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2.
Artículo en Inglés | MEDLINE | ID: mdl-33533810

RESUMEN

Osteomyelits due to concurrent multi-drug resistance organisms is difficult to treat for any surgeon and infectious disease physician. An eleven-year-old boy presenting with an open fracture of the left radius and ulna after a fall in a stagnant wet field. Despite prophylactic antibiotics and surgical intervention, the open wound was infected, and Chromobacterium violaceum as well as Klebsiella pneumoniae were isolated. He was treated with six weeks of parenteral cefepime and amikacin and was discharged upon clinical improvement. Unfortunately, chronic osteomyelitis set in with persistent sinus drainage. He then underwent a second procedure for debridement of the wound and Burkholderia pseudomallei was isolated. Parenteral antibiotic therapy was initiated progressing with a marked improvement. However, the long course of antibiotics had exhausted the patient and his family, leading to a premature interruption of the parenteral antibiotic. Despite the suboptimal antibiotic course, there were no signs of relapsed osteomyelitis during subsequent review. The timely surgical intervention with appropriate sampling for subsequent microorganism isolation guided the suitability of the treatment line.


Asunto(s)
Antibacterianos/uso terapéutico , Chromobacterium/aislamiento & purificación , Klebsiella pneumoniae/aislamiento & purificación , Osteomielitis/tratamiento farmacológico , Niño , Resistencia a Múltiples Medicamentos , Humanos , Infecciones por Klebsiella/diagnóstico , Infecciones por Klebsiella/tratamiento farmacológico , Masculino , Osteomielitis/diagnóstico , Osteomielitis/microbiología , Resultado del Tratamiento
3.
Khirurgiia (Mosk) ; (2): 84-87, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33570360

RESUMEN

Acute hematogenous osteomyelitis (AHO) in adults is a rare disease complicating timely diagnosis. Even greater difficulties are observed in case of pelvic bone lesion. The authors report AHO of the pelvis an adult. Osteomyelitis was complicated by generalized infection and multiple pyogenic abscesses in subcutaneous adipose tissue of the upper and lower extremities. Detection of primary infectious focus was complicated by extreme severity of the patient's condition and low informative value of X-ray and ultrasound at the early stage of disease. Staphylococcus aureus was obtained from blood culture and infectious foci. Surgical debridement along with complex intensive care ensured a positive outcome.


Asunto(s)
Absceso , Osteomielitis , Huesos Pélvicos , Infecciones Estafilocócicas , Absceso/diagnóstico , Absceso/etiología , Absceso/microbiología , Absceso/terapia , Enfermedad Aguda , Adulto , Antibacterianos/uso terapéutico , Desbridamiento , Extremidades/microbiología , Humanos , Osteomielitis/diagnóstico , Osteomielitis/etiología , Osteomielitis/microbiología , Osteomielitis/terapia , Huesos Pélvicos/microbiología , Huesos Pélvicos/cirugía , Pelvis/diagnóstico por imagen , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/terapia , Staphylococcus aureus/aislamiento & purificación , Grasa Subcutánea/microbiología
4.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33526521

RESUMEN

Vertebral osteomyelitis is an infection of the vertebrae that can lead to spinal degeneration, most commonly caused by Staphylococcus aureus Here, we report an unusual case of pyogenic osteomyelitis caused by Gardnerella vaginalis and Streptococcus parasanguinis in a 61-year-old postmenopausal woman. The patient presented with a 2-week history of worsening lower back pain and fever and a recent episode of cystitis following re-engagement of sexual activity. Imaging revealed a deterioration of vertebrae discs and spinal canal stenosis at the L3-L4 levels with a formation of abscess in the right psoas muscle. Needle aspiration of the abscess identified G. vaginalis and S. parasanguinis and the patient was successfully treated with a 6-week course of ceftriaxone and metronidazole. This case describes an unusual coinfection of two pathogens that normally reside in the urogenital tract and oral cavity, respectively, and highlights the risk posed when these organisms breach the body's normal barriers.


