Pseudomonas aeruginosa necrotizing chondritis complicating high helical ear piercing case report: clinical and public health perspectives

Health risks for body pierced community: a systematic review

OBJECTIVE

Body piercing is defined as the penetration of jewellery into openings made in different body areas. In the last decades, it has become increasingly common in the general population. The aim is to analyse the available literature about complications from body piercing for contributing to raise the awareness towards this issue and to plan and perform appropriate prevention interventions.

STUDY DESIGN

This is a systematic review.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to perform this systematic review; the protocol was registered with PROSPERO [CRD42020177972]. PubMed, Scopus and Web of Science were searched from database inception to April 2020, and articles in English language reporting a proven association between piercings and health risks were included, and their quality were assessed by adequate quality assessment tools.

RESULTS

A total of 4748 studies were found, and after duplicates removal and screening, 84 articles were included. Studies dealing with microbiological effects reported these complications both locally and at distant sites as a result of the spreading of the primary site infection: mastitis, endocarditis, glomerulonephritis, cephalic tetanus, viral hepatitis, HIV, cerebellar brain abscess and toxic shock syndrome. In addition, bleeding, gingival recession, dental injuries, contact dermatitis, granulomatous dermatitis, keloid, fibroma and basal cell carcinoma were reported.

CONCLUSIONS

Health authorities should promote educational campaigns to spread the knowledge on health risks related to piercings. Besides, piercers are often not adequately aware of all the possible adverse effects due to piercings because their professional training differs among countries. It is therefore advisable to provide periodical upgrade of their education in this field.

The Best-Practice Organism for Single-Species Studies of Antimicrobial Efficacy against Biofilms Is Pseudomonas aeruginosa

As potable water scarcity increases across the globe; it is imperative to identify energy and cost-effective processes for producing drinking-water from non-traditional sources. One established method is desalination of brackish and seawater via reverse osmosis (RO). However, the buildup of microorganisms at the water-membrane interface, known as biofouling, clogs RO membranes over time, increasing energy requirements and cost. To investigate biofouling mitigation methods, studies tend to focus on single-species biofilms; choice of organism is crucial to producing useful results. To determine a best-practice organism for studying antimicrobial treatment of biofilms, with specific interest in biofouling of RO membranes, we answered the following two questions, each via its own semi-systematic review: 1. Which organisms are commonly used to test antimicrobial efficacy against biofilms on RO membranes? 2. Which organisms are commonly identified via genetic analysis in biofilms on RO membranes? We then critically review the results of two semi-systematic reviews to identify pioneer organisms from the listed species. We focus on pioneer organisms because they initiate biofilm formation, therefore, inhibiting these organisms specifically may limit biofilm formation in the first place. Based on the analysis of the results, we recommend utilizing Pseudomonas aeruginosa for future single-species studies focused on biofilm treatment including, but not limited to, biofouling of RO membranes.

[Pseudomonas aeruginosa in post-piercing perichondritis: Two case reports]

The frequency of body piercing has increased in France over the past few years, particularly among teenagers. Piercing can be performed at different sites on the body, especially in the cartilage of the ears. We relate two cases of Pseudomonas aeruginosa chondritis. A 10-year retrospective study at the Marseille University Hospital found no additional pediatric cases. These infectious complications can sometimes be necrotizing. It is therefore important to inform the medical staff on the hygiene measures that need to be respected and the patients on the treatment to follow after the piercing as well as the signs to watch for, possibly indicating chondritis. The esthetic consequences depend on early diagnosis.

Transcartilaginous ear piercing and infectious complications: a systematic review and critical analysis of outcomes

OBJECTIVES/HYPOTHESIS

The purpose of this systematic review was to critically analyze infectious complications and treatment following transcartilaginous ear piercing.

DATA SOURCES

MEDLINE Pubmed database.

REVIEW METHODS

A MEDLINE PubMed database search using free text, including "ear chondritis," "ear perichondritis," "ear cartilage piercing," and "auricle piercing," yielded 483 titles. Based on set inclusion and exclusion criteria, the titles, abstracts, and full text articles were reviewed for inclusion and underwent data extraction. Pooled outcomes are reported.

RESULTS

A total of 29 articles met inclusion criteria, including 66 patients. The mean age of the patients was 18.7 ± 7.6 years (range: 11-49), 87.5% female. Ear deformity was more likely to occur following postpiercing perichondritis of the scapha 100% versus the helix 43% (P = 0.003). Mean duration of symptoms prior to patients seeking medical attention was 6.1 ± 4.1 days. Greater than 5 days of symptoms prior to seeking treatment was significantly more likely to result in hospitalization. Pseudomonas aeruginosa accounted for 87.2% infections. Of the patients with Pseudomonas, 92.3% were hospitalized versus 75% of the patients infected with Staphylococcus aureus. Initial oral antibiotics prescribed did not target the cultured bacterium in 53.3% of cases; of these, 87.5% were hospitalized.

CONCLUSIONS

Transcartilaginous postpiercing infection may lead to ear deformity and hospitalization. Patients (customers) and practitioners must be aware of optimal treatment strategies to minimize associated morbidity. Scapha piercing and delay in presentation are associated with poorer outcomes. Pseudomonas is the most common bacterial infection. Initial antibiotic selection must be optimized accordingly.

