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Suárez JA, Urriola M, Moreno-Botello MM, Naranjo-Lara L, Gundacker N, Ascanio LC, Olivo-Freites C, Paniz-Mondolfi A. Colubrid snake envenomation: Erythrolamprus bizona "false coral" snakebite - clinical aspects and importance of identifying mimics. Am J Emerg Med 2024:S0735-6757(24)00458-3. [PMID: 39289053 DOI: 10.1016/j.ajem.2024.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 09/06/2024] [Accepted: 09/08/2024] [Indexed: 09/19/2024] Open
Abstract
Colubrids represent a diverse group of snakes historically regarded as harmless. With over 300 genera, the Colubridae family is the largest, encompassing approximately two-thirds of extant snake species. We describe a case of an 18-year-old male who suffered a colubrid snakebite from Erythrolamprus bizona, commonly known as the double-stranded coral snake mimic or false coral snake, which he misidentified as Lampropeltis sp., a fangless colubrid snake. Patient experienced localized erythema and edema, which later spread to the entire left hand along with moderate pain. Laboratory tests revealed leukocytosis and elevated creatine kinase. Symptoms resolved one week later. This case highlights the public health significance of ophidian accidents due to apparently "non-venomous snakes" or low-risk snakes such as the opisthoglyphous colubrid E. bizona. It also underscores the need to correctly identify and differentiate these snakes from other harmless colubrids, particularly double-stranded coral snake mimics in areas of geographic overlap and avoid their manipulation if uncertain of their taxonomic status.
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Affiliation(s)
- Jose Antonio Suárez
- Sistema Nacional de Investigación-SENACYT, Panamá; Bella Vista, Manuel E. Batista y Ave. Jose De Fabrega, Panama City, Panama Province, Panama; Infectotrópico, SA, Panamá
| | - Mario Urriola
- Serpentario Maravillas Tropicales, Valle de Antón, Panamá
| | | | - Laura Naranjo-Lara
- Sistema Nacional de Investigación-SENACYT, Panamá; Infectotrópico, SA, Panamá
| | - Nathan Gundacker
- Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Luis C Ascanio
- Department of Pathology, Molecular, and Cell-based medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | - Alberto Paniz-Mondolfi
- Department of Pathology, Molecular, and Cell-based medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
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2
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Hua C, Urbina T, Bosc R, Parks T, Sriskandan S, de Prost N, Chosidow O. Necrotising soft-tissue infections. THE LANCET. INFECTIOUS DISEASES 2023; 23:e81-e94. [PMID: 36252579 DOI: 10.1016/s1473-3099(22)00583-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/05/2022] [Accepted: 08/22/2022] [Indexed: 11/07/2022]
Abstract
The incidence of necrotising soft-tissue infections has increased during recent decades such that most physicians might see at least one case of these potentially life-threatening infections in their career. Despite advances in care, necrotising soft-tissue infections are still associated with high morbidity and mortality, underlining a need for continued education of the medical community. In particular, failure to suspect necrotising soft-tissue infections, fuelled by poor awareness of the disease, promotes delays to first surgical debridement, amplifying disease severity and adverse outcomes. This Review will focus on practical approaches to management of necrotising soft-tissue infections including prompt recognition, initiation of specific management, exploratory surgery, and aftercare. Increased alertness and awareness for these infections should improve time to diagnosis and early referral to specialised centres, with improvement in the prognosis of necrotising soft-tissue infections.
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Affiliation(s)
- Camille Hua
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris, Créteil, France; Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France; Epidemiology in Dermatology and Evaluation of Therapeutics, Université Paris Est Créteil, Créteil, France; Groupe Infectiologie Dermatologique-Infections Sexuellement Transmissibles, Société Française de Dermatologie, Paris, France
| | - Tomas Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Bosc
- Service de Chirurgie Plastique, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Tom Parks
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Shiranee Sriskandan
- Department of Infectious Diseases, Imperial College London, London, UK; MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London, UK
| | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, Créteil, France; CARMAS Research Group, UPEC-Université Paris-Est Créteil Val de Marne, Faculté de médecine de Créteil, Créteil, France
| | - Olivier Chosidow
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris, Créteil, France; Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France; Groupe Infectiologie Dermatologique-Infections Sexuellement Transmissibles, Société Française de Dermatologie, Paris, France; Research group Dynamyc, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France.
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3
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Molla YD, Kassa SA. Primary necrotizing fasciitis of the breast in a young patient, a case report. Int J Surg Case Rep 2022; 102:107844. [PMID: 36592555 PMCID: PMC9823132 DOI: 10.1016/j.ijscr.2022.107844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis is a life-threatening and potentially fatal condition which commonly affects extremities, abdominal wall and perineum. However, it can affect any body part. Breasts are very rarely affected, with most of the cases are following surgical intervention or trauma. Predisposing conditions include diabetes, chronic alcoholism, advanced age, vascular disease, and immunosuppression and many cases are preceded by an injury or invasive procedure. Here we present necrotizing fasciitis of the breast in a 28-year-old female patient with no identified risk factor. CLINICAL PRESENTATION A 28-year-old woman on her 4th month of lactation presented to the emergency department with a 4-day history of right breast pain and swelling. Associated with this, she had darkening of the skin of the right breast, high-grade fever, and foul-smelling discharge from the wound. On examination, she was febrile, tachycardic and hypotensive. Breast examination showed signs suggestive of NF. Subsequently, the patient was managed with broad spectrum antibiotics, supportive care, surgical debridement followed by partial mastectomy and finally the patient was discharged improved. CONCLUSION Although it is a rare phenomenon, necrotizing soft-tissue infections of the breast can progress rapidly and carry a high mortality rate. Therefore, early diagnosis and immediate surgical intervention are of paramount importance. Here, we aim to show the importance of early diagnosis and the need for appropriate therapy to avoid complications and death.
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Affiliation(s)
- Yohannis Derbew Molla
- Department of Surgery, University of Gondar, Collage of Medicine and Health Sciences, Gondar, Ethiopia.
| | - Samrawit Andargie Kassa
- Department of Surgery, University of Gondar, Collage of Medicine and Health Sciences, Gondar, Ethiopia
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4
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Staurengo-Ferrari L, Deng L, Chiu IM. Interactions between nociceptor sensory neurons and microbial pathogens in pain. Pain 2022; 163:S57-S68. [PMID: 36252233 PMCID: PMC9586460 DOI: 10.1097/j.pain.0000000000002721] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/21/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Larissa Staurengo-Ferrari
- Harvard Medical School, Blavatnik Institute, Department of Immunology, Boston, Massachusetts, United States of America
| | - Liwen Deng
- Harvard Medical School, Blavatnik Institute, Department of Immunology, Boston, Massachusetts, United States of America
| | - Isaac M. Chiu
- Harvard Medical School, Blavatnik Institute, Department of Immunology, Boston, Massachusetts, United States of America
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5
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Quilling LL, Outerbridge CA, White SD, Affolter VK. Retrospective case series: Necrotising fasciitis in 23 dogs. Vet Dermatol 2022; 33:534-544. [PMID: 36043338 DOI: 10.1111/vde.13113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/12/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Necrotising fasciitis (NF) is a rare, rapidly progressive subcutaneous bacterial infection. Few studies have characterised NF in dogs. HYPOTHESIS/OBJECTIVES To retrospectively describe clinical and laboratory findings, with treatments and outcomes, in dogs with NF. ANIMALS Twenty-three client-owned dogs treated at a veterinary teaching hospital between 1998 and 2021. MATERIALS AND METHODS Medical records and laboratory data from 23 dogs diagnosed with NF were reviewed. RESULTS Male dogs were significantly over-represented (p = 0.003). The most common presenting complaint was sudden lameness. Infection occurred in one or two limbs in 19 of 23 dogs, with right hindlimbs most often affected (13 of 23). Pitting oedema was evident in 14 of 23 dogs. Antibiotic and nonsteroidal anti-inflammatory drugs were administered before presentation in nine and 13 of 23 dogs, respectively. Common clinicopathological abnormalities included hypoalbuminemia, hyponatremia, elevated liver enzymes, elevated creatine kinase, increased bands and lymphopenia. Streptococcus canis was isolated from 18 of 23 dogs. Histopathological features included acute necrosis and severe neutrophilic inflammation. Fifteen dogs were euthanised or died, while surgical intervention led to survival in eight of 23 dogs. CONCLUSIONS AND CLINICAL RELEVANCE Dogs presenting for acute swelling of a limb with oedema should have the diagnosis of NF considered and early surgical intervention might increase survival.
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Affiliation(s)
- Laura L Quilling
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Catherine A Outerbridge
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Stephen D White
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Verena K Affolter
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, California, USA
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6
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Household Transmission of Group A Streptococcus Necrotizing Fasciitis. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202208000-00001. [PMID: 35930803 PMCID: PMC9351906 DOI: 10.5435/jaaosglobal-d-21-00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/07/2022] [Indexed: 11/22/2022]
Abstract
A healthy 40-year-old woman was diagnosed with necrotizing fasciitis 2 days after her husband's death from the same infectious process. Prompt identification and immediate surgical intervention prevented a similar result in this patient. Additional investigation into both patients' medical records found the inciting organism to be group A streptococcus. Although the exact mechanism of inoculation is unknown, the spread of this infection within a household prompts the question of whether antibiotic prophylaxis should be given among close contacts in future cases of necrotizing fasciitis.
