RESUMEN
Until recently the number of patients with syphilis has been diminishing. Although that trend has reversed cases of tertiary syphilis are rare and often difficult to diagnose as a substantial number of patients will have a negative rapid plasma reagin. Histologically, cutaneous lesions in late stage syphilis exist in two forms, noduloulcerative and gummatous. Silver stains for spirochetes are almost invariably negative and, surprisingly, immunohistochemical stains are problematic as most lesions contain few, if any organisms. Presented here is a case of gummatous tertiary syphilis arising in association with foreign material deposited after a motor vehicle accident.
Asunto(s)
Traumatismos del Antebrazo/microbiología , Cuerpos Extraños/microbiología , Sífilis/diagnóstico , Accidentes de Tránsito , Anciano , Manejo de la Enfermedad , Humanos , MasculinoRESUMEN
This paper presents the case of a 75-year-old Brazilian man who developed inflammatory skin lesions with nodules and ulcerations on the right forearm after an injury caused by handling barbed-wire and Eucalyptus spp. logs. Histopathological assessment of the lesions showed granulomatous processes with yeasts similar to Cryptococcus spp. Tissue fragments yielded yeasts when cultured that were identified as Cryptococcus gattii VGII through biochemical reactions and URA5-RFLP genotype. No evidence of systemic involvement or any underlying immunosuppressive diseases were identified, which supported the diagnosis of primary cutaneous cryptococcosis. After 5 months on therapy with high fluconazole doses, the skin lesions had fully healed.
Asunto(s)
Criptococosis/diagnóstico , Cryptococcus gattii/aislamiento & purificación , Dermatomicosis/diagnóstico , Traumatismos del Antebrazo/microbiología , Anciano , Antifúngicos/uso terapéutico , Criptococosis/tratamiento farmacológico , Criptococosis/patología , Cryptococcus gattii/patogenicidad , Dermatomicosis/tratamiento farmacológico , Fluconazol/uso terapéutico , Humanos , MasculinoRESUMEN
BACKGROUND: It is important to predict the occurrence of deep infection in open fractures when treating such fractures. We tried to develop a new scoring system for predicting the occurrence of deep infection in open upper and lower extremity fractures on the basis of the Hannover Fracture Scale'98 (HFS-98). METHODS: A total of 394 open upper and lower extremity fractures (351 patients) were retrospectively reviewed in the initial analysis. The relationship between Gustilo's grade and the eight items on HFS-98 in the open extremity fractures was first investigated by multivariate analysis. By this analysis, we selected significant items that correlated with Gustilo's grade. Among these cases, 318 patients with 352 open extremity fractures (humerus = 27, forearm = 62, femur = 76, tibia = 187) were used for the following infection analyses. The relationships between the incidence of deep infection and sex (male or female), age (<30, 30-50, <50 years), grade of polytrauma (ISS < 18, 18 < or = ISS < or = 30, ISS > 30), site of fracture (humerus, forearm, femur, tibia), existence of fracture line around joint (+ or -) or some significant items in the above initial analysis were further analyzed by multivariate analysis after univariate analysis. We devised a new scoring system of open extremity fractures based on P values in the above analysis. The discrimination of the newly devised scoring system was evaluated with receiver operating characteristic (ROC) curves. RESULTS: The following factors: muscle injury (MI, P = 0.0001); wound contamination (WC, P = 0.0001); and local circulation (LC, P = 0.0001) were significant factors affecting the occurrence of deep infection on multivariate analysis. We devised a new scoring system for open extremity fractures (MI: 0-20 points, WC: 0-20 points, and LC: 0-20 points). The cut-off point for occurrence of deep infection in these fractures was 35 by ROC analysis. CONCLUSIONS: This new scoring system was thought to be useful for predicting the occurrence of deep infection in open extremity fractures. However, further prospective study or multicenter study would be needed to clarify the validity of this scale.
