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1.
BMC Infect Dis ; 20(1): 770, 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33076815

RESUMO

BACKGROUND: Orbital mucormycosis is a rare but potentially severe and troublesome invasive fungal infection that could be occurred even in healthy individuals. The initial clinical presentation is similar to bacterial pre-septal or septal cellulitis, especially in early stages. CASE PRESENTATION: Herein, we describe the successful management of a series of five cases presenting with orbital mucormycosis in previously healthy children. CONCLUSIONS: Orbital mucormycosis is extremely rare in healthy children and maybe life-threatening when diagnosis delayed given a similar clinical presentation with bacterial septal cellulitis. Intravenous antifungal therapy with amphotericin B and timely surgical drainage is live-saving.


Assuntos
Mucormicose , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/tratamento farmacológico , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Mucormicose/etiologia , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/etiologia , Fatores de Risco
2.
S D Med ; 73(7): 318-322, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32805782

RESUMO

Cellulitis is an infection of the dermis and subcutaneous layers of the skin. One challenge in treating the disease is that it is often difficult to identify the causative agent; although ß-hemolytic Streptococci and Staphylococcus aureus are the most common causes. In addition, patients who recover from the disease are susceptible to recurrent infections. Here, we briefly review cellulitis and describe a patient's 24-year struggle with recurrent streptococcal cellulitis noting how the patient was negatively affected by changes in care.


Assuntos
Celulite (Flegmão) , Infecções Estreptocócicas , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/microbiologia , Humanos , Pele , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus
4.
Georgian Med News ; (299): 7-12, 2020 Feb.
Artigo em Russo | MEDLINE | ID: mdl-32242836

RESUMO

The aim of the study - to identify the causes and develop methods of treatment and prevention of septic phlegmons of the lower extremities after combined phlebectomy. The article presents the experience of treating 6 patients between the ages of 21 and 69 years with severe pyo-inflammatory complications (septic phlegmons) of the lower extremities after combined phlebectomy between 2012 and 2019. All patients had signs of a expressed systemic inflammatory response (SIRS3 and SIRS4) when they received admission. Against the background of intensive detoxification therapy in intensive care department, all patients were operated on emergency indications. Under anesthesia, they were performed an opening the subcutaneous phlegmons of the lower extremities using wide stripes incisions. Comprehensive therapy included the prescribing of antibiotics, anti-inflammatory drugs, stage necrectomy, the treatment of purulent wounds with various variants of surgical energy (plasma flows and NO-therapy) in various modes. The results of the treatment were estimated in the near and distant periods. Timely diagnosis, surgical treatment with the opening of purulent cavities with a wide excision of necrotized subcutaneous fat and fascia, as well as the subsequent plasmadynamic stage wound purification in therapeutic mode allowed in all cases to stop systemic inflammatory syndrome, to achieve rapid cleansing and healing of wounds. All patients were discharged for outpatient treatment. There were no fatalities. The long-term results of treatment were found to be satisfactory, and no patients were found to be disabled. The careful compliance to the main stages of the combined phlebectomy, especially the quality control of postoperative hemostasis, can minimize the development of septic complications. The comprehensive treatment with active surgical tactics and the use of air-plasma technologies allow to achieve a rapid cleansing of wounds and a speedy recovery of patients.


Assuntos
Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Celulite (Flegmão)/terapia , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto , Idoso , Celulite (Flegmão)/diagnóstico , Humanos , Extremidade Inferior , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Cicatrização , Adulto Jovem
6.
Chest ; 157(2): e41-e45, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32033660

RESUMO

CASE PRESENTATION: A 72-year-old man presented to our ED less than 24 hours following the acute onset of nausea, vomiting, and diarrhea. Within 12 hours of symptom onset, he noted bilateral lower extremity pain and swelling. His pain was associated with a new violaceous irregular rash on the anterior aspect of both feet and legs. There was no history of inciting trauma or recent wounds. In addition, there was no history of consumption of raw or undercooked food (including seafood) or recent change in food source. There was accompanying fever and chills for the same duration and painful swelling of his left thumb. His comorbidities included stage IIIb classical Hodgkin lymphoma diagnosed 4 months prior. His last dose of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy was 4 days before presentation. He had previously failed anti-CD30 monoclonal therapy resulting from attributed pancolitis.


