Severe Streptococcal Infection Following Cat Scratch.

INTRODUCTION: Cats can transmit bacterial infections to humans through biting and scratching. Streptococcal infections in wounds caused by cat bites or scratches rarely have been reported in the literature. CASE REPORT: The case of severe streptococcal skin infection after a 2-day-old cat scratch of the right arm, elbow, and forearm in a 68-year-old woman is presented herein. Group A ß-hemolytic streptococci (GABHS) was isolated from the wound of the patient as well as the oral cavity and claws of the cat; likewise, Escherichia coli also was isolated from the oral cavity and claws of the cat. She was successfully treated with intravenous tigecycline for 2 weeks at a starting dosage of 100 mg daily. Tetanus prophylaxis was performed. Complete remission was observed 3 weeks after beginning treatment. Follow-up visit at 32 months was negative for clinical manifestations. CONCLUSIONS: For the first time documented in the literature, GABHS were isolated from the wound of the patient and from the cat's oral cavity and claws.

[Necrotising fasciitis caused by Saksenaea vasiformis in an immunocompetent patient after a car accident]. / Fascitis necrotizante por Saksenaea vasiformis en una paciente inmunocompetente tras un accidente de tráfico.

BACKGROUND: Cutaneous mucormycosis (zygomycosis), with subcutaneous spreading and dissemination, in immunocompetent patients is an uncommon disease caused by species belonging to the fungal genera Apophysomyces, Rhizopus and Saksenaea, among others. CASE REPORT: A case of necrotising fasciitis by Saksenaea vasiformis in an immunocompetent woman is described. The infection was acquired through a car accident resulting in multiple injuries affecting mainly her right arm. After the surgical reduction of fractures, skin lesions worsened and led to necrosis. The patient quickly developed a severe necrotising fasciitis with negative cultures at first. Despite the extensive surgical debridement and the aggressive antifungal treatment, the patient died. The histopathological study showed a fungal infection due to a fungus belonging to the Mucorales order, which was confirmed by culturing the clinical sample on Sabouraud agar, and identifying the species by cultures on Czapek-Dox agar, and sequencing of the ITS region of the ribosomal DNA. CONCLUSIONS: This case confirm the presence of this fungus in Spain, the value of histopathology for the mucormycosis diagnosis, as well as the need to perform special cultures to facilitate their isolation and identification to the species level by the combined use of Czapek-Dox agar and sequencing of the ITS region.

Persistent erythematous plaque after minor trauma in an immunocompromised woman.

Scedosporium apiospermum is a ubiquitous soil fungus with a worldwide distribution. It can cause a wide range of clinical disease, from cutaneous and subcutaneous infections, to pneumonia, brain abscess, and life threatening systemic illness. The diagnosis of cutaneous disease is with biopsy and culture. We discuss the case of an elderly immunocompromised woman who presented with a persistent erythematous plaque on the elbow after minor trauma. A biopsy revealed Scedosporium apiospermum. Treatment usually requires surgical resection in conjunction with antifungal therapy.

Prevention of infections associated with combat-related extremity injuries.

During combat operations, extremities continue to be the most common sites of injury with associated high rates of infectious complications. Overall, ∼ 15% of patients with extremity injuries develop osteomyelitis, and ∼ 17% of those infections relapse or recur. The bacteria infecting these wounds have included multidrug-resistant bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, extended-spectrum ß-lactamase-producing Klebsiella species and Escherichia coli, and methicillin-resistant Staphylococcus aureus. The goals of extremity injury care are to prevent infection, promote fracture healing, and restore function. In this review, we use a systematic assessment of military and civilian extremity trauma data to provide evidence-based recommendations for the varying management strategies to care for combat-related extremity injuries to decrease infection rates. We emphasize postinjury antimicrobial therapy, debridement and irrigation, and surgical wound management including addressing ongoing areas of controversy and needed research. In addition, we address adjuvants that are increasingly being examined, including local antimicrobial therapy, flap closure, oxygen therapy, negative pressure wound therapy, and wound effluent characterization. This evidence-based medicine review was produced to support the Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update contained in this supplement of Journal of Trauma.

The microbiology and risk of infection following open, agricultural upper extremity injuries.

