RESUMO
OBJECTIVES: Little is known regarding the differences in microbiology associated with cellulitis or abscess with or without lymphangitic streaking. The objective of our study is to assess whether there are differences in the pathogens identified from wound cultures of patients with paronychia with and without associated lymphangitis. METHODS: Retrospective cross-sectional study at a tertiary pediatric emergency department over 25 years. We opted to assess patients with paronychia of the finger, assuming that these cases will have a greater variety of causative pathogens compared to other cases of cellulitis and soft tissue abscess that are associated with nail biting. Case identification was conducted using a computerized text-screening search that was refined by manual chart review. We included patients from 1 month to 20 years of age who underwent an incision and drainage (I&D) of a paronychia and had a culture obtained. The presence or absence of lymphangitis was determined from the clinical narrative in the medical record. We excluded patients treated with antibiotics prior to I&D as well as immune-compromised patients. We used descriptive statistics for prevalence and χ2 tests for categorical variables. RESULTS: Two hundred sixty-six patients met inclusion criteria. The median age was 9.7 years [IQR 4.7, 15.4] and 45.1% were female. Twenty-two patients (8.3%) had lymphangitic streaking associated with their paronychia. Patients with lymphangitis streaking were similar to those without lymphangitis in terms of age and sex (p = 0.52 and p = 0.82, respectively). Overall, the predominant bacteria was MSSA (40%) followed by MRSA (26%). No significant differences were found between the pathogens in the 22 patients with associated lymphangitis compared to the 244 patients without. CONCLUSION: Staphylococcus aureus represent the majority of pathogens in paronychia, although streptococcal species and gram-negative bacteria were also common. Among patients with paronychia of the finger, there seems to be no association between pathogen type and presence of lymphangitic streaking.
Assuntos
Linfangite/microbiologia , Criança , Estudos Transversais , Registros Eletrônicos de Saúde , Feminino , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Linfangite/etiologia , Masculino , Staphylococcus aureus Resistente à Meticilina , Processamento de Linguagem Natural , Paroniquia/complicações , Paroniquia/microbiologia , Estudos Retrospectivos , Infecções Estafilocócicas/microbiologiaRESUMO
BACKGROUND: Oncologic treatments may lead to the development of paronychia, which may cause severe pain and disability. However, a detailed objective scoring system is lacking. OBJECTIVE: To develop an objective scoring system to quantify the severity of paronychia and also examine the correlation of this score with a pain index and patients' quality of life. METHODS: A novel scoring system for paronychia related to oncologic treatments (SPOT), consisting of four parameters, namely redness, oedema, discharge and granulation tissue, was designed to assess the severity of paronychia. The visual analogue scale (VAS) and Dermatology Quality of Life Index (DLQI) were recorded, and their association with the SPOT scores was analysed. RESULTS: Ninety patients were enrolled from three medical centres in Taiwan. Severity of paronychia was determined by the scores of SPOT. Patients in the severe group had higher DLQI scores (severe vs. mild: P = 0.0018; severe vs. moderate: P = 0.0015). Both the DLQI and pain index scores were significantly higher in patients with higher dominant hand SPOT scores. CONCLUSIONS: The SPOT scores demonstrated the association of the paronychia severity with DLQI and pain. It may thus be useful in clinical practice and future studies.
Assuntos
Antineoplásicos/efeitos adversos , Medição da Dor , Paroniquia/induzido quimicamente , Qualidade de Vida , Índice de Gravidade de Doença , Edema/induzido quimicamente , Eritema/induzido quimicamente , Exsudatos e Transudatos , Feminino , Tecido de Granulação/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Paroniquia/complicações , Paroniquia/patologia , Estudos ProspectivosAssuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Hiperplasia Angiolinfoide com Eosinofilia/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Paroniquia/terapia , Timolol/administração & dosagem , Administração Tópica , Idoso , Hiperplasia Angiolinfoide com Eosinofilia/induzido quimicamente , Hiperplasia Angiolinfoide com Eosinofilia/complicações , Hiperplasia Angiolinfoide com Eosinofilia/diagnóstico , Antibacterianos/administração & dosagem , Terapia Combinada/métodos , Crioterapia/métodos , Receptores ErbB/antagonistas & inibidores , Feminino , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Paroniquia/induzido quimicamente , Paroniquia/complicações , Paroniquia/diagnóstico , Inibidores de Proteínas Quinases/efeitos adversos , Estudos Retrospectivos , Índice de Gravidade de Doença , Nitrato de Prata/administração & dosagem , Resultado do TratamentoRESUMO
We report the case of a patient with severe thromboangiitis obliterans (Buerger's disease) and untreated paronychia which eroded into the digital joint space causing acrolysis of digits and significant soft tissue and joint destruction.
