Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.977
Filtrar
1.
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 , Imagem 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
2.
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
4.
Drug Dev Ind Pharm ; 47(2): 280-291, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33493022

RESUMO

Osteomyelitis is one of the infections of the bone, and the treatment needs to the infection problems. Here, a local therapeutic approach for efficient drug delivery systems was designed to enhance the antibiotic drug's therapeutic activity. Calcium-Alginate nanoparticle (Ca-Alg) crosslinked phosphorylated polyallylamine (PPAA) was prepared through the salting-out technique, and it achieved 82.55% encapsulation of Clindamycin drug. The physicochemical characterizations of FTIR, SEM/EDX, TEM, and XRD were investigated to confirm the materials nature and formation. Clindamycin loaded Ca-Alg/PPAA system showed sustained Clindamycin release from the carrier. Cell viability was assessed in bone-related cells by Trypan blue assay and MTT assay analysis method. Both assay results exhibited better cell viability of synthesized materials against MG63 cells. MIC value of Ca-Alg/PPAA/Clindamycin in the Methicillin-resistant Staphylococcus aureus (MRSA) pathogen was 275 µg/mL, and it was 120 µg/mL for Enterobacter cloacae pathogen. The materials promising material for Osteomyelitis affected bone regeneration without any destructive effect and speedy recovery of infected parts from these investigations.


Assuntos
Clindamicina/química , Staphylococcus aureus Resistente à Meticilina , Nanopartículas , Osteomielite , Poliaminas/química , Infecções Estafilocócicas , Staphylococcus aureus/química , Alginatos/uso terapêutico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Clindamicina/administração & dosagem , Preparações de Ação Retardada/uso terapêutico , Humanos , Osteomielite/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico
5.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(6): 1140-1145, 2020 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-33331328

RESUMO

A case of chronic multifocal osteomyelitis was described in terms of its clinical manifestations, serological and imaging examinations, diagnostic criteria, treatment options, and follow-up evaluation after discharge. The pathogenesis, diagnosis, differential diagnosis and treatment of chronic multifocal osteomyelitis were reviewed, and the characteristics of autoinflammatory osteopathy were reviewed. The patient with onset from youth had developed severe skin lesions, progressive arthralgia and rachialgia. The clinical manifestation and the auxiliary examination of the patient accorded with the diagnosis of chronic multifocal osteomyelitis. After poor anti-inflammatory and analgesic effects, the switch to tumor necrosis factor alpha (TNF-α) inhibitor resulted in pain relief, normalization of inflammation indexes, and significant improvement in rash and imaging examination. Chronic recurrent multifocal osteomyelitis was a kind of autoinflammatory bone disease of multiple genes in disease with low incidence, unknown mechanism and unified diagnostic criteria. It was also known as chronic nonbacterial osteomyelitis, which was a rare, noninfectious inflammatory disorder that caused multifocallytic bone lesions characterized by periodic exacerbations and remissions. The exact pathophysiology or mechanism of the sterile bone inflammation was poorly understood, although chronic nonbacterial osteomyelitis was probably an osteoclast-mediated disease. In addition, an imbalance between pro- and anti-inflammatory cytokines was suspected to play a role. The available data so far pointed to the interplay among genetics, environmental, and immunologic factors as the causes of chronic nonbacterial osteomyelitis. Infectious etiology did not seem to play a crucial role in the pathogenesis of chronic nonbacterial osteomyelitis. It was often confused with metabolic bone disease, infection, tumor and other diseases. Its clinical manifestations were bone pain, fever, rash, fracture and so on. Laboratory examination showed significant increase in inflammatory markers. Radiographic examination revealed osteolytic or sclerosing changes. Magnetic resonance imaging was very useful for identifying bone lesions and tissue edema and was more accurate than bone emission computed tomography (ECT). Most of the patients begin to use non-steroidal anti-inflammatory drugs (NSAIDs) for treatment, but they are prone to relapse and new lesions appear. Other treatment options can be selected, including glucocorticoids, TNF-α inhibitors, bisphosphonates, methotrexate and other disease-modifying anti-rheumatic drugs (DMARDs). Early diagnosis and treatment can prevent and reduce complications and improve prognosis.