Assuntos
Celulite (Flegmão)/diagnóstico , Gastroenterite/diagnóstico , Doença de Hodgkin/imunologia , Hospedeiro Imunocomprometido , Miosite/diagnóstico , Sepse/diagnóstico , Vibrioses/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Celulite (Flegmão)/imunologia , Celulite (Flegmão)/terapia , Desbridamento , Gastroenterite/imunologia , Gastroenterite/terapia , Doença de Hodgkin/complicações , Doença de Hodgkin/tratamento farmacológico , Humanos , Dermatoses da Perna , Masculino , Miosite/imunologia , Miosite/terapia , Músculo Quadríceps/diagnóstico por imagem , Sepse/imunologia , Sepse/terapia , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/imunologia , Infecções dos Tecidos Moles/terapia , Tomografia Computadorizada por Raios X , Vibrioses/imunologia , Vibrioses/terapia , Vibrio vulnificus
9.
PLoS One ; 15(1): e0227748, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978094

RESUMO

OBJECTIVES: The Laboratory Risk Indicator for Necrotizing Fasciitis score was developed as a clinical decision tool for distinguishing necrotizing fasciitis from other soft tissue infections. We prospectively evaluated the performance of the Laboratory Risk Indicator for Necrotizing Fasciitis score for the diagnosis of patients with necrotizing fasciitis in the extremities. METHODS: We conducted a prospective and observational cohort study of emergency department patients with necrotizing fasciitis or severe cellulitis in the extremities between April 2015 and December 2016. The Laboratory Risk Indicator for Necrotizing Fasciitis score was calculated for every enrolled patient. The sensitivity, specificity, positive predictive value, and negative predictive value of cut-off scores of 6 and 8 were evaluated. The accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis score was expressed as the area under the receiver operating characteristic curve. RESULTS: A total of 106 patients with necrotizing fasciitis and 825 patients with cellulitis were included. With an Laboratory Risk Indicator for Necrotizing Fasciitis cut-off score ≥6, the sensitivity was 43% (95% confidence interval 34% to 53%), specificity was 83% (95% confidence interval 80% to 86%), positive predictive value was 25% (95% confidence interval 20% to 30%), and negative predictive value was 92% (95% confidence interval 91% to 93%); with an Laboratory Risk Indicator for Necrotizing Fasciitis cut-off score ≥8, the sensitivity was 27% (95% confidence interval 19% to 37%), specificity was 93% (95% confidence interval 91% to 94%), positive predictive value was 33% (95% confidence interval 25% to 42%), and negative predictive value was 91% (95% confidence interval 90% to 92%). The area under the receiver operating characteristic curve for accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis score was 0.696 (95% CI 0.640 to 0.751). CONCLUSION: The Laboratory Risk Indicator for Necrotizing Fasciitis score may not be an accurate tool for necrotizing fasciitis risk stratification and differentiation between severe cellulitis and necrotizing fasciitis in the emergency department setting based on our study.


Assuntos
Celulite (Flegmão)/diagnóstico , Tomada de Decisão Clínica/métodos , Técnicas de Apoio para a Decisão , Fasciite Necrosante/diagnóstico , Infecções dos Tecidos Moles/diagnóstico , Idoso , Celulite (Flegmão)/sangue , Celulite (Flegmão)/mortalidade , Diagnóstico Diferencial , Fasciite Necrosante/sangue , Fasciite Necrosante/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Infecções dos Tecidos Moles/sangue , Infecções dos Tecidos Moles/mortalidade
11.
Isr Med Assoc J ; 12(21): 806-811, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31814344

RESUMO

BACKGROUND: Untreated dental caries or even dental manipulations, such as a tooth extraction, might cause direct spread of an odontogenic infection and consequently the development of life-threatening conditions such as deep neck infections (DNI). The most common source of DNI is of odontogenic origin (38.8-49%). Abscess formation or cellulitis can lead to life-threatening complications, despite new diagnostic imaging technology and widespread availability of antibiotics. OBJECTIVES: To demonstrate the dangers of DNI, which can create life-threatening situations. METHODS: Five cases of DNI of odontogenic origin, which were referred to the oral and maxillofacial surgery unit, are presented. RESULTS: Clinical manifestations included trismus, dysphagia, dysphonia, dyspnea, and infection symptoms. In all cases, computed tomography confirmed diagnosis and extent of abscess. Complications included mediastinitis, respiratory distress, osteomyelitis of the jaws, and in rare cases the mandibular condyle. Treatment included securing the airway, immediate surgical drainage, removal of the infection source, and antibiotic therapy. All patients were discharged in stable and improved condition. CONCLUSIONS: DNI treatment on an emergency basis requires proper diagnosis and effective management. To confirm diagnosis and prevent serious complications, it is essential for physicians to recognize the spaces of the head and neck that are likely to be affected by DNI.


Assuntos
Abscesso , Antibacterianos/administração & dosagem , Celulite (Flegmão) , Cárie Dentária/complicações , Drenagem/métodos , Pescoço , Procedimentos Cirúrgicos Bucais/métodos , Extração Dentária/efeitos adversos , Abscesso/diagnóstico , Abscesso/etiologia , Abscesso/fisiopatologia , Abscesso/cirurgia , Adulto , Idoso , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/fisiopatologia , Celulite (Flegmão)/cirurgia , Feminino , Humanos , Masculino , Mediastinite/diagnóstico , Mediastinite/etiologia , Mediastinite/terapia , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Pescoço/patologia , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
12.
Georgian Med News ; (294): 57-61, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687950

RESUMO

Objective of the investigation - to increase the effectiveness of treatment of phlegmon of the maxillo-facial area and neck with the influence onto the pathogenic factors, complementing the main treatment plan with the injection of a second antibiotic in a regionary lymphatic way. 100 patients with acute inflammatory odontogenic diseases of the maxillofacial area were examined. Patients received both traditional medical treatment and regional lymphotropic antibiotic therapy added to the main method of treatment as well. Regionarnl lymphotropic antibiotic injection in the treatment of phlegmon of the maxillofacial area and neck leads to an accelerated onset of the second phase of the development of the wound process, more rapid detoxification of the body. Key words: acute inflammatory odontogenic diseases, maxillofacial area, lymphatic system.


Assuntos
Abscesso/diagnóstico , Abscesso/terapia , Antibacterianos/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Dermatoses Faciais/tratamento farmacológico , Pescoço , Doença Aguda , Adolescente , Adulto , Idoso , Celulite (Flegmão)/sangue , Celulite (Flegmão)/diagnóstico , Face , Dermatoses Faciais/diagnóstico , Feminino , Infecção Focal Dentária/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
13.
J Eur Acad Dermatol Venereol ; 33 Suppl 6: 36-39, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31535756

RESUMO

The case of a 24-year-old male patient affected by follicular occlusion tetrad (acne conglobata, hidradenitis suppurativa, pilonidal cyst and dissecting cellulitis of the scalp) associated with clinical signs of pachyonychia congenita (PC)-2 (focal palmoplantar keratoderma, plantar pain, onycodystrophy and multiple cysts) is reported. The diagnosis was supported by genetic analysis that showed heterozygous mutation within the exon 1 of KRT17 gene. This case may reflect different expressions of a phenotypic spectrum induced by a common genetic alteration.


