Chronic Localized Infection Research Articles

Case series of calcaneal osteomyelitis in patients with melioidosis

Background: Melioidosis is an emerging infectious disease caused by the Gram-negative bacterium Burkholderia pseudomallei, which can lead to a range of clinical manifestations including acute septicaemia and chronic localized infections. Osteomyelitis is an uncommon but well-recognized complication of melioidosis, with the calcaneus being a relatively rare site of involvement. Case Description: The authors present a case series of three patients with calcaneal osteomyelitis caused by B. pseudomallei infection. All three patients presented with non-specific symptoms like fever and weight loss, followed by localized ankle/foot pain and swelling. Diagnosis was made based on imaging findings (radiographs and MRI) and isolation of Burkholderia pseudomallei from blood or pus cultures. Treatment involved a combination of initial intravenous antibiotic therapy (meropenem or ceftazidime) for 4-6 weeks, followed by oral trimethoprim-sulfamethoxazole for 6 months. One patient required surgical drainage of a plantar abscess. All patients had a favourable clinical outcome with resolution of osteomyelitis on follow-up imaging. Conclusion: Calcaneal osteomyelitis is a rare but potentially serious complication of melioidosis. Early recognition and prompt initiation of appropriate antibiotic therapy are crucial for favourable outcomes. Clinicians should maintain a high index of suspicion for osteomyelitis in patients with melioidosis, especially in patients from endemic areas as well as in patients with risk factors like diabetes. Close follow-up and monitoring for potential relapse or reactivation are essential, particularly in immunocompromised individuals.

Mycetoma due to Nocardia brasiliensis (Maduromycosis) in the Mixteca Poblana: Case report with successful treatment

The case of a Mexican patient of the Mixteca Poblana, Region until today little studied, dedicated to domestic work with a skin infection caused by Nocardia brasiliensis, which evolved favorably despite taking more than 8 years with the injury is presented. The diagnosis was made by direct examination and culture of the specimen. The mycetoma is a progressive chronic localized infection caused by fungi or bacteria that affects the feet, upper limbs or back. The symptoms of the case include: edema, fistuous formation. The diagnosis is clinical, confirmed with microscopic examination of exudate and culture. The treatment consists of antibiotics for a long time 21 days central intensive phase and one year with supportive treatment orally and locally.

Machine learning based major complication prediction for patients undergoing transvenous lead extraction

Abstract Funding Acknowledgements Type of funding sources: None. Background Relative benefits of transvenous lead extraction (TLE) should be weighed against the risks on an individual basis. Observational studies have identified disparate risk factors for major adverse events (MAEs), however there are few available tools to aid the clinician risk-stratifying patients. Purpose The purpose of this study was to develop a machine learning (ML)-based risk stratification system to predict risk of MAEs following transvenous lead extraction (TLE). Methods Multiple ML models were derived from a training cohort of 3555 patients undergoing TLE to pre-procedurally identify patients at high and low risk of major adverse events (procedure-related major complication, including procedure-related death). The ML models were then tested on an independent, reference centre cohort of 1171 patients undergoing TLE. Clinical features were selected based on whether they were available in both datasets without large gaps. For model selection we compared the ML algorithms logistic regression, ridge regression, support vector machines (SVM), gradient boosting classifier and random forest. The best performing of these was then compared to a self-normalising network (SNN). Results In total 3122 cases with the required features were included from the training cohort with 53 MAEs (1.7%), and 998 cases in the test cohort with 24 MAEs (2.4%). SVM identified lead dwell time, left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), chronic respiratory disease, local infection, heart failure, sepsis and male gender as predictors of MAEs in order of decreasing importance (see figure). For the training data, the SVM provided a more sensitive result compared with SNN (0.83 vs 0.71) at the cost of specificity (0.63 vs 0.79). For the test data, the SVM identified MAEs in 12 out of 123 (9.8%) "high risk" patients, 10 out of 552 (1.8%) "medium risk" patients, and 2 out of 323 (0.006%) "low risk" patients. Conclusion Machine learning provided good discriminative capabilities for identifying patients in a "high risk" and "low risk" category for MAEs. Abstract Figure. 8 most important predictors of MAEs

Whole-genome comparative analysis of Malaysian Burkholderia pseudomallei clinical isolates.

