Perianal Reactivation of Herpes Simplex Virus Type 2 After Laser-Assisted Hair Removal.

ABSTRACT: We report a case of perianal reactivation of herpes simplex virus type 2 in a 27-year-old man, who was HIV positive with good immunovirological status, after a laser-assisted (alexandrite) hair removal session. We discuss the clinical and laboratory features and the role of prophylaxis with antivirals, particularly in certain patients such as immunocompromised ones.

Adult Native Joint Septic Arthritis: A Nine-Year Retrospective Analysis in a Portuguese University Hospital.

INTRODUCTION: Septic arthritis of a native joint represents a medical emergency. Drainage and effective antibiotic treatment are critical to avoid joint destruction and long-term impairment. The aim of this study was to evaluate epidemiological and clinical characteristics of patients with the diagnosis of septic arthritis to help establish local guidelines for empirical antibiotic treatment. MATERIAL AND METHODS: Retrospective analysis of adult patients admitted at Centro Hospitalar Universitário do Porto from 2009 to 2017 with suspected native joint septic arthritis. Relevant demographics, microbiology findings and respective antibiotic susceptibilities were analysed. RESULTS: Ninety-seven patients, predominantly males (59.8%) with a median age of 61 years old were included. The most commonly reported comorbidity associated with septic arthritis was diabetes mellitus (20.6%). The knee was the most commonly affected joint (71.1%). Arthrocentesis was performed in all patients, but only 50.5% had positive microbial growth in the synovial fluid. Staphylococcus aureus was the most frequently identified microorganism, 86% of which were methicillin susceptible. Gram-negative bacteria were the causative agent in 15% of cases. A wide range of empirical antibiotic regimens were prescribed with a combination of vancomycin/carbapenem being the most common (30.9%). Analysis of antibiotic susceptibility profiles revealed that amoxicillin/clavulanate would have been appropriate as the initial regimen in 89% of cases. DISCUSSION: The main causative pathogen was Staphylococcus aureus, with methicillin resistant Staphylococcus aureus remaining rare. The proportion of Gram-negative bacteria implies that these agents should be covered by empirical treatment, although no case of Pseudomonas infection has been identified. Therefore, antipseudomonal coverage is not necessary in empirical regimens. CONCLUSION: Routine coverage of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa is not warranted but must be considered when specific risk factors are found. Amoxicillin/clavulanate can provide adequate antibiotic coverage as an empirical treatment for adult native joint septic arthritis. Its use may allow a reduction in use of broader spectrum antibiotics.

Introdução: A artrite séptica representa uma patologia grave que pode levar à destruição articular e diminuição funcional a longo prazo. Adicionalmente à drenagem articular, uma antibioterapia efetiva é crucial. O objetivo deste estudo consistiu em avaliar as características epidemiológicas e clínicas dos doentes admitidos com diagnóstico de artrite séptica e analisar a terapêutica antimicrobiana, estabelecendo orientações locais de tratamento antibiótico empírico. Material e Métodos: Análise retrospetiva de doentes adultos admitidos no Centro Hospitalar Universitário do Porto com artrite séptica de articulação nativa de 2009 a 2017. Foram revistos os resultados microbiológicos, os perfis de suscetibilidade aos antimicrobianos e os registos médicos. Resultados: Dos 97 doentes incluídos, 59,8% eram do género masculino, com uma idade média de 61 anos. A comorbilidade mais comum foi a diabetes mellitus (20,6%). O joelho foi a articulação mais afetada (71,1%). Realizou-se artrocentese em todos os doentes, com isolamento microbiano em 50,5% dos produtos. O Staphylococcus aureus foi o microrganismo mais frequente, sendo sensível à meticilina, em 86% dos casos. As bactérias Gram-negativo foram o agente causal em 15% das infeções. A associação do carbapenemo e vancomicina foi a antibioterapia empírica mais comummente iniciada (30,9%), embora em 89% dos casos a amoxicilina/clavulanato teria sido apropriada como regime inicial. Discussão: O principal agente etiológico foi o Staphylococcus aureus, continuando o Staphylococcus aureus resistente à meticilina a ser um agente raro. A percentagem de bactérias Gram-negativo implica a sua cobertura como terapêutica empírica, embora não tenha havido casos de infeção por Pseudomonas. Por isso, a utilização empírica de um antibiótico com atividade antipseudomónica não é necessária. Conclusão: A cobertura antibiótica de Staphylococcus aureus resistente à meticilina e Pseudomonas não é obrigatória, mas pode ser considerada na presença de alguns fatores de risco específicos. A amoxicilina/ clavulanato é uma antibioterapia empírica adequada para a artrite séptica de articulação nativa, permitindo reduzir a utilização inadequada de antibióticos de espectro mais alargado.

