RESUMEN
BACKGROUND: Opportunistic infection is an under-recognized complication of Cushing's syndrome, with infection due to atypical mycobacterium rarely reported. Mycobacterium szulgai commonly presents as pulmonary infection, with cutaneous infection seldom reported in the literature. CASE PRESENTATION: 48-year-old man with a newly-diagnosed Cushing's syndrome secondary to adrenal adenoma presented with a subcutaneous mass on the dorsum of his right hand, was diagnosed with cutaneous Mycobacterium szulgai infection. The most likely source of the infection was through minor unnoticed trauma and inoculation from a foreign body. The patient's Cushing's syndrome, high serum cortisol levels and secondary immune suppression facilitated mycobacterial replication and infection. The patient was successfully treated with adrenalectomy, surgical debridement of cutaneous lesion, and a combination of rifampicin, levofloxacin, clarithromycin, and ethambutol for 6 months. There were no signs of relapse one year after cessation of anti-mycobacterial treatment. A literature review on cutaneous M. szulgai infection to further characterize the clinical characteristics of this condition, identified 17 cases of cutaneous M. szulgai infection in the English literature. Cutaneous M. szulgai infections with subsequent disease dissemination are commonly reported in immunocompromised hosts (10/17, 58.8%), as well as in immunocompetent patients with a history of breached skin integrity, such as invasive medical procedures or trauma. The right upper extremity is the most commonly involved site. Cutaneous M. szulgai infection is well controlled with a combination of anti-mycobacterial therapy and surgical debridement. Disseminated infections required a longer duration of therapy than localized cutaneous infections. Surgical debridement may shorten the duration of antibiotics. CONCLUSIONS: Cutaneous M. szulgai infection is a rare complication of adrenal Cushing's syndrome. Further studies are needed to provide evidence-based guidelines on the best combination of anti-mycobacterial and surgical therapy for managing this rare infective complication.
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Síndrome de Cushing , Infecciones por Mycobacterium no Tuberculosas , Mycobacterium , Enfermedades Cutáneas Bacterianas , Masculino , Humanos , Persona de Mediana Edad , Síndrome de Cushing/complicaciones , Síndrome de Cushing/diagnóstico , Micobacterias no Tuberculosas , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Enfermedades Cutáneas Bacterianas/complicacionesRESUMEN
We report a patient with X-linked agammaglobulinaemia and spastic paraplegias who developed skin abscesses. We highlight that dermatologists should consider the possibility of primary immunodeficiency when patients present with repeated skin infections, and should advise patients to be particularly careful about skin hygiene and avoid scratching.
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Absceso/complicaciones , Agammaglobulinemia/complicaciones , Enfermedades Genéticas Ligadas al Cromosoma X/complicaciones , Paraplejía/complicaciones , Enfermedades Cutáneas Bacterianas/complicaciones , Absceso/tratamiento farmacológico , Absceso/patología , Agammaglobulinemia/tratamiento farmacológico , Antibacterianos/uso terapéutico , Enfermedades Genéticas Ligadas al Cromosoma X/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Linaje , Recurrencia , Cuidados de la Piel , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Enfermedades Cutáneas Bacterianas/patología , Adulto JovenRESUMEN
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the main pathogens that cause infections in diabetic individuals. In this paper, we report the outcomes of our investigation on the intradermal application of antimicrobial photodynamic therapy (PDT) with curcumin in an infection induced by MRSA ATCC 43300 strain in the ear of mice with Type 1 Diabetes Mellitus (T1DM). A solution containing 100 µg of curcumin was photoactivated ex vivo with a LED light (450 nm) delivering a fluency of 13.5 J/cm3. This solution was administered in the ear intradermally, at the same inoculum site as the MRSA ATCC 43300 strain (PDT Group). This study also included the use of two control groups (both infected): One was treated with saline and the other was treated with non-photoactivated curcumin. The animals were euthanized 24 h after these treatments and samples of draining lymph node and treated ear were collected for examination. The PDT group showed lower bacterial load in the draining lymph node when compared to the saline and curcumin groups (p-value <0.05) 24 h after treatment. In addition to bacterial load, the PDT group presented a higher concentration of nitrates and nitrites in the draining lymph node when compared to the saline and curcumin groups (p-value <0.001). Examining the infectious site, despite apparently having similar inflammatory cell recruitment compared with the control groups, the PDT group showed a profile with less intense activity in the myeloperoxidase expression when compared to the saline group (p-value <0.001). Additionally, the detected concentration of cytokines such as IL-1ß, IL-12, and IL-10 was significantly lower in the PDT group when compared to the saline group (p-value <0.01; p-value <0.05; p-value <0.05, respectively), thus presenting a less intense inflammatory response during infection resolution. Our pilot study showed for the first time the therapeutic potential of PDT using curcumin when administered intradermally in the treatment of infections caused by S. aureus in mice with T1DM.
