1/7. Cutaneous melioidosis.melioidosis is a rare tropical disease caused by infection with the bacterium burkholderia pseudomallei. It occurs predominantly in south-east asia, northern and central australia and central and south america. patients often present to the internal medicine physicians with a severe, potentially fatal sepsis. We report three patients who presented to our dermatology department with cutaneous melioidosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. FNA diagnosis of primary adult onset lymphocutaneous Langerhans' cell histiocytosis masquerading as deep fungal mycosis.Langerhans' cell histiocytosis (LCH) in its aggressive disseminated form seen most often in children is easily diagnosed by the treating physician. On the contrary, LCH in an adult is localized, extremely rare, and, hence, its diagnosis is missed quite often or underdiagnosed. We describe the troubleshooters encountered in the fine-needle aspiration (FNA) diagnosis of LCH in an adult who presented for 4 years with ulceronodular lesions over the neck, both axillae, and inguinal regions since 4 years of age, which had closely mimicked deep mycosis both clinically and histopathologically.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. A cluster of anthrax cases including meningitis.We report a common-source outbreak of anthrax. The source of infection was the carcass of a cow. Three patients developed anthrax, which affects meninx, skin and larynx. The patient with meningitis died. In all, 20 people who contacted or ate the cooked meat of the dead cow were given prophylactic tetracycline and remained well. This small outbreak calls for the increased awareness of physicians to this clinical entity in locations in which anthrax is endemic and for health education.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. ecthyma gangrenosum and septic shock syndrome secondary to chromobacterium violaceum.chromobacterium violaceum is a gram-negative bacterium of soil and water in tropical and subtropical environments. Typically, it is considered a bacterium of low virulence although, uncommonly, it causes human infection, particularly in persons with defects in host defenses. Infection generally follows exposure of broken skin to contaminated water and soil, and is often characterized by pustules, lymphadenitis, fever, and vomiting, as well as rapid dissemination and a high mortality rate. Unfortunately, because C violaceum is ubiquitous, it is often dismissed as a contaminant when cultured. Because rapid diagnosis (by taking appropriate specimens) and treatment are vital to a good prognosis, it is imperative that physicians be aware of this organism. In addition, patients with chromobacterial infections should have an immunologic workup because infections in immunocompetent individuals are rare. Here we report an aggressive yet nonfatal case of C violaceum septicemia in an adolescent male, diagnosed through a punch biopsy of a skin lesion, and resulting in a new diagnosis of chronic granulomatous disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Retained Hickman catheter cuff as an infection source following allogeneic bone marrow transplant.The case is presented of an infected, retained Hickman catheter cuff in a patient suffering from chronic graft-versus-host disease (GVHD) following allogeneic bone marrow transplantation. This infection seeded to a distant site causing systemic symptoms and requiring inpatient surgical and medical treatment. Although many physicians leave the dacron Hickman cuff in place when removing catheters, the presence of chronic skin changes associated with GVHD may predispose these patients to long-term infectious complications from this retained foreign body. We therefore advocate cuff removal at the time of catheter removal in all transplant patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Primary septicemia caused by vibrio cholerae non-o1 acquired on Cape Cod, massachusetts.We describe a patient with non-O1, non-O139 Vibrio cholerae septicemia associated with hemorrhagic bullous skin lesions of the lower extremities. The patient had underlying liver disease, and he probably acquired the organism through ingestion of raw clams. Although his condition rapidly improved during appropriate therapy, the patient's cellulitis and skin lesions persisted and he developed a fluid collection of the lower extremity that required drainage. Molecular methods were used to examine the non-O1 V. cholerae isolate for several known virulence factors of V. cholerae O1. The isolate failed to express cholera toxin and toxin-coregulated pilus (Tcp) and was negative in Southern hybridizations for ctxB, tcpA, toxR, and toxT. The vast majority of vibrio infections in the United States are clustered in the Gulf Coast area. This patient acquired the infection on Cape Cod. To our knowledge, this is the first case of non-O1 V. cholerae septicemia reported to have occurred in massachusetts. Given the high fatality rate of this infection, it is important for physicians to consider this diagnosis in patients who have underlying risk factors and appropriate epidemiologic exposures, even when they reside as far north as the new england states.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. eikenella corrodens infections. Case report in two adolescent females with IDDM.OBJECTIVE: To alert physicians caring for patients with diabetes to the microorganism eikenella corrodens and to discuss the appropriate preventive and therapeutic measures to take against this potentially morbid opportunistic Gram-negative bacilli. CASES: We present two cases of extra-oral E. corrodens infections in adolescent females with IDDM. The first patient had diabetes of 4 years' duration, which was moderately well controlled. Chronic finger biting resulted in a complex felon that evolved gradually and worsened while the patient received cephalexin orally. Delay in seeking further intervention resulted in necrosis of her distal fingertip and nail bed. The second patient had poorly controlled diabetes for 5 years. She developed an acute thigh abscess at an insulin injection site that resolved after drainage and intravenous antibiotics. CONCLUSIONS: E. corrodens commonly inhabits the human oral cavity and becomes a pathogen mostly when host defenses are impaired, causing abscesses and infections that are at times fatal. patients with IDDM are compromised hosts and with daily microtrauma to their skin via glucose monitoring and insulin injections, are prone to develop E. corrodens infections that can be introduced through oral secretions by licking or biting their skin. Educational efforts aimed at preventing exposure of traumatized skin to oral secretions can minimize the risk of E. corrodens infections in compromised hosts. Early intravenous administration of antibiotics, bearing in mind E. corrodens resistance to clindamycin, metronidazole, and other antibiotics, coupled with prompt surgical intervention, is essential in successfully managing E. corrodens infections.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |