RESUMEN
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.
Asunto(s)
Criptococosis/diagnóstico , Cryptococcus neoformans/aislamiento & purificación , Dermatomicosis/diagnóstico , Accidentes por Caídas , Anciano , Brazo/microbiología , Biopsia , Celulitis (Flemón) , Criptococosis/etiología , Criptococosis/microbiología , Dermatomicosis/microbiología , Dermatomicosis/patología , Humanos , Masculino , Factores de Riesgo , Piel/microbiologíaRESUMEN
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.
Asunto(s)
Antifúngicos/farmacología , Arthrodermataceae/efectos de los fármacos , Arthrodermataceae/aislamiento & purificación , Tiña/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brazo/microbiología , Brazo/patología , Arthrodermataceae/clasificación , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Tailandia/epidemiología , Tiña/epidemiología , Medicina Tropical , Adulto JovenRESUMEN
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.
Asunto(s)
Anticuerpos Antibacterianos/sangre , Grupo Borrelia Burgdorferi/inmunología , Neuroborreliosis de Lyme/diagnóstico , Anciano , Brazo/microbiología , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Pierna/microbiología , Neuroborreliosis de Lyme/microbiología , Masculino , Persona de Mediana Edad , Cuello/microbiología , Torso/microbiologíaRESUMEN
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.
Asunto(s)
Fascitis Necrotizante/diagnóstico por imagen , Ultrasonografía/métodos , Antibacterianos , Brazo/diagnóstico por imagen , Brazo/microbiología , Brazo/cirugía , Diagnóstico Diferencial , Fascitis Necrotizante/tratamiento farmacológico , Fascitis Necrotizante/cirugía , Humanos , Pierna/diagnóstico por imagen , Pierna/microbiología , Pierna/cirugía , Masculino , Persona de Mediana Edad , Índice de Severidad de la EnfermedadRESUMEN
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.
Asunto(s)
Lepra Lepromatosa/diagnóstico , Adulto , Brazo/microbiología , Brazo/patología , Oído Externo/microbiología , Oído Externo/patología , Histiocitoma Fibroso Benigno/microbiología , Histiocitoma Fibroso Benigno/patología , Histocitoquímica , Humanos , Masculino , Piel/microbiología , Piel/patologíaRESUMEN
We report an invasive mucormycosis caused by Actinomucor elegans in a patient with refractory aplastic anemia. The organism was isolated from a necrotic skin lesion on the patient's left arm and demonstrated angioinvasive features on histopathology examination. In contrast to three cases described previously, we describe the first case of A. elegans invasive fungal infection in an immunocompromised patient. This report, along with the three previously reported cases, is convincing evidence that A. elegans is an emerging fungal pathogen capable of causing invasive mucormycosis in humans.
Asunto(s)
Anemia Aplásica/complicaciones , Mucorales/clasificación , Mucorales/aislamiento & purificación , Mucormicosis/diagnóstico , Mucormicosis/microbiología , Brazo/microbiología , Brazo/patología , ADN de Hongos/química , ADN de Hongos/genética , ADN Ribosómico/química , ADN Ribosómico/genética , ADN Espaciador Ribosómico/química , ADN Espaciador Ribosómico/genética , Histocitoquímica , Humanos , Huésped Inmunocomprometido , Masculino , Técnicas Microbiológicas , Microscopía , Persona de Mediana Edad , Datos de Secuencia Molecular , Mucorales/genética , Mucormicosis/patología , Necrosis , Filogenia , Análisis de Secuencia de ADN , Piel/microbiología , Piel/patologíaRESUMEN
Axillary web syndrome (AWS) is defined as a cord-like structure extending from the axilla to the medial arm following axillary surgery in women with breast cancer. There is only limited literature on the pathogenesis of this syndrome and the etiology of the cord. A 57-year-old man presented with a band-like skin depression and tightness over the medial aspect of his arm extending from the axilla to the antecubital fossa following development of a furuncle in the ipsilateral axilla. Histopathologic examination of the 'band' revealed fibroblastic proliferation surrounding the lymphatic vessel which was identified by presence of an obvious valve as well as positive staining for D2-40, a specific marker for lymphatic endothelium. This is the first report of AWS following axillary furunculosis. This case adds to the limited data on the histopathology of AWS, further confirming the etiology of the 'cord' to be of lymphatic origin.