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François S, Helissey C, Cavallero S, Drouet M, Libert N, Cosset JM, Deutsch E, Meziani L, Chargari C. COVID-19-Associated Pneumonia: Radiobiological Insights. Front Pharmacol 2021; 12:640040. [PMID: 34113249 PMCID: PMC8185272 DOI: 10.3389/fphar.2021.640040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/04/2021] [Indexed: 12/15/2022] Open
Abstract
The evolution of SARS-CoV-2 pneumonia to acute respiratory distress syndrome is linked to a virus-induced “cytokine storm”, associated with systemic inflammation, coagulopathies, endothelial damage, thrombo-inflammation, immune system deregulation and disruption of angiotensin converting enzyme signaling pathways. To date, the most promising therapeutic approaches in COVID-19 pandemic are linked to the development of vaccines. However, the fight against COVID-19 pandemic in the short and mid-term cannot only rely on vaccines strategies, in particular given the growing proportion of more contagious and more lethal variants among exposed population (the English, South African and Brazilian variants). As long as collective immunity is still not acquired, some patients will have severe forms of the disease. Therapeutic perspectives also rely on the implementation of strategies for the prevention of secondary complications resulting from vascular endothelial damage and from immune system deregulation, which contributes to acute respiratory distress and potentially to long term irreversible tissue damage. While the anti-inflammatory effects of low dose irradiation have been exploited for a long time in the clinics, few recent physiopathological and experimental data suggested the possibility to modulate the inflammatory storm related to COVID-19 pulmonary infection by exposing patients to ionizing radiation at very low doses. Despite level of evidence is only preliminary, these preclinical findings open therapeutic perspectives and are discussed in this article.
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Affiliation(s)
- Sabine François
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | | | - Sophie Cavallero
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | - Michel Drouet
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | | | - Jean-Marc Cosset
- Centre de Radiothérapie Charlebourg/La Défense, Groupe Amethyst, La Garenne-Colombes, France
| | - Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France.,INSERM U1030, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Lydia Meziani
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France.,INSERM U1030, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Cyrus Chargari
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France.,Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France.,INSERM U1030, Université Paris Saclay, Le Kremlin Bicêtre, France
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8
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Pitché P, Diata AB, Faye O, Tounkara TM, Niamba P, Mouhari-Toure A, Ly F, Soumah MM, Some-Korsaga N, Akakpo AS, Diané BF, Cissé M, Niang S, Traore A, Saka B. Risk factors associated with necrotizing fasciitis of the lower limbs: A multicenter case-control study. Ann Dermatol Venereol 2021; 148:161-164. [PMID: 33558036 DOI: 10.1016/j.annder.2020.08.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/29/2020] [Accepted: 08/31/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this case-control study was to identify risk factors associated with necrotizing fasciitis (NF) of the lower limbs. PATIENTS AND METHODS We conducted a prospective case-control study in hospital dermatology departments in 5 sub-Saharan African countries over a 2-year period (April 2017 to July 2019). The cases were patients with NF of the lower limbs and the controls were patients with leg erysipelas. Each case was matched with two controls for age (±5 years) and sex. We analyzed local and general factors. RESULTS During the study period, 159 cases (73 females, 86 males) were matched with 318 controls. The mean age was 48.5±15.8 years for cases and 46.5±16.2 years for controls (P=0.24). The main local signs of NF were cutaneous necrosis (83.7%), pain (75.5%) and induration (42.1%). Multivariate analysis showed the following to be independent risk factors associated with NF of the lower limbs: obesity (odds ratio [OR]=2.10; 95% confidence interval [CI]: 1.21-3.42), diabetes (OR=3.97; 95% CI: 1.95-6.13), nicotine addiction (OR=5.07; 95% CI: 2.20-11.70), use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR=7.85; 95% CI 4.60-14.21) and voluntary cosmetic depigmentation (OR=2.29; 95% CI: 1.19-3.73). CONCLUSION Our study documents the role of NSAID use at the onset of symptoms as a risk factor for NF of the lower limbs. However, the originality of our study consists in the identification of voluntary cosmetic depigmentation as a risk factor for NF of the lower limbs in sub-Saharan Africa patients. Our results also identified typical overarching factors such as diabetes, obesity and nicotine addiction. Knowing these factors and taking them into account will enable optimization of management strategies for these conditions.
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Affiliation(s)
- P Pitché
- Department of Dermatology, Sylvanus Olympio University Hospital, Université de Lomé, Lomé, Togo.
| | - A-B Diata
- Department of Dermatology, Le Dantec University Hospital, Université Cheik Anta Diop, Dakar, Senegal
| | - O Faye
- Department of Dermatology-STD, Donka University Hospital, Université de Conakry, Conakry, Guinea
| | - T-M Tounkara
- Department of Dermatology, CNAM, Université de Bamako, Bamako, Mali
| | - P Niamba
- Department of Dermatology, Yaldago Ouédraogo University Hospital, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - A Mouhari-Toure
- Department of Dermatology, Kara University Hospital, Université de Kara, Kara, Togo
| | - F Ly
- Department of Dermatology, Le Dantec University Hospital, Université Cheik Anta Diop, Dakar, Senegal
| | - M-M Soumah
- Department of Dermatology-STD, Donka University Hospital, Université de Conakry, Conakry, Guinea
| | - N Some-Korsaga
- Department of Dermatology, Yaldago Ouédraogo University Hospital, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - A-S Akakpo
- Department of Dermatology, Sylvanus Olympio University Hospital, Université de Lomé, Lomé, Togo
| | - B-F Diané
- Department of Dermatology-STD, Donka University Hospital, Université de Conakry, Conakry, Guinea
| | - M Cissé
- Department of Dermatology-STD, Donka University Hospital, Université de Conakry, Conakry, Guinea
| | - S Niang
- Department of Dermatology, Le Dantec University Hospital, Université Cheik Anta Diop, Dakar, Senegal
| | - A Traore
- Department of Dermatology, Yaldago Ouédraogo University Hospital, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - B Saka
- Department of Dermatology, Sylvanus Olympio University Hospital, Université de Lomé, Lomé, Togo
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9
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Quaglietta L, Martinelli M, Staiano A. Serious infectious events and ibuprofen administration in pediatrics: a narrative review in the era of COVID-19 pandemic. Ital J Pediatr 2021; 47:20. [PMID: 33514404 PMCID: PMC7844800 DOI: 10.1186/s13052-021-00974-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/21/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose of review Despite its recognized efficacy and tolerability profile, during the last decade a rise of adverse events following ibuprofen administration in children has been reported, including a possible role in worsening the clinical course of infections. Our aim was to critically evaluate the safety of ibuprofen during the course of pediatric infectious disease in order to promote its appropriate use in children. Recent findings Ibuprofen is associated with severe necrotizing soft tissue infections (NSTI) during chickenpox course. Pre-hospital use of ibuprofen seems to increase the risk of complicated pneumonia in children. Conflicting data have been published in septic children, while ibuprofen in the setting of Cystic Fibrosis (CF) exacerbations is safe and efficacious. No data is yet available for ibuprofen use during COVID-19 course. Summary Ibuprofen should not be recommended for chickenpox management. Due to possible higher risks of complicated pneumonia, we suggest caution on its use in children with respiratory symptoms. While it remains unclear whether ibuprofen may have harmful effects during systemic bacterial infection, its administration is recommended in CF course. Despite the lack of data, it is seems cautious to prefer the use of paracetamol during COVID-19 acute respiratory distress syndrome in children.
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Affiliation(s)
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
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Delbet-Dupas C, Devoize L, Mulliez A, Barthélémy I, Pham Dang N. Does anti-inflammatory drugs modify the severe odontogenic infection prognosis? A 10-year's experience. Med Oral Patol Oral Cir Bucal 2021; 26:e28-e35. [PMID: 32851983 PMCID: PMC7806345 DOI: 10.4317/medoral.23926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/24/2020] [Indexed: 01/15/2023] Open
Abstract
Background Numerous biochemical datas support the noxious role of anti-inflammatory drugs on immune response. Those observations are often put forward for unfavorable evolution of odontogenic infection but has never been really proven in clinic. The aim of this study is to try to clarify this role based on the collection of the clinical course of odontogenic infections over a 10-year analysis period.
Material and Methods The investigators implemented a prospective observational study. The sample was composed of patients managed between January 2004 and December 2014 for severe odontogenic infection based on three criteria: hospital admission, intravenous antibiotic therapy, tooth extraction and collections drainage under general anesthesia. Clinical and pharmacological data were collected at admission, during hospitalization until discharged home. The population was first separated into two groups patients with or without anti-inflammatory drugs on admission, then on four groups (non-steroidal anti-inflammatory drugs, corticosteroids drugs, both and none on admission). Analysis were performed each time by univariate analysis, multivariate analysis and propensity score matching.
Results Six hundred and fifty-three patients were included in the study, 329 (50%) patients report orally anti-inflammatory treatment before presenting to hospital, 50 (7.6%) received corticosteroids, 242 (37%) received NSAIDs and 37 (5.6%) both. Evolution is worsening for patients under anti-inflammatory drugs in term of hospitalization in ICU (p=0.016), number of surgeries (p=0.003), risk of tracheotomy (p=0.036), duration of hospitalization (p=0.005) and spaces involved by the infection (p<0.001). When separating patients into 4 groups, dysphonia and odynophagia are more frequent for patients under corticosteroid and NSAID (35.14%, p<0.001), mediastinal erythema is more frequent for patients under corticosteroid (16%, p=0.004), fever is more frequent for patients under NSAID (35.5%, p=0.032), pain is higher for patients under corticosteroids (p=0.024). But, in order to reduce bias, linked to factors of gravity, a regression weighted by propensity scores was performed and any group of patients is different from the others.
Conclusions Patients under anti-inflammatory drugs have more severe dental infection on admission and their complex evolution seems to be linked to the severity of infection on admission. Key words:Severe odontogenic infection, anti-inflammatory drugs, corticosteroids.
