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3.
J Eur Acad Dermatol Venereol ; 33(4): 781-785, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30633375

RESUMO

BACKGROUND: Ecthyma gangrenosum (EG) is characterized by the occurrence of erythematous, violaceous or haemorrhagic macules and/or vesicles, often evolving into necrotic ulcers, with a central grey-black eschar. It is a rare skin condition, usually occurring in immunocompromised patients suffering from bacterial sepsis caused by Pseudomonas aeruginosa. However, seemingly healthy children have been diagnosed with this skin disease as well. OBJECTIVES: We report the workup of a case of vulvar EG caused by P. aeruginosa in a toddler, which led to a diagnosis of an underlying neutropenia. Moreover, we provide a brief literature review on those cases of EG where an underlying primary immunodeficiency, neutropenia in particular, was eventually diagnosed. METHODS: A one-and-a-half-year-old girl presented with a history of recurrent (respiratory) infections and the sporadic occurrence of purpuric, vulvar ulcers. Workup consisted of microbiological and haematological investigations, including repeated blood analyses. RESULTS: Bacterial swabs from the vulvar ulcers showed the growth of P. aeruginosa. No concomitant sepsis was present, but laboratory investigations pointed towards a cyclic neutropenia, coinciding with the occurrence of the EG lesions. Topical gentamicin ointment allowed the skin lesions to heal faster. Following the administration of granulocyte colony-stimulating factor (G-CSF), the girl experienced less infections in general and had no recurrence of EG lesions in particular. Treatment with G-CSF could eventually be stopped, and the neutropenia, ultimately transient in nature, completely resolved. CONCLUSION: Children presenting with (anogenital) EG should always alert a physician to consider a potentially underlying immunodeficiency, neutropenia in particular.


Assuntos
Ectima/microbiologia , Gangrena/microbiologia , Neutropenia/tratamento farmacológico , Infecções por Pseudomonas/complicações , Pseudomonas aeruginosa , Doenças da Vulva/microbiologia , Antibacterianos/uso terapêutico , Feminino , Gentamicinas/uso terapêutico , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Lactente , Neutropenia/complicações , Infecções por Pseudomonas/tratamento farmacológico
5.
Artigo em Inglês | MEDLINE | ID: mdl-30559311

RESUMO

X-linked agammaglobulinemia (XLA, OMIM#300300) is a rare monogenic primary immunodeficiency caused by mutations in the Bruton tyrosine kinase (BTK) gene. XLA is characterized by insufficient immunoglobulin levels and susceptibility to life-threatening bacterial infections. We report on a patient that presented with ecthyma gangrenosum and septicemia. Rapid trio whole-genome sequencing (rWGS) revealed an apparently de novo hemizygous pathogenic variant (c.726dupT; p.Ile243TyrfsTer15) in the BTK gene. Metagenomic analysis of rWGS sequences that did not align to the human genome revealed 770 aligned to the Pseudomonas aeruginosa PAO1 genome. The patient was diagnosed with XLA and pseudomonal sepsis.


Assuntos
Tirosina Quinase da Agamaglobulinemia/genética , Agamaglobulinemia/genética , Ectima/genética , Doenças Genéticas Ligadas ao Cromossomo X/genética , Tirosina Quinase da Agamaglobulinemia/metabolismo , Agamaglobulinemia/diagnóstico , Bacteriemia , Ectima/diagnóstico , Gangrena/microbiologia , Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico , Humanos , Síndromes de Imunodeficiência , Lactente , Masculino , Infecções por Pseudomonas/genética , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/patogenicidade , Sepse/genética , Sepse/metabolismo , Pele/microbiologia , Sequenciamento Completo do Genoma/métodos
6.
Yakugaku Zasshi ; 138(10): 1249-1253, 2018.
Artigo em Japonês | MEDLINE | ID: mdl-30270267

