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1.
Pan Afr Med J ; 39: 84, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34466186

RESUMO

The treatment of acute osteomyelitis is becoming more challenging since the emergence of community-acquired methicillin-resistant Staphylococcus aureus. We collected data on all patients with acute osteomyelitis caused by this germ over a period of 21 years (January 1995-December 2016) and we analyzed the peculiarities of this disorder. Our case series includes 15 children, with an average age of 9 years. All patients had affected lower limb. Local trauma was reported in 8 cases and skin carriage in 4 cases. Acute onset was reported in 12 cases associated with pseudo-paralysis of the affected limb. One patient had Staphylococcus aureus pulmonary infection with signs of septicopyemia. Blood culture was positive in 8 cases. In one case PCR assay for detection of Panton-Valentine leukocidin was performed with positive result. All these patients underwent surgical debridement and received secondarily adapted empirical antibiotic therapy. Outcome was good in 8 cases and poor in the other cases, with transition to a chronic state in 6 cases and one case of death. Pathological fracture was reported in 3 cases. Osteomyelitis cause by community-acquired methicillin-resistant Staphylococcus aureus is associated with a pejorative outcome. Recognizing the clinical and paraclinical signs of these infections is essential for a specific and early therapeutic management.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Osteomielite/diagnóstico , Infecções Estafilocócicas/diagnóstico , Doença Aguda , Adolescente , Antibacterianos/administração & dosagem , Criança , Pré-Escolar , Terapia Combinada , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/terapia , Desbridamento/métodos , Feminino , Humanos , Masculino , Osteomielite/microbiologia , Osteomielite/terapia , Estudos Retrospectivos , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapia
2.
Pan Afr Med J ; 38: 349, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367428

RESUMO

Nocardia infection is an uncommon and rare condition in immunocompetent patient. A case of cutaneous nocardiosis complicated with osteomyelitis of the vault scalp in a 64-year-old man, with no remarkable past medical history, is reported. Treatment with trimethoprime-sulfamethoxazole than doxycycline for 12 months led to complete resolution and no evidence of recurrence was noted. Nocardia infection should be considered even in immunocomptent patients and doxycycline is a good alternative for treatment.


Assuntos
Antibacterianos/administração & dosagem , Nocardiose/diagnóstico , Osteomielite/diagnóstico , Crânio/patologia , Doxiciclina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Nocardiose/complicações , Nocardiose/tratamento farmacológico , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Crânio/microbiologia , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem
3.
Undersea Hyperb Med ; 48(3): 297-321, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34390634

RESUMO

Refractory osteomyelitis is defined as a chronic osteomyelitis that persists or recurs after appropriate interventions have been performed or where acute osteomyelitis has not responded to accepted management techniques [1]. To date, no randomized clinical trials examining the effects of hyperbaric oxygen (HBO2) therapy on refractory osteomyelitis exist, and the number of new osteomyelitis clinical trials conducted over the past decade has been limited. However, based on a comprehensive review of the scientific literature, the addition of HBO2 therapy to routine surgical and antibiotic treatment of previously refractory osteomyelitis appears to be both safe and ultimately improves infection resolution rates. In most cases, the best clinical results are obtained when HBO2 treatment is administered in conjunction with culture-directed antibiotics and initiated soon after clinically indicated surgical debridement. Where extensive surgical debridement or removal of fixation hardware is relatively contraindicated (e.g., cranial, spinal, sternal, or pediatric osteomyelitis), a trial of culture-directed antibiotics and HBO2 therapy prior to undertaking more than limited surgical interventions provides a reasonable prospect for osteomyelitis cure. HBO2 therapy is ordinarily delivered on a once daily basis, five-seven days per week, for 90-120 minutes using 2.0-3.0 atmospheres absolute (ATA) pressure. Where prompt clinical improvement is seen, the existing regimen of antibiotics and HBO2 therapy should be continued for approximately four to six weeks. Typically, 20-40 HBO2 sessions are required to achieve sustained therapeutic benefit. In contrast, if prompt clinical response is not noted or osteomyelitis recurs after this initial treatment period, then continuation of the current antibiotic and HBO2 treatment regimen is unlikely to be effective. Instead, clinical management strategies should be reassessed and additional surgical debridement and/or modification of antibiotic therapy considered. Subsequent reinstitution of HBO2 therapy will again help maximize the overall chances for treatment success in these persistently refractory patients.


