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1/4. Perianal mass and recurrent cellulitis due to enterobius vermicularis.

    A unique case of enterobiasis presenting as recurrent cellulitis and a perianal mass in a six-year-old girl is reported. Complicated perianal lesions due to enterobius are unusual. Only 10 previous cases are known, with unclear pathogenesis in most of them, although mucosal breaches and perianal crypt or gland entry have been postulated. The association of the mass in this case with a deep crypt, and the histopathologic finding of squamous epithelium focally surrounding the granulomatous reaction to the enterobius eggs suggest that the worm entered the perianal tissues via a crypt. Local secondary bacterial infection can cause significant morbidity. Surgical excision of such granulomatous mass lesions is necessary in symptomatic or complicated cases.
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ranking = 1
keywords = bacterial infection
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2/4. actinomyces as a cause of recurrent perianal fistula in the immunocompromised patient.

    actinomycosis is an uncommon bacterial infection that has a characteristic chronic indolent course. patients with this infection frequently undergo multiple surgical procedures before a correct diagnosis is made. Perianal actinomycosis should be suspected if a nontender perianal mass is found to contain thin purulent material and small yellow particles (sulfur granules). The diagnosis is confirmed by special stains and anaerobic cultures. Recognition of this infection is important because successful treatment requires combined surgical and antibiotic therapy. We report two patients, one with diabetes mellitus and one with human immunodeficiency virus III, who had recurrent perianal abscesses caused by actinomyces and were treated successfully with surgical drainage and antimicrobial therapy.
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ranking = 1
keywords = bacterial infection
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3/4. Bacterial infection as a presenting manifestation of visceral leishmaniasis.

    Two patients admitted to the hospital because of severe bacterial infection were diagnosed as having visceral leishmaniasis. The types of bacterial infection were perianal abscess and pneumonia; escherichia coli and streptococcus pneumoniae were isolated from exudates and blood cultures, respectively. A third patient admitted because of acute necrotizing infection of the pharynx and visceral leishmaniasis is also discussed. Cultures from this patient failed to yield pathogens. anemia, leukopenia, or thrombocytopenia was present in all patients, and bone marrow aspirate revealed the presence of Leishmania in macrophages. We conclude that in areas where leishmaniasis is endemic, early bone marrow aspirate should, in most instances, be performed in patients with bacterial infection associated with anemia, leukopenia, or thrombocytopenia if hepatomegaly and/or splenomegaly is present.
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ranking = 3
keywords = bacterial infection
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4/4. Perirectal and perineal infections in end-stage renal disease patients.

    Eight patients with end-stage renal disease (ESRD) who developed bacterial infection of the perirectal area or perineum are reported. The diagnosis was not always straightforward. bacteremia was seen in 3 of 8 patients and one of these died. Careful examination of the anus, rectum, and perineum should be mandatory in ESRD patients with undiagnosed fever. Treatment consisted of extensive surgical debridement and drainage along with antimicrobial therapy.
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ranking = 1
keywords = bacterial infection
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