Unilateral inguinal lymphadenitis caused by Yersinia pseudotuberculosis. A case report.

Acute inguinal lymphadenitis is usually caused by lower extremity infection and sexually transmitted diseases, such as chancroid, lymphogranuloma venereum, genital herpes, or syphilis. Yersinia pseudotuberculosis is a non-spore forming, pleomorphic, non-lactose fermenting Gram negative bacillus and a member of the family Enterobacteriaceae, which is associated with diarrheal diseases. It also causes mesenteric lymphadenitis at the terminal ileum, which can be clinically indistinguishable from acute appendicitis (pseudoappendicitis). However, lymphadenitis in other regions caused by the organism is rarely reported. Herein, we report a case of a man in his 20s, who presented with unilateral inguinal lymphadenitis caused by Y. pseudotuberculosis, with discussion regarding the pathogenesis of this rare occurrence.

Steady increase of lymphogranuloma venereum cases, Czech Republic, 2010 to 2015.

Since the notification of the first case of lymphogranuloma venereum (LGV) in the Czech Republic in 2010, the numbers of LGV cases have steadily increased in the country. In 2015, 40 LGV cases were diagnosed, bringing the total for 2010-2015, to 88 cases. The profile of the most affected group, HIV-positive men who have sex with men with a previous sexually transmitted infection, matches that of those described in LGV outbreaks in western Europe.

Direct extraction of DNA from positive transparent dressing and swab to identify Candida albicans infection in intertriginous Candidiasis in the inguinal region.

We report a case of a patient infected by Candida albicans which was identified by direct extraction of DNA from a positive transparent dressing and a swab. The patient was a 32-year-old male who complained of erosion in his inguinal region. Large patches of erythema and erosion were present in his inguinal and perianal region, with soya-bean like residue discharge. He was diagnosed with erythrasma and treated with antibiotics but his clinical condition did not improve. KOH examination furnished a positive result for candidiasis. Morphologic characteristics confirmed his infection was caused by Candida albicans. Sequencing of the internal transcribed spacer (ITS) 1/4 polymerase chain reaction products, amplified from positive transparent dressing and cotton swab with discharge and from primary culture isolates, established the Candida albicans lineage. The patient was cured by treatment with itraconazole 200 mg twice a day orally in combination with topical wash with 2 % ketoconazole shampoo and topical use of 1 % naftifine-0.25 % ketoconazole cream.

Asymptomatic urethral lymphogranuloma venereum: a case report.

Since 2003, there has been a resurgence of lymphogranuloma venereum (LGV), a variant of Chlamydia trachomatis (CT), among men who have sex with men (MSM) in several urban areas of Europe and North America. LGV infection occurs most often at anal sites causing proctitis. Urethral and oropharyngeal infections are rare. In Quebec, LGV incidence has been increasing exponentially in recent years and the current guidelines support systematic LGV genotype testing among anorectal CT-positive samples only. This case report describes a patient with a urethral LGV infection, remarkable due to its prolonged asymptomatic development prior to the manifestation of an inguinal bubo. Physicians should be vigilant of potential cases of LGV and forward CT-positive samples occurring among individuals with LGV risk factors for genotype testing.

Antimicrobial effect of chlorhexidine on bacteria of groin, perineum and vagina.

The antimicrobial effects of two chlorhexidine preparations, Hibiclens and Hibitane Tincture, were evaluated in 154 obstetric patients. Both agents produced bacterial kills of over 99% on skin bacteria of groin and perineum ten and 30 minutes after their application. Five minutes after vaginal cleansing with Hibiclens more than 99% of bacteria originally present were destroyed. Even though both preparations proved to be potent bactericidal agents, Hibitane Tincture cannot be recommended as a perigenital antiseptic since it causes vulvar irritation due to its high isopropanol content. With Hibiclens application to groin and perineal skin no side effects were observed. In one of 51 patients treated vaginally with Hibiclens a rather strong burning sensation occurred, without any aftereffect. Hibiclens seems to be a promising antiseptic for obstetric and gynecologic patients.

Acute pyogenic inguinal abscess from complex soft-tissue infection or intra-abdominal pathology.

BACKGROUND: Abscesses involving the inguinal region are uncommon as manifestations of complex soft-tissue infections or intra-abdominal pathology, and the routes by which they cause infection are usually unclear and may be overlooked. METHODS: A comprehensive review of reports in the English language literature of the clinical presentations, outcomes, and causes of abscess in the inguinal/groin area requiring surgical intervention. The cases of 33 patients, including 30 patients in 27 reports in the literature and 3 patients in the Chang Gung Memorial Hospital at Chia-Yi, were reviewed to determine the ages, positions, gender, hypothesized causes, diagnostic modalities, and clinical outcomes of abscesses in the inguinal/groin area. Clinical data, laboratory examination findings, and culture results were analyzed. RESULTS: Inguinal abscesses presented as tender inguinal masses that could extend from gastrointestinal, genitourinary, or retroperitoneal sites as well as being of miscellaneous origin. Most patients with such abscesses presented with fever and leukocytosis. Computed tomography provided a sensitive means for establishing the correct diagnosis and surgical plan of treatment for inguinal sbscesses. Gram-positive pathogens were associated with infections involving hip or thigh muscles and gram-negative pathogens were associated with infections involving the gastrointestinal (GI) and genitourinary (GU) tracts as well as with abscesses of the psoas muscle, Discussion: The inguinal region communicates through several routes with the peritoneal and retroperitoneal spaces as well as with the region of the thigh. The lymphatics drain from the external genitalia, inferior anal canal or perianal region, adjoining abdominal wall, and the lower extremities. Evaluation of a patient with inguinal abscess and with signs of infection should include computed tomography (CT) to elucidate the extent of infectious disease. Information obtained from CT is important in guiding the prescription of antibiotics and surgical planning for the treatment of inguinal abscesses. CONCLUSIONS: Computed tomography is helpful in diagnosing inguinal abscess and determining the extent of infection. In patients presenting with inguinal abscess. Early recognition of its origin can facilitate further surgical planning and possibly improve the outcome.

