Cause Of Soft Tissue Infections Research Articles

Staphylococcus aureus Enters Hair Follicles Using Triacylglycerol Lipases Preserved through the Genus Staphylococcus

The bacteria belonging to the genus Staphylococcus are a group of organisms that readily inhabit human skin and the upper respiratory tract. Staphylococcus aureus (SA) is a leading cause of soft tissue infections and bacteremia (Miller and Cho, 2011) but is closely related to many other species of Staphylococcus that are skin commensals and rarely cause disease. These species densely populate follicular structures that may serve as a reservoir for long-term colonization (Nakatsuji et al., 2013).

Antimicrobial peptides-An alternative candidates to antibiotics against Staphylococcus aureus and its antibiotic-resistant strains

Staphylococcus aureus and its antibiotic-resistant strains are the cause of soft tissue infections representing some severe life-threatening infections. These situations have caused great concern for its treatment worldwide. Thus, the need to introduce new antibiotics or an alternative to antibiotics markedly increasing. Antimicrobial peptides (AMPs) have been shown to have various properties and uses in the biological system since their discovery. This review is based on the increasing concern for S. aureus, its resistant strains, the associated infections, pathogenicity, and the mechanism of resistance to antibiotics. Lastly, the overall significance of AMPs against S. aureus showed that they can be ideal candidates as an alternative to antibiotics with high potential for future therapeutics.

Skin and Soft-Tissue Infections

Sorting through the myriad of causes of soft tissue infections can be a daunting diagnostic challenge to even the astute clinician. While much is written about empiric treatment of skin and soft tissue infections, it is important to make a correct diagnosis, since clinical findings in common versus exotic and mild versus life-threatening infections have significant overlap. Historical information, such as the temporal progression of signs and symptoms, travel history, animal exposure, age, occupation, bite history, underlying diseases, and lifestyle, is important in focusing the differential diagnosis toward specific causes. Still, clinical assessment is frequently not sufficient and laboratory tests, radiographic imaging, and surgical intervention may be necessary to establish a specific diagnosis and to provide the rationale for definitive management.

P26 Case of atypical cutaneous Mycobacterium chelonae infection in a patient with SLE after cyclophosphamide therapy

Abstract Background Mycobacterium chelonae is a rapidly growing non-tuberculous mycobacteria that can be isolated from water, soils and aerosols. Localised infection has been reported associated with surgical and cosmetic procedures. Disseminated infection is rare and usually occurs in individuals who are immunocompromised. We present a patient with severe SLE on immunosuppressive therapy who developed localised severe cutaneous infection of the foot. Methods A 69-year-old lady with complex SLE - RNP+, Raynaud's, arthritis, stable for several years had deteriorated within the last year with cardiac myositis and, peripheral neuropathy. Three months pulsed intravenous cyclophosphamide (EUROLUPUS regime) was completed in November 2018. Five weeks later she developed severe pain, inability to weight-bear and extensive erythema and swelling of the right ankle and lower leg. An MRI showed extensive skin thickening especially dorsally in the R foot and anteriorly in distal leg. There was also increased signal in the distal achilles tendon. Orthopedic review confirmed no evidence of septic arthritis or osteomyelitis. A skin biopsy was performed, cultures from which grew Mycobacterium chelonae. She was admitted and started on tobramycin, on which she developed long QTc, linezolid which caused thrombocytopenia and clarithromycin. In March 2019 she was re-admitted with confusion, weakness and AKI, secondary to clarithromycin. She was, then switched to clofazimine and low dose clarithromycin, on which she was stabilized. MRI brain scan was normal, lumbar puncture was negative for M chelonae PCR and MRI spine confirmed cervical cord compression and cervical and lumbar canal stenosis due to osteophytes and disc disease. Results The infection improved considerably after 5 months of successful mycobacterial treatment. It was then possible to treat with rituximab for a deteriorating peripheral neuropathy confirmed on EMG and cardiac myositis. Sadly, whilst awaiting rehabilitation, the patient died unexpectedly in April 2019 from an arrhythmia. Conclusion Mycobacterium chelonae is an uncommon cause of soft tissue infection, which is resistant to all anti-tuberculous drugs. It is susceptible to a wider range of antimicrobial agents including tobramycin, imipenem, clarithromycin, linezolid, co-trimoxazole. A high index of suspicion is necessary for diagnosis, particularly in immunocompromised patients. The incidence may be increasing, possibly due to enhanced detection. Infection can mimic MSK presentations including capsulitis, tendonitis and tenosynovitis. Close monitoring is required as anti-microbial therapy complications are common including prolongation of QTc on tobramycin. Vigilance for disseminated multiorgan involvement is essential due to high mortality, particularly with CNS and lung involvement. Atypical infections should always be considered in the immunocompromised, particularly mycobacteria, nocardia & fungi. Disclosures S. Rasool None. A. Afifi None. D. De Lord None.