Burkholderia pseudomallei , a soil-dwelling Gram-negative bacterium, is the causative agent of the endemic tropical disease melioidosis. Clinical manifestations of B. pseudomallei infection range from acute or chronic localized infection in a single organ to fulminant septicaemia in multiple organs. The diverse clinical manifestations are attributed to various factors, including the genome plasticity across B. pseudomallei strains. We previously characterized B. pseudomallei strains isolated in Malaysia and noted different levels of virulence in model hosts. We hypothesized that the difference in virulence might be a result of variance at the genome level. In this study, we sequenced and assembled four Malaysian clinical B. pseudomallei isolates, UKMR15, UKMPMC2000, UKMD286 and UKMH10. Phylogenomic analysis showed that Malaysian subclades emerged from the Asian subclade, suggesting that the Malaysian strains originated from the Asian region. Interestingly, the low-virulence strain, UKMH10, was the most distantly related compared to the other Malaysian isolates. Genomic island (GI) prediction analysis identified a new island of 23 kb, GI9c, which is present in B. pseudomallei and Burkholderia mallei , but not Burkholderia thailandensis . Genes encoding known B. pseudomallei virulence factors were present across all four genomes, but comparative analysis of the total gene content across the Malaysian strains identified 104 genes that are absent in UKMH10. We propose that these genes may encode novel virulence factors, which may explain the reduced virulence of this strain. Further investigation on the identity and role of these 104 proteins may aid in understanding B. pseudomallei pathogenicity to guide the design of new therapeutics for treating melioidosis.

Clear Cell Change in Reactive Angiogenesis: A Potential Diagnostic Pitfall.

Reactive angiogenesis is commonplace, occurs in many circumstances, and is important in the repair of injured tissue. Histologically, it is characterized by newly formed capillaries arranged in a lobular architecture and lined by plump endothelial cells. We have encountered a form of reactive angiogenesis not well described; composed of large endothelial cells with abundant clear cytoplasm that causes diagnostic challenges. The cohort includes 10 patients, aged 4 to 61, mean 40 years; 7 males, 3 females. One case involved bone (ilium), and 9 involved soft tissue: fingers (n=2), toes (n=2), hip joint (n=1), shoulder (n=1), thigh (n=2), and anal mucosa (n=1). Clinically, the patients had chronic ulcers, osteomyelitis, or localized infection. All cases exhibited a lobular proliferation of capillaries lined by large polyhedral endothelial cells that obscured the vessel lumens and were admixed with acute and chronic inflammation. The endothelial nuclei were vesicular with small nucleoli and the cytoplasm was abundant and clear or palely eosinophilic. The endothelial cells were stained with CD31 and ERG (7/7 cases), CD34 (6/6), FLI1 (4/4), and were negative for keratin and CD68 (6/6). Periodic acid-Schiff stain and periodic acid-Schiff stain-diastase on 3 cases did not demonstrate glycogen. Using a polymerase chain reaction, no Bartonella henselae was found in all 6 cases tested. Reactive angiogenesis with clear cell change unassociated with Bartonella spp. has not been described. It causes diagnostic challenges and the differential diagnosis includes benign and malignant tumors, as well as unusual infections. It is important to distinguish between these possibilities because of the significant impact on treatment and prognosis.

Mycetoma of breast

Mycetoma is a chronic subcutaneous localized infection characterized by the triad of swelling, discharging sinuses and discharge of grains that may be caused by bacteria (actinomycetoma) or fungi (eumycetoma). Although it most commonly involves the foot, lower leg or hand, involvement of the head or back may also occur. The incidence is low in other parts of the body such as breast because of the lower risk of trauma as the initiating factor. We report an adult woman with single nodules in the breast on FNAC chronic granulomatous decease and later proved to be mycetoma after excisional biopsy.

Melanonychia striata: clarifying behind the Black Curtain. A review on clinical evaluation and management of the 21st century.

