Tuesday, October 20, 2009

Florid osseous dysplasia: report of a case presenting acute cellulitis.

Florid osseous dysplasia: report of a case
presenting acute cellulitis

Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany. poramate.pitakarnnop@gmail.com

In this review, we examined a 45-year-old Asian man who had been diagnosed with florid osseous dysplasia (FOD) of the mandible and acute perimandibular cellulitis. This presentation occurred after a history of off-and-on swellings of the jaw and multiple treatments received at another hospital. An aggressive resection of the jaw was planned; however, the patient denied the treatment and came to our clinic to seek a second opinion. The patient was successfully treated by conservative surgery and antibiotic treatment with preservation of the jaw integrity and the mandibular neurovascular canal. Intraoperatively, a piece of a calcified mass was removed and submitted for histopathological examination. The specimen showed woven bone and densely sclerotic mass of calcified materials exhibiting reversal lines and inflammatory cell infiltration of the connective tissue. The definitive diagnosis was FOD with a secondary infection. Treatments for FOD were discussed.

Full Text: Med Oral Patol Oral

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Campylobacter fetus cellulitis in an immunocompromised patient: case report and review of the literature.

Campylobacter fetus cellulitis in an immunocompromised patient:
case report and review of the literature

Acta Clin Belg. 2009 Jul-Au

Department of internal medicine, infectious and tropical diseases, Saint Luc University hospital, Bruxelles.

Campylobacter fetus is an opportunist Gram-negative bacillus. The most frequent clinical manifestation is bacteriemia but it can also be responsable for soft tissue infections, endovascular infections, meningitis, peritonitis and thrombophlebitis. Campylobacter fetus cellulitis has been described, but rarely identified in subcutaneous puncture samples. We report a case of an immunocompromised patient with Campylobacter fetus bacteriemia associated with a soft tissue infection whose subcutaneous puncture also revealed the bacteria.

PMID: 19810424 [PubMed - in process]

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Sunday, October 11, 2009

How Cracked heels can let killer bacteria invade your body

How Cracked heels can let killer bacteria
invade your body

Last updated at 10:20 AM on 06th October

One night as Chris Banting was undressing for bed, he was surprised

when his wife Helen pointed out to him that the back of his right calf was

a worrying scarlet colour.

'It was strange because I wasn't in any discomfort at all,' says Chris, 62.

'If you have an infection, you think you'd be in pain or running a temperature,

but I felt fine.'

It was November 2007 and the busiest time of the year in his job as a charity

fundraising manager, but he decided it was something he should get checked


In fact, Chris was suffering from cellulitis - a serious bacterial infection of the


Left untreated, the bacteria can spread through the body and cause potentially

fatal blood poisoning or an infection of the muscle, bone or heart valve.

Around 70,000 people are hospitalised with it every year.

Cellulitis - not to be confused with cellulite - affects the deep layer of skin

known as the dermis, and sometimes the layer of fat and soft tissues beneath.

Initially, it causes the skin to become sore, red and swollen.

Though it commonly affects the lower legs, it can occur on any part of the body.

Dr Nick Lowe, consultant dermatologist and spokesperson for the

British Skin Foundation, explains that we all have bacteria living on our skin.

Usually this doesn't cause any harm, but if the skin is damaged by an ulcer, cut,

graze or insect bite, or even if it is simply cracked through conditions such as

eczema, the bacteria can get in, causing an infection.

Nail infections or ingrown toenails can also be a source.

'When this happens, the infected area becomes inflamed, tender, red and

often hot,' says Dr Lowe.

'It may also blister. The infection is usually accompanied by symptoms of feeling

generally unwell, including fever and nausea.'

Those with weakened immune systems are particularly vulnerable, as their bodies

lack the strength to fight off the infection.

Other risk factors include diabetes, as it often causes poor blood supply to the skin,

which may lead to ulcers that can serve as an entry point for bacteria.

Athlete's foot can also make you more prone to cellulitis, as this may cause the skin to


A severe case of cracked heels could make you more vulnerable, too. As can

lymphedema - a condition that causes swelling in a part of the body because of fluid

build-up under the skin.

However, cellulitis can occur without a wound, when bacteria enters through

the lymphatic system.

The speed at which the symptoms manifest themselves depends on the

health of the infected patient.

'In a very healthy person, symptoms may take up to a week to appear,' says Dr Lowe.

'But in the elderly or those with weakened immune systems, symptoms can come

on rapidly, in just a day or two.

'This is why prompt diagnosis-and treatment with antibiotics is vital, before the

infection spreads.'

When Chris Banting discovered the angry rash on his leg, he made an appointment

at an out- of-hours clinic near his home in .

The doctor diagnosed cellulitis and gave Chris a prescription for antibiotics.

'He told me the most likely point of entry for the bacteria that had caused

my cellulitis had been cracks on the soles of my feet,' says Chris.

'I'd had athlete's foot since I was a teenager, and on top of a recent attack, which I'd

been treating with an anti-fungal cream, had developed a secondary fungal

infection that had caused the cracks.

'I'd heard cellulitis can potentially kill you, but that didn't even enter my head

then. My wife had been through the same thing, and although she'd spent a week

in hospital, she'd been cured, so I thought I'd take the antibiotics and I'd be fine.'

Generally, a course of antibiotics is enough to clear up the infection, but despite

the prompt diagnosis, his symptoms got progressively worse.