Assuntos
Acne Conglobata/diagnóstico , Celulite (Flegmão)/diagnóstico , Hidradenite Supurativa/diagnóstico , Queratina-17/genética , Paquioníquia Congênita/genética , Seio Pilonidal/diagnóstico , Dermatoses do Couro Cabeludo/diagnóstico , Dermatopatias Genéticas/diagnóstico , Hidradenite Supurativa/genética , Humanos , Masculino , Paquioníquia Congênita/diagnóstico , Síndrome , Adulto Jovem
14.
Korean J Gastroenterol ; 74(3): 175-182, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554034

RESUMO

Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome is a rare but critical disease with a high mortality rate. The diagnostic dilemma of PPP syndrome is the fact that symptoms occur unexpectedly. A 48-year-old man presented with fever and painful swelling of the left foot that was initially mistaken for cellulitis and gouty arthritis. The diagnosis of PPP syndrome was made based on the abdominal CT findings and elevated pancreatic enzyme levels, lobular panniculitis with ghost cells on a skin biopsy, and polyarthritis on a bone scan. The pancreatitis and panniculitis disappeared spontaneously over time, but the polyarthritis followed its own course despite the use of anti-inflammatory agents. In addition to this case, 30 cases of PPP syndrome in the English literature were reviewed. Most of the patients had initial symptoms other than abdominal pain, leading to misdiagnosis. About one-third of them were finally diagnosed with a pancreatic tumor, of which pancreatic acinar cell carcinoma was the most dominant. They showed a mortality rate of 32.3%, associated mainly with the pancreatic malignancy. Therefore, PPP syndrome should be considered when cutaneous or osteoarticular manifestations occur in patients with pancreatitis. Active investigation and continued observations are needed for patients suspected of PPP syndrome.


Assuntos
Artrite/diagnóstico , Pancreatite/diagnóstico , Paniculite/diagnóstico , Artrite/tratamento farmacológico , Artrite/patologia , Artrite Gotosa/diagnóstico , Osso e Ossos/diagnóstico por imagem , Celulite (Flegmão)/diagnóstico , Diagnóstico Diferencial , Eritema/diagnóstico , Eritema/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Octreotida/uso terapêutico , Pancreatite/tratamento farmacológico , Pancreatite/patologia , Paniculite/tratamento farmacológico , Paniculite/patologia , Tomografia Computadorizada por Raios X
15.
Eur J Dermatol ; 29(4): 396-400, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31512577

RESUMO

Cellulitis ranks among the most frequent infections, and antibiotic treatment is the accepted mainstay of therapy. There is disagreement on the guidelines for the use of compression bandaging as supplementary treatment, and the evidence within the field is scarce. To determine whether compression bandaging impairs microcirculation in patients with cellulitis of the lower leg, thereby having a negative impact on the supply of oxygen, nutritional components, and antibiotics. Adult patients were prospectively enrolled for compression bandaging in addition to antibiotic treatment. The peripheral blood flow rate was measured before and after application of the compression bandage and on the following day. For this, we applied the heat-washout method, which has previously been shown to provide an accurate estimate of peripheral microcirculation. Comparing the blood flow rate before and after application of the compression bandage showed no significant change and therefore no alteration in microcirculation (p = 0.61). Compression bandaging of the lower leg does not impair microcirculation in patients with cellulitis. This strongly indicates that compression bandaging can play a positive role as supportive treatment in addition to standard antibiotic therapy.


Assuntos
Antibacterianos/uso terapêutico , Celulite (Flegmão)/terapia , Bandagens Compressivas/estatística & dados numéricos , Microcirculação/fisiologia , Segurança do Paciente , Cicatrização/fisiologia , Adulto , Celulite (Flegmão)/diagnóstico , Estudos de Coortes , Bandagens Compressivas/efeitos adversos , Dinamarca , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Medição de Risco , Resultado do Tratamento
16.
Pediatr. aten. prim ; 21(83): e145-e149, jul.-sept. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-188646