Melanonychia striata is characterized by a tan, brown, or black longitudinal streak within the nail plate that runs from the proximal nail fold to the distal part of the nail plate. Melanonychia striata is due to increased activity of melanocytes or melanocytic hyperplasia in the nail matrix with subsequently increased melanin deposition in the nail plate. The most common cause of melanonychia striata associated with melanocytic activation is ethnic melanonychia which occurs in dark-skinned individuals. Other causes of melanonychia striata related to melanocytic activation include pregnancy, chronic local trauma, infections, medications, dermatological disorders, endocrine disorders, alkaptonuria, hemochromatosis, porphyria, graft-vs-host disease, Peutz-Jeghers syndrome, and Laugier-Hunziker syndrome. Causes of melanonychia striata associated with melanocytic hyperplasia include nail matrix melanocytic nevus, nail lentigo, and nail apparatus/subungual insitu and invasive melanoma. In most cases, melanonychia striata is a benign condition, especially in children. Consequently, most investigators advocate a wait-and-see approach. Nail apparatus/subungual melanoma should be suspected if there is an abrupt onset after middle age, personal or family history of melanoma, rapid growth, darkening of a melanonychia band, pigment variegation, blurry lateral borders, irregular elevation of the surface, a bandwidth >3mm, proximal widening, associated nail plate dystrophy, single rather than multiple digit involvement, and periungual spread of pigmentation onto the adjacent cuticle and/or proximal and/or lateral nail folds (Hutchinson sign). Prolonged follow-up is mandatory for early detection of possible malignant changes.

Endoprosthetic replacement of the proximal humerus in revision shoulder arthroplasty

Reconstruction of proximal humeral bone defects in the setting of shoulder revision arthroplasty by implantation of amodular humeral component. Severe segmental humeral bone defects in revision total shoulder arthroplasty, after tumor resection, trauma, pathological fractures, post-infectious or after failed osteosynthesis. Acute or chronic local infections, large diaphyseal bone defects preventing adequate anchorage of the prosthesis, very short life expectancy (<3months). Removal of the implant using an extended deltopectoral approach. Periarticular arthrolysis with preservation of neurovascular structures. Resection of the meta-diaphyseal bone and reconstruction of the humeral length with the help of different extension sleeves and amodular humeral component. Soft tissue management is crucial, especially with reverse shoulder arthroplasty. Three weeks postoperatively immobilization in ashoulder sling, active assisted movement therapy by gradual pain-adapted increase of movement, muscle coordination, and strength. The results of 11 consecutive patients treated with amodular humeral component due to afailed shoulder arthroplasty between 2008 and 2016 were evaluated retrospectively. Mean length of reconstruction was 100 mm. Due to recurrent dislocations one patient required revision and conversion to areverse component. No cases of aseptic loosening or periprosthetic infection were observed.

The missing grains in Madura foot: imaging to the rescue

&lt;p class="abstract"&gt;Mycetoma or Madura foot is a chronic localized granulomatous infection caused by varied species of fungi or actinomycetes clinically diagnosed by active discharging sinuses containing ‘grains’. In atypical presentations or patients unwilling for invasive investigations, imaging essentially plays a key role in diagnosis and helps to differentiate actinomycetoma from eumycetoma. Here we present such an atypical case of unilateral foot swelling without sinuses–cryptic mycetoma. This 69 year old male from Kerala had a swelling over the left foot following trauma initially painless. An x-ray taken showed normal underlying bones with mild soft tissue swelling. To evaluate further USG was taken which showed fine hyperechoiec foci settled at the bottom of cavities highly suggestive of mycetoma. For confirmation USG guided biopsy was taken but was inconclusive. As patient was not willing for repeat biopsy, we advised non invasive MRI that revealed classical ‘Dot In Circle’ sign specific for mycetoma. The distinction that makes the case stand out is its absence of classical picture of discharging sinuses and the fact that imaging rather than histopathology helped confirm the diagnosis in mycetoma.&lt;/p&gt;

Prevalence and surgical management of concurrent adult acquired buried penis and urethral stricture disease.

