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Checkley T, Cole M, Shoja MM, Schwartz G. Progressive Ulnar Neuropathy Following a Presumed Catfish Sting. Wilderness Environ Med 2024:10806032241272131. [PMID: 39221541 DOI: 10.1177/10806032241272131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Catfish are a highly diverse group of fish comprising more than 3500 species found in both freshwater and marine ecosystems. Upon handling, they can inflict a sting, with certain species capable of inducing significant pain and injury to the affected extremity. The prevalence of aquatic activities, such as fishing by line or manual capture ("noodling"), increases the likelihood of catfish stings, making prompt identification and treatment an important aspect of managing such encounters. A case of a presumed catfish spine injury during noodling in Tallahassee, Florida, is presented. The pectoral fin penetrated the volar aspect of the patient's right hand resulting in immediate pain and numbness. Over the course of 2 weeks, the patient developed distal ulnar neuropathy with conduction block at the wrist level. Surgical exploration revealed the ulnar nerve to be grossly intact, but the area surrounding the terminal division point of the ulnar nerve in the hand displayed infiltration by fibrous tissue that entrapped the nerve and its branches. Following surgical release of the ulnar nerve and its terminal branches from the fibrous tissue, complete resolution of distal ulnar neuropathy was achieved. In this patient's case, the absence of foreign bodies and the lack of visible nerve damage suggest that the injury to the patient's hand was largely attributable to toxin-mediated proinflammatory response and fibrosis.
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Affiliation(s)
- Taylor Checkley
- Department of Medical Education, Dr Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Madeline Cole
- Department of Medical Education, Dr Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Mohammadali M Shoja
- Department of Medical Education, Dr Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Gary Schwartz
- Department of Medical Education, Dr Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
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Lim PK, Hacquebord J, Shafiq B, Gupta R. Management of Open Fractures of the Extremities and Pediatrics. J Am Acad Orthop Surg 2024:00124635-990000000-01028. [PMID: 38968700 DOI: 10.5435/jaaos-d-23-00757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 05/23/2024] [Indexed: 07/07/2024] Open
Abstract
The modern management of open fractures was established after the foundational work of Gustilo and Anderson, but we continue to strive to determine the optimal treatment of open fractures to diminish the risk of infection. The ideal timing of antibiotics, presentation to the operating room, and timing of procedures such as flap coverage continue to be investigated with incremental changes recommended over the years. This article aims to provide the most recent review of the literature regarding the timing and management of both upper and lower extremity open fractures, pediatric open fractures, current topics of controversy, and the data supporting current treatment recommendations.
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Affiliation(s)
- Philip K Lim
- From the Department of Orthopaedic Surgery, UC Irvine, Irvine, CA (Lim and Gupta), the Department of Orthopaedic Surgery, NYU, New York, NY (Hacquebord), the Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD (Shafiq), and Hansjorg Wyss Department of Plastic Surgery, New York University, New York, NY (Hacquebord)
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Appelbaum RD, Farrell MS, Gelbard RB, Hoth JJ, Jawa RS, Kirsch JM, Mandell S, Nohra EA, Rinderknecht T, Rowell S, Cuschieri J, Stein DM. Antibiotic prophylaxis in injury: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open 2024; 9:e001304. [PMID: 38835634 PMCID: PMC11149135 DOI: 10.1136/tsaco-2023-001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/11/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Rachel D Appelbaum
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael S Farrell
- Department of Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Rondi B Gelbard
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J Jason Hoth
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Randeep S Jawa
- Department of Surgery, Stony Brook University, Stony Brook, New York, USA
| | - Jordan M Kirsch
- Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Samuel Mandell
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Eden A Nohra
- Department of Surgery, University of Colorado, Denver, Colorado, USA
| | | | - Susan Rowell
- Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Joseph Cuschieri
- Department of Surgery at ZSFG, University of California San Francisco, San Francisco, California, USA
| | - Deborah M Stein
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland, USA
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Noh M, Kyoung KH, Kim S, Keum MA, Choi S, Choi K, Kim J. Uncommon Mechanism of Mangled Extremity; Three Cases of Rope Entanglement Injury of the Lower Leg. JOURNAL OF ACUTE CARE SURGERY 2023. [DOI: 10.17479/jacs.2023.13.1.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Abstract
Rope entanglement injury is a rare entity. Previous reported studies mainly consisted of finger-related injuries. We describe three cases of rope entanglement injury of the lower leg. In the first patient, a belowthe- knee amputation was performed as the primary treatment for unilateral amputated lower limb. In the second patient, a below-the-knee amputation and perineal wound management were simultaneously performed. The third patient had vascular injury combined with internal soft tissue injury without related bone fracture. He suffered serious sequelae from a delay in transfer from a local hospital. Rope entanglement injuries of the lower leg do not present in a consistent manner, and the treatment of accompanying injuries should be considered from an early stage. Care should be taken to ensure that there are no internal injuries missed because the exterior appears to be stable.
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Prentice KC, Himstead AS, Briggs AL, Algaze-Gonzalez IM. Emergency Management Strategies and Antimicrobial Considerations for Nonmammalian Marine Vertebrate Penetrating Trauma in North America, the Caribbean, and Hawaii: A Review Article. Wilderness Environ Med 2023; 34:106-112. [PMID: 36610916 DOI: 10.1016/j.wem.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/06/2022] [Accepted: 09/16/2022] [Indexed: 01/06/2023]
Abstract
There are numerous emergency department visits in the United States for all types of marine animal injuries each year. These injuries may result in significant morbidity or mortality if not managed appropriately. Accurate identification of the offending species, thorough wound hygiene, and judicious use of antibiotics are important for preventing infections. This review aims to describe management strategies and antimicrobial considerations for nonmammalian marine vertebrate penetrating trauma in North America, the Caribbean, and Hawaii. A literature search was performed to identify studies on this subject. This literature consisted of clinical case reports and case series. Reports extracted included those on sharks, barracuda, eels, catfish, stingrays, lionfish, stonefish, and scorpionfish. The majority of reported trauma occurred to beachgoers, fishermen, or commercial aquarium employees who routinely handle these animals. Injury patterns depended on the species but most commonly affected the lower extremities. Infections were seen from saltwater bacteria, human skin flora, or marine animal oral flora. After thorough wound irrigation and exploration, most authors recommended prophylactic antimicrobials to cover Vibrio species, in addition to other gram-negative and gram-positive species. The literature is notable for the lack of controlled studies. Some authors recommended radiographic and/or ultrasonographic imaging to identify retained foreign bodies, such as spines, sand, or teeth.
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Affiliation(s)
- Kylie C Prentice
- School of Medicine, University of California, Irvine, Irvine, CA
| | | | - Amy L Briggs
- Department of Emergency Medicine, University of California, Irvine, Irvine, CA
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Byrkit BN, LaScala EC, MenkinSmith L, Hall GA, Weant KA. Characterization of Prophylactic Antimicrobial Therapy Practices for Patients With Marine-Associated Injuries in the Emergency Department. J Pharm Pract 2023; 36:53-59. [PMID: 34098786 DOI: 10.1177/08971900211021058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Centers for Disease Control and Prevention (CDC) recommendations for the treatment of marine-associated wound infections include empiric coverage for Vibrio species with a combination of a third-generation cephalosporin and doxycycline. These recommendations are based on limited data and it remains unclear if this regimen is also indicated for prophylaxis. OBJECTIVE The purpose of this analysis was to assess the antibiotic regimens used in the emergency department (ED) for prophylaxis of marine-associated injuries relative to the CDC recommendations and evaluate any clinical impact. METHODS A retrospective review evaluated adult patients discharged from the ED over a 4-year period with an antibiotic prescription following an injury with marine exposure. RESULTS 114 patients were included in the analysis. The majority of patients were < 40 years of age with no previous medical history and presented after sustaining a laceration secondary to oyster shells. 97.4% received prophylactic antibiotic therapy that did not match the CDC recommendations, with the majority receiving doxycycline monotherapy (82%). A 1.8% 30-day ED revisit rate was noted with 2 patients returning for therapy failure. No patients were admitted to the hospital within 30 days and no documented adverse effects related to antibiotic therapy were noted. CONCLUSION Current prophylactic antibiotic prescribing practices diverge from the current CDC recommendations for the treatment of marine-associated infections, however, an effect secondary to these variations was not observed. Further investigations of prophylaxis against Vibrio infections in low-risk patients is warranted to limit collateral damage and improve antimicrobial stewardship in the ED.
