Penicillin to prevent recurrent leg cellulitis.

Penicillin to prevent recurrent leg cellulitis.

May 2013

Thomas KS, Crook AM, Nunn AJ, Foster KA, Mason JM, Chalmers JR, Nasr IS, Brindle RJ, English J, Meredith SK,Reynolds NJ, de Berker D, Mortimer PS, Williams HC; U.K. Dermatology Clinical Trials Network's PATCH I Trial Team.

Collaborators (146)

Source

Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, United Kingdom.

Abstract

BACKGROUND:

Cellulitis of the leg is a common bacterial infection of the skin and underlying tissue. We compared prophylactic low-dose penicillin with placebo for the prevention of recurrent cellulitis.

METHODS:

We conducted a double-blind, randomized, controlled trial involving patients with two or more episodes of cellulitis of the leg who were recruited in 28 hospitals in the United Kingdom and Ireland. Randomization was performed according to a computer-generated code, and study medications (penicillin [250 mg twice a day] or placebo for 12 months) were dispensed by a central pharmacy. The primary outcome was the time to a first recurrence. Participants were followed for up to 3 years. Because the risk of recurrence was not constant over the 3-year period, the primary hypothesis was tested during prophylaxis only.

RESULTS:

A total of 274 patients were recruited. Baseline characteristics were similar in the two groups. The median time to a first recurrence of cellulitis was 626 days in the penicillin group and 532 days in the placebo group. During the prophylaxis phase, 30 of 136 participants in the penicillin group (22%) had a recurrence, as compared with 51 of 138 participants in the placebo group (37%) (hazard ratio, 0.55; 95% confidence interval [CI], 0.35 to 0.86; P=0.01), yielding a number needed to treat to prevent one recurrent cellulitis episode of 5 (95% CI, 4 to 9). During the no-intervention follow-up period, there was no difference between groups in the rate of a first recurrence (27% in both groups). Overall, participants in the penicillin group had fewer repeat episodes than those in the placebo group (119 vs. 164, P=0.02 for trend). There was no significant between-group difference in the number of participants with adverse events (37 in the penicillin group and 48 in the placebo group, P=0.50).

CONCLUSIONS:

In patients with recurrent cellulitis of the leg, penicillin was effective in preventing subsequent attacks during prophylaxis, but the protective effect diminished progressively once drug therapy was stopped. (Funded by Action Medical Research; PATCH I Controlled-Trials.com number, ISRCTN34716921.).

PubMed

http://www.ncbi.nlm.nih.gov/pubmed/23635049 (or)

NEJM

http://www.nejm.org/doi/full/10.1056/NEJMoa1206300

I have not been well as soon as I am I will again be posting 04/10/13

Prevalence of concurrent deep vein thrombosis in patients with lower limb cellulitis: a prospective cohort study.

Mar 2013

Maze MJ, Skea S, Pithie A, Metcalf S, Pearson JF, Chambers ST.

Source

Department of Infectious Diseases, Christchurch Hospital, Christchurch, 8002, New Zealand. Michael.Maze@cdhb.health.nz.

Abstract

BACKGROUND:

Lower limb cellulitis and deep vein thrombosis share clinical features and investigation of patients withcellulitis for concurrent DVT is common. The prevalence of DVT in this group is uncertain. This study aimed to determine the prevalence of deep vein thrombosis (DVT) in patients with lower limb cellulitis and to investigate the utility of applying the Wells algorithm to this patient group.

METHODS: Patients admitted with lower limb cellulitis prospectively underwent a likelihood assessment for DVT using the Wells criteria followed by investigation with D-dimer and ultrasonography of ipsilateral femoral veins as appropriate. Diagnoses of contralateral DVT or pulmonary embolism during admission were recorded.

RESULTS:

200 patients assessed for DVT. 20% of subjects were high risk by Wells criteria. D-dimer was elevated in 74% and 79% underwent insonation of the affected leg. Ipsilateral DVT was found in 1 patient (0.5%) and non-ipsilateral VTE in a further 2 (1%).

CONCLUSIONS:

Deep vein thrombosis rarely occurs concurrently with lower limb cellulitis. The Wells score substantially overestimates the likelihood of DVT due to an overlap of clinical signs. Investigation for DVT in patients with cellulitis is likely to yield few diagnoses and is not warranted in the absence of a hypercoaguable state.

TRIAL REGISTRATION:

ACTRN: 12610000792022 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=320662).