Clinical Profile and Outcome of Patients Suffering from Soft Tissue Infection in Lower Limb Disease in the Department of Surgery in Tertiary Care Center

Background Patients with lower limb diseases are commonly seen in surgical wards 7% to 10% of hospitalized patients are affected by soft tissue infections in the United States. The most common cause of soft tissue infections is Staphylococcus aureus.[1] Frequently these patients are diabetic, immune compromised, etc. Establishing the diagnosis of Necrotizing Soft Tissue Infection (NSTI) can be the main challenge in treating patients with NSTI, and knowledge of all available tools is the key for early and accurate diagnosis[2] The skin is the largest organ of the body and, with the underlying soft tissue, which includes the fat layers, fascia and muscle, represents the majority of the tissue in the body. It acts as a tough, flexible, structural barrier to invasion.[3] Failure to do so result in an extremely high mortality rate (80 to 100%), and even with rapid recognition and intervention, current mortality rates remain approximately 30 to 50%.[4]

Leclercia adecarboxylata, a rare cause of soft tissue infections in immunocompromised patients, case report and review of the literatura

Leclercia adecarboxylata is a member of the Enterobacteriaceae family that has been isolated from several environmental and animal specimens, however it rarely causes diseases in human beings. It has natural resistance to several antibiotics, and has shown the ability to harbor and produce enzymes capable of hydrolyzing most of the antibiotics used in daily clinical practice, making its treatment a challenge when a strain with such characteristics causes disease. Here we report the first known case of infection by Leclercia adecarboxylata after a trauma with plant material, in a 69-year-old male patient, with poorly controlled Diabetes Mellitus type 2.

Interleukin-26 (IL-26) is a novel anti-microbial peptide produced by T cells in response to staphylococcal enterotoxin.

Anti-microbial peptides are produced at outer and inner surfaces by epithelia and innate immune cells in response to bacterial infection. Staphylococcus aureus is an enterotoxin producing, Gram-positive pathogen, which is a major cause of soft tissue infections and life-threatening bacteremia and sepsis. Here we show that (i) skin T cells in chronic wounds infected with S. aureus express interleukin-26 (IL-26) in situ, (ii) staphylococcal enterotoxins (SE) trigger IL-26 expression in T cell lines and primary skin T cells, and (iii) IL-26 triggers death and inhibits biofilm formation and growth of S. aureus. Thus, we provide novel evidence that IL-26 is an anti-microbial peptide produced by T cells in response to SE. Accordingly, we propose that IL-26 producing T cells take part in the innate immune response to SE producing S. aureus and thus play a novel role in the primary innate immune defense in addition to their classical role in adaptive immunity.

Shewanella putrefaciens: A Rare Anaerobic Bacterium Mimicking Necrotizing Soft Tissue Infection

Background:Shewanella putrefaciens, an anaerobic, gram-negative, iron-reducing bacterium found in marine environments, is described here as cause of septic shock and a rare type of soft tissue infection. Case Presentation: We report a case of a 52-year-old female who presented to our facility with findings of altered mental status, septic shock, and right lower extremity swelling, redness, bullae formation, and erysipelas. Intra-operative evaluation was undertaken out of concern for necrotizing soft tissue infection, which was ruled out clinically. Prospective follow-up of intra-operative cultures showed evidence of marine pathogen Shewanella putrefaciens in the tissue culture and a cause of bacteremia. Discussion: With only 255 cases reported in the literature since 1973, Shewanella putrefaciens is known for causing ear infections, abdominal, biliary tract infections, and rarely, soft tissue infections. Severe bacteremia with fulminant septic shock may develop in as much as 28% of patients. In our case, Shewanella infection mimicked necrotizing soft tissue infection in its clinical presentation and aggressive evolution. It is therefore prudent to be familiar with this rare pathogen as a cause of soft tissue infection and sepsis and to be able to differentiate it from necrotizing soft tissue infection. Conclusion: Diligence in surgical site debridement and surgical site exploration are paramount in dictating patient care for these types of infections.