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Curcumina/uso terapéutico , Diabetes Mellitus Tipo 1/complicaciones , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Fotoquimioterapia , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Animales , Biomarcadores/metabolismo , Mediadores de Inflamación/metabolismo , Ratones , Ratones Endogámicos C57BL , Proyectos Piloto , Enfermedades Cutáneas Bacterianas/complicaciones , Enfermedades Cutáneas Bacterianas/microbiología , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/microbiología , EstreptozocinaRESUMEN
Syphilis has many atypical morphologies which can present a diagnostic challenge, especially in patients with HIV/AIDS who may have multiple concurrent conditions. We describe a 41-year-old man with recently diagnosed HIV who was admitted for acute right vision loss and a diffuse rash with involvement of the palms and soles. He received diagnoses of secondary syphilis and Kaposi sarcoma in the setting of AIDS. Examination revealed an unusual dark brown-to-purple umbilicated papule with a necrotic center on the abdomen, raising a diagnostic dilemma. Skin biopsy showed secondary syphilis, despite the concurrent diagnosis of Kaposi sarcoma. The patient was treated with antibiotic and antiretroviral therapy and symptoms resolved. This case aims to share the clinical reasoning behind diagnosing a patient with HIV/AIDS with multiple concurrent conditions and to raise awareness of the many atypical cutaneous manifestations of secondary syphilis.
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Enfermedades Cutáneas Bacterianas/diagnóstico , Sífilis/diagnóstico , Abdomen , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Humanos , Masculino , Enfermedades Cutáneas Bacterianas/complicaciones , Sífilis/complicacionesRESUMEN
ABSTRACT: This study aims to identify predictive factors associated with surgical intervention and the visual outcome of orbital cellulitis and to evaluate the treatment outcomes.A retrospective study involving 66 patients (68 eyes; 64 unilateral and 2 bilateral) diagnosed with bacterial orbital cellulitis was conducted between November 2005 and May 2019.The mean (± standard deviation) age was 42.1 (± 25.8) years (range: 15 days-86âyears). Sinusitis was the most frequent predisposing factor, occurring in 25 patients (37.9%), followed by skin infection in 10 patients (15.2%), and acute dacryocystitis in 9 patients (13.6%). Subperiosteal abscesses were found in 24 eyes and orbital abscesses in 19 eyes. Surgical drainage was performed in 31 eyes. Regarding the abscess volume for surgical drainage, a cut-off of 1514 mm3 showed 71% sensitivity and 80% specificity. There was significant improvement in visual acuity (VA) and decrease in proptosis after treatment (for both, P ≤ .001). Only pre-treatment VA ≤20/200 was a significant predictor for post-treatment VA of 20/50 or worse (adjusted odds ratio: 12.0, Pâ=â.003). The presence of a relative afferent pupillary defect was the main predictor of post-treatment VA of 20/200 or worse (adjusted odds ratio: 19.0, Pâ=â.003).The most common predisposing factor for orbital cellulitis in this study was sinusitis. VA and proptosis significantly improved after treatment. We found that the abscess volume was strongly predictive of surgical intervention. Pre-treatment poor VA and the presence of relative afferent pupillary defect can predict the worst visual outcome. Hence, early detection of optic nerve dysfunction and prompt treatment could improve the visual prognosis.
