RESUMO
Rat bite fever is a systemic illness most commonly caused by Streptobacillus moniliformis that is classically characterized by fever, rash and migratory polyarthritis. Here, we highlight the highly variable clinical presentations of rat bite fever in children and the importance of maintaining a high degree of suspicion so appropriate treatment can be promptly initiated.
Assuntos
Gerenciamento Clínico , Febre por Mordedura de Rato/diagnóstico , Streptobacillus/patogenicidade , Adolescente , Animais , Artrite Infecciosa/microbiologia , Criança , Pré-Escolar , Exantema/microbiologia , Feminino , Febre/microbiologia , Humanos , Lactente , Recém-Nascido , Masculino , Febre por Mordedura de Rato/complicações , Febre por Mordedura de Rato/microbiologia , Ratos , Estudos RetrospectivosAssuntos
Exantema/etiologia , Mucosite/etiologia , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/complicações , Adulto , Conjuntivite Bacteriana/etiologia , Conjuntivite Bacteriana/microbiologia , Conjuntivite Bacteriana/patologia , Exantema/microbiologia , Exantema/patologia , Humanos , Masculino , Boca/patologia , Mucosite/microbiologia , Mucosite/patologia , Pneumonia por Mycoplasma/patologia , Pele/patologiaRESUMO
BACKGROUND: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection is associated with various complications. PMA (primary meningococcal arthritis) is a rare meningococcus-associated disease causing arthritis of the knee usually, without any signs of invasive meningococcal disease. No case of PMA in a COVID-19 (coronavirus disease, 2019) patient has yet been described. PMA mainly strikes young adults. PMA is not associated with any immunocompromising condition. It has a better outcome than usual septic arthritis CASE PRESENTATION: Herein, we report an 18-year-old man diagnosed with COVID-19, later admitted with persistent fever, right knee arthralgia and maculopapular rash. Due to family history, psoriasis and Henoch-Schönlein purpura were hypothesized and ruled out. Finally, synovial fluid culture confirmed Neisseria meningitidis serogroup B arthritis without any other symptoms of invasive meningococcal disease. Healing was achieved quickly with surgery and antibiotics. We concluded in a PMA. CONCLUSION: We describe here the first primary meningococcal arthritis in a COVID-19 patient and we hope to shine a light on this rare but serious complication.
Assuntos
Artrite Infecciosa/diagnóstico , COVID-19/complicações , Infecções Meningocócicas/diagnóstico , Adolescente , Antibacterianos , Artrite Infecciosa/microbiologia , Exantema/microbiologia , Humanos , Articulação do Joelho/microbiologia , Masculino , Neisseria meningitidis Sorogrupo B/isolamento & purificação , Líquido Sinovial/microbiologiaRESUMO
Syphilis is known as the great imitator with various clinical presentations which often lead to confusion and misdiagnosis. A 28-year-old male presented with non-pruritic and painless erythematous patches around the anus and scrotum. Initial differential diagnosis with tinea cruris. Fungal examination was negative. Serological tests for syphilis were positive and anti-HIV screening was reactive. A diagnosis of secondary syphilis was established and the patient was given intramuscular injection of 2.4 million unit of benzathine penicillin. The skin lesions improved significantly 1 week after treatment, confirming a diagnosis of secondary syphilis with HIV. Annular skin lesions in secondary syphilis are uncommon and often misleading. This case emphasizes the importance of considering secondary syphilis in the differential diagnosis of annular lesions.
Assuntos
Antibacterianos/administração & dosagem , Penicilina G Benzatina/administração & dosagem , Sífilis/diagnóstico , Tinea Cruris/diagnóstico , Adulto , Diagnóstico Diferencial , Exantema/diagnóstico , Exantema/microbiologia , Infecções por HIV/complicações , Humanos , Injeções Intramusculares , Masculino , Dermatopatias/diagnóstico , Dermatopatias/microbiologia , Sífilis/tratamento farmacológicoRESUMO
Mycoplasma pneumoniae-induced rash and mucositis is the most accurate diagnosis for patients with blistering mucocutaneous disease provoked by an infection. Recent literature suggests expansion of the name is required, as other infections have caused a clinically similar presentation. This review provides a concise update on current understanding of M. pneumoniae-induced rash and mucositis and other reactive infectious mucocutaneous eruptions.
