Celulitis facial por Staphylococcus aureus con metástasis infecciosas y evolución tórpida. Caso pediátrico / Facial cellulitis due to Staphylococcus aureus with metastatic infection and torpid course. A pediatric case report

La bacteriemia por Staphylococcus aureus se define como el aislamiento de dicho germen en al menos un cultivo de sangre. Las metástasis infecciosas se originan por diseminación hematógena y su posterior localización en un sitio distinto al órgano en donde se originó el proceso infeccioso. La prevalencia en la presentación de estos focos infecciosos secundarios es baja en la edad pediátrica, por lo que representa un desafío diagnóstico. Se presenta el caso de un paciente pediátrico con una celulitis facial por Staphylococcus aureus, con metástasis infecciosas y evolución tórpida.

Bacteremia due to Staphylococcus aureus is defined as the isolation of this microorganism in at least one blood culture. A metastatic infection is caused by the hematogenous dissemination and subsequent location of the microorganism in a site other than the one where the infection started. The prevalence of these secondary sources of infection is low in the pediatric population, which is a diagnostic challenge. Here we describe the case of a pediatric patient with facial cellulitis due to Staphylococcus aureus, with metastatic infection and torpid course.

Role of systemic corticosteroids in orbital cellulitis: a meta-analysis and literature review / Papel dos corticosteroides sistêmicos na celulite orbitária: uma metanálise e revisão da literatura ,

Abstract Introduction: The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis. Objective: The purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome. Methods: We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated group and only antibiotics treated group. Results: Lengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD = −4.02 [−7.93; −0.12], p -value = 0.04, I2 = 96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR = 0.78 [0.27; 2.23], p -value = 0.64,I2 = 0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group. Conclusion: Use of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.

Resumo Introdução: O tratamento padrão da celulite orbitária inicia-se com uma combinação de antibióticos intravenosos de amplo espectro concomitante ao tratamento do seio comprometido. Objetivos: O objetivo deste estudo foi avaliar se a adição de corticosteroides poderia levar a uma resolução mais precoce da inflamação e melhorar o desfecho da doença. Método: Fizemos uma pesquisa independente em cinco bancos de dados (PubMed, SCOPUS, Embase, Web of Science e o banco de dados Cochrane) em busca de estudos publicados até dezembro de 2019. Dos estudos incluídos, revisamos a celulite orbitária e a morbidade da doença através dos períodos de internação, incidência de drenagem cirúrgica, edema periorbital, visão, níveis de proteína C-reativa e níveis séricos de leucócitos com foco na comparação do grupo tratado com esteroides e antibióticos e do grupo tratado apenas com antibióticos. Resultados: Os tempos de internação após a admissão dos diagnosticados com celulite orbitária (SMD = -4,02 [-7,93; -0,12], p-valor = 0,04, I2 = 96,9%) diminuíram no grupo tratado com esteroides e antibióticos em comparação ao grupo tratado apenas com antibióticos. A incidência de drenagem cirúrgica (OR = 0,78 [0,27; 2,23], p-valor = 0,64, I2 =0,0%) foi menor no grupo tratado com esteroides e antibióticos em comparação com o grupo tratado apenas com antibióticos. Conclusão: O uso de esteroides sistêmicos como adjuvante da antibioticoterapia sistêmica para celulite orbitária pode diminuir a inflamação orbitária com baixo risco de agravar a infecção. Com base em nossa análise, concluímos que o uso precoce de esteroides por um curto período pode ajudar a encurtar os dias de internação e prevenir a progressão da inflamação.

Validación del instrumento para determinación de prevalencia de celulitis facial y su relación con la caries dental en pacientes de 5 a 9 años de edad / Validation of the instrument for the determination of prevalence of facial cellulite and its relationship with cariesdental in patients from 5 to 9 years of age

La celulitis facial odontogénica es comúnmente observada en las salas de emergencia hospitalarias en los pacientes pediátricos debido a la caries dental. Objetivo: Validar el instrumento de prevalencia de celulitis facial y su relación con la caries dental en pacientes de 5 a 9 años de edad en el Hospital General IESS Milagro. Materiales y métodos: Enfoque mixto cuantitativa y cualitativa, tipo de investigación de campo, corte transversal, descriptivo, no experimental, se realizó un plan piloto de 15 pacientes pediátricos, un instrumento cuantitativo (Ficha de recolección de datos) contó con 9 expertos para un juicio de expertos y en el instrumento cualitativo (Entrevista) contó con 6 expertos para la validación del instrumento en total son de 15 profesionales en salud, calificando Validez, Pertinencia y Coherencia. Resultados: El instrumento cuantitativo tiene una puntuación de 80,85 de confiablidad y el instrumento cualitativo tiene una puntuación de 87,11 de confiablidad. En el instrumento cuantitativo se determinó la prevalencia de celulitis facial de niños de 5 a 9 años de edad, género masculino (80%), rango de 7 a 8 años (53,3%), cita por primera vez (60%), antecedente referencial caries dental (93,3%), diagnóstico CIES10 fue el L032 celulitis de la cara (93,3%), región afectada en la zona submandibular (73,3%), prevalencia de caries dental, molares deciduos (93,3%), no registran antecedentes de buena salud (73,3%), tratamientos odontológicos de prevención al año ninguna (80%), causa frecuente en la aparición de celulitis facial, la necrosis pulpar K041. Conclusión: La validación del instrumento tuvo un grado de confiabilidad muy buena y su cifra de alfa de Cronbach alto, la misma que da seguridad y confianza, gracias a la calificación de los jueces que revisaron cada detalle(AU)