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Absceso/terapia , Antibacterianos/uso terapéutico , Drenaje/estadística & datos numéricos , Celulitis Orbitaria/terapia , Sinusitis/epidemiología , Absceso/sangre , Absceso/diagnóstico , Absceso/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacterias/aislamiento & purificación , Niño , Preescolar , Dacriocistitis/complicaciones , Dacriocistitis/epidemiología , Dacriocistitis/microbiología , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/epidemiología , Enfermedades del Nervio Óptico/microbiología , Enfermedades del Nervio Óptico/terapia , Órbita/diagnóstico por imagen , Órbita/microbiología , Celulitis Orbitaria/sangre , Celulitis Orbitaria/diagnóstico , Celulitis Orbitaria/microbiología , Pronóstico , Trastornos de la Pupila/diagnóstico , Trastornos de la Pupila/epidemiología , Trastornos de la Pupila/microbiología , Trastornos de la Pupila/terapia , Estudios Retrospectivos , Sinusitis/complicaciones , Sinusitis/microbiología , Enfermedades Cutáneas Bacterianas/complicaciones , Enfermedades Cutáneas Bacterianas/epidemiología , Enfermedades Cutáneas Bacterianas/microbiología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Agudeza Visual , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVES: Bacterial infection-related GN occurs concurrent to or after known or unknown infections. It is important to understand the clinical implications of the bacterial isolates, antimicrobial resistance patterns, and effect of latency-based classification on kidney and patient outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 501 consecutive adults diagnosed with bacterial infection-related GN between 2005 and 2017 were included from a biopsy registry of 15,545 patients at a single center in South India, and follow-up data were collected from electronic medical records until December 2019. Latency was defined as time between resolution of infection and onset of GN, which was classified as parainfectious, peri-infectious, or postinfectious GN. Longitudinal kidney and patient outcomes were studied. RESULTS: The mean age of the cohort was 40 (± 15) years, 6% were above 65 years, and 330 (66%) were men. Diabetes was present in 93 (19%) patients. Seventy percent (353 of 501) of patients had known infections, with the median latent period for parainfectious (115 of 353, 33%), peri-infectious (97 of 353, 27%), and postinfectious (141 of 353, 40%) GN being 0, 5 (4-7), and 15 (10-31) days, respectively. The most common predisposing organism was Streptococcus pyogenes (137 of 353, 39%). Drug-resistant nonstreptococcal bacteria were methicillin-resistant Staphylococcus aureus (25%, four of 16), extended-spectrum ß-lactamases (20%, 12 of 59), and carbapenem-resistant organisms (10%, six of 59). Twenty of 22 (91%) of the drug-resistant organisms were isolated from the parainfectious group. The most common site of infection was skin in peri- (23 of 97, 24%) and postinfectious GN (61 of 141, 43%), and urinary tract in parainfectious GN (35 of 115, 30%). Of 321 patients with >3 months of follow-up, 48 (15%) developed kidney failure over a median period of 10 (2-37) months and 14 (4%) died. Parainfectious GN, eGFR<30 ml/min per 1.73 m2, moderate-to-severe interstitial fibrosis and tubular atrophy, and nontreatment with renin-angiotensin system blockers were significant risk factors for progression to kidney failure by a Cox proportional-hazards model. CONCLUSIONS: Along with clinical and histologic predictors, parainfectious GN caused predominantly by nonstreptococcal and drug-resistant bacterial infections was associated with poor kidney prognosis.
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Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/microbiología , Glomerulonefritis/microbiología , Glomerulonefritis/fisiopatología , Insuficiencia Renal/fisiopatología , Adulto , Atrofia , Biopsia , Carbapenémicos , Farmacorresistencia Bacteriana , Femenino , Fibrosis , Tasa de Filtración Glomerular , Glomerulonefritis/tratamiento farmacológico , Glomerulonefritis/patología , Humanos , Riñón/patología , Masculino , Staphylococcus aureus Resistente a Meticilina , Persona de Mediana Edad , Sistema de Registros , Insuficiencia Renal/etiología , Estudios Retrospectivos , Factores de Riesgo , Enfermedades Cutáneas Bacterianas/complicaciones , Enfermedades Cutáneas Bacterianas/microbiología , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/microbiología , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes , Factores de Tiempo , Infecciones Urinarias/complicaciones , Adulto Joven , beta-LactamasasAsunto(s)
