Infection-Associated Mycobacterium Fortuitum Infection

Introduction: Mycobacterial species are unusual causes of skin and soft tissue infections and can be difficult to diagnose in the absence of consideration as they often require specific culture media and longer incubation times. We report a Mycobacterium fortuitum subcutaneous abscess in a diabetic related to medication injection that was initially diagnosed without specialized media or prolonged incubation times. Case Report: A 48 year old diabetic female developed a progressive subcutaneous swelling in the tissues of the right lower abdominal wall where she had been injecting liraglutide. Because of continued enlargement to almost egg size with pain, she was empirically treated with cephalexin and trimethoprim/sulfamethoxazole without effect. Subsequently, a formal I&D was performed producing non-foul smelling purulence. The Gram stain showed many WBCs without any organisms seen and the culture revealed a Gram positive rod subsequently identified as M. fortuitum by the Michigan Department of Health and Human Services. She was referred to out-patient Infectious Diseases clinic. when seen, neither before or after drainage had she complained of any fever, chills sweats, unintentional weight loss or other constitutional symptoms. On examination, there was a 2 mm opening without drainage at the inferior-lateral aspect of the otherwise healed I&D incision. The patient was prescribed oral SXT and clarithromycin to be continued for 6 months. On therapy, the incision completely healed and two months following the end of the therapy, she was totally asymptomatic. Conclusion: M. fortuitum is one of the species of mycobacteria that grows rapidly upon culture and can be found during the time that a routine bacterial culture is incubated growing on standard culture media. These organisms are more often identified when the clinician suspects a more unusual etiology of infection because of poor response to standard antimicrobial therapy. In this case, the microbiology laboratory was able to isolate the pathogen without requiring specialized media leading to more rapid and curative therapy

Cryptococcal Empyema: A Rare Manifestation of Disease

Introduction: Cryptococcus neoformans is a pathogenic yeast that is generally acquired by man from the environment via the respiratory route. Despite this route of acquisition, overt pulmonary infection is uncommonly diagnosed and the disease is usually manifest as a subacute meningitis which is mostly manifest in individuals who are celluarly immunoincompetent such as those on cancer chemotherapy, receiving anti-solid organ rejection medications and those with HIV/AIDS. Infection of the pleural space with C. neoformans is quite uncommon. We report a non-immunosuppressed man who was found to have infection of the pleural in the wake of bacterial empyema who was successfully treated with fluconazole. Case Report: A 66 year old man was referred to Infectious Diseases clinic in the wake of an admission for Streptococcus intermedius right sided thoracic empyema which was treated with appropriate antimicrobial therapy and chest tube drainage as well as a decortication of the right pleura. The pathology of the pleural peel showed acute and chronic inflammation and the pleural fluid and pleural tissue cultures were negative at the time of discharge. After discharge, the pleural peel culture grew C. neoformans and the patient was referred to ID. At the time of the visit, he complained as being generally fatigued but without fever, chills, sweats or cough. He also denied headache, stiff neck, nausea, vomiting or photophobia. A review of the pleural peel pathology showed no direct evidence of cryptococcosis. A serum cryptococcal antigen was ordered and he was begun on oral fluconazole for a planned 6 month course. The cryptococcal antigen was positive at 1:80 and serial assays performed during the treatment course. Date Serum Cryptococcal Antigen Aug2016 1:80 Sep2016 1:20 Dec2016 1:5 Jan2017 Non-reactive He remains asymptomatic following the therapeutic antifungal course. Conclusion: C. neoformans pleural peel infection was diagnosed from a pleural decortication procedure performed in the wake of S. intermedius bacterial empyema. Infections of the pleura or pleural space with Cryptococci are quite uncommon. The patient was successfully treated with fluconazole

Effect of three wound dressings on infection, healing comfort, and cost in patients with sternotomy wounds - a randomized trial