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Affiliation(s)
- C Delbet-Dupas
- Department of Oral and Maxillofacial surgery Université d'Auvergne, NHE - CHU de Clermont-Ferrand 1 place Lucie Aubrac, 63000 Clermont-Ferrand, France
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11
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Chae MK, Shin SY, Kwak MS, Yoon JY, Kim HI, Cha JM. Fatal Necrotizing Fasciitis Following Uncomplicated Colonoscopic Polypectomy: A Case Report. Clin Endosc 2020; 54:280-284. [PMID: 33302329 PMCID: PMC8039750 DOI: 10.5946/ce.2020.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/09/2020] [Indexed: 11/18/2022] Open
Abstract
Necrotizing fasciitis (NF) is a life-threatening infection that can be caused by various procedures or surgery and may develop in healthy elderly patients. Here, we report a case of a 66-year-old man with diabetes mellitus who underwent colonoscopic polypectomy, without complications. However, he visited the emergency department 24 hours after the procedure complaining of abdominal pain. Abdominopelvic computed tomography revealed multiple air bubbles in the right lateral abdominal muscles. After a diagnosis of NF was made, immediate surgical debridement was performed. However, despite three sessions of extensive surgical debridement and best supportive care at the intensive care unit, the patient died because of sepsis and NF-associated multiple-organ failure. In conclusion, physicians should pay special attention to the possibility of NF if a patient with risk factors for NF develops sepsis after colonoscopic polypectomy.
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Affiliation(s)
- Min Kyu Chae
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang Youn Shin
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ha Il Kim
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Abstract
Necrotizing soft tissue infections occur after traumatic injuries, minor skin lesions, nonpenetrating injuries, natural childbirth, and in postsurgical and immunocompromised patients. Infections can be severe, rapidly progressive, and life threatening. Survivors often endure multiple surgeries and prolonged hospitalization and rehabilitation. Despite subtle nuances that may distinguish one entity from another, clinical approaches to diagnosis and treatment are highly similar. This review describes the clinical and laboratory features of necrotizing soft tissue infections and addresses recommended diagnostic and treatment modalities. It discusses the impact of delays in surgical debridement, antibiotic use, and resuscitation on mortality, and summarizes key pathogenic mechanisms.
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Affiliation(s)
- Dennis L Stevens
- Infectious Diseases Center of Biomedical Research Excellence, Veterans Affairs Medical Center, 500 West Fort Street (Mail Stop 151), Boise, ID 83702, USA
| | - Amy E Bryant
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Idaho State University, 1311 East Central Drive, Meridian, ID 83642, USA.
| | - Ellie Jc Goldstein
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90074, USA; R M Alden Research Laboratory, 2021 Santa Monica Boulevard, Suite #740 East, Santa Monica, CA 90404, USA
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13
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Abstract
Necrotizing soft tissue infections typically begin with direct inoculation of bacteria into the subcutaneous tissues. Here, we present a case with no such exposure, but with severe necrotizing fasciitis. We present a middle-aged man presented to the emergency department for a presumed allergic reaction after having initially sought care twice at an urgent care facility. The patient had swelling, but no tenderness of his right lateral chest and flank. Subsequent imaging showed extensive fluid in the fascial planes of the right chest wall requiring surgical debridement. Necrotizing fasciitis that is not treated with surgical debridement carries a mortality rate approaching 100%. This case highlights a potential atypical presentation as well as highlights the fact that the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score lacks sensitivity to rule out a necrotizing soft tissue infection, requiring surgical debridement for diagnosis.
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Affiliation(s)
- Patrick J Rogers
- Emergency Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Brent M Lewis
- Emergency Medicine, Community Medical Center, Toms River, USA
| | - Mihir Odak
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Joshua Bucher
- Emergency Medicine, Robert Wood Johnson University Hospital, New Brunswick, USA
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Sailani MR, Metwally AA, Zhou W, Rose SMSF, Ahadi S, Contrepois K, Mishra T, Zhang MJ, Kidziński Ł, Chu TJ, Snyder MP. Deep longitudinal multiomics profiling reveals two biological seasonal patterns in California. Nat Commun 2020; 11:4933. [PMID: 33004787 PMCID: PMC7529769 DOI: 10.1038/s41467-020-18758-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
The influence of seasons on biological processes is poorly understood. In order to identify biological seasonal patterns based on diverse molecular data, rather than calendar dates, we performed a deep longitudinal multiomics profiling of 105 individuals over 4 years. Here, we report more than 1000 seasonal variations in omics analytes and clinical measures. The different molecules group into two major seasonal patterns which correlate with peaks in late spring and late fall/early winter in California. The two patterns are enriched for molecules involved in human biological processes such as inflammation, immunity, cardiovascular health, as well as neurological and psychiatric conditions. Lastly, we identify molecules and microbes that demonstrate different seasonal patterns in insulin sensitive and insulin resistant individuals. The results of our study have important implications in healthcare and highlight the value of considering seasonality when assessing population wide health risk and management.
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Affiliation(s)
- M Reza Sailani
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | - Ahmed A Metwally
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | - Wenyu Zhou
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | | | - Sara Ahadi
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | - Kevin Contrepois
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | - Tejaswini Mishra
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | - Martin Jinye Zhang
- Department of Electrical Engineering, Stanford University, Stanford, CA, 94305, USA
| | - Łukasz Kidziński
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Theodore J Chu
- Department of Pediatrics, Division of Allergy and Immunology, Stanford University, Stanford, CA, 94305, USA
| | - Michael P Snyder
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA.
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15
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Capuano A, Scavone C, Racagni G, Scaglione F. NSAIDs in patients with viral infections, including Covid-19: Victims or perpetrators? Pharmacol Res 2020; 157:104849. [PMID: 32360482 PMCID: PMC7189871 DOI: 10.1016/j.phrs.2020.104849] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/31/2022]
Abstract
Taking anti-inflammatory drugs, including non-steroidal (NSAIDs), during Covid-19 infection, how much is risky? The French Minister of Health, who has raised an alarm on a possible risk deriving from the use of ibuprofen for the control of fever and other symptoms during the disease, opened the debate a few days ago. In this paper we examine available evidence from preclinical and clinical studies that had analysed the role of COX in the inflammatory process and the effects of NSAIDs in patients with infections. Most of the published studies that suggested not protective effects of NSAIDs were mainly performed in vitro or on animals. Therefore, their meaning in humans is to be considered with great caution. Based also on data suggesting protective effects of NSAIDs, we concluded that currently there is no evidence suggesting a correlation between NSAIDs and a worsening of infections. Further studies will be certainly needed to better define the role of NSAIDs and particularly COX2 inhibitors in patients with infections. In the meantime, we must wait for results of the revision started by the PRAC on May 2019 on the association ibuprofen/ketoprofen and worsening of infections. Since nowadays no scientific evidence establishes a correlation between NSAIDS and worsening of COVID-19, patients should be advice against any NSAIDs self-medication when COVID-19 like symptoms are present.
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Affiliation(s)
- Annalisa Capuano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy; Regional Centre of Pharmacogilance, Campania Region, Naples, Italy.
| | - Cristina Scavone
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy; Regional Centre of Pharmacogilance, Campania Region, Naples, Italy
| | - Giorgio Racagni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy; Clinical Pharmacology Unit, ASST-GOM Niguarda Hospital, Milan, Italy
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16
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Attitude du pharmacien face à une demande d’ibuprofène sans ordonnance. ACTUALITES PHARMACEUTIQUES 2020. [DOI: 10.1016/j.actpha.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Voiriot G, Philippot Q, Elabbadi A, Elbim C, Chalumeau M, Fartoukh M. Risks Related to the Use of Non-Steroidal Anti-Inflammatory Drugs in Community-Acquired Pneumonia in Adult and Pediatric Patients. J Clin Med 2019; 8:E786. [PMID: 31163625 PMCID: PMC6617416 DOI: 10.3390/jcm8060786] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/22/2019] [Accepted: 05/27/2019] [Indexed: 12/22/2022] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to alleviate symptoms during community-acquired pneumonia (CAP), while neither clinical data nor guidelines encourage this use. Experimental data suggest that NSAIDs impair neutrophil intrinsic functions, their recruitment to the inflammatory site, and the resolution of inflammatory processes after acute pulmonary bacterial challenge. During CAP, numerous observational data collected in hospitalized children, hospitalized adults, and adults admitted to intensive care units (ICUs) support a strong association between pre-hospital NSAID exposure and a delayed hospital referral, a delayed administration of antibiotic therapy, and the occurrence of pleuropulmonary complications, even in the only study that has accounted for a protopathic bias. Other endpoints have been described including a longer duration of antibiotic therapy and a greater hospital length of stay. In all adult series, patients exposed to NSAIDs were younger and had fewer comorbidities. The mechanisms by which NSAID use would entail a complicated course in pneumonia still remain uncertain. The temporal hypothesis and the immunological hypothesis are the two main emerging hypotheses. Current data strongly support an association between NSAID intake during the outpatient treatment of CAP and a complicated course. This should encourage experts and scientific societies to strongly advise against the use of NSAIDs in the management of lower respiratory tract infections.
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Affiliation(s)
- Guillaume Voiriot
- Assistance Publique-Hôpitaux de Paris, Service de Réanimation médico-chirurgicale, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, 75020 Paris, France.
- Sorbonne Université, UFR Médecine, 75006 Paris, France.
- Faculté de Médecine, GRC CARMAS, Université Paris Est, 94000 Créteil, France.
| | - Quentin Philippot
- Assistance Publique-Hôpitaux de Paris, Service de Réanimation médico-chirurgicale, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, 75020 Paris, France.
| | - Alexandre Elabbadi
- Assistance Publique-Hôpitaux de Paris, Service de Réanimation médico-chirurgicale, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, 75020 Paris, France.
| | - Carole Elbim
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, Team "Immune System, Neuroinflammation and Neurodegenerative Diseases", Hôpital Saint-Antoine, 75012 Paris, France.
| | - Martin Chalumeau
- UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris Descartes University, 75014 Paris, France.
