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Tidsskrift For Den Norske Laegeforening... Mar 2023A young boy presented with acute ethmoiditis and recurrent periorbital swelling. The periorbital swelling was confirmed to be caused by a rare condition.
BACKGROUND
A young boy presented with acute ethmoiditis and recurrent periorbital swelling. The periorbital swelling was confirmed to be caused by a rare condition.
CASE PRESENTATION
Debut symptoms were acute rhinitis, unilateral periorbital swelling, fatigue, and swelling in the temple region, probably caused by an insect bite. Magnetic resonance imaging (MRI) of the sinuses showed bilateral ethmoiditis and unilateral periorbital cellulitis without subperiostal abscess formation, and antibiotics were prescribed. Because of recurrence of the periorbital swelling, an interdisciplinary team started an investigation for a differential diagnosis. The infestation of Hypoderma tarandi was confirmed by recent history of hiking in reindeer habitat, typical clinical presentation and detection of IgG hypodermin C antibodies.
INTERPRETATION
Human myiasis by Hypoderma tarandi is a rare condition in Norway. Typical clinical signs are unaffected general condition, migration of swelling in the forehead, recurrent unilateral periorbital swelling and normal CRP levels. Early-stage diagnosis and treatment will contribute to rapid symptom relief and prevent rare eye and intracranial complications. This case illustrates the importance of investigation for other conditions when the disease course is unexpected. The authors emphasise that knowledge about this disease is important in a variety of medical specialties.
Topics: Male; Animals; Humans; Child; Diptera; Myiasis; Eye Diseases; Edema; Acute Disease; Reindeer
PubMed: 36919299
DOI: 10.4045/tidsskr.22.0434 -
Journal of Investigative Medicine High... 2023Freshwater exposure is associated with a diverse range of infections from pathogens present in soil and water. This includes skin and soft tissue infections and wound...
Freshwater exposure is associated with a diverse range of infections from pathogens present in soil and water. This includes skin and soft tissue infections and wound infections, gastrointestinal infections, and central nervous system infections acquired through recreational exposure or trauma. Case reports of freshwater-associated infections typically focus on waterborne pathogens as the cause of illness; however, patients who experience significant physical trauma during freshwater exposure may also be at increased risk for infection with their own flora if the nature of the injury allows entry of bacteria through a mechanism such as mucosal injury. Here, we present a case of a healthy 18-year-old man who rapidly developed bacteremia with oral flora following several falls submerging his face into lake water while water skiing, as well as acute polymicrobial sinusitis and subsequent pre-septal cellulitis. Shortly after his water skiing falls, the patient developed sinusitis that rapidly progressed to headaches, emesis, and significant periorbital swelling. Blood cultures grew , a bacterium naturally found in the oral cavity. Sinus cultures grew and , which may be associated with lake water. The infection improved with antibiotic therapy, and the patient was discharged on a regimen of amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole. Reports of bacteremia with oral flora following freshwater injury are not typically reported, and to our knowledge, this is the first report describing bacteremia with .
Topics: Male; Humans; Adolescent; Lakes; Bacteremia; Water Sports; Sinusitis; Water
PubMed: 36914977
DOI: 10.1177/23247096231159796 -
Plastic and Reconstructive Surgery.... Mar 2023Noma is an infectious disease affecting mostly children aged 0-10. Although it has almost completely disappeared from the Western world, it is still prevalent in many...
UNLABELLED
Noma is an infectious disease affecting mostly children aged 0-10. Although it has almost completely disappeared from the Western world, it is still prevalent in many developing regions, mainly Africa's Sahel region. The infection behaves like a necrotizing fasciitis of the face, originating from the gums and progressively expanding into the cheek, nose, or eye regions. In an estimated 90% of cases, the disease is lethal as a result of systemic sepsis. For survivors, typical results are extensive defects of the cheek, nose, and periorbital and perioral regions. Due to the defects, extensive scarring is common, which leads to secondary problems such as growth alterations in an infant's skeleton due to inhibition and restraint of growth resulting typically in cicatricial skeletal hypoplasia. Other sequelae include trismus, partially caused by scarring or complete fusion between maxilla/zygomatic arch and mandible. The resulting overall disfiguring facial appearance results in patients being disabled and socially isolated.
METHODS
Facing Africa is a UK-based non-governmental organization that treats the secondary problems of Ethiopian noma survivors. Operations are performed in Addis Ababa by a visiting expert team. Postoperatively, patients are seen annually for years after the surgery.