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Affiliation(s)
- Britany N Byrkit
- College of Pharmacy, 2345Medical University of South Carolina, Charleston, SC, USA
- Department of Pharmacy, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth C LaScala
- Department of Pharmacy, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Lacey MenkinSmith
- Department of Emergency Medicine, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Gregory A Hall
- Department of Emergency Medicine, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Kyle A Weant
- College of Pharmacy, 2629University of South Carolina, Columbia, SC, USA
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Alelign D, Tena T, Tessema M, Kidanewold A. Drug-Resistant Aerobic Bacterial Pathogens in Patients with Crocodile Bite Wounds Attending at Arba Minch General Hospital, Southern Ethiopia. Int J Gen Med 2022; 15:8669-8676. [PMID: 36568839 PMCID: PMC9785188 DOI: 10.2147/ijgm.s395046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background A polymicrobial infection containing a diverse range of drug-resistant bacteria worsens the success of treatment for crocodile bite wound infection. However, there is a dearth of data in Ethiopia, where crocodile bite injuries are relatively common, particularly in the area around Lake Abaya and Lake Chamo in southern Ethiopia. Methods A hospital-based cross-sectional study was conducted from May 1st, 2021, to April 30th, 2022, at Arba Minch General Hospital. Eleven consenting patients with crocodile bite wounds were enrolled in this study. Wound swabs were collected aseptically following microbiological procedures. The diversity and type of aerobic bacterial pathogens, and drug-resistant patterns were used to determine and characterize the nature of crocodile bite wound infections. Results Among 11 patients with crocodile bite wounds, 72.7% (8/11) of wound samples were found to be culture-positive, with a total of 21 aerobic bacterial isolates. Gram-negative bacterial isolates were found in 57.1% (12/21). Triple-bacterial isolates were found in 62.5% (5/8) of wound samples, followed by 37.5% (3/8) of double bacterial isolates. Pseudomonas aeruginosa (n = 5), followed by Citrobacter spp. (n = 4), and coagulase-negative Staphylococci (CoNS) (n = 4) were frequently isolated bacteria. Methicillin resistance (MR-CoNS) was found in 75% of isolated CoNS. 6.7% of the isolated Enterococcus faecalis was vancomycin-resistant (VRE), while 60% of the isolated P. aeruginosa were piperacillin-resistant. Overall, 85.7% (18/21) of the isolates were found to be multidrug-resistant (MDR), with 55.6% (10/18) of them being Gram-negative MDR bacterial isolates. Conclusion Numerous aerobic bacteria that are resistant to the majority of common antibiotics have been associated with infections in crocodile bite wounds. Thus, the key to providing empirical therapy for such wounds is detecting the drug-resistant pattern of bacterial isolates.
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Affiliation(s)
- Dagninet Alelign
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia,Correspondence: Dagninet Alelign, Tel +251-964-428-118, Email
| | - Teshome Tena
- School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Moges Tessema
- School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Aschalew Kidanewold
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Xu L, Fan J, Fu H, Yang Y, Luo Q, Wan F. The variants of polymyxin susceptibility in different species of genus Aeromonas. Front Microbiol 2022; 13:1030564. [PMID: 36386612 PMCID: PMC9642839 DOI: 10.3389/fmicb.2022.1030564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/07/2022] [Indexed: 06/23/2024] Open
Abstract
The aquatic environment is an important medium for the accumulation and dissemination of antibiotic-resistant bacteria as it is often closely related to human activities. Previous studies paid little attention to the prevalence and mechanism of polymyxin-resistant bacteria in the aquatic environment. As a Gram-negative opportunistic pathogen widely distributed in aquatic ecosystems, the antibiotic-resistant profile of Aeromonas spp. deserves much attention. In this study, we identified 61 Aeromonas spp. isolates from water samples in the section of the Yangtze River. The total polymyxin B (PMB) resistance rate of these strains was 49.18% (30/61), showing a high level of polymyxin resistance in Aeromonas spp. The MIC50 and MIC90 for PMB exhibited a significant discrepancy among different species (p < 0.001). The MIC50 and MIC90 for PMB in the Aeromonas hydrophila were 128 mg/L and above 128 mg/L while in Aeromonas caviae and Aeromonas veronii, the MIC50 and MIC90 value were both 2 mg/L. Only two A. veronii strains (MIC = 2 mg/L) and one A. caviae strain (MIC = 0.5 mg/L) were identified as carrying mobilized polymyxin resistant gene mcr-3.42, and mcr-3.16. All mcr genes were located in the chromosome. This is the first report that the downstream region of mcr-3.42 was the truncated mcr-3-like gene separated by the insertion sequences of ISAs20 (1,674 bp) and ISAs2 (1,084 bp). Analysis of epidemiology of mcr-positive Aeromonas genomes from GenBank database showed that the genus Aeromonas and the aquatic environment might be the potential container and reservoir of mcr-3. By the whole-genome sequencing and qRT-PCR, we inferred that the sequence differences in the AAA domain of MlaF protein and its expression level among these three species might be involved in the development of polymyxin resistance. Our study provided evidences of the possible mechanism for the variety of polymyxin susceptibility in different species of the genus Aeromonas and a theoretical basis for the surveillance of the aquatic environment.
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Affiliation(s)
- Linna Xu
- School of Laboratory Medicine and Biotechnology, Hangzhou Medical College, Hangzhou, China
| | - Junfeng Fan
- School of Laboratory Medicine and Biotechnology, Hangzhou Medical College, Hangzhou, China
| | - Hao Fu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medical School, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yuyi Yang
- Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, China
| | - Qixia Luo
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medical School, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fen Wan
- School of Laboratory Medicine and Biotechnology, Hangzhou Medical College, Hangzhou, China
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Bishop J, Morell S. Intraosseous Catfish Barb Treated With Cannulated Drill in a Pediatric Patient. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:311-314. [PMID: 36157306 PMCID: PMC9492794 DOI: 10.1016/j.jhsg.2022.07.001] [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: 03/17/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022] Open
Abstract
Catfish injuries to the upper extremity following fishing activities are common in the southern United States, especially because noodling is commonplace in this region. Noodling is when a fisher will stick their hand into an area where a catfish is guarding its eggs and grab the catfish by its mouth. Different mechanisms of injury, including envenomation and spine embedment, can occur and ultimately lead to different patient presentations, including the retention of foreign bodies or infection. Literature reviews of catfish injuries primarily report the retention of foreign bodies within soft tissues, infection, and envenomation. We present the first case report of a patient who sustained a ring finger proximal phalangeal physeal injury involving the growth cartilage caused by a penetration injury from a catfish barb. A novel method for safely extracting these barbs with no subsequent growth arrest or range of motion limitation is also presented.