RESUMO

 Whereas granulopoiesis during Gram-negative bacterial infection is accelerated through activation of toll-like receptor 4 (TLR4), it has not been elucidated whether Gram-positive bacterial infection can stimulate granulopoiesis. Using the well-known TLR2 agonist peptidoglycan (PGN), it was shown that neutrophils in bone marrow and spleen and plasma granulocyte colony-stimulating factor were increased in mice that had received intraperitoneal administration of PGN. Incorporation of bromodeoxyuridine into bone marrow neutrophils increased in mice administered PGN, demonstrating that PGN promotes granulopoiesis. These results illustrate that bacterial recognition by TLR2 facilitates granulopoiesis during Gram-positive bacterial infection. Thus, granulopoiesis is accelerated to suppress bacterial infection, but some bacteria can still cause severe infections. Clostridium perfringens is a Gram-positive, anaerobic pathogenic bacterium and causes life-threatening gas gangrene in humans. Of the many toxins produced by C. perfringens, α-toxin is known to be a major virulence factor during infection. Recently, it has been revealed that C. perfringens α-toxin impairs the innate immune system by inhibiting neutrophil differentiation, which is crucial for the pathogenesis of C. perfringens. Moreover, the toxin also attenuates erythropoiesis, which would cause severe anemia in clinical settings. The findings provide new insight to understand how hosts strengthen innate immunity to fight pathogenic bacteria and how they evade the hosts' immune systems.


Assuntos
Toxinas Bacterianas/toxicidade , Infecções por Bactérias Gram-Negativas/imunologia , Infecções por Bactérias Gram-Positivas/imunologia , Interações Hospedeiro-Patógeno/imunologia , Imunidade Inata/efeitos dos fármacos , Imunidade Inata/imunologia , Neutropenia/imunologia , Peptidoglicano/farmacologia , Animais , Bromodesoxiuridina/metabolismo , Proteínas de Ligação ao Cálcio/toxicidade , Diferenciação Celular/efeitos dos fármacos , Clostridium perfringens/patogenicidade , Gangrena/microbiologia , Fator Estimulador de Colônias de Granulócitos/metabolismo , Humanos , Camundongos , Neutropenia/etiologia , Neutropenia/metabolismo , Neutrófilos/efeitos dos fármacos , Neutrófilos/fisiologia , Peptidoglicano/administração & dosagem , Receptor 2 Toll-Like/agonistas , Receptor 4 Toll-Like/imunologia , Fosfolipases Tipo C/toxicidade
7.
Vet Res ; 49(1): 72, 2018 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-30045763

RESUMO

Staphylococcus aureus is the major cause of very severe mastitis of dairy goats. The initial objective of our study was to fine-tune an experimental model of infection of the goat mammary gland with two strains of S. aureus and two lines of goats (low and high somatic cell score lines). Following the challenge, the 10 infected goats divided in two clear-cut severity groups, independently of the S. aureus strain and the goat line. Five goats developed very severe mastitis (of which four were gangrenous) characterized by uncontrolled infection (UI group), whereas the other five kept the infection under control (CI group). The outcome of the infection was determined by 18 h post-infection (hpi), as heralded by the bacterial milk concentration at 18 hpi: more than 107/mL in the UI group, about 106/mL in the CI group. Leukocyte recruitment and composition did not differ between the groups, but the phagocytic killing at 18 hpi efficiency did. Contributing factors involved milk concentrations of α-toxin and LukMF' leukotoxin, but not early expression of the genes encoding the pentraxin PTX3, the cytokines IL-1α and IL-1ß, and the chemokines IL-8 and CCL5. Concentrations of TNF-α, IFN-γ, IL-17A, and IL-22 rose sharply in the milk of UI goats when infection was out of control. The results indicate that defenses mobilized by the mammary gland at an early stage of infection were essential to prevent staphylococci from reaching critical concentrations. Staphylococcal exotoxin production appeared to be a consequent event inducing the evolution to gangrenous mastitis.