Assuntos
Osteomielite , Tomografia Computadorizada por Raios X , Adolescente , Anti-Inflamatórios não Esteroides/uso terapêutico , Doença Crônica , Humanos , Imagem por Ressonância Magnética , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico
6.
BMJ Case Rep ; 13(12)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33372019

RESUMO

A 71-year-old man presented with a 3-month history of low back pain radiating to his right hip and thigh associated with lower limb weakness and constitutional symptoms. Imaging confirmed a lumbosacral spondylodiscitis at L2-3 and L5-S1 as well as a right-side psoas abscess which was treated with urgent CT-guided drainage and intravenous antibiotics. His admission was complicated by a number of issues, including the development of osteomyelitis with vertebral body destruction at multiple sites, epidural abscess formation and deep vein thrombosis. Additionally, the patient developed severe sepsis which necessitated admission to the intensive care unit. The patient's clinical condition improved gradually with intravenous antibiotics until he was well enough for transfer to a rehabilitation centre, where he underwent regular occupational and physical therapy. Repeat imaging showed overall resolution of the aforementioned pathologies and is currently being followed up by the spinal surgeons on an outpatient basis.


Assuntos
Discite/complicações , Abscesso Epidural/complicações , Vértebras Lombares , Osteomielite/complicações , Sacro , Sepse/complicações , Infecções Estafilocócicas/complicações , Idoso , Antibacterianos/uso terapêutico , Discite/diagnóstico por imagem , Drenagem , Abscesso Epidural/diagnóstico , Abscesso Epidural/tratamento farmacológico , Humanos , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Abscesso do Psoas/complicações , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/tratamento farmacológico , Sacro/diagnóstico por imagem , Sepse/diagnóstico , Sepse/tratamento farmacológico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Tomografia Computadorizada por Raios X , Trombose Venosa
7.
Bone Joint J ; 102-B(11): 1587-1596, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135450

RESUMO

AIMS: This study presents patient-reported quality of life (QoL) over the first year following surgical debridement of long bone osteomyelitis. It assesses the bone involvement, antimicrobial options, coverage of soft tissues, and host status (BACH) classification as a prognostic tool and its ability to stratify cases into 'uncomplicated' or 'complex'. METHODS: Patients with long-bone osteomyelitis were identified prospectively between June 2010 and October 2015. All patients underwent surgical debridement in a single-staged procedure at a specialist bone infection unit. Self-reported QoL was assessed prospectively using the three-level EuroQol five-dimension questionnaire (EQ-5D-3L) index score and visual analogue scale (EQ-VAS) at five postoperative time-points (baseline, 14 days, 42 days, 120 days, and 365 days). BACH classification was applied retrospectively by two clinicians blinded to outcome. RESULTS: In total, 71 patients with long-bone osteomyelitis were included. There was significant improvement from time of surgery to one year postoperatively in mean EQ-VAS (58.2 to 78.9; p < 0.001) and mean EQ-5D-3L index scores (0.284 to 0.740; p < 0.001). At one year following surgery, BACH 'uncomplicated' osteomyelitis was associated with better QoL compared to BACH 'complex' osteomyelitis (mean EQ-5D-3L 0.900 vs 0.685; p = 0.020; mean EQ-VAS 87.1 vs 73.6; p = 0.043). Patients with uncomplicated bone involvement (BACH type B1, cavitary) reported higher QoL at all time-points when compared to complex bone involvement (B2, segmental or B3, osteomyelitis involving a joint). Patients with good antimicrobial options (Ax or A1) gave higher outcome scores compared to patients with multidrug-resistant isolates (A2). The need for microvascular tissue transfer (C1 and C2) did not impact significantly on QoL. Patients without major comorbidities (uncomplicated, H1) reported higher QoL compared to those with significant disease (complex, H2). CONCLUSION: Uncomplicated osteomyelitis, as defined by BACH, gave higher self-reported QoL when compared to complex cases. The bone involvement, antimicrobial options, and host status variables were able to stratify patients in terms of QoL. These data can be used to offer prognostic information to patients who are undergoing treatment for long bone osteomyelitis. Cite this article: Bone Joint J 2020;102-B(11):1587-1596.