RESULTS
This article discusses basic principles, goals, and a practical surgical algorithm for operating on lip, cheek, and oral defects, based on 210 noma patients who were operated on in Ethiopia over a period of 11 years.
CONCLUSIONS
The suggested algorithm has proven to work for the Facing Africa team members and is considered shareware for all surgeons to use and benefit from.
PubMed: 36891565
DOI: 10.1097/GOX.0000000000004844 -
The American Journal of Case Reports Mar 2023BACKGROUND As an AIDS-defining illness, the neoplasm Kaposi sarcoma (KS) classically presents as cutaneous lesions that are often associated with periorbital edema. This...
BACKGROUND As an AIDS-defining illness, the neoplasm Kaposi sarcoma (KS) classically presents as cutaneous lesions that are often associated with periorbital edema. This association with KS is important because it frequently leads to the misuse of steroids in HIV-infected patients. This report presents 2 cases of AIDS-related Kaposi sarcoma (AIDS-KS) associated with severe steroid-unresponsive periorbital lymphedema that responded to chemotherapy. CASE REPORT Case 1: A 30-year-old African-American man with KS-related periorbital edema suffered progression after receiving multiple corticosteroids for a presumed hypersensitivity reaction. After multiple hospitalizations, the patient's KS had disseminated, and he eventually opted for hospice. Case 2: A 29-year-old White male with recurrent facial edema had been repeatedly treated with corticosteroids for impending anaphylaxis reactions. He had multiple admissions with similar presentations, and it was found that his KS had progressed. After receiving chemotherapy, his facial edema has not recurred. CONCLUSIONS The failure to recognize periorbital edema as tumor-associated edema has direct consequences for the management of AIDS-KS. In addition to a delay in administering chemotherapy, the mischaracterization of periorbital edema as a hypersensitivity/allergic reaction often prompts the use of corticosteroids, potentially exacerbating the underlying AIDS-KS. Despite the current evidence, clinicians continue to order steroids in advanced AIDS-KS patients presenting with periorbital edema. Although that management is started with the best intentions and done with concerns for airway compromise, this anchoring bias could lead to devastating consequences and a rather poor prognosis.
Topics: Humans; Male; Adult; Sarcoma, Kaposi; Acquired Immunodeficiency Syndrome; Steroids; Angioedema; Blepharoptosis; Cellulitis; Lymphedema
PubMed: 36879523
DOI: 10.12659/AJCR.938801 -
PLoS Neglected Tropical Diseases Feb 2023Trichinellosis, caused by a parasitic nematode of the genus Trichinella, is a zoonosis that affects people worldwide. After ingesting raw meat containing Trichinella...
BACKGROUND
Trichinellosis, caused by a parasitic nematode of the genus Trichinella, is a zoonosis that affects people worldwide. After ingesting raw meat containing Trichinella spp. larvae, patients show signs of myalgia, headaches, and facial and periorbital edema, and severe cases may die from myocarditis and heart failure. The molecular mechanisms of trichinellosis are unclear, and the sensitivity of the diagnostic methods used for this disease are unsatisfactory. Metabolomics is an excellent tool for studying disease progression and biomarkers; however, it has never been applied to trichinellosis. We aimed to elucidate the impacts of Trichinella infection on the host body and identify potential biomarkers using metabolomics.
METHODOLOGY/PRINCIPAL FINDINGS
Mice were infected with T. spiralis larvae, and sera were collected before and 2, 4, and 8 weeks after infection. Metabolites in the sera were extracted and identified using untargeted mass spectrometry. Metabolomic data were annotated via the XCMS online platform and analyzed with Metaboanalyst version 5.0. A total of 10,221 metabolomic features were identified, and the levels of 566, 330, and 418 features were significantly changed at 2-, 4-, and 8-weeks post-infection, respectively. The altered metabolites were used for further pathway analysis and biomarker selection. A major pathway affected by Trichinella infection was glycerophospholipid metabolism, and glycerophospholipids comprised the main metabolite class identified. Receiver operating characteristic revealed 244 molecules with diagnostic power for trichinellosis, with phosphatidylserines (PS) being the primary lipid class. Some lipid molecules, e.g., PS (18:0/19:0)[U] and PA (O-16:0/21:0), were not present in metabolome databases of humans and mice, thus they may have been secreted by the parasites.
