Assuntos
Aspergilose/imunologia , Aspergilose/patologia , Dermatomicoses/imunologia , Dermatomicoses/patologia , Hospedeiro Imunocomprometido , Abdome/microbiologia , Abdome/patologia , Braço/microbiologia , Braço/patologia , Aspergilose/diagnóstico , Aspergillus/isolamento & purificação , Dermatomicoses/diagnóstico , Enterocolite Neutropênica/complicações , Enterocolite Neutropênica/imunologia , Evolução Fatal , Pé/microbiologia , Pé/patologia , Humanos , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/imunologia , Masculino , Pessoa de Meia-IdadeRESUMO
A 73 year old female presented with five non-painful nodules on the dorsal side of her right lower arm that occured after an infection on her third digit finger after cleaning her aquarium. PCR of the biopsy from on of the nodules shows a mycobacterium marinum infection.
Assuntos
Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium marinum , Dermatopatias Bacterianas/diagnóstico , Idoso , Braço/microbiologia , Braço/patologia , Biópsia , Feminino , Dedos/microbiologia , Dedos/patologia , Humanos , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/patologia , Dermatopatias Bacterianas/microbiologia , Dermatopatias Bacterianas/patologiaRESUMO
Systemic use of voriconazole (VCZ) might be restricted by adverse events, such as hepatotoxicity and neurotoxicity, or drug-drug interactions. Topical VCZ application to skin may help to treat local infection more effectively and limit unwanted whole-body exposure. Topical VCZ cream was stable for 90 days when refrigerated. A patient with cutaneous Fusarium solani infection on his right forearm was successfully treated with topical 1% VCZ cream after failure of oral VCZ treatment.
Assuntos
Antifúngicos/uso terapêutico , Fusariose/tratamento farmacológico , Fusarium/efeitos dos fármacos , Voriconazol/uso terapêutico , Administração Tópica , Adulto , Braço/microbiologia , Interações Medicamentosas , Fusariose/microbiologia , Humanos , Masculino , Creme para a Pele/administração & dosagem , Creme para a Pele/uso terapêuticoRESUMO
BACKGROUND: Clostridium tetani is a gram-positive spore-forming bacterium that produces toxins and grows under anaerobic conditions. Infections with this bacterium can lead to local or generalised forms of tetanus. CASE DESCRIPTION: An 83-year-old man presented to the acute cardiac care unit with a painful left arm and jaw. Because the patient had a hypertonic left arm and was unable to open his mouth fully, the neurologist was consulted. The patient had been to the emergency department 9 days earlier for an infected wound after falling in the garden. He had not been actively or passively immunised against tetanus at that time. On inquiry, it appeared that the patient had also not been vaccinated as a child. We made a clinical diagnosis of tetanus. The patient was admitted and treated with tetanus immunoglobulin, metronidazole, diazepam and painkillers. He was also administered tetanus toxoid and the wound was cleaned. After 1 month and 7 months, the patient was again administered tetanus toxoid. CONCLUSION: Patients with a wound that may have come into contact with road grime, dirt or manure, should always be asked for their vaccination status, especially people from high-risk groups, such as the elderly.
Assuntos
Antibacterianos/uso terapêutico , Clostridium tetani , Dor/tratamento farmacológico , Tétano/tratamento farmacológico , Infecção dos Ferimentos/tratamento farmacológico , Idoso de 80 Anos ou mais , Braço/microbiologia , Humanos , Arcada Osseodentária/microbiologia , Masculino , Metronidazol/uso terapêutico , Dor/microbiologia , Tétano/microbiologia , Toxoide Tetânico/uso terapêutico , Infecção dos Ferimentos/microbiologiaAssuntos
Candida albicans , Candidíase/terapia , Piomiosite/terapia , Antifúngicos/uso terapêutico , Braço/microbiologia , Braço/patologia , Candida albicans/efeitos dos fármacos , Candida albicans/isolamento & purificação , Candidíase/diagnóstico , Desbridamento , Humanos , Masculino , Pessoa de Meia-Idade , Piomiosite/diagnóstico , Recidiva , Fatores de Tempo , Resultado do TratamentoRESUMO
Opportunistic fungal infections occur predominantly in immunocompromised (IC) patients. Mucormycosis has the highest mortality among fungal infections. The organism is ubiquitous in its presence. The infection is commonly acquired by inhalation of fungal spores or by inoculation by direct trauma. Rhinocerebral and pulmonary mucormycosis present commonly with high mortality rates. Cutaneous mucormycosis (CM) is rarely reported and usually presents in two forms, superficial and disseminated. The superficial infection occurs commonly in immunocompetent hosts, and it can sometimes turn angioinvasive and become a fatal and very aggressive disseminated disease, especially in IC hosts. Coexistant risk factors increase the mortality rate. We report a case of posttraumatic, highly lethal, angioinvasive, and gangrenous type of CM of the arm in an IC patient. Diabetic ketoacidosis and cirrhosis due to chronic alcoholic liver disease were the risk factors.