NIH

Fatal neck necrotizing cellulitis in a patient with Riedel's thyroiditis.

Fatal neck necrotizing cellulitis in a patient with Riedel's thyroiditis.

Mar 2013

Dupret-Bories A, Caron PJ, Rouquette I, Vairel B, Vergez S.

Source

CHU Hautepierre, Otolaryngology Head and Neck Surgery, Strasbourg, France ; agnes.dupret@chru-strasbourg.fr.

Abstract

Background: Riedel's thyroiditis (RT) is a rare chronic disease of the thyroid gland. In clinical practice, the first-line treatment is corticosteroids in symptomatic patients and in most cases the prognosis is favourable. Here we report a case of Riedel's thyroiditis with the development of necrotizing cellulitis of the neck after a wedge biopsy and during glucocorticoid treatment 

Patient Findings: An 81-year-old immunocompetent man presented with dysphonia and episodic dyspnea. An enlarged, hard and fixed thyroid mass was palpated and fibroscopic examination revealed a bilateral vocal cord immobility. A wedge biopsy was taken and a tracheotomy was performed. The histopathology was consistent with the diagnosis of Riedel's thyroiditis. The patient underwent a glucocorticoid treatment. After one month, an excavation of the surface of the neck appeared. 

Despite intravenous adapted antibiotic treatment and surgical debridement of the tissue necrosis, we observed a dramatic extension of cervical necrosis to the thorax. The patient died of severe sepsis 15 days after the surgery. 

Summary: In this patient, the diagnosis of Riedel's thyroiditis was made based on the clinical and histological criteria previously reported in the literature. In most cases, Riedel's thyroiditis has a benign course and mortality is extremely rare. Glucocorticoid therapy is usually effective and can lead to long-term remission. Here the patient developed a fatal neck necrotizing cellulitis 1 month after thyroid biopsy and glucocorticoid treatment. 

Conclusion: Massive necrotizing infection of the neck is rare and usually occurs as a complication of traumatic wounds in diabetic patients. We are unaware of similar cases in the literature of fatal neck necrotizing cellulitis in a patient with Riedel's thyroiditis.

Mary Ann Liebert

Genetic susceptibility to non-necrotizing erysipelas/cellulitis.

Genetic susceptibility to non-necrotizing erysipelas/cellulitis.

2013

Hannula-Jouppi K, Massinen S, Siljander T, Mäkelä S, Kivinen K, Leinonen R, Jiao H, Aitos P, Karppelin M, Vuopio J,Syrjänen J, Kere J.

Source

Department of Medical Genetics, University of Helsinki, and Folkhälsan Institute of Genetics, University of Helsinki, Helsinki, Finland.

Abstract

BACKGROUND:

Bacterial non-necrotizing erysipelas and cellulitis are often recurring, diffusely spreading infections of the skin and subcutaneous tissues caused most commonly by streptococci. Host genetic factors influence infection susceptibility but no extensive studies on the genetic determinants of human erysipelas exist.

METHODS:

We performed genome-wide linkage with the 10,000 variant Human Mapping Array (HMA10K) array on 52 Finnish families with multiple erysipelas cases followed by microsatellite fine mapping of suggestive linkage peaks. A scan with the HMA250K array was subsequently performed with a subset of cases and controls.

RESULTS:

Significant linkage was found at 9q34 (nonparametric multipoint linkage score (NPL(all)) 3.84, p = 0.026), which is syntenic to a quantitative trait locus for susceptibility to group A streptococci infections on chromosome 2 in mouse. Sequencing of candidate genes in the 9q34 region did not conclusively associate any to erysipelas/cellulitis susceptibility. Suggestive linkage (NPL(all)>3.0) was found at three loci: 3q22-24, 21q22, and 22q13. A subsequent denser genome scan with the HMA250K array supported the 3q22 locus, in which several SNPs in the promoter of AGTR1 (Angiotensin II receptor type I) suggestively associated with erysipelas/cellulitis susceptibility.

CONCLUSIONS:

Specific host genetic factors may cause erysipelas/cellulitis susceptibility in humans.

PLOS

Serratia marcescens: an unusual pathogen associated with snakebite cellulitis.

Feb 2013 

Subramani P, Narasimhamurthy GB, Ashokan B, Madappa BP.

Source

Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, India. mjchand@gmail.com.