Asunto(s)
Discitis/microbiología , Gardnerella vaginalis/aislamiento & purificación , Vértebras Lumbares , Osteomielitis/microbiología , Absceso del Psoas/microbiología , Infecciones Estreptocócicas/microbiología , Streptococcus/aislamiento & purificación , Antibacterianos/uso terapéutico , Técnicas de Cultivo , Discitis/diagnóstico por imagen , Discitis/tratamiento farmacológico , Discitis/fisiopatología , Femenino , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Osteomielitis/diagnóstico por imagen , Osteomielitis/tratamiento farmacológico , Osteomielitis/fisiopatología , Posmenopausia , Absceso del Psoas/diagnóstico por imagen , Absceso del Psoas/tratamiento farmacológico , Estenosis Espinal/fisiopatología , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico
6.
J Laryngol Otol ; 135(3): 217-223, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33593449

RESUMEN

OBJECTIVE: This study aimed to describe the clinical presentation, microbiological profile and management of complications of bone wax usage for surgical procedures at the skull base. METHOD: The case records of a series of five patients who developed post-operative surgical site complications because of bone wax usage during skull base surgery were reviewed. RESULTS: In all five patients, persistent site-specific clinical features were noted along with intra-operative presence of excessive bone wax. Three unique cases of presentation, one with a fungal brain abscess because of Aspergillus flavus infection, another with fungal osteomyelitis because of Trichosporon beigelii infection and a third with intradural migration of bone wax into the cerebellopontine angle cistern are highlighted. CONCLUSION: The presentation of surgical site infection at the skull base because of excessive use of bone wax can be manifold. The need for testing appropriate cultures including fungal culture is highlighted.


Asunto(s)
Osteomielitis/microbiología , Palmitatos/efectos adversos , Complicaciones Posoperatorias/etiología , Base del Cráneo/cirugía , Infección de la Herida Quirúrgica/microbiología , Ceras/efectos adversos , Adulto , Aspergilosis/microbiología , Aspergillus flavus , Basidiomycota , Absceso Encefálico/microbiología , Ángulo Pontocerebeloso , Femenino , Migración de Cuerpo Extraño/etiología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/microbiología , Tricosporonosis/microbiología , Adulto Joven
7.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547128

RESUMEN

Awareness of rare differential diagnoses of common clinical presentations helps promote early detection and prompt management of serious conditions. A 54-year-old man, with an infected non-union following a high tibial osteotomy, presented with an acutely discharging abscess to his proximal tibia. He was generally unwell with a Staphylococcus aureus bacteraemia. The tibia was debrided, CERAMENT G used as dead space management and a spanning external fixator applied. Postoperatively, pregabalin and tapentadol were commenced in addition to amitriptyline and sertraline, which the patient was taking regularly. Overnight, the patient developed hyperthermia, inducible clonus, hyperreflexia, agitation, confusion and rigors. Prompt recognition of the possibility of serotonin syndrome resulted in early cessation of serotonergic medications and a positive outcome. From this case an important message is that fever in a patient taking serotonergic medications should prompt a screening neurological examination. Clinicians should also be wary when patients are commenced on multimodal analgesia, including tapentadol.


Asunto(s)
Analgésicos Opioides/efectos adversos , Osteomielitis/microbiología , Síndrome de la Serotonina/diagnóstico , Infecciones Estafilocócicas/microbiología , Infección de la Herida Quirúrgica/microbiología , Tapentadol/efectos adversos , Bacteriemia/microbiología , Desbridamiento , Diagnóstico Diferencial , Fiebre , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/cirugía , Osteotomía , Infecciones Estafilocócicas/cirugía , Infección de la Herida Quirúrgica/cirugía , Tibia/cirugía
8.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-33462043

RESUMEN

Group A streptococcus (GAS) causes a wide variety of infections in the paediatric population, ranging from pharyngitis to rare but severe invasive diseases, such as bacterial arthritis and osteomyelitis. Dental neglect is a type of child neglect in which caregivers fail to provide adequate care and treatment for dental diseases. This results in poor oral hygiene and can lead to complications including sepsis. We report the case of a 4-year-old boy, suffering from child neglect, presenting with GAS pharyngitis and subsequent bacterial arthritis in the right ankle, osteomyelitis in the right talus and abscess in the right calcaneus. He was first treated with penicillin, which was changed to clindamycin because of a suspected drug-induced rash. He was discharged after 6 weeks of intravenous therapy when symptoms had resolved and inflammatory markers were within the normal range. The case highlights that dental neglect may present a risk for subsequent invasive infections.