Odontogenic facial cellulite is commonly observed in hospital emergency rooms in pediatric patients due to the dental caries. Objective: to validate the facial cellulite prevalence instrument and its relationship with dental caries in patients from 5 to 9 years of age in the IESS Miracle General Hospital. Materials and methods: mixed approach quantitative and qualitative, type of field research, cross section, descriptive, non-experimental, a pilot plan of 15 patients was carried out ediatric patients, a quantitative instrument (data collection form) counted with 9 experts for an expert judgment and in the qualitative instrument (Interview) had 6 experts for the validation of the instrument in total they are of 15 health professionals, qualifying Validity, Relevance and Coherence. Results: the quantitative instrument has a score of 80.85 of reliability and the qualitative instrument has a score of 87.11 out of reliability. In the quantitative instrument, the prevalence of facial cellulite in children 5 to 9 years of age, male gender (80%), range 7 to 8 years old (53.3%), appointment for the first time (60%), referential history dental caries (93.3%), CIES10 diagnosis was L032 facial cellulite (93.3%), affected region in the submandibular area (73.3%), prevalence of dental caries, deciduous molars (93.3%), do not record a history of good health (73.3%), preventive dental treatments per year none (80%), frequent cause in the appearance of facial cellulitis, pulpal necrosis K041. Conclusion: the validation of the instrument had a very high degree of reliability. good and its high Cronbach's alpha figure, the same one that gives security and confidence, thanks to the rating of the judges who reviewed every detail(AU)

Co-relationship between Escherichia coli in broiler cellulitis and liver lesions / Correlação entre a presença de Escherichia coli em lesões de celulite e fígados de frango

Abstract Pathogenic strains of Escherichia coli may invade the subcutaneous tissue of poultry and cause cellulitis, whilst the pathogen may also cause lesions in internal organs such as the liver. Current paper co-relates Escherichia coli and virulence genes characteristic of Avian Pathogenic Escherichia coli (APEC) in broilers´ cellulitis and liver lesions. One hundred carcasses were retrieved from the production chain in an avian abattoir in the state of Bahia, Brazil, between August 2013 and January 2014, due to detection of cellulitis lesions. Cellulitis and liver samples were retrieved aseptically to quantify E. coli by Petrifilm™ count fast method (3M Company) (AOAC 998.8). Virulent genes iss and iutA were removed from E. coli isolates by Polymerase Chain Reaction (PCR). Escherichia coli was isolated from 82.0% of broilers removed from the production chain and the bacterium was concomitantly detected in cellulitis and liver lesions in 40.0% of broilers. E. coli counts ranged between 1.00 and 4.73 log CFU/g in liver lesions and between 2.00 and 9.00 log UFC/g in cellulitis lesions. Virulent genes iutA and iss were detected in 97.56% and 89.02% of E. coli isolates, respectively. Genotype analysis demonstrated the concomitant amplification of genes iutA and iss in 60.0% (n=40) of samples of cellulitis and liver lesions in which the simultaneous isolation of E. coli occurred. There was a positive and significant co-relationship (r=0.22; p<0.05) between the variables occurrence of E. coli isolated from liver samples and the occurrence of E. coli isolated from cellulitis lesions. There were also positive and significant co-relationships between populations of E. coli from liver isolates and cellulitis lesions (r=0.46; p<0.05) when E. coli isolated in the liver and in cellulitis lesions was detected. Since results showed a relationship between E. coli in cellulitis and liver lesions and possible systemic infection, the occurrence of cellulitis lesions as a criterion for total discarding of carcass may be suggested.

