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Acta Medica Indonesiana Jan 2021Acute bacterial skin and skin-structure infections (ABSSSI) is defined in 2013 by the US Food and Drug Administration as a bacterial cellulitis/erysipelas, major skin...
Acute bacterial skin and skin-structure infections (ABSSSI) is defined in 2013 by the US Food and Drug Administration as a bacterial cellulitis/erysipelas, major skin abscesses, and wound infections. The Infectious Diseases Society of America (IDSA) in 2014 classifies skin and soft-tissue infection (SSTI) as either non-purulent (which includes cellulitis, erysipelas, and necrotizing infection) or purulent (including furuncle, carbuncle, and abscess). Among hospitalized patients with SSTI, healthcare-associated infections account for 73.5% of all cases. Notably, skin and skin-structure infections caused by Pseudomonas aeruginosa, a common hospital pathogen, was reported to cause higher total cost and longer hospital length of stay compared to non-P. aeruginosa cases, despite causing only approximately 5.7% of all healthcare-associated SSTIs. Infection with P. aeruginosa should always be considered in non-healing skin infections in patients with prolonged hospitalization and antibiotic exposure. Tissue culture, preferably taken by surgical debridement, should be promptly performed; and when hospital-infection is suspected, appropriate antibiotics should be started along with removal of all devitalized tissue and to promote skin and soft tissue healing. Expedited discharge should be considered when possible, with adequate antibiotic treatment and follow up for definitive wound treatment.
Topics: Anti-Bacterial Agents; COVID-19; Debridement; Female; Hospitalization; Humans; Iatrogenic Disease; Linezolid; Middle Aged; SARS-CoV-2; Skin; Skin Diseases, Infectious; Treatment Outcome
PubMed: 33818413
DOI: No ID Found -
The Israel Medical Association Journal... May 2020Buried bumper syndrome (BBS) mostly occurs as a late complication after percutaneous endoscopic gastrostomy (PEG) insertion; however, early BBS has been rarely reported,... (Review)
Review
BACKGROUND
Buried bumper syndrome (BBS) mostly occurs as a late complication after percutaneous endoscopic gastrostomy (PEG) insertion; however, early BBS has been rarely reported, and the treatment of this condition is still unclear.
OBJECTIVES
To evaluate the Seldinger technique for treatment of early BBS after PEG insertion.
METHODS
We report two cases of early BBS in two consecutive patients who underwent PEG insertion to maintain oral intake. The first patient was an 83-year-old woman showing Alzheimer type dementia, while the other one was a 76-year-old man who presented with maxillary cancer and treated with radiotherapy followed by left maxillectomy. Post-surgery, he developed progressive difficulty of swallowing due to mouth deformation and treatment related nerve toxicity. The first patient presented with fever and purulent discharge from the gastrostomy insertion site, without ability to rotate or slide the tube through the stoma 10 days after the PEG insertion. The man was admitted to the hospital 5 days following PEG insertion due to a fever of 38°C and peritubal swelling with purulent discharge. In addition, the tube could not rotate or slide through the stoma.
RESULTS
Buried bumper syndrome was demonstrated by computed tomography scan. Gastroscopy and gastrostomy tube replacement was performed successfully according to the Seldinger technique (replacement over guidewire) in both cases. Correct intragastric tube positioning was demonstrated radiographically before resuming tube feeding. The two patients were discharged in good physical condition several days later.
CONCLUSIONS
External replacement over guide wire should be considered in such cases.
Topics: Aged; Aged, 80 and over; Device Removal; Enteral Nutrition; Female; Gastrostomy; Humans; Male; Point-of-Care Systems; Postoperative Complications; Retreatment; Time Factors
PubMed: 32378825
DOI: No ID Found -
CJEM Nov 2022Current guidelines suggest adjuvant antibiotics after incision and drainage (I&D) of small, uncomplicated abscesses may improve patient outcomes, minimize pain, and...
INTRODUCTION
Current guidelines suggest adjuvant antibiotics after incision and drainage (I&D) of small, uncomplicated abscesses may improve patient outcomes, minimize pain, and prevent recurrence. The objective was to explore antibiotic prescribing at ED discharge and describe patient outcomes.