Raoultella Planticola in a Soft Tissue Infection! An Emerging Pathogen

Raoultella planticola is a gram-negative aerobic bacillus commonly found in water, plant and soil. Few cases have been reported of this organism affecting humans. We present the case of 68-year-old woman with a five-day history of inability to move right hand. Physical examination revealed an erythematous fluctuant swelling which was incised and drained. Drainage specimen was cultured and grew Raoultella planticola susceptible to augmented penicillin’s. Patient achieved significant clinical improvement following treatment with ampicillin-sublactam. Clinicians should be aware of this emerging pathogen as a cause of soft tissue infection in humans.

Staphylococcus aureus soft tissue infection may increase the risk of subsequent staphylococcal soft tissue infections

Staphylococcus aureus is the most common cause of soft tissue infections. It is unknown, however, if a patient who has had such an infection is at greater risk for future soft tissue infections with S. aureus. We conducted an epidemiological survey of adult patients hospitalized in the only public hospital in Geneva for treatment (usually combined surgical and medical) of a soft tissue infection caused by S. aureus. By reviewing nursing and medical records from the emergency department and hospital wards, we assessed whether or not they developed any other soft tissue infections (excluding a recurrence) after or before the index one. Among 1023 index episodes of soft tissue infections, 670 (65%) were caused by S. aureus, of which 47 were caused by methicillin-resistant strains (30 healthcare-associated and 17 community-acquired). The patients' median age was 51 years and 334 (34%) were immune-compromised. The median time span between the patient's first and last consultation (for any reason) in our hospital was 21.4 years (interquartile range, 10-30 years). In addition to their index infection, 124 patients (12%) developed a new nosocomial or community-acquired soft tissue infection. Among the index cases with an S. aureus infection, 92 (14%) had another soft tissue infection, compared to 32 (9%) who had a non-staphylococcal index infection (Pearson-χ2-test; p=0.03). Similarly, patients with an index S. aureus infection, compared to those with a non-S. aureus infection, had a higher rate of another soft tissue infection caused by S. aureus (χ2-test; p<0.01). In multivariate analysis, an index infection due to S. aureus shows a high association to further S. aureus soft tissue infections (logistic regression; odds ratio 2.5, 95% confidence interval 1.4-4.6). Among adult patients hospitalised for a soft tissue infection, those infected with S. aureus (compared with other pathogens) may be at higher risk of a subsequent soft tissue infection, particularly with S. aureus.

Staphylococcal Cassette Chromosome mec Typing of Community - Acquired Methicillin - Resistant Staphylococcus Aureus Isolates in Sohag University Hospital, Egypt

Background: community-acquired MRSA is an emerging pathogen increasingly reported worldwide. It is the most commonly reported microorganism to cause skin and soft tissue infections. Objectives: This study aimed to detect CA-MRSA in skin and soft-tissue infections (SSTIs), their pattern of antibiotic resistance, with molecular characterization of the isolated strains by detection of PVL gene and SCCmec typing. Patients& Methods: A total of 180 pus samples were collected from patients attending at outpatient clinics of General Surgery and Dermatology departments, Sohag University Hospital. Staph aureus was isolated and MRSA detected phenotypicall by using cefoxitin discs, subculturing on ORSAB medium and detection of PBP by PBP2' Latex Agglutination Test. Antibiotic susceptibility testing was done by disc diffusion method and confirmed by Vitek 2 compact system. Conventional PCR was used to detect mecA gene and PVL gene, while SCCmec typing was done by multiplex PCR. Results: Eighty five (47.2 %) S. aureus strains were isolated; 36 (42.4%) out of them were diagnosed phenotypically as MRSA and confirmed by mecA gene testing. Twenty three (63.6%) of proved CA-MRSA were PVL positive. Typing of SCC showed 16 strains (44.4%) SCCmec type V, 10 (27.7%) SCCmec type IVd and 10 (27.7%) were untypable. Conclusion: CA-MRSA is an important cause of SSTIs in our community. PVL gene is a good diagnostic marker for CA-MRSA identification. SCCmec types V, IVd are the most prevalent CA-MRSA types in our community.