Resumo Cepas patogênicas de Escherichia coli podem invadir o tecido subcutâneo das aves e provocar celulite aviária e este patógeno pode provocar lesões nos órgãos internos, como o fígado. Desta forma, objetivou-se correlacionar a presença de Escherichia coli e os genes de virulência característicos de Escherichia coli Patogênica para Aves (APEC) nas lesões de celulite e nos fígados dos frangos. Entre agosto de 2013 a janeiro de 2014, foram retiradas 100 carcaças da linha de produção por apresentarem lesões de celulite em um matadouro avícola da Bahia (Brasil). Foram coletadas amostras de celulite e fígados de frango assepticamente para quantificação de E. coli pelo método rápido de contagem Petrifilm™ (3M Company) (AOAC 998.8). Em seguida foi realizada a pesquisa dos genes de virulência iss e iutA nos isolados de E. coli utilizando a Reação em Cadeia da Polimerase (PCR). Escherichia coli foi isolada em 82,00% das aves retiradas da linha de produção e a bactéria foi detectada concomitantemente nas lesões de celulite e fígado em 40,00% das aves. As contagens de E. coli variaram de 1,00 a 4,73 log UFC/g nos fígados e de 2,00 a 9,00 log UFC/g nas lesões de celulite. Os genes de virulência iutA e iss foram encontrados em 97,56% e 89,02% dos isolados de E. coli, respectivamente. A análise genotípica revelou a amplificação concomitante dos genes iutA e iss em 60,00% (n=40) das amostras de lesões de celulite e fígado nas quais houve o isolamento simultâneo de E. coli. Foi observada correlação positiva e significativa (r=0,22; p<0,05) entre as variáveis ocorrência de E. coli isolada das amostras dos fígados e ocorrência E. coli isolada das lesões de celulite e, nos casos em que foi detectada a ocorrência de E. coli isolada em fígado e lesões de celulite, correlações positivas e significativas também foram evidenciadas entre as populações de E. coli dos isolados dos fígados e das lesões de celulite, (r=0,46; p<0,05). Assim ficou evidenciada a relação entre E. coli presente nas lesões de celulite e no fígado e uma possível infecção sistêmica, desta forma, sugere-se que a presença de lesões de celulite seja utilizada como critério para o descarte total da carcaça.

Prescripción de analgésicos no opioides en un Servicio de Ortopedia / Prescription of non-opioid analgesics in an Orthopedics Service

Introducción: El dolor asociado a las alteraciones del sistema musculoesquelético debe ser tratado frecuentemente por los especialistas en Ortopedia. Los analgésicos no opioides se ubican dentro de los fármacos que más se prescriben en este Servicio, aunque no siempre de modo adecuado, según los principios de la prescripción racional. Objetivo: Caracterizar el uso de analgésicos no opioides en el servicio de Ortopedia del Hospital Dr. Salvador Allende. Material y Métodos: Estudio descriptivo de utilización de medicamentos del tipo prescripción-indicación y esquema terapéutico. Se revisaron las historias clínicas de 70 pacientes ingresados en el Servicio de Ortopedia del Hospital Dr. Salvador Allende, durante el período comprendido desde septiembre de 2018 hasta enero de 2019. Resultados: Predominó el sexo femenino y la media de edad de 71,3 años en los pacientes estudiados con una desviación estándar de 22.2 años. Los analgésicos más prescritos fueron dipirona, diclofenaco y paracetamol, en indicaciones aprobadas donde destacaron las fracturas, la celulitis y la seudoartrosis. En la totalidad de los casos, las dosis empleadas fueron adecuadas, no así los intervalos de administración ni la duración del tratamiento. Conclusiones: Es alentador el predominio de la prescripción de analgésicos no opioides con buena relación beneficio-riesgo. No obstante, la presencia de prescripciones irracionales en cuanto a intervalos de administración y duración del tratamiento, indica un déficit en la práctica de la terapéutica analgésica que no debe ser ignorado(AU)

Introduction: The pain associated with alterations of the musculoskeletal system should be frequently treated by the specialist in Orthopedics. Non-opioid analgesics are the most prescribed drugs in this medical service although they are not always used appropriately according to the principles of national prescription. Objective: To characterize the use of non-opioid analgesics in the orthopedics service of the Dr. Salvador Allende Hospital. Material and Methods: A descriptive study of the use of prescription-indication medications and therapeutic scheme was conducted. Medical records of 70 patients admitted to the orthopedics service of the Dr. Salvador Allende Hospital during the period between September 2018 and January 2019 were reviewed. Results: The female sex and a mean age of 71.3 years with standard deviation of 22,2 years predominated in the study. The most frequently used analgesics, which were indicated in the treatment of fractures, cellulitis and pseudarthrosis, were dipyrone, diclofenac and paracetamol. In all cases, the doses used were adequate, but not the administration intervals or the duration of treatment. Conclusions: The predominance of the prescription of non-opioid analgesics with a good benefit-risk ratio is encouraging. However, the presence of irrational prescriptions regarding administration intervals and duration of treatment indicates a deficit in analgesic therapy that should not be ignored(AU)

Escherichia coli vacuolating factor, involved in avian cellulitis, induces actin contraction and binds to cytoskeleton proteins in fibroblasts

Avian pathogenic Escherichia coli (APEC) isolated from avian cellulitis lesions produces a toxin, named Escherichia coli vacuolating factor (ECVF), that causes cell vacuolization and induces inflammatory response in broiler chicken. Methods We investigated the intracellular activities of ECVF in avian fibroblasts using fluorescence staining, electron microscopy, MTT and LDH measurements. As ECVF act specifically in avian cells, we performed blotting assay followed by mass spectrometry to better understand its initial intracellular protein recognition. Results ECVF induced actin contraction, mitochondrial damage and membrane permeability alterations. Ultrastructural analysis showed intracellular alterations, as nuclear lobulation and the presence of degraded structures inside the vacuoles. Moreover, ECVF induced cell death in fibroblasts. ECVF-biotin associates to at least two proteins only in avian cell lysates: alpha-actinin 4 and vinculin, both involved in cytoskeleton structure. Conclusion These findings demonstrated that ECVF plays an important role in avian cellulitis, markedly in initial steps of infection. Taken together, the results place this toxin as a target for drug and/or vaccine development, instead of the use of large amounts antibiotics.(AU)