Assuntos
Antibacterianos/uso terapêutico , Oxigenação Hiperbárica/métodos , Osteomielite/terapia , Adulto , Animais , Criança , Doença Crônica , Estudos de Coortes , Terapia Combinada/métodos , Desbridamento , Humanos , Oxigenação Hiperbárica/estatística & dados numéricos , Osteomielite/classificação , Osteomielite/microbiologia , Seleção de Pacientes , Recidiva , Fatores de Tempo
4.
Int J Mol Sci ; 22(14)2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34299362

RESUMO

While the infection rate after primary total joint replacements (TJR) sits at 1-2%, for trauma-related surgery, it can be as high as 3.6 to 21.2% based on the type of trauma; the risk of reinfection after revision surgery is even higher. Current treatments with antibiotic-releasing PMMA-based bone cement/ beads and/or systemic antibiotic after surgical debridement do not provide effective treatment due to fluctuating antibiotic levels at the site of infection, leading to insufficient local antibiotic concentration. In addition, non-biodegradable PMMA does not support bone regrowth in the debrided void spaces and often must be removed in an additional surgery. Here, we report a bioactive glass or bioglass (BG) substrate-based biodegradable, easy to fabricate "press fitting" antibiotic-releasing bone void filling (ABVF-BG) putty to provide effective local antibiotic release at the site of infection along with support for bone regeneration. The ABVF-BG putty formulation had homogenously distributed BG particles, a porous structure, and showed putty-like ease of handling. Furthermore, the ABVF-BG putty demonstrated in vitro antibacterial activity for up to 6 weeks. Finally, the ABVF-BG putty was biodegradable in vivo and showed 100% bacterial eradication (as shown by bacterial cell counts) in the treatment group, which received ABVF-BG putty, compared to the infection control group, where all the rats had a high bacterial load (4.63 × 106 ± 7.9 × 105 CFU/gram bone) and sustained osteomyelitis. The ABVF-BG putty also supported bone growth in the void space as indicated by a combination of histology, µCT, and X-ray imaging. The potential for simultaneous infection treatment and bone healing using the developed BG-based ABVF-BG putty is promising as an alternative treatment option for osteomyelitis.


Assuntos
Antibacterianos/farmacologia , Osso e Ossos/efeitos dos fármacos , Cerâmica/farmacologia , Osteomielite/tratamento farmacológico , Vancomicina/farmacologia , Cicatrização/efeitos dos fármacos , Animais , Cimentos Ósseos/farmacologia , Substitutos Ósseos/farmacologia , Portadores de Fármacos/farmacologia , Feminino , Vidro , Masculino , Osteomielite/microbiologia , Ratos , Ratos Sprague-Dawley
6.
Jt Dis Relat Surg ; 32(2): 556-559, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145840

RESUMO

Osteomyelitis of the phalanx caused by Candida species are rare. A 49-year-old female patient was admitted to an external center with a splinter injury of the third phalanx of the middle finger of her left hand about 45 days ago. She was referred to our clinic with persistent pain and discharge, despite four-week antibiotherapy. Debridement and curettage were performed and partial excision of the distal phalanx at an appropriate level was done. Her complaints gradually resolved postoperatively with prescribed antibiotics for the pathogen identified as Candida lusitaniae based on the intraoperative cultures. At her three-month follow-up visit, treatment yielded near-excellent results. To the best of our knowledge, this is the first case of osteomyelitis of the distal phalanx caused by Candida lusitaniae in the literature, highlighting the importance of definitive diagnosis and pathogen-specific treatment, rather than empirical treatment, to achieve favorable results with cure.


Assuntos
Falanges dos Dedos da Mão/fisiopatologia , Micoses/diagnóstico , Osteomielite/diagnóstico , Saccharomycetales/isolamento & purificação , Candidíase/diagnóstico , Candidíase/diagnóstico por imagem , Candidíase/microbiologia , Feminino , Humanos , Pessoa de Meia-Idade , Micoses/diagnóstico por imagem , Micoses/microbiologia , Osteomielite/diagnóstico por imagem , Osteomielite/microbiologia , Turquia
7.
Int J Infect Dis ; 108: 510-512, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34091004

RESUMO

We describe a challenging case of patient with metallo-beta-lactamase-producing Pseudomonas aeruginosa sternal osteomyelitis following aortic valve replacement with biological prosthesis. The strain exhibited a multidrug-resistance phenotype carrying the blaVIM-1 gene and belonged to the high-risk clone sequence type ST235. The patient was successfully treated with surgical debridement plus antibiotic therapy with ceftazidime/avibactam, aztreonam, and amikacin. Time-kill curves showed that this triple antibiotic combination at 1 × MIC was strongly synergic after 8 h, achieving 99.9% killing and maintaining this until 48 h.


