RESUMEN
Infections of the hand can result in significant limitation of the function of the hand, and may even require partial amputation of a digit. A felon is an abscess of the distal pulp of the fingertip, which can spread rapidly through the flexor tendon sheath when not treated appropriately. Knowledge of the anatomy and the correct method of physical examination are essential when assessing a patient suspected of having a felon or flexor tendon sheath infection. Here we present two patients with a complicated felon resulting in palmar necrosis of the distal phalanx of the thumb, in which a groin flap was used to reconstruct the thumb. This article describes the relevant anatomy, physical examination and treatment of a felon and flexor tendon sheath infection to prevent a complicated course.
Asunto(s)
Absceso/patología , Absceso/cirugía , Pulgar/microbiología , Pulgar/patología , Pulgar/cirugía , Absceso/diagnóstico , Adulto , Infecciones Bacterianas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Colgajos Quirúrgicos , TendonesAsunto(s)
Artritis Infecciosa/etiología , Infecciones por Bacterias Grampositivas/microbiología , Lactobacillus plantarum/aislamiento & purificación , Osteoartritis/etiología , Pulgar , Infección de Heridas/microbiología , Amoxicilina/uso terapéutico , Amputación Quirúrgica , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Artritis Infecciosa/cirugía , Citrus sinensis/microbiología , Terapia Combinada , Complicaciones de la Diabetes/microbiología , Susceptibilidad a Enfermedades , Resistencia a Medicamentos , Sustitución de Medicamentos , Falanges de los Dedos de la Mano/diagnóstico por imagen , Falanges de los Dedos de la Mano/microbiología , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/etiología , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Laceraciones , Lactobacillus plantarum/efectos de los fármacos , Lactobacillus plantarum/patogenicidad , Masculino , Persona de Mediana Edad , Osteoartritis/tratamiento farmacológico , Osteoartritis/microbiología , Osteoartritis/cirugía , Pulgar/lesiones , Pulgar/microbiología , Pulgar/cirugía , Vancomicina/farmacología , Vancomicina/uso terapéuticoAsunto(s)
Deformidades Adquiridas de la Mano/microbiología , Mycobacterium tuberculosis/aislamiento & purificación , Infecciones Oportunistas/microbiología , Pulgar/microbiología , Tuberculosis Cutánea/microbiología , Tuberculosis Miliar/microbiología , Anciano , Antituberculosos/uso terapéutico , Femenino , Deformidades Adquiridas de la Mano/diagnóstico , Deformidades Adquiridas de la Mano/tratamiento farmacológico , Deformidades Adquiridas de la Mano/inmunología , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/inmunología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/inmunología , Pulgar/patología , Resultado del Tratamiento , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/tratamiento farmacológico , Tuberculosis Cutánea/inmunología , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Miliar/inmunologíaRESUMEN
Leclercia adecarboxylata is a motile Gram negative rod that is not often pathogenic in immunocompetent patients. We will present the first case report of a L. adecarboxylata in a pediatric patient with no systemic medical disease and present a detailed literature review.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Enterobacteriaceae/aislamiento & purificación , Preescolar , Traumatismos de los Dedos/microbiología , Humanos , Masculino , Pulgar/microbiologíaAsunto(s)
Artritis Reactiva/patología , Articulación Metacarpofalángica , Pulgar , Tuberculosis Osteoarticular/patología , Accidentes por Caídas , Artritis Reactiva/diagnóstico por imagen , Traumatismos de los Dedos/etiología , Humanos , Masculino , Articulación Metacarpofalángica/diagnóstico por imagen , Articulación Metacarpofalángica/lesiones , Articulación Metacarpofalángica/microbiología , Articulación Metacarpofalángica/patología , Persona de Mediana Edad , Radiografía , Pulgar/diagnóstico por imagen , Pulgar/lesiones , Pulgar/microbiología , Pulgar/patología , Tuberculosis Osteoarticular/diagnóstico por imagenRESUMEN
Necrotising fasciitis is a rare condition that should be diagnosed early and managed aggressively in order to avoid death. We present a case of necrotising fasciitis of the thumb and discuss the assessment and management of this serious condition. A 44-year-old woman presented with a painful and erythematous right thumb and progressive swelling of her hand following a minor injury to the tip of her thumb 3 days previously. A diagnosis of necrotising fasciitis was made and the patient underwent urgent debridement of non-viable tissue. She required 1 week of supportive therapy in intensive treatment unit and was discharged from hospital after 3 weeks. Necrotising fasciitis is a rapidly progressing life-threatening infection, usually caused by streptococcal organisms. Immediate resuscitation, broad-spectrum intravenous antibiotics and early surgical debridement are necessary in order to avoid significant morbidity and mortality.
