Subject(s)
Bacteremia , Capnocytophaga , Gram-Negative Bacterial Infections , Humans , Capnocytophaga/isolation & purification , Bacteremia/microbiology , Bacteremia/diagnosis , Bacteremia/drug therapy , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/complications , Purpura/microbiology , Purpura/etiology , Male , FemaleABSTRACT
Severe group A streptococcus (GAS) infections, particularly necrotizing soft tissue infections (NSTIs), have been associated with the development of streptococcal toxic-shock syndrome (STSS), a systemic illness caused by GAS-derived toxins. Traditional physical examination findings in NSTIs include skin necrosis, crepitus, and hemorrhagic bullae. However, these findings are limited in sensitivity and additional clinical markers may aid in making an early diagnosis of NSTI. We present a case of a superficial infection, specifically GAS necrotizing cellulitis, complicated by STSS in a healthy boy with an associated skin finding of retiform purpura that aided in early diagnosis of a NSTI.
Subject(s)
Cellulitis/microbiology , Fasciitis, Necrotizing/microbiology , Purpura/microbiology , Shock, Septic/microbiology , Soft Tissue Infections/microbiology , Streptococcal Infections/microbiology , Anti-Bacterial Agents/therapeutic use , Cellulitis/drug therapy , Child , Diagnosis, Differential , Fasciitis, Necrotizing/drug therapy , Humans , Male , Purpura/drug therapy , Shock, Septic/drug therapy , Soft Tissue Infections/drug therapy , Streptococcal Infections/drug therapy , Streptococcus pyogenes/isolation & purificationABSTRACT
El parvovirus B19 generalmente infecta a niños y adultos jóvenes, presentando cuadros exantemáticos característicos, como el eritema infeccioso. Dentro de las manifestaciones hemorrágicas con erupción purpúrica-petequial, está el síndrome papular-purpúrico en guantes y calcetines. En ocasiones, distribuciones atípicas con erupciones petequiales asimétricas podrían complicar el diagnóstico, llevando a plantear diagnósticos diferenciales y a realizar pruebas de laboratorio. Se describe un caso inusual de parvovirus B19 con erupción petequial atípica, y se hace una revisión de la literatura médica reciente
Parvovirus B19 generally infects children and young adults, presenting characteristic rashes such as erythema infectiosum. Among the hemorrhagic manifestations with purpuric-petechial eruption is the papular purpuric socks and gloves syndrome. Occasionally, atypical distributions with asymmetric petechial rashes could complicate the diagnosis leading to differential diagnoses and laboratory tests. We describe an unusual case of parvovirus B19 with atypical petechial rash, and a recent literature review is reported
Subject(s)
Humans , Male , Adolescent , Purpura/microbiology , Parvovirus B19, Human/isolation & purification , Parvoviridae Infections/diagnosis , Skin Diseases, Infectious/microbiology , Diagnosis, Differential , Parvovirus B19, Human/pathogenicity , Exanthema/microbiology , Thrombocytopenia/diagnosisSubject(s)
Enterobacteriaceae Infections/diagnosis , Morganella morganii , Purpura/microbiology , Skin Diseases, Bacterial/diagnosis , Acute Disease , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Bandages , Disseminated Intravascular Coagulation/diagnosis , Enterobacteriaceae Infections/therapy , Humans , Levofloxacin/therapeutic use , Male , Purpura/therapy , Skin Diseases, Bacterial/therapyABSTRACT
We present a 13-year-old boy who developed invasive infection with Saprochaete clavata after induction chemotherapy for B-cell acute lymphoblastic leukemia, complicated by fungemia, septic shock and acute renal, and liver failure. He developed purpuric papulonodules over bilateral upper and lower limbs, which also grew S clavata on fungal culture.
Subject(s)
Dermatomycoses/microbiology , Invasive Fungal Infections/diagnosis , Opportunistic Infections/microbiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Purpura/microbiology , Adolescent , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Humans , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapyABSTRACT
Capnocytophaga canimorsus infection was recently recognized as a zoonosis. We report the first case of fulminant septic shock in Italy caused by this pathogen. The patient, with a history of splenectomy, died at the main hospital in Brescia with a presumptive diagnosis of sepsis. PCR and sequencing on post mortem samples confirmed C. canimorsus as a causative organism. Our purpose is to alert medical professionals to the virulence of C. canimorsus in asplenic and immunocompromised patients.