Trichoscopic stages of dissecting cellulitis: a potential complementary tool to clinical assessment

Abstract Dissecting cellulitis is a chronic, progressive, and relapsing inflammatory disease that predominantly affects the vertex and occiput of young Afro-descendent men. It starts with papules and pustules that evolve to nodules, abscesses, and cicatricial alopecia. This article illustrates the evolutive trichoscopy of dissecting cellulitis, from its early phase, through the abscess phase, to the fibrotic cicatricial phase. Trichoscopy complements clinical-pathological classification, representing a complementary tool useful in early diagnosis and monitoring of the patient during treatment.

Evaluation of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio in patients with cellulitis

SUMMARY OBJECTIVE Cellulite infection is a non-necrotizing inflammation of the skin and subcutaneous tissue and is one of the most common reasons for admission to hospital. This retrospective study aimed to investigate the Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), and Lymphocyte to Monocyte Ratio (LMR) in patients with cellulitis. METHODS In our study, we retrospectively analyzed 96 patients with cellulitis and 98 age- and sex-matched healthy controls. The study and control groups were compared regarding NLR, PLR, and LMR.0.001). When patients with cellulitis were divided into two groups, i.e., ≥65 years and <65 years, a statistically significant difference was noted in the NLR and LMR values (p < 0.05). In the ROC curve analysis, NLR had the highest discriminative power in distinguishing between cellulitis and healthy controls (AUC = 0.950, 95% CI: 0.920-0.979, p < 0.001; 91.6% sensitivity and 89.8% specificity). CONCLUSION NLR was significantly higher in differentiating cellulite and in patients older than 65 years. Larger, prospective studies are required to determine its usefulness in assessing differential diagnosis and prognosis in cellulitis patients.

RESUMO OBJETIVO A celulite infecciosa é uma inflamação não necrotizante da pele e do tecido subcutâneo e uma das causas mais comuns para internação. O objetivo deste estudo retrospectivo foi investigar as relações Neutrófilo/Linfócito (RNL), Plaqueta/Linfócito (RPL) e Linfócito/Monócito (RLM) em pacientes com celulite. MÉTODOS Nós analisamos, retrospectivamente, 96 pacientes com celulite e 98 controles saudáveis equivalentes em sexo e idade. Os grupos foram comparados quanto a RNL, RPL e RLM. RESULTADOS Os valores de RPL e RNL do grupo com celulite foram significativamente mais elevados do que os do grupo de controle (p < 0,001). Após dividir os pacientes com celulite em dois grupos, ≥65 anos e <65 anos, uma diferença estatisticamente significativa foi observada nos valores de RNL e RLM (p < 0,05). Na análise da curva ROC, a RNL apresentou o maior poder de discriminação para distinguir entre pacientes com celulite e controles saudáveis (AUC = 0,950, 95% CI: 0,920 - 0,979; p < 0,001; 91,6% de sensibilidade e 89,8% de especificidade). CONCLUSÃO O valor de RNL foi significativamente maior para a diferenciação de pacientes com celulite e pacientes com mais de 65 anos. Estudos prospectivos maiores são necessários para determinar a sua utilidade na avaliação de diagnósticos diferenciais e prognósticos em pacientes com celulite.

Abscesos cervicofaciales de origen odontógeno: ¿cuándo y cómo debemos drenarlos? / 6 EFFICACY OF PERCUTANEOUS TREATMENT AND SURGICAL DRAINAGE IN DENTAL ABSCESSES