METHODS
This was a health records review of adult patients (≥ 18 years) discharged from an academic hospital ED (annual census 65,000) over a 2-year period with diagnosis of an uncomplicated skin abscess. Outcomes included any unplanned return ED visits within 30 days, repeat I&D, and escalation to intravenous (IV) antibiotics.
RESULTS
Of 389 ED visits, 85.6% patients underwent I&D, of which 62.2% were prescribed antibiotics at discharge. Of these patients, 36.7% received guideline recommended antibiotics (TMP-SMX or clindamycin). Of all patients who underwent I&D, 13.2% had an unplanned return ED visit within 30 days, 6.9% required repeat I&D, and 0.6% patients were escalated to IV antibiotics. Patients treated with cefalexin were more likely to have an unplanned return ED visit within 30 days (20.0 vs 5.3%; Δ14.7, 95% CI 4.6-24.4), and were more likely to have a repeat I&D within 30 days (13.7 vs 0%; Δ13.7, 95% CI 6.4-22.0), compared to patients prescribed guideline recommended antibiotics. Treatment with guideline recommended antibiotics reduced treatment failure significantly in MRSA positive patients (0.0 vs 44.4%; Δ44.4, 95% CI 13.4-73.3).
CONCLUSIONS
Antibiotics were prescribed for most abscesses that underwent I&D. Less than half of the patients received antibiotics that were guideline recommended. Compared to those who received cefalexin, patients prescribed TMP-SMX or clindamycin had fewer return ED visits and were less likely to have a repeat I&D within 30 days. However, adjuvant antibiotic use did not significantly improve outcomes overall, with most patients not requiring a change in management irrespective of antibiotic use.
Topics: Adult; Humans; Soft Tissue Infections; Anti-Bacterial Agents; Clindamycin; Abscess; Trimethoprim, Sulfamethoxazole Drug Combination; Emergency Service, Hospital; Cephalexin; Retrospective Studies
PubMed: 36166156
DOI: 10.1007/s43678-022-00366-1 -
The Pan African Medical Journal 2019Mycetoma is a chronic inflammatory process during which exogenous fungal or actinomycosic agents produce grains. The infection involves the skin, the subcutaneous...
Mycetoma is a chronic inflammatory process during which exogenous fungal or actinomycosic agents produce grains. The infection involves the skin, the subcutaneous tissues, the muscles and the bones. We report the case of a 39-year old woman, a teacher, living in Brazzaville, who had regularly resided in the village. She presented with a painless suppurative mass in the left thigh that had been treated with bandages over the past 4 years. The patient didn't have fever. Her general condition was good. Physical examination showed poly-lobed, firm tumor mass in the posterior surface of the left thigh, measuring 11cm in diameter on the major axis, with ulcerations discharging purulent serosity. There was no satellite adenopathy. The remainder of the physical examination was normal. Bacteriological analysis showed sterile serosity. Skin biopsy revealed alteration of the connective tissue and the presence of small foci of grains, typical of Actinomadura pelletieri. CRP level was 48mg/L; blood count, blood glucose, blood lipids and LDH were normal. Standard radiography of the affected thigh was normal. The diagnosis of actinomycosic mycetoma was retained. Patient's outcome, after a 12-month treatment with cotrimoxazole, was marked by the epidermization of the ulcers and the persistence of the tumor mass, justifying secondary surgical resection.
PubMed: 32153703
DOI: 10.11604/pamj.2019.34.163.20300 -
American Journal of Ophthalmology Case... Sep 2022This report describes a case of conjunctival chronic lymphocytic leukemia (CLL) in a 73 year-old female with a prior history of CLL thought to be in remission who...
PURPOSE
This report describes a case of conjunctival chronic lymphocytic leukemia (CLL) in a 73 year-old female with a prior history of CLL thought to be in remission who presented with bilateral chronic conjunctivitis.
OBSERVATION
Examination revealed bilateral conjunctival injection, mildly purulent discharge, and the presence of large follicle-like lesions involving the bilateral superior and inferior palpebral conjunctiva. Conjunctival cultures grew Corynebacterium species. The patient was treated with topical antibiotics and steroids which improved the conjunctival injection and discharge, but the follicle-like lesions persisted. A conjunctival biopsy was performed and was consistent with the diagnosis of chronic lymphocytic leukemia. Fundoscopic exam did not demonstrate posterior uveal or retinal involvement. She was referred to her oncologist for further evaluation and management. Marked clinical improvement was noted after starting treatment with ibrutinib.