Colonization of residents and staff of a long-term-care facility and adjacent acute-care hospital geriatric unit by multiresistant bacteria.

Long-term-care facilities (LTCFs) are reservoirs of resistant bacteria. We undertook a point-prevalence survey and risk factor analysis for specific resistance types among residents and staff of a Bolzano LTCF and among geriatric unit patients in the associated acute-care hospital. Urine samples and rectal, inguinal, oropharyngeal and nasal swabs were plated on chromogenic agar; isolates were typed by pulsed-field gel electrophoresis; resistance genes and links to insertion sequences were sought by PCR; plasmids were analysed by PCR, restriction fragment length polymorphism and incompatibility grouping. Demographic data were collected. Of the LTCF residents, 74.8% were colonized with ≥1 resistant organism, 64% with extended-spectrum ß-lactamase (ESBL) producers, 38.7% with methicillin-resistant Staphylococcus aureus (MRSA), 6.3% with metallo-ß-lactamase (MBL) producers, and 2.7% with vancomycin-resistant enterococci. Corresponding rates for LTCF staff were 27.5%, 14.5%, 14.5%, 1.5% and 0%, respectively. Colonization frequencies for geriatric unit patients were lower than for those in the LTCF. Both clonal spread and plasmid transfer were implicated in the dissemination of MBL producers that harboured IncN plasmids bearing bla(VIM-1), qnrS, and bla(SHV-12). Most (44/45) ESBL-producing Escherichia coli isolates had bla(CTX-M) genes of group 1; a few had bla(CTX-M) genes of group 9 or bla(SHV-5); those with bla(CTX-M-15) or bla(SHV-5) were clonal. Risk factors for colonization of LTCF residents with resistant bacteria included age ≥86 years, antibiotic treatment in the previous 3 months, indwelling devices, chronic obstructive pulmonary disease, physical disability, and the particular LTCF unit; those for geriatric unit patients were age and dementia. In conclusion, ESBL-producing and MBL-producing Enterobacteriaceae and MRSA were prevalent among the LTCF residents and staff, but less so in the hospital geriatric unit. Education of LTCF employees and better infection control are proposed to minimize the spread of resistant bacteria in the facility.

Inguinal lymphadenitis associated with Capnocytophaga bacilli.

Capnocytophaga organisms are capnophilic, gram-negative bacilli that have been associated with infections deriving from the flora of the oropharynx. We report a case of inguinal adenitis caused by Capnocytophaga species that probably represents sexual transmission of the pathogen.

Colonization of caesarean section babies by Excherichia coli.

Eight babies all delivered by Caesarean section were observed for evidence of colonization by E. coli from birth until discharge from hospital 10 to 14 days later. Faecal specimens were cultured daily for E. coli as were swabs from the rectum, groin, umbilicus, head, hands und mouth. Different serotypes of E. coli were isolated from four babies on day 1, one baby on day 2, one baby on day 7 and two babies on day 9. Three babies excreted more than one serotype of E. coli. Serotypes of E. coli isolated from the faeces and rectum were usually isolated from the groin but less often from the umbilicus. Other sides were rarely colonized. In all instances except one the primary site of colonization appeared to be the gastrointestinal tract. Colonization by E. coli was influenced by antibiotic therapy and possibly by the method of feeding.

Infected arterial grafts.

The case notes of 664 patients who underwent surgery and arterial grafting between the years of 1955 and 1973 at the University of Rochester Medical Center have been analyzed. There were 15 cases of infected grafts-a rate of 2.3%. The outcome of the infection was determined in 12 of these cases. Four patients had no surgical treatment and all 4 died. Three patients had simple ligations with excision and one died, one had an above knee amputation and one continues to have a draining sinus. Five patients had axillofemoral bypasses. Two died and three patients are alive and well. The role of prophylactic antibiotics is briefly discussed and the influence of possible etiological factors is also considered.

Staphylococcus lugdunensis infections: high frequency of inguinal area carriage.

Following a change in surgical practice, we noted that the rate at which Staphylococcus lugdunensis was isolated from samples from the plastic surgery unit of our hospital increased considerably. We investigated the sources of these S. lugdunensis strains, and we found that in the case of drain colonization or surgical site infection, the strain was more likely to have come from the patient's skin bacteria when the pubic site had been shaved preoperatively. To test the hypothesis of pubic site colonization, we evaluated the prevalence of S. lugdunensis carriage among the cutaneous flora of the inguinal area. We found that 22% of 140 incoming patients carried S. lugdunensis in this area and that carriage at both inguinal folds was frequent (68% of carriers). A study of the genetic structure of the total population, including the clinical (n = 18) and the commensal (n = 53) strains, revealed that the diversity of the species was low and that the population was composed of two major groups that diverged at a distance of 35%. No particular characteristics made it possible to distinguish between clinical and commensal strains. Only isolates producing beta-lactamase were homogeneous; six of the eight beta-lactamase-positive strains displayed the same pulsed-field gel electrophoresis pattern.