Asunto(s)
Artritis Infecciosa/microbiología , Higiene Bucal , Osteomielitis/microbiología , Faringitis/microbiología , Infecciones Estreptocócicas/diagnóstico , Streptococcus pyogenes/aislamiento & purificación , Artritis Infecciosa/diagnóstico , Preescolar , Humanos , Masculino , Osteomielitis/diagnóstico , Faringitis/diagnóstico
10.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431445

RESUMEN

A 42-year-old woman presented with fever, left ear pain, restricted mouth opening, difficulty in swallowing and inability to open her left eyelid for a period of 10 days. She was treated with antibiotics for the same at a local medical facility; however, a sudden decrease in her left eye vision prompted her to visit our tertiary centre. Her history was insignificant except for having multiple left ear syringing for an insect removal 10 days before onset of her current symptoms. On examination, she had ptosis of the left eye with chemosis, dilated pupil with only perception of light and restricted ocular mobility. Oral examination revealed trismus and bulge in the left peritonsillar region. Left ear examination revealed a large central perforation with mucopurulent discharge. CT of the neck with contrast demonstrated a collection in the left peritonsillar space with left internal carotid artery thrombosis. MRI of the brain with gadolinium revealed left cavernous sinus thrombosis with acute infarcts in the left frontal lobe. An emergency incision and drainage of the left peritonsillar abscess was performed. Culture grew broad aseptate fungal hyphae. Despite starting on antifungal therapy, she succumbed to her illness.


Asunto(s)
Trombosis del Seno Cavernoso/diagnóstico , Cuerpos Extraños en el Ojo/complicaciones , Mucormicosis/diagnóstico , Osteomielitis/diagnóstico , Base del Cráneo/microbiología , Adulto , Anfotericina B/uso terapéutico , Animales , Seno Cavernoso/diagnóstico por imagen , Trombosis del Seno Cavernoso/tratamiento farmacológico , Trombosis del Seno Cavernoso/etiología , Escarabajos/microbiología , Drenaje , Quimioterapia Combinada , Enoxaparina/uso terapéutico , Cuerpos Extraños en el Ojo/diagnóstico , Cuerpos Extraños en el Ojo/microbiología , Cuerpos Extraños en el Ojo/terapia , Resultado Fatal , Femenino , Humanos , Hifa/aislamiento & purificación , Imagen por Resonancia Magnética , Meropenem/uso terapéutico , Mucorales/aislamiento & purificación , Mucormicosis/microbiología , Mucormicosis/terapia , Osteomielitis/microbiología , Osteomielitis/terapia , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/patología , Base del Cráneo/cirugía , Vancomicina/uso terapéutico
11.
Bone Joint J ; 102-B(11): 1587-1596, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33135450

