infectious Disease, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA; Harvard Medical School, Boston, MA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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Blanes Hernández R, Rodríguez Pérez M, Fernández Navarro J, Salavert Lletí M. Current approach to skin and soft tissue infections. Thinking about continuity of care. Rev Esp Quimioter 2023; 36 Suppl 1:37-45. [PMID: 37997870 PMCID: PMC10793549 DOI: 10.37201/req/s01.10.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Skin and soft tissue infections are a common reason for patients seeking inpatient and outpatient medical care. Surgery is an essential part of managing in many episodes. Careful evaluation of antibiotic therapy could help clinicians in early identification to patients with treatment failure and to consider an alternative approach or a new surgical revision in "focus control". With the arrival of new drugs, there is a need to refine the appropriate drug's decision-making. Drugs with a long half-life (long-acting lipoglycopeptides such as dalbavancin or oritavancin), which allows weekly administration (or even greater), can reduce hospital admission and length of stay with fewer healthcare resources through outpatient management (home hospitalization or day hospitals). New anionic fluoroquinolones (e.g. delafloxacin), highly active in an acidic medium and with the possibility of switch from the intravenous to the oral route, will also make it possible to achieve these new healthcare goals and promote continuity of care. Therefore, management should rely on a collaborative multidisciplinary group with experience in this infectious syndrome.
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Affiliation(s)
| | | | | | - M Salavert Lletí
- Miguel Salavert Lletí. Unidad de Enfermedades Infecciosas (Infectious Diseases Unit). Área Clínica Médica. Hospital Universitario y Politécnico La Fe, Valencia. Av. Fernando Abril Martorell, nº 106; 46026-Valencia. (Spain). /
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Anil A, Kumar MB, Chauhan S, Ray P, Dahiya D, Angrup A. A fatal case of Aeromonas jandaei necrotizing fasciitis. Access Microbiol 2023; 5:000636.v4. [PMID: 37970078 PMCID: PMC10634483 DOI: 10.1099/acmi.0.000636.v4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/17/2023] [Indexed: 11/17/2023] Open
Abstract
Introduction Necrotizing soft tissue infections (NSTIs) are associated with a fulminating course because of their rapid destruction of tissue planes underlying the skin. Aeromonas -associated monomicrobial NSTIs are usually associated with exposure to fresh water, particularly among agricultural workers and fish handlers. Albeit uncommon in incidence, urgent medical and surgical intervention are required once a diagnosis has been made. Case report A 40-year-old male patient, a known case of alcoholic liver disease, presented to the emergency department with pain and diffuse swelling of bilateral lower limbs, which quickly progressed to form blackish discolouration and blebs. Blood for preliminary haematological and biochemical investigations, as well as fluid draining from blebs, were sent for microbiological investigation. The Gram stain revealed occasional neutrophils and Gram-negative bacilli, and pure growth in aerobic culture was identified as Aeromonas jandaei by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). The patient was started on empirical antimicrobials, although lesions continued to progress and he ultimately succumbed within 12 h of hospital admission. Conclusion As appropriate antimicrobial therapy and early surgical intervention are required for management of the same, occupational exposure and the fulminant course should raise suspicion of Aeromonas -associated infections.
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Affiliation(s)
- Anjali Anil
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mani Bhushan Kumar
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sachin Chauhan
- Department of General Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Divya Dahiya
- Department of General Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Archana Angrup
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Dolapsakis C, Charalampidis C, Kkirgia M, Kollia P. First Case of Zoonotic Transmission of Streptococcus equi Subspecies zooepidemicus From Cat to Human. Cureus 2023; 15:e46306. [PMID: 37916256 PMCID: PMC10616676 DOI: 10.7759/cureus.46306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/03/2023] Open
Abstract
Streptococcus equi subspecies zooepidemicus is a pathogen of veterinary interest that causes disease in horses, pigs, and dogs and is recognized as an emerging cause of feline respiratory disease. Human zoonotic disease is rare but can occur in patients who are taking care of horses and via consumption of unpasteurized animal products. We describe a case of soft tissue infection and bacteremia in an elderly patient who had contact with a cat presenting respiratory symptoms and was treated with antibiotics. To the best of our knowledge, this is the first description of cat-to-human transmission of Streptococcus zooepidemicus.
