Concurrence of Stevens-Johnson Syndrome and Bilateral Parotitis after Minocycline Therapy

Minocycline is an antibiotic of tetracycline derivatives that is commonly used in the treatment of moderate to severe acne vulgaris. It has been reported to cause rare adverse events from mild cutaneous eruption to severe forms including drug-induced lupus, serum sickness-like reaction, and hypersensitivity reactions, etc. The risks of adverse events attributed to minocycline have not been ascertained reliably and there are concerns about the safety of minocycline which could possibly result in life-threatening events such as the Stevens-Johnson syndrome. Here we demonstrate an unusual case of Stevens-Johnson syndrome in conjunction with bilateral parotitis after the intake of minocycline in a Korean boy suggesting discreet use of the drug

Infections with rapidly growing mycobacteria: report of 20 cases

AbstractObjectives: A series of cases infected with rapidly growing mycobacteria was studied to determine the spectrum of disease, antimicrobial susceptibility, treatment, and outcome.Methods: The cases identified as infections with rapidly growing mycobacteria in Ramathibodi Hospital from January 1993 to December 1999 were retrospectively studied.Results: Most of the cases had no underlying disease. Only two cases were HIV-infected patients. The presenting clinical features were lymphadenitis (seven cases), skin and/or subcutaneous abscess (seven cases), localized eye infection (four cases), pulmonary infection (one case), and chronic otitis media (one case). Four of seven cases with lymphadenitis had Sweet's syndrome, and one had psoriasis as an associated skin manifestation. Anemia was present in five cases, and improved with treatment of the primary disease. The organisms were Mycobacterium chelonae/abscessus group (17 cases) and Mycobacterium fortuitum group (three cases). Susceptibility patterns of the organisms showed susceptibility to amikacin, netilmicin, and imipenem. M. fortuitum group was susceptible to more antibiotics than M. chelonae/abscessus group. The clinical responses corresponded to the antimicrobial susceptibility. Combinations of two or more drugs were used for the medical treatment. Surgical resection was performed where possible, to reduce the load of the organism, especially in cases with very resistant organisms.Conclusions: Infections with rapidly growing mycobacteria can occur in apparently normal hosts. The clinical syndrome is variable. The pathology is nonspecific. Clinical responses varied, but seemed to correlate with the in vitro susceptibility result. More studies are needed to enable us to deal with this infection effectively

The epidemiology of melioidosis and its association with diabetes mellitus : a systematic review and meta-analysis

Melioidosis is an under-recognized fatal disease in humans, caused by the Gram-negative bacterium Burkholderia pseudomallei. Globally, more than 35,000 human melioidosis cases have been reported since 1911. Soil acts as the natural reservoir of B. pseudomallei. Humans may become infected by this pathogen through direct contact with contaminated soil and/or water. Melioidosis commonly occurs in patients with diabetes mellitus, who increase the occurrence of melioidosis in a population. We carried out a systematic review and meta-analysis to investigate to what extent diabetes mellitus affects the patient in getting melioidosis. We selected 39 articles for meta-analysis. This extensive review also provided the latest updates on the global distribution, clinical manifestation, preexisting underlying diseases, and risk factors of melioidosis. Diabetes mellitus was identified as the predominant predisposing factor for melioidosis in humans. The overall proportion of melioidosis cases having diabetes was 45.68% (95% CI: 44.8–46.57, p < 0.001). Patients with diabetes mellitus were three times more likely to develop melioidosis than patients with no diabetes (RR 3.40, 95% CI: 2.92–3.87, p < 0.001). The other potential risk factors included old age, exposure to soil and water, preexisting underlying diseases (chronic kidney disease, lung disease, heart disease, and thalassemia), and agricultural activities. Evidence-based clinical practice guidelines for melioidosis in patients with diabetes mellitus may be developed and shared with healthcare professionals of melioidosis endemic countries to reduce morbidity. © 2022 by the authors. Licensee MDPI, Basel, Switzerland