Assuntos
Doenças das Cabras/microbiologia , Cabras/genética , Mastite/veterinária , Seleção Genética , Infecções Estafilocócicas/veterinária , Staphylococcus aureus/fisiologia , Animais , Contagem de Células/veterinária , Feminino , Gangrena/microbiologia , Gangrena/veterinária , Mastite/microbiologia , Leite/microbiologia , Infecções Estafilocócicas/microbiologia
8.
BMC Pediatr ; 18(1): 198, 2018 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-29933752

RESUMO

BACKGROUND: Hemolytic streptococcus gangrene is a life threatening invasive bacterial infection. Hemolytic streptococcus gangrene in the danger triangle of the face is too lethal to operate. A case of the confirmed hemolytic streptococcus gangrene in the danger triangle of the face caused by Group A beta-hemolytic streptococcus (GAS) in 20-months old boy is presented to draw attention of clinicians to this uncommon but frequently fatal infection. CASE PRESENTATION: Previously healthy 20 months old boy suddenly developed paranasal gangrene on the left side of the danger triangle of the face, followed by rapidly progressive thrombocytopenia and hepatitis. The clinical features, liver function, and hematological and serological parameters resembled to a description of streptococcal toxic shock syndrome (STSS). Aggressive antibiotics, substitutional and supportive therapy were conducted without surgical debridement of facial tissues. Prompt diagnosis and aggressive timely treatment completely cured the disease in 28 days. CONCLUSIONS: The present case report demonstrates prompt diagnosis and timely treatment as a strategy to cure the fatal hemolytic streptococcus gangrene located in too risky body part to operate.


Assuntos
Face/patologia , Gangrena/complicações , Gangrena/microbiologia , Hepatite/complicações , Infecções Estreptocócicas/complicações , Streptococcus pyogenes , Trombocitopenia/complicações , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Diagnóstico Precoce , Humanos , Lactente , Masculino , Meropeném/uso terapêutico , Penicilina G/uso terapêutico , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Vancomicina/uso terapêutico
9.
Emerg Infect Dis ; 24(2): 370-373, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29350147

RESUMO

Wohlfahrtiimonas species bacteria were isolated from the bloodstream of a patient with septicemia and wound myiasis. Environmental investigations identified a Wohlfahrtiimonas sp. among insects in the Americas and in a previously undescribed vector, the green bottle fly (Lucilia sericata). The isolates possibly represent a new species within the genus Wohlfahrtiimonas.


Assuntos
Bacteriemia/microbiologia , Dípteros/microbiologia , Gammaproteobacteria/isolamento & purificação , Miíase/complicações , Animais , Evolução Fatal , Gangrena/microbiologia , Humanos , Larva/microbiologia , Masculino , Pessoa de Meia-Idade
11.
J Trop Pediatr ; 64(6): 548-552, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29253258

RESUMO

We describe a case of progressive cutaneous mucormycosis, which caused gangrenous necrotizing fasciitis, in an immunocompetent neonate from Oman. Extensive wound contamination and a favorable environment for the growth of Mucorales were the predisposing factors. Early aggressive management including frequent wound debridement, targeted pharmacotherapy with liposomal amphotericin B and supportive care is pivotal for improved outcomes.


Assuntos
Fasciite Necrosante/diagnóstico , Fasciite Necrosante/microbiologia , Gangrena/diagnóstico , Mucormicose/diagnóstico , Mucormicose/microbiologia , Streptococcus agalactiae/isolamento & purificação , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Desbridamento , Fasciite Necrosante/tratamento farmacológico , Fasciite Necrosante/cirurgia , Feminino , Gangrena/microbiologia , Gangrena/cirurgia , Humanos , Recém-Nascido , Mucormicose/tratamento farmacológico , Mucormicose/cirurgia , Streptococcus agalactiae/classificação , Resultado do Tratamento
12.
Ann Dermatol Venereol ; 145(2): 95-99, 2018 Feb.
Artigo em Francês | MEDLINE | ID: mdl-29169658