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Affiliation(s)
- Christodoulos Dolapsakis
- Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, GRC
| | - Charalampos Charalampidis
- Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, GRC
| | - Maria Kkirgia
- Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Pinelopi Kollia
- Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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Ethridge BA, Dixon CJ, Vu PQ, Steadman MB, Tillman AP, Barefield NS, Ragan MC. Unusual Presentation of Coxsackievirus B and Methicillin-Sensitive Staphylococcus aureus Cellulitis Causing Sepsis. Cureus 2023; 15:e47826. [PMID: 38021765 PMCID: PMC10679847 DOI: 10.7759/cureus.47826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
The clinical association between Coxsackievirus B (CVB) and methicillin-sensitive Staphylococcus aureus (MSSA) has not been well established in the current literature. Here, we report a case of a 29-year-old male who presented with fever and malaise 24 hours after noticing a pruritic lesion on the anterior foreleg that resembled a mosquito bite. After multiple ED visits, laboratory studies, and imaging tests, the patient was admitted for treatment of high fevers and pancytopenia. The final diagnosis was viral sepsis complicated by co-infection with MSSA.
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Affiliation(s)
- Britton A Ethridge
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Cory J Dixon
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Paul Q Vu
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Michael B Steadman
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Aaron P Tillman
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Natalie S Barefield
- Department of Primary Clinical Skills, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Matthew C Ragan
- Department of Obstetrics and Gynecology, Aventa Specialized Women's Care, Dothan, USA
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Williams OM, Hamilton F, Brindle R. The Natural History of Antibiotic-Treated Lower Limb Cellulitis: Analysis of Data Extracted From a Multicenter Clinical Trial. Open Forum Infect Dis 2023; 10:ofad488. [PMID: 37849504 PMCID: PMC10578506 DOI: 10.1093/ofid/ofad488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
Background Although cellulitis is a relatively common skin infection, there remains uncertainty about management, particularly the length and route of antimicrobials required. Further information on the symptomatology and biomarker changes associated with cellulitis over time would guide clinicians and patients as to the expected natural history. Methods We extracted data from a randomized clinical trial (NCT01876628) of clindamycin as adjunctive therapy in cellulitis to illustrate the evolution of local parameters (pain, swelling, local erythema, and warmth) and the resolution of biomarkers over time. Results Data from 247 individuals with mild to moderate unilateral lower limb cellulitis, who attended at least 1 face-to-face interview following recruitment, were used to examine response dynamics. Although there was a local improvement in swelling, warmth, erythema, and pain by day 5 compared with baseline, some individuals still had evidence of local inflammation at 10 days. Most biomarkers demonstrated a return to normal by day 3, although the initial fall in albumin only returned to baseline by day 10. Conclusions Although there was initial resolution, a significant number of individuals still had local symptoms persisting to day 10 and beyond. Clinicians can use these data to reassure themselves and their patients that ongoing local symptoms and signs after completion of antibiotic treatment do not indicate treatment failure or warrant extension of the initial antibiotic treatment or a change in antibiotic class or mode of administration.
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Affiliation(s)
- O Martin Williams
- UK Health Security Agency Microbiology Laboratory Services Bristol, Bristol Royal Infirmary, Bristol, UK
- University Hospitals and Weston NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
| | - Fergus Hamilton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Infection Sciences, North Bristol NHS Trust, Bristol, UK
| | - Richard Brindle
- School of Clinical Services, University of Bristol, Bristol, UK
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Mukhtar M, Khan B, Mukhtar N. Disposable Barrel Used for Easy and Fast Toe Space Examination. J Cutan Aesthet Surg 2023; 16:355-356. [PMID: 38314370 PMCID: PMC10833485 DOI: 10.4103/jcas.jcas_92_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Chronic candidiasis with bacterial infection is common infection in the toe web which is is not inspected and treated well in early stage, and it is now the cause of cellulitis in the leg in a number of cases. To examine the narrow space of the toe web and to treat and to reduce the complication, we described the use a disposable syringe barrel.
