1
|
Ditsios K, Katsimentzas T, Pitsilos C, Koukourikos I, Christidis P, Ditsios T, Konstantinou P, Varitimidis S. Deep Fungal Infections of the Upper Extremity - A Review. Orthop Rev (Pavia) 2024; 16:94570. [PMID: 38469579 PMCID: PMC10927313 DOI: 10.52965/001c.94570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 02/05/2024] [Indexed: 03/13/2024] Open
Abstract
Deep fungal infections are rare in the upper extremity. Vessel and nerve infection, synovitis, tenosynovitis, myofasciitis, arthritis and osteomyelitis have been discovered in literature. Treatment in most cases includes surgical procedure and antifungal agent use. Amputation is the final, most devastating for patient's functionality, solution. Intravenous antifungal drugs, frequently followed by oral administration, are important ancillary agents both for the initial treatment and the prevention of recurrence. We therefore performed a review of the current literature, in order to assemble the dispersed results of different studies and clarify the various aspects of upper extremity fungal infections.
Collapse
Affiliation(s)
- Konstantinos Ditsios
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Triantafyllos Katsimentzas
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Charalampos Pitsilos
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Ilias Koukourikos
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | | | | | - Panagiotis Konstantinou
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Sokrates Varitimidis
- Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, University of Thessaly, Larisa, Greece
| |
Collapse
|
2
|
Nguyen D, Le ZHM, Ranasinghe S. Salmonella Subcutaneous Abscess: A Rare Complication Post Salmonella Gastroenteritis. Cureus 2024; 16:e52945. [PMID: 38406137 PMCID: PMC10894045 DOI: 10.7759/cureus.52945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Salmonella is a gram-negative bacilli bacterium that can infect and colonize humans, causing a wide range of clinical manifestations. The most common manifestation is gastroenteritis, usually after ingestion of undercooked and ill-prepared food, particularly in developing countries. Indonesia is among those reported to have a high incidence of Salmonella infection. Uncommonly, extraintestinal manifestations can affect distant body sites, either during or after the episode of bacteremia. This case report presents a rare case of a healthy 19-year-old female who developed an atypical chest wall abscess colonized by Salmonella in the context of experiencing gastroenteritis three weeks prior on her return from Bali, Indonesia. This case highlights the indolent course associated with a Salmonella chest wall abscess with a discussion of the current literature and management.
Collapse
|
3
|
Suarez RI, Polmann M, Del Pilar Bonilla L, Torres-Viera CG, Bedran K. Immunosuppression and Opportunistic Infections: A Rare Case Report of Nocardia Osteomyelitis of the Pelvis. Cureus 2023; 15:e45306. [PMID: 37846230 PMCID: PMC10576979 DOI: 10.7759/cureus.45306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/15/2023] [Indexed: 10/18/2023] Open
Abstract
Patients with a long-standing history of immunosuppression are at significantly increased risk of opportunistic infections. One such group of organisms that may cause these types of infections includes the Nocardia genus, a gram-positive, filamentous rod that demonstrates a branching pattern, is urease-producing and has acid-fast properties. The disease profile of Nocardia varies with manifestations ranging from cutaneous infection to severe pulmonary or central nervous system (CNS) infections, and rarely, osteomyelitis. In this case report, we present an 87-year-old female with persistent left gluteal and lumbar pain, generalized body aches, chills, and fevers diagnosed with Nocardia asiatica osteomyelitis of the pelvis, likely secondary to dissemination from pulmonary cavitary disease in an immunosuppressed host with chronic neutropenia. On magnetic resonance imaging (MRI), the patient was found to have heterogeneous enhancement, central necrosis, and loss of cortical margins of the left iliac wing, alongside a rim-enhancing soft tissue mass from the left iliac bone into the left gluteal soft tissues and left paraspinal musculature representing an abscess. She was promptly treated with surgical irrigation and drainage with surgical wound cultures growing Nocardia asiatica. She received treatment with trimethoprim-sulfamethoxazole antibiotics with symptom improvement and is following up with an infectious disease physician outpatient. Management of osteomyelitis, like in this case, involves long-term antibiotics with the potential need for surgical intervention. There are few reported cases of extrapulmonary Nocardia infections, particularly osteomyelitis, demonstrating the importance of their inclusion in the literature to better serve patients to allow for timely intervention for rare and life-threatening conditions. In immunocompromised hosts, the differential diagnosis should include opportunistic infections and less common pathogens, especially in those with atypical presentations, including gluteal and leg pain.