Asunto(s)
Desbridamiento/métodos , Fascitis Necrotizante/diagnóstico , Procedimientos de Cirugía Plástica/métodos , Infecciones Estreptocócicas/microbiología , Pulgar/microbiología , Heridas Penetrantes/microbiología , Administración Intravenosa , Adulto , Antibacterianos/uso terapéutico , Celulitis (Flemón)/diagnóstico , Diagnóstico Diferencial , Diagnóstico Precoz , Fascitis Necrotizante/microbiología , Fascitis Necrotizante/cirugía , Femenino , Guías como Asunto , Humanos , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/terapia , Pulgar/lesiones , Resultado del Tratamiento , Heridas Penetrantes/complicaciones , Heridas Penetrantes/terapiaRESUMEN
A 41-year-old male who was 3 years status post heart transplant presented with a 3-month history of painful erythematous nodules and ulcers on his lower legs and right hand. First, Mycobacterium chelonae infection was revealed through several biopsies with molecular sequence analysis, and combination treatment, including clarithromycin, was started. During the treatment, lesions of the legs showed an improvement, but a fluctuant erythematous nodule on the thumb did not respond. Repetitive biopsy from the thumb ultimately identified Paecilomyces species and the patient was treated with itraconazole and terbinafine sequentially. Our case is the first report, to our knowledge, of synchronous infection with non-tuberculous mycobacteria (NTM) and Paecilomyces in a solid organ transplant recipient. Our findings highlight the importance of recognizing cutaneous NTM infections or deep mycoses, as well as the importance of choosing an appropriate treatment.
Asunto(s)
Dermatomicosis/complicaciones , Trasplante de Corazón/efectos adversos , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Mycobacterium chelonae/aislamiento & purificación , Paecilomyces/aislamiento & purificación , Enfermedades Cutáneas Bacterianas/complicaciones , Adulto , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Biopsia , Claritromicina/uso terapéutico , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/microbiología , Dermatomicosis/patología , Quimioterapia Combinada , Humanos , Itraconazol/uso terapéutico , Pierna/microbiología , Pierna/patología , Masculino , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/microbiología , Infecciones por Mycobacterium no Tuberculosas/patología , Mycobacterium chelonae/clasificación , Mycobacterium chelonae/efectos de los fármacos , Mycobacterium chelonae/genética , Paecilomyces/clasificación , Paecilomyces/efectos de los fármacos , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Enfermedades Cutáneas Bacterianas/microbiología , Enfermedades Cutáneas Bacterianas/patología , Pulgar/microbiología , Pulgar/patologíaRESUMEN
Fusarium species are non-dermatophytic moulds, which are commonly known soil saprophytes and important plant pathogens, and have been frequently reported to be aetiological agents of opportunistic infections in humans. The prevalence of onychomycosis caused by Fusarium species varies in the literature because of geographical differences in mould distribution and diagnostic methods. Onychomycosis caused by Fusarium species is considered rare in Korea, and only four cases have been described to date. Pseudomonas aeruginosa also can infect nails and cause green nail syndrome, and recent research has shown that fungal infection may potentiate the colonisation or growth of P. aeruginosa within a nail. Furthermore, such coinfection with P. aeruginosa can prevent the isolation of the fungus because of bacterial overgrowth in culture. The authors report the cases of two immunocompetent patients with F. solani onychomycosis coinfected with P. aeruginosa. Both presented with a greenish/yellowish discolouration and thickening of a thumbnail, and were treated with systemic ciprofloxacin in combination with itraconazole or terbinafine.
