Sunday, June 29, 2008

Two Cases of Cellulitis in the Course of African Tick Bite Fever: A Fortuitous Association?

Two Cases of Cellulitis in the Course of African Tick Bite Fever: A Fortuitous Association?
Dermatology. 2008 May
Bouvresse S, Del Giudice P, Franck N, Buffet M, Avril MF, Mondain V, Rolain JM, Raoult D, Dupin N.
Department of Dermatology, Tarnier-Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris V, Université René Descartes, Paris, France.

In African tick bite fever (ATBF), inoculation eschar - resulting from disruption of the cutaneous barrier - may be a risk factor for cellulitis. We report 2 cases of ATBF associated with cellulitis. A 77-year-old woman was referred for severe leg cellulitis upon returning from sub-Saharan Africa. She developed erythematous macules. Rickettsia africae was detected by PCR assay from a skin biopsy specimen, and ATBF diagnosis was confirmed. A 75-year-old man was hospitalized after his return from Zimbabwe for a maculopapular exanthema and erysipelas-like rash of the leg. The diagnosis of cellulitis associated with ATBF was confirmed by PCR and serological methods. Both patients were treated for ATBF and cellulitis by a combination of doxycycline and beta-lactam antibiotics, and both had a good recovery. Inoculation eschar may be a risk factor for cellulitis; thus, we hypothesize a non-fortuitous association between ATBF and cellulitis.



Friday, June 27, 2008

Clindamycin-resistant Clostridium perfringens cellulitis

Clindamycin-resistant Clostridium perfringens cellulitis

J Tissue Viability. 2008 Jun 14.

Khanna N.
Department of Microbiology, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, United Kingdom.

Clostridium perfringens is responsible for a number of clinical conditions ranging from relatively mild food poisoning to the potentially life-threatening gas gangrene. Fortunately, C. perfringens has remained relatively susceptible to first line antibiotics in the treatment of soft tissue infection, however, the prevalence of antibiotic resistance is increasing amongst other anaerobic organisms. A case of anaerobic cellulitis caused by a clindamycin-resistant C. perfringens is described here, emphasising the emerging problem of antimicrobial resistance.

Elsevier ScienceDirect


Tuesday, June 10, 2008

Spontaneous Onset of Bacterial Cellulitis in Lower Limbs with Chronic Obstructive Venous Disease.

Spontaneous Onset of Bacterial Cellulitis in Lower Limbs with Chronic Obstructive Venous Disease.

Eur J Vasc Endovasc Surg. 2008 Jun

Raju S, Tackett P Jr, Neglen P.
University of Mississippi Medical Center and River Oaks Hospital, Flowood, MS 39232, USA.

BACKGROUND: Cellulitis, often recurrent is a common complication of severe chronic venous disease (CVD) when dermatitis or ulcer is present. The skin breakdown obviously provides easy entry for bacteria but other factors such as edema and lymphatic dysfunction likely play a role in pathogenesis as well. An iliac obstructive lesion is commonly present and correction with stent(s) often heals dermatitis/ulcer and relieves cellulitis. The current manuscript focuses on a relatively infrequent "spontaneous" variety of cellulitis which also occurs in obstructive venous disease in the absence of overt skin breakdown. Stenting results are of particular interest in this subset because its therapeutic efficacy can be related to factors other than healing of dermatitis/ulceration (portal of entry).

MATERIAL AND METHODS: One thousand and nine limbs underwent iliac vein stenting for symptomatic CVD over a 7 year period; 29 limbs that were stented to treat spontaneous recurrent cellulitis of two or more prior attacks and 16 additional limbs with only one prior episode (stented for other indications) are analysed. Eighty two percent of the limbs had obvious swelling and the remainder had none at the time of stenting when cellulitis was inactive. Iliac vein outflow obstruction was found by intravascular ultrasound (IVUS) and all limbs were stented.

RESULTS: Median age was 54 and male to female ratio 1:2. Aetiology of iliac obstruction was post-thrombotic in 33% and non-thrombotic in 67%. Preoperatively, lymphatic abnormalities were present in 17 (38%) of the limbs: no activity in 7, delayed flow in 8 and pooling of isotope in the lower leg in 2 limbs. Swelling and pain improved significantly after stent placement. Cumulative freedom from recurrent attacks of cellulitis was 76% at 3 years.

CONCLUSION: Iliac vein outflow obstruction may underlie CVD limbs afflicted with cellulitis. IVUS examination is recommended if cellulitis is recurrent and conventional therapy had failed. Correction of outflow obstruction by venous stent placement appears to yield moderate freedom from repeat infections in the near term.

Elsevier Science Direct