RESUMEN

AIMS: This study presents patient-reported quality of life (QoL) over the first year following surgical debridement of long bone osteomyelitis. It assesses the bone involvement, antimicrobial options, coverage of soft tissues, and host status (BACH) classification as a prognostic tool and its ability to stratify cases into 'uncomplicated' or 'complex'. METHODS: Patients with long-bone osteomyelitis were identified prospectively between June 2010 and October 2015. All patients underwent surgical debridement in a single-staged procedure at a specialist bone infection unit. Self-reported QoL was assessed prospectively using the three-level EuroQol five-dimension questionnaire (EQ-5D-3L) index score and visual analogue scale (EQ-VAS) at five postoperative time-points (baseline, 14 days, 42 days, 120 days, and 365 days). BACH classification was applied retrospectively by two clinicians blinded to outcome. RESULTS: In total, 71 patients with long-bone osteomyelitis were included. There was significant improvement from time of surgery to one year postoperatively in mean EQ-VAS (58.2 to 78.9; p < 0.001) and mean EQ-5D-3L index scores (0.284 to 0.740; p < 0.001). At one year following surgery, BACH 'uncomplicated' osteomyelitis was associated with better QoL compared to BACH 'complex' osteomyelitis (mean EQ-5D-3L 0.900 vs 0.685; p = 0.020; mean EQ-VAS 87.1 vs 73.6; p = 0.043). Patients with uncomplicated bone involvement (BACH type B1, cavitary) reported higher QoL at all time-points when compared to complex bone involvement (B2, segmental or B3, osteomyelitis involving a joint). Patients with good antimicrobial options (Ax or A1) gave higher outcome scores compared to patients with multidrug-resistant isolates (A2). The need for microvascular tissue transfer (C1 and C2) did not impact significantly on QoL. Patients without major comorbidities (uncomplicated, H1) reported higher QoL compared to those with significant disease (complex, H2). CONCLUSION: Uncomplicated osteomyelitis, as defined by BACH, gave higher self-reported QoL when compared to complex cases. The bone involvement, antimicrobial options, and host status variables were able to stratify patients in terms of QoL. These data can be used to offer prognostic information to patients who are undergoing treatment for long bone osteomyelitis. Cite this article: Bone Joint J 2020;102-B(11):1587-1596.


Asunto(s)
Osteomielitis/terapia , Adulto , Anciano , Anciano de 80 o más Años , Desbridamiento , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/tratamiento farmacológico , Osteomielitis/microbiología , Osteomielitis/cirugía , Medición de Resultados Informados por el Paciente , Pronóstico , Calidad de Vida , Medición de Riesgo , Método Simple Ciego , Resultado del Tratamiento , Adulto Joven
12.
Med. clín (Ed. impr.) ; 155(8): 335-339, oct. 2020. graf, tab
Artículo en Inglés | IBECS | ID: ibc-197036

RESUMEN

INTRODUCTION/OBJECTIVES: To describe the clinical, radiological and microbiological characteristics of vertebral osteomyelitis patients, analysing the factors that played a role on their outcome. PATIENTS AND METHODS: Single-centre retrospective observational study including patients diagnosed with vertebral osteomyelitis, based on the combination of clinical presentation with either a definitive bacteriological diagnosis and/or imaging studies. RESULTS: 116 adult patients were included with a mean age of 62.75 (14.98) years. Males predominated (68.10%). Eighteen patients (15.51%) were immunosuppressed. The most frequent symptom was back pain (99.14%) followed by fever, which was detected in 45 patients (38.79%). Puncture-aspiration or biopsy was performed in 84 patients (72.10%) and its culture was positive in 48 samples (57.14%). Gram positive species predominated (73.86%) on cultures, followed by Gram negative (12.5%), mycobacteria (10.23%) and fungi (3.41%). No microorganism was identified in 28 patients (24.14%). On imaging, most of the patients (92.24%) had paravertebral or epidural abscess. 63 cases (54.31%) showed vertebral destruction and 39 (33.62%) cord compression. Twenty-two patients (18.97%) required further surgical procedures and 13 (11.21%) died. CONCLUSIONS: The average patient is middle aged (often male) with a history of subacute back pain, sometimes presenting fever and/or neurological damage on diagnosis. Acute phase reactants are frequently raised. Diabetes mellitus, endocarditis and immunosuppressed patients may have the worst chance of a good outcome, therefore these patients should be more carefully managed (always try to obtain an imaging-guided biopsy, correct antibiotic treatment, and a functional and clinical follow-up)