Assuntos
Amicacina/uso terapêutico , Antibacterianos/uso terapêutico , Compostos Azabicíclicos/uso terapêutico , Aztreonam/uso terapêutico , Ceftazidima/uso terapêutico , Osteomielite/tratamento farmacológico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa , Idoso , Desbridamento , Combinação de Medicamentos , Farmacorresistência Bacteriana Múltipla/genética , Quimioterapia Combinada , Feminino , Humanos , Osteomielite/microbiologia , Osteomielite/cirurgia , Infecções por Pseudomonas/cirurgia
8.
Microb Cell Fact ; 20(1): 102, 2021 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001083

RESUMO

As treatment of Staphylococcus aureus (S. aureus) osteomyelitis is often hindered by the development of antibiotic tolerance, novel antibacterial therapeutics are required. Here we found that the cell-free supernatant of Bacillus subtilis (B. subtilis CFS) killed planktonic and biofilm S. aureus, and increased S. aureus susceptibility to penicillin and gentamicin as well. Further study showed that B. subtilis CFS suppressed the expression of the genes involved in adhesive molecules (Cna and ClfA), virulence factor Hla, quorum sensing (argA, argB and RNAIII) and biofilm formation (Ica and sarA) in S. aureus. Additionally, our data showed that B. subtilis CFS changed the membrane components and increased membrane permeabilization of S. aureus. Finally, we demonstrated that B. subtilis CFS increased considerably the susceptibility of S. aureus to penicillin and effectively reduced S. aureus burdens in a mouse model of implant-associated osteomyelitis. These findings support that B. subtilis CFS may be a potential resistance-modifying agent for ß-lactam antibiotics against S. aureus.


Assuntos
Antibacterianos/farmacologia , Bacillus subtilis/crescimento & desenvolvimento , Meios de Cultura/farmacologia , Osteomielite/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Animais , Antibacterianos/administração & dosagem , Antibacterianos/química , Bacillus subtilis/química , Proteínas de Bactérias/antagonistas & inibidores , Proteínas de Bactérias/genética , Biofilmes/efeitos dos fármacos , Permeabilidade da Membrana Celular/efeitos dos fármacos , Meios de Cultura/química , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Testes de Sensibilidade Microbiana , Osteomielite/tratamento farmacológico , Percepção de Quorum , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética
9.
Front Immunol ; 12: 651515, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33815412

RESUMO

Staphylococcus aureus is the predominant pathogen causing osteomyelitis. Unfortunately, no immunotherapy exists to treat these very challenging and costly infections despite decades of research, and numerous vaccine failures in clinical trials. This lack of success can partially be attributed to an overreliance on murine models where the immune correlates of protection often diverge from that of humans. Moreover, S. aureus secretes numerous immunotoxins with unique tropism to human leukocytes, which compromises the targeting of immune cells in murine models. To study the response of human immune cells during chronic S. aureus bone infections, we engrafted non-obese diabetic (NOD)-scid IL2Rγnull (NSG) mice with human hematopoietic stem cells (huNSG) and analyzed protection in an established model of implant-associated osteomyelitis. The results showed that huNSG mice have increases in weight loss, osteolysis, bacterial dissemination to internal organs, and numbers of Staphylococcal abscess communities (SACs), during the establishment of implant-associated MRSA osteomyelitis compared to NSG controls (p < 0.05). Flow cytometry and immunohistochemistry demonstrated greater human T cell numbers in infected versus uninfected huNSG mice (p < 0.05), and that T-bet+ human T cells clustered around the SACs, suggesting S. aureus-mediated activation and proliferation of human T cells in the infected bone. Collectively, these proof-of-concept studies underscore the utility of huNSG mice for studying an aggressive form of S. aureus osteomyelitis, which is more akin to that seen in humans. We have also established an experimental system to investigate the contribution of specific human T cells in controlling S. aureus infection and dissemination.