ANTECEDENTES: La afectación de los espacios cervicales como resultado de focos infecciosos cervicofaciales son eventos infrecuentes, pero potencialmente mortales. La causa más frecuente de infecciones profundas del cuello son el resultado de la infección odontogénica (IO). Estas afectan a individuos de todas las edades y pueden presentar distintos grados de severidad. Son diagnosticadas con examen físico, estudios por imágenes, Ecografía o Tomografía Computada (TC). Debe realizarse siempre el drenaje quirúrgico de forma clásica o percutánea según el caso de las colecciones en forma precoz. OBJETIVO: Analizar la eficacia clínica del tratamiento percutáneo y el drenaje quirúrgico en abscesos odontogenos MATERIALES Y MÉTODOS: Se llevo a cabo un trabajo transversal de enero de 2015 a diciembre de 2019. Se realizo revisión de historias clínicas en la sección de Cirugía de Cabeza y Cuello de nuestro Hospital de todos los pacientes que requirieron internación y fueron sometidos a drenaje quirúrgico y/o percutáneo por la presencia de absceso cervical de origen odontogeno. RESULTADOS: Fueron analizados 174 pacientes. Edad promedio 36 +/- 2 años. Solo al 37% se les realizo drenaje quirúrgico abierto. Al resto se realizó punciones percutáneas en forma seriada. El 25 % presento algún signo de compromiso de vía aérea (escala de severidad 3), y solo 2 pacientes con mediastinitis que requirieron drenaje urgente. Se realizo la exodoncia a todas los pacientes durante la internación. DISCUSION: Las infecciones cervicofaciales representan un tipo de infección potencialmente fatal si no se inicia rápidamente un tratamiento eficaz. La causa principal son IO que se manifiestan como flemones o abscesos. Las caries dentales suelen ser el origen. Debe establecerse la terapéutica antibiótica empírica en forma precoz y corticoides con bajas dosis cuando hay edema y/o trismus. A estos pacientes se les realiza tratamiento antibiótico (ampicilina sulbactam), acompañado de tratamiento quirúrgico (drenaje percutáneo o drenaje quirúrgico). La complicación más temida, es la progresión de la infección al mediastino (mediastinitis descendente) y / o Angina de Ludwig. CONCLUSIONES: No está protocolizado a quienes se les debe realizar tratamiento quirúrgico o tratamiento percutáneo. El drenaje quirúrgico abierto parece ser la primera opción frente al compromiso de vía aérea o colecciones no pasibles de drenaje percutáneo. Para el resto de los pacientes, que son la mayoría, las punciones percutáneas guidas con ecografía y en forma seriada son la mejor opción

Background: The involvement of cervical spaces as a result of cervical infectious focuses are rare but life-threatening events. The most common cause of deep neck infections is the result of dental infection (DI). These affect individuals of all ages and may have varying degrees of severity. They are diagnosed with physical examination, imaging, ultrasound or computed tomography (CT). Surgical drainage should always be performed in a classic or percutaneous method early. Objective: To analyze the clinical efficacy of percutaneous treatment and surgical drainage in dental abscess Materials and methods: Cross-sectional study was carried out from January 2015 to December 2019. Medical records were reviewed in the Head and Neck Surgery Section of our Hospital of all patients who required hospitalization and were subjected to surgical and/or percutaneous drainage due to the presence of cervical abscess of dental origin. Results: 174 patients were analyzed. Average age was 36 +/- 2 years old. Only 37% were performed open surgical drainage. The rest of them were percutaneous drainage. 25% showed any signs of airway engagement (severity scale 3). Only 2 patients had mediastinitis who required urgent drainage. Exodontics was performed on all patients during hospitalization Discussion: Cervical infections represent a potentially fatal type of infection if effective treatment is not initiated quickly. The main cause is DI that manifest as phlegmons or abscesses. Tooth decay is usually the source. Empirical antibiotic therapy should be established early and low-dose corticosteroids should be established when there is edema and/or trismus. These patients are treated with antibiotics (ampicillin sulbactam), accompanied by surgical treatment (percutaneous drainage or surgical drainage). The most feared complication is the progression of infection to the mediastinum (descending mediastinitis) and/or Ludwig's Angina. Conclusions: Surgical or percutaneous treatment are not protocolized. Open surgical drainage seems to be the first choice over airway compromise or non-passable collections of percutaneous drainage. For the rest of the patients, who are the majority, guided percutaneous drainage with ultrasound and serial form are the best option

Sepsis por celulitis necrotizante en paciente embarazada con sindrome antifosfolípido en tratamiento / Necrotizing sepsis cellulitis pregnant patient with antiphospholipid syndrome treatment

Introducción: El término ''síndrome antifosfolipídico'' (SAF) describe la asociación de los anticuerpos antifosfolipídicos (AAF) con un cuadro clínico de hipercoagulabilidad caracterizado por trombosis a repetición y abortos recurrentes. Objetivo: Presentar un caso de celulitis severa de periné en paciente con SAF y tratamiento con hidroxicloroquina. Caso clínico: Paciente de 39 años con embarazo de término con SAF tratado con hidroxicloroquina y anticoagulación que desarrolló una infección severa de partes blandas del periné que fue tratado con interrupción del embarazo, drenaje agresivo del periné y tratamiento antibiótico extenso con buena evolución. Conclusión: La asociación del tratamiento con hidroxicloroquina, embarazo y una complicación séptica es incierta. El tratamiento con inmunosupresión no es estándar y podría haber favorecido el mal pronóstico del cuadro clínico. (AU)

Objetive: To present a case of severe perineal cellulitis in a pregnant patient with Antiphospholipid syndrome treated wiht hidroxicloroquine. Case report: A 39 years old female pregnant patient with AFS treated with hidroxicloroquine and heparin developed severe perineal infection with systemic impairment. Final treatment included aggressive perineal drainage in multiple sessions, pregnancy delivered and systemic treatment with wide spectrum antibiotics and general measures. Discusion and Conclusion: Treatment with hidroxicloroquine, pregnancy and septic complication is infrequent. This approach is not standard and it could favored worst prognostic of the general syndrome. (AU)