INTRODUCCIÓN/OBJETIVOS: Describir las características clínicas, radiológicas y microbiológicas de pacientes con osteomielitis vertebral en nuestro centro, analizando qué variables tuvieron influencia pronóstica. MATERIAL Y MÉTODOS: Se llevó a cabo un estudio observacional, unicéntrico y retrospectivo incluyendo pacientes adultos diagnosticados de osteomielitis vertebral sobre la base de la combinación de las manifestaciones clínicas con un diagnóstico microbiológico y/o radiológico compatible. RESULTADOS: Se incluyeron un total de 116 pacientes con una media de edad de 62,75 (14,98) años, predominando el género masculino (68,10%). Dieciocho de ellos (15,51%) estaban inmunosuprimidos. El síntoma más frecuente fue el dolor lumbar (99,14%) seguido de la fiebre, detectada en 45 pacientes (38,79%). Se realizó punción-biopsia en 84 pacientes (72,10%) con positividad en el cultivo en 48 muestras (57,14%) donde predominó el crecimiento de Gram positivos (73,86%) seguido de Gram negativos (12,5%), micobacterias (10,23%) y hongos (3,41%). En 28 pacientes (24,14%) no se pudo identificar el agente causal. En el estudio de resonancia magnética, la mayoría de los pacientes tenían abscesificación paravertebral o epidural (92,24%); 63 pacientes (54,31%) tenían hallazgos compatibles con destrucción vertebral y 39 (33,62%), compresión medular. En 22 casos (18,97%) se requirió un abordaje quirúrgico posterior. Trece pacientes (11,21%) fallecieron a causa de la infección o de sus complicaciones. CONCLUSIONES: El paciente promedio es un varón de edad media, con historia de dolor lumbar de curso subagudo e insidioso, con presencia inconstante de fiebre, presente en menos de la mitad de los casos. Con relativa frecuencia se ha detectado una exploración neurológica patológica en la presentación clínica. Los reactantes de fase aguda estaban elevados en la mayoría de los pacientes. Los casos en los que exista comorbilidad (sobre todo diabetes mellitus o inmunosupresión), así como la concomitancia con endocarditis, debe de implicar un manejo más cauto


Asunto(s)
Humanos , Masculino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Osteomielitis/diagnóstico por imagen , Osteomielitis/microbiología , Dolor de la Región Lumbar/etiología , Osteomielitis/patología , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Enfermedades de la Columna Vertebral/patología , Estudios Retrospectivos , Punción Espinal/métodos , Infecciones/complicaciones , Tomografía Computarizada por Tomografía de Emisión de Positrones
13.
Nat Commun ; 11(1): 4446, 2020 09 07.
Artículo en Inglés | MEDLINE | ID: mdl-32895387

RESUMEN

Owing to the poor penetration depth of light, phototherapy, including photothermal and photodynamic therapies, remains severely ineffective in treating deep tissue infections such as methicillin-resistant Staphylococcus aureus (MRSA)-infected osteomyelitis. Here, we report a microwave-excited antibacterial nanocapturer system for treating deep tissue infections that consists of microwave-responsive Fe3O4/CNT and the chemotherapy agent gentamicin (Gent). This system, Fe3O4/CNT/Gent, is proven to efficiently target and eradicate MRSA-infected rabbit tibia osteomyelitis. Its robust antibacterial effectiveness is attributed to the precise bacteria-capturing ability and magnetic targeting of the nanocapturer, as well as the subsequent synergistic effects of precise microwaveocaloric therapy from Fe3O4/CNT and chemotherapy from the effective release of antibiotics in infection sites. The advanced target-nanocapturer of microwave-excited microwaveocaloric-chemotherapy with effective targeting developed in this study makes a major step forward in microwave therapy for deep tissue infections.


Asunto(s)
Nanopartículas de Magnetita/uso terapéutico , Microondas/uso terapéutico , Osteomielitis/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Animales , Antibacterianos/uso terapéutico , Sistemas de Liberación de Medicamentos/métodos , Quimioterapia/métodos , Óxido Ferrosoférrico/uso terapéutico , Gentamicinas/uso terapéutico , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Nanotubos de Carbono , Osteomielitis/microbiología , Conejos
15.
BMC Infect Dis ; 20(1): 512, 2020 Jul 16.
Artículo en Inglés | MEDLINE | ID: mdl-32677896

