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Rommens OA, Kolkman WF, van Wijngaarden P. Mycobacterium wolinskyi infection after breast augmentation: A case report and comprehensive review. IJID REGIONS 2024; 11:100378. [PMID: 38947736 PMCID: PMC11214365 DOI: 10.1016/j.ijregi.2024.100378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/06/2024] [Indexed: 07/02/2024]
Abstract
We present a case report about a 26-year-old female with a Mycobacterium wolinskyi surgical site infection after bilateral breast augmentation. In a unique approach compared with previously reported cases, the patient was successfully treated in an outpatient setting using only orally administered cotrimoxazole (trimethoprim-sulfamethoxazole) and ciprofloxacin with one-sided preservation of the breast prothesis. We also provide a comprehensive overview of all report cases of M. wolinskyi infections available in the PubMed database until December 2023 and compare the different diagnostic and therapeutic approaches.
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Affiliation(s)
- Oscar A. Rommens
- Department of Internal Medicine, Amphia Hospital, Breda, Netherlands
- Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
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Ou Y, Liu D, Feng J, Xu X, Lin T, Zhang Y, Luo L, Wu M, Cui Y. Subcutaneous infection caused by Mycobacterium abscessus following botulinum toxin injections: A case report and literature review. J Cosmet Dermatol 2024; 23:1527-1532. [PMID: 38178368 DOI: 10.1111/jocd.16170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/30/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The rapid development of cosmetic injections has led to an increased incidence of nontuberculous mycobacterial (NTM) infection. PATIENTS AND METHODS Here, we presented a case of cutaneous Mycobacterium abscessus infection subsequent to botulinum toxin injection for treating masseter hypertrophy, and reviewed the literature on skin and soft tissue infections caused by NTM after cosmetic injections. RESULTS AND CONCLUSIONS The patient underwent surgical excision and regular antibiotic therapy and has had nearly 2 months of follow-up without any signs of infection. The diagnosis and treatment of NTM infection have always been challenging, and further research is needed to standardize and guide the treatment.
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MESH Headings
- Adult
- Female
- Humans
- Anti-Bacterial Agents/administration & dosage
- Anti-Bacterial Agents/adverse effects
- Anti-Bacterial Agents/therapeutic use
- Botulinum Toxins, Type A/adverse effects
- Botulinum Toxins, Type A/administration & dosage
- Cosmetic Techniques/adverse effects
- Hypertrophy
- Masseter Muscle/abnormalities
- Mycobacterium abscessus/isolation & purification
- Mycobacterium Infections, Nontuberculous/drug therapy
- Mycobacterium Infections, Nontuberculous/diagnosis
- Mycobacterium Infections, Nontuberculous/etiology
- Mycobacterium Infections, Nontuberculous/microbiology
- Skin Diseases, Bacterial/diagnosis
- Skin Diseases, Bacterial/microbiology
- Skin Diseases, Bacterial/drug therapy
- Skin Diseases, Bacterial/etiology
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Affiliation(s)
- Yanting Ou
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- Medical College, Shantou University, Shantou, China
| | - Dandan Liu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jun Feng
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiangwen Xu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Tingyin Lin
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- Medical College, Shantou University, Shantou, China
| | - Yihan Zhang
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- Medical College, Shantou University, Shantou, China
| | - Lin Luo
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Mengfan Wu
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yongyan Cui
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
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Deng L, Luo YZ, Liu F, Yu XH. Subcutaneous infection caused by Mycobacterium abscessus following cosmetic injections of botulinum toxin: A case report. World J Clin Cases 2022; 10:6141-6147. [PMID: 35949848 PMCID: PMC9254168 DOI: 10.12998/wjcc.v10.i18.6141] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/27/2021] [Accepted: 04/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent years, the cosmetic intervention related infections caused by nontuberculous mycobacteria (NTM) are increasing as the informal cosmetic treatments are performed. However, many dermatologists are inexperienced in the diagnosis and management of similar cases. Here we report a case of subcutaneous infection caused by Mycobacterium abscessus (M. abscessus) following cosmetic injections of botulinum toxin.