Asunto(s)
Fracturas Abiertas/complicaciones , Indicadores de Salud , Infección de Heridas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Fémur/complicaciones , Fracturas del Fémur/microbiología , Traumatismos del Antebrazo/complicaciones , Traumatismos del Antebrazo/microbiología , Fracturas Abiertas/microbiología , Humanos , Fracturas del Húmero/complicaciones , Fracturas del Húmero/microbiología , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Curva ROC , Estudios Retrospectivos , Fracturas de la Tibia/complicaciones , Fracturas de la Tibia/microbiología , Adulto JovenRESUMEN
A 63-year-old man was admitted to hospital. He had a history of splenectomy secondary to trauma, previous alcohol abuse, cirrhosis and oesophagus varices. The patient had been bitten by a dog three days before admittance. He rapidly developed disseminated intravascular coagulation and multiple organ dysfunction. Six days after the bite, the patient died despite antibiotic treatment. The gram-negative rod Capnocytophaga canimorsus was found in the blood culture. This case emphasizes the importance of early diagnosis and prompt treatment of infections in post-splenectomy patients as they carry a greater-than-normal risk of serious complications.
Asunto(s)
Mordeduras y Picaduras/microbiología , Capnocytophaga , Infecciones por Bacterias Gramnegativas/microbiología , Sepsis/microbiología , Animales , Capnocytophaga/aislamiento & purificación , Perros , Resultado Fatal , Traumatismos del Antebrazo/microbiología , Traumatismos del Antebrazo/patología , Humanos , Masculino , Persona de Mediana Edad , EsplenectomíaAsunto(s)
Traumatismos del Antebrazo/microbiología , Resistencia a la Meticilina , Infecciones de los Tejidos Blandos/microbiología , Infecciones Estafilocócicas/complicaciones , Absceso/microbiología , Absceso/cirugía , Adulto , Antibacterianos , Clindamicina/uso terapéutico , Infecciones Comunitarias Adquiridas/microbiología , Servicio de Urgencia en Hospital , Traumatismos del Antebrazo/complicaciones , Humanos , Masculino , Agua de Mar/microbiología , Infecciones de los Tejidos Blandos/complicaciones , Infecciones Estafilocócicas/cirugíaRESUMEN
INTRODUCTION: Domestic animal bites are quite common, but mostly cause minor lesions, for which no medical help is sought. The objective of this study is to define the complications resulting from cat and dog bites that lead to hospital admission. This analysis led to updated guidelines for the treatment of dog and cat bites in humans. PATIENTS AND METHODS: The emergency department (ED) data of our hospital for the year 2004 were retrospectively analysed, seeking patients that presented with bite wounds from either cat or dog. The patient files were reviewed. RESULTS: 34 patients, bitten by cats or dogs, presented to our ED in 2004. 73.5% of them (n = 25) consulted within 24 hours after the bite. In 11 of these patients (44.0%), primary closure of the wound was performed after thorough rinsing and evaluation of the dead space. All these patients were given prophylactic antibiotics. In none of these did the wounds need to be reopened afterwards. Nine patients (26.5%) did not present to the ED until after the day they were bitten. In all these patients, the bite wounds were located on the hand (n = 6) or forearm (n = 3). They all consulted because of complications. The main symptoms were limited and there was painful mobilisation of fingers and wrist, and swelling and redness in the area of the bite wound. Their wounds were thoroughly explored and in 6 of these nine late-presenting patients, a tendon lesion or a purulent flexor tenosynovitis was diagnosed. These six patients needed admission for further management. The mean admission duration was 6 days (range 4 to 10 days). None of the admitted patients showed any signs of limited mobility or disability during follow-up after discharge. CONCLUSION: While cat and dog bites often cause minor lesions that can be treated by thorough wound care if presented early, the importance of possible late complications should not be overlooked. Patients that present with the symptoms of tissue infection due to a cat or dog bite should be examined adequately and may need admission. Due to aggressive treatment, we had no serious or disabling complications in our population after discharge.