Asunto(s)
Forunculosis/diagnóstico , Enfermedades Linfáticas/diagnóstico , Antibacterianos/uso terapéutico , Brazo/microbiología , Brazo/patología , Doxiciclina/uso terapéutico , Femenino , Forunculosis/tratamiento farmacológico , Forunculosis/microbiología , Forunculosis/patología , Humanos , Enfermedades Linfáticas/tratamiento farmacológico , Enfermedades Linfáticas/patología , Masculino , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Persona de Mediana Edad , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Síndrome , Resultado del TratamientoRESUMEN
A new Nocardia species, N. concava, was first reported in Japan in 2005. To date, there have been only 3 case reports of N. concava infection worldwide (2 in Japan and 1 in China), and only 1 of these reports has detailed the clinical characteristics of N. concava, in China. Here we report the first case of disseminated infection caused by N. concava- in a patient with a history of glucocorticoid use-in South Korea. Species identification of N. concava was done with 16S rRNA sequencing and was confirmed by biochemical tests using urea, xanthine, tyrosine, and hypoxanthine decomposition. The patient was successfully treated with trimethoprim-sulfamethoxazole.
Asunto(s)
Nocardiosis/diagnóstico , Nocardiosis/inmunología , Absceso/tratamiento farmacológico , Absceso/inmunología , Absceso/microbiología , Absceso/patología , Antibacterianos/uso terapéutico , Brazo/microbiología , Brazo/patología , Músculo Deltoides/microbiología , Músculo Deltoides/patología , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Nocardia , Nocardiosis/tratamiento farmacológico , Nocardiosis/microbiología , República de Corea , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
We present a case of axillary hematoma complicating an ultrasound-guided infraclavicular block in a patient with undiagnosed mycotic aneurysms of the peripheral arteries. Mycotic aneurysm is a rare medical condition with well-identified risk factors. When performing regional anesthesia in patients with these risk factors, clinicians should have a high degree of suspicion about the possible existence of vascular anomalies. A preprocedure Doppler study of the block area and real-time guidance of the needle using ultrasound may be useful.
Asunto(s)
Aneurisma Infectado/microbiología , Brazo/microbiología , Axila/microbiología , Hematoma/microbiología , Bloqueo Nervioso , Infecciones Estreptocócicas/microbiología , Ultrasonografía Intervencional , Adulto , Aneurisma Infectado/diagnóstico , Brazo/irrigación sanguínea , Axila/irrigación sanguínea , Diagnóstico Diferencial , Femenino , Hematoma/diagnóstico , Humanos , Bloqueo Nervioso/efectos adversos , Infecciones Estreptocócicas/diagnóstico , Ultrasonografía Intervencional/efectos adversosRESUMEN
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.
Asunto(s)
Antifúngicos/uso terapéutico , Fusariosis/tratamiento farmacológico , Fusarium/efectos de los fármacos , Voriconazol/uso terapéutico , Administración Tópica , Adulto , Brazo/microbiología , Interacciones Farmacológicas , Fusariosis/microbiología , Humanos , Masculino , Crema para la Piel/administración & dosificación , Crema para la Piel/uso terapéuticoRESUMEN
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.
Asunto(s)
Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Mycobacterium marinum , Enfermedades Cutáneas Bacterianas/diagnóstico , Anciano , Brazo/microbiología , Brazo/patología , Biopsia , Femenino , Dedos/microbiología , Dedos/patología , Humanos , Infecciones por Mycobacterium no Tuberculosas/microbiología , Infecciones por Mycobacterium no Tuberculosas/patología , Enfermedades Cutáneas Bacterianas/microbiología , Enfermedades Cutáneas Bacterianas/patologíaRESUMEN
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.
