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Journal of Cranio-maxillo-facial... Mar 2024The present study aimed to investigate outcomes following open surgery for extensive skull base ORN. Open surgery through a personalized sequential approach was employed...
The present study aimed to investigate outcomes following open surgery for extensive skull base ORN. Open surgery through a personalized sequential approach was employed to deal with five cases of extensive skull base ORN. Two patients with mild cases underwent regional debridement and sequestrectomy, and three patients with severe cases underwent extensive resection with reconstruction using free anterolateral thigh (ALT) flap. Biological glues and vascularized flaps were used for obturation of the skull base bony defect to prevent postoperative cerebrospinal fluid (CSF) leakage. The infections were controlled by antibiotic administrations which strictly followed the principles of antimicrobial stewardship (AMS). As results, both regional debridement plus sequestrectomy and extensive resection achieved satisfied outcomes in all patients. No severe complications and delayed hospitalization occurred. During the follow-up period (8-19 months), all patients were alive, pain free, without crusting or purulent discharge, and no sequestration or CSF leakage occurred. In conclusion, a personalized sequential approach including open surgery, pedicled/vascularized free flap reconstruction and AMS was advocated for patients with extensive skull base ORN.
Topics: Humans; Osteoradionecrosis; Skull Base; Plastic Surgery Procedures; Skull Base Neoplasms; Free Tissue Flaps; Cerebrospinal Fluid Leak; Retrospective Studies; Postoperative Complications
PubMed: 38368207
DOI: 10.1016/j.jcms.2024.01.012 -
Medicine Feb 2024Lemierre-like syndrome (LLS) is characterized by bacteremia, septic thrombophlebitis of the internal jugular vein, and metastatic abscesses. In contrast to classic... (Review)
Review
RATIONALE
Lemierre-like syndrome (LLS) is characterized by bacteremia, septic thrombophlebitis of the internal jugular vein, and metastatic abscesses. In contrast to classic Lemierre syndrome, sources of infection are not related to oropharyngeal infections, as are frequent soft tissue infections. In recent years, Staphylococcus aureus has been identified as an emergent pathogen that causes this syndrome. The mortality rate of LLS caused by this pathogen is approximately 16%. Timely diagnosis, antibiotic treatment, and infection control are the cornerstones to treat LLS. Anticoagulant therapy as adjuvant treatment remains controversial.
PATIENT CONCERNS
A 31-year-old woman from California, United States (US), was admitted to the emergency room with a history of 2 days of fever and severe throbbing pain in the left cervical region. Thorax and neck CT tomography revealed confluent cavities suggestive of septic embolism in the lungs and a filiform thrombus in the lumen of the left internal jugular vein, with moderate swelling of the soft and muscular tissues. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the blood culture.
DIAGNOSIS
The thrombus in the internal jugular vein associated with cellulitis in the neck and multiple cavitary lesions in the lungs support the diagnosis of LLS caused by MRSA with septic embolization.
INTERVENTIONS
During treatment, the patient received vancomycin IV for 25 days and returned to the US with linezolid orally. In addition, assisted video-thoracoscopy and bilateral mini-thoracotomy with pleural decortication were performed for infectious source control, where 1700cc of purulent pleural fluid was drained.
OUTCOMES
The patient was discharged with optimal evolution.
LESSONS
LLS should be suspected in patients with skin and soft tissue infections who develop thrombosis or metastatic infections. MRSA infections should be considered in patients from areas where this pathogen is prevalent.
Topics: Female; Humans; Adult; Lemierre Syndrome; Methicillin-Resistant Staphylococcus aureus; Soft Tissue Infections; Thrombophlebitis; Staphylococcus aureus; Anti-Bacterial Agents
PubMed: 38363930
DOI: 10.1097/MD.0000000000037006 -
The Journal of Small Animal Practice Apr 2024We describe two canine cases of cutaneous infection caused by Serratia marcescens. A 2-year-old castrated male mixed dog (Case 1) presented with multiple ulcerations on...
