Group C streptococcal septic arthritis of a prosthetic hip joint following dental treatment

We report a case of a prosthetic joint infection occurring secondary to group C Streptococcus following dental treatment in a 66-year-old woman. This patient presented 11 years following a right hip resurfacing procedure with increasing pain and difficulty mobilising the right hip. An ultrasound and MRI scan identified a collection in the right hip joint, which was subsequently aspirated. Cultures revealed a group C Streptococcus. Extensive washout and surgical debridement of the hip joint was undertaken and the patient was treated with a protracted course of antibiotics. At 1 year follow-up, the patient demonstrated no evidence of recurrent infection. We discuss the evidence underlying prophylactic antibiotic usage regarding dental procedures in the prevention of septic arthritis in patients with prosthetic joints. We also review the spectrum of diseases caused by this organism

‘Not a Plastic Surgeon’s best friend: Dog bites an increasing burden on UK Plastic Surgery services’

Injuries from dog bites are increasing in the United Kingdom (UK). Our study aims to highlight the public health burden of dog bites within the United Kingdom, in particular to the plastic and reconstructive surgeon. National data relating to hospital attendances and admissions was obtained from the Health and Social Care Information Database. Data relating to demographics of the patients admitted, the site and nature of the injury and the epidemiology was analysed. A total of 14,010 patients with dog bites were admitted between March 2013 and February 2015 of which 52% were admitted to Plastic and Reconstructive surgery departments. The incidence in 2014 increased by 6.5% compared with the previous year. The most frequent patient group were children under the age of nine (16%, n=1159) who most commonly sustained bites to the face and head. In total 19% of all dog bite injuries were associated with underlying fractures. Individuals living in most socially deprived areas (based on the national Index of Multiple Deprivation) were 2.8 times more likely to be admitted to hospital with a dog bite. In spite of the current UK legislation, the incidence of dog bites is increasing. Morbidity, mortality and considerable costs to the health service are amongst some of the consequences of these injuries.Accepted manuscript 12 month embarg

Periorbital necrotising fasciitis with underlying undiagnosed hepatitis C infection

We report the case of a 56-year-old man, previously well, who presented with a spontaneous right-sided periorbital necrotising soft tissue infection and subsequently found to have undiagnosed hepatitis C and liver cirrhosis. The patient presented with rapid onset right eye pain, periorbital swelling and septic shock. CT scan revealed diffuse inflammatory changes to the soft tissue anterior to the right eye. The initial treatment included intravenous antibiotics, emergency debridement of necrotic tissue and admission to intensive care. Group A streptococcus was cultured from the debrided tissue. The patient developed decompensated liver failure and life-threatening haematemesis. Liver screening detected hepatitis C positive serology, the only risk factor for which was an old tattoo. The patient was effectively managed by early involvement of multiple clinical teams. We review the literature surrounding periorbital necrotising fasciitis, discuss the evidence for hepatic disorders as a potential cause and make recommendations for managing these patient

Periorbital necrotising fasciitis with underlying undiagnosed hepatitis C infection

We report the case of a 56-year-old man, previously well, who presented with a spontaneous right-sided periorbital necrotising soft tissue infection and subsequently found to have undiagnosed hepatitis C and liver cirrhosis. The patient presented with rapid onset right eye pain, periorbital swelling and septic shock. CT scan revealed diffuse inflammatory changes to the soft tissue anterior to the right eye. The initial treatment included intravenous antibiotics, emergency debridement of necrotic tissue and admission to intensive care. Group A streptococcus was cultured from the debrided tissue. The patient developed decompensated liver failure and life-threatening haematemesis. Liver screening detected hepatitis C positive serology, the only risk factor for which was an old tattoo. The patient was effectively managed by early involvement of multiple clinical teams. We review the literature surrounding periorbital necrotising fasciitis, discuss the evidence for hepatic disorders as a potential cause and make recommendations for managing these patients.</jats:p