Asunto(s)
Antibacterianos/uso terapéutico , Clostridium tetani , Dolor/tratamiento farmacológico , Tétanos/tratamiento farmacológico , Infección de Heridas/tratamiento farmacológico , Anciano de 80 o más Años , Brazo/microbiología , Humanos , Maxilares/microbiología , Masculino , Metronidazol/uso terapéutico , Dolor/microbiología , Tétanos/microbiología , Toxoide Tetánico/uso terapéutico , Infección de Heridas/microbiologíaRESUMEN
A slowly enlarging arm ulcer appeared in a 61-year-old man with cutaneous T cell lymphoma. Skin biopsy revealed aseptate hyphae and nodular small/medium-sized pleomorphic CD4(+) T cell infiltration. Cultures yielded Absidia corymbifera which was identified by phenotypic and molecular methods. Since a thorough examination did not detect organ involvement, the patient was diagnosed as having primary cutaneous zygomycosis. This is the first case report of cutaneous zygomycosis caused by A. corymbifera in a patient with primary cutaneous CD4(+) small/medium-sized pleomorphic T-cell lymphoma. Other cases of primary cutaneous zygomycosis caused by A. corymbifera are also reviewed.
Asunto(s)
Absidia/aislamiento & purificación , Linfoma Cutáneo de Células T/complicaciones , Cigomicosis/complicaciones , Cigomicosis/diagnóstico , Absidia/citología , Absidia/genética , Brazo/microbiología , Brazo/patología , ADN de Hongos/análisis , Humanos , Inmunohistoquímica , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Úlcera/microbiología , Úlcera/patología , Cigomicosis/microbiología , Cigomicosis/patologíaRESUMEN
Actinomycetomas represent 97.8% of mycetomas in Mexico, where 86.6% are produced by Nocardia brasiliensis. We report a case of actinomycetoma in the arm by Nocardia brasiliensis disseminated to lung. Uncommon grains were observed which present outside peripheral filaments and also numerous filaments loosing the grains. These characteristics of the grains are due probably because for the long treatment with antibiotics of the patient. In situ antibiotic action against the microcolonies is discussed.
Asunto(s)
Brazo/microbiología , Enfermedades Pulmonares Fúngicas/microbiología , Micetoma/diagnóstico , Nocardiosis/diagnóstico , Nocardia/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Humanos , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Masculino , México , Micetoma/tratamiento farmacológico , Micetoma/microbiología , Nocardia/citología , Nocardiosis/tratamiento farmacológico , Nocardiosis/microbiologíaRESUMEN
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.
Asunto(s)
Brazo/microbiología , Huésped Inmunocomprometido , Mucormicosis/diagnóstico , Infecciones Oportunistas/diagnóstico , Piel/patología , Adulto , Brazo/patología , Resultado Fatal , Gangrena , Humanos , Masculino , Piel/microbiologíaAsunto(s)
Infecciones por VIH/microbiología , Infecciones por VIH/patología , Neumonía/microbiología , Neumonía/patología , Tuberculosis Cutánea/microbiología , Tuberculosis Cutánea/patología , Adulto , Antibacterianos/uso terapéutico , Brazo/microbiología , Brazo/patología , Humanos , Masculino , Neumonía/virología , Piel/microbiología , Piel/patología , Tuberculosis Cutánea/tratamiento farmacológico , Tuberculosis Cutánea/virologíaAsunto(s)
Piel/patología , Tiña/microbiología , Trichophyton/aislamiento & purificación , Adulto , Antifúngicos/uso terapéutico , Brazo/microbiología , Clotrimazol/uso terapéutico , Humanos , Masculino , Piel/microbiología , Esporas Fúngicas/crecimiento & desarrollo , Tiña/diagnóstico , Trichophyton/genética , Trichophyton/crecimiento & desarrolloAsunto(s)
Arvicolinae/microbiología , Reservorios de Enfermedades/microbiología , Úlcera Cutánea/diagnóstico , Úlcera Cutánea/microbiología , Esporotricosis/diagnóstico , Esporotricosis/microbiología , Anciano , Animales , Antifúngicos/uso terapéutico , Brazo/microbiología , Brazo/patología , Femenino , Humanos , Itraconazol/uso terapéutico , Úlcera Cutánea/tratamiento farmacológico , Esporotricosis/tratamiento farmacológico , Resultado del TratamientoRESUMEN
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.