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Magnetic Resonance Imaging of Nontraumatic Musculoskeletal Emergencies. Magn Reson Imaging Clin N Am 2016; 24:369-89. [DOI: 10.1016/j.mric.2015.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Turunç V, Eroğlu A, Cihandide E, Tabandeh B, Oruğ T, Güven B. Escherichia Coli-Related Necrotizing Fasciitis After Renal Transplantation: A Case Report. Transplant Proc 2016; 47:1518-21. [PMID: 26093756 DOI: 10.1016/j.transproceed.2015.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 39-year-old man who had received cadaveric renal transplantation (RT) 1 month previously presented with rash and pain on his left lower extremity. Initially, bacterial cellulitis was suspected, and ampicillin/sulbactam was initiated; however, 3 days later, skin necrosis occurred and pain increased. Ampicillin/sulbactam was replaced with imipenem+ciprofloxacin, and surgical debridement was performed. Escherichia coli was identified in the wound culture, urine culture, and blood culture. After repeated debridement, wound care, and appropriate antimicrobial treatment, wounds began to heal and skin grafting was planned at the 4th month of therapy. However, the patient died of viral pneumonia. To date, 20 cases of necrotizing fasciitis (NF) after RT have been reported (including our case), and, as far as we know, this is the second E coli-related NF case. An analysis of all 20 cases showed that the most common infection site was the extremities (90%) and that 45% of pathogens were fungus. The mortality rate was 30%. NF is a rare but rapidly developing and life-threatening soft-tissue infection in RT patients. To reduce mortality rates, early diagnosis, recurrent surgical debridement, and aggressive therapy are mandatory.
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Affiliation(s)
- V Turunç
- Goztepe Medical Park Hospital, Organ Transplantation Center, Istanbul, Turkey.
| | - A Eroğlu
- Goztepe Medical Park Hospital, Organ Transplantation Center, Istanbul, Turkey
| | - E Cihandide
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Bahcesehir University, Istanbul, Turkey
| | - B Tabandeh
- Department of General Surgery, Bahcesehir University, Istanbul, Turkey
| | - T Oruğ
- Department of General Surgery, Bahcesehir University, Istanbul, Turkey
| | - B Güven
- Goztepe Medical Park Hospital, Organ Transplantation Center, Istanbul, Turkey
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el-Azhary R, Weenig RH, Gibson LE. The dermatology hospitalist: creating value by rapid clinical pathologic correlation in a patient-centered care model. Int J Dermatol 2012; 51:1461-6. [DOI: 10.1111/j.1365-4632.2011.05412.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Baker JR, McEneaney PA, Prezioso JL, Adajar MA, Goldflies ML, Zambrano CH. Aggressive management of necrotizing fasciitis through a multidisciplinary approach using minimal surgical procedures: a case report. Foot Ankle Spec 2008; 1:160-7. [PMID: 19825711 DOI: 10.1177/1938640008318966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Necrotizing fasciitis is an aggressive, destructive infection of the soft tissue and fascia and is a life-threatening surgical emergency. A case study is presented of necrotizing fasciitis in the right lower extremity of a 53-year-old male resident of a long-term skilled nursing facility. Limb salvage was achieved through a multidisciplinary approach with early surgical management and aggressive postoperative management. Through 3 surgical procedures, the combined efforts of podiatric surgery, orthopaedic surgery, general/trauma surgery, and infectious disease provided early wound closure and limb salvage. An aggressive multidisciplinary approach to the management of necrotizing fasciitis in the lower extremity is necessary for limb salvage. Use of this multidisciplinary approach will minimize the number of surgical procedures and decrease the potential morbidity and mortality seen in patients with this infection.
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Affiliation(s)
- Jeffrey R Baker
- Weil Foot and Ankle Institute, Des Plaines, Illinois 60610, USA.
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Abstract
PURPOSE To update the practitioner with causes, diagnosis, and treatment options for necrotizing fasciitis. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in better understanding the pathophysiology, diagnosis, and treatment of necrotizing fasciitis. OBJECTIVES After reading this article and taking this test, the reader should be able to: 1. Identify the risk factors and causes of necrotizing fasciitis (NF). 2. Describe the clinical presentation and diagnosis of NF. 3. Explain the treatment options for NF.