Fallo Renal Crónico/complicaciones , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Enfermedades Cutáneas Bacterianas/complicaciones , Enfermedades Cutáneas Bacterianas/diagnóstico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: The higher frequency of infections in diabetic patients is caused by a hyperglycemic environment, which promotes immune dysfunction. People with diabetes are more prone to skin infections. A continuous glucose monitoring (CGM) system provides information on changes in blood glucose (BG) levels throughout the day. Its use facilitates optimal therapeutic decisions for a diabetic patient. One of the factors limiting the use of CGM is inflammation at the insertion site. AIM OF THE STUDY: The aim of the study was the microbiological identification of the bacterial strains which are found on CGM sensor electrodes. MATERIAL AND METHODS: We performed microbiological tests on patients' CGM Enlite Medtronic electrodes, which were removed after 6 days of usage according to the manufacturer's instructions. 31 sensors were examined from 31 children (14 girls) aged from 0.5 to 14.6 years. The microbiological analysis was routinely performed at the Department of Children's Diabetology Medical University of Silesia in Katowice, Poland. RESULTS: 12 (39%) of the electrodes were colonized. In 11 (92%) cases the electrodes were colonized by one bacteria strain. 7 times methicillin-sensitive coagulase negative staphylococcus (MSCNS) was detected. We also found one case of Klebsiella pneumoniae, Ochrobactrum tritici, Bacillus sonorensis and methicillin-resistant coagulase-negative Staphylococci (MRCNS) colonization. One electrode was colonized by the mixed flora Enterococcus faecalis, methicillin-susceptible coagulase-negative Staphylococci (MSCNS), Pseudomonas stutzeri, methicillin-susceptible Staphylococcus aureus (MSSA). The median HbA1c in the group with colonization of electrodes was 6, 85% (6, 3-7, 6%) versus 6, 3% (5, 8-7, 5%) in the group without colonization. The median BMI in the group with colonization of the electrodes was 17.10 kg/m2 (16.28-18.62 kg/m2) versus 15.98 kg/m2 (15.14-17.96 kg/m2) in the group without colonization. Statistically, significantly more frequently electrodes are colonized in older children (median age in the group with colonization of electrodes 11.43 years (6.52-12.27 years), without colonization 8.42 years. (3.098-9.375 years); (p = 0.033). CONCLUSIONS: It seems that older children are more likely to have their sensor electrode colonized by bacterial strains.
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Bacterias/aislamiento & purificación , Glucemia/análisis , Diabetes Mellitus Tipo 1/sangre , Contaminación de Equipos/estadística & datos numéricos , Equipos y Suministros/microbiología , Adolescente , Bacillus/aislamiento & purificación , Bacterias/clasificación , Automonitorización de la Glucosa Sanguínea/instrumentación , Automonitorización de la Glucosa Sanguínea/estadística & datos numéricos , Niño , Preescolar , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/microbiología , Electrodos/efectos adversos , Electrodos/microbiología , Electrodos/estadística & datos numéricos , Equipos y Suministros/efectos adversos , Equipos y Suministros/normas , Equipos y Suministros/estadística & datos numéricos , Femenino , Humanos , Lactante , Masculino , Ochrobactrum/aislamiento & purificación , Polonia/epidemiología , Enfermedades Cutáneas Bacterianas/complicaciones , Enfermedades Cutáneas Bacterianas/epidemiología , Enfermedades Cutáneas Bacterianas/microbiología , Staphylococcus/aislamiento & purificaciónAsunto(s)
Blefaritis/microbiología , Piodermia/patología , Enfermedades Cutáneas Bacterianas/patología , Estomatitis/patología , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , Blefaritis/diagnóstico , Blefaritis/etiología , Blefaritis/patología , Enfermedad de Crohn/complicaciones , Diagnóstico Diferencial , Femenino , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Herpes Simple/genética , Humanos , Persona de Mediana Edad , Mucosa Bucal/patología , Mucosa Bucal/virología , Piodermia/microbiología , Salmonella/genética , Salmonella/aislamiento & purificación , Enfermedades Cutáneas Bacterianas/complicaciones , Enfermedades Cutáneas Bacterianas/microbiología , Enfermedades Cutáneas Bacterianas/virología , Estomatitis/diagnóstico , Estomatitis/virología , Resultado del TratamientoRESUMEN
BACKGROUND: Many antibiotics require dosage adjustments in patients with renal impairment. In Phase III studies, omadacycline was non-inferior to moxifloxacin and linezolid in adults with community-acquired bacterial pneumonia (CABP) and acute bacterial skin and skin structure infections (ABSSSI), respectively. This analysis evaluated efficacy and safety measures from three omadacycline studies by patient renal function. METHODS: Patients were stratified as having normal renal function (creatinine clearance >89 mL/min), mild renal impairment (creatinine clearance 60-89 mL/min) or moderate renal impairment (creatinine clearance <60 mL/min); creatine clearance ≤30 mL/min (severe renal impairment) was an exclusion criterion. Efficacy endpoints were clinical success at the early clinical response (ECR) and post-treatment evaluation (PTE) time-points. Safety was evaluated as treatment-emergent adverse events (TEAEs) and laboratory measures. RESULTS: This subgroup analysis included 773 patients with CABP and 1339 patients with