Assuntos
Paroniquia/complicações , Tromboangiite Obliterante/complicações , Adulto , Doença Crônica , Articulações dos Dedos , Dedos , Humanos , Masculino , Paroniquia/microbiologia , Paroniquia/patologia , Fumar/efeitos adversosRESUMO
Herpetic whitlow is a viral infection of the fingers or toes caused by the herpes simplex virus. Herpes simplex virus is a common pathogen that causes infections in any cutaneous or mucocutaneous surface, most commonly gingivostomatitis or genital herpes. However, infection of the digits is also infrequently reported. Herpetic whitlow occurs when the virus infects the distal phalanx of the fingers or toes by means of direct inoculation, causing pain, swelling, erythema, and vesicle formation. The proper diagnosis is important because the condition can mimic various other podiatric abnormalities such as paronychia, bacterial cellulitis, or even embolic disease. Improper diagnosis often leads to unnecessary work-up, antibiotic therapy, or even surgical intervention. This case will help illuminate the clinical presentation of herpetic whitlow in an atypical location, and the patient's subsequent treatment. We present an atypical case of right hallux herpetic whitlow with delayed diagnosis and associated cellulitis. The patient was admitted after seeing multiple providers for a progressive right hallux infection that presented as a mixture of vesicular lesions and apparent cellulitis. His history was positive for biting his fingernails and toenails, and the lesions were noted to be honeycomb-like, with minimal drainage. The lesions were then deroofed and viral cultures were obtained, which were positive for herpes simplex virus type 1, thus confirming a diagnosis of herpetic whitlow. Although he remained afebrile with negative wound cultures during admission, a secondary bacterial infection could not be excluded because of his nail avulsion and surrounding cellulitis. He was discharged on oral antibiotics, antivirals, and wound care recommendations. Herpetic whitlow should be included in the differential diagnosis of pedal digital lesions that appear as vesicular or cellulitic in the pediatric population.
Assuntos
Dermatoses da Mão , Herpes Simples , Paroniquia , Celulite (Flegmão) , Criança , Dedos , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/tratamento farmacológico , Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Herpes Simples/etiologia , Humanos , Masculino , Paroniquia/complicações , SimplexvirusRESUMO
We evaluated the efficacy and safety of red light LED as an adjuvant treatment for epidermal growth factor receptor inhibitor-induced paronychia. Eight patients were recruited in this randomized, single-blinded controlled trial. They were randomized to receive red-light on one hand or foot 2-3 times/week for 6 weeks while the contralateral side served as controls. The standard treatments were continued. Erythema and lesion elevation observed by Anthera® 3D, severity and pain scores were obtained at weeks 0, 2, 4, 6, and 8. The red light group showed significantly lower erythema, severity, and pain scores at weeks 4, 6, and 8. The elevation was significantly lower in the red light group at every follow-up visit. No adverse events occurred. Red light therapy may be an option as adjunctive treatment for EGFRi-induced paronychia.
Assuntos
Paroniquia , Fototerapia , Inibidores de Proteínas Quinases , Receptores ErbB/antagonistas & inibidores , Eritema/etiologia , Eritema/terapia , Humanos , Dor/etiologia , Paroniquia/induzido quimicamente , Paroniquia/complicações , Paroniquia/terapia , Fototerapia/métodos , Inibidores de Proteínas Quinases/efeitos adversos , Método Simples-CegoRESUMO
Remote necrotizing soft tissue infection (NSTI) resulting from paronychia is very unusual but potentially lethal. We report a case of a 39-year-old woman affected by this unusual infection. The paronychia completely resolved in less than 2 weeks, however, a NSTI involved the right chest and flank and the left thigh. The patient required intensive care and multiple surgical debridements. This recent experience and literature data suggest that paronychia can cause a remote NSTI that can rapidly spread and become life-threatening. Broad spectrum antibiotics and aggressive surgical debridement are essential to a successful outcome.
Assuntos
Paroniquia/complicações , Infecções dos Tecidos Moles/etiologia , Adulto , Desbridamento , Fasciite Necrosante/etiologia , Feminino , Humanos , Necrose , Infecções dos Tecidos Moles/cirurgiaRESUMO
Fusarium is a saprophytic organism that is widely found distributed in soil, subterranean and aerial plants, plant debris, and other organic substrates. It can cause local tissue infections in immunocompetent patients, such as onychomycosis, bone and joint infections, or sinusitis. The incidence of disseminated disease has notably increased since the initial cases of disseminated Fusarium were described, particularly affecting immunocompromised patients with hematologic malignancies. We report a 39-year-old man hospitalized with newly diagnosed acute myelocytic leukemia who developed disseminated Fusarium infection originating from toenail paronychia in the setting of neutropenia. Pathologic diagnosis of Fusarium is difficult because the septate hyphae of Fusarium are difficult to distinguish from Aspergillus, which has a more favorable outcome. Cultures of potential sources of infection as well as tissue cultures are essential in identifying the organism and initiating early aggressive therapy.