- Department of General Pediatrics and Pediatric Infectious Diseases, Necker hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, 75015 Paris, France.
| | - Muriel Fartoukh
- Assistance Publique-Hôpitaux de Paris, Service de Réanimation médico-chirurgicale, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, 75020 Paris, France.
- Sorbonne Université, UFR Médecine, 75006 Paris, France.
- Faculté de Médecine, GRC CARMAS, Université Paris Est, 94000 Créteil, France.
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18
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Bishop DG, Gibbs MW, Dyer RA. Post-caesarean delivery analgesia in resource-limited settings: a narrative review. Int J Obstet Anesth 2019; 40:119-127. [PMID: 31230992 DOI: 10.1016/j.ijoa.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 04/02/2019] [Accepted: 05/10/2019] [Indexed: 01/26/2023]
Abstract
Post-caesarean pain is an important and often neglected outcome. It causes suffering, affects breastfeeding and is associated with postpartum depression and the development of chronic pain syndromes. Pain control is often difficult even in resource-rich environments; it is likely far worse in resource-limited settings, where emphasis is on reducing the high maternal mortality rate. Lack of adequate staffing, education, and postoperative monitoring severely limit the options in resource-limited settings. Resource-limited settings are further compromised by limited access to essential analgesic drugs and equipment for their administration. Solutions using affordable and accessible medications as part of a multimodal analgesic strategy are possible, supplemented by education and training programmes. More research is required, both to establish current practice and to test methods for improving maternal pain control. While government involvement is necessary to improve infrastructure and resources in individual countries, other solutions should also be sought, empowering local institutions and harnessing individual cultural characteristics.
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Affiliation(s)
- D G Bishop
- Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
| | - M W Gibbs
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
| | - R A Dyer
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
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19
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Voiriot G, Chalumeau M, Messika J, Basille D, Philippe B, Ricard JD, Andrejak C, Jounieaux V, Sanchez O, Fartoukh M. [Risks associated with the use of non-steroidal anti-inflammatory drugs during pneumonia]. Rev Mal Respir 2018; 35:430-440. [PMID: 29754841 DOI: 10.1016/j.rmr.2017.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/10/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Outpatient treatment of community-acquired pneumonia (CAP) patients with non-steroidal anti-inflammatory drugs (NSAIDs) is frequent, although this is not based on clinical recommendations and there is no scientific evidence supporting better symptom relief in comparison to acetaminophen. STATE OF THE ART Experimental data suggest that NSAIDs alter the intrinsic functions of neutrophils, limit their locoregional recruitment, alter bacterial clearance and delay the resolution of inflammatory processes during acute bacterial pulmonary challenge. In hospitalized children and adults with CAP, observational data suggest a strong and independent association between the outpatient exposure to NSAIDs and the occurrence of pleuropulmonary complications (pleural empyema, excavation, and abscess). In the only study taking into account possible protopathic bias, the association still persists. Other markers of morbidity have been described, including delay in hospital management, prolonged antibiotic therapy, and higher transfer rate to an intensive care unit. PERSPECTIVES Data describing the role of self-medication and the biological mechanisms involved are needed. CONCLUSIONS Intake of NSAIDs during outpatient treatment of CAP is probably the second modifiable factor of morbidity after inadequate antibiotic therapy. In light of existing data in children and adults, health authorities should urgently reassess the risk-benefit ratio of NSAIDS in CAP.
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Affiliation(s)
- G Voiriot
- Service de réanimation médico-chirurgicale, hôpital Tenon, hôpitaux universitaires de l'Est-Parisien, Assistance publique-hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France.
| | - M Chalumeau
- Service de pédiatrie générale et maladies infectieuses, hôpital universitaire Necker-Enfants-Malades, Assistance publique-hôpitaux de Paris, 75015 Paris, France; Faculté de médecine, université Paris-Descartes-Paris-V, 75006 Paris, France
| | - J Messika
- Service de réanimation médico-chirurgicale, hôpital Louis-Mourier, hôpitaux universitaires Paris-Nord-Val-de-Seine, Assistance publique-hôpitaux de Paris, 92700 Colombes, France
| | - D Basille
- Service de pneumologie et réanimation respiratoire, centre hospitalier universitaire Amiens-Picardie, 80080 Amiens, France
| | - B Philippe
- Service de pneumologie, centre hospitalier René-Dubos, 95300 Pontoise, France
| | - J-D Ricard
- Service de réanimation médico-chirurgicale, hôpital Louis-Mourier, hôpitaux universitaires Paris-Nord-Val-de-Seine, Assistance publique-hôpitaux de Paris, 92700 Colombes, France; Faculté de médecine, université Paris-Diderot-Paris-VII, 75013 Paris, France
| | - C Andrejak
- Service de pneumologie et réanimation respiratoire, centre hospitalier universitaire Amiens-Picardie, 80080 Amiens, France; Faculté de médecine, université de Picardie-Jules-Verne, 80025 Amiens, France
| | - V Jounieaux
- Service de pneumologie et réanimation respiratoire, centre hospitalier universitaire Amiens-Picardie, 80080 Amiens, France; Faculté de médecine, université de Picardie-Jules-Verne, 80025 Amiens, France
| | - O Sanchez
- Faculté de médecine, université Paris-Descartes-Paris-V, 75006 Paris, France; Service de pneumologie, soins intensifs et endoscopies bronchiques, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, Assistance Publique-hôpitaux de Paris, 75015 Paris, France
| | - M Fartoukh
- Service de réanimation médico-chirurgicale, hôpital Tenon, hôpitaux universitaires de l'Est-Parisien, Assistance publique-hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine, Sorbonne université Paris, 75013 Paris, France
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20
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Staphylococcus aureus produces pain through pore-forming toxins and neuronal TRPV1 that is silenced by QX-314. Nat Commun 2018; 9:37. [PMID: 29295977 PMCID: PMC5750211 DOI: 10.1038/s41467-017-02448-6] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/30/2017] [Indexed: 12/22/2022] Open
Abstract
The hallmark of many bacterial infections is pain. The underlying mechanisms of pain during live pathogen invasion are not well understood. Here, we elucidate key molecular mechanisms of pain produced during live methicillin-resistant Staphylococcus aureus (MRSA) infection. We show that spontaneous pain is dependent on the virulence determinant agr and bacterial pore-forming toxins (PFTs). The cation channel, TRPV1, mediated heat hyperalgesia as a distinct pain modality. Three classes of PFTs-alpha-hemolysin (Hla), phenol-soluble modulins (PSMs), and the leukocidin HlgAB-directly induced neuronal firing and produced spontaneous pain. From these mechanisms, we hypothesized that pores formed in neurons would allow entry of the membrane-impermeable sodium channel blocker QX-314 into nociceptors to silence pain during infection. QX-314 induced immediate and long-lasting blockade of pain caused by MRSA infection, significantly more than lidocaine or ibuprofen, two widely used clinical analgesic treatments.
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21
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Deneubourg DL, Catherine Z, Lejuste P, Breton P. Periorbital Necrotizing Fasciitis Induced by Streptococcus pyogenes : A Case Report and Clarification. J Oral Maxillofac Surg 2018; 76:154.e1-154.e5. [DOI: 10.1016/j.joms.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 11/30/2022]
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Ture Z, Demiraslan H, Kontas O, Alp E, Doganay M. The role of nonsteroidal anti-inflammatory drugs intramuscular injection in the development and severity of deep soft tissue infection in mice. Fundam Clin Pharmacol 2017; 32:147-154. [PMID: 29172254 DOI: 10.1111/fcp.12336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/09/2017] [Accepted: 11/21/2017] [Indexed: 11/30/2022]
Abstract
The aim of this study was to determine the role of nonsteroidal anti-inflammatory drugs (NSAID) injection on the severity of local infection and the effect on the progression of soft tissue infection (STI).The mouse model of STI with Group A streptococcus (GAS) was developed and treated with diclofenac sodium (DS) intramuscularly. Mice were divided into five groups: administered DS for 48 h before GAS (Group 1), GAS-DS and maintained DS for 48 h (Group 2), DS for 48 h (Group 3), GAS on zero time (Group 4), and control (Group 5). In vitro, a high concentration (40 mg/L) of DS inhibited GAS growth, whereas a lower concentration (0.4 mg/L) was not effective. Sepsis was observed in animals with DS and GAS inoculation (group 1 and 2). Group 4 had statistically significant higher bacterial load than groups 1 and 2. All groups had a higher inflammation rate than the control group. The median of TNF-alpha and mean IL-6 in the groups 1, 2, and 4 was significantly higher than those in the control group. Even if the animals that were treated with DS injection prior to the GAS inoculation had similar inflammation score, similar cytokine levels and low bacterial load in the tissue, they had a rather high rate of sepsis. In conclusion, DS injection prior to bacterial inoculation might predispose to bacteremia and sepsis.