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Affiliation(s)
- Jared Bishop
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
- Corresponding author: Jared Bishop, MD, Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham St. Slot #531, Little Rock, AR 72205.
| | - Sean Morell
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
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Creech ZA, Truong GTD, Kenny DX, Butt DN, Li C, Cavalieri S, El-Herte R. Unusual Freshwater-Related Infections Caused by Haematospirillum jordaniae. Cureus 2022; 14:e25480. [PMID: 35800845 PMCID: PMC9246461 DOI: 10.7759/cureus.25480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/05/2022] Open
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Cevik J, Hunter-Smith DJ, Rozen WM. Infections following stingray attacks: A case series and literature review of antimicrobial resistance and treatment. Travel Med Infect Dis 2022; 47:102312. [PMID: 35304330 DOI: 10.1016/j.tmaid.2022.102312] [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: 02/02/2022] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Injuries sustained following stingray attacks are at high risk of infection and can progress to serious, debilitating consequences for the patient if not appropriately addressed. Antibiotic treatment of such infections is important to minimise the morbidity experienced by patients. However, antibiotic guidelines relating specific to this patient group are not well established. This study aims to report the experience of a single institution at treating stingray associated wound infections and to review the literature for reported cases. Additionally, we review the microbiological risk in these patients and summarise the literature surrounding antibiotic choice. METHODS A retrospective review of all patients presenting with injuries sustained following stingray attacks was conducted at a single institution. Additionally, a comprehensive literature review was conducted to identify cases of infected stingray associated trauma and review the causative micro-organisms and antibiotics used to treat such infections. RESULTS 22 cases of stingray injuries were identified from a single institution. Of these, eight infections were reported. One case grew a highly resistant Vibrio species. Among the literature, 18 cases of infections were identified many of which led to significant complications for patients. The micro-organisms identified were diverse and there was little consistency among the antibiotic regimens utilised. CONCLUSION Based on the antibiotic susceptibilities of causative bacteria along with extrapolation from recommendations and guidelines identified in the literature, ciprofloxacin, doxycycline and trimethoprim-sulfamethoxazole appear to be the most appropriate antibiotics choices for prophylaxis or treatment of localised infection. Antibiotic choices for the empiric treatment of systemic infection requires further research and clarification.
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Affiliation(s)
- Jevan Cevik
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, Victoria, Australia.
| | - David J Hunter-Smith
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, Victoria, Australia
| | - Warren M Rozen
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, Victoria, Australia
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Ehrhardt JD, Newsome K, Das S, McKenney M, Elkbuli A. Evaluation and Management of Watercraft-Related Injuries for Acute Care Surgeons: Towards Improving Care and Implementing Effective Public Health Prevention Policies. ANNALS OF SURGERY OPEN 2022; 3:e149. [PMID: 37600112 PMCID: PMC10431368 DOI: 10.1097/as9.0000000000000149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/15/2022] [Indexed: 11/27/2022] Open
Abstract
Boating has exposed humans to elemental hazards for centuries. What was once a lifelong craft and time-honored skillset is now, with modern technology, a popular recreational activity. Boating safety has inherent limitations and has been historically challenging to enforce. These circumstances have given way to a rising number of watercraft-associated injuries and fatalities. This review aims to investigate the diagnosis, work-up, and management of watercraft-related injuries, including blunt mechanisms, propeller wounds, water-force trauma, associated marine infections, and submersion injuries, as well as outline gaps in current public health policy on watercraft injuries, potential interventions, and available solutions. Motorboats and personal watercraft differ in size, power modality, and differential risk for injury. Accidents aboard watercraft often share commonalities with motor vehicles and motorcycles, namely: rapid deceleration, ejection, and collision with humans. The complexity of care is added by the austere environment in which many watercraft accidents occur, as well as the added morbidity of drowning and hypothermia. Wounds can also become infected by marine organisms, which require wound care and antimicrobial therapy specific to the aquatic environment in which the injury occurred. The treatment of these patients can be further exacerbated by the prolonged transportation times due to complicated water rescue. There are many measures that can prevent or abate watercraft injuries, but inconsistent regulations and enforcement may impair the success of these interventions. Further research is needed to identify possible solutions to common causes of watercraft injuries, such as inconsistent lifejacket use and bow riding.
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Affiliation(s)
- John D. Ehrhardt
- From the Department of Surgery, Kendall Regional Medical Center, Miami, Florida, USA
| | - Kevin Newsome
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida, USA
| | - Snigdha Das
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida, USA
| | - Mark McKenney
- From the Department of Surgery, Kendall Regional Medical Center, Miami, Florida, USA
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida, USA
- University of South Florida, Tampa, Florida, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, Florida, USA
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Silverberg B, Moyers A, Wainblat BI, Cashio P, Bernstein K. A Stitch in Time. Prim Care 2022; 49:23-38. [DOI: 10.1016/j.pop.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Scala VA, Ng K, Kaneshige J, Furuta S, Hayashi MS. Cookiecutter Shark-Related Injuries: A New Threat to Swimming Across the Ka'iwi Channel. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:31-37. [PMID: 34820633 PMCID: PMC8609194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In a 5-month period in 2019, 3 long-distance swimmers sustained cookiecutter shark-related injuries while attempting to cross the Ka'iwi Channel between the Hawaiian Islands of O'ahu and Moloka'i. This report is the first case series of cookiecutter shark bites on live humans. A retrospective review of the State of Hawai'i Division of Aquatic Resources Shark Incidents List was conducted between March 1, 2019, and July 31, 2019. Trauma registry data and medical records were reviewed in patients treated for cookiecutter shark bites at The Queen's Medical Center in Honolulu, Hawai'i. All 3 patients sustained nonfatal cookiecutter shark bite circular wounds measuring between 8-13 cm in diameter. They were injured swimming over waters with depths of greater than 2000 feet at night. Patients had prolonged transport times to the emergency department (ED), averaging 73 minutes, due to their injuries occurring on the open water. All were hemodynamically stable upon ED arrival and did not require blood products. Tetanus toxoid was updated, and prophylactic antibiotic coverage, including doxycycline for Vibrio spp., was administered. Two of 3 patients were treated with operative management. Open water swimmers crossing the deep waters between the Hawaiian Islands at night are most at risk for cookiecutter shark bites. Wounds may penetrate down to and through the fascial level. Immediate life-saving hemorrhage control administered by personnel accompanying the swimmers on the open water is important for preventing morbidity and mortality. Antibiotic prophylaxis for marine bacteria is recommended.