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Affiliation(s)
- Muhammed Mukhtar
- Mukhtar Skin Centre, Katihar Medical College Road, Katihar, India
| | | | - Nadia Mukhtar
- Mukhtar Skin Centre, Katihar Medical College Road, Katihar, India
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Weaver JS, Omar I, Epstein K, Brown A, Chadwick N, Taljanovic MS. High-resolution ultrasound in the evaluation of musculoskeletal infections. J Ultrason 2023; 23:e272-e284. [PMID: 38020512 PMCID: PMC10668941 DOI: 10.15557/jou.2023.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 12/01/2023] Open
Abstract
Soft tissue and osseous musculoskeletal infections are common but can be difficult to diagnose clinically. Signs, symptoms, and physical examination findings may be nonspecific, and laboratory values can be inconclusive. The extent of disease may also be underestimated on physical examination. Soft tissue infections most commonly occur secondary to direct inoculation from broken skin and less frequently due to the seeding of the soft tissues from hematogenous spread, while osseous infections are more commonly due to hematogenous seeding. Infections may also be iatrogenic, following surgery or other procedural interventions. High-resolution ultrasound is an extremely useful imaging modality in the evaluation of musculoskeletal soft tissue and joint infections, and can occasionally be used to evaluate osseous infections as well. Ultrasound can aid in the early diagnosis of musculoskeletal infections, allowing for prompt treatment, decreased risk of complications, and treatment optimization. Ultrasound is sensitive and specific in evaluating soft tissue edema and hyperemia; soft tissue abscesses; joint, bursal and tendon sheath effusions/synovitis; and subperiosteal abscesses. This article describes the typical high-resolution grayscale as well as color and power Doppler ultrasound imaging findings of soft tissue infections including cellulitis, fasciitis, necrotizing deep soft tissue infection, pyomyositis, soft tissue abscess, infectious bursitis, and infectious tenosynovitis. Ultrasound findings of septic arthritis as well as osteomyelitis, such as subperiosteal spread of infection (subperiosteal abscess). are also reviewed. In addition, the use of ultrasound to guide fluid and tissue sampling is discussed.
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Affiliation(s)
- Jennifer S. Weaver
- Department of Radiology, University of Texas Health San Antonio, San Antonio, USA
| | - Imran Omar
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Katherine Epstein
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
| | | | - Nicholson Chadwick
- Department of Radiology, Vanderbilt University Medical Center, Nashville, USA
| | - Mihra S. Taljanovic
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico, USA
- Departments of Medical Imaging and Orthopedic Surgery, Banner University Medical Center, Tucson, Arizona, USA
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Salle R, Skayem C, Hua C, Chosidow O, Duong TA. Reply to the comment of Gallardo et al to "Challenges and limitations of teledermatology for skin and soft-tissue infections: A real-world study of an expert center". J Am Acad Dermatol 2023; 89:e151-e152. [PMID: 36948299 DOI: 10.1016/j.jaad.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Romain Salle
- Assistance Publique des Hôpitaux de Paris (AP-HP), Dermatology Department, Henri Mondor Hospital, Créteil, France.
| | - Charbel Skayem
- Assistance Publique des Hôpitaux de Paris (AP-HP), Dermatology Department, Henri Mondor Hospital, Créteil, France; Faculty of Medicine, Sorbonne University, Paris, France
| | - Camille Hua
- Assistance Publique des Hôpitaux de Paris (AP-HP), Dermatology Department, Henri Mondor Hospital, Créteil, France; EpiDermE, Université Paris Est Créteil, Créteil, France
| | - Olivier Chosidow
- Assistance Publique des Hôpitaux de Paris (AP-HP), Dermatology Department, Henri Mondor Hospital, Créteil, France; Faculté de Santé de Créteil, École nationale vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - Tu-Anh Duong
- Assistance Publique des Hôpitaux de Paris (AP-HP), Dermatology Department, Henri Mondor Hospital, Créteil, France; UF Telemedecine, GHU Paris Saclay, Boulogne-Billancourt, France; Chaire Avenir Santé numérique, Équipe 8 IMRB U955 INSERM, Créteil, France; Research Group Dynamyc, EA7380, Créteil, France
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Lee JW, Sun B, Hanna M, Rihawi A. A Case of Community-Acquired Elizabethkingia meningoseptica. Cureus 2023; 15:e45183. [PMID: 37720113 PMCID: PMC10503884 DOI: 10.7759/cureus.45183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 09/19/2023] Open
Abstract
Many nosocomial infections commonly arise as a result of contaminated water sources in the hospital setting, such as sinks, air-conditioning systems, ventilation devices, and catheters. Among the microorganisms found in these environments is Elizabethkingia meningoseptica, a gram-negative bacterium first discovered in 1959 by Elizabeth O. King. This bacterium is a rare cause of meningitis, pneumonia, bacteremia, and skin and soft tissue infections in hospital settings. This case report examines a unique community-acquired transmission of E. meningoseptica in a 78-year-old male patient with an extensive medical history who presented with acute fever and confusion coupled with multiple recent falls. Examination and culturing of an open wound on a dry blister of the left lower extremity revealed the presence of E. meningoseptica.