RESUMO

BACKGROUND: Symmetric peripheral gangrene (SPG) is a symmetrical distal ischemic lesion on at least 2 or more extremities in the absence of proximal arterial obstruction and vasculitis. It is a rare and severe clinical entity. The aim of this study was to describe clinical symptoms, etiological agents and the management of SPG through a series of 4 cases. PATIENTS AND METHODS: We included all cases of SPG hospitalized between 2000 and 2014. The inclusion criterion was the presence of distal ischemic damage at two or more sites in the absence of large vessel obstruction. RESULTS: Four patients (2 men and 2 women) were included. The mean age was 43.2±12 years. Two patients had a history of splenectomy. All patients had blackening of the tips of the fingers and toes. Three patients presented with septic shock. The etiology was bacteremia involving Streptococcus pneumoniae in two cases and a malignant form of Mediterranean spotted fever (MSF). In addition to specific antibiotics, we used a potent vasodilator (iloprost) in two cases and curative heparin therapy in two cases. The outcome was favorable in 3 cases, with regression of necrotic lesions. One case required the amputation of non-perfused necrotic fingers and toes. CONCLUSION: SPG can complicate MSF in some rare cases. Thorough and repeated skin examinations are essential to ensure timely diagnosis and treatment of GPS in order to improve the prognosis.


Assuntos
Dedos/patologia , Gangrena/microbiologia , Gangrena/terapia , Dedos do Pé/patologia , Adulto , Amputação , Antibacterianos/uso terapêutico , Febre Botonosa/complicações , Febre Botonosa/tratamento farmacológico , Feminino , Fibrinolíticos/uso terapêutico , Dedos/cirurgia , Heparina/uso terapêutico , Humanos , Iloprosta/uso terapêutico , Masculino , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/tratamento farmacológico , Estudos Retrospectivos , Choque Séptico/etiologia , Dedos do Pé/cirurgia , Vasodilatadores/uso terapêutico
13.
An Bras Dermatol ; 92(5): 698-700, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29166510

RESUMO

Ecthyma gangrenosum is a rare skin infection classically associated with Pseudomonas aeruginosa. We performed a retrospective study of all cases diagnosed with ecthyma gangrenosum from 2004-2010 in a university hospital in Mexico (8 cases, 5 female patients and 3 male patients, ages between 4 months and 2 years). The most common risk factor for ecthyma gangrenosum is neutropenia in immunocompromised patients. In previously healthy patients, immunological evaluation is important to rule out underlying immunodeficiency. Ecthyma gangrenosum in healthy patients has a high mortality rate and early diagnosis and aggressive antibiotic treatment is imperative as it can improve patients' prognosis.


Assuntos
Ectima/microbiologia , Gangrena/microbiologia , Infecções por Pseudomonas/complicações , Pseudomonas aeruginosa/isolamento & purificação , Pré-Escolar , Ectima/tratamento farmacológico , Feminino , Gangrena/tratamento farmacológico , Humanos , Lactente , Masculino , Estudos Retrospectivos
14.
An. bras. dermatol ; 92(5): 698-700, Sept.-Oct. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-887040

RESUMO

Abstract: Ecthyma gangrenosum is a rare skin infection classically associated with Pseudomonas aeruginosa. We performed a retrospective study of all cases diagnosed with ecthyma gangrenosum from 2004-2010 in a university hospital in Mexico (8 cases, 5 female patients and 3 male patients, ages between 4 months and 2 years). The most common risk factor for ecthyma gangrenosum is neutropenia in immunocompromised patients. In previously healthy patients, immunological evaluation is important to rule out underlying immunodeficiency. Ecthyma gangrenosum in healthy patients has a high mortality rate and early diagnosis and aggressive antibiotic treatment is imperative as it can improve patients' prognosis.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Pseudomonas aeruginosa/isolamento & purificação , Infecções por Pseudomonas/complicações , Ectima/microbiologia , Gangrena/microbiologia , Estudos Retrospectivos , Ectima/tratamento farmacológico , Gangrena/tratamento farmacológico
15.
Infect Dis Clin North Am ; 31(3): 497-511, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28779832

RESUMO

Despite advances in antibiotic and surgical management and supportive care for necrotizing soft tissue infections, morbidity and mortality remain substantial. Although there are clinical practice guidelines in place, there still remains much variability in choice and duration of antibiotic therapy, time to initial surgical debridement, and use of adjuvant medical therapies. This article offers an overview of necrotizing soft tissue infections with a focus on current diagnostic and treatment modalities.