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Affiliation(s)
- Victoria A. Scala
- Division of Orthopedic Surgery, Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI (VAS, JK)
| | - Karen Ng
- Department of Trauma, The Queen’s Medical Center, Honolulu, HI (KN, SF, MSH)
| | - Jason Kaneshige
- Division of Orthopedic Surgery, Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI (VAS, JK)
- Department of Orthopedic Surgery, The Queen’s Medical Center, Honolulu, HI (JK)
| | - Sho Furuta
- Department of Trauma, The Queen’s Medical Center, Honolulu, HI (KN, SF, MSH)
- Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI (SF, MSH)
| | - Michael S. Hayashi
- Department of Trauma, The Queen’s Medical Center, Honolulu, HI (KN, SF, MSH)
- Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI (SF, MSH)
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Wang D, Zheng Q, Lv Q, Zhang C, Zheng Y, Chen H, Zhang W. Assessment of seawater bacterial infection in rabbit tibia by Illumina MiSeq sequencing and bacterial culture. J Orthop Surg Res 2021; 16:463. [PMID: 34289854 PMCID: PMC8293552 DOI: 10.1186/s13018-021-02553-9] [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: 01/07/2021] [Accepted: 06/11/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives We aimed to explore the bacterial community composition following ocean bacterial infection using an animal model. Methods This animal-based experiment was conducted from September 2019 to November 2019. Eighteen seawater filter membranes were collected from Changle City, Fujiian Province, China, on September 8, 2019. Ten filter membranes were used for implantation. Eight filter membranes that were used in the bacterial culture for the exploration of seawater bacteria were assigned to the seawater group (SG). Fourteen healthy adult New Zealand rabbits were randomly divided into the experimental group (EG) and control group (CG). Seawater filter membranes and asepsis membranes were implanted into the tibia in the EG and CG, respectively. One week after surgery, tibial bone pathology tissues were collected and assessed using light microscopy and scanning electron microscopy (SEM). Medullary cavity tissues were collected for the performance of Illumina MiSeq sequencing and bacterial culture. The differences between EG and CG were assessed by pathological observation under light microscopy and SEM, high-throughput bacterial sequencing, and bacterial culture. Results Compared with the CG, the infection rate was 100%, and the mortality value was 20% after the implantation of the filter membranes in the EG. Both light microscopy and SEM showed that a large number of bacteria were distributed in the bone marrow cavity after ocean bacterial infection. No bacterial growth was found in the CG. Illumina MiSeq sequencing found that Firmicutes, Proteobacteria, Thermotogae, Fusobacteria, Bacteroidetes, and Actinobacteria were the dominant bacteria at the phylum level and Clostridium_sensu_stricto_7, Haloimpatiens, Clostridium_sensu_stricto_15, Clostridiaceae_1, Clostridium_sensu_stricto_18, and Oceanotoga were the dominant bacteria in genus level among the EG. In the bacterial culture of the medullary cavity tissues, Klebsiella pneumoniae, Shewanella algae, Staphylococcus aureus, Escherichia coli, Enterobacter cloacae, and Vibrio vulnificus were the predominant infective species. Moreover, compared with the SG, the EG showed a higher detection rate of E. coli and S. aureus (P = 0.008 and P = 0.001, respectively). The detection rates of V. alginolyticus, V. parahaemolyticus, and V. fluvialis were higher in the SG than the EG (P = 0.007, P = 0.03, and P = 0.03, respectively). Conclusions Our model, which was comprehensively evaluated using four techniques: histopathology and SEM observation, gene detection, and bacteria culture, provides a scientific basis for the clinical diagnosis and treatment of patients in such settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02553-9.
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Affiliation(s)
- Du Wang
- Department of Joint Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qingcong Zheng
- Department of Orthopedics, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
| | - Qi Lv
- Department of Orthopedics, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
| | - Chaofan Zhang
- Department of Joint Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yun Zheng
- Department of Orthopedics, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
| | - Huidong Chen
- Department of Orthopedics, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
| | - Wenming Zhang
- Department of Joint Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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Clinical Considerations in Initial Evaluation and Treatment of Hardhead Catfish Spine Puncture Wounds. Case Rep Emerg Med 2021; 2021:8841234. [PMID: 33763266 PMCID: PMC7964103 DOI: 10.1155/2021/8841234] [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: 09/12/2020] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Abstract
A 17-year-old male presented to our ED complaining of pain and swelling at the base of the first metacarpal after attempting to remove a catfish from his fishing line 12 hours prior to arrival. Radiographic images demonstrated a foreign body (FB), which was detectable by ultrasound. Hand surgery was consulted and took the patient to the operating room for exploration and removal of two serrated radiopaque catfish spines that were deeply embedded in the left thumb. Conclusion. Penetrating injury from hardhead catfish (Ariopsis felis) spines can cause hidden FB, envenomation, infection, and secondary damage to nearby structures. Imaging should be done for these patients to ensure they obtain timely and complete extraction of the venomous structures. Surgery should be consulted for operative management to avoid damage on removal of the catfish spine remnants.
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Gonçalves E Silva F, Dos Santos HF, de Assis Leite DC, Lutfi DS, Vianna M, Rosado AS. Skin and stinger bacterial communities in two critically endangered rays from the South Atlantic in natural and aquarium settings. Microbiologyopen 2020; 9:e1141. [PMID: 33226191 PMCID: PMC7755814 DOI: 10.1002/mbo3.1141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 01/04/2023] Open
Abstract
Bacterial communities of two critically endangered rays from the South Atlantic, the butterfly ray (Gymnura altavela) and the groovebelly ray (Dasyatis hypostigma), were described using 16S rRNA gene metabarcoding. The study characterized the bacterial communities associated with (i) G. altavela in natural (in situ) and aquarium (ex situ) settings, (ii) skin and stinger of G. altavela, and D. hypostigma in aquaria, and (iii) newborns and adults of D. hypostigma. The results revealed potentially antibiotic‐producing bacterial groups on the skin of rays from the natural environment, and some taxa with the potential to benefit ray health, mainly in rays from the natural environment, as well as possible pathogens to other animals, including fish and humans. Differences were observed between the G. altavela and D. hypostigma bacteria composition, as well as between the skin and stinger bacterial composition. The bacterial community associated with D. hypostigma changed with the age of the ray. The aquarium environment severely impacted the G. altavela bacteria composition, which changed from a complex bacterial community to one dominated almost exclusively by two taxa, Oceanimonas sp. and Sediminibacterium sp. on the skin and stinger, respectively.
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Affiliation(s)
- Fernanda Gonçalves E Silva
- BioTecPesca-Laboratory of Biology and Fisheries Technology-Institute of Biology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,LEMM, Laboratory of Molecular Microbial Ecology, Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,The Oceanography Graduate Program of University of Rio de Janeiro State (PPG-OCN/UERJ), Rio de Janeiro, Brazil
| | | | | | | | - Marcelo Vianna
- BioTecPesca-Laboratory of Biology and Fisheries Technology-Institute of Biology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,The Oceanography Graduate Program of University of Rio de Janeiro State (PPG-OCN/UERJ), Rio de Janeiro, Brazil.,IMAM-AquaRio-Rio de Janeiro Aquarium Research Center, Rio de Janeiro, Brazil
| | - Alexandre Soares Rosado
- LEMM, Laboratory of Molecular Microbial Ecology, Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,IMAM-AquaRio-Rio de Janeiro Aquarium Research Center, Rio de Janeiro, Brazil
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Edwardsiella tarda as a Cause for Limb- and Life- threatening Soft Tissue Infections: What All Plastic Surgeons Need to Know. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3016. [PMID: 33133929 PMCID: PMC7544378 DOI: 10.1097/gox.0000000000003016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 06/08/2020] [Indexed: 01/27/2023]
Abstract
Edwardsiella tarda (ET), a Gram-negative bacterium, causes an extremely uncommon, yet highly aggressive, soft tissue infection. Although plastic surgeons are frequently involved in the primary care, debridement, and secondary reconstruction of difficult soft tissue infections, infections caused by ET have received scant attention in the plastic surgery literature, perhaps because of the rarity of occurrence. We present a case of a 58-year-old man with alcohol abuse and hepatitis C who developed an upper extremity soft tissue infection after a catfish injury, which rapidly deteriorated to cause multiorgan failure and death within 5 days of admission. We will discuss the management of this rare but potentially lethal infection as well as the review of the current literature.
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Ayub A, Zatarain JR, Bowen-Jallow K, Tran S. Fishing out a foreign body for a penetrating renal injury by a dead catfish in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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20
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Finger Flexor Tenosynovitis From Stonefish Envenomation Injury. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:e024. [PMID: 31321369 PMCID: PMC6553631 DOI: 10.5435/jaaosglobal-d-19-00024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This case illustrates the challenges in the diagnosis and treatment of chronic tenosynovitis caused by stonefish envenomation injury. Persistence of symptoms can be secondary to an indolent infection, retained micro-foreign bodies, or persistence inflammatory response to verrucotoxin. Successful treatment was obtained with serial debridement coupled with a prolonged antibiotic regimen for coverage of the marine base pathogens. Level of Evidence: Level IV.