CASE SUMMARY A 53-year-old woman presented with multiple abscesses and nodules on her forehead and both temporal sites for half a month after cosmetic injections of botulinum toxin. Her lesions did not show any alleviation after 2-wk prescription of antibiotics. Laboratory examinations indicated that she had no sign of immunodeficiency and the whole body of computed tomography did not find any systemic infection or diseases. The pathology of skin tissue showed inflammatory cell infiltration with the negative results of Periodic acid Schiff (PAS) and Acid-fast staining and the culture yielded no microbiome. Afterwards, the puncture on abscess was performed and M. abscessus was successfully isolated. The pathogen was identified by acid-fast staining and DNA sequencing. The patient was treated with the strategy of clarithromycin, ofloxacin, and amikacin according to the result of drug sensitivity test and got complete remission of the lesions.
CONCLUSION The case presents the whole process of diagnosis and management of NTM infection after cosmetic intervention and highlights the diagnostic thoughts. In a word, the mycobacterium infection should be aware in patients after cosmetic performance.
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Affiliation(s)
- Lin Deng
- Department of Dermatology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Ying-Zhi Luo
- Department of Dermatology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Fang Liu
- Department of Dermatology, Jinling Hospital, Nanjing 210002, Jiangsu Province, China
| | - Xiao-Hong Yu
- Department of Dermatology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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Rauch-Pucher M, McCartney T, Cox-Reber J, Markwell A. Abdominal Soft Tissue Infection Caused by Mycobacterium wolinskyi After Cosmetic Surgery: A Case Report. J Wound Ostomy Continence Nurs 2021; 48:573-577. [PMID: 34781315 DOI: 10.1097/won.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mycobacterium wolinskyi is a rare, fast-growing, painful bacterium causing soft tissue infections. Sparse case reports focus on long-term intravenous antibiotic therapy and surgical interventions. We searched the literature and found almost no discussion about treatment from a nursing and wound care perspective. CASE Ms P, a 30-year-old Arabic female patient, underwent cosmetic surgery in Iraq including liposuction, abdominoplasty, and herniorrhaphy. One month postoperatively, she presented with an infection identified as M. wolinskyi resulting in multiple hospital admissions. Ms P received treatment with long-term antibiotic therapy and underwent multiple surgical debridements with extensive wound care management. CONCLUSION Mycobacterium wolinskyi is an exceedingly rare bacterium not typically seen in the clinical setting and requires prolonged and aggressive treatment. It is painful and fast-growing, as evidenced by multiple abscess formations and tissue necrosis in this case. Daily assessments and wound management using a collaborative approach were important to promote optimal healing.
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Affiliation(s)
- Mackenzie Rauch-Pucher
- Mackenzie Rauch-Pucher, BSN, RN, CWOCN, Beaumont Hospital, Dearborn, Michigan.,Teresa McCartney, BSN, RN, CWOCN, Beaumont Hospital, Dearborn, Michigan.,Jessica Cox-Reber, BSN, RN, CWOCN, Beaumont Hospital, Dearborn, Michigan.,Ashley Markwell, MSN, RN, AGCNS-BC, CWOCN, Beaumont Hospital, Dearborn, Michigan
| | - Teresa McCartney
- Mackenzie Rauch-Pucher, BSN, RN, CWOCN, Beaumont Hospital, Dearborn, Michigan.,Teresa McCartney, BSN, RN, CWOCN, Beaumont Hospital, Dearborn, Michigan.,Jessica Cox-Reber, BSN, RN, CWOCN, Beaumont Hospital, Dearborn, Michigan.,Ashley Markwell, MSN, RN, AGCNS-BC, CWOCN, Beaumont Hospital, Dearborn, Michigan
| | - Jessica Cox-Reber
- Mackenzie Rauch-Pucher, BSN, RN, CWOCN, Beaumont Hospital, Dearborn, Michigan.,Teresa McCartney, BSN, RN, CWOCN, Beaumont Hospital, Dearborn, Michigan.,Jessica Cox-Reber, BSN, RN, CWOCN, Beaumont Hospital, Dearborn, Michigan.,Ashley Markwell, MSN, RN, AGCNS-BC, CWOCN, Beaumont Hospital, Dearborn, Michigan
| | - Ashley Markwell
- Mackenzie Rauch-Pucher, BSN, RN, CWOCN, Beaumont Hospital, Dearborn, Michigan.,Teresa McCartney, BSN, RN, CWOCN, Beaumont Hospital, Dearborn, Michigan.,Jessica Cox-Reber, BSN, RN, CWOCN, Beaumont Hospital, Dearborn, Michigan.,Ashley Markwell, MSN, RN, AGCNS-BC, CWOCN, Beaumont Hospital, Dearborn, Michigan