Assuntos
Osteomielite/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Osteomielite/cirurgia , Medidas de Resultados Relatados pelo Paciente , Prognóstico , Qualidade de Vida , Medição de Risco , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
9.
Nat Commun ; 11(1): 4446, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32895387

RESUMO

Owing to the poor penetration depth of light, phototherapy, including photothermal and photodynamic therapies, remains severely ineffective in treating deep tissue infections such as methicillin-resistant Staphylococcus aureus (MRSA)-infected osteomyelitis. Here, we report a microwave-excited antibacterial nanocapturer system for treating deep tissue infections that consists of microwave-responsive Fe3O4/CNT and the chemotherapy agent gentamicin (Gent). This system, Fe3O4/CNT/Gent, is proven to efficiently target and eradicate MRSA-infected rabbit tibia osteomyelitis. Its robust antibacterial effectiveness is attributed to the precise bacteria-capturing ability and magnetic targeting of the nanocapturer, as well as the subsequent synergistic effects of precise microwaveocaloric therapy from Fe3O4/CNT and chemotherapy from the effective release of antibiotics in infection sites. The advanced target-nanocapturer of microwave-excited microwaveocaloric-chemotherapy with effective targeting developed in this study makes a major step forward in microwave therapy for deep tissue infections.


Assuntos
Nanopartículas de Magnetita/uso terapêutico , Micro-Ondas/uso terapêutico , Osteomielite/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Animais , Antibacterianos/uso terapêutico , Sistemas de Liberação de Medicamentos/métodos , Tratamento Farmacológico/métodos , Óxido Ferroso-Férrico/uso terapêutico , Gentamicinas/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Nanotubos de Carbono , Osteomielite/microbiologia , Coelhos
10.
Br J Community Nurs ; 25(8): 376-380, 2020 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-32772722

RESUMO

There has been a surging interest in using elastomeric infusion devices to deliver outpatient parenteral antimicrobial therapy (OPAT), which is more cost-effective than standard antibiotic administration, which requires multiple daily home visits. This has been particularly important since the outbreak of the coronavirus pandemic, because reducing patient contact can also help to minimise transmission of COVID-19 to outpatients who are at a high risk of COVID-19-triggered complications. In this retrospective study, the clinical effectiveness of intravenous (IV) infusion of flucloxacillin using an elastomeric device was explored in a convenience sample of patients. Patients with three primary infective diagnoses-bloodstream infection, non-vertebral osteomyelitis and vertebral osteomyelitis-were included in the analyses. In non-vertebral osteomyelitis patients, Accufuser antibiotic infusion shortened the course of OPAT care relative to standard antibiotic administration (p<.05). In contrast, in vertebral osteomyelitis patients, it prolonged the course of OPAT care relative to standard administration (p<.05). In patients with bloodstream infections, no significant difference was found between the treatment modes (p=.93). Thus, the clinical effectiveness of Accufuser antibiotic infusion varies among patients with different infective diagnoses, and there seems to be a complex relationship between the method of antibiotic delivery and the patient's condition.


Assuntos
Antibacterianos/administração & dosagem , Bacteriemia/tratamento farmacológico , Enfermagem em Saúde Comunitária/métodos , Floxacilina/administração & dosagem , Terapia por Infusões no Domicílio/métodos , Bombas de Infusão , Osteomielite/tratamento farmacológico , Doenças da Coluna Vertebral/tratamento farmacológico , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/métodos , Elastômeros , Humanos , Infusões Intravenosas/instrumentação , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Estudos Retrospectivos
11.
Artigo em Inglês | MEDLINE | ID: mdl-32771415

RESUMO

OBJECTIVE: This study aimed to assess the clinical effectiveness of using pamidronate disodium to treat patients with diffuse sclerosing osteomyelitis of the mandible (DSOM ). STUDY DESIGN: Patients with DSOM who were hospitalized in the Department of Oral and Maxillofacial Surgery, Peking University Hospital of Stomatology (Beijing, China), between March 2018 and March 2019 were included. All patients were treated with intravenous administration of pamidronate disodium for 3 days. Pain intensity, mouth opening, blood workup findings, imaging examination findings, and incidence of complications before and after treatment and during the follow-up period, were recorded and compared. RESULTS: Forty-three patients were treated with pamidronate disodium. Adverse reactions, including fever, hypocalcemia, hypokalemia, and diarrhea, were observed during treatment. Fourteen patients had moderate to severe pain before treatment, and the pain was markedly alleviated after days 2 and 3 of treatment. Pain and swelling were found to have disappeared at the 6-month follow-up in 39 patients (90.7%). Mean mouth opening increased from 28.5 mm to 38.1 mm. Imaging examinations showed that the bone mass in the affected area had markedly improved in 32 patients (74.4%). CONCLUSIONS: Pamidronate disodium alleviated pain and swelling and improved mouth opening in patients with DSOM. Follow-up after 6 to 18 months demonstrated stable treatment effectiveness.