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Affiliation(s)
- Jae Woo Lee
- Medicine, Trinity School of Medicine, Warner Robins, USA
| | - Bo Sun
- Medicine, Trinity School of Medicine, Warner Robins, USA
| | - Mina Hanna
- Medicine, Trinity School of Medicine, Warner Robins, USA
| | - Ayman Rihawi
- Infectious Diseases, Houston Healthcare, Warner Robins, USA
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Khan M, Pyle HJ, Vandergriff TW, Thomas C. Edematous pink plaque in a patient on immunosuppression. JAAD Case Rep 2023; 39:158-160. [PMID: 37701722 PMCID: PMC10494304 DOI: 10.1016/j.jdcr.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Affiliation(s)
- Mehvish Khan
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hunter J. Pyle
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Travis W. Vandergriff
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cristina Thomas
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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Singh A, Patni N, Kaur A, Sinha A, Khaliq W. Tissierella praeacuta Bacteremia Associated With Acute on Chronic Osteomyelitis: A Case Report. Cureus 2023; 15:e44962. [PMID: 37818513 PMCID: PMC10561989 DOI: 10.7759/cureus.44962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/12/2023] Open
Abstract
Tissierella praeacuta is a rare gram-variable bacillus that naturally occurs in the environment and is pathogenic in humans with chronic infections. We report the case of a 45-year-old man with a history of chronic osteomyelitis of the left tibia and recurrent bacteremia secondary to intravenous drug use (IVDU). He had previously received multiple partially completed courses of antibiotics over the past one year. Blood cultures demonstrated polymicrobial infection, including T. praeacuta and methicillin-sensitive Staphylococcus aureus managed with parenteral beta-lactams, and the subsequent first surveillance cultures remained sterile. Medical literature on human infections with T. praeacuta is limited due to its rare occurrence. Most cases have reported sensitivity to beta-lactam antibiotics, making them an antibiotic of choice. T. praeacuta infections should prompt a search for additional underlying infectious foci and treatment of any additional co-infecting microbes.
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Affiliation(s)
- Amteshwar Singh
- Medicine, Johns Hopkins Bayview Medical Center, Baltimore, USA
- Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Nassar Patni
- Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND
| | - Ashampreet Kaur
- Internal Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Amitasha Sinha
- Hospital Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Waseem Khaliq
- Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Forga A, Robbins K, Smith A, Coles M, Tellez-Isaias G, Vuong CN, Hargis B, Graham D. Evaluation of Clostridium septicum hemolytic activity, administration route, and dosage volume of a clostridial dermatitis ( cellulitis) bacterin-toxoid on humoral immune response in commercial turkeys. Poult Sci 2023; 102:102873. [PMID: 37390548 PMCID: PMC10466222 DOI: 10.1016/j.psj.2023.102873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 07/02/2023] Open
Abstract
Clostridial cellulitis or dermatitis affects commercial turkey flocks, primarily as they approach market age. In the field, this disease has been effectively controlled with antibiotics, but alternatives to antibiotics are needed. Bacterin-toxoid vaccination programs have been shown to prevent clostridial diseases in other species, including humans. Results from previous field studies indicate that vaccination with an experimental whole-cell Clostridium septicum (CS) bacterin-toxoid oil emulsion vaccine reduced clostridial dermatitis-associated mortality and antibiotic usage for some commercial turkey flocks, but vaccination was not always efficacious. To improve vaccine efficacy, studies were conducted to optimize the antigenic component of the experimental vaccine and to determine the appropriate antigen to adjuvant ratio, route, and volume for vaccine administration. It was determined that the phase of culture at time of formalin inactivation played a key role in serum antibody titer and larger volume vaccine doses produced higher serum antibody immune response regardless of antigen:adjuvant formulation ratio or route of injection. No significant differences (P > 0.05) were found between formulation ratios or between the subcutaneous and tail head injection sites. Based on these results, we propose to look further into the relationship between culture phase and antigenic components produced by CS under different culture conditions.