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5
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Bae JY, Yun IS, Roh TS, Kim YS. Treatment strategy for skin and soft tissue infections caused by nontuberculous mycobacteria following various procedures. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2021. [DOI: 10.14730/aaps.2020.02327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kitajima H, Oba Y, Ohira T, Asaoka T, Atsumi Y, Nakajima T, Okura T. First case report of prosthetic valve endocarditis caused by Mycobacterium wolinskyi. J Infect Chemother 2021; 27:766-769. [PMID: 33402304 DOI: 10.1016/j.jiac.2020.12.019] [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: 08/20/2020] [Revised: 11/14/2020] [Accepted: 12/18/2020] [Indexed: 11/29/2022]
Abstract
To date, only 26 cases of Mycobacterium wolinskyi infections have been reported in humans. We herein report a first case of prosthetic valve endocarditis due to this organism after cardiovascular surgery. An 82-year-old man presented with repeat episodes of syncope and fever after aortic valve replacement, mitral valve replacement, left atrial appendage closure, and pulmonary vein isolation. Blood cultures maintained in aerobic bottles were repeatedly positive after 90-100 hours, and Gallium scan revealed abnormal accumulations in the sternum and left testis. While colonies formed by culturing the fluid of the parasternal area and blood cultures revealed gram-positive rods, we could not analyze the colony using matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF). M. wolinskyi was finally identified on 16S rRNA, hsp65, and rpoB gene sequencing. We treated the patient with multiple antimycobacterial drugs, i.e., amikacin, imipenem, and clarithromycin for 6 weeks, which was changed to oral ciprofloxacin and minocycline for 12 months. This case highlights the need to consider rapidly growing mycobacteria, including M. wolinskyi, if chronic fever persists from weeks to months after surgery, the blood culture is positive, and the organism is not identified. In addition, sequencing the 16S rRNA, hsp65, and rpoB genes is essential for diagnosis.
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Affiliation(s)
- Heita Kitajima
- Department of General Medicine, Osaka General Medical Center, 3-1-56, Sumiyoshi Bandaihigashi, Osaka, 558-8558, Japan.
| | - Yuichiro Oba
- Department of General Medicine, Osaka General Medical Center, 3-1-56, Sumiyoshi Bandaihigashi, Osaka, 558-8558, Japan
| | - Takahisa Ohira
- Department of General Medicine, Osaka General Medical Center, 3-1-56, Sumiyoshi Bandaihigashi, Osaka, 558-8558, Japan
| | - Tomohiro Asaoka
- Department of General Medicine, Osaka General Medical Center, 3-1-56, Sumiyoshi Bandaihigashi, Osaka, 558-8558, Japan
| | - Yoshihiro Atsumi
- Department of General Medicine, Osaka General Medical Center, 3-1-56, Sumiyoshi Bandaihigashi, Osaka, 558-8558, Japan
| | - Takahiro Nakajima
- Department of General Medicine, Osaka General Medical Center, 3-1-56, Sumiyoshi Bandaihigashi, Osaka, 558-8558, Japan
| | - Takayuki Okura
- Department of General Medicine, Osaka General Medical Center, 3-1-56, Sumiyoshi Bandaihigashi, Osaka, 558-8558, Japan
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Chung J, Ince D, Ford BA, Wanat KA. Cutaneous Infections Due to Nontuberculosis Mycobacterium: Recognition and Management. Am J Clin Dermatol 2018; 19:867-878. [PMID: 30168084 DOI: 10.1007/s40257-018-0382-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Nontuberculous mycobacteria (NTM) are a diverse group of organisms that are ubiquitous in the environment, and the incidence of cutaneous infections due to NTM has been steadily increasing. Cutaneous infections due to NTM can be difficult to diagnose, due to their wide spectrum of clinical presentations and histopathological findings that are often nonspecific. A variety of modalities including tissue culture and polymerase chain reaction (PCR) assays may be necessary to identify the organism. Treatment can also be challenging, as it can depend on multiple factors, including the causative organism, the patient's immunological status, and the extent of disease involvement. In this review, we discuss the common presentations of cutaneous NTM infections, diagnostic tools, and treatment recommendations. A multi-disciplinary approach that involves good communication between the clinician, the histopathologist, the microbiologist, and infectious disease specialists can help lead to successful diagnosis and management.
