Assuntos
Osteomielite/microbiologia , Abscesso do Psoas/microbiologia , Infecções por Salmonella/microbiologia , Salmonella enterica/isolamento & purificação , Adulto , Anemia Falciforme , Feminino , Humanos , Ílio , Osteomielite/diagnóstico , Osteomielite/terapia , Recidiva , Sacro , Infecções por Salmonella/complicações , Resultado do TratamentoRESUMO
We present a case of Fusarium osteomyelitis attributed to innocuous trauma in a patient with significant peripheral vascular disease and diabetes mellitus type 2. Fusarium species have been reported to cause an increasing number of infections, particularly in severely immunocompromized patients. Colonization of normal skin has also been reported. To the best of the author's knowledge, there are 5 cases of Fusarium osteomyelitis described in English-language literature. There is also a report with little detail of Fusarium infection involving bone in 3 patients with hematologic malignancy. We tabulated the pertinent facts of the 5 detailed cases and compared them to ours. Early diagnosis requires some suspicion of invasive fungal infection. Tissue culture and pathologic examination are necessary for definitive diagnosis and to distinguish infection from colonization. Therapy includes antifungal drugs and aggressive surgical debridement, and even when these modalities are readily implemented the outcome may not be optimal because of the angioinvasive character of the organism.
Assuntos
Fusarium/isolamento & purificação , Osteomielite/microbiologia , Idoso , Humanos , Masculino , Micoses/microbiologiaRESUMO
A case of Nocardia transvalensis osteomyelitis and cerebral abscesses is described. To the authors' knowledge, the patient described here represents the first reported case of primary N. transvalensis leg abscess with contiguous osteomyelitis of the femur and secondary brain abscesses. The literature on nocardial osteomyelitis and cerebral nocardiosis is reviewed, and treatment of both conditions is discussed. The interactions between the immune system and nocardial organisms are described, as well as the host defense defects in diabetic patients as they relate to pathogenicity of the bacteria. Finally, the patient's paradoxical therapeutic response of resolving brain abscesses with concomitant unresolving osteomyelitis is discussed, as well as its implications for managing similar cases in the future.