Skin infections caused by community-acquired methicillin-resistant Staphylococcus aureus: clinical and microbiological characteristics of 11 cases.

INTRODUCTION: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen that causes skin and soft-tissue infections. OBJECTIVE: To describe the clinical characteristics of skin infections caused by CA-MRSA and correlations with the available demographic and microbiological data. MATERIAL AND METHODS: This was a descriptive study of patients with a microbiologically confirmed diagnosis of CA-MRSA infection treated in a dermatology department between June 2009 and December 2011. We recorded demographic details, the clinical characteristics of lesions, and the treatments used. RESULTS: We studied 11 patients (5 men and 6 women); 91% were under 40 years of age and had no relevant past medical history. The most common presentation was a skin abscess (with or without cellulitis). In all such cases, marked tissue necrosis and little or no purulent exudate was observed when the abscess was drained. Fifty percent of these abscesses had been treated previously with ß-lactam antibiotics, and in all cases the lesions resolved after surgical drainage, which was combined in 63% of cases with quinolones or cotrimoxazole. CONCLUSIONS: Today, skin infections due to CA-MRSA affect healthy young athletes who have no contact with healthcare settings. The most common presentation is a skin abscess characterized by marked tissue necrosis and little or no purulent exudate. In cases with these characteristics in susceptible patients, the involvement of CA-MRSA as the causative agent should be suspected. The abscesses should be drained whenever possible and, if necessary, antibiotic treatment should be prescribed; empirical use of ß-lactam antibiotics should be avoided.

Eritema nudoso leproso y reacción de reversión en 2 casos de lepra importada / Erythema Nodosum Leprosum and Reversal Reaction in 2 Cases of Imported Leprosy

Las leprorreacciones suponen cambios clínicos de inicio súbito en los pacientes que presentan formas inmunológicamente inestables de la enfermedad de Hansen. Estos cuadros pueden enmascarar los signos cardinales de la misma y demorar así su diagnóstico y tratamiento. Las principales complicaciones derivadas de este retraso son las relacionadas con la afectación neural, local (ulceraciones, piodermitis, osteomielitis, etc.) y/o sistémica característica de estos cuadros. Ante su sospecha debe realizarse un minucioso examen clínico, exploración de la sensibilidad y, cuando se precise, estudio histopatológico y microbiológico. La instauración inmediata de tratamiento antiinflamatorio disminuye el riesgo de secuelas funcionales, principal causa de morbilidad en la lepra. A continuación, se presentan 2 casos de leprorreacciones de tipo I y II en pacientes no diagnosticados hasta ese momento de enfermedad de Hansen (AU)

Leprosy reactions, which are abrupt changes in the clinical condition of patients with immunologically unstable forms of the disease, can mask the cardinal signs of leprosy, delaying both diagnosis and treatment. The main complications that arise from delayed diagnosis reflect the characteristic features of the disease, involving impaired nerve function and both local (ulcers, pyogenic infection, osteomyelitis) and systemic compromise. Thorough clinical examination, sensory testing, and, where necessary, histopathology and microbiology, are essential when leprosy is suspected. Rapid initiation of anti-inflammatory treatment reduces the risk of functional impairment, the main concern in leprosy. We describe type 1 and type 2 leprosy reactions in 2 patients who had not yet been diagnosed with the disease (AU)

Erythema nodosum leprosum and reversal reaction in 2 cases of imported leprosy.

Leprosy reactions, which are abrupt changes in the clinical condition of patients with immunologically unstable forms of the disease, can mask the cardinal signs of leprosy, delaying both diagnosis and treatment. The main complications that arise from delayed diagnosis reflect the characteristic features of the disease, involving impaired nerve function and both local (ulcers, pyogenic infection, osteomyelitis) and systemic compromise. Through clinical examination, sensory testing, and, where necessary, histopathology and microbiology, are essential when leprosy is suspected. Rapid initiation of anti-inflammatory treatment reduces the risk of functional impairment, the main concern in leprosy. We describe type 1 and type 2 leprosy reactions in 2 patients who had not yet been diagnosed with the disease.