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Abstract
Extremity injuries sustained in aquatic environments require unique considerations compared with injuries sustained on land. Knowledge of these considerations is becoming more important as aquatic recreational activities increase in popularity. Aquatic injuries may occur through mechanical contact with a variety of different objects or surfaces, such as a recreational device or watercraft part, or may occur through contact with marine animals. Marine animal injuries can be further categorized into bites, stings, or blunt contact, as well as venomous or nonvenomous, distinctions that should be used to guide clinical management. Numerous instances of retained foreign bodies after marine animal stings exist, which can result in infection and prolonged envenomization; thus, radiographic examination should be routinely performed in aquatic sting injuries to prevent these harmful sequelae. Any aquatic injury resulting in an open wound has an increased risk for infection, and prophylactic antibiotics must be given with consideration for the unique microbiologic flora of the aquatic environment.
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22
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Retzky JS, Humbyrd CJ. Near-Complete Traumatic Amputation of the Forefoot After Motorboat Propeller Injury. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011418822278. [PMID: 35097315 PMCID: PMC8696818 DOI: 10.1177/2473011418822278] [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] [Indexed: 11/15/2022] Open
Abstract
We report a case of a near-complete amputation of the forefoot of a 20-year-old man as a result of a motorboat propeller injury sustained in a saltwater river. He was treated with open reduction, percutaneous pinning, extensor tendon repair, and an extended course of antibiotic prophylaxis. We review the literature regarding motorboat propeller injuries to the foot and ankle.
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Affiliation(s)
- Julia S. Retzky
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Casey Jo Humbyrd
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Kropp LM, Parsley CB, Burnett OL. Millepora species (Fire Coral) Sting: A Case Report and Review of Recommended Management. Wilderness Environ Med 2018; 29:521-526. [PMID: 30236886 DOI: 10.1016/j.wem.2018.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 01/22/2023]
Abstract
Fire corals (Millepora spp) are the second most common reef-forming organisms and are frequently found in tropical and subtropical waters. Fire corals are not true corals but rather hydrozoans more closely related to jellyfish and sea nettles. Rigidly affixed to the reef and with a branching structure, each fire coral is a colony of numerous individual hydrozoans forming a collective symbiotic organism. It is common for divers to accidentally make contact with fire corals. Fire coral contact is characterized by the immediate onset of burning pain caused by venom discharge from numerous tiny nematocysts located externally on the creature. Treatment consists of saltwater irrigation of the wound, nematocyst removal, and supportive care of the associated symptoms of pain, dermatitis, and pruritus. Rarely, fire coral can cause systemic toxicity. We present a case report of a 30-y-old recreational diver who experienced a fire coral sting of her left anterior thigh and review the recommended prevention and management of fire coral stings.
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Affiliation(s)
- Lauren M Kropp
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL.
| | - Christopher B Parsley
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Omer Lee Burnett
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL
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24
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Emigh B, Trust MD. Contaminated Wounds: Fresh Water, Salt Water, and Agricultural Contamination. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0144-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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25
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Spitler C, Rehm J. A Zone-II Flexor Tendon Injury Secondary to a Catfish Spine: A Case Report. JBJS Case Connect 2018; 7:e61. [PMID: 29252890 DOI: 10.2106/jbjs.cc.16.00198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present the case of a 17-year-old man who sustained a delayed rupture of a zone-II flexor tendon injury in the long finger from a catfish spine, which caused local envenomization and a likely secondary bacterial infection. He underwent surgical exploration and irrigation and debridement of the finger. The flexor digitorum profundus tendon was found to be lacerated and was primarily repaired. CONCLUSION Catfish spines can cause traumatic disruption of anatomic structures and can envenomate the area of injury, which can lead to a secondary bacterial infection. We review the literature regarding catfish spine injuries and describe a basic treatment algorithm for patients who are injured by catfish spines.
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Affiliation(s)
- Clay Spitler
- Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jason Rehm
- Department of Plastic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee
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Vasagar B, Jain V, Germinario A, Watson HJ, Ouzts M, Presutti RJ, Alvarez S. Approach to Aquatic Skin Infections. Prim Care 2018; 45:555-566. [PMID: 30115341 DOI: 10.1016/j.pop.2018.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aquatic-based infections can present a treatment challenge for primary care physicians because of the likely polymicrobial nature of the infection and the possibility of uncommon pathogenic organisms. Although Staphylococcus and Streptococcus species that colonize the skin are the most common etiologic agents associated with saltwater and freshwater skin and soft tissue infections, other significant pathogens can include Vibrio, Aeromonas, Edwardsiella, Erysipelothrix, and Mycobacterium. Early detection and appropriate management of aquatic infections can significantly decrease morbidity and mortality. This article reviews the pathophysiology, presentation, and management for the most common water-borne pathogens causing skin and soft tissue infections.
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Affiliation(s)
- Brintha Vasagar
- Department of Family Medicine, Medical University of South Carolina, 5 Charleston Center, Charleston, SC 29425, USA.
| | - Vasudha Jain
- Department of Family Medicine, Tidelands Health MUSC Family Medicine Residency Program, 4320 Holmestown Road, Myrtle Beach, SC 29578, USA
| | - Anthony Germinario
- Department of Family Medicine, Tidelands Health MUSC Family Medicine Residency Program, 4320 Holmestown Road, Myrtle Beach, SC 29578, USA
| | - Heber J Watson
- Department of Family Medicine, Tidelands Health MUSC Family Medicine Residency Program, 4320 Holmestown Road, Myrtle Beach, SC 29578, USA
| | - Michael Ouzts
- Department of Family Medicine, Tidelands Health MUSC Family Medicine Residency Program, 4320 Holmestown Road, Myrtle Beach, SC 29578, USA
| | - Richard John Presutti
- Department of Family Medicine, Mayo School of Medicine, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Salvador Alvarez
- Department of Internal Medicine, Mayo School of Medicine, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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27
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On the complexity of shark bite wounds: From associated bacteria to trauma management and wound repair. J Trauma Acute Care Surg 2018; 85:398-405. [PMID: 29613948 DOI: 10.1097/ta.0000000000001920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The mouth of a shark is a breeding ground for a large variety of bacteria which can easily get transferred onto a human body in the event of a shark bite. Here, we review infections originating from shark oral bacterial flora, which originate from the microbiome of its prey, as well as from the surroundings where an incident takes place. We use the example of an incident which occurred in an aquarium involving a sandtiger shark, Carcharias taurus. In addition to a succinct analysis and interpretation of the wound and recovery process, an overview of currently known bacteria associated with shark bite wounds is given, as well as a summary of the effects of various previously tested antibiotics on bacteria derived from blacktip sharks, Carcharhinus limbatus, bull sharks, C. leucas, and tiger sharks, Galeocerdo cuvier. LEVEL OF EVIDENCE Therapeutic study, level V.