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Affiliation(s)
- Jina Chung
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Dilek Ince
- Division of Infectious Disease, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Bradley A Ford
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Karolyn A Wanat
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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Fujikura H, Kasahara K, Ogawa Y, Hirai N, Yoshii S, Yoshihara S, Ogawa T, Yonekawa S, Imakita N, Nishioka Y, Yoneda T, Yoshida K, Samejima KI, Tanabe K, Saito Y, Yano H, Mikasa K. Mycobacterium wolinskyi Peritonitis after Peritoneal Catheter Embedment Surgery. Intern Med 2017; 56:3097-3101. [PMID: 28943571 PMCID: PMC5725868 DOI: 10.2169/internalmedicine.8871-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Mycobacterium wolinskyi belongs to the Mycobacterium smegmatis group, which comprises rapidly growing non-tuberculous mycobacteria. The number of case reports on M. wolinskyi infections associated with postoperative wounds has increased in recent years. We herein report a case of peritonitis due to M. wolinskyi after peritoneal catheter embedment surgery. Identification was achieved based on 16S ribosomal RNA and rpoB gene sequencing of the isolate. The patient recovered following catheter removal and treatment with levofloxacin and minocycline for one month.
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Affiliation(s)
| | - Kei Kasahara
- Center for Infectious Diseases, Nara Medical University, Japan
| | - Yoshihiko Ogawa
- Center for Infectious Diseases, Nara Medical University, Japan
| | - Nobuyasu Hirai
- Center for Infectious Diseases, Nara Medical University, Japan
| | - Seiya Yoshii
- Center for Infectious Diseases, Nara Medical University, Japan
| | | | - Taku Ogawa
- Center for Infectious Diseases, Nara Medical University, Japan
| | | | - Natsuko Imakita
- Center for Infectious Diseases, Nara Medical University, Japan
| | - Yuichi Nishioka
- Center for Infectious Diseases, Nara Medical University, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Japan
| | | | - Ken-Ichi Samejima
- First Department of Internal Medicine, Nara Medical University, Japan
| | - Kaori Tanabe
- First Department of Internal Medicine, Nara Medical University, Japan
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University, Japan
| | - Hisakazu Yano
- Department of Microbiology and Infectious Diseases, Nara Medical University, Japan
| | - Keiichi Mikasa
- Center for Infectious Diseases, Nara Medical University, Japan
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Bossart S, Schnell B, Kerl K, Urosevic-Maiwald M. Ulcers as a Sign of Skin Infection with Mycobacterium wolinskyi: Report of a Case and Review of the Literature. Case Rep Dermatol 2016; 8:151-5. [PMID: 27462223 PMCID: PMC4943297 DOI: 10.1159/000446470] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 12/21/2022] Open
Abstract
Infection with Mycobacterium wolinskyi, if not detected, may cause severe skin and soft tissue infection with prolonged healing process and is therefore associated with high morbidity. Only about 20 cases of M. wolinskyi infections in humans have been described in the literature until now, none of them in Switzerland. We report a case of an infection in a 72-year-old male patient with recurrent subcutaneous abdominal wall abscesses and ulcer formation after insulin injection in the underbelly. A culture of skin biopsy tissue showed rapid growth of non-tuberculous mycobacteria (NTM), which were identified by 16S rRNA gene sequencing as M. wolinskyi. Surgical excision and primary closure of all abdominal ulcers in combination with antibiotic therapy, based on the antimicrobiotic susceptibility test results, were performed and resulted in complete resolution of the clinical symptoms and no recurrence of infection at a 6-month follow-up. The present case emphasizes the importance of accurate diagnosis and treatment of chronic infection with ulcer formation. In such cases, it is crucial to consider the presence of NTM, such as M. wolinskyi, in order to obtain rapid diagnosis, specific treatment and improved patient care.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Barbara Schnell
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Katrin Kerl
