RESUMO
History and clinical findings We report on three patients suffering from skin and soft tissue infections of the legs due to toxigenic Corynebacterium ulcerans strains. In all three patients, there was a predisposition due to chronic diseases. Three patients had domestic animals (cat, dog) in their households. Investigations and diagnosis A mixed bacterial flora including Corynebacterium ulcerans was found in wound swab samples. Diphtheric toxin was produced by the Corynebacterium ulcerans strains in all three cases. Treatment and course In all three patients, successful handling of the skin and soft tissue infections was possible by combining local treatment with antibiotics. Diphtheria antitoxin was not administered in any case. Conclusion Based on a review of the recent literature pathogenesis, clinical symptoms and signs, diagnostics and therapy of skin and soft tissue infections due to Corynebacterium ulcerans are discussed. Corynebacterium ulcerans should be considered as a potential cause of severe skin and soft tissue infections. Occupational or domestic animal contacts should be evaluated.
Assuntos
Infecções por Corynebacterium/microbiologia , Dermatopatias Bacterianas/microbiologia , Infecções dos Tecidos Moles/microbiologia , Idoso de 80 Anos ou mais , Animais , Animais Domésticos , Toxinas Bacterianas/biossíntese , Corynebacterium/classificação , Corynebacterium/metabolismo , Infecções por Corynebacterium/complicações , Infecções por Corynebacterium/diagnóstico , Infecções por Corynebacterium/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dermatopatias Bacterianas/complicações , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/terapia , Infecções dos Tecidos Moles/complicações , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/terapiaRESUMO
BACKGROUND: 30,000 to 50,000 injuries are caused by bites in Germany every year. Dog and cat bites are common, human bites relatively rare. 25% of the victims are under age 6, and 34% are aged 6 to 17. METHODS: This review is based on pertinent literature retrieved by a selective search and on the authors' clinical and scientific experience. RESULTS: In small children, most bite wounds are on the head and neck; in older children and adolescents, most are on the limbs. Bite injuries range from trivial ones needing no medical intervention to major soft-tissue defects with the loss of functionally important structures. A bite can transmit unusual pathogens from the saliva into the wound. The risk of infection after a bite is 10-20%, and about 30-60% of the infections are of mixed aerobic-anaerobic origin. Prophylactic antibiotics are recommended only for wounds that are considered at high risk of infection in view of their type and location, the species of the biting animal, and the characteristics of the patient. CONCLUSION: Structured surgical management of bite wounds is the most important factor in the prevention of infection. High-risk wounds must be differentiated from trivial ones. Interdisciplinary management is advisable for wounds on the hands and face.
Assuntos
Mordeduras e Picadas/diagnóstico , Mordeduras e Picadas/terapia , Infecções/diagnóstico , Infecções/terapia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/terapia , Animais , Mordeduras e Picadas/epidemiologia , Mordeduras Humanas/diagnóstico , Mordeduras Humanas/epidemiologia , Mordeduras Humanas/terapia , Causalidade , Cricetinae , Cães , Medicina Baseada em Evidências , Alemanha , Cobaias , Humanos , Infecções/epidemiologia , Camundongos , Coelhos , Ratos , Fatores de Risco , Ferimentos Penetrantes/epidemiologiaAssuntos
Infestações por Piolhos/diagnóstico , Animais , Humanos , Inseticidas/administração & dosagem , Infestações por Piolhos/parasitologia , Infestações por Piolhos/terapia , Infestações por Piolhos/transmissão , Pediculus/anatomia & histologia , Pediculus/crescimento & desenvolvimento , Prevenção Secundária , Falha de TratamentoAssuntos
Infestações por Piolhos/diagnóstico , Infestações por Piolhos/parasitologia , Couro Cabeludo/parasitologia , Animais , Diagnóstico Diferencial , Dimetilpolisiloxanos/administração & dosagem , Dimetilpolisiloxanos/efeitos adversos , Resistência a Medicamentos , Interações Hospedeiro-Parasita , Humanos , Inseticidas/administração & dosagem , Inseticidas/efeitos adversos , Infestações por Piolhos/tratamento farmacológico , Pediculus/fisiologia , Permetrina/administração & dosagem , Permetrina/efeitos adversos , Piretrinas/administração & dosagem , Piretrinas/efeitos adversosRESUMO
Non-tuberculous mycobacteria are rarely responsible for skin and soft tissue infections. These infections are caused by different mycobacterial species originating from the environment (water, soil, plants, and animals). Various factors influence the clinical manifestation of the cutaneous infection: the immunological situation of the patient, the degree of cutaneous impairment, and the extent of the contact with the contaminated environment. The clinical manifestation is non-specific and often the cause of extensive diagnostic activities. The diagnosis is based on the cultural detection of the causative pathogen. The management of these skin and subcutaneous infections is a challenge for each physician. The treatment comprises administration of several antibiotics and antituberculosis drugs for many months. Surgical procedures are necessary in some patients.