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28
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Orthopaedic Watercraft Injuries: Characterization of Mechanisms, Fractures, and Complications in 216 Injuries. J Orthop Trauma 2018; 32:e134-e138. [PMID: 29557939 DOI: 10.1097/bot.0000000000001111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review the orthopaedic injuries from watercraft treated surgically at our institution and report the mechanisms, fractures, and complications encountered. DESIGN Retrospective case series. SETTING Level I trauma center. PATIENTS/PARTICIPANTS There were 216 fractures from watercraft in 146 patients. Average age was 33 years (range 4-78 years), there were 68% males (99/146), and 16% of the injuries occurred in children. INTERVENTION Operative fracture fixation. MAIN OUTCOME MEASUREMENTS After IRB approval, data were collected from January 1, 1998, to December 31, 2015, for patients including demographics, watercraft type, mechanism of injury, fracture pattern, infection, organisms, union, and amputation. Descriptive statistics were used. RESULTS There were 130 closed fractures (60%) and 86 open fractures (40%). There were 146 (67%) lower extremity injuries, 49 (23%) upper extremity injuries, and 21 (10%) pelvic injuries. The overall postoperative infection rate was 9% (20/216) and was commonly polymicrobial in nature. The postoperative infection rate in closed fractures was 4% (5/130) and the postoperative infection rate in open fractures was 17% (15/86). Open fractures also had a high proportion of nonunion (8%) and amputation (16%). CONCLUSIONS This is the largest reported series of orthopaedic injuries from watercraft. These injuries can be devastating in nature and difficult to manage, particularly when they are open (40%). There is a high rate of postoperative infection (17%), nonunion (8%), and amputation (16%) associated with open orthopaedic watercraft fractures. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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30
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Field Wound Care: Prophylactic Antibiotics. Wilderness Environ Med 2018; 28:S90-S102. [PMID: 28601215 DOI: 10.1016/j.wem.2016.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 12/28/2022]
Abstract
Adequate management of wounds requires numerous interventions, one of which is the appropriate use of antimicrobials to attempt to minimize the risk of excess morbidity or mortality without increasing toxicity or multidrug resistant bacterial acquisition. There are numerous recommendations and opinions for not only the use of systemic prophylactic antimicrobials, but also the agent, dose, route, and duration. To best address the implementation of systemic antimicrobials in a field scenario, one must weigh the factors that go into that decision and then determine the best agents possible. The epidemiologic triangle (ie, the host, the agent, and the environment) forms the basis for selecting the correct prophylactic antibiotic for field wound care. Extreme conditions can be encountered in both military and nonmilitary systems, requiring a unique selection process to make the right antibiotic choice. A modifiable weighted matrix, recommended previously for point of injury combat casualty care, assists in selecting the best oral and intravenous/intramuscular agent based on the epidemiologic risk determination.
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31
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Motorboat Propeller Injuries; A Case Series and Review of the Literature. Trauma Mon 2017. [DOI: 10.5812/traumamon.40270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Traumatic Amputation of Finger From an Alligator Snapping Turtle Bite. Wilderness Environ Med 2016; 27:277-81. [PMID: 27116923 DOI: 10.1016/j.wem.2016.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 11/21/2022]
Abstract
Legend states that the alligator snapping turtle (Macrochelys temminckii) should be handled with extreme caution as it has jaw strength powerful enough to bite a wooden broomstick in half. Tales of bite injuries from what is the largest freshwater turtle in North America exist anecdotally, yet there are few descriptions of medical encounters for such. The risk of infection from reptilian bites to the hand in an aquatic environment warrants thorough antibiotic treatment in conjunction with hand surgery consultation. We present the first case report of a near total amputation of an index finger in an adolescent boy who had been bitten by a wild "gator snapper."
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Abstract
Vibriosis is a group of intestinal and extraintestinal infections caused by marine-dwelling bacteria of the genus Vibrio. Infections range from indolent illnesses to fulminant diseases, including cholera and necrotizing fasciitis. Most illnesses result from direct contact with the marine environment or consumption of shellfish, especially oysters. In the United States vibrio infections are increasing but are underreported because of lack of clinical recognition and appropriate detection in the microbiology laboratory. Recent advances to aid in the detection and identification of vibrio illnesses in the laboratory include rapid identification tests, new media, and molecular identification systems.
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Affiliation(s)
- J Michael Janda
- Department of Public Health, Alameda County Public Health Laboratory, 1000 Broadway, Suite 500, Oakland, CA 94607, USA
| | - Anna E Newton
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA
| | - Cheryl A Bopp
- Enteric Diseases Laboratory Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Antibiotic susceptibilities of bacteria isolated within the oral flora of Florida blacktip sharks: guidance for empiric antibiotic therapy. PLoS One 2014; 9:e104577. [PMID: 25110948 PMCID: PMC4128751 DOI: 10.1371/journal.pone.0104577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 07/15/2014] [Indexed: 11/19/2022] Open
Abstract
Sharks possess a variety of pathogenic bacteria in their oral cavity that may potentially be transferred into humans during a bite. The aim of the presented study focused on the identification of the bacteria present in the mouths of live blacktip sharks, Carcharhinus limbatus, and the extent that these bacteria possess multi-drug resistance. Swabs were taken from the oral cavity of nineteen live blacktip sharks, which were subsequently released. The average fork length was 146 cm (±11), suggesting the blacktip sharks were mature adults at least 8 years old. All swabs underwent standard microbiological work-up with identification of organisms and reporting of antibiotic susceptibilities using an automated microbiology system. The oral samples revealed an average of 2.72 (±1.4) bacterial isolates per shark. Gram-negative bacteria, making up 61% of all bacterial isolates, were significantly (p<0.001) more common than gram-positive bacteria (39%). The most common organisms were Vibrio spp. (28%), various coagulase-negative Staphylococcus spp. (16%), and Pasteurella spp. (12%). The overall resistance rate was 12% for all antibiotics tested with nearly 43% of bacteria resistant to at least one antibiotic. Multi-drug resistance was seen in 4% of bacteria. No association between shark gender or fork length with bacterial density or antibiotic resistance was observed. Antibiotics with the highest overall susceptibility rates included fluoroquinolones, 3rd generation cephalosporins and sulfamethoxazole/trimethoprim. Recommended empiric antimicrobial therapy for adult blacktip shark bites should encompass either a fluoroquinolone or combination of a 3rd generation cephalosporin plus doxycycline.
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Schwartz BS, Nydick JA, Abzug JM. Aquatic hand injuries. J Hand Surg Am 2014; 39:1623-6; quiz 1627. [PMID: 25070031 DOI: 10.1016/j.jhsa.2014.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Brandon S Schwartz
- Department of Orthopaedics, University of Maryland School of Medicine, Timonium, MD; Department of Orthopedics, Naval Hospital Pensacola, Pensacola, FL
| | - Jason A Nydick
- Department of Orthopaedics, University of Maryland School of Medicine, Timonium, MD; Department of Orthopedics, Naval Hospital Pensacola, Pensacola, FL
| | - Joshua M Abzug
- Department of Orthopaedics, University of Maryland School of Medicine, Timonium, MD; Department of Orthopedics, Naval Hospital Pensacola, Pensacola, FL.
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Jha S, Khan WS, Siddiqui NA. Mammalian bite injuries to the hand and their management. Open Orthop J 2014; 8:194-8. [PMID: 25067974 PMCID: PMC4110393 DOI: 10.2174/1874325001408010194] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/23/2014] [Accepted: 03/27/2014] [Indexed: 11/22/2022] Open
Abstract
Bite wounds are a common form of hand injury with the potential to lead to severe local and systemic sequelae and permanent functional impairment. Mammalian bite wounds may be caused by a variety of animal class and species; injuries resulting from dogs, cats and humans are the most widely discussed and reported in the literature. Bite wounds may be contaminated with aggressive pathogens and the anatomical vulnerability of structures within the hand means that without early recognition and treatment with irrigation and antibiotics, alongside a low index of suspicion for deep structural involvement requiring formal surgical exploration and washout, the consequences of such injuries can be disastrous. We review the literature and discuss the epidemiology, pathophysiology and microbiology relating to these injuries, as well as clinical aspects including signs, symptoms, and management.
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Affiliation(s)
- Shilpa Jha
- Department of Trauma & Orthopaedics, Kingston Hospital NHS Trust, Kingston, London, UK
| | - Wasim S Khan
- University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, London, UK
| | - Nashat A Siddiqui
- Department of Trauma & Orthopaedics, Kingston Hospital NHS Trust, Kingston, London, UK
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Catfish noodling forearm injury requiring urgent surgical treatment: a case report and review of the literature. Wilderness Environ Med 2014; 25:75-9. [PMID: 24412658 DOI: 10.1016/j.wem.2013.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 10/28/2013] [Accepted: 10/31/2013] [Indexed: 11/24/2022]
Abstract
"Noodling" is an ancient form of hand fishing recently gaining in popularity as a hobby and sport. We present one of the first case reports of a noodling injury in an adolescent male seeking to land a large catfish, and also review the literature on catfish-related injuries.