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Affiliation(s)
- Aaron Forga
- Division of Agriculture, Department of Poultry Science, University of Arkansas, Fayetteville, AR 72701, USA
| | | | | | - Makenly Coles
- Division of Agriculture, Department of Poultry Science, University of Arkansas, Fayetteville, AR 72701, USA
| | - Guillermo Tellez-Isaias
- Division of Agriculture, Department of Poultry Science, University of Arkansas, Fayetteville, AR 72701, USA
| | - Christine N Vuong
- Division of Agriculture, Department of Poultry Science, University of Arkansas, Fayetteville, AR 72701, USA
| | - Billy Hargis
- Division of Agriculture, Department of Poultry Science, University of Arkansas, Fayetteville, AR 72701, USA
| | - Danielle Graham
- Division of Agriculture, Department of Poultry Science, University of Arkansas, Fayetteville, AR 72701, USA.
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Pach JJ, Nelson C, Leventhal JS. Pseudo cellulitis in oncology patients: A single institutional retrospective analysis investigating the clinical presentation, therapeutic response, and implications for cancer therapy. JAAD Int 2023; 12:186-188. [PMID: 37560470 PMCID: PMC10407291 DOI: 10.1016/j.jdin.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Affiliation(s)
- Jolanta J Pach
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Caroline Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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Hara H, Mihara M, Todokoro T. Necrotizing Fasciitis Occurred in the Lymphedematous leg. INT J LOW EXTR WOUND 2023; 22:599-604. [PMID: 34057385 DOI: 10.1177/15347346211023030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lymphedema is a chronic edema that sometimes occurs after treatment of gynecologic cancer, and cellulitis often occurs concomitantly with lymphedema. On the other hand, necrotizing fasciitis (NF) is a relatively rare, but life-threatening disease. The symptoms in cellulitis and NF are very similar. In this case report, we describe a case in which the diagnosis of NF in a lymphedematous limb was difficult. A 70-year-old woman had secondary lymphedema in bilateral legs and consulted our department. On the first day of lymphedema therapy, the patient complained of vomiting, diarrhea, and fever (37.7 °C) without local fever in the legs. She was diagnosed with acute gastroenteritis. On the next day, swelling and pain in her left leg occurred and her blood pressure was 59/44 mmHg. She was diagnosed with cellulitis accompanied by lower limb lymphedema and septic shock. On the second day, blisters appeared on the left leg, and computed tomography showed NF. We performed debridement under general anesthesia and her vital signs improved postoperatively. Streptococcus agalactiae (B) was detected in blood culture, and we administered bixillin and clindamycin. Postoperatively, necrosis in the skin and fat around the left ankle gradually spread, and it took 5 months to complete epithelialization. The diagnosis was more difficult than usual NF because patients with lymphedema often experience cellulitis. Clinicians should always think of NF to avoid mortality due to delayed treatment. This case report was approved by the institutional ethics committee.