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Affiliation(s)
- Zeynep Ture
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Melikgazi, Kayseri, Turkey
| | - Hayati Demiraslan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Melikgazi, Kayseri, Turkey
| | - Olgun Kontas
- Department of Pathology, Faculty of Medicine, Erciyes University, Melikgazi, Kayseri, Turkey
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Melikgazi, Kayseri, Turkey
| | - Mehmet Doganay
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Melikgazi, Kayseri, Turkey
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Affiliation(s)
- Dennis L Stevens
- From the Veterans Affairs Medical Center, Boise, ID; and the University of Washington School of Medicine, Seattle
| | - Amy E Bryant
- From the Veterans Affairs Medical Center, Boise, ID; and the University of Washington School of Medicine, Seattle
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A Propensity Score-Matched Study of the Use of Non-steroidal Anti-inflammatory Agents Following Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2017; 25:351-358. [PMID: 27000643 DOI: 10.1007/s12028-016-0266-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Inflammation may contribute to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Here, we compared outcomes among propensity score-matched cohorts who did and did not receive non-steroidal anti-inflammatory drug (NSAID) use after aSAH. METHODS Propensity score-matched analysis of 413 subjects enrolled in the Clazosentan to Overcome Neurological iSChemia and Infarction OccUring after Subarachnoid hemorrhage (CONSCIOUS-1) study. Propensity score matching was performed on the basis of age, sex, baseline National Institutes of Health Stroke Scale score, World Federation of Neurological Societies grade on admission, procedure used for securing aneurysm, and SAH clot burden. RESULTS 178 patients were matched (89 received NSAIDs, 89 did not). Propensity score matching was considered acceptable. Patients who had received NSAIDs during their hospital stay had significantly lower mortality rate, and reduced duration of intensive care unit stay and total length of hospital stay (P = 0.035, P = 0.009, and P = 0.053, respectively). At 6 weeks, 80.9 % of patients treated with NSAIDs had good functional outcome compared to 68.5 % of matched controls (P = 0.083). There was no significant difference in the proportions of patients who developed delayed ischemic neurological deficits, angiographic vasospasm, or required rescue therapy. CONCLUSIONS Inflammation may play a crucial role in the poor outcomes after SAH, and that NSAIDs may be a useful therapeutic option, once validated by larger prospective studies.
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Contou D, Lecronier M, Bitot V, Hersant B, Zakine A, Hua C, de Prost N. Fatal Clostridium septicum multifocal myonecrosis in a previously healthy 25-year-old man: Role of NSAIDs? Med Mal Infect 2017; 47:432-434. [PMID: 28705640 DOI: 10.1016/j.medmal.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/03/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
Affiliation(s)
- D Contou
- Service de réanimation médicale, groupe Henri-Mondor-Albert-Chenevier, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; UPEC-Université Paris-Est Créteil Val de Marne, faculté de médecine de Créteil, CARMAS Research Group, 94010 Créteil, France.
| | - M Lecronier
- Service de réanimation médicale, groupe Henri-Mondor-Albert-Chenevier, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - V Bitot
- Service d'anesthésiologie et réanimation chirurgicale, groupe Henri-Mondor-Albert-Chenevier, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - B Hersant
- Service de chirurgie plastique, groupe Henri-Mondor-Albert-Chenevier, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - A Zakine
- Service des urgences, groupe Henri-Mondor-Albert-Chenevier, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - C Hua
- Service de dermatologie, groupe Henri-Mondor-Albert-Chenevier, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - N de Prost
- Service de réanimation médicale, groupe Henri-Mondor-Albert-Chenevier, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; UPEC-Université Paris-Est Créteil Val de Marne, faculté de médecine de Créteil, CARMAS Research Group, 94010 Créteil, France
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26
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Narasimhan V, Ooi G, Weidlich S, Carson P. Laboratory Risk Indicator for Necrotizing Fasciitis score for early diagnosis of necrotizing fasciitis in Darwin. ANZ J Surg 2017; 88:E45-E49. [DOI: 10.1111/ans.13895] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/27/2016] [Accepted: 12/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Vignesh Narasimhan
- Department of Surgery, Royal Darwin Hospital; Darwin Northern Territory, Australia
- Department of General Surgery; The Alfred Hospital; Melbourne Victoria Australia
| | - Geraldine Ooi
- Department of General Surgery; The Alfred Hospital; Melbourne Victoria Australia
- Department of Surgery; Monash University; Melbourne Victoria Australia
| | - Stephanie Weidlich
- Department of Surgery, Royal Darwin Hospital; Darwin Northern Territory, Australia
| | - Phillip Carson
- Department of Surgery, Royal Darwin Hospital; Darwin Northern Territory, Australia
- Flinders University, Northern Territory Medical Program; Darwin Northern Territory, Australia
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Davis JS, Mackrow C, Binks P, Fletcher W, Dettwiller P, Marshall C, Day J, Pratt W, Tong SYC. A double-blind randomized controlled trial of ibuprofen compared to placebo for uncomplicated cellulitis of the upper or lower limb. Clin Microbiol Infect 2017; 23:242-246. [PMID: 28274772 DOI: 10.1016/j.cmi.2017.02.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/26/2017] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Cellulitis is a common skin infection resulting in inflammation that may take weeks to resolve despite appropriate antibiotics. It is unclear whether the adjunctive use of nonsteroidal anti-inflammatory drugs hastens the resolution of inflammation in patients with cellulitis. METHODS We conducted a double-blind, randomized controlled trial comparing ibuprofen 400 mg three times daily for 5 days with identical placebo in adults with uncomplicated cellulitis of the upper or lower limb who were treated with intravenous cefazolin via an outpatient parenteral antibiotic treatment service at one of two Australian hospitals. Participants were assessed twice daily by a study nurse. The primary outcome measure was the proportion of patients with regression of inflammation 48 hours after the first effective dose of parenteral antibiotics (trial registration ANZCTR 12611000515998). RESULTS Fifty-one patients were enrolled; 48 had sufficient data available to be included in the modified intention-to-treat analysis. Inflammation had begun to regress at 48 hours in 20 participants (80%) in the ibuprofen group compared to 15 (65%) in the placebo group (absolute risk difference +15%; 95% confidence interval -10 to +40; p >0.05). There was no significant difference in any secondary outcome. Ibuprofen appeared safe, with no patients developing renal impairment or necrotizing fasciitis. CONCLUSIONS This trial demonstrated no significant benefit of adjunctive ibuprofen in adults with uncomplicated cellulitis. The trial was powered to detect a large effect, and hence it is unclear whether the 15% absolute increase in the primary end point in the ibuprofen group was attributable to chance.
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Affiliation(s)
- J S Davis
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia; Department of Infectious Diseases, John Hunter Hospital and the University of Newcastle, Newcastle, New South Wales, Australia.
| | - C Mackrow
- Hospital in the Home Program, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - P Binks
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - W Fletcher
- Hospital in the Home Program, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - P Dettwiller
- Katherine Rural Clinical School, Flinders University, Katherine, Northern Territory, Australia
| | - C Marshall
- Hospital in the Home Program, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - J Day
- Hospital in the Home Program, Shoalhaven Hospital, Nowra, New South Wales, Australia
| | - W Pratt
- Hospital in the Home Program, Shoalhaven Hospital, Nowra, New South Wales, Australia
| | - S Y C Tong
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia; Victorian Infectious Diseases Service, The Royal Melbourne Hospital, and the University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Basille D, Plouvier N, Trouve C, Duhaut P, Andrejak C, Jounieaux V. Non-steroidal Anti-inflammatory Drugs may Worsen the Course of Community-Acquired Pneumonia: A Cohort Study. Lung 2016; 195:201-208. [PMID: 28005149 DOI: 10.1007/s00408-016-9973-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 12/16/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed or used as self-medication in cases of community-acquired pneumonia (CAP). Nevertheless, the consequences of such medication on the risk of pleuroparenchymal complications are not well known. The aim was to investigate whether exposure to NSAIDs prior to hospital admission among patients suffering from CAP is associated with the development of pleural complications or a lung abscess. METHODS All consecutive non-immunocompromised patients with CAP and admitted to a university hospital were prospectively included (2-year period). The risk of pleuropulmonary complications was analyzed according to previous exposure to NSAIDs. RESULTS Of the 221 included patients, 40 (18.1%) had developed a pleuropulmonary complication. NSAIDs intake prior to admission was reported for 24 patients (10.9%) who were younger (50.6 ± 18.5 vs. 66.5 ± 16.4 years; p = 0.001), had less comorbidities (60 vs. 25.1%; p = 0.001), had a longer duration between the first symptoms of CAP and the start of an antibiotic therapy (6.1 ± 7.6 vs. 2.8 ± 3.8 days; p = 0.001), and who had a higher incidence of pleuropulmonary complications (33.3 vs. 16.2%; p = 0.048). In multivariate analyses, two factors were independently associated with the development of pleuroparenchymal complications: NSAIDs intake [Odds Ratio (OR) = 2.57 [1.02-6.64]; p = 0.049] and alcohol abuse (OR = 2.68 [1.27-5.69]; p = 0.01). CONCLUSIONS Our findings suggest that NSAIDs, often taken by young and healthy patients, may worsen the course of CAP with delayed therapy and a higher rate of pleuropulmonary complications.
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Affiliation(s)
- Damien Basille
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, 80054, France. .,Recif Unit, University Hospital Amiens, Amiens, France.
| | - Nathalie Plouvier
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, 80054, France
| | - Charlotte Trouve
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, 80054, France
| | - Pierre Duhaut
- Recif Unit, University Hospital Amiens, Amiens, France.,Internal Medicine, University Hospital Amiens, Amiens, France
| | - Claire Andrejak
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, 80054, France.,Recif Unit, University Hospital Amiens, Amiens, France
| | - Vincent Jounieaux
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, 80054, France
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29
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Is there an association between prior anti-inflammatory drug exposure and occurrence of peritonsillar abscess (PTA)? A national multicenter prospective observational case-control study. Eur J Clin Microbiol Infect Dis 2016; 36:57-63. [PMID: 27604832 DOI: 10.1007/s10096-016-2770-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
The aim of this study was to evaluate whether recent systemic anti-inflammatory agents (AIAs) exposure in patients with sore throat managed with or without antibiotic therapy influenced the risk of peritonsillar abscess (PTA). We conducted a multicenter case-control study in 13 French university hospitals in 2009-2012 comparing patients admitted with PTA to matched controls: patients with sore throat but without PTA who were followed up for 10 days after visiting their primary-care physician. In the multivariate stepwise logistic regression model comparing 120 cases with PTA to 143 controls, factors significantly associated with PTA were male gender (odds ratio [OR], 2.0; p = 0.03), smoking (OR, 2.0; p = 0.03), and prior self-medication with systemic AIAs (OR, 3.5; p = 0.01). Topical treatment was associated with significant protection against PTA (OR, 0.3; p < 0.001). In conclusion, self-medication with systemic AIAs appears to be an independent factor associated with the occurrence of PTA. This is an important message as non-steroidal AIAs access is favored by their over-counter availability in pharmacies. This finding must be interpreted with caution due to the study design and a prospective, randomized study is needed to substantiate these possible causal risk factors.