Study objective: To compare three dressing types in terms of their ability to protect against infection and promote healing, patient comfort, and cost-effectiveness.Design: Prospective, randomized controlled trial.Setting: Major metropolitan, academically affiliated, tertiary referral center.Patients: Seven hundred thirty-seven patients were randomized to receive a dry absorbent dressing (n = 243) [Primapore; Smith &amp; Nephew; Sydney, NSW, Australia], a hydrocolloid dressing (n = 267) [Duoderm Thin ConvaTec; Mulgrave, VIC, Australia], or a hydroactive dressing (n = 227) [Opsite; Smith &amp; Nephew] in the operating theater on skin closure.Results: There was no difference in the rate of wound infection or wound healing between treatment groups. The Primapore dressing was the most comfortable and cost-effective dressing option for the sternotomy wound. Duoderm Thin dressings were associated with increased wound exudate (p &lt; 0.001), poor dressing integrity (p &lt; 0.001), more frequent dressing changes (p &lt; 0.001), more discomfort with removal (p &lt; 0.05), and increased cost (p &lt; 0.001).Conclusions: In the context of no additional benefit for the prevention of wound infection or the rate of wound healing for any of the three dressing products examined, dry absorbent dressings are the most comfortable and cost-effective products for sternotomy wounds following cardiac surgery.<br /

Managing and preventing vascular catheter infections : a position paper of the international society for infectious diseases

CITATION: Lutwick, L., et al. 2019. Managing and preventing vascular catheter infections : a position paper of the international society for infectious diseases. International Journal of Infectious Diseases, 84:22-29, doi:10.1016/j.ijid.2019.04.014.The original publication is available at https://www.clinicalkey.com/ENGLISH ABSTRACT: A panel of experts was convened by the International Society for Infectious Diseases (ISID) to overview recommendations on managing and preventing vascular catheter infections, specifically for the prevention and management of central line-associated bloodstream infections. These recommendations are intended to provide insight for healthcare professionals regarding the prevention of infection in the placement and maintenance of the catheter and diagnosis as well as treatment of catheter infection. Aspects of this area in pediatrics and in limited-resource situations and a discussion regarding the selection of empiric or targeted antimicrobial therapy are particular strengths of this position paper.https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1201971219301845?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1201971219301845%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2FPublisher's versio

Adipose Tissue Serves as a Reservoir for Recrudescent Rickettsia prowazekii Infection in a Mouse Model

Brill-Zinsser disease, the relapsing form of epidemic typhus, typically occurs in a susceptible host years or decades after the primary infection; however, the mechanisms of reactivation and the cellular reservoir during latency are poorly understood. Herein we describe a murine model for Brill-Zinsser disease, and use PCR and cell culture to show transient rickettsemia in mice treated with dexamethasone >3 months after clinical recovery from the primary infection. Treatment of similarly infected mice with cyclosporine failed to produce recrudescent bacteremia. Therapy with doxycycline for the primary infection prevented recrudescent bacteremia in most of these mice following treatment with dexamethasone. Rickettsia prowazekii (the etiologic agent of epidemic typhus) was detected by PCR, cell culture, and immunostaining methods in murine adipose tissue, but not in liver, spleen, lung, or central nervous system tissues of mice 4 months after recovery from the primary infection. The lungs of dexamethasone-treated mice showed impaired expression of β-defensin transcripts that may be involved in the pathogenesis of pulmonary lesions. In vitro, R. prowazekii rickettsiae infected and replicated in the murine adipocyte cell line 3T3-L1. Collectively these data suggest a role for adipose tissue as a potential reservoir for dormant infections with R. prowazekii

Assessment of splenic function

Hyposplenic patients are at risk of overwhelming post-splenectomy infection (OPSI), which carries mortality of up to 70%. Therefore, preventive measures are warranted. However, patients with diminished splenic function are difficult to identify. In this review we discuss immunological, haematological and scintigraphic parameters that can be used to measure splenic function. IgM memory B cells are a potential parameter for assessing splenic function; however, more studies are necessary for its validation. Detection of Howell–Jolly bodies does not reflect splenic function accurately, whereas determining the percentage of pitted erythrocytes is a well-evaluated method and seems a good first-line investigation for assessing splenic function. When assessing spleen function, 99mTc-labelled, heat-altered, autologous erythrocyte scintigraphy with multimodality single photon emission computed tomography (SPECT)-CT technology is the best approach, as all facets of splenic function are evaluated. In conclusion, although scintigraphic methods are most reliable, they are not suitable for screening large populations. We therefore recommend using the percentage of pitted erythrocytes, albeit suboptimal, as a first-line investigation and subsequently confirming abnormal readings by means of scintigraphy. More studies evaluating the value of potentially new markers are needed