Asunto(s)
Fusarium/aislamiento & purificación , Dermatosis de la Mano/microbiología , Onicomicosis/microbiología , Pseudomonas aeruginosa/aislamiento & purificación , Pulgar/microbiología , Anciano , Femenino , Fusarium/genética , Humanos , Persona de Mediana Edad , Pseudomonas aeruginosa/genéticaRESUMEN
Coagulase-negative staphylococci (CoNS) are a major cause of sepsis in neonatal intensive care units (NICU) worldwide. Infecting strains of these commensal bacteria may originate from NICU personnel. Therefore, we studied the characteristics of CoNS isolates from NICU personnel and compared them to those of isolates from the general population and from sepsis patients. Furthermore, we studied the epidemiological effect on CoNS carriage of NICU personnel after a period of absence. In our study, we isolated CoNS from the thumbs of NICU personnel every 2 weeks during the summer of 2005 and sampled personnel returning from vacation and a control group from the general population. Furthermore, we collected sepsis isolates from this period. Isolates were tested for antibiotic resistance, mecA and icaA carriage, biofilm production, and genetic relatedness. We found that mecA and icaA carriage as well as penicillin, oxacillin, and gentamicin resistance were significantly more prevalent in CoNS strains from NICU personnel than in community isolates. Similar trends were observed when postvacation strains were compared to prevacation strains. Furthermore, genetic analysis showed that 90% of the blood isolates were closely related to strains found on the hands of NICU personnel. Our findings revealed that CoNS carried by NICU personnel differ from those in the general population. Hospital strains are replaced by community CoNS after a period of absence. NICU personnel are a likely cause for the cross-contamination of virulent CoNS that originate from the NICU to patients.
Asunto(s)
Portador Sano/microbiología , Piel/microbiología , Infecciones Cutáneas Estafilocócicas/microbiología , Staphylococcus/aislamiento & purificación , Adulto , Técnicas de Tipificación Bacteriana , Coagulasa/metabolismo , Dermatoglifia del ADN , Femenino , Genes Bacterianos , Genotipo , Personal de Salud , Humanos , Lactante , Recién Nacido , Cuidado Intensivo Neonatal , Masculino , Pruebas de Sensibilidad Microbiana , Sepsis/microbiología , Staphylococcus/clasificación , Pulgar/microbiología , Adulto JovenRESUMEN
Isolated gonococcal tenosynovitis is rare, and is part of disseminated gonococcal infection. It is due to blood-borne contamination of the flexor tendon sheath. One to 3% of gonococcal mucosal infections develop disseminated infections. Tenosynovitis is present in two-thirds of cases, sometimes in association with arthritis and skin rash. We report a case of a 26-year-old man with isolated gonococcal tenosynovitis of the thumb, with no other medical history, occurring 15 days after unprotected sex. Except local inflammatory signs of the thumb extending to the wrist, and a biological inflammatory syndrome, the patient had no arthritis, skin or mucosa symptoms. Immediate surgical drainage was performed under antibiotic cover with 3rd generation cephalosporin. All bacteriological samples were negative, except for one blood culture positive for Neisseria gonorrhoeae. Thus, in case of an asymptomatic patient with suspected gonococcal infection through a mucus portal, a precise examination, including geographical and sexual history, and a review of screening are recommended. Although the pathophysiology of gonococcal tenosynovitis is still obscure, the best prevention remains that of sexually transmitted diseases.