PURPOSE: This study was designed to determine the microbiology and risk of infection following open, agricultural, upper extremity injuries. Specifically, we sought to evaluate the microbiology of the wounds at the time of initial treatment and the development of any subsequent infections, determine whether the development of subsequent infection was related to injury severity, and clarify whether the microorganisms isolated at the time of initial treatment and development of subsequent infection were susceptible to the initial antibiotic prophylaxis. METHODS: A retrospective chart review of 214 patients was conducted. RESULTS: The initial injuries were classified into 1 of 3 groups, with 1 being the least severe and 3 being the most severe. Twenty-six were type 1 injuries, 94 type 2, and 94 type 3 injuries. Forty patients developed infection following the injury. Seventeen had superficial wound infection, 16 had deep soft tissue infections, and 7 developed osteomyelitis. Six went on to an amputation due to infection. Fifteen of the infections were polymicrobial. The number of patients who developed infection in the first 6 months following injury was 2, 14, and 24 for type 1, 2, and 3 injuries respectively (p=.07). CONCLUSIONS: Empiric antimicrobial regimens for the management of infection requiring surgical debridement following open upper extremity agricultural injury should be active against staphylococci, aerobic gram-negative bacilli, and anaerobes, but not necessarily against fungi. These antibiotics ideally should be administered on initial presentation of the patient to the emergency department. Prospective studies with emphasis on timely acquisition of cultures and sensitivities are needed to determine optimal prophylactic antimicrobial therapy for these injuries and directed antibiotic regimens for the infections that may develop. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

[The wound microflora of patients with gunshot injuries to the extremities during a mass hospitalization]. / Mikroflora ran bol'nykh v usloviiakh ikh massovogo postupleniia v statsionar s ognestrel'nymi povrezhdeniiami konechnostei.

The dynamic study of the microflora of bullet wounds in 32 patients was carried out. In cases of mass hospitalization coccal microflora (staphylococci and streptococci) was mainly isolated from wounds, at the period of treatment hospital infections with enterobacteria, Pseudomonas and Enterococcus occurred. Before cleaning the wound a decrease in the contamination rate for all microbial species was observed. As the disease progressed an increase in the amount of antibiotic-resistant bacterial strains was registered. The results of sanitary microbiological investigations made in the wards where the wounded patients were treated correspond to the structure of the causative agents of purulent processes in patients.

[Toxic shock syndrome caused by Streptococcus pyogenes]. / Toxisches Schocksyndrom hervorgerufen durch Streptococcus pyogenes.

Necrotizing fasciitis and myositis due to Lancefield group A beta-haemolytic streptococcal infection is a medical emergency. Survival depends on aggressive early wound management as well as high-dose intravenous antibiotics. We report about a 28-year-old man with fulminant necrotizing fasciitis and myositis of his right arm, in whom many features of the toxic shock syndrome were present, including profound hypotension and renal failure. After extensive surgical debridement with amputation of his arm in combination with high-dose intravenous penicillin G the patient recovered from this serious infection.

[The dynamics of the wound microflora in the victims of the earthquake in Armenia]. / Dinamika mikroflory ran postradavshikh pri zemletriasenii v Armenii.

The data on the composition of wound microflora, as well as changes in the contamination index over the course of treatment of patients with the syndrome of prolonged compression, who were brought to the institute after the earthquake in Armenia, are presented. The authors characterize the structure of the causative agents of wound infection in the patients treated at the traumatological department of the institute over several years. The epidemiological situation in the hospital in the period when the earthquake victims were treated there is analyzed.

[Experimental substantiation of using gentacycol for prevention of wound infection in gunshot bone fractures of the extremities]. / Eksperimental'noe obosnovanie primeneniia gentatsikola dlia profilaktiki ranevoi infektsii pri ognestrel'nykh perelomakh kostei konechnoste'i.

There have been experimentally studied the antibacterial properties of the preparation "gentacycol" developed in the research institute of antibiotics. Its effective agent is gentamycin and as the matrix of a carrier modified collagen is used. It is indicated that in vitro and at implantation in preliminary infected ordinary and gunshot osseous wounds in rabbits and dogs gentacycol inhibits the growth of aerobic and, that is especially important, anaerobic microflora, limits the development of inflammatory Process and stimulates, to a certain extent, reparative osteogenesis. The obtained data allows to recommend gentacycol application for prophylaxis of wound infection in treatment of gunshot limb bone injuries.