Severe soft tissue infection in a patient with type 2 diabetes mellitus caused by Serratia marcescens as single pathogen

Serratia marcescens is a rare cause of soft tissue infection. However, it has been increasingly recognised as a pathogen causing infection in both immunocompromised patients and in patients in an intensive treatment unit setting. Here we describe an elderly patient with type 2 diabetes mellitus presenting with severe necrotic soft tissue infection due to S. marcescens acquired in the community. The literature on S. marcescens soft tissue infection is reviewed and management is discussed.

Aerococcus Viridians: Under-Recognized Cause of Pyomyositis

Introduction: Aerococcal infection is a rarely described pathogen in the literature. Aerococcus species may be isolated from urine, blood or other sources. Several sites of infection caused by aerococcal infection have been reported including arthritis, UTI, endocarditis and meningitis. However, to our knowledge there is not a single case of soft tissue infection caused by this germ. Case presentation: We report a case of middle aged patient with multiple comorbidities, presenting with right supraclavicular mass following chest trauma. Imaging study showed multilobulated collection involving thoracic and neck muscles and invading the clavicle. Intraoperative drainage of the pus grew exclusively Aerococcus viridens. Conclusion: Aerococcus viridans is unusual cause of soft tissue infection, but should be considered in the differential diagnosis when evaluating patients with suspected deep soft tissue infection. A. viridens infection is underestimated because of technical difficulties in the identification of this organism. The introduction of matrixassisted laser desorption ionization time-of-flight mass spectrometry carried great success in accurate identification, as early identification of the offending organism guides physicians to appropriate treatment.

A rare cause of soft tissue infections: Pseudallescheria boydii

Pseudallescheria boydii, a rare cause of infection in humans, are saprofitic microorganisms which are found in soil. In this report, we describe a renal transplant patient who had a skin-soft tissue infection at the anterior side of her left tibia due to P. boydii. Tissue biopsy was taken from her tibial lesion. Pathologic examination revealed hyphae plus fungal spores and mycological cultures were positive for P. boydii. The fungus was also identified by molecular methods. Fluconazole and topical isoconazole nitrate were given to the patient until the antifungal susceptibility results were seen. Fluconazole was changed to itraconazole via susceptibility results. Clinical response was seen at the 1 month control. Because of limited data regarding the optimal antifungal drug choice and duration of treatment for P. boydii infections, the proper identification of pathogen and antifungal susceptibility tests have vital importance. J Microbiol Infect Dis 2015;5(4): 176-179 Key words: Pseudallescheria boydii, renal transplant, soft tissue infection

A rare cause of soft tissue infections: Pseudallescheria boydii

Pseudallescheria boydii, a rare cause of infection in humans, are saprofitic microorganisms which are found in soil. In this report, we describe a renal transplant patient who had a skin-soft tissue infection at the anterior side of her left tibia due to P. boydii. Tissue biopsy was taken from her tibial lesion. Pathologic examination revealed hyphae plus fungal spores and mycological cultures were positive for P. boydii. The fungus was also identified by molecular methods. Fluconazole and topical isoconazole nitrate were given to the patient until the antifungal susceptibility results were seen. Fluconazole was changed to itraconazole via susceptibility results. Clinical response was seen at the 1 month control. Because of limited data regarding the optimal antifungal drug choice and duration of treatment for P. boydii infections, the proper identification of pathogen and antifungal susceptibility tests have vital importance. J Microbiol Infect Dis 2015;5(4): 176-179 Key words: Pseudallescheria boydii, renal transplant, soft tissue infection

Immunization with recombinant bivalent chimera r-Cpae confers protection against alpha toxin and enterotoxin of Clostridium perfringens type A in murine model

Clostridium perfringens type A, an anaerobic pathogen is the most potent cause of soft tissue infections like gas gangrene and enteric diseases like food poisoning and enteritis. The disease manifestations are mediated via two important exotoxins, viz. myonecrotic alpha toxin (αC) and enterotoxin (CPE). In the present study, we synthesized a bivalent chimeric protein r-Cpae comprising C-terminal binding regions of αC and CPE using structural vaccinology rationale and assessed its protective efficacy against both alpha toxin (αC) and enterotoxin (CPE) respectively, in murine model. Active immunization of mice with r-Cpae generated high circulating serum IgG (systemic), significantly increased intestinal mucosal s-IgA antibody titres and resulted in substantial protection to the immunized animals (100% and 75% survival) with reduced tissue morbidity when administered with 5×LD100 doses of αC (intramuscular) and CPE (intra-gastric gavage) respectively. Mouse RBCs and Caco-2 cells incubated with a mixture of anti-r-Cpae antibodies and αC and CPE respectively, illustrated significantly higher protection against the respective toxins. Passive immunization of mice with a similar mixture resulted in 91–100% survival at the end of the 15 days observation period while mice immunized with a concoction of sham sera and respective toxins died within 2–3 days. This work demonstrates the efficacy of the rationally designed r-Cpae chimeric protein as a potential sub unit vaccine candidate against αC and CPE of C. perfringens type A toxemia.