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30
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LaRock CN, Todd J, LaRock DL, Olson J, O’Donoghue AJ, Robertson AAB, Cooper MA, Hoffman HM, Nizet V. IL-1β is an innate immune sensor of microbial proteolysis. Sci Immunol 2016; 1:eaah3539. [PMID: 28331908 PMCID: PMC5358671 DOI: 10.1126/sciimmunol.aah3539] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Interleukin-1β (IL-1β) is a key proinflammatory cytokine that drives antimicrobial immune responses. IL-1β is aberrantly activated in autoimmune diseases, and IL-1β inhibitors are used as therapeutic agents to treat patients with certain autoimmune disorders. Review of postmarketing surveillance of patients receiving IL-1β inhibitors found a disproportionate reporting of invasive infections by group A Streptococcus (GAS). IL-1β inhibition increased mouse susceptibility to GAS infection, but IL-1β was produced independent of canonical inflammasomes. Newly synthesized IL-1β has an amino-terminal prodomain that blocks signaling activity, which is usually proteolytically removed by caspase-1, a protease activated within the inflammasome structure. In place of host caspases, the secreted GAS cysteine protease SpeB generated mature IL-1β. During invasive infection, GAS isolates may acquire pathoadaptive mutations eliminating SpeB expression to evade detection by IL-1β. Pharmacological IL-1β inhibition alleviates this selective pressure, allowing invasive infection by nonpathoadapted GAS. Thus, IL-1β is a sensor that directly detects pathogen-associated proteolysis through an independent pathway operating in parallel with host inflammasomes. Because IL-1β function is maintained across species, yet cleavage by caspases does not appear to be, detection of microbial proteases may represent an ancestral system of innate immune regulation.
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Affiliation(s)
- Christopher N. LaRock
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California (UC), San Diego, La Jolla, CA 92093, USA
| | - Jordan Todd
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California (UC), San Diego, La Jolla, CA 92093, USA
| | - Doris L. LaRock
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California (UC), San Diego, La Jolla, CA 92093, USA
| | - Joshua Olson
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California (UC), San Diego, La Jolla, CA 92093, USA
| | - Anthony J. O’Donoghue
- Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, La Jolla, CA 92093, USA
| | - Avril A. B. Robertson
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland 4072, Australia
| | - Matthew A. Cooper
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland 4072, Australia
| | - Hal M. Hoffman
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California (UC), San Diego, La Jolla, CA 92093, USA
| | - Victor Nizet
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California (UC), San Diego, La Jolla, CA 92093, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, La Jolla, CA 92093, USA
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31
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Chhetry M, Banerjee B, Subedi S, Koirala A. Necrotizing fasciitis of anterior abdominal wall following cesarean section in a low-risk patient. J Surg Case Rep 2016; 2016:rjw122. [PMID: 27402541 PMCID: PMC4937995 DOI: 10.1093/jscr/rjw122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report a case of a mono-microbial post-cesarean necrotizing fasciitis caused by methicillin resistant Staphylococcus aureus, in a low-risk healthy woman who presented with acute fulminant infection, sepsis and features of multi-organ dysfunction syndrome on sixth post-operative day. Aggressive management with multiple surgical debridement and supportive therapy was the key to favorable outcome in this case.
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Affiliation(s)
- Manisha Chhetry
- Department of Obstetrics and Gynecology, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - Basudeb Banerjee
- Department of Obstetrics and Gynecology, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - Shanti Subedi
- Department of Obstetrics and Gynecology, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - Ashok Koirala
- Department of Surgery, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
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32
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Arruda JA, Figueiredo E, Álvares P, Silva L, Silva L, Caubi A, Silveira M, Sobral AP. Cervical Necrotizing Fasciitis Caused by Dental Extraction. Case Rep Dent 2016; 2016:1674153. [PMID: 27375905 PMCID: PMC4916313 DOI: 10.1155/2016/1674153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/16/2016] [Indexed: 11/18/2022] Open
Abstract
Cervical necrotizing fasciitis is an unusual infection characterized by necrosis of the subcutaneous tissue and fascial layers. Risk factors for the development of necrotizing fasciitis include diabetes mellitus, chronic renal disease, peripheral vascular disease, malnutrition, advanced age, obesity, alcohol abuse, intravenous drug use, surgery, and ischemic ulcers. This report presents a case of necrotizing fasciitis in the cervical area caused by dental extraction in a 73-year-old woman. Cervical necrotizing fasciitis in geriatric patient is rare, and even when establishing the diagnosis and having it timely treated, the patient can suffer irreversible damage or even death. Clinical manifestations in the head and neck usually have an acute onset characterized by severe pain, swelling, redness, erythema, presence of necrotic tissue, and in severe cases obstruction of the upper airways. Therefore, the presentation of this clinical case can serve as guidance to dentists as a precaution to maintain an aseptic chain and be aware of the clinical condition of older patients and the systemic conditions that may increase the risk of infections.
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Affiliation(s)
- José Alcides Arruda
- Faculdade de Odontologia de Pernambuco, Universidade de Pernambuco, Avenida General Newton Cavalcante, 1650 Aldeia dos Camarás, 54753-020 Camaragibe, PE, Brazil
| | - Eugênia Figueiredo
- Hospital da Restauração, Avenida Governador Agamenon Magalhães, S/N, Derby, 52010-040 Recife, PE, Brazil
| | - Pâmella Álvares
- Faculdade de Odontologia de Pernambuco, Universidade de Pernambuco, Avenida General Newton Cavalcante, 1650 Aldeia dos Camarás, 54753-020 Camaragibe, PE, Brazil
| | - Luciano Silva
- Faculdade de Odontologia de Pernambuco, Universidade de Pernambuco, Avenida General Newton Cavalcante, 1650 Aldeia dos Camarás, 54753-020 Camaragibe, PE, Brazil
| | - Leorik Silva
- Universidade Federal do Rio Grande do Norte, Campus Universitário Lagoa Nova, P.O. Box 1524, 59078-970 Natal, RN, Brazil
| | - Antônio Caubi
- Faculdade de Odontologia de Pernambuco, Universidade de Pernambuco, Avenida General Newton Cavalcante, 1650 Aldeia dos Camarás, 54753-020 Camaragibe, PE, Brazil
| | - Marcia Silveira
- Faculdade de Odontologia de Pernambuco, Universidade de Pernambuco, Avenida General Newton Cavalcante, 1650 Aldeia dos Camarás, 54753-020 Camaragibe, PE, Brazil
| | - Ana Paula Sobral
- Faculdade de Odontologia de Pernambuco, Universidade de Pernambuco, Avenida General Newton Cavalcante, 1650 Aldeia dos Camarás, 54753-020 Camaragibe, PE, Brazil
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33
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Hyvernat H, Chambon R, Doyen D, Baudin G, Dellamonica J, Bernardin G. Méningo-encéphalite bactérienne secondaire à une sinusite : imputabilité des anti-inflammatoires non stéroïdiens ? Presse Med 2016; 45:473-5. [DOI: 10.1016/j.lpm.2016.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/12/2016] [Accepted: 01/18/2016] [Indexed: 11/29/2022] Open
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34
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Lepelletier D, Pinaud V, Le Conte P, Bourigault C, Asseray N, Ballereau F, Caillon J, Ferron C, Righini C, Batard E, Potel G. Peritonsillar abscess (PTA): clinical characteristics, microbiology, drug exposures and outcomes of a large multicenter cohort survey of 412 patients hospitalized in 13 French university hospitals. Eur J Clin Microbiol Infect Dis 2016; 35:867-73. [PMID: 26942743 DOI: 10.1007/s10096-016-2609-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
The aim of this study was to describe the epidemiology of hospitalized patients with peritonsillar abscess (PTA). We conducted a multicenter survey in 13 French university hospitals in 2009-2012 describing 412 patients. Median age was 29 year (range, 2-84) and current smoking habit was reported by 177 (43 %) patients. Most of the patients (92 %) had consulted a physician for sore throat within 10 days before admission for PTA diagnosis. Additional symptoms such as visible tonsil abnormalities (83 %), tender cervical adenopathy (57 %) and fever ≥ 38.5 °C (53 %) were also reported. A total of 65 % patients (269/412) reported recent systemic anti-inflammatory agents (AIAs) exposure by medical prescription (70 %), self-medication (22 %), or both (8 %); 61 % and 27 % reported recent exposure to antibiotic and topical treatments for sore throat, respectively. Non-steroidal AIAs were used most often (45 %), particularly arylpropionic derivatives. A rapid diagnosis antigen test (RDT) for Streptococcus pyogenes was performed in 70 (17 %) patients and was positive in 17 (24 %), of whom 9 (53 %) were exposed to AIAs and 14 (82 %) to antibiotics. To treat PTA, antibiotic therapy was given to 392 (95 %) patients. Of 333 antibiotic prescriptions, amoxicillin-clavulanic acid and metronidazole were the most prescribed antibiotics (42 and 17 %, respectively). Surgical drainage of the abscess was performed in 119 (29 %) cases and tonsillectomy in 75 (18 %) cases. The clinical outcome was favorable during the hospital stay in 404 (98 %) patients. In conclusion, patients with sore throat are often exposed to AIAs before PTA diagnosis, and antibiotic prescription was not often based on the RDT positivity.