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Maulida M, Vella V, Budini SS, Kamarlis RK, Junaidi F, Pradistha A, Bulqiah M. Systemic manifestation of necrotic erythema nodosum leprosum: A case report of a fatal leprosy. Narra J 2023; 3:e216. [PMID: 38450265 PMCID: PMC10914046 DOI: 10.52225/narra.v3i2.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/22/2023] [Indexed: 03/08/2024]
Abstract
Necrotic erythema nodosum leprosum (ENL) is an uncommon manifestation of type 2 lepra reaction, encountered in lepromatous and borderline lepromatous cases of leprosy. Necrotic ENL is associated with the involvement of multiple organs, therefore delayed diagnosis and treatment will lead to complications and poor prognosis. The aim of this case report was to report a challenging case of necrotic ENL misdiagnosed with multiple cellulitis since there were no signs of prior leprosy nor had any antimycobacterial treatment. A 45-year-old man was presented to the surgery department of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, with complaints of fever, joint pain, and painful tender skin lesions with ulceration over the trunk, extremities, and ears for one month. The patient was diagnosed clinically with multiple cellulitis and underwent a debridement procedure. Clinical improvement was absent, the patient was then consulted to the dermatology department. Physical examination showed normal vital signs, madarosis, inguinal lymphadenopathy, thickening of nerves, and sensation of numbness in both hands and feet. Laboratory examinations on admission showed leucocytosis, anemia, thrombocytopenia, hypoalbuminemia, hypocalcemia, and elevated creatinine and ureum level. A slit skin smears examination yielded positive acid-fast bacilli (AFB) with a bacteriological index (BI) value of 3+ and morphological index (MI) of 72%. The patient was diagnosed with lepromatous leprosy with necrotic ENL reaction. Intravenous methylprednisolone and cefoperazone-sulbactam were given. Multidrug therapy mulitbacillary (MDT-MB) without dapsone, and ofloxacin 400 mg was initiated. On day 17, the patient had septic shock. The patient became unconscious and experienced death. This case highlights that medical professionals should be aware of the various manifestations of necrotic ENL to correctly diagnose and provide treatment as soon as possible to prevent mortality, especially in leprosy-endemic country, Indonesia.
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Affiliation(s)
- Mimi Maulida
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Dermatology and Venereology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Vella Vella
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Dermatology and Venereology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Sulamsih S. Budini
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Dermatology and Venereology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Reno K. Kamarlis
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Anatomical Pathology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Fachrul Junaidi
- Department of Surgery, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Surgery, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | | | - Mikyal Bulqiah
- Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
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Nightingale R, Yadav K, Hamill L, Glasziou P, Scott AM, Clark J, Keijzers G. Misdiagnosis of Uncomplicated Cellulitis: a Systematic Review and Meta-analysis. J Gen Intern Med 2023; 38:2396-2404. [PMID: 37231210 PMCID: PMC10406744 DOI: 10.1007/s11606-023-08229-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Cellulitis is a clinical diagnosis with several mimics and no gold standard diagnostic criteria. Misdiagnosis is common. This review aims to quantify the proportion of cellulitis misdiagnosis in primary or unscheduled care settings based on a second clinical assessment and describe the proportion and types of alternative diagnoses. METHODS Electronic searches of Medline, Embase and Cochrane library (including CENTRAL) using MeSH and other subject terms identified 887 randomised and non-randomised clinical trials, and cohort studies. Included articles assessed the proportion of cellulitis misdiagnosis in primary or unscheduled care settings through a second clinical assessment up to 14 days post initial diagnosis of uncomplicated cellulitis. Studies on infants and patients with (peri-)orbital, purulent and severe or complex cellulitis were excluded. Screening and data extraction was conducted independently in pairs. Risk of bias was assessed using a modified risk of bias tool from Hoy et al. Meta-analyses were undertaken where ≥ 3 studies reported the same outcome. RESULTS Nine studies conducted in the USA, UK and Canada, including a total of 1600 participants, were eligible for inclusion. Six studies were conducted in the inpatient setting; three were in outpatient clinics. All nine included studies provided estimates of the proportion cellulitis misdiagnosis, with a range from 19 to 83%. The mean proportion misdiagnosed was 41% (95% CI 28 to 56% for random effects model). Heterogeneity between studies was very high both statistically (I2 96%, p-value for heterogeneity < 0.001) and clinically. Of the misdiagnoses, 54% were attributed to three conditions (stasis dermatitis, eczematous dermatitis and edema/lymphedema). DISCUSSION The proportion of cellulitis misdiagnosis when reviewed within 14 days was substantial though highly variable, with the majority attributable to three diagnoses. This highlights the need for timely clinical reassessment and system initiatives to improve diagnostic accuracy of cellulitis and its most common mimics. TRIAL REGISTRATION Open Science Framework ( https://osf.io/9zt72 ).