RESUMO

El síndrome de Lemierre es una patología poco frecuente y potencialmente letal, que se origina como complicación de una infección localizada a nivel de cabeza y cuello que se extiende al espacio carotídeo. Se asocia a tromboflebitis séptica de la vena yugular interna y con frecuencia produce embolias sépticas a distancia. Se presenta generalmente como un cuadro de fiebre y odinofagia de varios días de evolución tras el antecedente de una infección orofaríngea aparentemente resuelta. Otros focos infecciosos menos frecuentes pueden corresponder a mastoiditis, sinusitis u otitis media aguda. El diagnóstico es fundamentalmente clínico y apoyado en las pruebas de imagen, como la ecografía Doppler y la tomografía computarizada cervical con contraste. El tratamiento consiste en antibioterapia prolongada con adecuada cobertura para anaerobios, especialmente Fusobacterium necrophorum, el patógeno más frecuente. El papel de la anticoagulación en el síndrome de Lemierre es controvertido. Se presenta un caso de síndrome de Lemierre secundario a una otitis media aguda


Lemierre's syndrome is a rare and potentially lethal disease that originates as a complication of a localized infection at the head and neck level that extends to the carotid space. It is associated with septic thrombophlebitis of the internal jugular vein and often produces septic emboli at a distance. It usually presents as a picture of fever and odynophagia several days after the history of an apparently resolved oropharyngeal infection. Other less frequent infectious foci may correspond to mastoiditis, sinusitis or acute otitis media. The diagnosis is fundamentally clinical and supported by imaging tests such as Doppler ultrasound and cervical CT with contrast. The treatment consists of prolonged antibiotic therapy with adequate coverage for anaerobes, especially Fusobacterium necrophorum, which is the most frequent pathogen. The role of anticoagulation in Lemierre's syndrome is controversial. We present a case of Lemierre's syndrome secondary to acute otitis media


Assuntos
Humanos , Feminino , Adolescente , Síndrome de Lemierre/diagnóstico , Otite Média/complicações , Tromboflebite/complicações , Antibacterianos/uso terapêutico , Celulite (Flegmão)/diagnóstico , Streptococcus intermedius/isolamento & purificação , Diagnóstico Diferencial , Embolia/diagnóstico , Mastoidite/diagnóstico , Veias Jugulares/fisiopatologia , Adenoma/diagnóstico , Infecções Estreptocócicas/diagnóstico
18.
Pan Afr Med J ; 33: 77, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31448039

RESUMO

We report the case of a 45-year old woman with a 15-day history of anterior cervical swelling increasing very quickly in size associated with a 7-day history of local inflammation. Clinical examination showed voluminous tender and fixed swelling occupying all the anterior cervical region. The skin's surface was inflammed with permeation nodule (Figure 1, A). The patient was febrile at 38° with good overall physical condition Cervical ultrasound showed voluminous right laterocervical mass that, given the size, made surgical exploration difficult. CT scan showed voluminous thyroid mass, multi-cystic in the superficial tissues, compressing the trachea and the esophagus and pressing the vascular axis of the neck (Figure 1, B and C). Laboratory tests showed leukocytosis 13500 cells/ml, anemia to 8.3 g/dl, CRP 42mg/L and normal thyroid test. Fine needle aspiration biopsy showed purulent and very inflammed material without cytologic signs of malignancy. The patient underwent surgery. Surgical exploration showed several superficial cystic and haemorrhagic cubicles with, in depth, tumor tissue infiltrating the trachea. The tumor laterally invaded the right vascular axis and spread to the suprahyoid muscles, the right submandibular region and the twelfth cranial nerve. Total extended thyroidectomy was performed. Histological examination showed papillary thyroid carcinoma measuring 11cm along its longer axis. Based on our literature review, this is the first case of locally invasive papillary cystic carcinoma of the thyroid revealed by subacute infection.


Assuntos
Celulite (Flegmão)/diagnóstico , Câncer Papilífero da Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Tireoidectomia/métodos , Biópsia por Agulha Fina , Celulite (Flegmão)/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Pescoço , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tomografia Computadorizada por Raios X
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