Friday, March 30, 2007

Bilateral proximal cellulitis and onychomycosis in both big toes due to Fusarium solani

Bilateral proximal cellulitis and onychomycosis in both big toes due to Fusarium solani

Rev Iberoam Micol. 2006 Dec

Torres-Rodriguez JM,
Sellart-Altisent M.
URMIM (Unidad de Investigacion de Enfermedades Infecciosas y Micologia), IMIM, Facultad de Medicina, Universitat Autonoma de Barcelona, c/ Dr. Aiguader, 80, 08003 Barcelona, Spain.

We report a case of proximal fold cellulitis in both big toes, associated with a bilateral proximal onychomycosis and an intertrigo of the fourth space due to Fusarium solani. The infection occurred in an immunocompetent man with diabetes mellitus type II. Apparently, the infection was acquired in a tropical country and once the patient was in Spain the infection progressed causing nail detachment (onychomadesis). Seven months later a relapse that affected the left toenail occurred. The patient was treated topically with chemical toenail avulsion contained 40% urea associated with bifonazole followed by ciclopirox-olamine nail lacquer for 12 months. Complete cure without relapse was observed after 10 years of follow-up. In vitro antifungal susceptibility study demonstrated that two of the recovered isolates were both resistant to itraconazole and voriconazole.

PMID: 17388651 [PubMed - in process]

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Thursday, March 22, 2007

Chlamydial conjunctivitis presenting as pre septal cellulitis.

Chlamydial conjunctivitis presenting as pre septal cellulitis.

Head Face Med. 2007 Mar 14

Drummond SR,
Diaper CJ.


Chlamydia conjuctivitis results from infection by chlamydia trachomatis, the commonest treatable sexually transmitted infection in Europe. Its clinical manifestations involve the conjunctiva and the cornea. The inflammation under the upper eyelid may be sufficient to present as ptosis, however previously it has not been documented to cause a preseptal cellulitis. We present such a case. A 15-year-old girl was diagnosed with a left viral conjunctivitis. Five days later, she returned with marked oedema of the left upper and lower lids accompanied by erythema.

The tarsal conjunctiva revealed follicles and large papillae and extra ocular movements revealed discomfort on elevation. A secondary diagnosis of bacterial pre septal cellulitis was made and the treatment was changed a broad spectrum oral antibiotic. On review at two days, the patient now complained of a large amount of purulent discharge in association with the marked pre septal swelling. As previous bacteriology and virology had been negative, the patient was re swabbed for chlamydia. This proved positive and her symptoms completely resolved following administration of Azithromycin.

In this particular case recognition of the pathogen is important to alert the patient to the likelihood of unknown genital infestation. In all cases of positive culture, the patient should be counselled to attend a genitourinary clinic and to alert any sexual partners to the need to do likewise.

Head and Face Medicine Full Text

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Wednesday, March 21, 2007

Clindamycin versus Unasyn in the treatment of facial cellulitis of odontogenic origin in children.

Clindamycin versus Unasyn in the treatment of facial cellulitis of odontogenic origin in children.

Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, USA.

The study was undertaken to characterize the microbiology of dental abscesses in children and to compare clindamycin and ampicillin/sulbactam in the treatment of facial cellulitis of odontogenic origin. Sixty children with acute facial cellulitis of dental origin underwent surgery (extraction or root canal procedure) within 24 hours of presentation. Pus samples were cultured aerobically and anaerobically. Patients were randomized (1:1) to receive intravenous ampicillin/sulbactam or clindamycin for 48 hours followed by oral amoxicillin/clavulanate or clindamycin for 7 days.

A total of 211 bacterial isolates were recovered from 54 samples. The most common aerobic and facultative organisms were viridans streptococci, Neisseria, and Eikenella species. Among anaerobes, Prevotella and Peptostreptococcus species were the most frequent. No treatment failure occurred in either group.

Dental abscesses in children are polymicrobial aerobic/anaerobic infections. Treatment of complicated dental infections with ampicillin plus a beta-lactamase inhibitor or clindamycinin combination with surgical drainage is very effective.

Key Words: clindamycin • Unasyn • dental • cellulitis • abscess • children

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Monday, March 19, 2007

Case of bacteraemic cellulitis by a non-haemolytic strain of Streptococcus pyogenes.

Case of bacteraemic cellulitis by a non-haemolytic strain of Streptococcus pyogenes.

Scand J Infect Dis. 2007
Sonksen UW, Ekelund K, Bruun BG. From the Department of Clinical Microbiology, Hillerod Sygehus. Copenhagen. Denmark.

Erysipelas and bacteraemia with what initially was diagnosed as a non-haemolytic streptococcus is reported. As neither colony morphology nor clinical picture was characteristic of non-haemolytic streptococci, the isolate was sent to a reference laboratory. 16S rRNA sequencing and phenotypic characterization identified the strain as a streptolysin S-deficient S. pyogenes..

PMID: 17366061 [PubMed - in process]

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Tuesday, March 13, 2007

Primary cryptococcal cellulitis in a lung transplant recipient.

Primary cryptococcal cellulitis in a lung transplant recipient.

Heart Lung Transplant. 2007 Mar

Van Grieken SA,
Dupont LJ,
Van Raemdonck DE,
Van Bleyenbergh P,
Verleden GM.

Department of Respiratory Diseases, University Hospital Gasthuisberg, Leuven, Belgium.

In organ transplant recipients there remains controversy whether cutaneous cryptococcal infection represents a primary infection or a manifestation of disseminated cryptococcosis. We describe a lung transplant patient who developed primary cryptococcal cellulitis in the immediate post-operative period. At presentation, disseminated disease was excluded. The patient was treated with liposomal amphotericin B and fluconazole and, in addition, a surgical debridement was performed. Shortly afterwards, computed tomography revealed dissemination to the brain. The patient died of cerebral edema. As there was no involvement of the central nervous system at presentation, we believe that cryptococcal cellulitis was the primary site of infection and origin of dissemination. In this study we review cryptococcosis, which should always be considered in the differential diagnosis of cellulitis in transplant recipients.

PMID: 17346632 [PubMed - in process]

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Tuesday, March 06, 2007

Streptococcus pneumoniae cellulitis in a diabetic patient

Streptococcus pneumoniae cellulitis in a diabetic patient
Med Mal Infect. 2007 Feb 28

Bouzat P,
Broux C,
Soriano E,
Pavese P,
Croize J,
Stahl JP,
Jacquot C.
Service de reanimation chirurgicale, departement d'anesthesie et de reanimation-I, CHU de Grenoble, BP 217 X, 38043 Grenoble cedex, France.

Pneumococcal cellulitis is an uncommon infection. Head, neck, and trunk are usually affected in patients with hematological malignancies and lupus erythematosus. Limb cellulitis is frequently observed in patients with diabetes mellitus, drug abusers, or alcoholics. Patients present with septic shock most of the time. Surgical treatment is necessary in 50% of the cases. The outcome is usually favorable. We describe the case of a 72-year-old alcoholic patient with diabetes mellitus presenting with cellulitis and septic shock.

Serotype 19 Streptococcus pneumoniae with abnormal susceptibility to penicillin (MIC: 0.75 mg/l) was isolated from cellulitis and in blood culture. The evolution was favorable after itavenous antibiotherapy combining ceftriaxone(DCI) (2 g/j), metronidazole(DCI) (1 g/j), and ciprofloxacin(DCI).

PMID: 17336015 [PubMed - as supplied by publisher]

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