Subject(s)
Bites and Stings/microbiology , Capnocytophaga/isolation & purification , Exanthema/microbiology , Gram-Negative Bacterial Infections/microbiology , Sepsis/microbiology , Shock, Septic/microbiology , Splenectomy/adverse effects , Animals , Anti-Bacterial Agents/administration & dosage , Dogs , Exanthema/etiology , Fatal Outcome , Gram-Negative Bacterial Infections/immunology , Gram-Negative Bacterial Infections/therapy , Humans , Immunocompromised Host , Italy , Male , Purpura/microbiology , Rare Diseases , Sepsis/immunology , Sepsis/therapy , Shock, Septic/immunology , Shock, Septic/therapy , Young Adult , ZoonosesABSTRACT
Stenotrophomonas maltophilia is a multidrug-resistant opportunistic pathogen with increasing prevalence and high morbidity and mortality. In addition to its classic association with pulmonary infections, S. maltophilia can cause skin and soft tissue infections with varying clinical presentations. We describe the case of a man in his 30s with B-cell acute lymphoblastic leukaemia who presented with a solitary patch of faint but tender purpura found to have rapidly progressive S. maltophilia infection diagnosed on skin biopsy. S. maltophilia infection should be considered in the cutaneous evaluation of the immunocompromised host.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Catheters, Indwelling/microbiology , Gram-Negative Bacterial Infections/microbiology , Leukemia, B-Cell/drug therapy , Opportunistic Infections/microbiology , Soft Tissue Infections/microbiology , Stenotrophomonas maltophilia/pathogenicity , Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage , Adult , Drug Resistance, Bacterial , Fatal Outcome , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/immunology , Humans , Immunocompromised Host , Leg , Leukemia, B-Cell/immunology , Male , Opportunistic Infections/drug therapy , Opportunistic Infections/immunology , Purpura/microbiologySubject(s)
Exanthema/pathology , Purpura/pathology , Rickettsia typhi/isolation & purification , Skin/pathology , Typhus, Endemic Flea-Borne/diagnosis , Animals , Anti-Bacterial Agents/therapeutic use , Asian People , Exanthema/microbiology , Fever/diagnosis , Fever/etiology , Fluorescent Antibody Technique, Indirect/methods , Humans , Immunoglobulin G/blood , Immunoglobulin M/blood , Male , Middle Aged , Purpura/microbiology , Rodentia , Skin/blood supply , Treatment Outcome , Typhus, Endemic Flea-Borne/blood , Typhus, Endemic Flea-Borne/drug therapyABSTRACT
Our patient's signs and symptoms developed one week after being bitten by a rat that she was feeding to her son's pet snake.
Subject(s)
Arthralgia/microbiology , Fever/microbiology , Purpura/microbiology , Rat-Bite Fever/diagnosis , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Animals , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Dyspnea/microbiology , Female , Humans , Middle Aged , Rat-Bite Fever/drug therapy , RatsABSTRACT
This article describes a man who presented to the ED in acute distress with signs and symptoms of sepsis, pneumonia, and a new petechial rash on his chest. He was eventually diagnosed with Rocky Mountain spotted fever. Aggressive treatment of sepsis and timely administration of empiric antibiotics were lifesaving in this situation.