CONCLUSIONS AND IMPORTANCE
This case demonstrates a rare ocular manifestation of the most common form of leukemia. It happened to present with common, nonspecific symptoms of eye redness, discharge, and follicular reaction consistent with a bilateral chronic conjunctivitis. Clinical appearance and symptoms improved with topical steroids and eventually resolved with systemic bruton kinase inhibitor therapy.
PubMed: 35959475
DOI: 10.1016/j.ajoc.2022.101670 -
International Ophthalmology Sep 2023Understanding the influence of microorganisms in patients with acquired nasolacrimal duct obstruction (NLDO) and investigating their effect on recurrence after external...
PURPOSE
Understanding the influence of microorganisms in patients with acquired nasolacrimal duct obstruction (NLDO) and investigating their effect on recurrence after external dacryocystorhinostomy (DCR).
METHODS
This prospective study included 50 patients. Evaluations were made before, on the first postoperative day and monthly after DCR. Nasolacrimal silicon tubes (NST) were removed after three months. Before the DCR, swab samples were taken from both hands and lower conjunctival fornices and from the lacrimal sac during the first DCR and from the relapsed cases during the second DCR.
RESULTS
Growth was observed in 90 (45%) cultures out of 200 and a total of 23 different strains were identified altogether. Staphylococcus aureus (40%) and Streptococcus pneumoniae (28%) were dominantly isolated which were all resistant to penicillin, tetracycline and erythromycin. Lacrimal syringing (LS) was successful in patients (100%) on the first postoperative day. After three months, before NST removal, purulent discharge from the punctum was observed in five patients, and blockage was detected by LS. S. pneumoniae was isolated from all five patients' obstructed side conjunctival cultures. Additionally, from their lacrimal sac, S. pneumoniae (4 patients), Capnocytophaga gingivalis, and Candida spp. (1 patient) strains were isolated. S pneumoniae was isolated in four out of five patients from the ipsilateral conjunctival and lacrimal sac cultures which obtained from the subsequent DCR.
CONCLUSION
Our results showed that S. pneumoniae was an isolated and persistent strain in cases with early recurrence even after a successful DCR.
Topics: Humans; Dacryocystorhinostomy; Lacrimal Duct Obstruction; Nasolacrimal Duct; Prospective Studies; Recurrence; Treatment Outcome; Retrospective Studies
PubMed: 37081132
DOI: 10.1007/s10792-023-02709-y -
IDCases 2019Pyometra is an unusual presentation of uterine infection, this condition is characterized by purulent fluid within the uterine cavity. In this report we describe...
Pyometra is an unusual presentation of uterine infection, this condition is characterized by purulent fluid within the uterine cavity. In this report we describe pyometra due to in a 90-year-old woman who presented with abdominal pain, nausea with emesis and diarrhea. She was evaluated at an outside emergency department and computed tomography (CT) revealed a large, complex, cystic mass measuring 9.2 cm (cm) in greatest diameter. Given her age, the diagnosis of malignancy was entertained. She was referred to gynecologic-oncology service for evaluation and underwent exploratory laparotomy with total abdominal hysterectomy and lysis of adhesions. Intraoperative findings were consistent with pyometra. Cultures ultimately grew . She initiated on antibacterial therapy and was discharged to a rehabilitation facility.
PubMed: 31193089
DOI: 10.1016/j.idcr.2019.e00554 -
Orbit (Amsterdam, Netherlands) Dec 2014The aim of this report is to present a case of a patient with bilateral lacrimal gland abscesses in the course of dacryoadenitis. A 45-year-old female patient with a...
The aim of this report is to present a case of a patient with bilateral lacrimal gland abscesses in the course of dacryoadenitis. A 45-year-old female patient with a long history of cocaine abuse presented with bilateral bacterial dacryoadenitis and upper lid inflammation with purulent discharge from a palpebral wound of the right upper lid. The diagnosis was confirmed with microbiology culture and an orbital CT scan, which revealed lacrimal gland abscesses. The patient admitted to vigorous eye scratching, which we believe was the mechanism responsible for the process. The infection resolved on targeted antibiotic therapy. This is the first reported case of bilateral infectious dacryoadenitis produced in a self-inflicted mechanism in a cocaine addict.
