Fulminant Acanthamoeba Endophthalmitis After Cataract Surgery-A Case Report.

PURPOSE: To report a case of Acanthamoeba endophthalmitis after an uneventful cataract surgery. METHODS: Description, management, and outcomes of a biopsy-proven case of Acanthamoeba endophthalmitis. RESULTS: Two days after a routine cataract surgery elsewhere, the patient presented with acute endophthalmitis diagnosed as a bacterial infection based on timing and severity. When conventional methods of management failed, the patient was referred to us. Only the presence of an atypical ring infiltrate suggested Acanthamoeba as a probable cause. Subsequent diagnostic evaluations confirmed the initial suspicion. Management with topical antiamoebics and intracameral and intravitreal voriconazole was attempted. Systemic voriconazole and metronidazole were also administered. However, because of relentless disease progression, the eye had to be eviscerated. The cornea, aqueous, vitreous, and sclera were positive by culture and/or polymerase chain reaction and histopathology. CONCLUSIONS: Acanthamoeba usually causes a chronic smoldering keratitis and, very rarely, scleritis. This report, which is the first of its kind, emphasizes the fact that fulminant endophthalmitis with associated scleritis can occur after ocular surgery in an immunocompetent individual, with no significant ophthalmic history.

Enterobious vermicularis induced infectious keratitis following penetrating keratoplasty.

A 28-year-old man with a prior history of penetrating keratoplasty in the left eye for total corneal melt presented with a 3-day history of a red, painful left eye. On examination, he was found to have graft infiltrates. Microscopic examination of wet mount preparation of corneal scrapings revealed the presence of embryonated eggs of E. vermicularis. Cellophane (scotch) tape preparation from perianal region also revealed embryonated eggs of E. vermicularis as well as live adult worms. Ocular and adnexal involvement by E. vermicularis is extremely rare. Here, we report the first case of infection of a corneal graft with E. vermicularis.

The Use of Cryotherapy for the Prevention of Wound Complications in the Treatment of Calcaneal Fractures.

We analyzed the risk factors for skin infection and necrosis after calcaneal fracture surgery and evaluated the effect of cryotherapy in preventing postoperative skin infections and necrosis. We studied 129 calcaneal fracture patients (148 feet) who had undergone open reduction and internal fixation from January 2008 to December 2010. Three groups included were: control (44 patients; 49 feet), preoperative cryotherapy (43 patients; 48 feet), and perioperative cryotherapy (42 patients; 51 feet). The wound infection rate, Maryland foot score, and postoperative visual analog scale (VAS) score were compared. Risk factors for infection were analyzed using multinomial logistic regression. Both cryotherapy groups had lower infection rates, higher Maryland foot scores, lower VAS scores, and shorter hospitalizations than the control group (p < .05). The perioperative cryotherapy group had a lower infection rate, higher Maryland foot score, and shorter hospitalization (p < .05) but similar VAS score compared with the preoperative cryotherapy group (p > .05). Pre- and postoperative cryotherapy, postoperative drainage, surgical timing, smoking index, alcoholism, and suture method were risk factors for postoperative infection and necrosis. The risk of these can be largely reduced by patients not smoking and drinking alcohol and surgeons choosing the appropriate surgical timing, improving the suturing method, and performing postoperative drainage. Perioperative cryotherapy might be an effective method to decrease the postoperative infection rate, shorten the hospital stay, and reduce postoperative pain. Our findings require further validation in well-designed randomized controlled trials.

Postoperative Wound Myiasis Caused by Sarcophaga carnaria.

Myiasis is a parasitic infection caused by dipteran larvae settling in living tissue and organs. Infestation is generally found in tropical and rural areas, where interaction with animals is common. It is diagnosed based on the evidence of the existence of dipteran larvae in tissues and organs. When planning the treatment, identifying the type of larvae is as important as identifying the infected organ or system. In this case report, we present the case of a female who had a biliary tract injury caused by laparoscopic cholecystectomy and who developed a postoperative enterocutaneous fistula and myiasis caused by third-stage Sarcophaga sp. larvae at the incision area.

Myiasis of the Tracheostomy Wound Caused by Sarcophaga (Liopygia) argyrostoma (Diptera: Sarcophagidae): Molecular Identification Based on the Mitochondrial Cytochrome c Oxidase I Gene.

Wound myiasis is the infestation of open wounds of mammalian hosts caused by larvae of various species of flies. This kind of myiasis can be a serious problem for immobilized patients with open wounds. Here, we identify a dipteran larva found in the tracheostomy wound of a child affected by a severe spinal muscular atrophy. The collected larva was dissected and microscopically analyzed. DNA was extracted from part of the larva and used for the molecular identification. A 487 bp fragment, including part of 5.8 S, the internal transcribed spacer 2 (ITS2), and part of 28S, was amplified using a novel PCR assay to be cloned and sequenced. The barcode region of cytochrome oxidase I (COI) was also cloned and sequenced after PCR amplification. The larva, designated as SASI1, was identified as a third instar of Sarcophaga sp. The COI sequencing confirmed a low similarity with Sarcophaga ruficornis (F.) (95%), yet COI showed a 100% similarity with Sarcophaga argyrostoma (Robineau-Desvoidy, 1830) species. Therefore, SASI1 was identified as a S. argyrostoma larva on the basis of its COI barcode. This is one of the rare cases of myiasis of tracheostomy wound and the first caused by S. argyrostoma.