RESUMEN

BACKGROUND: The aims of this study were to identify the predictive factors for microbiological diagnosis through disco-vertebral biopsy (DVB) in patients with pyogenic vertebral osteomyelitis (PVO) and negative blood cultures, and compare the performance of DVB under fluoroscopic versus scanographic guidance. METHODS: We performed a cohort study comparing positive and negative DVB among patients with PVO. All cases of PVO undergoing a DVB for microbiological diagnosis in our center were retrospectively reviewed. Infections due to Mycobacterium tuberculosis, infections on foreign device, and non-septic diseases were excluded. Anamnestic, clinical, biological, microbiological, as well as radiological data were collected from medical charts thanks to a standardized data set. RESULTS: A total of 111 patients were screened; 88 patients were included. Microbiological cultures were positive in 53/88 (60.2%) patients. A thickening of the paravertebral tissue ≥10 mm on magnetic resonance imaging (MRI) in axial MR scans was a predictive factor of DVB microbiological positivity (52.4% vs. 13.3%; p = 0.006; OR = 5.4). Overall, 51 DVB were performed under fluoroscopic guidance and 37 under scanographic guidance. Considering lumbar DVB, 25/36 (69.4%) of cases yielded positive results under fluoroscopic guidance versus 5/15 (33.3%) under scanographic guidance (p = 0.02; OR = 4.4). No adverse event linked to DVB was notified. CONCLUSION: Every patient with PVO and negative blood cultures should undergo a DVB. A thickening of the paravertebral tissue ≥10 mm on MRI is associated with a higher rate of positive DVB culture. A lumbar DVB under fluoroscopic guidance is more sensitive than under scanographic guidance to identify the micro-organism involved.


Asunto(s)
Disco Intervertebral/patología , Vértebras Lumbares/patología , Osteomielitis/diagnóstico , Enfermedades de la Columna Vertebral/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Absceso Epidural/diagnóstico , Absceso Epidural/patología , Femenino , Fluoroscopía/métodos , Humanos , Biopsia Guiada por Imagen/métodos , Disco Intervertebral/microbiología , Vértebras Lumbares/microbiología , Masculino , Persona de Mediana Edad , Osteomielitis/microbiología , Osteomielitis/patología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Enfermedades de la Columna Vertebral/microbiología , Enfermedades de la Columna Vertebral/patología , Infecciones Estafilocócicas/patología , Tomografía Computarizada por Rayos X/métodos , Adulto Joven
16.
Orthopade ; 49(8): 702-709, 2020 Aug.
Artículo en Alemán | MEDLINE | ID: mdl-32671414

RESUMEN

BACKGROUND: The high demands that fracture-related infections put on patients, physicians and the healthcare system have led to the establishment of a international group of experts called the Fracture-Related Infection (FRI) Consensus Group, whose aim is to develop evidence-based treatment recommendations. DIAGNOSIS: Fracture-related infections are classified according to the time of occurrence, extent and treatment options. The diagnostic algorithm distinguishes between confirmatory and suggestive diagnostic criteria. If there are indications of an infection, tissue biopsy with microbiological and histological workup is recommended to confirm the diagnosis. THERAPY: The primary objective of FRI treatment is to achieve fracture consolidation, while avoiding osteomyelitis. Therapeutic options are removal of the implant, eradication of the infection with implant retention or suppression of FRI. A multidisciplinary team is recommended to develop a patient-specific, optimized surgical and antimicrobial therapy.


Asunto(s)
Antibacterianos/uso terapéutico , Desbridamiento/métodos , Fracturas Óseas/complicaciones , Fracturas Óseas/cirugía , Osteomielitis/tratamiento farmacológico , Complicaciones Posoperatorias/microbiología , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/terapia , Algoritmos , Biopelículas , Fracturas Óseas/microbiología , Humanos , Osteomielitis/diagnóstico , Osteomielitis/microbiología , Complicaciones Posoperatorias/terapia , Infección de la Herida Quirúrgica/microbiología , Traumatología
17.
BMC Infect Dis ; 20(1): 438, 2020 Jun 22.
Artículo en Inglés | MEDLINE | ID: mdl-32571233