Asunto(s)
Gonorrea/complicaciones , Neisseria gonorrhoeae , Tenosinovitis/microbiología , Pulgar , Adulto , Antibacterianos/uso terapéutico , Cefalosporinas/uso terapéutico , Drenaje , Gonorrea/diagnóstico , Gonorrea/terapia , Humanos , Masculino , Neisseria gonorrhoeae/aislamiento & purificación , Tenosinovitis/diagnóstico , Tenosinovitis/terapia , Pulgar/microbiología , Pulgar/cirugía , Resultado del TratamientoAsunto(s)
Dermatosis de la Mano/terapia , Linfangitis/terapia , Nocardiosis/terapia , Pulgar/microbiología , Anciano , Antibacterianos/uso terapéutico , Cactaceae , Terapia Combinada , Desbridamiento , Drenaje , Femenino , Dermatosis de la Mano/microbiología , Humanos , Nocardiosis/microbiología , Reoperación , Irrigación Terapéutica , Pulgar/lesiones , Heridas PunzantesAsunto(s)
Dermatomicosis/diagnóstico , Exophiala/aislamiento & purificación , Dermatosis de la Mano/diagnóstico , Úlcera Cutánea/microbiología , Pulgar/microbiología , Anciano de 80 o más Años , Dermatomicosis/microbiología , Exophiala/crecimiento & desarrollo , Dermatosis de la Mano/microbiología , Humanos , Masculino , Onicomicosis/microbiologíaAsunto(s)
Calcinosis/complicaciones , Infecciones de los Tejidos Blandos/etiología , Infecciones Estafilocócicas/etiología , Trastornos de la Motilidad Esofágica , Femenino , Humanos , Persona de Mediana Edad , Enfermedad de Raynaud , Esclerodermia Localizada , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Síndrome , Pulgar/microbiología , Pulgar/patologíaRESUMEN
Mycobacterium marinum infections (fish tank granuloma) are infrequently encountered and when they do arise, they can pose a diagnostic challenge for clinicians. They can present as non-healing wounds along with several other presentations that may not be typical, as patients can have other comorbidities that cause immunosuppression and invasive symptoms of the disease. Treatment regimens vary in length, and are based on the patient's response to treatment couple with resolution of symptoms. Rifampicin and ethambutol are effective treatment options, together with use of macrolides. A thorough history from patients must be taken as to establish contact with aquatic animals.
Asunto(s)
Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Mycobacterium marinum , Enfermedades Cutáneas Bacterianas/diagnóstico , Pulgar/lesiones , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Claritromicina/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Masculino , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Rifampin/uso terapéutico , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Pulgar/microbiología , Resultado del TratamientoRESUMEN
Necrotizing fasciitis of the hand is a rare clinical entity, frequently with devastating functional consequences. A case of necrotizing fasciitis of the thumb and thenar eminence caused by Group A Streptococcus is reported and the management of this condition in the upper limb discussed.
Asunto(s)
Fascitis Necrotizante/cirugía , Streptococcus pyogenes/aislamiento & purificación , Pulgar/microbiología , Pulgar/cirugía , Adulto , Amputación Quirúrgica , Desbridamiento , Fascitis Necrotizante/diagnóstico , Femenino , Humanos , Colgajos Quirúrgicos , Pulgar/patología , Dedos del Pie/trasplanteAsunto(s)
Fascitis Necrotizante/etiología , Saliva/microbiología , Pulgar/lesiones , Adulto , Conducta , Eikenella corrodens/aislamiento & purificación , Fascitis Necrotizante/microbiología , Haemophilus/aislamiento & purificación , Humanos , Masculino , Streptococcus/aislamiento & purificación , Pulgar/microbiologíaRESUMEN
Two hundred and thirty-one cases of orf were reported in one year from 18 meat works slaughtering lambs and sheep. This represented 1.4 percent of the total employees at these works and 4 percent of those working on the mutton slaughter board. One hundred and nineteen of these reports were accompanied by samples of the lesion and 85 percent of lesions contained orf virus particles as determined by electron microscopy. The tasks that led to the greatest risk of contracting orf were related to handling pelts and/or wool. Ninety-five percent of lesions were on the hands. The risk of a worker contracting orf did not decrease with the number of years employed at the meat works and 18 cases of re-infection were reported. Control of the disease in man in the meat industry will be difficult in the short term. In the long term control of the disease in man will rely on control of the disease in sheep. Alternative vaccines for sheep will need to be found.