Deep neck space infection and Lemierre's syndrome caused by Streptococcus anginosus: A case report.

INTRODUCTION: Deep neck space infections most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, middle ear or sinuses, usually with a rapid onset and frequently with progression to life-threatening complications. Lemierre's syndrome is classically defined by an oropharyngeal infection with internal jugular vein thrombosis followed by metastatic infections in other organs. CASE PRESENTATION: A 32-year-old female patient, with no significant past medical history, was diagnosed with a dental abscess on her left inferior 3rd molar. Six days later, the condition complicated with severe upper respiratory distress, odynophagia and trismus, and extension of the inflammatory signs to the anterior cervical region, involving the upper airway. Computed tomography scan confirmed extension to submandibular, parapharyngeal and retrosternal spaces), which required nasotracheal intubation due to compromised airway. Urgent and subsequent surgical drainages were performed, alongside with concomitant antibiotic therapy. Additionally, left internal jugular vein thrombosis was described - with later extension to the brachiocephalic vein, without other complications, consistent with Lemierre's syndrome, although without full features. Streptococcus anginosus was identified in the drained pus specimens. The patient made a satisfactory clinical progress and was discharged after 25 days, still under therapeutic hypocoagulation. CONCLUSION: As deep neck space infections can be life-threatening, clinicians must be aware and not underestimate their potential severity. Lemierre's syndrome is a complication difficult to recognize, which requires additional awareness of the many possible presentations, for appropriate diagnostic studies and therapeutic plan.

[Human Psittacosis: A Case Report]. / Psitacose: A Propósito de Um Caso Clínico.

Psittacosis is a rare disease caused by Chlamydophila psittaci, an intracellular bacteria transmitted by contaminated birds. The clinical and radiological presentations are nonspecific. We describe a case of a 42-year-old woman, with known exposure to birds, who presented to the emergency department with one-week evolution of myalgia, polyarthritis, and respiratory symptoms. At admission, she had fever, respiratory failure, raised inflammatory markers and bilateral interstitial infiltrates at chest radiography. Considering the clinical findings and epidemiological background, we raised the hypothesis of a Chlamydophila psittaci atypical pneumonia that was serologically confirmed. Tetracyclines are the mainstay of treatment and the macrolides are an effective alternative. We highlight the importance of the epidemiological context in the early diagnosis and treatment of this infection.

A psitacose é uma entidade rara provocada pela Chlamydophila psittaci, uma bactéria intracelular obrigatória que se transmite através do contacto com aves contaminadas. A apresentação clínica e imagiológica é inespecífica. Reporta-se o caso clínico de uma mulher de 42 anos, com história de exposição a pássaros, que se apresenta no Serviço de Urgência com um quadro de mialgias, poliartralgias e clínica de infeção respiratória, com uma semana de evolução. À admissão, encontrava-se febril, com insuficiência respiratória do tipo 1, elevação dos parâmetros inflamatórios e infiltrados intersticiais difusos bilaterais na radiografia de tórax. Considerando o quadro clínico e o contexto epidemiológico de risco, colocou-se a hipótese de pneumonia atípica por Chlamydophila psittaci, confirmada serologicamente. As tetraciclinas são o esteio do tratamento, sendo os macrólidos uma alternativa eficaz. Realça-se a importância do contexto epidemiológico, para uma abordagem diagnóstica e terapêutica apropriadas.

[Late Neuroborreliosis in an Erasmus Programme Student]. / Neuroborreliose Tardia num Estudante em Programa Erasmus.

Lyme disease is an endemic zoonosis, the most prevalent tick-transmitted infection in temperate areas of Europe, North America and Asia. It is a multisystemic disease with cutaneous, musculoskeletal, neurologic and cardiac manifestations, according to the stage of the disease. We describe a case of late neuroborreliosis in an Erasmus programme student living in Porto. We discuss the importance of the epidemiological suspicion, the clinical approach, the diagnostic criteria and the most adequate treatment.

A doença de Lyme é uma zoonose endémica nos Estados Unidos da América (EUA), na Ásia e no continente europeu, nomeadamente nos países do centro da Europa. Trata-se de uma doença multissistémica, com manifestações cutâneas, articulares, neurológicas e cardíacas, que variam de acordo com a fase da doença. Apresentamos o caso de uma neuroborreliose tardia num jovem estudante belga a residir temporariamente no Porto. Discutimos a importância da suspeita epidemiológica, a investigação etiológica, os critérios de diagnóstico e o tratamento mais adequado.