Assuntos
Exantema/microbiologia , Mucosite/microbiologia , Infecções por Mycoplasma/diagnóstico , Mycoplasma pneumoniae , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Exantema/diagnóstico , Humanos , Incidência , Mucosite/diagnóstico , Infecções por Mycoplasma/classificação , Infecções por Mycoplasma/tratamento farmacológico , Infecções por Mycoplasma/epidemiologia , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/microbiologia , Terminologia como AssuntoRESUMO
PURPOSE: To evaluate the natural history and ophthalmologic morbidity of Mycoplasma pneumoniae-induced rash and mucositis (MIRM) and propose a treatment algorithm. DESIGN: Retrospective, interventional case series. METHODS: Retrospective chart review of all MIRM patients examined by the department of ophthalmology at a tertiary children's hospital. Diagnosis was established clinically concomitant with either positive Mycoplasma pneumoniae IgM or PCR testing from January 1, 2010, until December 31, 2019. The main outcome measures were best-corrected visual acuity, long-term ocular sequelae, and duration and type of ophthalmic intervention. RESULTS: There were 15 patients (10 male and 5 female) aged 10.9 ± 4.2 years who had primary episodes of MIRM; of those, 4 had multiple episodes. All patients required topical steroid treatment, 3 required amniotic membrane transplantation, and 1 patient underwent placement of a sutureless biologic corneal badage device. There were no patients who suffered visual loss, but 1 was left with mild symblephara near the lateral canthus in each eye and 2 others had scarring of the eyelid margins and blepharitis. CONCLUSIONS: The ocular morbidity is significantly less in MIRM than in other closely related syndromes such as erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. However, these patients still require close observation and a low threshold for intervention to avoid permanent ophthalmic sequelae and possible blindness.
Assuntos
Âmnio/transplante , Exantema/microbiologia , Infecções Oculares Bacterianas/microbiologia , Doenças Palpebrais/microbiologia , Glucocorticoides/uso terapêutico , Mucosite/microbiologia , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/microbiologia , Adolescente , Criança , DNA Bacteriano/genética , Exantema/diagnóstico , Exantema/terapia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/terapia , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/terapia , Feminino , Seguimentos , Humanos , Imunoglobulina M/sangue , Masculino , Mucosite/diagnóstico , Mucosite/terapia , Mycoplasma pneumoniae/genética , Mycoplasma pneumoniae/imunologia , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/terapia , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Acuidade Visual/fisiologiaRESUMO
El parvovirus B19 generalmente infecta a niños y adultos jóvenes, presentando cuadros exantemáticos característicos, como el eritema infeccioso. Dentro de las manifestaciones hemorrágicas con erupción purpúrica-petequial, está el síndrome papular-purpúrico en guantes y calcetines. En ocasiones, distribuciones atípicas con erupciones petequiales asimétricas podrían complicar el diagnóstico, llevando a plantear diagnósticos diferenciales y a realizar pruebas de laboratorio. Se describe un caso inusual de parvovirus B19 con erupción petequial atípica, y se hace una revisión de la literatura médica reciente
Parvovirus B19 generally infects children and young adults, presenting characteristic rashes such as erythema infectiosum. Among the hemorrhagic manifestations with purpuric-petechial eruption is the papular purpuric socks and gloves syndrome. Occasionally, atypical distributions with asymmetric petechial rashes could complicate the diagnosis leading to differential diagnoses and laboratory tests. We describe an unusual case of parvovirus B19 with atypical petechial rash, and a recent literature review is reported
Assuntos
Humanos , Masculino , Adolescente , Púrpura/microbiologia , Parvovirus B19 Humano/isolamento & purificação , Infecções por Parvoviridae/diagnóstico , Dermatopatias Infecciosas/microbiologia , Diagnóstico Diferencial , Parvovirus B19 Humano/patogenicidade , Exantema/microbiologia , Trombocitopenia/diagnósticoAssuntos
Tosse/microbiologia , Exantema/microbiologia , Exantema/patologia , Febre/microbiologia , Mucosite/microbiologia , Mucosite/patologia , Pneumonia por Mycoplasma/complicações , Corticosteroides/uso terapêutico , Adulto , Antibacterianos/uso terapêutico , Exantema/complicações , Exantema/tratamento farmacológico , Feminino , Humanos , Levofloxacino/uso terapêutico , Mucosite/complicações , Mucosite/tratamento farmacológico , Dor/etiologia , Pneumonia por Mycoplasma/tratamento farmacológicoAssuntos
Exantema/etiologia , Rickettsia , Rickettsiose do Grupo da Febre Maculosa/microbiologia , Idoso , Varicela/diagnóstico , Diagnóstico Diferencial , Exantema/microbiologia , Feminino , Humanos , Pele/patologia , Rickettsiose do Grupo da Febre Maculosa/diagnóstico , Rickettsiose do Grupo da Febre Maculosa/patologiaRESUMO
A rash is a disseminated eruption of cutaneous lesions with great variation in appearance, cause, and severity. When the physician is facing a rash, the history and physical examination of the patient are extremely important for the identification of the disease and its causal agent. There are various causes for a rash, which may be infectious, allergic, or rheumatologic, besides many others. Rashes associated with mucosal ulcers may have causes related to viral and bacterial infections or drug reactions. They may be associated with measles; erythema infectiosum; roseola infantum; rubella; hand, foot, and mouth disease; pityriasis rosea; dengue fever; chikungunya; zika; scarlet fever; meningococcal diseases; syphilis; and exanthematous drug eruptions.