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Spano SJ, Dimock B. They had me in stitches: a Grand Canyon river guide's case report and a review of wilderness wound management literature. Wilderness Environ Med 2014; 25:182-9. [PMID: 24418453 DOI: 10.1016/j.wem.2013.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 10/21/2013] [Accepted: 10/27/2013] [Indexed: 11/27/2022]
Abstract
We present a case of failed conservative management of a traumatic wound sustained in a wilderness setting. The patient was initially treated with a povidone-iodine scrub, suture closure, and expectant management by 2 physicians who were paying clients on a multiday river rafting expedition. Empiric antibiotic coverage and irrigation of the dehisced wound were initiated several days after initial treatment. The patient arranged his own evacuation 8 days after injury. Hospitalization, intravenous (IV) antibiotics, and surgical debridement with wound vacuum placement led to a full recovery. This case presents several common wound care pitfalls. The sequelae to these pitfalls are more dramatic in a wilderness setting and underscore the importance of early aggressive management and considering prompt evacuation when treating wounds sustained in the wilderness.
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Affiliation(s)
| | - Brad Dimock
- Arizona Raft Adventures (AzRA), Flagstaff, AZ
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39
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Huang G, Goldstein R, Mildvan D. Catfish spine envenomation and bacterial abscess with Proteus and Morganella: a case report. J Med Case Rep 2013; 7:122. [PMID: 23631594 PMCID: PMC3651315 DOI: 10.1186/1752-1947-7-122] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 03/19/2013] [Indexed: 11/28/2022] Open
Abstract
Introduction Abscess formation and cellulitis in the setting of envenomation are rare complications of handling catfish. To the best of our knowledge, isolation of Proteus vulgaris has not been previously recorded, and recovery of Morganella morganii has been reported in only one prior case from wound cultures in patients injured by catfish stings. We report a case of catfish envenomation characterized by abscess formation and cellulitis, in which wound cultures grew these unusual organisms. Case presentation A 52-year-old Chinese-American man was hospitalized with erythema and swelling of his right arm of 10 days’ duration after skin penetration by a catfish barb. An abscess of his right thumb had undergone incision and drainage, with purulent drainage sent for wound culture immediately prior to admission. Laboratory studies revealed elevated white blood count, sedimentation rate, and C-reactive protein. The patient was treated with intravenous ampicillin-sulbactam and vancomycin during his hospitalization, and symptoms improved. Wound cultures obtained prior to presentation grew many Proteus vulgaris and Morganella morganii. He was subsequently discharged on a 10-day course of oral ciprofloxacin and amoxicillin-clavulanate. At a 12-month telephone follow-up, the patient denied developing further symptoms and reported that the wound had healed completely without complication. Conclusion Although envenomation and secondary infection are not uncommon sequelae of handling catfish, the present case is unique by virtue of the infecting organisms isolated. Given the prevalence of injury from catfish stings, a review of the literature is presented in order to provide recommendations for prevention and treatment of catfish envenomation.
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Affiliation(s)
- Gary Huang
- Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA.
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Abstract
Complex distal radius fractures are high-energy injuries of the wrist with articular disruption, ligamentous instability, significant comminution, soft tissue injury, and/or neurovascular impairment. The management of these injuries requires a thorough understanding of wrist functional anatomy and familiarity with a wide selection of approach and fixation options. This article reviews an approach that involves structured evaluation, aggressive soft tissue management, early reduction and skeletal stabilization, and a columnar approach to definitive care. Outcome is determined by multiple factors and depends greatly on the soft tissue injury, patient factors, and management and the adequacy of restoration of osseous and ligamentous relationships.
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Affiliation(s)
- Stephen A Kennedy
- Hand and Microvascular Surgery, Department of Orthopaedics and Sports Medicine, University of Washington-Roosevelt II, Seattle, WA 98105, USA
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41
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Charruau P, Pérez-Flores J, Pérez-Juárez JG, Cedeño-Vázquez JR, Rosas-Carmona R. Oral and cloacal microflora of wild crocodiles Crocodylus acutus and C. moreletii in the Mexican Caribbean. DISEASES OF AQUATIC ORGANISMS 2012; 98:27-39. [PMID: 22422127 DOI: 10.3354/dao02418] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Bacterial cultures and chemical analyses were performed from cloacal and oral swabs taken from 43 American crocodiles Crocodylus acutus and 28 Morelet's crocodiles C. moreletii captured in Quintana Roo State, Mexico. We recovered 47 bacterial species (28 genera and 14 families) from all samples with 51.1% of these belonging to the family Enterobacteriaceae. Fourteen species (29.8%) were detected in both crocodile species and 18 (38.3%) and 15 (31.9%) species were only detected in American and Morelet's crocodiles, respectively. We recovered 35 bacterial species from all oral samples, of which 9 (25.8%) were detected in both crocodile species. From all cloacal samples, we recovered 21 bacterial species, of which 8 (38.1%) were detected in both crocodile species. The most commonly isolated bacteria in cloacal samples were Aeromonas hydrophila and Escherichia coli, whereas in oral samples the most common bacteria were A. hydrophila and Arcanobacterium pyogenes. The bacteria isolated represent a potential threat to crocodile health during conditions of stress and a threat to human health through crocodile bites, crocodile meat consumption or carrying out activities in crocodile habitat. We especially warn about the presence of Salmonella arizonae and S. typhi, which cause enteritis and septicemia in crocodiles and salmonellosis and typhoid fever in humans. The risk of bacterial contamination from crocodiles to humans could increase in the future because of the accelerated destruction of crocodile habitat, which could lead to an augmentation of human-crocodile interactions. Information on bacterial diversity reported here could help in the choice of antibacterial products in case of infections that are of crocodile origin.
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Affiliation(s)
- Pierre Charruau
- Departamento de Zoología, Universidad Nacional Autónoma de México, Distrito Federal 04510, Mexico.
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Garg H, Twerenbold R, Zellweger R. Propeller and jet-ski injuries during Christmas and New Year in Western Australia. Med J Aust 2011; 195:704-5. [PMID: 22171870 DOI: 10.5694/mja11.10136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This is the first published case series of patients with injuries from watercraft propellers and jet skis. Five patients presented to the level-one trauma centre of Western Australia with such injuries over 10 days during the 2010-2011 Christmas holidays; all required surgery, and all but one sustained multiple, severe injuries.
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Finkelstein R, Oren I. Soft tissue infections caused by marine bacterial pathogens: epidemiology, diagnosis, and management. Curr Infect Dis Rep 2011; 13:470-7. [PMID: 21785929 DOI: 10.1007/s11908-011-0199-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Skin and soft tissue infections (SSTIs) are one of the most common infection syndromes and may be caused by a large number of microorganisms. Some principles of aquatic injuries are different than those of land-based trauma. Wounds sustained in marine environment are exposed to a milieu of bacteria rarely encountered in different settings. These include Vibrio spp., Aeromonas spp., Shewanella spp., Erysipelothrix rhusiopathiae, Mycobacterium marinum, Streptococcus iniae, and other microbes. Failure to recognize and treat these uncommon pathogens in a timely manner may result in significant morbidity or death. These infections are frequently contracted as a result of recreational swimming, fishing injuries, or seafood handling. The spectrum of manifestations is wide, varying from cases of mild cellulitis, to severe life-threatening necrotizing fasciitis requiring radical surgery, to sepsis and death. This review will focus on the epidemiology, clinical manifestations, and treatment of SSTIs caused by the most important marine pathogens.