Incidence and risk factors for major infections in hospitalized children with nephrotic syndrome / Incidência e fatores de risco para infecções graves em crianças hospitalizadas com síndrome nefróticas

ABSTRACT Introduction: Children with nephrotic syndrome are at increased risk of infections because of disease status itself and use of various immunosuppressive agents. In majority, infections trigger relapses requiring hospitalization with increased risk of morbidity and mortality. This study aimed to determine the incidence, spectrum, and risk factors for major infections in hospitalized children with nephrotic syndrome. Methods: All consecutive hospitalized children between 1-12 years of age with nephrotic syndrome were enrolled in the study. Children with acute nephritis, secondary nephrotic syndrome as well as those admitted for diagnostic renal biopsy and intravenous cyclophosphamide or rituximab infusion were excluded. Results: A total of 148 children with 162 admissions were enrolled. Incidence of major infections in hospitalized children with nephrotic syndrome was 43.8%. Peritonitis was the commonest infection (24%), followed by pneumonia (18%), urinary tract infection (15%), and cellulitis (14%), contributing with two thirds of major infections. Streptococcus pneumoniae (n = 9) was the predominant organism isolated in children with peritonitis and pneumonia. On logistic regression analysis, serum albumin < 1.5gm/dL was the only independent risk factor for all infections (OR 2.6; 95% CI, 1.2-6; p = 0.01), especially for peritonitis (OR 29; 95% CI, 3-270; p = 0.003). There were four deaths (2.5%) in our study, all due to sepsis and multiorgan failure. Conclusions: Infection remains an important cause of morbidity and mortality in children with nephrotic syndrome. As Pneumococcus was the most prevalent cause of infection in those children, attention should be paid to the pneumococcal immunization in children with nephrotic syndrome.

RESUMO Introdução: Crianças com síndrome nefrótica apresentam maior risco de infecções devido ao próprio status da doença e ao uso de vários agentes imunossupressores. Em grande parte, as infecções desencadeiam recidivas que exigem hospitalização, com risco aumentado de morbidade e mortalidade. Este estudo teve como objetivo determinar a incidência, o espectro e os fatores de risco para infecções graves em crianças hospitalizadas com síndrome nefrótica. Métodos: Todas as crianças hospitalizadas consecutivamente entre 1 e 12 anos de idade com síndrome nefrótica foram incluídas no estudo. Crianças com nefrite aguda, síndrome nefrótica secundária, bem como aquelas admitidas para biópsia renal diagnóstica e infusão intravenosa de ciclofosfamida ou rituximabe foram excluídas. Resultados: Foram cadastradas 148 crianças com 162 internações. A incidência de infecções graves em crianças hospitalizadas com síndrome nefrótica foi de 43,8%. A peritonite foi a infecção mais comum (24%), seguida por pneumonia (18%), infecção do trato urinário (15%) e celulite (14%), contribuindo com dois terços das principais infecções. Streptococcus pneumoniae (n = 9) foi o organismo predominantemente isolado em crianças com peritonite e pneumonia. Na análise de regressão logística, a albumina sérica < 1,5gm / dL foi o único fator de risco independente para todas as infecções (OR 2,6; 95% CI, 1,2-6; p = 0,01), especialmente para peritonite (OR 29; IC95% 3 -270, p = 0,003). Houve quatro mortes (2,5%) em nosso estudo, todas devido a sepse e falência de múltiplos órgãos. Conclusões: A infecção continua sendo uma importante causa de morbimortalidade em crianças com síndrome nefrótica. Como o Pneumococo foi a causa mais prevalente de infecção nessas crianças, deve-se atentar para a imunização pneumocócica em crianças com síndrome nefrótica.

Rol de los estreptococos del grupo Streptococcus anginosus en infecciones de piel y partes blandas: reporte de 3 casos / Role of streptococci of the Streptococcus anginosus group in skin and soft tissue infections: report of 3 cases

Los estreptococos del grupo Streptococcus anginosus (GSA) comprenden uno de los grupos que conforman el grupo viridans de estreptococos y son parte de la microbiota humana habitual de la cavidad oral, del tracto respiratorio superior y del tracto gastrointestinal. Pueden producir colecciones purulentas de órganos sólidos, abscesos cutáneos y celulitis, entre otras infecciones. Este grupo posee numerosos factores de virulencia como hialuronidasa, adhesinas, enzimas extracelulares y hemolisinas. El objetivo de este trabajo fue presentar tres casos clínicos de infecciones asociadas a traumatismos vinculados con la cavidad oral como golpes de puño o mordeduras humanas. En todos ellos, los GSA desarrollaron como germen único, lo que pone de manifiesto su importante rol en este tipo de infecciones.

The Streptococcus anginosus group (SAG) is part of the viridans group streptococci and they belong to the normal human microbiota of the oral cavity, the upper respiratory tract and the gastrointestinal tract. It can produce purulent collections of solid organs, cutaneous abscesses and cellulitis, among other infections. This group has numerous virulence factors such as hyaluronidase, adhesins, extracellular enzymes and hemolysins. The objective of this work is to present three clinical cases of infections associated with trauma related to the oral cavity such as fist bumps or human bites. In all of them, the SAG developed as a single organism, which highlights its important role in this type of infection.