Assuntos
Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/etiologia , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/etiologia , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/etiologia , Antibacterianos/uso terapêutico , Antibióticos Antituberculose/uso terapêutico , Técnicas Bacteriológicas , Estudos Transversais , Diagnóstico Diferencial , Humanos , Assistência de Longa Duração , Infecções por Mycobacterium/tratamento farmacológico , Infecções por Mycobacterium/epidemiologia , Fatores de Risco , Dermatopatias Bacterianas/tratamento farmacológico , Dermatopatias Bacterianas/epidemiologia , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/epidemiologiaAssuntos
Infestações por Piolhos/diagnóstico , Pediculus , Prurido/etiologia , Dermatoses do Couro Cabeludo/etiologia , Adolescente , Animais , Diagnóstico Diferencial , Feminino , Humanos , Inseticidas , Infestações por Piolhos/tratamento farmacológico , Dermatoses do Couro Cabeludo/diagnóstico , Dermatoses do Couro Cabeludo/tratamento farmacológicoRESUMO
A 56-year-old man was bitten by a dog. 8 days later he was admitted to a hospital because of severe deterioration of his clinical situation. He developed the clinical picture of fulminant sepsis. In spite of aggressive intensive care therapy the patient died 24 hours later. Capnocytophaga canimorsus was identified from initial blood cultures. This gram-negative rod is part of the normal oral flora of dogs and cats. It can be spread to humans by bites, licking or scratches and causes severe infections, especially in persons with special risk factors (splenectomy, alcoholism). The mortality rate in the published cases is 25-30%.
Assuntos
Mordeduras e Picadas/complicações , Mordeduras e Picadas/microbiologia , Capnocytophaga , Cães , Infecções por Bactérias Gram-Negativas/microbiologia , Choque Séptico/microbiologia , Alcoolismo/complicações , Alcoolismo/microbiologia , Alcoolismo/patologia , Animais , Mordeduras e Picadas/patologia , Evolução Fatal , Infecções por Bactérias Gram-Negativas/patologia , Infecções por Bactérias Gram-Negativas/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/complicações , Infecções Oportunistas/microbiologia , Infecções Oportunistas/patologia , Choque Séptico/patologia , Choque Séptico/transmissãoRESUMO
Listeriosis is a rare disease with increasing incidence occurring mainly in elderly people and patients suffering from underlying diseases and immunosuppressive therapy. On the basis of three case reports and a review of the literature the most important aspects of epidemiology, pathogenesis, clinical manifestations, diagnostics and therapy of listeriosis are discussed.
Assuntos
Listeriose/diagnóstico , Adulto , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Bacteriemia/transmissão , Estudos Transversais , Quimioterapia Combinada , Humanos , Listeriose/tratamento farmacológico , Listeriose/epidemiologia , Listeriose/transmissão , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/transmissão , Pleuropneumonia/diagnóstico , Pleuropneumonia/tratamento farmacológico , Pleuropneumonia/epidemiologia , Fatores de RiscoRESUMO
Human tuberculosis is caused by members of the Mycobacterium tuberculosis complex, which includes M. tuberculosis, M. bovis, M. africanum and M. bovis BCG. However there are increasing reports of rarely occurring genetic variants such as M. canettii, M. microti and M. pinipedii. The natural reservoir, mode of transmission and potential modification of host interaction of these species is not yet fully elucidated. We report a rare case of extensive cavitary smear-positive tuberculosis of the left lung caused by M. microti in an immunocompetent tuberculin-negative 68-year-old man. Transmission by a raccoon dog or raccoon as a novel M. microti reservoir was suspected. Spoligotyping of the isolate revealed the llama subtype. The strain exhibited no detectable drug resistance. Response to standard tuberculosis treatment, initially comprising isoniacid, rifampicin, pyrazinamide and ethambutol, was excellent. Delayed growth on solid media, specific phenotypic features and contact with animals should raise suspicion for this rare mycobacterial infection.