Collapse
Affiliation(s)
- Richard I Suarez
- Health Policy, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Michaela Polmann
- Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | | | | | - Kebir Bedran
- Hospital Medicine, Baptist Health South Florida, Miami, USA
| |
Collapse
|
4
|
Semy M, Lee-Kwen P, Semy S. Lyme Disease Presenting With Interesting Neurological Features of Weakness and Hyporeflexia: A Case Report. Cureus 2023; 15:e43296. [PMID: 37692616 PMCID: PMC10492644 DOI: 10.7759/cureus.43296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Lyme disease is a tick-borne bacterial infection caused primarily by three pathogenic species of spirochete Borrelia (B. burgdorferi, B. afzelii, and B. garinii). It has a wide range of clinical manifestations ranging in severity. Although, it is generally divided into three phases: early localized, early disseminated, and late disease. Certain cases do not follow the same order described in standard books like Harrison's. Thus, it is vital to establish a chronological timeline when establishing the diagnosis. Here, we describe a 25-year-old female with numbness and tingling that began in her torso and then spread to her entire body. Physical examination revealed diminished motor reflexes and power, but the diagnosis of neuroborreliosis with monoradiculitis was only established with positive laboratory antibody evaluation and lumbar puncture. The patient's symptoms resolved quickly with a four-day inpatient course of IV ceftriaxone followed by 10 days of oral doxycycline.
Collapse
Affiliation(s)
- Mehak Semy
- Internal Medicine, Dr. Dnyandeo Yashwantrao (DY) Patil School of Medicine, Mumbai, IND
| | | | | |
Collapse
|
5
|
Tomlinson MG, Chidarala S, Lobo BC, Kalyatanda GS. Non-tuberculous Mycobacterium Rhinosinusitis in an Immunocompetent Patient. Cureus 2023; 15:e44002. [PMID: 37746497 PMCID: PMC10516704 DOI: 10.7759/cureus.44002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Non-tuberculous mycobacteria (NTM) are slow-growing opportunistic pathogens that cause a variety of cutaneous, soft tissue, and pulmonary infections. On rare occasions, NTM causes chronic rhinosinusitis, with the majority of cases presenting in immunocompromised individuals. Other potential risk factors include the presence of foreign bodies, previous sinus surgery or chemoradiation, and use of contaminated water in sinus rinses. We report here a rare case of NTM rhinosinusitis in an otherwise immunocompetent 66-year-old female. The patient underwent functional endoscopic sinus surgery where intraoperative acid-fast bacteria cultures grew Mycobacterium abscessus. She received five weeks of broad-spectrum IV antibiotic therapy followed by three months of oral azithromycin, tigecycline, and linezolid. A one-year post-operative visit showed appropriate healing without crusting or visible infection. This case contributes to the small handful of documented presentations of NTM rhinosinusitis in immunocompetent patients. NTM should be considered when patients present with refractory rhinosinusitis as they may require extended courses of antibiotic treatment. Familiarity with risk factors can further expedite making a diagnosis, ensuring prompt initiation of treatment and relief of symptoms for patients.
Collapse
Affiliation(s)
- Michelle G Tomlinson
- Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, USA
| | - Shreya Chidarala
- Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, USA
| | - Brian C Lobo
- Otolaryngology - Head and Neck Surgery, University of Florida, Gainesville, USA
| | - Gautam S Kalyatanda
- Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, USA
| |
Collapse
|
6
|
Alhoukail A, Alrawaf T, Alotaibi A, Alanazi H. Necrotizing Fasciitis in COVID-19 Patient: A Case Report of Atypical Early Presentation. Cureus 2023; 15:e37290. [PMID: 37168208 PMCID: PMC10166124 DOI: 10.7759/cureus.37290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023] Open
Abstract
A 48-year-old male, known to have hypertension (HTN), ischemic heart disease (IHD) post-percutaneous coronary intervention (PCI) before one year, and morbid obesity (BMI: 60), presented to the emergency department complaining of right thigh pain and swelling that started two days before. The swelling got increasingly worsen over the previous days, associated with dyspnea, for which he sought medical attention in another hospital. He was found to have a picture of sepsis where they offered him irrigation and debridement (I&D) but he refused and presented to our institution in a hemodynamically unstable condition. The patient underwent immediate surgery with subsequent intensive care unit (ICU) admission as a case of necrotizing fasciitis complicated by sepsis. Later he was found to have coronavirus disease 2019 (COVID-19) infection.
Collapse
Affiliation(s)
- Amro Alhoukail
- Department of Orthopedic Surgery, King Fahad Medical City, Riyadh, SAU
| | - Talal Alrawaf
- Department of Orthopedic Surgery, King Fahad Medical City, Riyadh, SAU
| | - Abdullah Alotaibi
- Department of Orthopedic Surgery, King Fahad Medical City, Riyadh, SAU
| | - Hassan Alanazi
- Department of Orthopedic Surgery, King Fahad Medical City, Riyadh, SAU
| |
Collapse
|
7
|
Muacevic A, Adler JR. A Case of Bronchopleural Fistula and Hydropneumothorax in a Patient With Necrotizing Pneumonia Complicated by Mycobacterium avium Complex. Cureus 2022; 14:e30280. [PMID: 36407137 PMCID: PMC9653535 DOI: 10.7759/cureus.30280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 01/25/2023] Open
Abstract
A bronchopulmonary fistula is a pathological connection that develops between the bronchi and the pleural cavity as a result of etiologies including surgery, infection, blunt or penetrating trauma, radiation, chemotherapy, and chronic obstructive pulmonary disease sequela. Diagnosis and treatment are challenging for intensivists. We present a case report of bronchopulmonary fistula resulting in hydropneumothorax caused by necrotizing pneumonia and complicated by mycobacterium avium complex that resolved spontaneously. The aim of this case report is to discuss the presentation and treatment of bronchopleural fistulas.