Variety of complications after auricle piercing

BACKGROUND

Body piercing is a known and popular method of body ornamentation. Modern body piercing includes wearing jewelry in such body areas as the helix (ear), eyebrows, nose, lips, tongue, chin, nipples, navel, and genitals. The current piercing definition does not comprise piercing of the earlobe; however, this body area is still the most common on which jewelry is worn. The aim of this research is to present a spectrum of complications after auricle piercing and to consider including earlobe piercing in the modern definition of body piercing.

METHODS

Studied group consisted of 75 patients treated in the Department of Plastic, Reconstructive, and Aesthetic Surgery (Medical University of Lodz, Lodz, Poland) for complications after auricle piercing. Age of participants ranged from 7 to 62 years (mean age 23.7 years).

RESULTS

The most common complications in the examined group were post-traumatic tearing of the earlobe and keloid formation. Of all the patients with complications after auricle piercing, most had lesions located in earlobes; it seems that complications in earlobes are significantly more common than in the helix (P < 0.001).

CONCLUSIONS

The fashion of body piercing is not safe. Complications after earlobe piercing are similar to those occurring in other sites of the auricle after piercing. Moreover, due to its prevalence, complications after earlobe piercing are statistically more common, which is why it is worth considering including earlobe piercing in the modern definition of body piercing.

Piercing associated perichondritis of the pinna: are we treating it correctly?

Objective:

This paper reports a series of patients with sporadic pinna perichondritis who presented to a district general hospital over a period of 10 years. The data examined included the causative organism, risk factors and pattern of antibiotic use.

Method:

A retrospective analysis of diagnosed cases of pinna perichondritis from 2001 to 2012 was performed. A literature review of pinna perichondritis was carried out using Pubmed with the key words ‘pinna perichondritis’, ‘pinna abscess’, ‘pinna infection’ and ‘piercing’.

Results:

Pinna perichondritis was more likely to result from chondral than lobe piercings. The majority of cases were caused byPseudomonas aeruginosa.

Conclusion:

Most patients were not prescribed anti-pseudomonal antibiotics on presentation. This may result in persistent infection and long-term cosmetic defects.

Infections associated with body modification

Although exact statistics are lacking, body modifications for cosmetic purposes are performed in many countries. The commonest forms include tattooing, body piercing, and breast and facial augmentation using implants or injectable fillers. Liposuction and, to a lesser extent, mesotherapy are also practiced in many countries. Infective complications of these procedures include local infections, transmission of bloodborne pathogens (viral hepatitis and human immunodeficiency virus), and distant infections such as infective endocarditis. Presence of foreign bodies, long healing time of piercing wounds, and poor compliance with infection control practices of some practitioners all predispose the recipients to infections. Apart from the endogenous microbial flora of the skin and mucosae, atypical mycobacteria, especially the rapid growers, have emerged as some of the most important pathogens in such settings. Outbreaks of infection are commonly reported. We hereby review the current knowledge of the topic with specific focus on infections associated with tattooing, body piercing, breast augmentation, mesotherapy, liposuction, and tissue filler injections. Greater awareness among consumers and health-care professionals, as well as more stringent regulations by the health authorities, is essential to minimize the health risks arising from these procedures.

Body piercing: complications and prevention of health risks

Body and earlobe piercing are common practices in the USA today. Minor complications including infection and bleeding occur frequently and, although rare, major complications have been reported. Healthcare professionals should be cognizant of the medical consequences of body piercing. Complications vary depending on the body-piercing site, materials used, experience of the practitioner, hygiene regimens, and aftercare by the recipient. Localized infections are common. Systemic infections such as viral hepatitis and toxic shock syndrome and distant infections such as endocarditis and brain abscesses have been reported. Other general complications include allergic contact dermatitis (e.g. from nickel or latex), bleeding, scarring and keloid formation, nerve damage, and interference with medical procedures such as intubation and blood/organ donation. Site-specific complications have been reported. Oral piercings may lead to difficulty speaking and eating, excessive salivation, and dental problems. Oral and nasal piercings may be aspirated or become embedded, requiring surgical removal. Piercing tracts in the ear, nipple, and navel are prone to tearing. Galactorrhea may be caused by stimulation from a nipple piercing. Genital piercings may lead to infertility secondary to infection, and obstruction of the urethra secondary to scar formation. In men, priapism and fistula formation may occur. Women who are pregnant or breastfeeding and have a piercing or are considering obtaining one need to be aware of the rare complications that may affect them or their child. Though not a 'complication' per se, many studies have reported body piercing as a marker for high-risk behavior, psychopathologic symptoms, and anti-social personality traits. When it comes to piercing complications, prevention is the key. Body piercers should take a complete medical and social history to identify conditions that may predispose an individual to complications, and candidates should choose a qualified practitioner to perform their piercing. As body piercing continues to be popular, understanding the risks of the procedures as well as the medical and psychosocial implications of wearing piercing jewelry is important for the medical practitioner.

Complications of ear rings

In this paper the complications of ear piercing are considered and the treatment of resultant deformities is described.