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Affiliation(s)
- Renato Finkelstein
- Infectious Diseases Unit, Rambam Healthcare Campus, 31096, Haifa, Israel,
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McNicholas MJ, Robinson SJ, Polyzois I, Dunbar I, Payne AP, Forrest M. 'Time critical' rapid amputation using fire service hydraulic cutting equipment. Injury 2011; 42:1333-5. [PMID: 21636083 DOI: 10.1016/j.injury.2011.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 05/03/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Entrapped trauma victims require extrication, which, on rare occasions, may involve amputation of a limb. Standard extrication techniques sometimes fail or may be impossible, leading to the death of the entrapped victim. We propose that the use of fire service hydraulic cutting equipment can be used effectively to urgently amputate a limb, where conventional techniques are unusable. METHOD The study aims to determine: (i) the potential use of this equipment to achieve expeditious life-saving amputations and (ii) the effect the fire service hydraulic cutting equipment has on the bony and surrounding soft tissues. Initially a porcine limb was used followed by fresh-frozen cadaveric lower limbs. We recorded the time, number of cuts, proximal fracture propagation and quality of bone cut when performing amputations at five levels. RESULTS The experiment confirms that faster guillotine amputations in human cadaveric lower limb specimens can be achieved by using fire service hydraulic cutting equipment. Overall, the average time to complete an amputation in these ideal experimental circumstances at all five levels was quicker using the hydraulic cutting equipment. Either one or two cutting actions were required to achieve the amputation using fire service hydraulic cutting equipment. The degree and proximal extent of the comminution were greater using the fire service hydraulic cutting equipment. CONCLUSION If circumstances and time constrains allow, a conventional amputation technique carried out by a trained medical practitioner would be preferable to the use of the fire service hydraulic cutting equipment. However, we feel that this technique could be used to perform emergent amputation under trained medical supervision, if it is felt that a standard amputation technique would take too long or the environment is too restrictive to perform a standard amputation safely.
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Affiliation(s)
- M J McNicholas
- Department of Orthopaedics & Trauma, North Cheshire Hospitals NHS Trust, Warrington, Lovely Lane WA5 1QG, UK
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Roth BJ, Geller SM. Deep soft-tissue necrosis of the foot and ankle caused by catfish envenomation: a case report. J Am Podiatr Med Assoc 2011; 100:493-6. [PMID: 21084536 DOI: 10.7547/1000493] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Catfish envenomations represent a relatively rare cause of complications in podiatric medicine. We report a case of an unusual event eliciting a severe soft-tissue necrosis in a 21-year-old man and his complicated wound-healing process. This case reviews the potential complications of catfish envenomations.
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Affiliation(s)
- Bryan J Roth
- Department of Podiatric Medicine and Surgery, Maricopa Medical Center, Phoenix, AZ, USA
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Abstract
Sepsis is a major cause of mortality and morbidity in the trauma patient. Sepsis following traumatic injury is related to the type of injury, together with the extent of injury and the anatomical location. Burn injuries are associated with the highest risk of sepsis. The diagnosis of sepsis in the trauma patient remains difficult. Interpretation of abnormal results is key to successful diagnosis, particularly in conjunction with clinical findings. This review will consider the specific features of sepsis in the context of trauma relating to epidemiology, risk factors, diagnosis and management.
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Affiliation(s)
- Robert Thornhill
- Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Raddlebarn Road, Selly Oak, Birmingham, B29 6JD, UK, , Department of Critical Care Medicine, Queen Elizabeth Medical Centre, University Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK
| | - Dan Strong
- Department of Critical Care Medicine, Queen Elizabeth Medical Centre, University Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK
| | - Suresh Vasanth
- Department of Critical Care Medicine, Queen Elizabeth Medical Centre, University Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK
| | - Iain Mackenzie
- Department of Critical Care Medicine, Queen Elizabeth Medical Centre, University Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK, School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Wamisho BL, Bates J, Tompkins M, Islam R, Nyamulani N, Ngulube C, Mkandawire NC. Ward round--crocodile bites in Malawi: microbiology and surgical management. Malawi Med J 2009; 21:29-31. [PMID: 19780476 DOI: 10.4314/mmj.v21i1.10986] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We present a case series of 5 patients admitted over 5 months to Queen Elizabeth Central Hospital who had sustained injuries from a crocodile bite. Three patients required amputation of a limb. The severe soft tissue injury associated with a crocodile bite and the unusual normal oral flora of the crocodile create challenges in treatment. Progressive tissue destruction and haemolysis are complications of such infected wounds. An antibiotic regime is recommended that covers gram negative rods, anaerobes and may include doxycycline, as well as the need to have a low threshold for early amputation.
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Affiliation(s)
- Biruk L Wamisho
- College of Medicine, Department of Surgery, Malawi, P.O. Box 122201, Addis Ababa, Ethiopia.
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Ribeiro NFF, Heath CH, Kierath J, Rea S, Duncan-Smith M, Wood FM. Burn wounds infected by contaminated water: case reports, review of the literature and recommendations for treatment. Burns 2009; 36:9-22. [PMID: 19501977 DOI: 10.1016/j.burns.2009.03.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 01/19/2009] [Accepted: 03/02/2009] [Indexed: 12/20/2022]
Abstract
First-aid education for the management of burns advocates cool running water over burnt skin to limit soft tissue damage. However, the water used may itself constitute a risk. We report three cases of severe invasive and necrotizing infection in patients who used or immersed themselves in contaminated water in an attempt to extinguish the fire following acute major burns. Wound cultures from all patients yielded Aeromonas hydrophila and two yielded Bacillus cereus. One patient had a complex polymicrobial infection, including zygomycosis with Rhizomucor variabilis. All patients were treated aggressively with wound débridement, including one patient who required bilateral lower limb amputations to control progressive infection. All infections were successfully treated and all patients survived their burn injuries. We review the management of burns complicated by exposure to contaminated water leading to burn wound infections. We describe commonly reported organisms from various water sources, the appropriate initial empirical antimicrobial chemotherapy and present the clinician with a proposed algorithm for managing these serious infections.
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Affiliation(s)
- Noel F F Ribeiro
- Department of Plastic Surgery, Royal Perth Hospital, Perth, Western Australia (WA), Australia.
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50
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Wilson JP, Burgess G, Winfield RD, Lottenberg L. Sturgeons versus Surgeons: Leaping Fish Injuries at a Level I Trauma Center. Am Surg 2009. [DOI: 10.1177/000313480907500306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We have recently noted an increase in patients injured by an unusual mechanism and source: leaping sturgeon. We present our experience with eight cases of sturgeon related injuries. Between January 2006 and June 2007, there were eight patients evaluated at our Level I trauma center for sturgeon related injuries. Injuries included isolated fractures, liver lacerations, severe facial trauma, and a closed head injury. The overall length of stay was 6 days (range 0-20) and 50 per cent of patients required an intensive care unit stay. For comparative purposes, injuries were classified as primary sturgeon injuries (injuries where the sturgeon directly impacted the patient) and secondary sturgeon injuries (injuries related to the sturgeon but not resultant from direct impact). There were five primary injuries and three secondary injuries in our series. Patients with secondary injuries had a longer length of stay (12 days vs 3 days) and a higher intensive care unit utilization (100 % vs 20%) when compared with patients having primary injuries. This is the first report of sturgeon-related injuries in the medical literature. These peculiar insults seem to have increased in recent years. Public awareness and proper boat safety are vital in reducing the number and severity of these incidents.
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Affiliation(s)
- Jason P. Wilson
- Department of Surgery and the University of Florida, Gainesville, Florida
| | - George Burgess
- Florida Program for Shark Research, Florida Museum of Natural History, University of Florida, Gainesville, Florida
| | - Robert D. Winfield
- Department of Surgery and the University of Florida, Gainesville, Florida
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