RESUMEN

BACKGROUND: Candida sp. osteoarticular infection is rare and most often due to hematogenous seeding during an episode of candidemia in immunocompromised patients. However, the diagnosis can be delayed in patients with subtle symptoms and signs of joint infection without a concurrent episode of candidemia. CASE PRESENTATION: A 75-year-old woman presented with a three-year history of pain and swelling of the left knee. Candida pelliculosa was detected from the intraoperative tissue when the patient had undergone left total knee arthroplasty 32 months ago, but no antifungal treatment was performed. One year after the total knee arthroplasty, C. pelliculosa was repeatedly isolated from the left knee synovial fluid and antifungal treatment comprising amphotericin B deoxycholate and fluconazole was administered. However, joint infection had extended to the adjacent bone and led to progressive joint destruction. The patient underwent surgery for prosthesis removal and received prolonged antifungal treatment with micafungin and fluconazole. CONCLUSIONS: This case shows that C. pelliculosa, an extremely rare non-Candida albicans sp., can cause fungal arthritis and lead to irreversible joint destruction owing to delayed diagnosis and treatment.


Asunto(s)
Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Candida/patogenicidad , Candidiasis/microbiología , Anciano , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Artroplastia de Reemplazo de Rodilla/efectos adversos , Candida/aislamiento & purificación , Candidemia/tratamiento farmacológico , Candidemia/etiología , Candidiasis/tratamiento farmacológico , Ácido Desoxicólico/uso terapéutico , Remoción de Dispositivos , Combinación de Medicamentos , Femenino , Fluconazol/uso terapéutico , Humanos , Cuidados Intraoperatorios , Prótesis Articulares , Rodilla/microbiología , Rodilla/cirugía , Micafungina/uso terapéutico , Osteomielitis/tratamiento farmacológico , Osteomielitis/microbiología
18.
J Pediatr Orthop ; 40(6): 314-321, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32501930

RESUMEN

BACKGROUND: Musculoskeletal infection is a major cause of morbidity in the pediatric population. Despite the canonical teaching that an irritable joint and signs of infection likely represent an infected joint space, recent evidence in the pediatric hip has demonstrated that alternative diagnoses are equally or more likely and that combinations of pathologies are common. The knee is the second most commonly infected joint in children, yet there remains a paucity of available data regarding the epidemiology and workup of the infected pediatric knee. The authors hypothesize that there is heterogeneity of pathologies, including combinations of pathologies, that presents as a potentially infected knee in a child. The authors aim to show the utility of magnetic resonance imaging and epidemiologic and laboratory markers in the workup of these patients. METHODS: A retrospective review of all consults made to the pediatric orthopaedic surgery team at a single tertiary care center from September 2009 through December 2015 regarding a concern for potential knee infection was performed. Excluded from the study were patients with penetrating trauma, postoperative infection, open fracture, no C-reactive protein (CRP) within 24 hours of admission, sickle cell disease, an immunocompromised state, or chronic osteomyelitis. RESULTS: A total of 120 patients were analyzed in this study. There was marked variability in pathologies. Patients with isolated osteomyelitis or osteomyelitis+septic arthritis were older, had an increased admission CRP, were more likely to be infected with Staphylococcus aureus, required an increased duration of antibiotics, and had an increased incidence of musculoskeletal complications than patients with isolated septic arthritis. CONCLUSIONS: When considering a child with an irritable knee, a heterogeneity of potential underlying pathologies and combinations of pathologies are possible. Importantly, the age of the patient and CRP can guide a clinician when considering further workup. Older patients with a higher admission CRP value warrant an immediate magnetic resonance imaging, as they are likely to have osteomyelitis, which was associated with worse outcomes when compared with patients with isolated septic arthritis. LEVEL OF EVIDENCE: Level III-retrospective research study.


Asunto(s)
Artritis Infecciosa , Articulación de la Rodilla/diagnóstico por imagen , Osteomielitis , Staphylococcus aureus/aislamiento & purificación , Adolescente , Factores de Edad , Antibacterianos/uso terapéutico , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/microbiología , Artritis Infecciosa/terapia , Niño , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Imagen por Resonancia Magnética/métodos , Masculino , Osteomielitis/diagnóstico , Osteomielitis/microbiología , Osteomielitis/terapia , Estudios Retrospectivos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/terapia , Estados Unidos/epidemiología
19.
BMC Infect Dis ; 20(1): 399, 2020 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-32503446