We describe two canine cases of cutaneous infection caused by Serratia marcescens. A 2-year-old castrated male mixed dog (Case 1) presented with multiple ulcerations on the dorsal trunk, which were observed 4 days after shampooing. A 4-year-old male wolf shepherd mix dog (Case 2) presented with ulceration and purulent discharge on the nasal bridge. Cytological examination of both cases revealed pyogranulomatous inflammatory cells with rod-like infectious agents identified as S. marcescens in aerobic bacterial culture. Both patients were treated with oral antibiotics and topical chlorhexidine. Case 1 received enrofloxacin 10 mg/kg once daily for 1 week, followed by trimethoprim/sulfamethoxazole 15 mg/kg twice daily for 3 weeks. Case 2 received doxycycline 10 mg/kg twice daily for 4 weeks. No skin lesions were detected 2 weeks after the initial administration. The antibiotics were discontinued after a total 4 weeks of administration, and the skin lesions did not reappear.
Topics: Animals; Dogs; Male; Anti-Bacterial Agents; Cellulitis; Dog Diseases; Doxycycline; Serratia marcescens; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 38332607
DOI: 10.1111/jsap.13709 -
Journal of Medical Cases Jan 2024Regional anesthesia is being used more frequently in pediatric anesthesia practice, including the perioperative care of neonates and infants. Adverse effects may be...
Regional anesthesia is being used more frequently in pediatric anesthesia practice, including the perioperative care of neonates and infants. Adverse effects may be encountered during epidural needle placement, with catheter advancement, or subsequently during infusion of local anesthetic agents. Despite applying standard practice of care regarding placement of epidural catheter, epidural catheter-related infections may still occur. We present the rare occurrence of an epidural abscess in a 4-month-old infant after placement and subsequent use of a tunneled caudal epidural catheter for postoperative pain management following abdominal surgery. Magnetic resonance imaging (MRI) was the gold standard diagnostic imaging modality and was used to identify the abscess. Management included intravenous antibiotic therapy as well as hemilaminectomy with evacuation of the epidural abscess and hematoma. The patient continued to progress well with no deficits noted on neurological examination. There were no other postoperative concerns. When there is a concern for epidural catheter-related infection, the catheter should be removed immediately. The epidural catheter tip as well as any purulent discharge from the insertion site should be sent for culture and sensitivity. Urgent neurosurgical and infectious disease consultation is suggested to provide opinions regarding surgical intervention and antibiotic therapy.
PubMed: 38328807
DOI: 10.14740/jmc4180 -
Veterinary Pathology Jul 2024Between September and November 2021, 5 snow leopards () and 1 lion () were naturally infected with severe acute respiratory coronavirus 2 (SARS-CoV-2) and developed...
Between September and November 2021, 5 snow leopards () and 1 lion () were naturally infected with severe acute respiratory coronavirus 2 (SARS-CoV-2) and developed progressive respiratory disease that resulted in death. Severe acute respiratory syndrome coronavirus 2 sequencing identified the delta variant in all cases sequenced, which was the predominant human variant at that time. The time between initial clinical signs and death ranged from 3 to 45 days. Gross lesions in all 6 cats included nasal turbinate hyperemia with purulent discharge and marked pulmonary edema. Ulcerative tracheitis and bronchitis were noted in 4 cases. Histologically, there was necrotizing and ulcerative rhinotracheitis and bronchitis with fibrinocellular exudates and fibrinosuppurative to pyogranulomatous bronchopneumonia. The 4 cats that survived longer than 8 days had fungal abscesses. Concurrent bacteria were noted in 4 cases, including those with more acute disease courses. Severe acute respiratory syndrome coronavirus 2 was detected by hybridization using probes against SARS-CoV-2 and genes and by immunohistochemistry. Viral nucleic acid and protein were variably localized to mucosal and glandular epithelial cells, pneumocytes, macrophages, and fibrinocellular debris. Based on established criteria, SARS-CoV-2 was considered a contributing cause of death in all 6 cats. While mild clinical infections are more common, these findings suggest that some SARS-CoV-2 variants may cause more severe disease and that snow leopards may be more severely affected than other felids.