Assuntos
Abscesso/imunologia , Osteólise/imunologia , Osteomielite/imunologia , Infecções Relacionadas à Prótese/imunologia , Infecções Estafilocócicas/imunologia , Abscesso/microbiologia , Abscesso/patologia , Animais , Modelos Animais de Doenças , Feminino , Transplante de Células-Tronco Hematopoéticas , Humanos , Camundongos , Osteólise/microbiologia , Osteólise/patologia , Osteomielite/microbiologia , Osteomielite/patologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/patologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/patologia , Staphylococcus aureus/imunologia , Quimeras de Transplante/imunologia
10.
Pan Afr Med J ; 38: 106, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33912276

RESUMO

Cemento-osseous dysplasia is a benign fibro-osseous lesion affecting the alveolar bone. It is classified into three forms: periapical, focal or florid dysplasia. It is often asymptomatic and fortuitously discovered during a routine radiological examination. However, it may become symptomatic after superinfection, after patient's exposure to oral bacterial flora. We here report a case of florid cemento-osseous dysplasia associated with actinomycosis of bone in a 53-year-old Tunisian woman. This superinfection has been rarely reported in the literature; Boolean Searching on PubMed for the keywords "cemento-osseous dysplasia AND actinomyces" displays a single article (Smith et al. 2011). The treatment of actinomycosis infection often requires long-term antibiotic therapy, sometimes associated with surgical debridement, as in the case of this patient who underwent piezosurgery to treat dysplasia and necrotic bone.


Assuntos
Actinomicose/diagnóstico , Displasia Fibrosa Óssea/diagnóstico , Osteomielite/diagnóstico , Piezocirurgia/métodos , Actinomyces/isolamento & purificação , Actinomicose/microbiologia , Actinomicose/cirurgia , Feminino , Displasia Fibrosa Óssea/microbiologia , Displasia Fibrosa Óssea/cirurgia , Humanos , Pessoa de Meia-Idade , Osteomielite/microbiologia , Osteomielite/cirurgia , Radiografia , Superinfecção/diagnóstico , Superinfecção/microbiologia
11.
Animal Model Exp Med ; 4(1): 59-70, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33738438

RESUMO

Infection of bone tissue, or osteomyelitis, has become a growing concern in modern healthcare due in no small part to a rise in antibiotic resistance among bacteria, notably Staphylococcus aureus. The current standard of care involves aggressive, prolonged antibiotic therapy combined with surgical debridement of infected tissues. While this treatment may be sufficient for resolving a portion of cases, recurrences of the infection and associated risks including toxicity with long-term antibiotic usage have been reported. Therefore, there exists a need to produce safer, more efficacious options of treatment for osteomyelitis. In order to test treatment regimens, animal models that closely mimic the clinical condition and allow for accurate evaluation of therapeutics are necessary. Establishing a model that replicates features of osteomyelitis in humans continues to be a challenge to scientists, as there are many variables involved, including choosing an appropriate species and method to establish infection. This review addresses the refinement of animal models of osteomyelitis to reflect the clinical disease and test prospective therapeutics. The aim of this review is to explore studies regarding the use of animals for osteomyelitis therapeutics research and encourage further development of such animal models for the translation of results from the animal experiment to human medicine.


Assuntos
Modelos Animais de Doenças , Osteomielite/etiologia , Animais , Osso e Ossos/lesões , Osteomielite/microbiologia , Próteses e Implantes/efeitos adversos , Infecções Estafilocócicas/patologia , Staphylococcus aureus/crescimento & desenvolvimento
13.
Ann Clin Microbiol Antimicrob ; 20(1): 14, 2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33639961

RESUMO

BACKGROUND: HACEK (Haemophilus spp., Aggregatibacter spp., Cardiobacterium spp., Eikenella corrodens, and Kingella spp.) group organisms are responsible for 0.8% to 6% of all infective endocarditis cases, with Cardiobacterium spp. being the third most commonly implicated HACEK microorganism. Within this genus is Cardiobacterium valvarum (C. valvarum), a novel organism described in 2004. To date, only 15 cases of C. valvarum infection have been reported in the English-language literature, and have primarily been cases of infective endocarditis in patients with valvular disease. C. valvarum has not been reported to cause infections spreading to the surrounding bone. CASE PRESENTATION: We present a case of a 57-year-old man with a history of aortic dissection followed by aortic endograft replacement who presented with back pain. He was found to have radiographic evidence of an infected aortic endograft, along with vertebral osteomyelitis, discitis, and epidural phlegmon. Blood cultures identified C. valvarum as the causative organism. The patient was treated with ceftriaxone and surgical intervention was deferred due to the patient's complex anatomy. His course was complicated by septic cerebral emboli resulting in cerebrovascular accident. CONCLUSIONS: This case report highlights C. valvarum, a rare and emerging HACEK group microorganism that warrants consideration in high-risk patients with evidence of subacute infection and disseminated disease. While C. valvarum classically presents as infective endocarditis, extra-cardiac manifestations have also been described. As demonstrated in this case, endograft involvement and osteomyelitis may occur in rare circumstances.