Assuntos
Braço/microbiologia , Hospedeiro Imunocomprometido , Mucormicose/diagnóstico , Infecções Oportunistas/diagnóstico , Pele/patologia , Adulto , Braço/patologia , Evolução Fatal , Gangrena , Humanos , Masculino , Pele/microbiologiaRESUMO
Cutaneous cryptococcosis is usually secondary to the hematogenous dissemination of pulmonary or meningeal Cryptococcus neoformans. Primary cutaneous cryptococcosis (PCC) is a rare form of the infection, typically caused by direct inoculation from trauma to the skin [1]. Most cases of PCC present as a localized cellulitis, abscess, nodule, or ulceration. Herein, we present a case of a rapidly spreading cellulitis characterized by bullae and ulceration, caused by direct inoculation from a fall.
Assuntos
Criptococose/diagnóstico , Cryptococcus neoformans/isolamento & purificação , Dermatomicoses/diagnóstico , Acidentes por Quedas , Idoso , Braço/microbiologia , Biópsia , Celulite (Flegmão) , Criptococose/etiologia , Criptococose/microbiologia , Dermatomicoses/microbiologia , Dermatomicoses/patologia , Humanos , Masculino , Fatores de Risco , Pele/microbiologiaAssuntos
Eritema/etiologia , Tinha/diagnóstico , Tinha/tratamento farmacológico , Animais , Antifúngicos/uso terapêutico , Braço/microbiologia , Criança , Diagnóstico Diferencial , Eritema/tratamento farmacológico , Exantema/tratamento farmacológico , Exantema/etiologia , Feminino , Griseofulvina/uso terapêutico , Cobaias/microbiologia , Humanos , Animais de Estimação/microbiologia , Prurido/tratamento farmacológico , Prurido/etiologia , Tórax/microbiologia , Tinha/etiologiaAssuntos
Amputação Cirúrgica , Falso Aneurisma/cirurgia , Aneurisma Infectado/cirurgia , Aneurisma Roto/cirurgia , Artéria Braquial/cirurgia , Dependência de Heroína/complicações , Falso Aneurisma/etiologia , Falso Aneurisma/microbiologia , Aneurisma Infectado/etiologia , Aneurisma Roto/etiologia , Braço/microbiologia , Braço/cirurgia , Artéria Braquial/microbiologia , Emergências , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Dermatophytes comprising the genera Trichophyton, Microsporum, and Epidermophyton are important causes of superficial mycoses. The number of infected patients and the distribution of species of these organisms in our hospital were unknown. We therefore aimed to investigate the clinical pattern of dermatophyte infections and to identify the species of these dermatophytes at the Dermatological Clinic of the Hospital for Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok in a 1-year period. Twenty-six patients who had typical dermatophytosis lesions were recruited (27 specimens); 17 were female (65.38%) and 9 (34.62%) were male. The age range of the patients was 16-92 years. In total, nine dermatophyte isolates were identified by macroscopic and microscopic morphological characteristics. We found Microsporum canis (four isolates), Trichophyton mentagrophytes complex (one), Trichophyton rubrum (two), Trichophyton verrucosum (one), and Trichophyton tonsurans (one). The in vitro susceptibility profiles of seven antifungal agents against the nine dermatophytes were as follows (minimum inhibitory concentration ranges in µg/ml): The results were as follows (MIC ranges in µg/ml): ciclopirox, ≤0.06-0.5, griseofulvin ≤0.06-0.5, itraconazole ≤0.002-0.06, posaconazole ≤0.015-0.03, voriconazole ≤0.02-≥1, fluconazole ≤0.08-8, and terbinafine ≤0.01-0.125. This study represents the current state of dermatophyte infections in a metropolitan area of Bangkok, Thailand.
Assuntos
Antifúngicos/farmacologia , Arthrodermataceae/efeitos dos fármacos , Arthrodermataceae/isolamento & purificação , Tinha/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Braço/microbiologia , Braço/patologia , Arthrodermataceae/classificação , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tailândia/epidemiologia , Tinha/epidemiologia , Medicina Tropical , Adulto JovemRESUMO
Necrotizing fasciitis is a rare but serious disease, and early diagnosis is essential to reducing its substantial morbidity and mortality. The 2 cases presented show that the key clinical and radiographic features of necrotizing fasciitis exist along a continuum of severity at initial presentation; thus, this diagnosis should not be prematurely ruled out in cases that do not show the dramatic features familiar to most clinicians. Although computed tomography and magnetic resonance imaging are considered the most effective imaging modalities, the cases described here illustrate how sonography should be recommended as an initial imaging test to make a rapid diagnosis and initiate therapy.