Unusual clinical case: extraluminal manifestation of a tapeworm from the eviscerated midline incision in a post-surgery patient.

Taenia saginata infestation is one of the most common cestode infestations in humans, that may cause gastrointestinal tract related complications as a result of obstruction, perforation or anastomotic leakage. A 55-year-old male patient who was receiving palliative chemotherapy for stage IV gastric cancer was admitted to the emergency department for abdominal pain. A hollow viscus organ perforation was diagnosed and an emergency surgery was performed. On postoperative day 5, the patient's midline incision eviscerated and a moving taenia emerged, with abundant particulated fluid from the incision line. The patient was admitted for abdominal surgery due to suspected bowel perforation. During the abdominal exploration, a relaxed purse stitch of the feeding tube was observed and no other bowel perforations were seen. The patient underwent two planned surgery for abdominal cavity lavage after the removal of cestode. Unfortunately, the patient died sixteen days after his admission to the intensive care unit. This is the first case describing an extraluminal manifestation of a tapeworm in a midline incision from evisceration without intestinal perforation.

Onchocerca armillata contamination of a bovine pericardial xenograft in a human patient with repaired tetralogy of Fallot.

BACKGROUND: Bovine pericardial patches are used for many purposes, including facilitating right ventricular outflow tract reconstruction in patients with congenital heart disease. Here we present a case of parasitic contamination of a bovine pericardium used as a transannular patch during repair of tetralogy of Fallot 28 years prior at a hospital in China. METHODS: The patient presented to the University of Washington Medical Center for congestive heart failure and pulmonic regurgitation, and heart tissues including the xenograft pericardial patch were submitted to the Pathology Department and subsequently to the Comparative Pathology Program. RESULTS: The pericardial parasitic nodules with intralesional adult nematodes and microfilaria in the bovine tissues were preserved at harvest by (presumed) glutaraldehyde fixation. CONCLUSION: Onchocerca armillata parasitic pericardiopathy was diagnosed in the xenograft tissue based on the characteristic nematode morphology and the presumed geographic location of the donor bovine. This resulted in O. armillata contamination of the pericardial xenograft in a human patient with repaired tetralogy of Fallot.

Microbial keratitis after corneal laser refractive surgery.

Corneal laser refractive surgery is increasingly being performed on patients with the aim of improving unaided vision. Most candidates for surgery have excellent spectacle- or contact lens-corrected vision. Although microbial keratitis following refractive surgery is a rare complication, and usually has a good visual outcome, it can be sight-threatening. The spectrum of pathogens differs to other causes of microbial keratitis, such as contact lens-associated keratitis, and a different management approach is required. Postoperatively, patients are prescribed topical steroids and broad-spectrum topical antibiotics, typically fluoroquinolones. These do not cover unusual organisms, such as fungi, Nocardia, Acanthamoeba and some atypical mycobacteria. In post-laser-assisted in situ keratomileusis microbial keratitis, the lamellar flap should be lifted to acquire samples for specific microbiological examination, including these atypical organisms. Confocal microscopy is a noninvasive test that provides morphological information, and is operator dependent, but may assist in the rapid diagnosis of fungal, Acanthamoeba or Norcardia keratitis. PCR is not in widespread use, but has high sensitivity and specificity, and may facilitate early diagnosis and specific treatment of the causative organism, which is critical in obtaining the best clinical outcome.

[A postoperative wound myiasis caused by Lucilia sericata (Diptera: Calliphoridae) in a woman in Kars]. / Kars'ta Bir Kadinda Lucilia sericata (Diptera: Calliphoridae)'nin Neden Oldugu Postoperatif Yara Myiasisi.

Lucilia sericata is known as a facultative ectoparasite and it often causes myiasis in open wounds, mouth, nose and eyes of animals and rarely in humans. This case report concerns a 56 year old woman who had right breast cancer surgery. Approximately 10 months after surgery, swelling, pain, redness occurred in the incision site. About two weeks later the site turned into an open wound then fly larvae (97 live larvae) were found. Under t operation conditions, a large surgical wound debridement and debulking were performed on the open wound. The patient was followed for three weeks after the operation. The wound dressings were carried out daily and it shrank partially. Medical treatment was given to the patient and she was discharged. The collected larvae were identified as Lucilia sericata by microscopic examination in the parasitology lab.

Babesiosis in the immediate postoperative period after splenectomy for trauma.

BACKGROUND: In an immunocompetent host, Babesia microti has not been reported as a cause of postoperative fever. METHODS: Case report and literature review. RESULTS: A 52-year-old woman living on Martha's Vineyard developed postoperative fever after splenectomy for trauma. The patient's mechanism of injury was a fall from a stationary bicycle. Intraoperatively, the patient was noted to have splenomegaly. Postoperatively, she developed fever and was found to have Babesia microti on blood smear with an otherwise negative fever evaluation. She was treated with atovaquone and azithromycin and made a full recovery. CONCLUSIONS: For individuals who have lived or traveled in endemic areas, babesiosis should be considered as a possible cause of postoperative fever when other sources have been excluded. Patients undergoing splenectomy in an endemic area should be screened for babesiosis to prevent postoperative recrudescence of symptoms.