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Affiliation(s)
- D Lepelletier
- Bacteriology and Infection Control Department, Nantes University Hospital, 44093, Nantes, France. .,Medical School, EA 3826, University of Nantes, 44035, Nantes, France.
| | - V Pinaud
- Emergency Department, Nantes University Hospital, 44093, Nantes, France
| | - P Le Conte
- Emergency Department, Nantes University Hospital, 44093, Nantes, France
| | - C Bourigault
- Bacteriology and Infection Control Department, Nantes University Hospital, 44093, Nantes, France
| | - N Asseray
- Infectious Diseases Department, Nantes University Hospital, 44093, Nantes, France.,Medical School, EA 3826, University of Nantes, 44035, Nantes, France
| | - F Ballereau
- Medqual, Nantes University Hospital, 44093, Nantes, France.,Medical School, EA 3826, University of Nantes, 44035, Nantes, France
| | - J Caillon
- Bacteriology and Infection Control Department, Nantes University Hospital, 44093, Nantes, France.,Medical School, EA 3826, University of Nantes, 44035, Nantes, France
| | - C Ferron
- Otorhinolaryngology Department, Nantes University Hospital, 44093, Nantes, France
| | - C Righini
- Otorhinolaryngology Department, Michallon University Hospital, 38000, Grenoble, France
| | - E Batard
- Emergency Department, Nantes University Hospital, 44093, Nantes, France.,Medical School, EA 3826, University of Nantes, 44035, Nantes, France
| | - G Potel
- Emergency Department, Nantes University Hospital, 44093, Nantes, France.,Medical School, EA 3826, University of Nantes, 44035, Nantes, France
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35
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The roles of injury and nonsteroidal anti-inflammatory drugs in the development and outcomes of severe group A streptococcal soft tissue infections. Curr Opin Infect Dis 2016; 28:231-9. [PMID: 25918957 DOI: 10.1097/qco.0000000000000160] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW This review summarizes clinical and basic science evidence linking trauma and nonsteroidal anti-inflammatory drug (NSAID) use to initiation and progression of severe group A streptococcal (GAS) soft tissue infection. RECENT FINDINGS New evidence includes recent clinical series and controlled studies that lend support to an NSAID/GAS association, basic science studies that demonstrate unique roles for nonpenetrating injury and NSAID administration in initiation of cryptogenic GAS infection and experimental studies showing that nonselective NSAIDs accelerate disease progression and limit antibiotic efficacy in established GAS soft tissue infections. Potential mechanisms for these processes are discussed. SUMMARY NSAIDs are important anti-inflammatory and analgesic drugs; however, new experimental data suggest that nonselective NSAIDs do more than simply mask the signs and symptoms of developing GAS infection. A more thorough understanding of the triadic interplay of injury-triggered immune signaling, GAS soft tissue infection and NSAIDs is of significant clinical importance and could shift the current paradigm of pain management to avert the consequences of such devastating infections.
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36
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Abstract
Necrotizing fasciitis (NF) is a severe and rapidly progressive infectious disease that attacks superficial an as well as deep fascia, subcutaneous fat tissue, and muscle. Although the incidence is of relatively low frequency, the median mortality is high. NF is a great burden to patients and hospitals. The most common cause of NF is trauma injuries, followed by other conditions with comorbidity. A classification for NF was presented concerning microbial cause, depth of infection, and anatomy. But the value of classification is not convincing. Early diagnosis of NF is essential and still to be realized by far. Information from clinic or laboratory might contribute to the purpose. Surgery is used in exploration debridement and tissue reconstruction as the main method with NF. Negative pressure wound therapy has proved to be useful in improving wound bed preparation and healing.
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Affiliation(s)
- Xiaofang Sun
- Shanghai 9th People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Xie
- Shanghai 9th People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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37
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LaRock CN, Nizet V. Inflammasome/IL-1β Responses to Streptococcal Pathogens. Front Immunol 2015; 6:518. [PMID: 26500655 PMCID: PMC4597127 DOI: 10.3389/fimmu.2015.00518] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/24/2015] [Indexed: 02/06/2023] Open
Abstract
Inflammation mediated by the inflammasome and the cytokine IL-1β are some of the earliest and most important alarms to infection. These pathways are responsive to the virulence factors that pathogens use to subvert immune processes, and thus are typically activated only by microbes with potential to cause severe disease. Among the most serious human infections are those caused by the pathogenic streptococci, in part because these species numerous strategies for immune evasion. Since the virulence factor armament of each pathogen is unique, the role of IL-1β and the pathways leading to its activation varies for each infection. This review summarizes the role of IL-1β during infections caused by streptococcal pathogens, with emphasis on emergent mechanisms and concepts countering paradigms determined for other organisms.
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Affiliation(s)
- Christopher N LaRock
- Department of Pediatrics, University of California San Diego , La Jolla, CA , USA
| | - Victor Nizet
- Department of Pediatrics, University of California San Diego , La Jolla, CA , USA ; Skaggs School of Medicine and Pharmaceutical Sciences, University of California San Diego , La Jolla, CA , USA
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38
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Dirou S, Voiriot G. [Anti-inflammatory drugs and community-acquired pneumonia]. Rev Mal Respir 2015; 32:841-4. [PMID: 26372616 DOI: 10.1016/j.rmr.2015.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/03/2015] [Indexed: 11/28/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in ambulatory medicine for their analgesic and antipyretic properties and are often used as self-medication. Their use in community-acquired pneumonia is associated with an increased risk of loco-regional complications, especially pleural empyema. Appropriate therapeutic care and hospital admissions are often delayed because of initial improvement of symptoms with NSAIDs. Despite worrying observational data, a causal link remains to be established. Currently, there is no recommendation cautioning against the use of NSAIDs in the management of community-acquired pneumonia.
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Affiliation(s)
- S Dirou
- Service de pneumologie, l'institut du thorax, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard J.-Monod, 44093 Nantes cedex 1, France.
| | - G Voiriot
- Service de réanimation médicale et infectieuse, hôpital Bichat-Claude-Bernard, Assistance publique-hôpitaux de Paris, 75018 Paris, France
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39
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40
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Demeslay J, De Bonnecaze G, Vairel B, Chaput B, Pessey JJ, Serrano E, Vergez S. Possible role of anti-inflammatory drugs in complications of pharyngitis. A retrospective analysis of 163 cases. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:299-303. [DOI: 10.1016/j.anorl.2013.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 02/15/2013] [Accepted: 08/28/2013] [Indexed: 01/07/2023]
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41
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Nolff MC, Meyer-Lindenberg A. Necrotising fasciitis in a domestic shorthair cat - negative pressure wound therapy assisted debridement and reconstruction. J Small Anim Pract 2014; 56:281-4. [DOI: 10.1111/jsap.12275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 07/10/2014] [Accepted: 08/03/2014] [Indexed: 12/01/2022]
Affiliation(s)
- M. C. Nolff
- Clinic for Small Animal Surgery and Reproduction; Ludwig Maximilians University; Munich Germany
| | - A. Meyer-Lindenberg
- Clinic for Small Animal Surgery and Reproduction; Ludwig Maximilians University; Munich Germany
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42
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Magala J, Makobore P, Makumbi T, Kaggwa S, Kalanzi E, Galukande M. The clinical presentation and early outcomes of necrotizing fasciitis in a Ugandan Tertiary Hospital--a prospective study. BMC Res Notes 2014; 7:476. [PMID: 25069415 PMCID: PMC4119938 DOI: 10.1186/1756-0500-7-476] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 07/21/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis is an infectious process characterized by rapidly progressing necrosis of superficial fascia and subcutaneous tissue with subsequent necrosis of overlying skin.Necrotizing fasciitis is a rare but fatal infection. The worldwide incidence is at 0.4 per 100,000. Mortality is up to 80% with no intervention, and 30-50% with intervention. Delay in intervention is associated with poor outcome. The risk factors for necrotizing fasciitis are diabetes mellitus, HIV, malignancy, illicit drug use, malnutrition among others.The aim of this study was to describe the clinical presentation and early outcomes of necrotizing fasciitis amongst Ugandan patients. METHODS A prospective descriptive case series study conducted at Mulago National Referral and Teaching hospital from 5th January to 30th April 2011. Patients with necrotizing fasciitis were consecutively recruited after clinical evaluation, laboratory and microbiological tests were performed. Aggressive debridement was done and broad-spectrum antibiotics administered. Patients were followed up on surgical wards. Ethical approval was obtained. RESULTS Thirty five patients were recruited over a 4 months period. More males were affected with, M: F 3:1. The 20-40 years age group was most affected. Attainment of healthy granulation tissue took 19 days on average. Mortality rate was 14% (5/35). Limbs were the most affected body parts 20/35 (57%), the scrotum and perineum (23%). Among infants the scalp was the most affected. Co-morbidities included HIV 8/35 (17%), and DM (5%) among others. The commonest organisms were gram negative. Split skin grafting was necessary in 74% (26/35) of patients. CONCLUSION There were a high number of patients with necrotizing fasciitis; it was associated with low mortality but high morbidity (long hospital stay). There was a high preponderance to males and limbs were the more affected body parts.
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Affiliation(s)
| | | | | | | | | | - Moses Galukande
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda.
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43
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Risks of nonsteroidal antiinflammatory drugs in undiagnosed intensive care unit pneumococcal pneumonia: younger and more severely affected patients. J Crit Care 2014; 29:733-8. [PMID: 24997726 DOI: 10.1016/j.jcrc.2014.05.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/18/2014] [Accepted: 05/10/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study is to investigate whether exposure to nonsteroidal antiinflammatory drugs (NSAIDs) at the early stage of severe pneumococcal community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission may affect its presentation and outcome. MATERIAL AND METHODS Medical records of ICU adult patients (12-year period) with a pneumococcal CAP diagnosis were retrospectively analyzed according to previous NSAID exposure. RESULTS One hundred six confirmed pneumococcal CAP were identified, 20 received NSAIDs within 4 (2-6) days before admission. Nonsteroidal antiinflammatory drug-exposed patients were younger (43.3 vs 62.2 years; P < .0001), had less frequently at least one chronic comorbid condition (40% vs 75%; P = .003), had more often complicated pleural effusions (20% vs 2.3%; P = .01), and more frequent pleuropulmonary complications (odds ratio: 5.75 [1.97-16.76]). Nonsteroidal antiinflammatory drug patients required more often noninvasive ventilatory support (25% vs 4.6%; P = .003). Intensive care unit length of stay and mortality were similar. CONCLUSIONS We report as severe pneumococcal pneumonia in young and healthy patients exposed to NSAIDs as in older, more comorbid, and nonexposed ones. Nonsteroidal antiinflammatory drug use may mask initial symptoms and delay antimicrobial therapy, thus predisposing to worse outcomes.