Subject(s)
Headache/microbiology , Purpura/microbiology , Rocky Mountain Spotted Fever/complications , Sepsis/microbiology , Adult , Humans , MaleABSTRACT
INTRODUCTION: The association of fever and petechiae in children is one of the most alarming findings for a paediatrician. To quickly distinguish between benign and life-threatening conditions is challenging in many cases. We aimed to evaluate the clinical practice of children presenting with fever and petechiae as initial symptoms. METHODS: 41 patients (age 3 months-11 years) presenting with fever and petechiae were identified in an Emergency Paediatric Assessment Unit over a period of 9 months. General data, symptoms and signs were assessed for each patient. The work-up consisted in: complete blood count, inflammatory tests, coagulation tests, Monospot test, nasopharyngeal rapid tests, blood culture, and cerebrospinal fluid culture where appropriate. RESULTS: Most children were <5 years of age (70.7%). Female to male ratio was 1:2.4. The most common clinical diagnoses were: viral respiratory illness (48.8%, 20/41) and upper respiratory tract infection (17.1%, 7/41). Meningococcal disease was found in one case. CRP>6 mg/l was poorly correlated with serious illness. The following variables were strongly associated with serious illness: ill appearance, shivering, lethargy, back rigidity, ESR>50 mm/h and prolonged capillary refill time. 59% (24/41) of children were treated with antibiotics, however, at discharge 42%(10/24) of them, did not have a work-up suggestive for a bacterial illness. CONCLUSIONS: Screening for low prevalence but high morbidity conditions, as the meningococcal disease, with an extensive work-up is time and resource consuming and may lead to unmotivated antibiotic use. Larger studies are needed to change the emergency practice for management of fever and rash.
Subject(s)
Fever , Purpura , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/microbiology , Child , Child, Preschool , Diagnosis, Differential , Emergency Service, Hospital/statistics & numerical data , Exanthema/microbiology , Exanthema/virology , Female , Fever/microbiology , Fever/virology , Humans , Infant , Male , Meningococcal Infections/complications , Meningococcal Infections/diagnosis , Nasopharynx/microbiology , Nasopharynx/virology , Prevalence , Purpura/microbiology , Purpura/virology , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/therapy , Respiratory Tract Infections/virology , Retrospective Studies , Risk Assessment , Risk Factors , Romania/epidemiology , Severity of Illness IndexSubject(s)
Pseudomonas Infections/diagnosis , Pseudomonas aeruginosa/isolation & purification , Purpura/diagnosis , Shock, Septic/diagnosis , Skin Diseases, Bacterial/diagnosis , Anti-Bacterial Agents/therapeutic use , Ciprofloxacin/therapeutic use , Diagnosis, Differential , Drug Therapy, Combination , Female , Humans , Infant , Meropenem , Neutropenia/diagnosis , Pseudomonas Infections/drug therapy , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/drug effects , Purpura/drug therapy , Purpura/microbiology , Shock, Septic/drug therapy , Shock, Septic/microbiology , Skin Diseases, Bacterial/drug therapy , Skin Diseases, Bacterial/microbiology , Thienamycins/therapeutic useSubject(s)
Candidiasis/complications , Embolism/complications , Fungemia/complications , Purpura/etiology , Aged , Candida/isolation & purification , Candida/pathogenicity , Candidiasis/microbiology , Embolism/microbiology , Fungemia/microbiology , Humans , Lymphoma, T-Cell/complications , Male , Purpura/microbiology , Purpura/pathologySubject(s)
Duodenal Diseases/microbiology , Duodenum/microbiology , Intestinal Mucosa/microbiology , Purpura/microbiology , Tropheryma/isolation & purification , Whipple Disease/microbiology , Aged , Anti-Bacterial Agents/therapeutic use , Biopsy , Duodenal Diseases/diagnosis , Duodenal Diseases/drug therapy , Duodenum/pathology , Endoscopy, Digestive System , Gastrointestinal Hemorrhage/microbiology , Humans , Intestinal Mucosa/pathology , Male , Purpura/diagnosis , Purpura/drug therapy , Treatment Outcome , Tropheryma/drug effects , Whipple Disease/diagnosis , Whipple Disease/drug therapyABSTRACT
Petechiae and purpura are among the most alarming findings a pediatrician will commonly observe in the office. Severity of illness can range from a temper tantrum, to common viral infections, to the most deadly infections and diseases. To avoid many of the pitfalls in diagnosis, practitioners will need to be thorough in history taking, assessing fever and immunization status, and physical examination. In addition, a few simple laboratory tests will usually be needed and possibly a manual differential.