Topics: Animals; COVID-19; SARS-CoV-2; Female; Male; Lions; Panthera; Lung; Cats; Felidae; Cat Diseases
PubMed: 38323378
DOI: 10.1177/03009858231225500 -
World Journal of Clinical Cases Jan 2024Marginal zone lymphoma (MZL) is an indolent subtype of non-Hodgkin lymphoma (NHL), which is rare clinically with severe rashes as the initial symptom.
BACKGROUND
Marginal zone lymphoma (MZL) is an indolent subtype of non-Hodgkin lymphoma (NHL), which is rare clinically with severe rashes as the initial symptom.
CASE SUMMARY
This study reports a case of MZL with generalized skin rashes accompanied by pruritus and purulent discharge. First-line treatment with rituximab combined with zanubrutinib had poor effects. However, after switching to obinutuzumab combined with zanubrutinib, the case was alleviated, and the rashes disappeared.
CONCLUSION
For patients with advanced stage MZL not benefiting from type I anti-CD20 monoclonal antibody (mAb) combination therapy, switching to a type II anti-CD20 mAb combination regimen may be considered. This approach may provide a new perspective in the treatment of MZL.
PubMed: 38322474
DOI: 10.12998/wjcc.v12.i3.565 -
Minerva Pediatrics Feb 2024Proper umbilical cord stump care during the first days of life (both in hospital and at home) should not be overlooked to prevent possible complications (e.g., purulent...
Umbilical cord stump medication with a topical dermo protective powder compared to dry care in healthy full-term and near-term newborns: a two-center prospective cohort study.
BACKGROUND
Proper umbilical cord stump care during the first days of life (both in hospital and at home) should not be overlooked to prevent possible complications (e.g., purulent discharge, granulomas, or periumbilical erythema or omphalitis). Despite the known benefits of its correct execution, the care of umbilical cord stump remains controversial, and many different approaches are described. The World Health Organization suggests the use of dry cord stump care (easy and economic technique) in developed countries, but in many cases in the real life various topical antiseptics are used in combination with dry cord stump. The extracts of Arnica Montana (AM) have been reported to possess antibacterial, anti-inflammatory, antifungal, and immunomodulatory activities, very useful in the management of cord stump in full term infants.
METHODS
In our study we evaluated the efficacy of a powder containing AM (study group- GrA) versus dry cord stump (control group-GrB) in a population of healthy newborn >35 weeks of gestational age (GA).
RESULTS
Three hundred twenty-six neonates (mean GA 39±1 in both groups and body weight 3200 g and 3400±448 g respectively in GrA and GrB) were enrolled in two standard neonatal care units (163 neonates in GrA and 163 in GrB). At T1 (48 hours after discharge) GrA showed significantly reduced incidence of mild complications in toto, in particular a lower rate of wet umbilical cord stump). No differences between the two groups at T2 (1 week after discharge).
CONCLUSIONS
The use of a natural topical dermo-protective powder containing AM reduces the risk of minor complications, both nurse and parental workload in the first days after discharge, but does not have an impact on cord detachment and other complications in neonates >35 weeks GA.
PubMed: 38319317
DOI: 10.23736/S2724-5276.23.07411-6 -
BMC Ophthalmology Feb 2024To report the microbiological isolates, aetiology, complications, antibiotic susceptibilities, and clinical remission of dacryocystitis and canaliculitis in a prominent...
BACKGROUND
To report the microbiological isolates, aetiology, complications, antibiotic susceptibilities, and clinical remission of dacryocystitis and canaliculitis in a prominent tertiary ophthalmic teaching and referral hospital located in northern China and to offer appropriate recommendations for preventing and formulating drug treatment strategies.
METHODS
This prospective study recruited a total of 477 participants who had been diagnosed with either dacryocystitis or canaliculitis. The cohort comprised 307 patients with chronic dacryocystitis, 111 patients with acute dacryocystitis, and 59 patients with canaliculitis. Purulent discharge from the lacrimal duct was collected using a sterile swab and immediately subjected to microbial culture. Antimicrobial susceptibility testing was conducted following established protocols. All participants were scheduled for follow-up visits within 14 days after receiving antibiotic therapy.