To describe the prevalence and surgical management of coexistent adult acquired buried penis (AABP) and urethral stricture disease. AABP patients often have urinary dribbling with resultant chronic local moisture, infection, and inflammation that combine to cause urethral stricture disease. To date, no screening or surgical management algorithms have been described. A multi-institutional retrospective study was conducted of the surgical management strategies for patients with concurrent AABP and urethral stricture disease from 2010 to 2017. AABP patient demographics, physical exam findings, and comorbidities were compared between those with and without stricture disease to suggest those that would selectively benefit from screening for stricture disease. Of the 42 patients surgically managed for AABP, 13 had urethral stricture disease (31.0%). Stricture location was universal in the anterior urethra. Sixty-one percent (n = 8) of strictures were 6cm or longer and managed prior to AABP repair with Kulkarni urethroplasty. Patients with urethral stricture disease were significantly more likely to have clinically diagnosed lichen sclerosus (p = 0.00019). There was no significant difference in BMI, age, or comorbidities between patients with and without urethral stricture disease. Extensive anterior urethral stricture is common in patients with AABP. Clinical characteristics cannot predict stricture presence except possibly the presence of lichen sclerosus. Definitive stricture surgical options include extensive Johanson Urethroplasty or Kulkarni Urethroplasty. Kulkarni Urethroplasty prior to AABP repair has the benefits of a single-stage repair, good cosmetic outcome with meatal voiding, and dorsal graft placement to allow safe degloving of the penis in the subsequent AABP repair.

Aspecte clinico-terapeutice în incluzia dentară

Introduction. Dental impaction represents the group of isolated dental anomalies characterized by retention of a tooth with a fully formed root in the jaw bone, after the eruption period has passed. This anomaly may affect deciduous teeth, permanent or supernumerary teeth causing aesthetic and / or functional disorders. Case report. The case presents a clinical situation of a girl who presented two maxillary teeth impacted (a central incisor and a cuspid) who underwent surgical exposure and orthodontic treatment for their arch alignments. Conclusions. Impacted teeth may produce dental malpositions or root resorption of the adjacent teeth, cysts or chronic local infections, which carry out a surgical orthodontic treatment, complex and for a long term, depending on the clinical situation existing.

Rhinofacial Conidiobolomycosis in a 16-Year-Old Girl

Objectives : To present the case of a 16-year old girl with progressive facial disfigurement spanning 11 months due to Conidiobolomycosis.&#x0D; Methods: &#x0D; Design: Case Report&#x0D; Setting: Tertiary Government Hospital&#x0D; Patient: One&#x0D; Results: A 16-year-old girl presented with a severe facial deformity of 11 months duration. The lesion started as a swelling in the right nasal vestibule, which later involved the entire nose, forehead, cheeks, upper and lower lip. A series of tissue biopsies revealed varied results -- chronic inflammation, chronic granulomatous inflammation with foreign body type giant cells, and eosinophilic granuloma—resulting in delayed provision of appropriate treatment. On the fourth biopsy using Grocott methenamine silver staining technique, septate fungal hyphae were identified. With a diagnosis of rhinofacial conidiobolomycosis, she was started on Itraconazole 100mg three times daily for eight months. Her facial swelling subsided gradually during the course of treatment and no systemic drug-related complications were observed.&#x0D; Conclusion: Rhinofacial conidiobolomycosis is a rare chronic localized fungal infection that usually affects midline facial structures in immunocompetent hosts. Early detection and diagnosis, and appropriate medication can give rapid resolution. To the best of our knowledge, this may be the first documented case of rhinofacial conidiobolomycosis in the Philippines.&#x0D; &#x0D; Keywords: Conidiobolomycosis; Conidiobolus; fungal infection; Itraconazole, Therapeutic use

Cutaneous Melioidosis Cluster Caused by Contaminated Wound Irrigation Fluid.