Os estreptococos do grupo do Streptococcus anginosus (GSA) são parte de um dos grupos que constituem o grupo viridans e fazem parte da microbiota normal da cavidade oral, do trato respiratório superior e do trato gastrointestinal dos seres humanos. Podem produzir coleções purulentas de órgãos sólidos, abscessos cutâneos e celulite, entre outras infecções. Este grupo possui numerosos fatores de virulência, como hialuronidases, adesinas, enzimas extracelulares e hemolisinas. O objetivo desse trabalho foi apresentar três casos clínicos de infecções associadas a traumatismos associados à cavidade oral, decorrentes de socos ou mordidas humanas. Em todos eles os GSA se desenvolveram como germe único, o que põe de manifesto seu papel importante nesse tipo de infecções.

Trichoscopy findings in dissecting cellulitis

Abstract Dissecting cellulitis is an inflammatory, chronic, and recurrent disease of the hair follicles that mainly affects young Afro-descendent men. Trichoscopy is a method of great diagnostic value for disorders of the scalp. Clinical and trichoscopic findings of dissecting cellulitis are heterogeneous and may present features common to non-cicatricial and scarring alopecia. This article presents the trichoscopic findings of dissecting cellulitis that help in the diagnosis and consequent institution of the appropriate therapy and better prognosis of the disease.

Síndrome celulitis-adenitis, una forma infrecuente de presentación de la sepsis neonatal tardía: A propósito de dos casos / Adenitis-cellulitis syndrome, an infrequent form of presentation of the late-onset neonatal septicemia: Report of two cases

La sepsis es la principal causa de mortalidad neonatal. La forma precoz, habitualmente, está relacionada con la colonización recto-vaginal u otros factores de riesgo materno. En la forma tardía, es difícil establecer su origen; por lo general, es nosocomial o de la comunidad. El Streptococcus agalactiae (Streptococcus beta-hemolítico del grupo B) es el germen implicado con más frecuencia en la sepsis neonatal en países desarrollados. La forma tardía, generalmente, se presenta con septicemia y meningitis, y, en ocasiones, pueden detectarse infecciones osteoarticulares o de piel y tejidos blandos. El síndrome celulitis-adenitis en la región cervical, forma poco frecuente de presentación, es causado por Staphylococcus aureus y, ocasionalmente, por Streptococcus agalactiae. Se reportan 2 casos de sepsis neonatal tardía con clínica de celulitis-adenitis cervical causados por Streptococcus beta-hemolítico del grupo B, con una evolución satisfactoria con terapia antibiótica de amplio espectro.

Septicemia is the main cause of neonatal mortality. The early-onset neonatal sepsis is usually related to maternal factor risks including recto-vaginal colonization. In the late-onset neonatal septicemia it is more difficult to establish the etiology because the majority of the cases are nosocomial or community related. The Streptococcus agalactiae (beta-hemolytic Streptococcus) is the most frequent germ associated with neonatal sepsis in developed countries. The late-onset form usually occurs with septic symptoms and meningitis and, in a few cases, with osteoarticular, skin and soft tissue infection. Adenitis-cellulitis syndrome is rarely seen, and its main cause is Staphylococcus aureus, followed by Streptococcus agalactiae. We report two cases of group B Streptococcus late-onset neonatal septicemia, both of them with adenitis-cellulitis syndrome. Patients recovered uneventfully after an adequate antibiotic therapy.

Injerto dermo-epidérmico como tratamiento del siliconoma de extremidad inferior / Dermoepidermal graft as treatment of lower extremity siliconoma

Resumen Introducción A pesar de la evidencia sobre los malos resultados y riesgos del uso de inyecciones subcutáneas de silicona para mejorar el contorno corporal, esta técnica sigue siendo utilizada por personas no calificadas. Caso clínico Paciente de 56 años quien consultó por cuadro de celulitis en pierna izquierda. Se obtuvo el antecedente de intervención con silicona en cara, dorso de las manos, glúteos y piernas el año 2000. El cuadro progresó con múltiples abscesos en la totalidad de la pierna y sepsis. Se realizaron aseos quirúrgicos exponiendo planos fascial y muscular, se utilizó terapia local con sistemas de presión negativa y posterior injerto dermo-epidérmico (IDE). El manejo multidisciplinario se realizó en unidades críticas. Los resultados del manejo fueron satisfactorios, salvando la extremidad con cobertura total, logrando el alta luego de 4 meses. Conclusión A pesar de conocerse los peligros de la inyección de silicona, este sigue siendo un procedimiento frecuente. En nuestra paciente se manifestó como fascitis de la pierna, requiriendo tratamiento quirúrgico agresivo. Conocer esta entidad, su diagnóstico y tratamiento es fundamental para tratar pacientes con complicaciones graves.