Asunto(s)
Mordeduras y Picaduras/terapia , Adolescente , Adulto , Anciano , Animales , Antibacterianos/uso terapéutico , Bélgica , Mordeduras y Picaduras/complicaciones , Mordeduras y Picaduras/microbiología , Gatos , Desbridamiento , Perros , Servicio de Urgencia en Hospital , Femenino , Traumatismos del Antebrazo/microbiología , Traumatismos del Antebrazo/terapia , Traumatismos de la Mano/microbiología , Traumatismos de la Mano/terapia , Humanos , Masculino , Persona de Mediana Edad , Admisión del Paciente/estadística & datos numéricos , Prevotella/aislamiento & purificación , Staphylococcus aureus/aislamiento & purificación , Tenosinovitis/etiología , Tenosinovitis/cirugía , Toxoide Tetánico/administración & dosificación , Irrigación TerapéuticaAsunto(s)
Alternaria/aislamiento & purificación , Dermatomicosis/diagnóstico , Traumatismos del Antebrazo/complicaciones , Infecciones Oportunistas/diagnóstico , Piel/lesiones , Heridas Penetrantes/complicaciones , Anciano , Antifúngicos/uso terapéutico , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/etiología , Dermatomicosis/microbiología , Diabetes Mellitus Tipo 2/complicaciones , Susceptibilidad a Enfermedades , Traumatismos del Antebrazo/microbiología , Humanos , Hipertensión/complicaciones , Itraconazol/uso terapéutico , Masculino , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/etiología , Infecciones Oportunistas/microbiología , Pinus , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Heridas Penetrantes/microbiologíaAsunto(s)
Mordeduras y Picaduras/complicaciones , Perros , Traumatismos del Antebrazo/microbiología , Osteomielitis/microbiología , Infecciones por Pasteurella/microbiología , Animales , Niño , Diagnóstico Diferencial , Humanos , Masculino , Pasteurella/aislamiento & purificación , Radio (Anatomía)/microbiologíaRESUMEN
The clinical and histological features of a dermomycosis caused by a new dematiaceum fungus are described. The mycological characteristics of this fungus individualize and differentiate it from other demiataceum hyphomycetes, proposing the name of Botryomyces caespitosus for it. The submicroscopic features are commented, as well.
Asunto(s)
Dermatomicosis/microbiología , Hongos Mitospóricos/aislamiento & purificación , Accidentes de Trabajo , Enfermedades de los Trabajadores Agrícolas/microbiología , Dermatomicosis/etiología , Dermatomicosis/patología , Traumatismos del Antebrazo/microbiología , Humanos , Masculino , Persona de Mediana Edad , Hongos Mitospóricos/clasificaciónRESUMEN
In a prospective study, 64 traumatic wounds to the hand and forearm were examined for infection by quantitative smear (Gram stain) and culture to determine whether significant wound contamination had occurred and to help in making the decisions regarding use of antibiotics and immediate or delayed closure. Sepsis developed in 23 of the 64 patients. The smears, available in 25 to 30 minutes, gave correct indications regarding development or absence of sepsis in 54 patients (84%); and the cultures, available in 24 to 36 hours, did so in 57 (89%). Prophylactic treatment with antibiotics in 36 patients was deemed unnecessary or inappropriate in 24 (smear and culture both negative, or organisms resistant to the agent). Quantitative smears and cultures, undertaken immediately by the techniques used in this study, are of practical value in management of traumatic wounds to the hand and forearm.
Asunto(s)
Traumatismos del Antebrazo/microbiología , Traumatismos de la Mano/microbiología , Infección de Heridas/prevención & control , Adulto , Amputación Traumática/microbiología , Antibacterianos/uso terapéutico , Desbridamiento , Infecciones por Enterobacteriaceae/prevención & control , Infecciones por Escherichia coli/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infecciones Estafilocócicas/prevención & control , Infecciones Estreptocócicas/prevención & control , Heridas por Arma de Fuego/microbiologíaRESUMEN
This is a report of two cases of hand and forearm infections caused by Aeromonas hydrophila. This organism is resistant to penicillin and most cephalosporins and is found in most freshwater environments. It is recommended that broad-spectrum coverage such as a combination of cephalosporin and aminoglycoside antibiotic be used.