1/29. Botfly infestation (myiasis) masquerading as furunculosis. With air travel so prevalent, diseases endemic to certain regions may appear anywhere. The botfly (Dermatobia hominis) is not native to north america. We describe a case of a young boy and his father who presented with furunculosis secondary to infestation with the botfly. The infected patients live in South florida and had been vacationing in central america. Standard surgical treatment as well as multiple native remedies are described. ( info) |
2/29. breast milk transmission of a Panton-Valentine leukocidin-producing staphylococcus aureus strain causing infantile pneumonia. We report on a 38-day-old infant who developed pleuropneumonia due to a staphylococcus aureus strain responsible for familial furunculosis, which was acquired by maternal breast-feeding. All isolates from the infant and parents were genetically related by randomly amplified polymorphic dna analysis and produced Panton-Valentine leukocidin. ( info) |
3/29. Repeated furunculosis in adult male with abnormal neutrophil activity. A 21 years old male suffered from repeated furunculosis in different regions of the body over the last two years. This coincided with the start of professional activities in hospital surroundings. The purulent secretions all showed growth of staphylococcus aureus. All laboratory tests were normal except for a decrease of the neutrophil phagocytic ingestion phase. Before the diagnosis of defective phagocytosis was made, antibiotic treatment was started about 4 to 5 days after the appearance of the infectious process and the furunculosis led to abscess formation with difficult healing and cellulitis. After the diagnosis of defective phagocytosis ingestion phase, personal hygiene was intensified during and after work shifts at the hospital and antibiotic treatment was started at the first signs of folliculitis, which showed healing. ( info) |
4/29. Multiple bilateral orbital abscesses secondary to nasal furunculosis. Orbital inflammation secondary to sinus inflammation is a well known entity and has been widely reported. However, nasal furunculosis resulting in orbital inflammation is a rare occurrence. We present a case of a 2-year-old boy who developed multiple bilateral orbital abscesses secondary to nasal furunculosis. To our knowledge such a case has not been reported before. ( info) |
5/29. Furuncular myiasis. We saw two cases of cutaneous myiasis from the larvae of the botfly, Dermatobia hominis. The first patient acquired the disease in brazil, the second in guatemala. The appearance is quite similar to furunculosis, but is not responsive to antibiotic therapy. Surgical excision is the treatment of choice. ( info) |
6/29. Furuncular myiasis: a simple and rapid method for extraction of intact Dermatobia hominis larvae. We report a case of furuncular myiasis complicated by staphylococcus aureus infection and beta-hemolytic streptococcal cellulitis. The Dermatobia hominis larva that caused this lesion could not be extracted using standard methods, including suffocation and application of lateral pressure, and surgery was contraindicated because of cellulitis. The botfly maggot was completely and rapidly extracted with an inexpensive, disposable, commercial venom extractor. ( info) |
| common variable immunodeficiency (CVID) is the most prevalent of the primary immunodeficiencies, and is characterised by low IgG and IgA, and sometimes IgM. There is some evidence of genetic susceptibility, with 20% of patients having a dominantly inherited disorder with variable expression. It is a heterogeneous disorder with protean manifestations, and as a result diagnosis is often delayed until the second or third decade, with resultant irreversible organ damage, in particular bronchiectasis. Effective treatment is available with regular 3-4-weekly infusions of immunoglobulin. The mechanism of the immunodeficiency has not yet been fully elucidated. The majority of patients present with recurrent sinopulmonary infection, however, this is a multisystem disorder and thus presents to physicians in diverse specialties including dermatology. Other clinical features of the disorder include gastrointestinal problems, granulomatous inflammation, cutaneous features, unusual presentations of enteroviral and mycoplasma infection, an increased incidence of autoimmunity, and a predisposition to lymphoma and stomach cancer. Therefore a knowledge of the disorder and appropriate suspicion by all clinicians of the possibility of such rare problems and a consequent low threshold for performing relevant investigations is imperative in allowing early recognition and instituting effective treatment. We describe a case of CVID identified when the patient developed widespread skin infection, fever and malaise. This case is an important example of a possible presentation of CVID within the dermatology clinic and demonstrates that maintaining a high level of clinical suspicion is essential for the diagnosis of the rare primary immunodeficiencies. ( info) |
8/29. Rapidly growing mycobacterial infections after pedicures. BACKGROUND: Rapidly growing mycobacteria (RGM) can cause a variety of cutaneous and systemic diseases. The causative organisms are typically mycobacterium fortuitum or mycobacterium chelonae (also known as Mycobacterium abscessus). Primary cutaneous lesions may develop after a variable latent period, from weeks to several months, and usually result from direct inoculation after trauma, from injections, or during surgery via contaminated medical instruments. Recently, investigators from the Centers for disease Control and Prevention, Atlanta, Ga, and the california Department of health services, Berkeley, documented a large, unprecedented outbreak of community-acquired RGM infection, during which more than 100 patrons of a northern california nail salon contracted furunculosis in their legs as a result of exposure to whirlpool footbaths that were contaminated with M fortuitum. OBSERVATIONS: We report the clinical and epidemiological findings in 3 cases of lower extremity RGM infections that occurred after similar whirlpool footbath exposure at several different nail salons in southern california. These infections typically presented as recurrent furunculosis, causing considerable morbidity as a result of scarring, delayed diagnosis, and the need for long-term polymicrobial therapy. CONCLUSIONS: Rapidly growing mycobacterial infections related to pedicures may continue to occur in a sporadic fashion. Clinicians should consider the possibility of RGM infection and inquire about recent pedicures in a patient with recurrent lower extremity furunculosis and abscesses that are unresponsive to conventional antibiotic therapy. ( info) |
9/29. Intractable chronic furunculosis: prevention of recurrences with pentoxifylline. A 60-year-old hiv-negative man with known noninsulin-dependent diabetes mellitus and glucose 6-phosphate-dehydrogenase deficiency anemia suffered from chronic recurrent furunculosis since the age of 30. In recent years, his condition had become increasingly severe and the recurrences increasingly frequent. Different measures including continuous therapy with large doses of systemic antibiotics for a period of 6 months failed to prevent the recurrences. Oral treatment with pentoxifylline 400 mg t.i.d. was prescribed, and 2 months later the patient experienced a dramatic and complete remission of his furunculosis. Six months later he was still totally free of lesions while continuing to take the same medication. pentoxifylline may provide a new and effective approach to the previously difficult and often disappointing problem of the management of patients with chronic recurrent furunculosis. ( info) |
10/29. furunculosis due to Mycobacterium mageritense associated with footbaths at a nail salon. We report two cases of lower-extremity furunculosis caused by Mycobacterium mageritense. Both patients were patrons of the same nail salon, where they received footbaths prior to pedicures. M. mageritense bacteria isolated from two whirlpool footbaths were determined to be closely related to the patient isolates by pulsed-field gel electrophoresis. ( info) |