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Affiliation(s)
- Rachael Nightingale
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, QLD Australia
| | - Krishan Yadav
- Clinical Epidemiology Unit, Department of Emergency Medicine, University of Ottawa, Ottawa, ON Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
| | - Laura Hamill
- Emergency Department, Te Whatu Ora, Waitaha, Christchurch, New Zealand
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, QLD Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD Australia
- School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, QLD Australia
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Rahmani E, Fayyazishishavan E, Afzalian A, Varshochi S, Amani-Beni R, Ahadiat SA, Moshtaghi Z, Shafagh SG, Khorram R, Asadollahzade E, Atbaei R, Kahrizi MS, Rahbari A, Baharlouie N, Mostanbet F, Amirabadiquchani B, Kiani M, memarizadeh M, Keshtkar Rajabi S, Barati R, Hajinouri H, Najafi S, Abdollahi Z, Dadashzadehasl N, Moghadam Fard A, Afshar M, Abedi A, Saeidi S, Mansourirad A, Emami Shahrezaei P, Shah Hosseini S, Rostami Ghotbabadi Z, Vafadar R, Roohinezhad R, Ghalamkarpour N, Farrokhi M. Point-Of-Care Ultrasonography for Identification of Skin and Soft Tissue Abscess in Adult and Pediatric Patients; a Systematic Review and Meta-Analysis. Arch Acad Emerg Med 2023; 11:e49. [PMID: 37609534 PMCID: PMC10440756 DOI: 10.22037/aaem.v11i1.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Introduction Differentiating the soft tissue abscess from other types of skin and soft tissue infections (SSTIs) poses a particular challenge because they have similar physical evaluation findings, but each disease has a different course, outcome, and treatment. This meta-analysis aimed to investigate the diagnostic accuracy of point-of-care ultrasonography for diagnosis of soft tissue abscess in the emergency departments. Methods A comprehensive literature search of MEDLINE, Scopus, Web of Science, Embase, and Google Scholar, from inception to January 2023, was conducted to identify relevant studies investigating the diagnostic performance of point-of-care ultrasonography for identification of abscess. Methodological quality of the included studies was assessed using a revised tool for the quality assessment of diagnostic accuracy studies (QUADAS-2). Results The pooled estimates of diagnostic parameters of ultrasonography for diagnosis of abscess were as follows: sensitivity, 0.93 (95% CI: 0.92-0.94); specificity, 0.87 (95% CI: 0.85-0.89), and the area under the summary receiver-operating characteristic (SROC), 0.95. The pooled sensitivity, specificity, and area under the SROC of studies in adult patients were 0.98 (95% CI: 0.92-1), 0.92 (95% CI: 0.86-0.95), and 0.99, respectively. The pooled sensitivity, specificity, and area under the SROC of studies in pediatric patients were 0.9 (95% CI: 0.87-0.92), 0.78 (95% CI: 0.73-0.82), and 0.91, respectively. Conclusion Our meta-analysis demonstrated that the point-of-care ultrasonography has excellent diagnostic value for the abscess in the emergency department. Furthermore, we found that the diagnostic performance of point-of-care ultrasonography for diagnosis of abscess was higher for adult cases than for pediatric patients.