ABSSSI in intent-to-treat (ITT) and modified ITT populations, respectively. Clinical success rates were high at ECR and PTE across the studies (CABP 75-90%; ABSSSI 74-95%), and broadly similar between treatments, irrespective of renal function. Rates of TEAEs in patients with ABSSSI ranged from 33% to 52%, and were similar across renal function groups. In patients with CABP, higher rates were observed in patients with moderate renal impairment (56-61%) compared with patients with normal renal function or mild renal impairment (35-49%). The most common TEAEs were nausea and vomiting. CONCLUSIONS: Clinical success was similar across renal function groups, indicating no notable difference in the efficacy of omadacycline in patients with mild or moderate renal impairment. Omadacycline and comparators displayed similar safety profiles. CLINICALTRIALS. GOV REGISTRY: OPTIC (NCT02531438); OASIS-1 (NCT02378480); OASIS-2 (NCT02877927).
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Antibacterianos/uso terapéutico , Neumonía Bacteriana/tratamiento farmacológico , Insuficiencia Renal/complicaciones , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Tetraciclinas/uso terapéutico , Adulto , Anciano , Antibacterianos/efectos adversos , Infecciones Comunitarias Adquiridas/complicaciones , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/complicaciones , Enfermedades Cutáneas Bacterianas/complicaciones , Tetraciclinas/efectos adversosRESUMEN
Scabies is an important predisposing factor for impetigo but its role in more serious skin and soft tissue infections (SSTIs) is not well understood. Information is limited on incidence of SSTIs in the presence of endemic scabies. We conducted a prospective study of hospital admissions for SSTIs in the Northern Division of Fiji (population: 131,914). Prospective surveillance for admissions with impetigo, abscess, cellulitis, wound infection, pyomyositis, necrotizing fasciitis, infected scabies, and crusted scabies was conducted at the Division's referral hospital between 2018 to 2019. Information was collected on demographic characteristics, clinical features, microbiology, treatment and outcomes. Over the study period, 788 SSTI admissions were recorded corresponding to a population incidence 647 per 100,000 person-years (95%CI 571-660). Incidence was highest at the extremes of age with peak incidence in children aged <5 years (908 per 100,000) and those aged ≥65 years (1127 per 100,000). Incidence was 1.7 times higher among the Indigenous Fijian population (753 per 100,000) compared to other ethnicities (442 per 100,000). Overall case fatality rate was 3.3%, and 10.8% for those aged ≥65 years. Scabies was diagnosed concurrently in 7.6% of all patients and in 24.6% of admitted children <5 years. There is a very high burden of hospital admissions for SSTIs in Fiji compared to high-income settings especially among the youngest, oldest and indigenous population which is concordant with scabies and impetigo distribution in this population. Our findings highlight the need for strategies to reduce the burden of SSTIs in Fiji and similar settings.
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Escabiosis/epidemiología , Enfermedades Cutáneas Bacterianas/complicaciones , Infecciones de los Tejidos Blandos/complicaciones , Adolescente , Adulto , Anciano , Niño , Preescolar , Enfermedades Endémicas , Femenino , Fiji/epidemiología , Hospitalización , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Enfermedades Cutáneas Bacterianas/microbiología , Infecciones de los Tejidos Blandos/microbiología , Adulto JovenRESUMEN
Severe burn injury induces gut barrier dysfunction and subsequently a profound systemic inflammatory response. In the present study, we examined the role of the small intestinal brush border enzyme, intestinal alkaline phosphatase (IAP), in preserving gut barrier function and preventing systemic inflammation after burn wound infection in mice. Mice were subjected to a 30% total body surface area dorsal burn with or without intradermal injection of Pseudomonas aeruginosa. Mice were gavaged with 2000 units of IAP or vehicle at 3 and 12 hours after the insult. We found that both endogenously produced and exogenously supplemented IAP significantly reduced gut barrier damage, decreased bacterial translocation to the systemic organs, attenuated systemic inflammation, and improved survival in this burn wound infection model. IAP attenuated liver inflammation and reduced the proinflammatory characteristics of portal serum. Furthermore, we found that intestinal luminal contents of burn wound-infected mice negatively impacted the intestinal epithelial integrity compared with luminal contents of control mice and that IAP supplementation preserved monolayer integrity. These results indicate that oral IAP therapy may represent an approach to preserving gut barrier function, blocking proinflammatory triggers from entering the portal system, preventing gut-induced systemic inflammation, and improving survival after severe burn injuries.