Assuntos
Fasciite Necrosante/diagnóstico por imagem , Ultrassonografia/métodos , Antibacterianos , Braço/diagnóstico por imagem , Braço/microbiologia , Braço/cirurgia , Diagnóstico Diferencial , Fasciite Necrosante/tratamento farmacológico , Fasciite Necrosante/cirurgia , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/microbiologia , Perna (Membro)/cirurgia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Information on the course and outcome of early European Lyme neuroborreliosis is limited. METHODS: The study comprised 77 patients (38 males, 39 females; median age, 58 years) diagnosed with painful meningoradiculitis (Bannwarth syndrome) who were followed up for 1 year at a single center. RESULTS: Duration of neurological symptoms before diagnosis was 30 (interquartile range, 14-50) days. The most frequent symptoms/signs were radicular pain (100%), sleep disturbances (75.3%), erythema migrans (59.7%), headache (46.8%), fatigue (44.2%), malaise (39%), paresthesias (32.5%), peripheral facial palsy (PFP) (36.4%), meningeal signs (19.5%), and pareses (7.8%). Cerebrospinal fluid (CSF) analysis revealed lymphocytic/monocytic pleocytosis, elevated protein concentration, and intrathecal synthesis of borrelial immunoglobulin M and immunoglobulin G antibody in 100%, 81.1%, 63%, and 88.7% of patients, respectively. Borreliae (predominantly Borrelia garinii) were isolated from CSF, skin, and blood in 15.6%, 40.6%, and 2.7% of patients, respectively. The outcome after 14-day treatment with ceftriaxone was favorable in 87.8% of patients. Control CSF examination at 3 months showed decreased leukocyte counts in all patients; however, 23.3% still had pleocytosis (>10 × 10(6) cells/L). A model based on pretreatment data and the findings at the end of 14-day antibiotic treatment accurately predicted which patients would have an unfavorable outcome 6 or 12 months after treatment. CONCLUSIONS: Our patients had fewer pretreatment neurological complications (PFP, pareses) than reported for Bannwarth syndrome decades ago, probably as the result of earlier recognition and prompt antibiotic treatment. Unfavorable outcome was rare and was predicted by the continued presence of symptoms 14 days after commencement of treatment.
Assuntos
Anticorpos Antibacterianos/sangue , Grupo Borrelia Burgdorferi/imunologia , Neuroborreliose de Lyme/diagnóstico , Idoso , Braço/microbiologia , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Perna (Membro)/microbiologia , Neuroborreliose de Lyme/microbiologia , Masculino , Pessoa de Meia-Idade , Pescoço/microbiologia , Tronco/microbiologiaRESUMO
UNLABELLED: We studied skin microbiota present in three skin sites (forearm, axilla, scalp) in men from six ethnic groups living in New York City. METHODS: Samples were obtained at baseline and after four days following use of neutral soap and stopping regular hygiene products, including shampoos and deodorants. DNA was extracted using the MoBio Power Lyzer kit and 16S rRNA gene sequences determined on the IIlumina MiSeq platform, using QIIME for analysis. RESULTS: Our analysis confirmed skin swabbing as a useful method for sampling different areas of the skin because DNA concentrations and number of sequences obtained across subject libraries were similar. We confirmed that skin location was the main factor determining the composition of bacterial communities. Alpha diversity, expressed as number of species observed, was greater in arm than on scalp or axilla in all studied groups. We observed an unexpected increase in α-diversity on arm, with similar tendency on scalp, in the South Asian group after subjects stopped using their regular shampoos and deodorants. Significant differences at phylum and genus levels were observed between subjects of the different ethnic origins at all skin sites. CONCLUSIONS: We conclude that ethnicity and particular soap and shampoo practices are secondary factors compared to the ecological zone of the human body in determining cutaneous microbiota composition.
Assuntos
Bactérias/genética , Etnicidade , Higiene , RNA Ribossômico 16S/genética , Pele/microbiologia , Adulto , Braço/microbiologia , Axila/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/etnologia , Couro Cabeludo/microbiologiaRESUMO
A tubercular swelling of the triceps muscle in a 25-year-old immunocompetent man is described in this report. He presented with hard, fixed swelling at the lower end of the triceps muscle. Confirmatory diagnosis was established by fine-needle aspiration cytology (FNAC) of the swelling with subsequent PCR for Mycobacterium tuberculosis of the FNAC specimen. The patient was completely cured with antitubercular therapy.
Assuntos
Antituberculosos/uso terapêutico , Braço/microbiologia , Músculo Esquelético/microbiologia , Mycobacterium tuberculosis , Tuberculose/diagnóstico , Adulto , Biópsia por Agulha Fina , Citodiagnóstico , Edema/diagnóstico , Edema/etiologia , Humanos , Masculino , Reação em Cadeia da Polimerase , Tuberculose/tratamento farmacológico , Tuberculose/microbiologiaAssuntos
Infecções por HIV/microbiologia , Infecções por HIV/patologia , Pneumonia/microbiologia , Pneumonia/patologia , Tuberculose Cutânea/microbiologia , Tuberculose Cutânea/patologia , Adulto , Antibacterianos/uso terapêutico , Braço/microbiologia , Braço/patologia , Humanos , Masculino , Pneumonia/virologia , Pele/microbiologia , Pele/patologia , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Cutânea/virologiaRESUMO
28 yr old male presented with asymptomatic nodules and few well to ill defined papules on ears, asymmetrical nerve enlargement and evanescent tender nodules on the extremities without any infiltration of the skin and madarosis. Slit skin smear done from normal skin was BI 6+. Skin biopsy showed features of lepromatous leprosy.