Lymphoid proliferation of the parotid gland in paediatric patients with HIV infection

MDent, Faculty of Health Sciences, Universiyt of the WitwatersrandIntroduction: HIV associated parotid lymphoepithelial lesions in children are not well documented. Most studies have concentrated on the adult population. Objectives: The present study aimed to document the disease, its risk factors and anti-retroviral treatment outcome in children. Materials and methods: The study was conducted at 2 HIV and AIDS facilities weekly over a 6 month period. “Parotid swellings” in children below 13 years were analysed. A retrospective medical chart review was conducted. Results: Seventy-one children were included; 47 with swelling (Group 1) and 24 without swelling (Group 2). Thirty-nine had parotid swelling of 1or both glands, 6 had submandibular and parotid swelling and 2 with only submandibular swelling. Twenty-six children in Group 1 were receiving HAART, 19 reported a reduction in size of lesion, 6 reported no effect and only 1 had the lesion after 11 months of HAART. Conclusion: Parotid lymphoid proliferation in children is more common than previously reported. The prevalence of this lesion could not be determined as not all children with parotid swelling presenting at the clinics were included in the study. Children with lower viral loads showed an increased risk of developing parotid lymphoid proliferation. The parotid lesions responded well to HAART but did not completely resolve

Acute scrotum: differential diagnosis and treatment

Acute scrotum (AS) is a clinical syndrome characterized by scrotal pain of acute onset, often accompanied by scrotal swelling and other local and systemic signs and symptoms. It may be the initial presentation of several diseases including testicular torsion, orchitis, epididymitis, hydatid torsion, strangulated hernia and, less frequently, scrotal hematoma and testicular tumor. In the setting of emergency services, physicians should be extremely careful with the possibility of testicular torsion. This condition consists in the torsion of the spermatic cord, leading to an interruption of the testicular blood flow, with ischemia and ultimately necrosis. It is associated with acute severe pain, nausea, absence of the cremasteric reflex, and a high-riding testis. Physical examination may help diagnosis. However, a color Doppler ultrasound of the scrotum is usually required for a definitive diagnosis. Ultrasound will reveal a reduction or no blood flow to the affected testis; surgical treatment is mandatory and should be performed as early as possible. A differential diagnosis is orchiepididymitis. It may be of viral etiology in early childhood and bacterial after the beginning of sexual activity. The most specific sign associated with this condition is the relief of pain after elevation of the testis, known as Prehn’s sign. Treatment for bacterial cases requires antibiotics, while cases of viral etiology require only symptomatics. Hydatid torsion, including torsion of appendix testicularis and appendix epididymis may mimic testicular torsion but on ultrasound, blood flow is preserved, and a twisted appendix is often seen. Treatment for this condition consists only in symptomatic control. Testicular torsion should be treated as early as possible, since a delay of 6 hours may result in organ loss. Surgery consists of bilateral orchiopexy in case of a viable testicle and orchiectomy of a necrotic organ, always with fixation of the contralateral testicle.Escroto agudo (EA) é uma síndrome caracterizada por dor escrotal aguda, frequentemente acompanhada por edema escrotal e outros sinais e sintomas locais e sistêmicos. EA pode ser a apresentação inicial de diversas doenças, incluindo torção testicular, orquite, epididimite, torção de hidátide, hérnia inguinal estrangulada e, menos frequentemente, hematoma escrotal e tumor testicular. No contexto de serviços de urgência, o examinador deve ser cauteloso quanto à possibilidade de torção testicular. Essa condição consiste na torção do cordão espermático, levando a interrupção de fluxo sanguíneo, com isquemia e finalmente necrose tecidual. Torção testicular está associada a dor intensa, náusea, alteração do reflexo cremastérico e elevação do testículo, sendo essas variáveis identificadas na história e no exame físico. No entanto, a ultrassonografia escrotal com Doppler frequentemente é necessária para complementação diagnóstica. O exame de ultrassom revela redução ou parada do fluxo sanguíneo para o testículo afetado; nesses casos, o tratamento cirúrgico está indicado e deve ser instituído com a maior brevidade possível, já que um atraso superior a 6 horas pode resultar em perda do órgão. A cirurgia consiste em orquidopexia bilateral em caso de testículo viável; nos casos em que o testículo sofre necrose, este deve ser removido, porém o testículo contralateral deve ser fixado para prevenir novos episódios. Um diagnóstico diferencial da torção tesiticular é a orquiepididimite, que pode ser de etiologia viral na infância e frequentemente bacteriana após o início da atividade sexual. O sinal mais específico para o diagnóstico de orquiepididimite é o alívio da dor com a elevação manual do testículo, conhecido como sinal de Prehn. O tratamento da doença bacteriana requer antibióticos, enquanto os casos de etiologia viral requerem somente sintomáticos. A torção de hidátide, que inclui torção do apêndice testicular ou do apêndice epididimal, pode simular o quadro clínico da torção testicular, porém ao ultrassom com Doppler, o fluxo sanguíneo está preservado e um apêndice torcido frequentemente é encontrado. O tratamento para essa condição requer somente controle sintomático