Assuntos
Cardiobacterium , Endocardite Bacteriana/microbiologia , Osteomielite/microbiologia , Antibacterianos/uso terapêutico , Aorta , Aorta Torácica/microbiologia , Aorta Torácica/cirurgia , Endocardite , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Transplantes
14.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526521

RESUMO

Vertebral osteomyelitis is an infection of the vertebrae that can lead to spinal degeneration, most commonly caused by Staphylococcus aureus Here, we report an unusual case of pyogenic osteomyelitis caused by Gardnerella vaginalis and Streptococcus parasanguinis in a 61-year-old postmenopausal woman. The patient presented with a 2-week history of worsening lower back pain and fever and a recent episode of cystitis following re-engagement of sexual activity. Imaging revealed a deterioration of vertebrae discs and spinal canal stenosis at the L3-L4 levels with a formation of abscess in the right psoas muscle. Needle aspiration of the abscess identified G. vaginalis and S. parasanguinis and the patient was successfully treated with a 6-week course of ceftriaxone and metronidazole. This case describes an unusual coinfection of two pathogens that normally reside in the urogenital tract and oral cavity, respectively, and highlights the risk posed when these organisms breach the body's normal barriers.


Assuntos
Discite/microbiologia , Gardnerella vaginalis/isolamento & purificação , Vértebras Lombares , Osteomielite/microbiologia , Abscesso do Psoas/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Antibacterianos/uso terapêutico , Técnicas de Cultura , Discite/diagnóstico por imagem , Discite/tratamento farmacológico , Discite/fisiopatologia , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Osteomielite/fisiopatologia , Pós-Menopausa , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/tratamento farmacológico , Estenose Espinal/fisiopatologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico
16.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547128

RESUMO

Awareness of rare differential diagnoses of common clinical presentations helps promote early detection and prompt management of serious conditions. A 54-year-old man, with an infected non-union following a high tibial osteotomy, presented with an acutely discharging abscess to his proximal tibia. He was generally unwell with a Staphylococcus aureus bacteraemia. The tibia was debrided, CERAMENT G used as dead space management and a spanning external fixator applied. Postoperatively, pregabalin and tapentadol were commenced in addition to amitriptyline and sertraline, which the patient was taking regularly. Overnight, the patient developed hyperthermia, inducible clonus, hyperreflexia, agitation, confusion and rigors. Prompt recognition of the possibility of serotonin syndrome resulted in early cessation of serotonergic medications and a positive outcome. From this case an important message is that fever in a patient taking serotonergic medications should prompt a screening neurological examination. Clinicians should also be wary when patients are commenced on multimodal analgesia, including tapentadol.


Assuntos
Analgésicos Opioides/efeitos adversos , Osteomielite/microbiologia , Síndrome da Serotonina/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Tapentadol/efeitos adversos , Bacteriemia/microbiologia , Desbridamento , Diagnóstico Diferencial , Febre , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/cirurgia , Osteotomia , Infecções Estafilocócicas/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Tíbia/cirurgia
17.
Khirurgiia (Mosk) ; (2): 84-87, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570360

RESUMO

Acute hematogenous osteomyelitis (AHO) in adults is a rare disease complicating timely diagnosis. Even greater difficulties are observed in case of pelvic bone lesion. The authors report AHO of the pelvis an adult. Osteomyelitis was complicated by generalized infection and multiple pyogenic abscesses in subcutaneous adipose tissue of the upper and lower extremities. Detection of primary infectious focus was complicated by extreme severity of the patient's condition and low informative value of X-ray and ultrasound at the early stage of disease. Staphylococcus aureus was obtained from blood culture and infectious foci. Surgical debridement along with complex intensive care ensured a positive outcome.