Assuntos
Infecções Bacterianas/complicações , Exantema/etiologia , Exantema/microbiologia , Mucosa/patologia , Úlcera/etiologia , Úlcera/microbiologia , Viroses/complicações , Infecções Bacterianas/patologia , Exantema/patologia , Humanos , Úlcera/patologia , Viroses/patologiaRESUMO
A 32-year-old man was referred to our clinic for evaluation of abnormal liver function tests and concurrent proteinuria. Physical examination revealed a maculopapular rash, involving the trunk and palms, and multiple 'moth-eaten' patches of alopecia. After a prolonged diagnostic work-up a hepatitis with concomitant nephrotic syndrome due to secondary syphilis was diagnosed. Treatment with benzylpenicillin led to complete clinical recovery. Syphilis is a re-emerging infectious disease with heterogeneous clinical presentation that should be considered in the differential diagnosis of inexplicable simultaneous liver and kidney dysfunction in patients with high-risk sexual behaviour.Syphilis is a re-emerging infectious disease with heterogeneous clinical presentation that should be considered in the differential diagnosis of inexplicable simultaneous liver and kidney dysfunction in patients with high-risk sexual behaviour.
Assuntos
Hepatite/diagnóstico , Síndrome Nefrótica/diagnóstico , Penicilina G/uso terapêutico , Sífilis/complicações , Adulto , Alopecia/microbiologia , Exantema/microbiologia , Hepatite/microbiologia , Humanos , Masculino , Síndrome Nefrótica/microbiologia , Proteinúria/microbiologiaAssuntos
Conjuntivite/microbiologia , Exantema/microbiologia , Doenças dos Genitais Masculinos/microbiologia , Infecções por Mycoplasma/diagnóstico , Mycoplasma pneumoniae , Estomatite/microbiologia , Adolescente , Conjuntivite/patologia , Farmacorresistência Bacteriana , Febre/etiologia , Humanos , Masculino , Mucosa Bucal/microbiologia , Mucosa Bucal/patologia , Infecções por Mycoplasma/complicações , Infecções por Mycoplasma/tratamento farmacológico , Mycoplasma pneumoniae/efeitos dos fármacos , Estomatite/patologiaAssuntos
Coinfecção/diagnóstico , Exantema/microbiologia , Infecções por HIV/diagnóstico , Sífilis/diagnóstico , Antibacterianos/uso terapêutico , Antirretrovirais/uso terapêutico , Biópsia , Coinfecção/sangue , Coinfecção/complicações , Coinfecção/tratamento farmacológico , Quimioterapia Combinada/métodos , Exantema/sangue , Exantema/tratamento farmacológico , Exantema/patologia , Pé , Testa , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/microbiologia , Mucosa Bucal/patologia , Pele/microbiologia , Pele/patologia , Sífilis/sangue , Sífilis/complicações , Sífilis/microbiologia , Sorodiagnóstico da Sífilis , Resultado do Tratamento , Treponema pallidum/imunologia , Treponema pallidum/isolamento & purificaçãoRESUMO
Papulopustular rash, an acneiform rash, appears on the seborrheic region during the first to second week of treatment with an epidermal growth factor receptor inhibitor (EGFRi). The rash gradually disappears after the fourth week; however, it persists or newly develops in other regions during EGFRi treatment. Because Staphylococcus aureus is frequently isolated from late-phase papulopustular rash, we assessed the incidence of bacterial infection and treatment outcomes of patients with late-phase papulopustular rash. Sixty-four cases treated with an EGFRi over 4 weeks who presented with papulopustular rash were assessed retrospectively. The median duration of EGFR inhibitor treatment was 5 months. Grade 2 and 3 papulopustular rash was observed in 47 and eight cases, respectively. Bacterial culture was performed in 51 cases, 50 of which yielded positive results: methicillin-sensitive S. aureus in 29, methicillin-resistant S. aureus in 14, Staphylococcus species in five, Pseudomonas aeruginosa in three, and other in four cases. Of the S. aureus isolates, 42% were resistant to minocycline and 40% to levofloxacin. After treatment with topical and/or oral antibiotics without topical corticosteroids, the papulopustular rash rapidly improved by an average of 2.9 ± 3.4 weeks. However, use of a combination of antibiotics and a topical corticosteroid prolonged the recovery period to an average of 18.9 ± 11.4 weeks. In conclusion, folliculitis that develops over 4 weeks after the initiation of EGFRi treatment is typically caused by staphylococcal infection. Bacterial culture is necessary due to the high rate of antibiotic resistance. It is important to distinguish late- from early-phase papulopustular rash and to treat using different approaches.