Melioidosis, caused by infection with the bacterium Burkholderia pseudomallei, is a disease with manifestations ranging from rapidly fatal septicemia, pneumonia, or meningoencephalitis to localized abscess formation, cellulitis, and asymptomatic seroconversion. This disease occurs most commonly in Southeast Asia and northern Australia after exposure to contaminated soil or surface water (1). The US National Notifiable Diseases Surveillance Systems case definition describes cutaneous melioidosis as “an acute or chronic localized infection which may or may not include symptoms of fever and muscle aches. Such infection often results in ulcer, nodule, or skin abscess” (2). Sporadic cases outside melioidosis-endemic regions usually occur in persons who have a history of travel in the tropics, which can be as long as several decades previously because of the ability of B. pseudomallei to persist undetected after the initial inoculation event (3). In these cases, B. pseudomallei infection might not be considered in the differential diagnosis. Detection of sporadic cases of melioidosis by clinical pathology laboratories requires microbiology laboratories to have robust bacterial identification procedures. Even with advanced equipment, a lack of awareness of the characteristic features of B. pseudomallei can result in misidentification of cultured organisms (4). Only a few point-source outbreaks of melioidosis have been reported (5). Two of these occurred in Western Australia; 1 was attributed to movement of livestock from the tropical north to the temperate southwest (6), and the other was caused by contamination of a potable water supply (7). Neither cluster was healthcare-associated. Only a few cases of healthcare-associated melioidosis have been reported. Some of the earliest accounts of melioidosis identified opiate injection as a potential source of infection (8). In animal healthcare, injected medication was thought responsible for a series of animal infections in northern Australia (9). The first report of hospital-acquired melioidosis originated in Hawaii, USA, and described pulmonary infection after bronchoscopy with a scope contaminated with B. pseudomallei (10). This report indicated that the contaminated bronchoscope had previously been used on a returned traveler with melioidosis. A second report described 2 patients with B. pseudomallei urinary tract infection on different wards of a hospital on whose grounds B. pseudomallei was isolated (11). Nosocomial contamination associated with faulty hospital hygiene and ineffective disinfectant solution was reported from a hospital in Thailand treating patients with melioidosis (12). More recently, cases of neonatal melioidosis from a hospital in Thailand were thought to be healthcare-associated, although the full details of transmission could not be determined (13). Melioidosis became a notifiable infection in Western Australia in January 2000 (14). Physicians, pathology service providers, and the state public health laboratory are required to report a diagnosis of melioidosis to the State Disease Control Directorate. Melioidosis notification is largely laboratory-generated in Western Australia because confirmation of infection according to the Australian Laboratory Case Definition relies on culture of B. pseudomallei from clinical specimens. Pathology service providers therefore routinely refer presumptive B. pseudomallei isolates to the state public health laboratory for confirmation, genotyping, and archiving in a reference culture collection (Western Australian Burkholderia Collection). Here we report the laboratory investigation of a cluster of cutaneous melioidosis in the temperate southwest of Australia, the identification of its source, and means of control.

Pitfalls and optimal approaches to diagnose melioidosis.

Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia with dissemination of infection to multiple organs characterized by abscesses. Pneumonia is the most common clinical presentation. Because of the wide range of clinical presentations, physicians may often misdiagnose and mistreat the disease for tuberculosis, pneumonia or other pyogenic infections. The purpose of this paper is to present common pitfalls in diagnosis and provide optimal approaches to enable early diagnosis and prompt treatment of melioidosis. Melioidosis may occur beyond the boundaries of endemic areas. There is no pathognomonic feature specific to a diagnosis of melioidosis. In endemic areas, physicians need to expand the diagnostic work-up to include melioidosis when confronted with clinical scenarios of pyrexia of unknown origin, progressive pneumonia or sepsis. Radiological imaging is an integral part of the diagnostic workup. Knowledge of the modes of transmission and risk factors will add support in clinically suspected cases to initiate therapy. In situations of clinically highly probable or possible cases where laboratory bacteriological confirmation is not possible, applying evidence-based criteria and empirical treatment with antimicrobials is recommended. It is of prime importance that patients undergo the full course of antimicrobial therapy to avoid relapse and recurrence. Early diagnosis and appropriate management is crucial in reducing serious complications leading to high mortality, and in preventing recurrences of the disease. Thus, there is a crucial need for promoting awareness among physicians at all levels and for improved diagnostic microbiology services. Further, the need for making the disease notifiable and/or initiating melioidosis registries in endemic countries appears to be compelling.

Lung Microbiota Changes Associated with Chronic Pseudomonas aeruginosa Lung Infection and the Impact of Intravenous Colistimethate Sodium.