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Affiliation(s)
- Erfan Rahmani
- Graduated, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Fayyazishishavan
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
| | - Arian Afzalian
- Graduated, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Varshochi
- Graduated, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Amani-Beni
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Zeynab Moshtaghi
- Graduated, Faculty of Nursing, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | - Roya Khorram
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elnaz Asadollahzade
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Raihaneh Atbaei
- School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | | | - Negar Baharlouie
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | - Moein Kiani
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Shahin Keshtkar Rajabi
- Firoozabadi hospital clinical research development unit (FHCRDU), Department of internal medicine, school of medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Reza Barati
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Shahrzad Najafi
- Graduated, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeynab Abdollahi
- Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nahid Dadashzadehasl
- Legal Medicine Research Center, Iranian Legal Medicine Organization, Tehran, Iran
| | | | - Mozhgan Afshar
- University of Psychology Sciences, South Azad Tehran, Iran
| | - Atefeh Abedi
- Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sara Saeidi
- Students Research Committee, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Adeleh Mansourirad
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | | | | | | | - Reza Vafadar
- Department of Orthopedic Surgery, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Nogol Ghalamkarpour
- Department of Clinical Laboratory Sciences, School of Allied Medicine, Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
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Manti M, Pappa E, Arkouli V, Marinos L, Christopoulos C. Wells Syndrome with Generalized Oedema. Eur J Case Rep Intern Med 2023; 10:003954. [PMID: 37455694 PMCID: PMC10348442 DOI: 10.12890/2023_003954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023] Open
Abstract
Wells syndrome or eosinophilic cellulitis is a rare and relapsing skin disease which lacks systemic involvement. A skin biopsy is needed to establish a diagnosis. Several precipitating factors have been proposed but no proven causative link has been found. On the other hand, Churg-Strauss syndrome, also known as eosinophilic granulomatosis with polyangiitis (EGPA), an auto-immune disease, is associated with multiorgan, including cutaneous manifestations. We report a case with overlapping features of Wells and Churg-Strauss syndrome, suggesting that these syndromes could be part of the same nosological entity. LEARNING POINTS Biopsies are essential to establish a diagnosis in unusual cases of cellulitis.COVID-19 vaccination is a putative trigger for Wells syndrome.There is significant overlap between Wells and Churg-Strauss syndromes.
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Affiliation(s)
- Magdalini Manti
- First Internal Medicine Department, “Sismanoglio” General Hospital, Athens, Greece
| | - Efthymia Pappa
- First Internal Medicine Department, “Sismanoglio” General Hospital, Athens, Greece
| | - Vasiliki Arkouli
- First Internal Medicine Department, “Sismanoglio” General Hospital, Athens, Greece
| | - Leonidas Marinos
- Department of Hematopathology “Evangelismos” General Hospital, Athens, Greece
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Yetmar ZA, Chesdachai S, Lahr BD, Challener DW, Arensman Hannan KN, Epps K, Stevens RW, Seville MT, Tande AJ, Virk A. Comparison of Oral and Intravenous Definitive Antibiotic Therapy for Beta-Hemolytic Streptococcus Species Bloodstream Infections from Soft Tissue Sources: a Propensity Score-Matched Analysis. Antimicrob Agents Chemother 2023; 67:e0012023. [PMID: 37191533 PMCID: PMC10269088 DOI: 10.1128/aac.00120-23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/26/2023] [Indexed: 05/17/2023] Open
Abstract
Beta-hemolytic streptococci are common causes of bloodstream infection (BSI). There is emerging data regarding oral antibiotics for BSI but limited for beta-hemolytic streptococcal BSI. We conducted a retrospective study of adults with beta-hemolytic streptococcal BSI from a primary skin/soft tissue source from 2015 to 2020. Patients transitioned to oral antibiotics within 7 days of treatment initiation were compared to those who continued intravenous therapy, after propensity score matching. The primary outcome was 30-day treatment failure (composite of mortality, infection relapse, and hospital readmission). A prespecified 10% noninferiority margin was used for the primary outcome. We identified 66 matched pairs of patients treated with oral and intravenous antibiotics as definitive therapy. Based on an absolute difference in 30-day treatment failure of 13.6% (95% confidence interval 2.4 to 24.8%), the noninferiority of oral therapy was not confirmed (P = 0.741); on the contrary, the superiority of intravenous antibiotics is suggested by this difference. Acute kidney injury occurred in two patients who received intravenous treatment and zero who received oral therapy. No patients experienced deep vein thrombosis or other vascular complications related to treatment. In patients treated for beta-hemolytic streptococcal BSI, those who transitioned to oral antibiotics by day 7 showed higher rates of 30-day treatment failure than propensity-matched patients. This difference may have been driven by underdosing of oral therapy. Further investigation into optimal antibiotic choice, route, and dosing for definitive therapy of BSI is needed.
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Affiliation(s)
- Zachary A. Yetmar
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Supavit Chesdachai
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian D. Lahr
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas W. Challener
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kevin Epps
- Department of Pharmacy, Mayo Clinic, Jacksonville, Florida, USA
| | - Ryan W. Stevens
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aaron J. Tande
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Abinash Virk
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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