RESULTS
The present findings indicated that women exhibited a higher susceptibility to the condition, as evidenced by the occurrence of 367 cases in comparison to 110 cases among men. Among the 477 patients, definitive causes were established in 59 individuals, accounting for 12.4% of the patients. Additionally, ocular complications were reported by 132 patients, representing 27.7% of the total. Monocular involvement was observed in the majority of cases, with 402 out of 477 patients (84.3%) affected, while binocular involvement was present in 75 patients (15.7%). In total, 506 microbiological strains were recovered from 552 eyes, with Staphylococcus epidermidis (16.4%) being the most prevalent microorganism. Other predominant isolates included Corynebacterium macginleyi (9.1%), Staphylococcus aureus (5.1%), Streptococcus pneumoniae (4.9%), Haemophilus (4.4%), Propionibacterium acnes (3.5%), and Eikenella corrodens (3.1%). Among the 12 isolated fungi, Candida parapsilosis accounted for 66.7%. The susceptibility to antimicrobial agents tested in gram-negative bacilli (79.5%) was observed to be higher than that of anaerobic bacteria (76.7%) and gram-positive cocci (55.4%). With pharmacological therapy, the remission rate of acute dacryocystitis (72.7%) was found to be higher than that of canaliculitis (53.3%) and chronic dacryocystitis (42.3%).
CONCLUSIONS
This study highlights the microbial spectrum of dacryocystitis and canaliculitis, particularly C.macginleyi, E.corrodens and C.parapsilosis, which are also more frequently isolated. Vancomycin and imipenem may be more effective treatment options. Most cases have an unknown aetiology, and essential preventive measures involve postoperative cleansing of the lacrimal passage following eye and nasal surgeries, as well as the proactive management of rhinitis.
Topics: Male; Humans; Female; Canaliculitis; Prospective Studies; Dacryocystitis; Lacrimal Apparatus; Anti-Bacterial Agents; Hospitals, Teaching
PubMed: 38317063
DOI: 10.1186/s12886-024-03323-x -
Infectious Disorders Drug Targets 2024The onset of prosthetic joint infections (PJIs) is characterized by early onset defined as within 90 days of the procedure, delayed onset defined as within 3 to 12...
INTRODUCTION
The onset of prosthetic joint infections (PJIs) is characterized by early onset defined as within 90 days of the procedure, delayed onset defined as within 3 to 12 months, and late onset defined as over 12 months. In only a scant number of case reports, Mycobacterium flavescens associated infections are typically found in sputum cultures and associated with various forms of penetrating joint traumas, particularly post-surgical interventions. Due to its rarity in presentation among cases of PJIs, we have presented a case of PJI caused by .
CASE PRESENTATION
We have, herein, reported a case of a 70-year-old male presenting with stabbing left knee pain over the past several months along with accompanying erythema and swelling with the presence of purulent discharge. Outpatient cultures have shown the growth of Mycobacterium flavescent; subsequently, the patient underwent a 2-stage revision arthroplasty and was treated with a three-drug regimen and implant 5 months later. Although being an atypical cause of PJIs, we emphasize the importance of considering NTM as a differential for immunocompromised patients, especially those with prior surgical intervention.
DISCUSSION
spp. related PJIs manifest clinical features similar to other bacteriacausing PJIs, such as warm, indurated edema at the surgical site resulting in wound dehiscence and joint effusion. Diagnosis of Mycobacterium spp. related PJIs includes history and physical examination findings, serum inflammatory markers, synovial fluid analysis, and culture. Concurrently with surgical interventions, utilization of antimicrobial agents provides additional control in Mycobacterium- related PJI. should be included among other NTMs as a possible cause of PJIs.
Topics: Humans; Male; Aged; Prosthesis-Related Infections; Mycobacterium Infections, Nontuberculous; Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Knee Prosthesis; Reoperation; Knee Joint; Nontuberculous Mycobacteria
PubMed: 38314682
DOI: 10.2174/0118715265274138231229070757