Assuntos
Abscesso , Osteomielite , Ossos Pélvicos , Infecções Estafilocócicas , Abscesso/diagnóstico , Abscesso/etiologia , Abscesso/microbiologia , Abscesso/terapia , Doença Aguda , Adulto , Antibacterianos/uso terapêutico , Desbridamento , Extremidades/microbiologia , Humanos , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/microbiologia , Osteomielite/terapia , Ossos Pélvicos/microbiologia , Ossos Pélvicos/cirurgia , Pelve/diagnóstico por imagem , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapia , Staphylococcus aureus/isolamento & purificação , Gordura Subcutânea/microbiologia
18.
J Laryngol Otol ; 135(3): 217-223, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33593449

RESUMO

OBJECTIVE: This study aimed to describe the clinical presentation, microbiological profile and management of complications of bone wax usage for surgical procedures at the skull base. METHOD: The case records of a series of five patients who developed post-operative surgical site complications because of bone wax usage during skull base surgery were reviewed. RESULTS: In all five patients, persistent site-specific clinical features were noted along with intra-operative presence of excessive bone wax. Three unique cases of presentation, one with a fungal brain abscess because of Aspergillus flavus infection, another with fungal osteomyelitis because of Trichosporon beigelii infection and a third with intradural migration of bone wax into the cerebellopontine angle cistern are highlighted. CONCLUSION: The presentation of surgical site infection at the skull base because of excessive use of bone wax can be manifold. The need for testing appropriate cultures including fungal culture is highlighted.


Assuntos
Osteomielite/microbiologia , Palmitatos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Base do Crânio/cirurgia , Infecção da Ferida Cirúrgica/microbiologia , Ceras/efeitos adversos , Adulto , Aspergilose/microbiologia , Aspergillus flavus , Basidiomycota , Abscesso Encefálico/microbiologia , Ângulo Cerebelopontino , Feminino , Migração de Corpo Estranho/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/microbiologia , Tricosporonose/microbiologia , Adulto Jovem
19.
Pediatrics ; 147(3)2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33563770

RESUMO

A previously healthy 15-year-old boy from a rural county in the southeastern United States was evaluated in the emergency department with fever and worsening toe pain in the absence of trauma. He initially presented to his primary care physician 4 weeks before with upper respiratory symptoms and was treated with corticosteroids for presumed reactive airway disease. His respiratory symptoms resolved. One week after this presentation, he developed fever and right great toe pain and presented to an outside hospital. Inflammatory markers were elevated. MRI confirmed a diagnosis of osteomyelitis with associated periosteal abscess. He was treated with intravenous antibiotics and drainage of the abscess. Ten days after his discharge from the outside hospital, he developed fever and had increasing drainage of the toe and pain refractory to oral pain medications. He presented to our facility for further evaluation. Repeat MRI and inflammatory markers corroborated his worsening disease, and he was admitted to the hospital for intravenous antibiotics and underwent serial surgical debridement. He developed painful subcutaneous nodules on his lower extremities and was found to have lung abnormalities on chest radiograph. A multispecialty team collaborated in the management of this patient and unveiled a surprising diagnosis.


Assuntos
Abscesso/microbiologia , Blastomicose/diagnóstico , Febre/microbiologia , Hallux , Osteomielite/microbiologia , Dor Intratável/etiologia , Doenças dos Trabalhadores Agrícolas/microbiologia , Amputação , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Blastomyces/isolamento & purificação , Blastomicose/complicações , Daptomicina/uso terapêutico , Progressão da Doença , Hallux/cirurgia , Humanos , Itraconazol/uso terapêutico , Masculino
20.
Artigo em Inglês | MEDLINE | ID: mdl-33533810

RESUMO

Osteomyelits due to concurrent multi-drug resistance organisms is difficult to treat for any surgeon and infectious disease physician. An eleven-year-old boy presenting with an open fracture of the left radius and ulna after a fall in a stagnant wet field. Despite prophylactic antibiotics and surgical intervention, the open wound was infected, and Chromobacterium violaceum as well as Klebsiella pneumoniae were isolated. He was treated with six weeks of parenteral cefepime and amikacin and was discharged upon clinical improvement. Unfortunately, chronic osteomyelitis set in with persistent sinus drainage. He then underwent a second procedure for debridement of the wound and Burkholderia pseudomallei was isolated. Parenteral antibiotic therapy was initiated progressing with a marked improvement. However, the long course of antibiotics had exhausted the patient and his family, leading to a premature interruption of the parenteral antibiotic. Despite the suboptimal antibiotic course, there were no signs of relapsed osteomyelitis during subsequent review. The timely surgical intervention with appropriate sampling for subsequent microorganism isolation guided the suitability of the treatment line.


Assuntos
Antibacterianos/uso terapêutico , Chromobacterium/isolamento & purificação , Klebsiella pneumoniae/isolamento & purificação , Osteomielite/tratamento farmacológico , Criança , Resistência a Múltiplos Medicamentos , Humanos , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/tratamento farmacológico , Masculino , Osteomielite/diagnóstico , Osteomielite/microbiologia , Resultado do Tratamento
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