BackgroundExacerbations associated with chronic lung infection with Pseudomonas aeruginosa are a major contributor to morbidity, mortality and premature death in cystic fibrosis. Such exacerbations are treated with antibiotics, which generally lead to an improvement in lung function and reduced sputum P. aeruginosa density. This potentially suggests a role for the latter in the pathogenesis of exacerbations. However, other data suggesting that changes in P. aeruginosa sputum culture status may not reliably predict an improvement in clinical status, and data indicating no significant changes in either total bacterial counts or in P. aeruginosa numbers in sputum samples collected prior to pulmonary exacerbation sheds doubt on this assumption. We used our recently developed lung segmental model of chronic Pseudomonas infection in sheep to investigate the lung microbiota changes associated with chronic P. aeruginosa lung infection and the impact of systemic therapy with colistimethate sodium (CMS).Methodology/Principal FindingsWe collected protected specimen brush (PSB) samples from sheep (n = 8) both prior to and 14 days after establishment of chronic local lung infection with P aeruginosa. Samples were taken from both directly infected lung segments (direct) and segments spatially remote to such sites (remote). Four sheep were treated with daily intravenous injections of CMS between days 7 and 14, and four were treated with a placebo. Necropsy examination at d14 confirmed the presence of chronic local lung infection and lung pathology in every direct lung segment.The predominant orders in lung microbiota communities before infection were Bacillales, Actinomycetales and Clostridiales. While lung microbiota samples were more likely to share similarities with other samples derived from the same lung, considerable within- and between-animal heterogeneity could be appreciated.Pseudomonadales joined the aforementioned list of predominant orders in lung microbiota communities after infection. Whilst treatment with CMS appeared to have little impact on microbial community composition after infection, or the change undergone by communities in reaching that state, when Gram negative organisms (excluding Pseudomonadales) were considered together as a group there was a significant decrease in their relative proportion that was only observed in the sheep treated with CMS. With only one exception the reduction was seen in both direct and remote lung segments. This reduction, coupled with generally increasing or stable levels of Pseudomonadales, meant that the proportion of the latter relative to total Gram negative bacteria increased in all bar one direct and one remote lung segment.Conclusions/SignificanceThe proportional increase in Pseudomonadales relative to other Gram negative bacteria in the lungs of sheep treated with systemic CMS highlights the potential for such therapies to inadvertently select or create a niche for bacteria seeding from a persistent source of chronic infection.

Postoperative infection and survival in osteosarcoma patients: Reconsideration of immunotherapy for osteosarcoma.

There is controversy regarding the impact of infection on long-term prognosis in osteosarcoma patients. Clinical trials and experiments relating to this field could bring reconsideration of immunotherapy for osteosarcoma. The clinical records were reviewed of 125 osteosarcoma patients with a mean follow-up of 5.1±3.9 years (range, 0.5-19.8 years), and a review of the literature was also carried out. Chronic localized infections (but not systemic infection) were determined in 6 patients (4.8%). Similar chemotherapeutic regimens (P=1.00) and histological reactions (P=0.65) were observed in patients with or without infection. Tumor location of proximal tibia (P=0.04) was more common in infected patients. More amputations (P<0.001) were necessitated in infected patients due to uncontrolled infection. The 5-year overall survival rate and event-free survival rate in infected patients were 100%, which were significantly higher than that of the non-infected patients, of whom the rates were 54 and 43% respectively (log-rank test: total survival, P=0.01; tumor-free survival, P=0.01). Distant metastasis was an independent risk factor for survival determined by Cox regression analysis (P<0.001, 95 confidence interval, 1.59-3.98). These findings suggested infection was likely to have positive effects on survival in osteosarcoma patients, however, underlying mechanisms remain to be elucidated. Reconsideration of the association of infection and survival in osteosarcoma patients will help to explore novel therapeutic routes and targets in these patients.

Ocular Rhinosporidiosis in a Nigerian Child: A Case Report and Literature Review from Niger Delta of Nigeria

Aim : The aim of this report is to raise the awareness of the existence of this rare ocular affliction in our locality and to highlight the importance of routine histopathological diagnosis of ocular mass lesions. Case Presentation: An 11 year old male school child presented to our centre with a 9 months history of a fleshy growth which bleeds spontaneously, on the inner aspect of the right upper eyelid. Other parts of both eyes including the left eye lid were normal A provisional diagnosis of squamous cell papilloma of the conjunctiva was made and the patient underwent an excisional biopsy of the lesion. Microscopic sections of the mass showed hyperplastic polypoid lesion with numerous globular cysts within the subepithelia conjunctiva with a surrounding of heavy inflammatory reaction composed of lymphocytes, plasma cells and neutrophils. A histopathological diagnosis of conjunctival rhinosporidiosis was made. Discussion: Rhinosporidiosis is a chronic localized granulomatous infection caused by an aquatic