CONCLUSIONS/SIGNIFICANCE
Our study highlighted glycerophospholipid metabolism as the major pathway affected by trichinellosis, hence glycerophospholipid species are potential markers of trichinellosis. The findings of this study represent the initial steps in biomarker discovery that may benefit future trichinellosis diagnosis.
Topics: Animals; Humans; Mice; Trichinella spiralis; Trichinellosis; Antibodies, Helminth; Trichinella; Larva; Lipids
PubMed: 36809241
DOI: 10.1371/journal.pntd.0011119 -
Journal of Feline Medicine and Surgery Feb 2023This study aimed to determine the prevalence and clinical presentation of ocular diseases in cats in South Korea.
OBJECTIVES
This study aimed to determine the prevalence and clinical presentation of ocular diseases in cats in South Korea.
METHODS
Medical records of cats that were presented for ophthalmology services at Seoul National University Veterinary Medical Teaching Hospital between 2009 and 2021 were reviewed. Collected data included patient signalment, clinical signs, diagnosed ophthalmic disorders and affected eyes. Odds ratios were calculated when a variable was over-represented.
RESULTS
This study recorded a total of 358 eyes (180 cats). Domestic shorthair (DSH) was the most common breed (42.2%), followed by Persian (13.9%) and Scottish Fold (8.3%); 14 (35.6%) other breeds were recorded. The median age at the first presentation was 3 years (range 2 months to 17 years); the highest percentage of cats presented at <1 year (21.7%). The most affected ocular structure was the cornea (28.5%), followed by the lens (19.9%) and uvea (15.3%). The most frequently reported disorders were corneal ulceration (13.2%), uveitis (11.9%), incipient cataract (11.0%), keratitis (5.4%), secondary glaucoma (5.2%) and sequestrum (4.2%). The Exotic Shorthair breed was significantly over-represented with regard to entropion and periorbital fat prolapse ( <0.01). The DSH breed was significantly over-represented with regard to eyelid agenesis ( <0.01).
CONCLUSIONS AND RELEVANCE
This study provides prevalence information for feline ophthalmic diseases and could contribute important data for diagnosing, treating and preventing feline ophthalmic diseases in South Korea.
Topics: Cats; Animals; Retrospective Studies; Prevalence; Corneal Ulcer; Cataract; Republic of Korea; Cat Diseases
PubMed: 36779421
DOI: 10.1177/1098612X231151478 -
Cureus Dec 2022Rhino-orbital cerebral mucormycosis has been commonly seen during the coronavirus disease 2019 (COVID-19) pandemic. Several factors responsible for etiology and...
Rhino-orbital cerebral mucormycosis has been commonly seen during the coronavirus disease 2019 (COVID-19) pandemic. Several factors responsible for etiology and pathophysiology have been identified, among which corticosteroids and diabetes have contributed to the lion's share of the outbreak of mucormycosis. In this report, we discuss a case of a 41-year-old non-diabetic male with a recent convalescence from COVID-19 infection presented with gradual vision loss and loss of sensations in his right eye. He was found to have periorbital swelling, restriction of extraocular movements in all gazes, chemosis, ptosis of the right eye, and right maxillary sinus tenderness. His serum investigations, radiologic findings, and blood culture were indicative of rhino-orbital cerebral mucormycosis. He was started on systemic liposomal amphotericin B immediately and underwent aggressive surgical debridement. A high index of clinical suspicion, aggressive multifaceted management, and follow-up are needed to have successful outcomes, thereby lowering the morbidity of coronavirus-associated mucormycosis.
PubMed: 36699798
DOI: 10.7759/cureus.32884 -
Laboratory Animals Jun 2023In this observational retrospective study, an outbreak of abscesses was correlated with the presence of sharp edges in damaged plastic environmental enrichment within... (Observational Study)
Observational Study
In this observational retrospective study, an outbreak of abscesses was correlated with the presence of sharp edges in damaged plastic environmental enrichment within the cages. In 2010, Lawson reported cases of mandibulofacial and maxillofacial abscess in mice and proposed excessive barbering or grooming, leading to the mastication and fragmentation of hair, as an aetiopathogenesis of abscesses. In contrast, in this study, the presence of hair was not found in any of the histopathology, and abscesses were present in the periorbital area. colonises the skin, nasopharynx and intestines, and may cause pyogenic infections if a breach in local defences promotes staphylococcal invasion. Whole genome sequencing and analysis supported the hypothesis that this outbreak resulted from clonal expansion of infected C57BL6/J mice imported into the area and infection transmission from humans to mice was ruled out. An additional aetiopathogenesis is proposed for abscesses with the sharp edges of damaged plastic environmental enrichment items leading to oral mucosal injury allowing entrance into tissues, its carriage into the submucosa, followed by abscess formation.