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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Nagpal A, Wentink JE, Berbari EF, Aronhalt KC, Wright AJ, Krageschmidt DA, Wengenack NL, Thompson RL, Tosh PK. A Cluster ofMycobacterium wolinskyiSurgical Site Infections at an Academic Medical Center. Infect Control Hosp Epidemiol 2016; 35:1169-75. [DOI: 10.1086/677164] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectiveTo study a cluster ofMycobacterium wolinskyisurgical site infections (SSIs).DesignObservational and case-control study.SettingAcademic hospital.Patients.Subjects who developed SSIs withM. wolinskyifollowing cardiothoracic surgery.MethodsElectronic surveillance was performed for case finding as well as electronic medical record review of infected cases. Surgical procedures were observed. Medical chart review was conducted to identify risk factors. A case-control study was performed to identify risk factors for infection; Fisher exact or Kruskal-Wallis tests were used for comparisons of proportions and medians, respectively. Patient isolates were studied using pulsed-field gel electrophoresis (PFGE). Environmental microbiologic sampling was performed in operating rooms, including high-volume water sampling.ResultsSix definite cases ofM. wolinskyiSSI following cardiothoracic surgery were identified during the outbreak period (October 1, 2008–September 30, 2011). Having cardiac surgery in operating room A was significantly associated with infection (odds ratio, 40;P= .0027). Observational investigation revealed a cold-air blaster exclusive to operating room A as well a microbially contaminated, self-contained water source used in heart-lung machines. The isolates were indistinguishable or closely related by PFGE. No environmental samples were positive forM. wolinskyi.ConclusionsNo single point source was established, but 2 potential sources, including a cold-air blaster and a microbially contaminated, self-contained water system used in heart-lung machines for cardiothoracic operations, were identified. Both of these potential sources were removed, and subsequent active surveillance did not reveal any further cases ofM. wolinskyiSSI.Infect Control Hosp Epidemiol2014;35(9):1169-1175
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Draft Genome Sequence of Mycobacterium wolinskyi, a Rapid-Growing Species of Nontuberculous Mycobacteria. GENOME ANNOUNCEMENTS 2016; 4:4/2/e00138-16. [PMID: 26988052 PMCID: PMC4796131 DOI: 10.1128/genomea.00138-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Mycobacterium wolinskyi is a nonpigmented, rapidly growing nontuberculous mycobacterium species that is associated with bacteremia, peritonitis, infections associated with implants/prostheses, and skin and soft tissue infections often following surgical procedures in humans. Here, we report the first functionally annotated draft genome sequence of M. wolinskyi CDC_01.
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12
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El-Khalawany M, Fawzy S, Saied A, Al Said M, Amer A, Eassa B. Dermal filler complications: a clinicopathologic study with a spectrum of histologic reaction patterns. Ann Diagn Pathol 2014; 19:10-5. [PMID: 25553966 DOI: 10.1016/j.anndiagpath.2014.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/25/2014] [Indexed: 10/24/2022]
Abstract
Although dermal fillers are generally accepted as safe and well-tolerable cosmetic tools, adverse reaction still forms a prognostic problem. The aim of this study was to demonstrate the clinicopathologic patterns of dermal filler complications in our center. A 5-year single-center study that included patients complained from filler complications and referred to the dermatopathology unit in Al-Azhar University for histologic assessment. The study included 38 female patients with an average age of 47 years. The mean onset of complications was 14.6 ± 5.27 months after injection. The injected material included hyaluronic acid (18.4%), silicone (52.6%), bovine collagen (15.8%) and polyacrylamide hydrogel (13.2%). Most lesions were located on the face (55.3%), less commonly on the hands (18.4%), buttocks (21%), and rarely on the vulva (5.3%). The clinical spectrum included indurated plaque (23.7%), nodular lesion (31.6%), inflammatory mass (15.8%), atrophic lesion (10.5%), skin discoloration (13.1%) and ulceration (5.3%). Histologically, granulomatous reaction was the major finding, either a foreign body granuloma (34.2%) or infectious granuloma (13.2%). Other histologic reactions included dermal pseudocysts with chronic inflammation (26.3%), dermal fibrosis (15.8%), and eosinophilic panniculitis (10.5%). Our results confirmed that dermal fillers could be manifested with variable clinical presentations and show different histologic reactions. Because of long-standing duration until complications occur, history taking is crucial and should be emphasized in every suspected patient. It is hoped that this article will increase awareness for recognition of these variable complications and help select the appropriate therapy.