Assuntos
Antibacterianos/uso terapêutico , Antineoplásicos Imunológicos/efeitos adversos , Exantema/diagnóstico , Foliculite/diagnóstico , Infecções por Pseudomonas/diagnóstico , Infecções Estafilocócicas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Cetuximab/efeitos adversos , Farmacorresistência Bacteriana , Receptores ErbB/antagonistas & inibidores , Exantema/tratamento farmacológico , Exantema/imunologia , Exantema/microbiologia , Feminino , Foliculite/tratamento farmacológico , Foliculite/imunologia , Foliculite/microbiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/imunologia , Panitumumabe/efeitos adversos , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/imunologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/imunologia , Pseudomonas aeruginosa/isolamento & purificação , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/imunologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/imunologia , Staphylococcus aureus/isolamento & purificação , Fatores de TempoAssuntos
Exantema/microbiologia , Neutropenia Febril/microbiologia , Histoplasmose/microbiologia , Hiperpigmentação/microbiologia , Dermatopatias Vesiculobolhosas/microbiologia , Adulto , Antifúngicos/uso terapêutico , Exantema/diagnóstico , Exantema/tratamento farmacológico , Neutropenia Febril/diagnóstico , Neutropenia Febril/tratamento farmacológico , Histoplasmose/complicações , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Humanos , Hiperpigmentação/diagnóstico , Hiperpigmentação/tratamento farmacológico , Masculino , Dermatopatias Vesiculobolhosas/diagnóstico , Dermatopatias Vesiculobolhosas/tratamento farmacológico , Resultado do TratamentoRESUMO
Neonatal tick bites place infants at risk for acquiring infections that have rarely or never been documented in this age group. We describe 2 rare cases of tickborne infection in neonates. The first patient presented with multiple erythema migrans and fever, leading to a diagnosis of early disseminated Lyme disease. The second patient presented with irritability, fever, and worsening anemia due to babesiosis. Both infants had been bitten by arthropods fitting the description of ticks before the onset of symptoms. Our cases demonstrate the clinical course of 2 common tickborne infections occurring at an atypical age, opening the door to new, complex questions for which little guiding data exists. As tickborne infections become more prevalent, we expect other clinicians will be faced with similarly challenging neonatal cases. Providers must use past experience and a keen eye to identify neonates with tickborne infections and sort through their optimal diagnosis and management. In this article, we raise some of the questions we faced and discuss our conclusions.
Assuntos
Babesiose/diagnóstico , Eritema Migrans Crônico/diagnóstico , Parasitemia/diagnóstico , Animais , Antibacterianos/uso terapêutico , Antiprotozoários/uso terapêutico , Atovaquona/uso terapêutico , Azitromicina/uso terapêutico , Babesiose/tratamento farmacológico , Ceftriaxona/uso terapêutico , Eritema Migrans Crônico/tratamento farmacológico , Exantema/microbiologia , Feminino , Humanos , Recém-Nascido , Parasitemia/tratamento farmacológico , Picadas de Carrapatos/complicaçõesRESUMO
Despite concerns about infection risks of floating tanks, outbreaks have rarely been reported. In May 2017, an outbreak of skin rash occurred among visitors of a floating tank open for the public in Norway. We assessed the extent and cause of the outbreak and the risk factors for infection in a retrospective cohort study among the visitors of the floating tank using a standardized web-based questionnaire. An environmental investigation was conducted including microbiological analysis of the floating tank water. Of the 46 respondents to the questionnaire (61 distributed), 22 reported symptoms, most commonly palmar and plantar rash, swollen lymph nodes, ear canal pain and itching. None of the investigated risk factors, such as sex, age, duration of bathing or use of the shower after bathing, were significantly associated with illness. The results of the environmental investigation indicated that the water was heavily contaminated by P. aeruginosa and heterotrophic bacteria. The outbreak investigation highlights the need to ensure adequate hygienic operation of floating tanks. Awareness about responsibilities should be raised among the operators of floating tanks and relevant operational parameters for floating tanks should be made available for local health authorities.