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Hamilton SM, Bayer CR, Stevens DL, Bryant AE. Effects of selective and nonselective nonsteroidal anti-inflammatory drugs on antibiotic efficacy of experimental group A streptococcal myonecrosis. J Infect Dis 2013; 209:1429-35. [PMID: 24218498 DOI: 10.1093/infdis/jit594] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Epidemiologic evidence suggests that nonsteroidal anti-inflammatory drugs (NSAIDs) contribute to more severe group A streptococcal (GAS) infections, yet a beneficial role for NSAIDs has been demonstrated in other experimental bacterial infections. METHODS Nonselective (ketorolac tromethamine, ibuprofen, indomethacin), COX-1-selective (SC-560), or COX-2-selective (SC-236) NSAIDs ± antibiotics (penicillin, clindamycin) were given to mice challenged intramuscularly with M-type 3 GAS and disease course was followed for 14 days. RESULTS. All nonselective NSAIDs significantly accelerated mortality and reduced antibiotic efficacy; COX-selective NSAIDs had no significant effects. CONCLUSIONS Use of nonselective NSAIDs, either alone or as adjuncts to antibiotic therapy, for GAS soft tissue infection may contribute to worse outcomes.
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Affiliation(s)
- Stephanie M Hamilton
- US Department of Veterans Affairs, Office of Research and Development, Boise, Idaho
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Das DK, Baker MG, Venugopal K. Risk factors, microbiological findings and outcomes of necrotizing fasciitis in New Zealand: a retrospective chart review. BMC Infect Dis 2012; 12:348. [PMID: 23234429 PMCID: PMC3538518 DOI: 10.1186/1471-2334-12-348] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 12/10/2012] [Indexed: 02/06/2023] Open
Abstract
Background The incidence and mortality from necrotizing fasciitis (NF) are increasing in New Zealand (NZ). Triggered by a media report that traditional Samoan tattooing was causing NF, we conducted a chart review to investigate the role of this and other predisposing and precipitating factors and to document NF microbiology, complications and interventions in NZ. Methods We conducted a retrospective review of 299 hospital charts of patients discharged with NF diagnosis codes in eight hospitals in NZ between 2000 and 2006. We documented and compared by ethnicity the prevalence of predisposing and precipitating conditions, bacteria isolated, complications and interventions used. Results Out of 299 charts, 247 fulfilled the case definition. NF was most common in elderly males. Diabetes was the most frequent co-morbid condition, followed by obesity. Nearly a quarter of patients were taking non-steroidal anti-inflammatory drugs (NSAID). Traditional Samoan tattooing was an uncommon cause. Streptococcus pyogenes and Staphylococcus aureus were the two commonly isolated bacteria. Methicillin-resistant Staphylococcus aureus was implicated in a relatively small number of cases. Shock, renal failure, coagulation abnormality and multi-organ dysfunction were common complications. More than 90% of patients underwent surgical debridement, 56% were admitted to an intensive care unit (ICU) and slightly less than half of all patients had blood product transfusion. One in six NF cases had amputations and 23.5% died. Conclusion This chart review found that the highest proportion of NF cases was elderly males with co-morbidities, particularly diabetes and obesity. Tattooing was an uncommon precipitating event. The role of NSAID needs further exploration. NF is a serious disease with severe complications, high case fatality and considerable use of health care resources.
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Affiliation(s)
- Dilip Kumar Das
- Department of Public Health, University of Otago, Wellington, New Zealand.
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Abstract
Necrotizing soft tissue infections and necrotizing fasciitis are life-threatening infections affecting the hypodermis, muscular fascia, and dermis secondarily. Mortality is high, with an average of 30%. The early diagnosis of necrotizing soft tissue infection is challenging, but is key to successful management of these patients. The mainstay of therapy includes early and wide surgical debridement, antibiotics and supportive care. Adjunctive therapies may have a role, but their effectiveness remains unproven. A review of the literature allows us to highlight this multidisciplinary management.
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Affiliation(s)
- A Forli
- Service de chirurgie plastique, de la main et des brûlés, hôpital Michalon, CHU de Grenoble, 38043 Grenoble, France.
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DeMuro J, Hanna A, Chalas E, Cunha B. Polymicrobial abdominal wall necrotizing fasciitis after cesarean section. J Surg Case Rep 2012; 2012:10. [PMID: 24960796 PMCID: PMC3649624 DOI: 10.1093/jscr/2012.9.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We report a case of a previously healthy woman after an uneventful caesarean section who developed polymicrobial necrotizing fasciitis. She was given a non-steroidal anti-inflamatory drug (NSAID) after her delivery. Her post-delivery course was complicated by septic shock, and required multiple debridements before abdominal reconstruction. This case describes the increased risk of necrotizing fasciitis with NSAID use. Unusual were the organisms causing the polymicrobial necrotizing fasciitis: Staphylococcus aureus, Enterobacter agglomerans, Acinetobacter baumannii, and two strains of Enterobacter cloacae.
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Affiliation(s)
- Jp DeMuro
- Winthrop University Hospital, Mineola, New York, USA
| | - Af Hanna
- Winthrop University Hospital, Mineola, New York, USA
| | - E Chalas
- Winthrop University Hospital, Mineola, New York, USA
| | - Ba Cunha
- Winthrop University Hospital, Mineola, New York, USA
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Wong SS, Yuen KY. Streptococcus pyogenes and re-emergence of scarlet fever as a public health problem. Emerg Microbes Infect 2012; 1:e2. [PMID: 26038416 PMCID: PMC3630912 DOI: 10.1038/emi.2012.9] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/16/2012] [Indexed: 11/09/2022]
Abstract
Explosive outbreaks of infectious diseases occasionally occur without immediately obvious epidemiological or microbiological explanations. Plague, cholera and Streptococcus pyogenes infection are some of the epidemic-prone bacterial infections. Besides epidemiological and conventional microbiological methods, the next-generation gene sequencing technology permits prompt detection of genomic and transcriptomic profiles associated with invasive phenotypes. Horizontal gene transfer due to mobile genetic elements carrying virulence factors and antimicrobial resistance, or mutations associated with the two component CovRS operon are important bacterial factors conferring survival advantage or invasiveness. The high incidence of scarlet fever in children less than 10 years old suggests that the lack of protective immunity is an important host factor. A high population density, overcrowded living environment and a low yearly rainfall are environmental factors contributing to outbreak development. Inappropriate antibiotic use is not only ineffective for treatment, but may actually drive an epidemic caused by drug-resistant strains and worsen patient outcomes by increasing the bacterial density at the site of infection and inducing toxin production. Surveillance of severe S. pyogenes infection is important because it can complicate concurrent chickenpox and influenza. Concomitant outbreaks of these two latter infections with a highly virulent and drug-resistant S. pyogenes strain can be disastrous.
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Affiliation(s)
- Samson Sy Wong
- Department of Microbiology, Research Centre for Infection and Immunology, Faculty of Medicine, The University of Hong Kong , Hong Kong, China
| | - Kwok-Yung Yuen
- Department of Microbiology, Research Centre for Infection and Immunology, Faculty of Medicine, The University of Hong Kong , Hong Kong, China
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Abstract
OBJECTIVE To describe the defining characteristics and treatment of necrotizing fasciitis (NF), emphasizing early diagnostic indications. QUALITY OF EVIDENCE PubMed was searched using the terms necrotizing fasciitis and necrotizing soft tissue infections, paired with early diagnosis. Results were limited to human studies in English. Additional articles were obtained from references within articles. Evidence is levels II and III. MAIN MESSAGE Necrotizing fasciitis is classified according to its microbiology (polymicrobial or monomicrobial), anatomy, and depth of infection. Polymicrobial NF mostly occurs in immunocompromised individuals. Monomicrobial NF is less common and affects healthy individuals who often have a history of trauma (usually minor). Patients with NF can present with symptoms of sepsis, systemic toxicity, or evidence of skin inflammation, with pain that is disproportional to the degree of inflammation. However, these are also present in less serious conditions. Hyperacute cases present with sepsis and quickly progress to multiorgan failure, while subacute cases remain indolent, with festering soft-tissue infection. Because the condition is rare with minimal specific signs, it is often misdiagnosed. If NF is suspected, histology of tissue specimens is necessary. Laboratory and radiologic tests can be useful in deciding which patients require surgical consultation. Once NF is diagnosed, next steps include early wound debridement, excision of nonviable tissue, and wide spectrum cover with intravenous antibiotics. CONCLUSION Necrotizing fasciitis is an uncommon disease that results in gross morbidity and mortality if not treated in its early stages. At onset, however, it is difficult to differentiate from other superficial skin conditions such as cellulitis. Family physicians must have a high level of suspicion and low threshold for surgical referral when confronted with cases of pain, fever, and erythema.
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Affiliation(s)
- Rukshini Puvanendran
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore.
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Abstract
With four types of necrotizing fasciitis (NF) now recognized, the diagnosis and management of NF becomes more challenging as physicians face more unusual pathogenic and atypical presentations. With few published guidelines and little evidence base to justify therapies, much of the literature is pragmatic or provides limited evidence with small underpowered studies and disparate case reports.
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Affiliation(s)
- Marina S Morgan
- Royal Devon & Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK,
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