Assuntos
Imunocompetência , Mycobacterium tuberculosis/classificação , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia , Idoso , Animais , Antituberculosos/uso terapêutico , Reservatórios de Doenças , Humanos , Masculino , Técnicas de Amplificação de Ácido Nucleico , Cães Guaxinins , Guaxinins/microbiologia , Tomografia Computadorizada por Raios X , Teste Tuberculínico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/transmissão , Zoonoses/microbiologiaRESUMO
CASE REPORT: A case of endocarditis due to Cardiobacterium (C.) hominis in a 41-year-old female patient 1 year after aortic valve replacement with a pulmonary autograft (Ross operation) is described. Diagnosis was established by blood culture and echocardiographic detection of a vegetation on the noncoronary cusp of the autograft. Despite clinical improvement by treatment with ceftriaxone and gentamicin, a cerebral hemorrhage occurred on the 7th day of treatment and neurosurgery was necessary. Progressive insufficiency of the aortic valve and persistent large vegetation required repeated aortic valve replacement 3 weeks after cerebral hemorrhage. REVIEW OF THE LITERATURE: C. hominis is a Gram-negative, slow-growing and fastidious bacterium, rarely causing endocarditis. Subacute and chronic courses are common. That is why diagnosis often is difficult and delayed. Reviewing the literature, clinical presentation, diagnostics and therapy of endocarditis due to C. hominis are discussed.
Assuntos
Estenose da Valva Aórtica/cirurgia , Cardiobacterium , Endocardite Bacteriana/diagnóstico , Infecções por Bactérias Gram-Negativas/diagnóstico , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias/diagnóstico , Valva Pulmonar/transplante , Adulto , Ecocardiografia Transesofagiana , Endocardite Bacteriana/cirurgia , Feminino , Seguimentos , Infecções por Bactérias Gram-Negativas/cirurgia , Humanos , Complicações Pós-Operatórias/cirurgia , ReoperaçãoRESUMO
A case of listeriosis in a patient undergoing long-term hemodialysis is reported. The 69-year-old man with chronic renal failure due to polycystic renal dysplasia had received hemodialysis treatment for 10 years. Renal anemia and iron overload developed within this time. In the course of a hemodialysis the patient presented with malaise, chills and fever to 38.7 degrees C. Blood culture specimens were obtained and the patient received ampicillin-sulbactam. Blood culture specimens subsequently showed growth of Listeria monocytogenes. During therapy the patient improved rapidly and was free from fever on day 5. The relation of iron overload and Listeria infection is discussed.
Assuntos
Bacteriemia/diagnóstico , Sobrecarga de Ferro/complicações , Falência Renal Crônica/terapia , Listeriose/diagnóstico , Infecções Oportunistas/diagnóstico , Diálise Renal , Idoso , Ampicilina/uso terapêutico , Anemia/complicações , Anemia/terapia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Humanos , Sobrecarga de Ferro/diagnóstico , Listeriose/tratamento farmacológico , Masculino , Doenças Renais Policísticas/complicações , Doenças Renais Policísticas/terapia , Sulbactam/uso terapêuticoRESUMO
CASE REPORT: A prosthetic aortic valve was implanted in a 41-year-old patient with connatal aortic stenosis. 14 months later a bacterial endocarditis was diagnosed and treated with ceftriaxone. 6 weeks later he had a relapse. Satellite streptococci could be cultivated from three blood cultures, later identified as Granulicatella adiacens. The patient was treated with penicillin and gentamicin. REVIEW OF THE LITERATURE: In a short review of the literature the most important aspects of pathogenesis, diagnostics and therapy of endocarditis due to satellite streptococci are presented.
Assuntos
Endocardite Bacteriana/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus/isolamento & purificação , Adulto , Valva Aórtica/microbiologia , Estenose da Valva Aórtica/congênito , Estenose da Valva Aórtica/cirurgia , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Técnicas Bacteriológicas , Ceftriaxona/uso terapêutico , Quimioterapia Combinada , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Gentamicinas/uso terapêutico , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Valva Mitral/microbiologia , Penicilina G/uso terapêutico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Recidiva , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Streptococcus/classificaçãoAssuntos
Notificação de Doenças , Sífilis/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Estudos Transversais , Medicina Baseada em Evidências , Feminino , Alemanha , Humanos , Recém-Nascido , Masculino , Neurossífilis/diagnóstico , Neurossífilis/tratamento farmacológico , Neurossífilis/epidemiologia , Penicilinas/uso terapêutico , Gravidez , Sífilis/tratamento farmacológico , Sífilis/epidemiologia , Sorodiagnóstico da Sífilis , Sífilis Congênita/diagnóstico , Sífilis Congênita/tratamento farmacológico , Sífilis Congênita/epidemiologia , Sífilis Cutânea/diagnóstico , Sífilis Cutânea/tratamento farmacológico , Sífilis Cutânea/epidemiologiaRESUMO
In an 8-week-old infant, kyphosis caused by destruction of the 7th thoracic vertebra was observed. A paraspinal mass and narrowing of the spinal canal due to vertebral osteomyelitis were present. Treatment with antibiotics and bracing was carried out with no evidence of neurologic disturbances over a follow-up period of 24 months.