Assuntos
Fusarium/isolamento & purificação , Micoses/microbiologia , Paroniquia/microbiologia , Adulto , Humanos , Hospedeiro Imunocomprometido , Leucemia Mieloide Aguda/complicações , Masculino , Micoses/diagnóstico , Micoses/etiologia , Neutropenia/complicações , Neutropenia/etiologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/etiologia , Infecções Oportunistas/microbiologia , Paroniquia/complicações , Paroniquia/etiologiaRESUMO
Purulent pericarditis is a rare infectious disease with significant mortality, even in the modern antibiotic era. The presenting signs can often be subtle and patients can deteriorate rapidly with cardiac tamponade. We report a previously healthy 16-month-old female who developed purulent pericarditis associated with paronychia and sepsis caused by methicillin-sensitive Staphylococcus aureus. In addition to antibiotic treatment, she required emergent pericardiocentesis for cardiac tamponade, followed by two surgical interventions including full median sternotomy incision and partial pericardiectomy. At 4-month follow-up, she did well with no evidence of constrictive pericarditis on echocardiogram.
Assuntos
Antibacterianos/uso terapêutico , Paroniquia/complicações , Pericardiectomia/métodos , Pericardiocentese/métodos , Pericardite Constritiva/etiologia , Infecções Estafilocócicas/etiologia , Ecocardiografia , Feminino , Humanos , Lactente , Paroniquia/cirurgia , Pericardite Constritiva/diagnóstico , Pericardite Constritiva/terapia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapiaRESUMO
Asplenia is associated with an increased incidence of fatal and life-threatening sepsis caused by encapsulated pathogens. Isolated congenital asplenia is a very rare condition, with only 33 cases reported in the literature. The authors report another case of this condition complicated by overwhelming Group B streptococcus sepsis secondary to paronychia that was managed successfully.
Assuntos
Anormalidades Congênitas/imunologia , Paroniquia/complicações , Sepse/microbiologia , Baço/anormalidades , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificação , Adulto , Humanos , Masculino , Radiografia AbdominalAssuntos
Anti-Inflamatórios/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Doenças da Unha/patologia , Psoríase/induzido quimicamente , Psoríase/complicações , Pele/patologia , Adalimumab , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Doença de Crohn/complicações , Doença de Crohn/tratamento farmacológico , Exantema/etiologia , Exantema/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Unhas/patologia , Paroniquia/complicações , Prurido/complicações , Prurido/etiologia , Psoríase/patologia , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
Ingrown toenail, or onychocryptosis, is a common inflammatory disease of the hallux. It results from the alteration of fit of the nail plate in the lateral nail fold. Ingrown toenails are usually seen in adolescents and young adults and can affect daily activities and social life. Generally, ingrown toenails are classified into three stages, including the inflammatory stage, the abscess stage, and the granulation stage. In this article, we present the rare case of a man with a diagnosis of paronychia with sporangium formation causing an ingrown toenail.
Assuntos
Corpos Estranhos/complicações , Unhas Encravadas/etiologia , Paroniquia/complicações , Esporângios/efeitos adversos , Adulto , Humanos , MasculinoRESUMO
OBJECTIVES: Onychomycosis shows a poor response to current topical, oral, or device-related antifungal therapies. The aim of this study was to identify factors influencing the cure rates of non-dermatophyte mold and Candida onychomycosis. METHODS: Eighty-one patients who completed treatments were divided into "cured" and "non-cured" groups. The statistical significance of differences between the two groups was studied. RESULTS: Male gender (P < 0.01), long duration of disease before the initiation of treatment (P < 0.02), three or more infected nails (P < 0.0002), continuous exposure to water and detergents (P < 0.05), frequent exposure to mud and soil (P < 0.01), barefoot walking (P < 0.025), concomitant diabetes and hypertension (P < 0.04), eczema (P < 0.03), and associated paronychia (P < 0.01) had negative effects on cure rates of onychomycosis. Patient age, occupation, site of illness (hand, foot or big toe), type of disease (distal and lateral subungual onychomycosis, proximal subungual onychomycosis or total dystrophic onychomycosis), pathogenic fungi, and treatment modality had no statistically significant impact on cure rate. CONCLUSIONS: To minimize the failure rate of antifungal therapies in the treatment of onychomycosis, patients are advised to start treatment as soon as possible, and to avoid predisposing factors such as exposure to water, detergents, mud and soil, and barefoot walking.