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Fosfatasa Alcalina/administración & dosificación , Quemaduras/complicaciones , Modelos Animales de Enfermedad , Inflamación/prevención & control , Mucosa Intestinal/efectos de los fármacos , Sepsis/prevención & control , Enfermedades Cutáneas Bacterianas/complicaciones , Fosfatasa Alcalina/fisiología , Animales , Femenino , Inflamación/etiología , Inflamación/patología , Mucosa Intestinal/microbiología , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Sepsis/etiología , Sepsis/patologíaRESUMEN
AIMS: Failure of irrigation and debridement (I&D) for prosthetic joint infection (PJI) is influenced by numerous host, surgical, and pathogen-related factors. We aimed to develop and validate a practical, easy-to-use tool based on machine learning that may accurately predict outcome following I&D surgery taking into account the influence of numerous factors. METHODS: This was an international, multicentre retrospective study of 1,174 revision total hip (THA) and knee arthroplasties (TKA) undergoing I&D for PJI between January 2005 and December 2017. PJI was defined using the Musculoskeletal Infection Society (MSIS) criteria. A total of 52 variables including demographics, comorbidities, and clinical and laboratory findings were evaluated using random forest machine learning analysis. The algorithm was then verified through cross-validation. RESULTS: Of the 1,174 patients that were included in the study, 405 patients (34.5%) failed treatment. Using random forest analysis, an algorithm that provides the probability for failure for each specific patient was created. By order of importance, the ten most important variables associated with failure of I&D were serum CRP levels, positive blood cultures, indication for index arthroplasty other than osteoarthritis, not exchanging the modular components, use of immunosuppressive medication, late acute (haematogenous) infections, methicillin-resistant Staphylococcus aureus infection, overlying skin infection, polymicrobial infection, and older age. The algorithm had good discriminatory capability (area under the curve = 0.74). Cross-validation showed similar probabilities comparing predicted and observed failures indicating high accuracy of the model. CONCLUSION: This is the first study in the orthopaedic literature to use machine learning as a tool for predicting outcomes following I&D surgery. The developed algorithm provides the medical profession with a tool that can be employed in clinical decision-making and improve patient care. Future studies should aid in further validating this tool on additional cohorts. Cite this article: Bone Joint J 2020;102-B(7 Supple B):11-19.
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Desbridamiento , Prótesis de Cadera/efectos adversos , Prótesis de la Rodilla/efectos adversos , Infecciones Relacionadas con Prótesis/terapia , Irrigación Terapéutica , Insuficiencia del Tratamiento , Factores de Edad , Anciano , Algoritmos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/métodos , Proteína C-Reactiva/análisis , Femenino , Infecciones por Bacterias Gramnegativas/terapia , Infecciones por Bacterias Grampositivas/terapia , Humanos , Inmunosupresores/efectos adversos , Aprendizaje Automático , Masculino , Infecciones Relacionadas con Prótesis/microbiología , Estudios Retrospectivos , Enfermedades Cutáneas Bacterianas/complicacionesAsunto(s)
Inflamación/etiología , Síndrome de Netherton/complicaciones , Enfermedades Cutáneas Bacterianas/complicaciones , Piel/patología , Abdomen/patología , Adulto , Humanos , Hiperplasia/etiología , Hiperplasia/patología , Hiperplasia/terapia , Masculino , Síndrome de Netherton/patología , Perineo/patologíaRESUMEN
PURPOSE OF REVIEW: Skin and soft tissue infections (SSTIs) in patients with hematological malignancies are frequent, but dedicated epidemiological studies are limited. The aim of this review is to provide updated description of the main etiological agents, differential diagnosis, and treatment. RECENT FINDINGS: In addition to common causes of bacterial skin infections in any kind of patients, such as streptococci and staphylococci (the letter frequently resistant to methicillin), Pseudomonas aeruginosa is a frequent agent in patients with hematological malignancies, with high virulence and typical infection presenting as ecthyma gangrenosum. Among fungi, fusariosis is the mold infection most frequently associated with skin lesions, although other molds and yeasts (including Candida tropicalis) should be also considered. External infections associated with central venous catheters are frequent in the hematological setting, and in addition to staphylococci, Gram-negative bacteria, fungi, and even rapid growing nontuberculous mycobacteria should be considered. Immunodeficiency might either blunt the typical inflammatory response and make sign or symptoms less evident, or predispose the patients to rapid progression of skin infection to subcutaneous tissues or dissemination. SUMMARY: SSTIs in hematology patients can be caused by various infectious agents resulting in similar clinical presentation. Rapid and accurate diagnosis is fundamental in order to reduce morbidity and mortality.