Poorly Regulated Blood Glucose in Diabetic Patients-predictor of Acute Infections.

Introduction:Diabetes mellitus, the most frequent endocrinology disease is a predisposing factor for infections. Diabetic patients have 4,4 times greater risk of systemic infection than non diabetics. Aim: a) To determine the prevalence and characteristics of acute infectious diseases in hospitalized diabetics; b) To correlate values of blood glucose levels and HbA1c with acute infections in hospitalized diabetics; c) To identify the etiology of infectious diseases.Material and methods:The study included 450 diabetic patients hospitalized in the 24-month period in the Intensive care unit of the Clinic for Endocrinology, Diabetes and Metabolic Disorders CCUS. In 204 patients (45,3%) there was an acute infectious condition and the following data was registered: a) gender and age; b) basic illness; c) laboratory parameters of inflammation (Le, CRP); d) blood glucose upon admission, parameters of glucoregulation (HbA1c, fructosamine); e) type of infection; f) verification of etiological agent; g) late complications of diabetes; and h) outcome.Results:Out of 204 diabetic patients with infection, there was 35,3% men and 64,7% women. More than half of patients (61%) were in the age group 61-80 years. The most common primary disease was Diabetes mellitus type 2. HbA1c and fructosamine were significantly increased in diabetic patients with acute infection compared to diabetics without acute infection. There is a positive correlation between HbA1c levels and CRP, and blood glucose and CRP in diabetic patients with acute infection. Most frequent infections: urinary tract infection (70,0%), followed by respiratory infections (11,8%), soft tissue infections (10,3%), generalized–bacteremia / sepsis (6,9%). The most common cause of urinary infection and generalized infection was Escherichia colli. The most common bacteria causing soft tissue infections was Staphylococcus aureus.Conclusion:Almost half (45,3%) of hospitalized diabetic patients had acute infectious condition. They present most frequently in women, aged 61-80 years, with Type 2 Diabetes mellitus. HbA1c and fructosamine were significantly increased in diabetic patients with acute infection. There is a positive correlation between the parameters of inflammation and glucoregulation in diabetics with acute infection. Most frequent was a urinary tract infection and the most common causative agent was Escherichia coli. The most common cause of soft tissue infections was Staphylococcus aureus. Out of 21 patients with verified soft tissue infections, 18 of them (85,7%) had confirmed diagnosis of diabetic microangiopathy diabetica. A total of 96,1% of patients fully recovered.

Probable Phaeoacremonium parasiticum as a cause of cavitary native lung nodules after single lung transplantation

Lung nodules after lung transplantation most often represent infection or post-transplant lymphoproliferative disorder in the allograft. Conversely, native lung nodules in single lung transplant recipients are more likely to be bronchogenic carcinoma. We present a patient who developed native lung cavitary nodules. Although malignancy was anticipated, evaluation revealed probable Phaeoacremonium parasiticum infection. Phaeoacremonium parasiticum is a dematiaceous fungus first described as a cause of soft tissue infection in a renal transplant patient. Lung nodules have not been previously described and this is the first case, to our knowledge, of P.parasiticum identified after lung transplantation.

Pasteurella multocida Supraglottitis Resulting in Bacteremia and Vascular Homograft Infection

Pasteurella multocida is a common cause of soft tissue infections in humans and usually results from a bite by a domestic or wild animal. Pasteurella supraglottitis is rare and likely results from a non-bite animal exposure. We report a case of P. multocida supraglottitis resulting in bacteremia and seeding of a vascular homograft resulting in pseudoaneurysm formation. After surgical repair of the graft and 6 weeks of postoperative antibiotic therapy, the patient resumed normal activities and has continued to do well after 1 year of follow-up. This case illustrates the potential for P. multocida to cause non-bite–associated infections. This is the first report of this zoonotic infection involving a vascular homograft.

Investigating migrating foreign bodies

Abstract Migrating foreign bodies are a frequent cause of soft tissue infection in small animals. Federica Rossi explains how diagnostic imaging can be used to track and help remove them.