Sexually Transmitted Diseases (STDs)

High rates of unprotected sexual behavior in adolescents result in millions of cases of STDs in the world. This chapter reviews factors inducing high STD rates, specific STDs, and their management based on 2010 U.S. Centers for Disease Control and Prevention (CDC) STD guidelines. Clinicians should screen all their sexually active adolescent patients for STDs and provide preventive education as well as treatment measures

Determinants of Recurrent Melioidosis

Recurrent melioidosis represents relapse following failure to eradicate bacteria responsible for the primary infection or re-infection with a new strain. The first results chapter (chapter 3) evaluates the proportion of recurrent melioidosis due to relapse versus re-infection. Isolates from the same patient with an identical genotype were considered as relapse and those with a different genotype as re-infection. Three quarters of recurrent cases were due to relapse and one quarter were due to re-infection. There are two ways in which this approach could be confounded. First, ‘re-infection’ could actually represent relapse if primary infection was caused by simultaneous infection with multiple B. pseudomallei strains, followed by chance selection of different strains from the two episodes for genotyping. The chance of this mistake occurring is based on the rate of polyclonal B. pseudomallei infection. Chapter 4 describes the rate of polyclonal infection in a large group of unselected patients in northeast Thailand, which was very low (2/133 cases, 1.5%). Second, ‘relapse’ could actually represent reinfection in the event that re-infection was caused by a B. pseudomallei strain that was by chance identical to the primary strain. The probability of this happening is based on the degree of genetic diversity of B. pseudomallei in the environment. Chapter 5 demonstrates that the population of B. pseudomallei in even a small sampling site is extremely diverse. Thus, it is unlikely that the assessment of the causes of recurrent melioidosis contained significant errors due to polyclonal infection or low genetic diversity of the organism. Chapter 6 examines specific risk factors of relapse and reinfection. Duration and choices of antibiotics used for the primary episode were major determinants of relapse. Chapter 7 compares the clinical manifestations of relapse and re-infection and develops a simple scoring index to predict relapse or re-infection in patients presenting with recurrent melioidosis

A Study on etiology, clinical features, diagnosis and prognosis in Acute Febrile Encephalopathy

To identify the etiology, clinical features, diagnosis and prognosis in patients with acute febrile encephalopathy a tertiary government general hospital in southern east India. Viral aetiology was more common cause of acute febrile encephalopathy and other aetiology like protozoal, fungal were rarely identified causes. Males were more commonly affected. Headache and fever were the most common clinical manifestations, neck rigidity, altered sensorium, seizures, focal neurologicial deficit was least common Viral encephalopathy was most common in our case study Septic encephalopathy was second most common Most of the patients recovered with good prognosis and few complication. Most common cause was viral meningitis- Herpes encephalitis, bacterial meningitis, cerebal malaria, tubercular meningitis, sepsis associated encephalopathy, typhoid encephalopathy, protozoal meninigitis were also seen