Human Infections by Wohlfahrtiimonas chitiniclastica: A Mini-Review and the First Report of a Burn Wound Infection after Accidental Myiasis in Central Europe.

Wohlfahrtiimonas chitiniclastica are bacteria that cause rare infections, typically associated with the infestation of an open wound with fly larvae. Here, we present a unique case report of the first W. chitiniclastica isolation from a burn wound with accidental myiasis in a 63-year-old homeless man and a literature review focused on human infections caused by these bacteria. So far, 23 cases of infection with W. chitiniclastica have been reported; in 52% of these, larvae were found in the wound area. Most of these cases suffered from chronic non-healing wound infections but none of these were burn injuries. The overall fatality rate associated directly with W. chitiniclastica in these cases was 17%. Infections with parasitic larvae occur in moderate climates (especially in people living in poor conditions); therefore, an infection with rare bacteria associated with accidental myiasis, such as W. chitiniclastica, can be expected to become more common there. Thus, in view of the absence of recommendations regarding the treatment of patients with accidental myiasis and, therefore, the risk of infection with W. chitiniclastica or other rare pathogens, we provide a list of recommendations for the treatment of such patients. The importance of meticulous microbial surveillance using molecular biological methods to facilitate the detection of rare pathogens is emphasized.

Impact of Antibiotics Associated with the Development of Toxic Epidermal Necrolysis on Early and Late-Onset Infectious Complications.

Toxic epidermal necrolysis (TEN) is a rare disease, which predominantly manifests as damage to the skin and mucosa. Antibiotics count among the most common triggers of this hypersensitive reaction. Patients with TEN are highly susceptible to infectious complications due to the loss of protective barriers and immunosuppressant therapy. The aim of this study was to investigate the potential relationship between antibiotics used before the development of TEN and early and late-onset infectious complications in TEN patients. In this European multicentric retrospective study (Central European Lyell syndrome: therapeutic evaluation (CELESTE)), records showed that 18 patients with TEN used antibiotics (mostly aminopenicillins) before the disease development (group 1), while in 21 patients, TEN was triggered by another factor (group 2). The incidence of late-onset infectious complications (5 or more days after the transfer to the hospital) caused by Gram-positive bacteria (especially by Enterococcus faecalis/faecium) was significantly higher in group 1 than in group 2 (82.4% vs. 35.0%, p = 0.007/p corr = 0.014) while no statistically significant difference was observed between groups of patients with infection caused by Gram-negative bacteria, yeasts, and filamentous fungi (p > 0.05). Patients with post-antibiotic development of TEN are critically predisposed to late-onset infectious complications caused by Gram-positive bacteria, which may result from the dissemination of these bacteria from the primary focus.

The first isolation of Westerdykella dispersa in a critically burned patient.

Patients with critical thermal trauma belong to one of the most high-risk groups for development of infectious complications. Fungal infections are not among frequent complications during therapy of patients with thermal trauma, yet their incidence dramatically aggravates the prognosis for patients with this disorder. In the case report, we present the case of a young man with a critical burn, where Westerdykella dispersa was isolated. Identification of the pathogen was provided with a combination of cultivation and molecular biological confirmation. In this case, the distinction between infection and colonization was very complicated. Histopathological examination for definitive diagnosis of infection was not performed because the material from unburned soft tissue sampling could further compromise the function of the hand. Repeated cultivation and molecular identification W. dispersa before and after the necrectomy is indicative of infection rather than colonization. It is the second documented case of positive cultivation with this pathogen in humans and the first such case in a non-neutropenic host.

Myofascial-manual lymphatic drainage for burn trauma: a service evaluation.

Improving microcirculation in the area of a wound is an important aspect of wound healing. It can be improved by a new manual methodology: myofascial-manual lymphatic drainage (M-MLD). This hybrid technique uses elements of musculoskeletal medicine and manual lymphatic drainage. Through palpation, M-MLD therapeutically affects the functional pathology of soft tissues, with reflection in trigger points, and also the functional pathology of lymphatic system, namely by lymphostasis in particular regional lymph nodes. Most cases of post-traumatic and postoperative conditions lead to dynamic insufficiency of the venous system and subsequently of the lymphatic system. If this is not treated promptly, it can lead to secondary post-traumatic lymphoedema. Early M-MLD treatment eliminates the development of secondary post traumatic lymphoedema and even secondary inflammation, thus decreasing the risk of cicatrix hypertrophy and contributing to faster wound healing and better regeneration of the afflicted area. Laboratory immunological examination of circulating immune complexes support 20 years of the authors' empirical experience. The level of circulating immune complexes before M-MLD reached constant values. After manual influencing of the functional pathology of soft tissue and lymphatic system, the dynamics of circulating immune complexes levels was observed, this is the effect of the improvement of microcirculation in the wound area. M-MLD is time- and cost-saving, but it requires professional training with a very good palpation technique. In the authors' experience, its use is indicated within 2-24 hours from the time of trauma (surgery), and then once a day until healing is achieved. This early manual therapeutic treatment can be delivered not only by physiotherapists, but also nurses working to encourage wound healing, such as in traumatology, surgery and orthopaedics. Using M-MLD makes the total treatment time shorter, and has an economical, biopsychosocial and society-wide impact.