Just two days later, he had developed a huge blister on his right calf, around

one-and-a-half inches deep and the diameter of a grapefruit.

'I'd never seen anything like it,' says Chris. 'It seemed to have come out of


'Worse still, the stuff leaking out of it looked like some kind of machine oil.

It was revolting!'

Chris went straight to his GP, who took one look at his leg and told him he

needed to go to hospital.

'She explained the infection had gone beyond the stage when oral

antibiotics would help, and that I'd need to be admitted for intravenous

antibiotics,' he says.

'It was all rather dramatic and happened very quickly.'

Chris was admitted to the Bristol Royal Infirmary.

'One of the first things the doctors did was to draw on my leg with a

marker pen around the outline of the infected skin, so they could keep

track of whether it was spreading or not,' says Chris.

'It would seem it can spread rapidly in some instances - but luckily mine

stayed roughly the same.'

Thankfully, within a couple of days, Chris's infection began to dwindle

(his athlete's foot was also effectively treated).

He remained in hospital for a week and was then released to the care

of his GP surgery, where he went daily for ten days to have his dressings


Now the only lasting sign he ever suffered from cellulitis is a patch of

discoloured skin extending from behind the knee to the ankle bone.

Though he's recovered, Chris could well suffer a recurrence. Around

one-third of people develop cellulitis again within three years.

'Once you've had cellulitis, you're more likely to get it again - and in

the same area,' says Dr Lowe.

'This is because the infection can damage the lymph channels in the

area, so they become less efficient at filtering out germs.

Therefore, you need to be scrupulous about skin cleansing and keeping

your skin moisturised, to prevent it drying out and cracking.'

Meanwhile, Chris is thankful for the first-class treatment he received -

and to his wife for spotting the symptoms in the first place.

'If she hadn't, goodness knows what could have happened,' he says.

Mail Online

For additional information:


Complications of Cellulitis and Lymphangitis

Prevention of Cellulitis

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What is Cellulitis?

What is Cellulitis?

Written by Amanda Wattson, MD
Saturday, 10 October 2009

Cellulitis is an infection of the skin and the layer of tissue under the skin.

What is going on in the body?

Cellulitis most often develops on the legs but can be seen on the face and on any other skin
on the body. It tends to affect a fairly large area of skin. Cellulitis is usually due to an infection
of the skin with bacteria, but it may also be caused by a fungus.

What are the causes and risks of the infection?

Cellulitis is usually caused by a break in the skin that becomes infected with bacteria or
fungi. It can occur in wounds caused by injury and in surgical wounds. It can also occur when
there is no obvious break in the skin.

Risk factors for cellulitis include the following:

- recent surgery
- diabetes
recent chickenpox infection
-immunodeficiency disorder, in which the body's infection-fighting mechanisms are impaired.
People with AIDS, for example, have a significant risk of cellulitis.
- impaired circulation, such as peripheral arterial disease, which limits blood flow to the legs
and arms.
- chronic use of steroids

What are the treatments for the infection?

For mild, superficial infections, oral antibiotics, such as cephalexin or dicloxacillin, are often
used. Over-the-counter pain medication, such as ibuprofen or acetaminophen, can be used
as needed to relieve discomfort. For more severe infections, individuals may need intravenous
(IV) antibiotics, such as oxacillin or nafcillin.

Cellulitis may get worse even with treatment, especially in people with diabetes. In these
cases, more aggressive treatment may be needed. This may include surgery to remove dead
skin or even bone.

What are the side effects of the treatments?

Antibiotics and over-the-counter pain medications may cause upset stomach, rash, or allergic
reactions. Surgery may cause bleeding, new infections, or allergic reaction to anesthesia.

What happens after treatment for the infection?

In most cases, cellulitis goes away after treatment. If treatment is successful, people can
usually return to normal activities.

How is the infection monitored?

The healthcare provider will examine the area of cellulitis regularly to assess healing. In
some cases, special X-ray tests may be used if a deeper infection is suspected. Any new
or worsening symptoms should be reported to the healthcare provider.

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Staphylococcus aureus is the most common identified cause of cellulitis: a systematic review

Staphylococcus aureus is the most common
identified cause of cellulitis: a systematic review

Epidemiol Infect. 2009 Aug 3

Alpert Medical School at Brown University, Providence, RI, USA.


c1 Author for correspondence: L. G. Miller, M.D., M.P.H., Division of Infectious Diseases, Harbor–UCLA Medical Center, 1000 W Carson St, Bin 466, Torrance, CA 90509, USA. (Email: lgmiller@ucla.edu)


We utilized Medline to perform a systematic review of the literature to quantify the aetiology of cellulitis with intact skin. Of 808 patients with cellulitis, 127-129 (15.7-16.0%) patients had positive needle aspiration and/or punch biopsy cultures from intact skin. Of the patients with positive cultures, 65 (50.4-51.2%) had cultures positive for Staphylococcus aureus, 35 (27.1-27.6%) for group A streptococcus, and 35-37 (27.1-29.1%) for other pathogens. The most common aetiology of cellulitis with intact skin, when it can be determined, is S. aureus, outnumbering group A streptococcus by a ratio of nearly 2:1. Given the increasing incidence of community-associated methicillin-resistant S. aureus infections, our findings may have critical therapeutic implications.


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