Introduction Despite the evidence of poor performance and risks of using silicone subcutaneous injections to improve body contour, this technique is still used by untrained people, generating an iatrogenic entity with serious complications. Case report 56 year old female presented left lower extremity cellulitis. A history of previous intervention with silicone injections in face, back of hands, buttocks and legs in year 2000 was obtained. An inflammatory process progressed locally and systemically with multiple abscesses, subcutaneous thickness in the entire leg and sepsis, requiring multiple surgical procedures, reaching fascial and muscle planes exposition of the left leg. The patient underwent local therapy with negative pressure systems and subsequent dermoepidermal graft. Multidisciplinary management was performed on a critical unit. The results were satisfactory, preserving the limb with full coverage. She was discharged after four months of inpatient management. Conclusion Despite knowing the risks of silicone injection (industrial or medical) it remains a common procedure. In our patient she presented as leg fasciitis, requiring aggressive surgical treatment. Knowing this entity, its diagnosis and treatment is essential to treat patients with serious complications.

Esporotricosis del pabellón auricular: comunicación de un caso atípico simulando una celulitis bacteriana / Auricular sporotrichosis: atypical case report simulating bacterial cellulitis

Resumen La esporotricosis es la micosis subcutánea o por implantación más frecuente en México. Se comunica el caso de una esporotricosis cutánea-fija preauricular que simuló una celulitis bacteriana atípica, en una paciente anciana sin antecedente de traumatismo. La biopsia mostró un granuloma supurativo con presencia de levaduras escasas. En el cultivo se identificó Sporothrix schenckii que se confirmó por biología molecular. Se trató con itraconazol obteniéndose una curación clínica y micológica. Se presenta el caso de presentación atípica, proveniente de una zona semidesértica con clima extremo.

Sporotrichosis is the most common subcutaneous or implantation mycosis in Mexico. The case of a preauricular cutaneous-fixed sporotrichosis simulating atypical bacterial cellulitis is reported in an elderly patient with no history of trauma. The biopsy showed a suppurative granuloma with scarce yeast. Sporothrix schenckii was identified in the culture and confirmed by molecular biology. She was treated with itraconazole and a clinical and mycological cure was obtained. The case of atypical presentation is presented, coming from a semi-arid zone with extreme weather.

Yellow dots in trichoscopy: relevance, clinical significance and peculiarities

Abstract: Yellow dots are follicular ostium filled with keratin and/or sebum. Initially, they were exclusively associated with alopecia areata. Currently they have also been described in androgenetic alopecia, chronic cutaneous (discoid) lupus erythematosus, and dissecting cellulitis. Due to the growing importance of trichoscopy and its findings in the evaluation of the scalp, this article describes the main diseases in which yellow dots are a common trichoscopic finding, highlighting its characteristics in each dermatosis.

Eosinophilic annular erythema in adults: report of two cases and review of the literature

Abstract We herein report two cases of eosinophilic annular erythema in adults, which is rare. In both patients, lesions developed rapidly in few days and were located mainly on the trunk, buttocks, and extremities. Diagnosis was histopathological, with typical features including acute dermal inflammatory infiltrate with abundant eosinophils. One of the patients recurred after treatment on three occasions and finally cured spontaneously. The second patient recurred once and was then successfully treated with topical clobetasol. Clinical and histopathological features of eosinophilic annular erythema in adults have rarely been reported. A review of the literature and discussion of relationship with Wells syndrome are also included.

Host inflammatory response to polypropylene implants: insights from a quantitative immunohistochemical and birefringence analysis in a rat subcutaneous model

ABSTRACT Objectives To describe acute and sub acute aspects of histological and immunohistochemical response to PP implant in a rat subcutaneous model based on objective methods. Materials and Methods Thirty rats had a PP mesh subcutaneously implanted and the same dissection on the other side of abdomen but without mesh (sham). The animals were euthanized after 4 and 30 days. Six slides were prepared using the tissue removed: one stained with hematoxylin-eosin (inflammation assessment); one unstained (birefringence evaluation) and four slides for immunohistochemical processing: IL-1 and TNF-α (pro-inflammatory cytokines), MMP-2 (collagen metabolism) and CD-31 (angiogenesis). The area of inflammation, the birefringence index, the area of immunoreactivity and the number of vessels were objectively measured. Results A larger area of inflammatory reaction was observed in PP compared to sham on the 4th and on the 30th day (p=0.0002). After 4 days, PP presented higher TNF (p=0.0001) immunoreactivity than sham and no differences were observed in MMP-2 (p=0.06) and IL-1 (p=0.08). After 30 days, a reduction of IL-1 (p=0.010) and TNF (p=0.016) for PP and of IL-1 (p=0.010) for sham were observed. Moreover, area of MMP-2 immunoreactivity decreased over time for PP group (p=0.018). Birefringence index and vessel counting showed no differences between PP and sham (p=0.27 and p=0.58, respectively). Conclusions The implantation of monofilament and macroporous polypropylene in the subcutaneous of rats resulted in increased inflammatory activity and higher TNF production in the early post implant phase. After 30 days, PP has similar cytokines immunoreactivity, vessel density and extracellular matrix organization.