Early diagnosis and treatment of falciparum malaria in Cambodian trauma patients.

Asymptomatically infected patients with falciparum malaria may develop symptomatic malaria infection secondary to injury or surgery. This complication increases the risk for postoperative wound infection and adds to the burden of trauma. The aims of the present study were to investigate the preventive effect of early antimalaria treatment of Plasmodium falciparum infected trauma patients, and to study the validity and accuracy of a rapid test to identify those infected. An open, non-randomized, interventional multi-center, cohort study was carried out at six district hospitals in northwestern Cambodia. Two hundred twenty-two trauma patients was examined for P. falciparum by dipstick test soon after injury. The patients testing positive were immediately treated with artesunate-mefloquine. A subset of 108 patients from Pailin, an area considered highly endemic for falciparum malaria, was used for the main analysis. Of 28 P. falciparum rapid test-positives, 21 developed symptomatic postinjury malaria despite early antimalarial treatment. The agreement between the dipstick test and blood smear examination was good (kappa 92.5; 95% CI 84.5-100). Early pre-operative treatment of parasite carriers does not seem to prevent symptomatic malaria after injury and surgery. The rapid test for falciparum malaria was reliable in early identification of asymptomatic P. falciparum infected patients.

Maggot infestation (myiasis) of external fixation pin sites in diabetic patients.

Diabetic patients, and especially elderly patients in a low-nutritional or immunocompromised state, are prone to a variety of opportunistic infections. 'Myiasis' is a term that refers to non-iatrogenic infestation of tissues by larvae, commonly known as maggots, of dipterous flies. Myiasis as a complication of fracture treatment by means of external fixation of long bones has not been reported. We present three diabetic patients, who suffered maggot infestation of their external fixation pin holes, and their outcome. Diabetes, immobilization, poor hygiene and low immune status are predisposing factors for developing myiasis, an extremely rare complication for external fixation of fractures.

Pin-site myiasis: a rare complication of a treated open fracture of tibia.

BACKGROUND: Pin-site myiasis is a rare complication of external fixation of open fractures of the tibia. METHODS: Case report and literature review. RESULTS: A 32 year-old man with a history of alcohol and drug abuse presented with an open fracture of the middle third of the fibula and tibia (Gustilo type IIIA) after a motor vehicle crash. Definitive surgical correction of the fracture was made with the insertion of an external skeletal fixator, type Baummer, with 2 bars, 6 pins, and 12 rotules. After three weeks, he presented again with a primary complaint of purulent secretion and maggots at the distal pin site. On removal of the pin, significant destruction of peripheral tissue was evidenced, with a wound approximately 5 cm diameter, from which 105 maggots were extracted, being identified as Cochliomyia hominivorax. CONCLUSIONS: There have been no previous reports of myiasis involving an external skeletal fixation and pin, and only one similar case has been reported in a patient with a halo orthosis for the management of a gunshot wound of the neck. As in that case, presumably, in our patient, myiasis occurred via the small infected wound adjacent to the distal pin. Adequate treatment for myiasis requires complete removal of the maggots, as well as antimicrobial therapy.

An overview of head lice infestation in neurosurgical patients.

Head lice or pediculosis is recognized as an increasing problem in medical practice (Down et al, 1999). Secondary bacterial infections can occur in patients with infestation. In neurosurgical patients, head lice infestation may be a potential risk factor for peri-operative complications. Secondary infection could further complicate neurosurgical wounds with subsequent complications. The authors discuss epidemiology, pathogenesis of potential peri-operative complications resulting from pediculosis and methodology of treatment of this common condition. The importance of early recognition and prompt treatment in patients with neurological diseases is highlighted. A simple algorithm to treat scalp pediculosis is suggested.

Acanthamoeba keratitis after LASIK.

PURPOSE: To report a case of Acanthamoeba infection following LASIK. METHODS: A 20-year-old woman developed pain, redness, decreased vision, and corneal infiltrate in the right eye 15 days after bilateral LASIK. She did not use contact lenses postoperatively. Patient examination 3 months after surgery revealed a large, central, full-thickness corneal infiltrate with multiple satellite lesions in the right eye. Corneal scrapings were taken and the flap excised, and submitted for histopathologic examination. RESULTS: Microscopic examination of smears revealed Acanthamoeba cysts and non-nutrient agar showed a significant growth of Acanthamoeba. Histopathology examination of the excised flap demonstrated numerous Acanthamoeba cysts in tissue sections. The infiltrate was treated with a combination of topical polyhexamethylene biguanide, chlorhexidine, atropine sulfate, and oral itraconazole and resolved within 2 months. CONCLUSIONS: Laser in situ keratomileusis can be complicated by Acanthamoeba infection. Microbiologic evaluation is essential for accurate early diagnosis and treatment.