Staphylococcal scalded skin syndrome in the Czech Republic: an epidemiological study.

OBJECTIVE: To identify the basic epidemiological characteristics of children hospitalized with diagnosis of Staphylococcal scalded skin syndrome in the Czech Republic in the years 1994-2009. INTRODUCTION: Staphylococcal scalded skin syndrome (SSSS) is a relatively rare disease in childhood. This syndrome was first defined in 1878 by Baron Gottfried Ritter von Rittershainem and belongs to the group of diseases called Burn-like syndromes. It is a bullous skin disease caused by exfoliative toxins which are produced by certain types of Staphyloccocus aureus. Typical structures affected by these toxins are desmosome proteins called Desmoglein-1 located in the stratum granulosum of epidermis. Unlike in Lyell's syndrome or Stevens-Johnson's syndrome, the exfoliation is caused by loss of adhesivity particularly in the stratum granulosum and not by induction of apoptosis in the dermo-epidermal junction. MATERIAL AND METHODS: This retrospective study was conducted on patients hospitalized in the Czech Republic in the period from 1.1.1994 to 31.12.2009. The basic condition for the inclusion in the retrospective study was age under 1 year and hospitalization due to SSSS. A total of 399 children (177 girls) fulfilled the criteria for inclusion into the study. Information was obtained from a central data depository, the Department of Health Information and Statistics, Czech Republic. RESULTS: A total of 399 children under 1 year were hospitalized for the diagnosis of SSSS in the study period. The group included 177 girls and 222 boys. M:F ratio was 1.25:1. The average incidence of SSSS in the Czech Republic was 25.11 cases per 100,000 children under 1 year of age. The highest recorded incidence in the followed period was in 1994, when a total of 57 cases of SSSS was reported, namely 53.47 per 100,000 children. By contrast, in 2003, there were reported only 12 cases and the incidence of 12.81 per 100,000 children. The average length of hospitalization was 6.39 days. In 1995, the highest average length of hospitalization was reported, which was 8.1 days, and then in 2007, the lowest average length of hospitalization, 4.4 days. There was no significant difference in the length of hospitalization in boys and girls. None of the 399 children in the population died. CONCLUSION: In our retrospective study, we established basic epidemiological characteristics of a group of children aged under 1 year with diagnosis of SSSS. As epidemiological data show, the occurrence of this syndrome is not sporadic, but steady.

Resorption and elimination kinetics of benzoic acid during chemical necrectomy in deep burns.

OBJECTIVE: Chemical necrectomy is an alternative to the surgical or sharp necrectomy for the removal of necrotic parts of the skin in the treatment of deep burns. The aim of our work was to monitor the dynamics of resorption and elimination of benzoic acid applied to the burnt skin. METHODS: The set consisted of 10 patients (9 men; 1 woman) aged 25-57 years with IIb-III-degree skin burns. 40% benzoic acid in white petrolatum was applied to the burnt area to the extent of 3-5% of TBSA (total body surface area) for a period of 48 hours. The concentrations of benzoic acid, hippuric acid, and glycine in the serum was monitored at the 10th, 20th, 60th, 120th, 240 th and 360 th minute thereafter and further at the 12th, 24th, 48th, and 72nd hour; the excretion of hippuric acid in urine was monitored in six 12-hour intervals. RESULTS: The highest concentration of benzoic acid in the serum was detected in the 60th minute sample (0.094+/-0.074 mmol/L) and of hippuric acid in the 120th minute sample (0.234+/-0.088 mmol/L) from the application of benzoic acid to the burnt skin. In the period between the 6th and 48th hour, the average concentration of benzoic acid in the serum ranged between 0.042 and 0.03 mmol/L. In this period there was also a significant decrease in serum glycine concentration (p<0.05). During the 48-hour application of benzoic acid to the burnt skin, 46.0-145 mmol of hippuric acid was excreted in urine. CONCLUSION: Chemical necrectomy with the use of 40% benzoic acid led only to a moderate increase of its concentration in the serum. After its resorption from the wound area it is transformed to hippuric acid, which is promptly excreted in urine.