Assuntos
Aspergilose/tratamento farmacológico , Candidíase/tratamento farmacológico , Dermatoses do Pé/tratamento farmacológico , Fusariose/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Onicomicose/tratamento farmacológico , Onicomicose/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Aspergilose/complicações , Candidíase/complicações , Candidíase/microbiologia , Detergentes , Complicações do Diabetes/complicações , Eczema/complicações , Feminino , Dermatoses do Pé/microbiologia , Fusariose/complicações , Dermatoses da Mão/microbiologia , Humanos , Hipertensão/complicações , Itraconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Naftalenos/uso terapêutico , Paroniquia/complicações , Fatores de Risco , Solo , Terbinafina , Tempo para o Tratamento , Resultado do Tratamento , Água , Adulto JovemRESUMO
Mechanical injuries to the terminal digit with or without bone involvement may lead to delayed changes involving a spongy hyperostosis of the tuberosities and hypertrophy of bone and soft tissues. In its most severe form it may lead to post-traumatic finger clubbing. These late results persist for many decades, despite juvenile growth and bone apposition in adult life.
Assuntos
Traumatismos dos Dedos/complicações , Doenças Ósseas/etiologia , Feminino , Dedos/diagnóstico por imagem , Humanos , Hipertrofia , Masculino , Paroniquia/complicações , RadiografiaRESUMO
Herpetic whitlow is a rare viral infection, that should be treated nonoperatively and managed by a hand surgeon. There is a high risk of infection for dentists and other medical personal. The authors present a case, describe findings, possible complications, and treatment.
Assuntos
Herpes Simples/diagnóstico , Paroniquia/diagnóstico , Animais , Encefalite/diagnóstico , Encefalite/etiologia , Herpes Simples/complicações , Herpes Simples/terapia , Humanos , Paroniquia/complicações , Paroniquia/terapiaRESUMO
Vascular insufficiency may complicate chronic digital infection. The reasons for this are twofold: firstly the oedema associated with chronic inflammation causes venous obstruction and this may lead to arterial occlusion. This report has also shown that a second cause of vascular insufficiency may result from direct damage to the vessel walls by the invading organisms, which leads to infectious thrombosis, particularly of the venous structures.
Assuntos
Arterite/patologia , Dedos/irrigação sanguínea , Isquemia/patologia , Paroniquia/complicações , Trombose/patologia , Idoso , Artérias/patologia , Endotélio/patologia , Feminino , Gangrena , Humanos , Paroniquia/patologia , Veias/patologiaRESUMO
Neonatal osteomyelitis is uncommon. The disease starts often without signs of infection and may lead to severe complications. A case is reported of a neonate with vertebral osteomyelitis of the cervical vertebrae. Difficulties of diagnosing the disease and several therapeutic regimes proposed in the literature are discussed.
Assuntos
Vértebras Cervicais , Osteomielite/microbiologia , Paroniquia/complicações , Infecções Estafilocócicas/microbiologia , Antibacterianos , Braquetes , Quimioterapia Combinada/uso terapêutico , Feminino , Humanos , Recém-Nascido , Osteomielite/complicações , Osteomielite/terapia , Compressão da Medula Espinal/etiologia , Staphylococcus aureus/isolamento & purificaçãoRESUMO
The experience of the treatment of 108 patients with complication forms of panaritium (osseous, tendinous, pandactylitis) is described. Complete rehabilitation of the hand function after the treatment was observed in 25% of cases.
Assuntos
Paroniquia/reabilitação , Adulto , Feminino , Seguimentos , Humanos , Masculino , Paroniquia/complicações , Paroniquia/terapiaRESUMO
Results of the treatment of 100 patients with bony, bony-articular panaritium, thecal whitlow and pandactylitis are described. Expediency of the complex treatment including surgery, regional administration of antibiotics and immunotherapy is shown.
Assuntos
Paroniquia/terapia , Infecções Estafilocócicas/terapia , Adolescente , Adulto , Artrite Infecciosa/terapia , Terapia Combinada , Articulações dos Dedos , Humanos , Pessoa de Meia-Idade , Osteoartrite/terapia , Paroniquia/complicaçõesRESUMO
The degree of the influence of angiotrophoneurosis on the development and outcome of purulent diseases of fingers and hand is analyzed on the basis of treatment of 394 patients with complicated forms of panaritium. It was established that angiotrophoneurosis is a predisposing factor to the development of complicated forms of panaritium and profound phlegmons of the hand. A scheme of using reovasotropic medicines is proposed for the compensation of trophic lesions of tissues of the upper limb distal segments.