RESUMEN

BACKGROUND: Disseminated cryptococcosis is a well-characterized complication in immunocompromised patients with cryptococcal pneumonia or meningitis; however, isolated cryptococcal osteomyelitis is a rare entity that occurs in approximately 5% of patients with cryptococcosis. Cryptococcal osteomyelitis in the head and neck region is extremely rare. To the best of our knowledge, no cases of cryptococcal osteomyelitis affecting only the zygomatic bone have been reported to date. CASE PRESENTATION: A 78-year-old man without other comorbidities presented with progressive swelling of the right cheek along with pain and trismus. Clinical examination revealed a tender swelling in the right zygomatic region; the maximal mandibular opening was about 2 cm. Laboratory data showed mildly elevated inflammatory indices (C-reactive protein: 0.45 mg/dL; erythrocyte sedimentation rate: 35 mm/h). Computed tomography showed a 30-mm-diameter lesion at the right zygomatic arch. A part of the lesion has extended to the subcutaneous area of the cheeks with signs of bone destruction and surrounding contrast effects. Histopathological examination of fine-needle aspirate and needle biopsy showed cryptococcus. Furthermore, culture of the aspirate showed growth of Cryptococcus neoformans. No evidence of any other site involvement was observed. Therefore, the patient was diagnosed with isolated cryptococcal osteomyelitis and was initiated on fluconazole therapy. The treatment was effective, and all symptoms were resolved in 4 weeks. Fluconazole therapy was stopped after 6 months. There are no signs of recurrence as of 15-month follow-up. The patient has no cosmetic abnormalities or sequelae. CONCLUSIONS: Fine-needle aspiration cytology, needle biopsy, and fungal culture were useful for definitive diagnosis. Immunocompetent patients with isolated osteomyelitis may be cured with oral fluconazole alone.


Asunto(s)
Cryptococcus neoformans/aislamiento & purificación , Osteomielitis/diagnóstico , Anciano , Antifúngicos/uso terapéutico , Biopsia con Aguja Fina , Fluconazol/uso terapéutico , Humanos , Huésped Inmunocomprometido , Masculino , Osteomielitis/tratamiento farmacológico , Osteomielitis/microbiología , Tomografía Computarizada por Rayos X , Cigoma/diagnóstico por imagen , Cigoma/patología
20.
J Infect Chemother ; 26(8): 843-846, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32402735

RESUMEN

Mycobacterium chelonae is a rapidly growing mycobacterium that has the potential to cause refractory infections in humans. Mycobacteremia resulting from the organism is extremely rare, and its clinical features are yet to be uncovered. We herein present a case of M. chelonae bloodstream infection involving an immunocompromised older patient. A 79-year-old woman, on a long-term treatment with prednisolone plus tacrolimus for rheumatoid arthritis, visited our outpatient department complaining of deteriorating pain and swelling at her right 1st toe. Laboratory parameters showed elevated C-reactive protein and leukocytosis, and magnetic resonance imaging indicated osteomyelitis at the proximal phalanx of her right 1st toe. Considering the refractory course, the infected toe was immediately amputated. M. chelonae was isolated from bacterial cultures of the resected tissue and blood (BD BACTEC™ FX blood culture system, Becton Dickinson, Sparks, MD, USA), leading to a diagnosis of disseminated M. chelonae infection. We treated the patient with an antibiotic combination of clarithromycin, minocycline, and imipenem (2 weeks), which was converted to oral therapy of clarithromycin, doxycycline, and levofloxacin. This case highlighted the potential pathogenesis of M. chelonae to cause mycobacteremia in an immunocompromised patient.


Asunto(s)
Bacteriemia/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Mycobacterium chelonae/aislamiento & purificación , Osteomielitis/diagnóstico , Dedos del Pie/patología , Anciano , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/etiología , Quimioterapia Combinada , Femenino , Humanos , Huésped Inmunocomprometido , Imagen por Resonancia Magnética , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/etiología , Osteomielitis/complicaciones , Osteomielitis/tratamiento farmacológico , Osteomielitis/microbiología , Dedos del Pie/diagnóstico por imagen , Resultado del Tratamiento
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