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Affiliation(s)
- Richard Sal Salcido
- Department of Rehabilitation Medicine, Institute of Medicine and Bioengineering, University of Pennsylvania Health System, Philadelphia, PA, USA
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Affiliation(s)
- J Brett Fugitt
- Department of Radiology, Naval Medical Center, 34800 Bob Wilson Dr, San Diego, CA 92134, USA.
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Abstract
Some infectious diseases may cause rapidly fatal eruptions that need to be diagnosed and treated in an early phase for patient survival. The main life-threatening eruptions of infectious etiology include Rocky Mountain spotted fever, meningococcemia, toxic shock syndrome, streptococcal toxic shock syndrome, and staphylococcal scalded skin syndrome.
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Affiliation(s)
- Marcia Ramos-e-Silva
- Sector of Dermatology and Post-Graduation Course, HUCFF-UFRJ and School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Abstract
Humans are a natural reservoir for Staphylococcal aureus. Colonization begins soon after birth and predisposes to infection. S. aureus is one of the most common causes of skin infection, giving rise to folliculitis, furunculosis, carbuncles, ecthyma, impetigo, cellulitis and abscesses. In addition, S. aureus may cause a number of toxin-mediated life-threatening diseases, including staphylococcal scalded skin syndrome (SSSS). Epidermolytic toxins released by certain S. aureus strains cause SSSS by cleaving the epidermal cell adhesion molecule, desmogelin-1, resulting in superficial skin erosion. Recent experiments have revealed similarities in the pathophysiology of SSSS and pemphigus foliaceus, an autoimmune disorder that is characterized by antibodies targeting the same epidermal attachment protein. SSSS typically affects neonates and infants but may also occur in predisposed adults. It is painful and distressing for the patient and parents, although most cases respond to antibiotic treatment. Mortality is low in infants but can be as high as 67% in adults, and is dependent on the extent of skin involvement and the comorbid state. Thus, the management of adults who develop SSSS remains a major therapeutic challenge. The antibody response against the toxins neutralizes their effect and prevents recurrence or limits the effects to the area of infection, which is known as bullous impetigo.
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Affiliation(s)
- Girish K Patel
- Department of Dermatology, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK.
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D'Apollo N, Saviola A, Longo G, Luppi M, Emilia G, Torelli G. Necrotising dermatitis in refractory acute myeloid leukaemia. Eur J Haematol 2004; 71:464-5. [PMID: 14703698 DOI: 10.1046/j.0902-4441.2003.00129.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Severe cutaneous infections in leukaemic patients are difficult to treat and can rapidly become fatal. We report on a case of essential thrombocythemia evolved to a myelodysplastic syndrome and finally, to an overt myeloid leukaemia, refractory to chemotherapy. In the presence of a marked neutropenia, the patients developed a wide Staphylococcus epidermidis necrotising dermatitis. The diagnosis was made possible only by a skin biopsy culture and the antibiotic treatment, based on antimicrobial susceptibility tests, rapidly resolved the infection. In neutropenic patients, appropriate laboratory tests and treatment, can lead to recovery of life-threatening infections.
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Affiliation(s)
- N D'Apollo
- Department of Oncology and Hematology, University of Modena and Reggio Modena, Italy
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Affiliation(s)
- Jennifer T Trent
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USA
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Abstract
Ticks are ectoparasites that cause dermatologic disease directly by their bite and indirectly as vectors of bacterial, rickettsial, protozoal, and viral diseases. In North America, where ticks are the leading cause of vector-borne infection, dermatologists should recognize several tick species. Basic tick biology and identification will be reviewed. Tick bites cause a variety of acute and chronic skin lesions. The tick-borne diseases include Lyme disease, tick-borne relapsing fever, tularemia, babesiosis, Rocky Mountain spotted fever, other spotted fevers, ehrlichiosis, Colorado tick fever, and others. The epidemiology, clinical features, diagnosis, and treatment of these diseases are reviewed with an emphasis on cutaneous manifestations. Finally, the prevention of diseases caused by ticks is reviewed.
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Abstract
Ticks, obligate, blood-sucking members of the order Acarina and class Arachnida, are the most common agents of vector-borne diseases in the United States. Ticks play an important role in transmitting viruses, bacteria, spirochetes, parasites, and rickettsia. This article reviews the epidemiology, microbiology, diagnosis, and treatment of the major tick-borne diseases in the United States.
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Affiliation(s)
- Divya Singh-Behl
- The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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