Abstract

This study reports a case of Serratia marcescens cellulitis following a snakebite in a 50-year-old woman. The bite was on the dorsum of the right hand with symptoms of envenomation. She developed swelling and cellulitis with tissue necrosis. Wound debridement was performed.  Pus and tissue biopsy cultures yielded Serratia marcescens sensitive to fluoroquinolones, aminoglycosides, third-generation cephalosporins and carbapenems. The patient responded to anti-snake venom (ASV) therapy, ciprofloxacin, local wound management and recovered uneventfully.

Full Text Article

Journal of Infection in Developing Countries

Innate immune cocktail partially protects broilers against cellulitis and septicemia.

Innate immune cocktail partially protects broilers against cellulitis and septicemia.

2012

Allan B, Buchanan RM, Hauta S, van den Hurk J, Wilson HL.

Source

Vaccine and Infectious Disease Organization (VIDO), International Vaccine Centre (Intervac), University of Saskatchewan, 120 Veterinary Road, Saskatoon, SK, Canada, S7N 5E3.

Abstract

Antimicrobial/host defense peptides (A/HDP) are natural compounds that are found in leucocyte cells and on the skin and bodily fluids of birds, reptiles, and mammals. Not only do they possess antibacterial, antiviral, and antiparasitic characteristics but they also stimulate the host immune system to combat infectious diseases and may play a role in the promotion of wound repair. Gamma-amino butyric acid (GABA) is an amino acid-based inhibitory neurotransmitter in the brain that has also been shown to promote wound healing on skin. The objective of this study was to establish a therapeutic cocktail that protects birds against Escherichia coli-related disease and lesions in broilers. We injected a cocktail of six A/HDPs with or without GABA into 3-wk-old broilers by a subcutaneous or intramuscular route followed 24 hr later by challenge with a field isolate of serogroup O2 E. coli. Birds were examined for 5-6 days post-E. coli challenge and clinical, pathologic, and bacteriologic assessments were conducted. Birds that were subcutaneously injected with an A/HDP plus GABA cocktail had significantly higher survival rates and lower levels of bacteremia (P < 0.05), but a similar percentage of the surviving birds had large cellulitis lesions compared to the surviving phosphate-buffered saline-injected control birds. When this cocktail was administered intramuscularly, there was a trend towards protection against E. coli-related death, although the results were not statistically significant and there was no reduction in bacteremia. A significant number of birds had a reduced bacterial load on cellulitis lesions but no reduction in lesion size, which suggests that when the cocktail was administered intramuscularly it failed to protect against cellulitis. These results suggest that the route of administration of the cocktail influences disease outcome. Gene expression analysis was performed to investigate whether the cocktail induced immunomodulatory functions in avian cells that complemented their antimicrobial and anti-endotoxic effects. A/HDP plus GABA mediated temporal induction of pro-inflammatory cytokines but no induction of any of the chemokines under investigation. This cocktail shows potential to protect against E. coli-related death, which is a major economic burden to the poultry industry.

PubMed

CD56 Negative Extranodal NK/T-cell Lymphoma of the Orbit Mimicking Orbital Cellulitis.

Feb 2013

Pine RR, Clark JD, Sokol JA.

Source

Oculofacial Plastic and Orbital Surgery, KU Eye, University of Kansas , Kansas City, Kansas , USA , and.

Abstract

Introduction: 

To report a case of Extranodal NK/T-cell lymphoma of the orbit mimicking orbital cellulitis. Case Description: A 52-year-old healthy male presented to our institution after 3 months of treatment for sinusitis with antibiotics and steroids. The patient was transferred due to the presence of an "orbital abscess" on CT with orbital signs that not responding to antibiotics. Clinical examination was significant for decreased vision in the affected orbit of 20/50, a trace RAPD OS, elevated IOP of 30 OS, proptosis and grossly decreased motility with diplopia, periorbital edema and chemosis. Dilated funded exam was unremarkable. CT imaging demonstrated a left sided pan-sinusitis, a medial "orbital process" with proptosis and erosion of the cribiform plate. The patient was taken for an emergent orbital exploration for histopathologic diagnosis. Intraorbital and sinus biopsy was consistent with extranodal NK/T-cell lymphoma, with extension into the skull base and left orbital space. The patient was started on radiation therapy followed by chemotherapy. Comments: The authors demonstrate how the acute presentation of an aggressive extranodal NK/T-cell lymphoma can present in a similar fashion as orbital cellulitis. Additionally, the case highlights that a unilateral pansinusitis with involvement of the skull base and orbit is likely due an aggressive malignant process in an immune competent patient.

PubMed