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Enfermedades Hematológicas/complicaciones , Enfermedades Cutáneas Bacterianas/complicaciones , Infecciones de los Tejidos Blandos/complicaciones , Humanos , Factores de RiesgoRESUMEN
PURPOSE OF REVIEW: Previous studies suggest an association between depression and increased risk of various type of infections, including acute bacterial skin and skin structure infections (ABSSSI). Here, we review the latest advancement in our understanding of immunity in patients with depression and its relevance to disease management and diagnosis, with a special focus on patients suffering from ABSSSI. RECENT FINDINGS: Recent studies have highlighted the role of hypothalamic-pituitary-adrenal axis, neuro-endocrine stress signaling pathways and behavioral attitudes (substance abuse and homelessness) in the pathogenesis of infections in depressed patients. Furthermore, acute bacterial infections, in turn, have emerged as a possible risk for depression development because of different mechanisms including antibiotic-driven changes in the microbiota. SUMMARY: Recent evidences have emphasized the threat that comanagement of depression and infection pose to infectious disease physician and psychiatrist. Depressed patients with ABSSSI must be closely monitored for drug side-effects, drug-drug interactions, toxicity, and adequate compliance. New management strategies including new long-acting antibiotics (e.g., dalbavancin) are welcome.
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Depresión/complicaciones , Enfermedades Cutáneas Bacterianas/complicaciones , Infecciones de los Tejidos Blandos/complicaciones , Humanos , Sistema Hipotálamo-Hipofisario , Sistema Hipófiso-SuprarrenalRESUMEN
INTRODUCTION: Streptococcal infections can cause various skin manifestations related to the direct action of the offending organism itself or to a reactional mechanism. Reactional manifestations are less well known and understood, and they include generalized acute pustulosis belonging to the spectrum of neutrophilic dermatoses. We report a case of generalized acute pustulosis followed by Sweet syndrome and erythema nodosum occurring after a streptococcal infection. PATIENTS AND METHODS: A 60-year-old woman was consulting for a diffuse pustular rash after a throat infection, with high levels of anti-streptolysin (337 U/L) and anti-streptodornase (2560 U/L). The biopsy showed folliculitis and a neutrophilic infiltrator of the dermis, and bacteriological and mycological cultures were sterile. The patient then developed papules evoking Sweet syndrome followed by nodules typical of erythema nodosum after 20 days. A favourable outcome was achieved under colchicine. DISCUSSION: Generalized acute pustulosis is a form of neutrophilic dermatosis whose mechanisms, area predilection and treatment are poorly known. The clinical presentation of this patient was initially typical and the secondary progression to lesions like those in Sweet syndrome is consistent with the pathophysiological continuity and overlap of these entities.