Collapse
|
8
|
Lajos P, Bangiyev R, Safir S, Weber T. Mycotic Popliteal Artery Aneurysm With Rapid Enlargement Post-Bypass. Cureus 2021; 13:e15746. [PMID: 34285852 PMCID: PMC8286778 DOI: 10.7759/cureus.15746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 11/24/2022] Open
Abstract
Popliteal artery aneurysms (PAAs) are the most common type of peripheral artery aneurysms. Mycotic aneurysms involving the popliteal artery are quite rare and can occur as either a primary de novo infection or a secondary infection from another site. To our knowledge, there are no previous case reports on mycotic PAA in which Staphylococcus epidermidis was the primary etiologic pathogen. We present the case of a 55-year-old male who presented with complaints of lower extremity pain and swelling, malaise, and low-grade temperatures for two weeks and was found to have a PAA. He underwent left femoral-popliteal bypass grafting with expanded polytetrafluoroethylene (ePTFE) graft and ligation of the aneurysm. On postoperative day 10, he experienced acute swelling and pain in his lower extremity with foot drop and was found to have rapid enlargement of his aneurysm sac on imaging. He was returned to the operating room emergently where he underwent aneurysmectomy via a posterior fossa approach. Cultures and gram staining of the aneurysm sac were consistent with Staphylococcus epidermidis. As noted above, this case of mycotic PAA was treated with standard vascular surgical techniques, yet it proceeded to enlarge acutely. PAAs that rapidly expand or rupture after surgical interventions may be a sign of infection.
Collapse
Affiliation(s)
- Paul Lajos
- Cardiothoracic and Vascular Surgery, University of Pittsburgh Medical Center Hamot, Erie, USA
| | - Ronald Bangiyev
- Vascular Surgery, University of Pittsburgh Medical Center Hamot, Erie, USA
| | - Scott Safir
- Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Thomas Weber
- Surgery, Brooklyn Veterans Affairs Medical Center, Brooklyn, USA
| |
Collapse
|
9
|
Abstract
Blastomycosis is an uncommon disease caused by the dimorphic fungus, Blastomyces dermatitidis, often found in endemic regions of Midwestern America. It can be found in forested, sandy soils, decaying vegetation, rotting wood near water sources, and even in bird feces. Most commonly, blastomycosis manifests as a pulmonary infection presenting as pneumonia, or in severe cases, respiratory distress syndrome (ARDS). Dissemination to the bone is less common but osteomyelitis of the lower thoracic and lumbar spine, ribs, skull, and long bones have been most frequently reported. Disseminated infection to the genitourinary system commonly manifests as prostatitis or epididymo-orchitis in men and as an endometrial infection or tubo-ovarian abscess in women. In the nervous system, blastomycosis can manifest as meningitis or with a cranial abscess. Having a high degree of clinical suspicion and obtaining a detailed medical and social history is important for making a diagnosis. Culturing a specimen will provide a definitive diagnosis. Sputum or tissue specimens stained in 10% potassium hydroxide under microscopy will reveal the classic appearance of B. dermatitidis (broad-based budding with a double-contoured cell wall). In mild to moderate disease without dissemination, itraconazole is the treatment of choice. In severe, life-threatening cases, patients with CNS involvement or in immunocompromised individuals, amphotericin B is the preferred initial drug of choice. We present an interesting case of a 42-year-old African-American male with no significant past medical history who was admitted initially for suspicion of cellulitis/septic arthritis and was started on broad-spectrum antibiotics. However, he was eventually found to have Blastomyces osteomyelitis.
Collapse
Affiliation(s)
- Amit Sapra
- Family Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Dorothy Pham
- Family Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Eukesh Ranjit
- Family Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Malika Q Baig
- Family Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Jason Hui
- Family Medicine, Southern Illinois University School of Medicine, Springfield, USA
| |
Collapse
|
10
|
Kearney L, O'Connor C, Fitzpatrick F, O'Sullivan JB. "More than skin deep": Recurrent primary hand abscesses in a warehouse operative. Case Reports Plast Surg Hand Surg 2015; 2:84-7. [PMID: 27252979 PMCID: PMC4793786 DOI: 10.3109/23320885.2015.1120641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 11/12/2015] [Indexed: 12/05/2022]
Abstract
A 25-year-old male right-hand dominant warehouse operator presented with two hand infections within 12 weeks both requiring surgical drainage and antimicrobial therapy. Subsequent testing confirmed Panton-Valentine leukocidin-positive Staphylococcus aureus (PVL-SA). This case highlights the need for prompt multidisciplinary management of hand infections to consider, diagnose and manage atypical infections.
Collapse
Affiliation(s)
- L Kearney
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
| | - C O'Connor
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - F Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - J B O'Sullivan
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|