Chronic Lung Nodule Secondary to Flavimonas oryzihabitans Infection in a Lung Transplant Recipient

Background Flavimonas oryzihabitans rarely causes infections in humans. We report a case of a chronic lung nodule in a lung transplant recipient and review the published literature. Objective This study aimed to describe the spectrum of disease caused by F. oryzihabitans. Methods We searched MEDLINE using the following key words: Bacterium typhiflavum, Chromobacterium typhiflavum, Pseudomonas oryzihabitans, and CDC group Ve 2. The references of the articles retrieved were screened to identify any literature missed during our primary search. We compared the clinical characteristics and outcomes of patients with indwelling catheters and patients without them. Results A total of 86 articles were retrieved. Of them, 45 articles described 110 infections with F. oryzihabitans. The median age of the patients was 45 years (interquartile range [IQR], 21–56) and 64 (58%) were men. Seventy-three (66%) patients had indwelling catheters at the time of diagnosis. Patients with indwelling catheters presented most commonly with bacteremia (54, 74%) after a latency period of 7 days (IQR, 7–7). Non–catheter-related infections encompassed most commonly the skin and soft tissue infections (11, 29%) after a latency period of 56 days (IQR, 14–130). Not removing the indwelling catheter was the only predictor of infection recurrence. There were no deaths attributable to F. oryzihabitans infection. Conclusions Flavimonas oryzihabitans can present in 2 different clinical patterns, namely, catheter-associated sepsis and chronic localized infection. Catheters not removed predicted recurrence of the infection. Although immunocompromised, our patient presented as a chronic localized infection.

Periodontal disease in pediatric rheumatic diseases

Gingivitis and periodontitis are immunoinflammatory periodontal diseases characterized by chronic localized infections usually associated with insidious inflammation This narrative review discusses periodontal diseases and mechanisms influencing the immune response and autoimmunity in pediatric rheumatic diseases (PRD), particularly juvenile idiopathic arthritis (JIA), childhood-onset systemic lupus erythematosus (C-SLE) and juvenile dermatomyositis (JDM). Gingivitis was more frequently observed in these diseases compared to health controls, whereas periodontitis was a rare finding. In JIA patients, gingivitis and periodontitis were related to mechanical factors, chronic arthritis with functional disability, dysregulation of the immunoinflammatory response, diet and drugs, mainly corticosteroids and cyclosporine. In C-SLE, gingivitis was associated with longer disease period, high doses of corticosteroids, B-cell hyperactivation and immunoglobulin G elevation. There are scarce data on periodontal diseases in JDM population, and a unique gingival pattern, characterized by gingival erythema, capillary dilation and bush-loop formation, was observed in active patients. In conclusion, gingivitis was the most common periodontal disease in PRD. The observed association with disease activity reinforces the need for future studies to determine if resolution of this complication will influence disease course or severity.

Doença periodontal em doenças reumáticas pediátricas

Gingivitis and periodontitis are immunoinflammatory periodontal diseases characterized by chronic localized infections usually associated with insidious inflammation This narrative review discusses periodontal diseases and mechanisms influencing the immune response and autoimmunity in pediatric rheumatic diseases (PRD), particularly juvenile idiopathic arthritis (JIA), childhood‐onset systemic lupus erythematosus (C‐SLE) and juvenile dermatomyositis (JDM). Gingivitis was more frequently observed in these diseases compared to health controls, whereas periodontitis was a rare finding. In JIA patients, gingivitis and periodontitis were related to mechanical factors, chronic arthritis with functional disability, dysregulation of the immunoinflammatory response, diet and drugs, mainly corticosteroids and cyclosporine. In C‐SLE, gingivitis was associated with longer disease period, high doses of corticosteroids, B‐cell hyperactivation and immunoglobulin G elevation. There are scarce data on periodontal diseases in JDM population, and a unique gingival pattern, characterized by gingival erythema, capillary dilation and bush‐loop formation, was observed in active patients. In conclusion, gingivitis was the most common periodontal disease in PRD. The observed association with disease activity reinforces the need for future studies to determine if resolution of this complication will influence disease course or severity.