Assuntos
Difosfonatos , Osteomielite , China , Difosfonatos/uso terapêutico , Humanos , Mandíbula , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Pamidronato
12.
Int J Nanomedicine ; 15: 5855-5871, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32848394

RESUMO

Purpose: Osteomyelitis, particularly chronic osteomyelitis, remains a major challenge for orthopedic surgeons. The traditional treatment for osteomyelitis, which involves antibiotics and debridement, does not provide a complete solution for infection and bone repair. Antibiotics such as vancomycin (VCM) are commonly used to treat osteomyelitis in clinical settings. VCM use is limited by a lack of effective delivery methods that provide sustained, high doses to entirely fill irregular bone tissue to treat infections. Methods: We engineered a chitosan (CS)-based thermosensitive hydrogel to produce a VCM-nanoparticle (NPs)/Gel local drug delivery system. The VCM-NPs were formed with quaternary ammonium chitosan and carboxylated chitosan nanoparticles (VCM-NPs) by positive and negative charge adsorption to enhance the encapsulation efficiency and drug loading of VCM, with the aim of simultaneously preventing infection and repairing broken bones. This hydrogel was evaluated in a rabbit osteomyelitis model. Results: The VCM-NPs had high encapsulation efficiency and drug loading, with values of 60.1±2.1% and 24.1±0.84%, respectively. When embedded in CS-Gel, the VCM-NPs maintained their particle size and morphology, and the injectability and thermosensitivity of the hydrogel, which were evaluated by injectability test and rheological measurement, were retained. The VCM-NPs/Gel exhibited sustained release of VCM over 26 days. In vitro tests revealed that the VCM-NPs/Gel promoted osteoblast proliferation and activity against Staphylococcus aureus. In vivo, VCM-NPs/Gel (with 10 mg vancomycin per rabbit) was used to treat rabbits with osteomyelitis. The VCM-NPs/Gel showed excellent anti-infection properties and accelerating bone repair under osteomyelitis conditions. Conclusion: The reported multifunctional NPs hydrogel system for local antibiotic delivery (VCM-NPs/Gel) showed bone regeneration promotion and anti-infection properties, demonstrating significant potential as a scaffold for effective treatment of osteomyelitis.


Assuntos
Antibacterianos/administração & dosagem , Hidrogéis/química , Nanopartículas/administração & dosagem , Osteomielite/tratamento farmacológico , Vancomicina/administração & dosagem , Animais , Antibacterianos/farmacocinética , Proliferação de Células/efeitos dos fármacos , Quitosana/química , Modelos Animais de Doenças , Sistemas de Liberação de Medicamentos , Hidrogéis/administração & dosagem , Hidrogéis/farmacologia , Injeções , Masculino , Nanopartículas/química , Osteoblastos/efeitos dos fármacos , Osteoblastos/microbiologia , Tamanho da Partícula , Coelhos , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Vancomicina/farmacocinética
13.
Orthopade ; 49(8): 702-709, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32671414

RESUMO

BACKGROUND: The high demands that fracture-related infections put on patients, physicians and the healthcare system have led to the establishment of a international group of experts called the Fracture-Related Infection (FRI) Consensus Group, whose aim is to develop evidence-based treatment recommendations. DIAGNOSIS: Fracture-related infections are classified according to the time of occurrence, extent and treatment options. The diagnostic algorithm distinguishes between confirmatory and suggestive diagnostic criteria. If there are indications of an infection, tissue biopsy with microbiological and histological workup is recommended to confirm the diagnosis. THERAPY: The primary objective of FRI treatment is to achieve fracture consolidation, while avoiding osteomyelitis. Therapeutic options are removal of the implant, eradication of the infection with implant retention or suppression of FRI. A multidisciplinary team is recommended to develop a patient-specific, optimized surgical and antimicrobial therapy.