Assuntos
Granuloma de Células Plasmáticas/complicações , Cifose/etiologia , Osteomielite/complicações , Doenças da Coluna Vertebral/complicações , Estenose Espinal/etiologia , Vértebras Torácicas , Humanos , LactenteRESUMO
Piercing and tattooing enjoy widespread popularity in modern society. Patients with congenital heart disease are at elevated risk for infective endocarditis. However, it is not yet known whether piercing and tattooing are dangerous for these patients.A search of the literature provided 10 published cases of infective endocarditis after piercing or tattooing. Affected patients were adolescents or young adults ranging in age from 13 to 30 years (5 male, 5 female). Four of the patients had a known cardiac risk factor for endocarditis (bicuspid aortic valve, postoperative trans-position of the great arteries, postoperative coarctation, postoperative aortic valve stenosis). Piercing preceded endocarditis in 9 cases (4 times mouth, 2 ear, 1 nose, 1 breast, 1 navel), one tattoo. The following agents were isolated: S. aureus in 4 cases, 2 S. epidermidis, 1 Str. viridans, 1 Neisseria mucosa, 1 Haemophilus aphrophilus, 1 Haemophilus parainfluenzae. All patients were treated with antibiotics. Six patients underwent cardiac surgery (5 of them valve replacement). Patients with congenital heart disease constitute less than 1% of the population. Thus, they are clearly overrepresented in the published literature. Epidemiologic conclusions are not possible from these data. However, patients with congenital heart disease and their parents should be strongly advised against piercing and tattooing with regard to the risk of infective endocarditis.
Assuntos
Técnicas Cosméticas/efeitos adversos , Endocardite Bacteriana/etiologia , Cardiopatias Congênitas/complicações , Tatuagem/efeitos adversos , Adolescente , Adulto , Coartação Aórtica/complicações , Coartação Aórtica/etiologia , Valva Aórtica/anormalidades , Estenose da Valva Aórtica/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Fatores de Risco , Transposição dos Grandes Vasos/complicações , Transposição dos Grandes Vasos/etiologiaRESUMO
Piercing, i.e. perforation of skin or mucous membranes in order to attach mostly metallic jewelery as well as multicolored skin tattooing have become more popular than ever before and a considerable number of (young) people practise these methods of body art which are supposed to increase the individuality. But there is a lot of side effects, among them especially infections. The most important bacteria cultivated from such patients are Staphylococcus aureus, group A streptococci and Pseudomonas aeruginosa. Viruses which can be transmitted by piercing or tattooing are especially hepatitis B virus and hepatitis C virus. Besides local bacterial infections also systemic infections (sepsis, endocarditis) occur. The main aspects of diagnostics, therapy and prevention are discussed.
Assuntos
Metais/administração & dosagem , Próteses e Implantes/efeitos adversos , Pele/lesões , Tatuagem/efeitos adversos , Infecção dos Ferimentos/etiologia , Hepatite B/transmissão , Hepatite C/transmissão , Humanos , Infecções por Pseudomonas/etiologia , Fatores de Risco , Infecções Estafilocócicas/etiologia , Infecções Estreptocócicas/etiologia , Streptococcus pyogenesRESUMO
OBJECTIVE: We assessed epidemiologic, clinical and laboratory features of aseptic meningitis during one season of multiserotype enteroviral meningitis in East Germany in 70 consecutive patients with aseptic meningitis admitted to the Children's University Hospital Leipzig. RESULTS: Patients, age 1 to 16 years, typically presented with headache, emesis and fever, whereas signs of meningeal irritation were only moderately expressed in one-half of the patients. The median number of leukocytes in the CSF was 151 cells/mm(3) (range, 2 to 1,820) with a high percentage of polymorphonuclear cells (PMNs). Initial blood counts showed mild leukocytosis and pronounced PMN predominance (78.9 +/- 1.3%). The percentage of PMNs in the peripheral blood decreased in favor of mononuclear cells after 3 days to a pattern more compatible with viral infection as opposed to that suggestive for bacteria in the beginning. Mean cerebrospinal fluid values of protein, glucose and lactate and the C-reactive protein were mildly elevated or normal. Nonpolio enteroviruses were detected in 30 of 70 patients. Subsequent serotyping revealed echovirus type 13 (13 patients), type 6 (2), type 30 (1) and coxsackie B virus type 5 (2). There were no differences in demographic or clinical data between enterovirus positive and negative patients. CONCLUSIONS: Even though individual laboratory values do not solely allow discrimination between viral and bacterial meningitis, the combined epidemiologic, clinical and laboratory data facilitate the diagnosis of aseptic meningitis in most cases. Viral diagnostics, identifying echovirus type 13 that thus far has not been associated with epidemics of meningitis, adds important epidemiologic information.