Topics: Humans; Mice; Animals; Abscess; Staphylococcus aureus; Retrospective Studies; Staphylococcal Infections; Mice, Inbred C57BL
PubMed: 36636791
DOI: 10.1177/00236772221146844 -
Cureus Dec 2022Periorbital cellulitis is an uncommon presentation to primary care and the emergency department. With multiple aetiologies, it is crucial that an appropriate history and...
Periorbital cellulitis is an uncommon presentation to primary care and the emergency department. With multiple aetiologies, it is crucial that an appropriate history and examination are applied to identify the primary cause and initiate therapy in a timely manner. We present a 30-year-old male who presented with recurrent periorbital cellulitis treated repeatedly with antibiotics without consideration of the origin of the infection. Subsequent investigations discovered a widely dehiscent mucopyocoele of the frontal sinus that had been unrecognised and untreated. Once identified, the patient underwent functional endoscopic sinus surgery to clear the mucopyocoele and improve the drainage of the frontal sinus. Symptoms have not recurred since the surgical intervention. A poor understanding of the aetiologies of periorbital cellulitis and the related anatomy likely played a role in his delayed definitive management. Clinicians should be aware that in a patient presenting with periorbital swelling and erythema, consideration should be given to the possibility of underlying sinonasal pathology.
PubMed: 36620801
DOI: 10.7759/cureus.32252 -
Surgical Neurology International 2022Keyhole neurosurgery is the notion of safely removing brain and skull base lesions through smaller and more precise openings that lessen collateral damage to the...
BACKGROUND
Keyhole neurosurgery is the notion of safely removing brain and skull base lesions through smaller and more precise openings that lessen collateral damage to the surrounding scalp, brain, blood vessels, and nerves. The traditional frontal and pterional approaches require large craniotomies and this predisposes patients to significant and avoidable morbidity. With the growing expectation for minimally invasive surgery, we present our experience with the supraorbital keyhole craniotomy for surgical lesions in the anterior cranial fossa and parasellar regions.
METHODS
We retrospectively analyzed and evaluated all cases of neoplastic, vascular, trauma, and infective pathologies of the anterior fossa and parasellar regions treated using a keyhole approach, the supraorbital eyebrow (SOE) approach from January 2018 to June 2022. Treatment outcomes were evaluated based on pathology.
RESULTS
A total of 50 patients underwent a SOE craniotomy during the study period (28 females and 22 males). Their average age ranged from 12 to 86 years, with a mean age of 47.4 years. All patients had anterior skull base and/or anterior frontal lobe pathologies: (23 tumors, 17 ruptured aneurysms, five traumatic frontal hematomas, three extradural empyema, one cerebral cavernous malformation, and one traumatic frontal skull base fracture with dural tear and CSF leak). Gross total tumor resection was achieved in 87% of cases (13 meningiomas of which six were giant, three gliomas, two craniopharyngiomas, and two cerebral metastases). Clip ligation occlusion rate for our aneurysm cases was 100% and intraoperative rerupture was observed in three cases. Mean ICU stay was 2.2 days for the entire series. The overall 30-day mortality rate for our series was 16% (eight deaths). This was highest in the ruptured aneurysm subgroup, with all 5 mortality cases in the aneurysmal subgroup presenting as World Federation of Neurological Surgeons (WFNS) grades ≥ III. 4 of the deaths were in WFNS IV and V patients. The most frequent perioperative complication was transient periorbital swelling which resolved within 7 days. It was observed in 18 of the 50 patients. The next common complications in descending frequency were eyebrow alopecia (three cases), supraorbital hypoesthesia (two cases), CSF leak (two cases), and surgical site infection (one case). There was one approach-related intraoperative complication secondary to carotid injury in a giant meningioma redo case. Conversion to a larger craniotomy was never necessary. Clinical outcome for our cases was evaluated according to the Modified Rankin Scale (mRS) at 3-month postsurgery. A good clinical outcome (mRS ≤ 2) was achieved for 78% of our patients.
CONCLUSION
The SOE approach craniotomy is an effective minimally invasive approach for various pathologies of the anterior cranial base and parasellar regions. With experience, giant tumors and complex vascular pathology can be addressed with this keyhole approach.
PubMed: 36600768
DOI: 10.25259/SNI_810_2022