Assuntos
Antibacterianos/uso terapêutico , Desbridamento/métodos , Fraturas Ósseas/complicações , Fraturas Ósseas/cirurgia , Osteomielite/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/terapia , Algoritmos , Biofilmes , Fraturas Ósseas/microbiologia , Humanos , Osteomielite/diagnóstico , Osteomielite/microbiologia , Complicações Pós-Operatórias/terapia , Infecção da Ferida Cirúrgica/microbiologia , Traumatologia
14.
Int J Oral Maxillofac Surg ; 49(12): 1595-1598, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32680809

RESUMO

Chronic non-bacterial osteomyelitis (CNO) is a rare and difficult-to-diagnose disease, especially when limited to the jaws. We report the case of a 5-year-old girl with spontaneous jaw pain and a large pre-auricular facial swelling overlying the angle of the mandible that was non-responsive to previous antibiotic and non-steroidal anti-inflammatory treatment. The diagnosis was confirmed as CNO following evaluation and workup by a multidisciplinary team. The patient exhibited a favourable response to oral alendronate sodium plus vitamin D3 combination treatment. We believe that alendronate sodium is an effective second-line drug for CNO.


Assuntos
Alendronato , Osteomielite , Administração Oral , Pré-Escolar , Colecalciferol/uso terapêutico , Feminino , Humanos , Mandíbula , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico
15.
BMC Infect Dis ; 20(1): 438, 2020 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-32571233

RESUMO

BACKGROUND: Candida sp. osteoarticular infection is rare and most often due to hematogenous seeding during an episode of candidemia in immunocompromised patients. However, the diagnosis can be delayed in patients with subtle symptoms and signs of joint infection without a concurrent episode of candidemia. CASE PRESENTATION: A 75-year-old woman presented with a three-year history of pain and swelling of the left knee. Candida pelliculosa was detected from the intraoperative tissue when the patient had undergone left total knee arthroplasty 32 months ago, but no antifungal treatment was performed. One year after the total knee arthroplasty, C. pelliculosa was repeatedly isolated from the left knee synovial fluid and antifungal treatment comprising amphotericin B deoxycholate and fluconazole was administered. However, joint infection had extended to the adjacent bone and led to progressive joint destruction. The patient underwent surgery for prosthesis removal and received prolonged antifungal treatment with micafungin and fluconazole. CONCLUSIONS: This case shows that C. pelliculosa, an extremely rare non-Candida albicans sp., can cause fungal arthritis and lead to irreversible joint destruction owing to delayed diagnosis and treatment.


Assuntos
Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Candida/patogenicidade , Candidíase/microbiologia , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Candida/isolamento & purificação , Candidemia/tratamento farmacológico , Candidemia/etiologia , Candidíase/tratamento farmacológico , Ácido Desoxicólico/uso terapêutico , Remoção de Dispositivo , Combinação de Medicamentos , Feminino , Fluconazol/uso terapêutico , Humanos , Cuidados Intraoperatórios , Prótese Articular , Joelho/microbiologia , Joelho/cirurgia , Micafungina/uso terapêutico , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia
16.
BMC Infect Dis ; 20(1): 399, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503446

RESUMO

BACKGROUND: Disseminated cryptococcosis is a well-characterized complication in immunocompromised patients with cryptococcal pneumonia or meningitis; however, isolated cryptococcal osteomyelitis is a rare entity that occurs in approximately 5% of patients with cryptococcosis. Cryptococcal osteomyelitis in the head and neck region is extremely rare. To the best of our knowledge, no cases of cryptococcal osteomyelitis affecting only the zygomatic bone have been reported to date. CASE PRESENTATION: A 78-year-old man without other comorbidities presented with progressive swelling of the right cheek along with pain and trismus. Clinical examination revealed a tender swelling in the right zygomatic region; the maximal mandibular opening was about 2 cm. Laboratory data showed mildly elevated inflammatory indices (C-reactive protein: 0.45 mg/dL; erythrocyte sedimentation rate: 35 mm/h). Computed tomography showed a 30-mm-diameter lesion at the right zygomatic arch. A part of the lesion has extended to the subcutaneous area of the cheeks with signs of bone destruction and surrounding contrast effects. Histopathological examination of fine-needle aspirate and needle biopsy showed cryptococcus. Furthermore, culture of the aspirate showed growth of Cryptococcus neoformans. No evidence of any other site involvement was observed. Therefore, the patient was diagnosed with isolated cryptococcal osteomyelitis and was initiated on fluconazole therapy. The treatment was effective, and all symptoms were resolved in 4 weeks. Fluconazole therapy was stopped after 6 months. There are no signs of recurrence as of 15-month follow-up. The patient has no cosmetic abnormalities or sequelae. CONCLUSIONS: Fine-needle aspiration cytology, needle biopsy, and fungal culture were useful for definitive diagnosis. Immunocompetent patients with isolated osteomyelitis may be cured with oral fluconazole alone.