Topics: Abscess; Anti-Infective Agents; Cocaine-Related Disorders; Dacryocystitis; Eye Infections, Bacterial; Female; Humans; Middle Aged; Self-Injurious Behavior; Staphylococcal Infections; Staphylococcus epidermidis; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 25208047
DOI: 10.3109/01676830.2014.950292 -
Journal of Infection and Chemotherapy :... Dec 2023Neonatal gonorrhea, caused by Neisseria gonorrhoeae, is an uncommon but important disease to prevent because its complications, such as gonococcal ophthalmia neonatorum...
Neonatal gonorrhea, caused by Neisseria gonorrhoeae, is an uncommon but important disease to prevent because its complications, such as gonococcal ophthalmia neonatorum causes blindness if untreated. Neonatal gonococcal nasopharyngitis is a rare, but important clinical manifestation to suspect gonococcal infection in a neonate. Herein we report a case of neonatal gonococcal nasopharyngitis, presented with purulent nasal discharge. A full-term male neonate without perinatal complications developed purulent eye discharge on the 7th day of life. N. gonorrhoeae was isolated from the eye discharge culture; however, he did not receive the standard regimen. Subsequently, he presented to our hospital with fever and nasal discharge on the 20th day of life. N. gonorrhoeae was also isolated from nasal discharge and nasopharyngeal swabs without any evidence of chlamydia or syphilis. He received intravenous cefotaxime until disseminated gonococcal infection was ruled out and was discharged without any sequelae. Rhinorrhea in newborns requires consideration of mother-to-child transmission of various microorganisms, not only common respiratory viruses, but also rare, serious preventable infections such as gonorrhea or syphilis. Along with the recent syphilis patients on the rise in Japan, gonorrhea is an important disease to recognize, and the incidence could increase. Clinical manifestations of neonatal gonococcal infections, including nasopharyngitis, need to be recognized to suspect the diagnosis and initiate appropriate treatment to prevent serious complications.
PubMed: 37558089
DOI: 10.1016/j.jiac.2023.08.005 -
Acta Dermatovenerologica Croatica : ADC Dec 2020A 45-year-old HIV-negative Caucasian man with no reported past medical history was referred to our Department with a large (7 cm in diameter) oozing nodule on the...
A 45-year-old HIV-negative Caucasian man with no reported past medical history was referred to our Department with a large (7 cm in diameter) oozing nodule on the occipital region of the scalp with spontaneous periodical bloody or purulent discharge. The lesion had appeared over a period of six months, had an irregular color, non-specific dermoscopic features, and resembled squamous cell carcinoma. The physical examination revealed three more atypical melanocytic lesions (on the abdomen, back, and buccal mucosa), and multiple swollen occipital, postauricular, as well as superficial and deep cervical lymph nodes. After clinical evaluation, the patient reported having another in situ melanoma (submammary region) excised 7 years ago. All the lesions were excised and sent for histopathologic examination, which was compatible with primary cutaneous melanoma. Total body computed tomography revealed the presence of multiple visceral metastases, and the patient was referred to an oncologist. He did not consent to proceed to genetic testing. The occurrence of multiple primary melanomas (MPM) is a rare but recognized phenomenon. The estimated incidence of a second primary tumor ranges from 0.2% to 8.7% in large retrospective reviews. While 63% to 88% of patients with MPM are reported to have two primary tumors, the occurrence of more than four primary melanomas is considered exceedingly rare (1-2). Whether the presence of multiple primary melanomas is a function of increased genetic susceptibility of the individual, consistent exposure to a common exogenous promoter of malignancy, or a combination of these two factors remains to be elucidated. These patients should undergo intensive dermatologic screening for the rest of their lives and should consider genetic testing.
Topics: Humans; Incidence; Male; Melanoma; Middle Aged; Neoplasms, Multiple Primary; Retrospective Studies; Skin Neoplasms
PubMed: 33834998
DOI: No ID Found