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Eritema Nudoso/etiología , Faringitis/complicaciones , Enfermedades Cutáneas Bacterianas/complicaciones , Infecciones Estreptocócicas/complicaciones , Síndrome de Sweet/etiología , Pustulosis Exantematosa Generalizada Aguda/diagnóstico , Artralgia/etiología , Biopsia , Colchicina/uso terapéutico , Diagnóstico Diferencial , Eritema Nudoso/tratamiento farmacológico , Femenino , Foliculitis/etiología , Foliculitis/microbiología , Foliculitis/patología , Humanos , Persona de Mediana Edad , Faringitis/microbiología , Psoriasis/diagnóstico , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Enfermedades Cutáneas Bacterianas/microbiología , Enfermedades Cutáneas Bacterianas/patología , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/patologíaRESUMEN
Mycobacterium c helonae is one of the rapidly growing non-tuberculous mycobacteria that can be isolated from water, soils and aerosols. Localised infections have been reported associated with tattoo parlours, pedicures and cosmetic procedures. But disseminated infection is usually associated with individuals who are immunocompromised, predominantly affecting limbs but sparing abdomen and back. We herein present a case where patient was on immunosuppressive therapy and developed locally severe infection around right ankle. A 69-year-old woman known to rheumatology presents in outpatients with severe pain in right ankle, unable to bear weight, oedematous right foot and lower leg. There was extensive erythematous cellulitic skin rash around right ankle and lower leg. She had background history of systemic lupus erythematosus with previous history of cardiac myositis and left foot drop. She had six cycles of cyclophosphamide for flare of lupus and after last cycle developed this presentation. Skin biopsy was arranged with dermatologist, cultures from which grew M . chelonae She was admitted and started on triple regimen for M . chelonae as per Microbiology guidelines with intention to complete 6-12 months treatment. Patient responded very well to treatment but unfortunately, she died after 5 months on treatment due to other comorbidities and likely cause of death was cardiac arrhythmia.
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Huésped Inmunocomprometido , Lupus Eritematoso Sistémico/inmunología , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Mycobacterium chelonae , Enfermedades Cutáneas Bacterianas/diagnóstico , Enfermedades Cutáneas Bacterianas/microbiología , Anciano , Antibacterianos/uso terapéutico , Claritromicina/uso terapéutico , Ciclofosfamida/uso terapéutico , Diagnóstico Diferencial , Femenino , Humanos , Imipenem/uso terapéutico , Inmunosupresores/uso terapéutico , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Enfermedades Cutáneas Bacterianas/complicaciones , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Tobramicina/uso terapéutico , Resultado del TratamientoRESUMEN
Diphtheria is an infectious disease transmitted by air or by contact. There are three main species of corynebacterium: diphtheriae, ulcerans, and pseudotuberculosis. They may or may not secrete a toxin responsible for serious cardiac or neurological complications. The frequent clinical presentations are diphtheria angina and cutaneous diphtheria. When it is suspected, it is urgent to send cutaneous or pharyngeal samples to the National Reference Center. If toxin is present, serotherapy should be instituted and the case should be reported. Antibiotic therapy with amoxicillin or azithromycin is the standard treatment. Vaccine prevention begun in the middle of the 20th century has helped to slow epidemics.
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Difteria/complicaciones , Hiperalgesia/microbiología , Enfermedades Cutáneas Bacterianas/complicaciones , Úlcera Cutánea/microbiología , Adulto , Humanos , Masculino , SenegalRESUMEN
BACKGROUND: Vibrio vulnificus necrotizing skin and soft tissue infections (VNSSTIs) are associated with a high mortality rate that varies remarkably with host susceptibility. Hepatic disease (HD) is considered the key risk factor for high VNSSTIs incidence and mortality; however, there is limited evidence in the literature to support this observation. METHODOLOGY: We examined all reported cases of VNSSTIs and associated mortality rates between 1966 and mid-2018. The PubMed, Medline and Cochrane Library databases were systematically searched for observational studies on patients with VNSSTIs. Twelve studies with 1157 total patients with VNSSTIs were included in the analysis. From the pooled dataset, nearly half (46.8%) of the patients with VNSSTIs had HD. The mortality rate in HD patients with VNSSTIs was 53.9% (n = 292/542), which was considerably higher than the mortality rate of 16.1% (n = 99/615) in non-HD patients. Patients with HD contracted VNSSTIs were found to be two or more times (RR = 2.61, 95% CI = 2.14-3.19) as likely to die compared with those without HD. Besides, liver cirrhosis (LC), the end-stage HD, was confirmed to be a significant risk factor, with risk ratios of 1.84 (95% CI 1.21-2.79) and 2.00 (95% CI 1.41-2.85) when compared to non-LC and non-HD, respectively. CONCLUSIONS: HD with or without LC can be associated with infections and complications from V. vulnificus. Clinicians should aggressively approach care and management of acutely and/or critically ill patients with VNSSTIs.