Assuntos
Cryptococcus neoformans/isolamento & purificação , Osteomielite/diagnóstico , Idoso , Antifúngicos/uso terapêutico , Biópsia por Agulha Fina , Fluconazol/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Masculino , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Tomografia Computadorizada por Raios X , Zigoma/diagnóstico por imagem , Zigoma/patologia
17.
Scand J Rheumatol ; 49(4): 312-322, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32484386

RESUMO

OBJECTIVE: This is the first randomized double-blinded, placebo-controlled pilot trial to investigate the efficacy of pamidronate in reducing radiological and clinical disease activity in chronic non-bacterial osteomyelitis (CNO). METHOD: Patients received pamidronate or placebo at baseline and weeks 12 and 24. Whole-body magnetic resonance imaging was performed at baseline and weeks 12 and 36, and computed tomography of the anterior chest wall (ACW) at baseline and week 36. Radiological disease activity was systematically scored in the ACW and spine. Patient-reported outcomes [visual analogue scale (VAS) pain, VAS global health, Health Assessment Questionnaire (HAQ), EuroQol-5 Dimensions (EQ-5D), and 36-item Short-Form Health Survey (SF-36)] and biomarkers of bone turnover and inflammation were assessed at baseline and weeks 1, 4, 12, 24, and 36. Data are expressed as median [interquartile range]. RESULTS: Fourteen patients were randomized and 12 were analysed. From baseline to week 36, the radiological disease activity score in the ACW decreased from 5 [4-7] to 2.5 [1-3] in the pamidronate group, but did not change in the placebo group (p = 0.04). From baseline to week 36, VAS pain and VAS global health tended to decrease more in the pamidronate than in the placebo group (p = 0.11, p = 0.08). Physical functioning (HAQ) and health-related quality of life (EQ-5D, SF-36) did not change. Biomarkers of bone turnover decreased only in the pamidronate group (p ≤ 0.02). CONCLUSION: Pamidronate may improve radiological and clinical disease activity in CNO. Methods to score radiological disease activity in adult CNO were suggested. Clinical Trials: NCT02594878.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Osteomielite/tratamento farmacológico , Pamidronato/uso terapêutico , Coluna Vertebral/efeitos dos fármacos , Parede Torácica/efeitos dos fármacos , Adulto , Biomarcadores/sangue , Conservadores da Densidade Óssea/farmacologia , Remodelação Óssea/efeitos dos fármacos , Método Duplo-Cego , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteomielite/sangue , Osteomielite/diagnóstico por imagem , Pamidronato/farmacologia , Medidas de Resultados Relatados pelo Paciente , Projetos Piloto , Coluna Vertebral/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Imagem Corporal Total , Adulto Jovem
18.
Medicine (Baltimore) ; 99(22): e20375, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481422