Assuntos
Fasciite Necrosante/diagnóstico , Fasciite Necrosante/terapia , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/terapia , Administração Intravenosa , Antibacterianos/uso terapêutico , Desbridamento , Gerenciamento Clínico , Fasciite Necrosante/complicações , Fasciite Necrosante/tratamento farmacológico , Gangrena/tratamento farmacológico , Gangrena/microbiologia , Humanos , Oxigenação Hiperbárica , Imunoglobulinas/administração & dosagem , Imunoglobulinas/uso terapêutico , Sepse/tratamento farmacológico , Sepse/microbiologia , Sepse/terapia , Infecções dos Tecidos Moles/complicações , Infecções dos Tecidos Moles/tratamento farmacológico
17.
Medicine (Baltimore) ; 96(10): e6244, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28272221

RESUMO

RATIONALE: Ecthyma gangrenosum (EG) is an aggressive cutaneous disease caused by local or systemic infection with Pseudomonas aeruginosa. EG is characterized by cutaneous manifestations ranging from nodule and papule, to necrotic ulceration with surrounding erythema, especially with black eschar or central crust. EG presents with characteristic skin lesions which is important to establish diagnosis of sepsis caused by P aeruginosa, a serious condition that can be treated efficiently if diagnosed early. PATIENT CONCERNS: A 3-month-old female infant was presented with characteristic skin lesions of EG and developed sepsis 3 days later. DIAGNOSES: Ecthyma gangrenosum and sepsis caused by Pseudomonas aeruginosa. INTERVENTIONS: Meropenem was used in combination with ceftazidime at first and excision of necrotic skin lesions was performed later. OUTCOMES: Cure. LESSONS: Early recognition of EG plays an important role in providing appropriate empiric antibiotic treatment at early stage of sepsis, and improves the prognosis. Surgical excision may be helpful if no improvement was achieved via antibiotic treatment.


Assuntos
Gangrena/microbiologia , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/isolamento & purificação , Pioderma Gangrenoso/microbiologia , Sepse/microbiologia , Antibacterianos/uso terapêutico , Ceftazidima/uso terapêutico , Feminino , Gangrena/tratamento farmacológico , Gangrena/cirurgia , Humanos , Lactente , Meropeném , Infecções por Pseudomonas/cirurgia , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/cirurgia , Sepse/tratamento farmacológico , Sepse/cirurgia , Tienamicinas/uso terapêutico
19.
Pediatr Emerg Care ; 32(1): 46-8, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26720066

RESUMO

We present the case of a 1-year-old healthy boy who was taking oral antibiotics for an otitis media and then developed an erythematous penile lesion that rapidly became ulcerated. He was admitted to the hospital for further diagnostic studies and intravenous therapy, and his wound culture grew Pseudomonas aeruginosa, consistent with the diagnosis of ecthyma gangrenosum. Serial blood counts also demonstrated a progressive neutropenia, and an immunodeficiency evaluation resulted in the diagnosis of autoimmune neutropenia of childhood. This case illustrates the importance of culturing wounds and the need for clinicians to recognize the characteristic features of ecthyma gangrenosum, to initiate appropriate antipseudomonal antibiotic therapy empirically, and to evaluate for a possible immunodeficiency, even in the apparently healthy child.


Assuntos
Genitália Masculina/patologia , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Úlcera Cutânea/tratamento farmacológico , Úlcera Cutânea/microbiologia , Antibacterianos/uso terapêutico , Ectima/microbiologia , Ectima/patologia , Serviço Hospitalar de Emergência , Gangrena/microbiologia , Gangrena/patologia , Genitália Masculina/microbiologia , Humanos , Lactente , Masculino , Infecções por Pseudomonas/patologia , Pseudomonas aeruginosa/isolamento & purificação , Úlcera Cutânea/patologia
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