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Affiliation(s)
| | - Sameh Fawzy
- Department of Dermatology, Al-Azhar University, Cairo, Egypt.
| | - Asmaa Saied
- Department of Dermatology, Al-Azhar University, Cairo, Egypt.
| | | | - Ahmed Amer
- Department of Dermatology, Al-Azhar University, Dumyat, Egypt.
| | - Bayoumi Eassa
- Department of Dermatology, Al-Azhar University, Cairo, Egypt.
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Reginelli A, Santagata M, Urraro F, Somma F, Izzo A, Cappabianca S, Rotondo A. Foreign bodies in the maxillofacial region: assessment with multidetector computed tomography. Semin Ultrasound CT MR 2014; 36:2-7. [PMID: 25639172 DOI: 10.1053/j.sult.2014.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Maxillofacial region is an anatomically complex area, representing a crossroads of different systems and apparatus. It is defined as the anatomical region lying on the facial skeleton from the inferior outline of maxilla up to an ideal plane passing through the skull base and the inion point, posteriorly. In this area, the digestive and respiratory systems connect to themselves and open in the mouth and sino-nasal cavities. Even the orbits with the ocular globes and their surrounding tissues lie in the same area. Despite the little exposed surface, the chance of penetrating injuries to this site is at least similar to other regions of the body due to the "pivotal role" of the face in human relations. Moreover, the external openings of respiratory and digestive systems and the orbital cavities represent an easy way in for foreign bodies (FBs). Based on the access paths, it is possible to distinguish ingested, inhaled, penetrating, and iatrogenic (owing to surgery) FBs. FB may stop in oral and ocular cavities, or proceed deeply, reaching the surrounding soft tissues, the facial bones, or other cavities such as sino-nasal region, mouth, orbits, and further spaces of the head and neck region, like infratemporal fossa, parapharyngeal space, and sphenopalatine fossa. Furthermore, FBs accidentally introduced and lost in visceral cavities (mouth, ear, and nose), particularly in pediatric subjects, may be quickly removed during direct inspection.
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Affiliation(s)
- Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy.
| | - Mario Santagata
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy
| | - Fabrizio Urraro
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy
| | - Francesco Somma
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy
| | - Andrea Izzo
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy
| | - Salvatore Cappabianca
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy
| | - Antonio Rotondo
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy
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Abstract
PURPOSE OF REVIEW Skin and soft tissues infections (SSTIs) caused by nontuberculous mycobacteria (NTM) are underrecognized and difficult to treat. Controversies exist for optimal medical management and the role of surgery. Defining the epidemiology in the environment, in animals and in healthcare aids disease prevention. This review focuses on recent advances in epidemiology, risk factors, diagnostics and therapy. RECENT FINDINGS The increasing consumer appetite for cosmetic and body-modifying procedures (e.g. tattooing, mesotherapy, liposuction) has been associated with rises in sporadic cases and outbreaks of NTM SSTIs. In mainstream healthcare, recent epidemiological studies have helped to quantify the increased risk of NTM infection related to anti-tumour necrosis factor-α monoclonal antibody therapy. Cervicofacial lymphadenitis in children poses management dilemmas, but recent studies and resultant algorithms have simplified decision-making. Molecular studies have led to a better understanding of the epidemiology, therapy and course of Mycobacterium ulcerans infection (Buruli ulcer) that remains prevalent in many areas including sub-Saharan Africa and southeastern Australia. Apart from molecular methods, the widespread adoption of matrix-assisted laser desorption ionization-time of flight mass spectrometry by routine laboratories has potential to simplify and expedite the laboratory identification of NTMs. SUMMARY An improved understanding of the epidemiology of NTM SSTIs indicates a need to apply effective infection control and ensure regulation of cosmetic and related procedures associated with nonsterile fluids. Broader access to newer diagnostic methods will continue to improve recognition of NTM disease. Along with a paucity of therapeutic agents, there is need for more reliable methods to assess susceptibility and selection of effective combination therapy.
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