RESUMO

INTRODUCTION: The prevalence of diabetes continues to rise around the world. Diabetic foot is a serious complication of diabetes, and diabetic patients with diabetic foot osteomyelitis (DFO) have a fourfold increased risk of amputation, usually indicating death. Therefore, it is particularly important to seek a more effective treatment for DFO. The treatment of DFO varies from person to person, and antimicrobial therapies vary widely. A large number of clinical studies have shown that rifampicin adjuvant therapy can reduce the rate of amputation and mortality in DFO patients. However, there is no systematic summary of clinical evidence, which limits the clinical application of rifampicin. Therefore, we attempted to provide high-quality evidence for the clinical efficacy and safety of rifampin in the adjuvant treatment of DFO through this meta-analysis. METHODS: English literature is mainly searched in Cochrane Library, PubMed, EMBASE and Web of Science, while Chinese literature is from CNKI, CBM, VIP and Wangfang databases. At the same time, we will search clinical registration tests and gray literature. Two methodologically trained researchers will read the title, abstract, and full text, and independently select qualified literature based on inclusion and exclusion criteria. Binary data is expressed as relative risk, continuous data is expressed as mean difference or standard mean difference. The final data are synthesized using a fixed effect model or a random effect model, depending on the presence of heterogeneity. In the end, the patient's amputation rate and mortality were the main research indicators. Survival rate, HbA1c, serum creatinine, changes in ulcer area, and SF-36 quality of life assessment were used as secondary indicators. We will perform a sensitivity analysis to assess the stability of the results. Then the publication bias was evaluated by funnel plot analysis and Egger test. Finally, we will use a "recommendation grading, evaluation, formulation and evaluation" system to assess the quality of the evidence. All data analysis will be meta-analyzed by the statistical software RevMan software version 5.3. RESULTS: This study will provide a high-quality comprehensive report on the effectiveness and safety of rifampicin in the treatment of DFO, and our findings will be published in peer-reviewed journals. CONCLUSION: This systematic review and meta-analysis will provide a comprehensive summary and careful evaluation of rifampicin as an adjuvant treatment of DFO with a view to providing multiple options for clinical treatment of the disease. REGISTRATION NUMBER:: is INPLASY202040084.


Assuntos
Antibacterianos/uso terapêutico , Pé Diabético/tratamento farmacológico , Osteomielite/tratamento farmacológico , Rifampina/uso terapêutico , Adjuvantes Farmacêuticos/uso terapêutico , Pé Diabético/complicações , Humanos , Osteomielite/etiologia
19.
J Infect Chemother ; 26(8): 843-846, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32402735

RESUMO

Mycobacterium chelonae is a rapidly growing mycobacterium that has the potential to cause refractory infections in humans. Mycobacteremia resulting from the organism is extremely rare, and its clinical features are yet to be uncovered. We herein present a case of M. chelonae bloodstream infection involving an immunocompromised older patient. A 79-year-old woman, on a long-term treatment with prednisolone plus tacrolimus for rheumatoid arthritis, visited our outpatient department complaining of deteriorating pain and swelling at her right 1st toe. Laboratory parameters showed elevated C-reactive protein and leukocytosis, and magnetic resonance imaging indicated osteomyelitis at the proximal phalanx of her right 1st toe. Considering the refractory course, the infected toe was immediately amputated. M. chelonae was isolated from bacterial cultures of the resected tissue and blood (BD BACTEC™ FX blood culture system, Becton Dickinson, Sparks, MD, USA), leading to a diagnosis of disseminated M. chelonae infection. We treated the patient with an antibiotic combination of clarithromycin, minocycline, and imipenem (2 weeks), which was converted to oral therapy of clarithromycin, doxycycline, and levofloxacin. This case highlighted the potential pathogenesis of M. chelonae to cause mycobacteremia in an immunocompromised patient.


Assuntos
Bacteriemia/diagnóstico , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium chelonae/isolamento & purificação , Osteomielite/diagnóstico , Dedos do Pé/patologia , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Quimioterapia Combinada , Feminino , Humanos , Hospedeiro Imunocomprometido , Imagem por Ressonância Magnética , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/etiologia , Osteomielite/complicações , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Dedos do Pé/diagnóstico por imagem , Resultado do Tratamento
20.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(5): 651-655, 2020 May 15.
Artigo em Chinês | MEDLINE | ID: mdl-32410435

RESUMO

Objective: To review the progress of clinical diagnosis and treatment of chronic osteomyelitis in adults. Methods: The literature related to chronic osteomyelitis in recent years was extensively reviewed, and the clinical diagnosis and treatment methods were summarized. Results: Clinical characteristics and laboratory examination can help to diagnose chronic osteomyelitis in adults. Pathogenic identification is the basis for choosing antibiotics. Diagnostic imaging is specific. The treatment includes systemic treatment and local treatment, and the local treatment is the key to radical cure. Conclusion: The diagnosis of chronic osteomyelitis in adults should be made as early as possible. According to the anatomical and physiological classification of the patients, the appropriate treatment plan should be made.


Assuntos
Antibacterianos/uso terapêutico , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Adulto , Doença Crônica , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...