Purulent Skin Research Articles

PLASMA COAGULATING AND NON-COAGULATING STAPHYLOCOCCUS SPP. IN SKIN SAMPLES FROM DOGS AND THEIR RESISTANCE TO ANTIBIOTICS

Staphylococci are human and animal mucosal surface and skin commensals that can cause a variety of infections, such as purulent skin infections, otitis externa, pyoderma, urinary tract infections, and postoperative infections. Dog skin is one of the protective barriers for animals. However, dogs can have and transmit a variety of microorganisms on their skin, including staphylococci. Most studies have compared plasma coagulating and non-coagulating Staphylococcus spp. by dog breeds, sex, and coat length. The aim – to identify plasma coagulating and non-coagulating Staphylococcus spp. in skin samples from dogs and its resistance to antibiotics by place of residence. Staphylococci were detected in more than half of the samples tested, one third of which were plasma coagulating and the remaining two thirds were non-coagulating plasma. Plasma non-coagulating staphylococci were mainly increased among dogs living at home and plasma coagulating – among dogs living outdoors, the difference between these groups is statistically significant. Staphylococcus aureus was predominantly resistant to penicillin and clindamycin, while plasma non-coagulants were resistant to fusidic acid.

1367. Management of Patients Presenting with Purulent Skin and Soft Tissue Infections in the Emergency Department (ED)

Abstract Background Incision and drainage (I&D) is the primary treatment for purulent skin and soft tissue infection (SSTI). Empiric adjunctive treatment of purulent SSTI targets methicillin-resistant Staphylococcus aureus (MRSA). In light of increasing antibiotic resistance, culture and sensitivity (C&S) from drained specimen and consideration of the local antibiogram are recommended.1 Our primary objective was to assess the utilization of C&S from drained specimen in out institution’s ED. Our secondary objectives were to describe antibiotic choice and duration of therapy upon discharge, to evaluate the appropriateness of antibiotic choice based on C&S and local antibiogram, and to assess the need for adjunctive antibiotic based on available literatures. Methods A retrospective cohort study was performed on a random sample of unique patients who underwent I&D procedure in the ED from January 2019 through December 2019. Demographic and clinical data were collected from the electronic medical record. Results Of 120 patients evaluated, only 14 patients (11.7%) had C&S performed on the initial I&D specimen (Table 1). Five patients received inappropriate antibiotic(s) based on C&S. Of 108 patients who were discharged from ED, antibiotic(s) was prescribed in 97 patients (Table 2). Mean duration of therapy was 7.8 days with 27.8% of patients prescribed a duration of therapy longer than 7 days. Despite high clindamycin resistant rate for MRSA (35%), clindamycin was the second most prescribed antibiotic. Adjunctive antibiotic(s) may have been unnecessary in 9.5% patients. Five patients reported possible adverse reaction related to prescribed antibiotic. Additional antibiotic course was prescribed in 15 patients for the same infection. Fifteen patients were readmitted to ED within 30 days and five of them required hospital admission Conclusion At our institution, majority of patients were discharged after I&D with adjunctive antibiotic(s) without microbiologic testing. Despite high local clindamycin resistance, it was the second most commonly prescribed empiric treatment. Developing a clinical pathway that emphasizes the importance of timely microbiologic testing and local antibiogram consideration along with the need for appropriate adjunctive antibiotics may improve patient outcomes. Disclosures All Authors: No reported disclosures

UJI AKTIVITAS ANTIBAKTERI EKSTRAK ETANOL 96% DAUN MIMBA (Azadirachta indica A. Juss. ) DENGAN METODE EKSTRAKSI PERKOLASI TERHADAP PERTUMBUHAN BAKTERI Staphylococcus aureus

Infeksi kulit yang paling sering didapatkan di negara-negara berkembang terutama di daerah tropis adalah radang kulit bernanah (pioderma) yang penyebab utamanya adalah bakteri Staphylococcus aureus. Semakin banyaknya kasus bakteri yang resisten terhadap antibakteri dapat mendorong penggalian sumber obat-obatan antibakteri dari bahan alam. Salah satu tanaman yang diduga memiliki aktivitas antibakteri Staphylococcus aureus adalah tanaman Mimba. Penelitian bertujuan untuk melakukan uji aktivitas antibakteri dengan metode difusi sumuran dari ekstrak etanol 96% daun Mimba yang telah diesktraksi dengan metode perkolasi. Hasil uji skrining fitokimia didapatkan ekstrak etanol 96% daun Mimba mengandung akaloid, saponin, tanin, steroid/terpenoid, dan flavonoid. Hasil penelitian pada uji aktivitas antibakteri menunjukkan konsentrasi 75% ekstrak etanol 96% daun Mimba tergolong mempunyai aktivitas kuat, pada konsentrasi 50% dan 25% tergolong mempunyai aktivitas sedang. Hal ini menunjukkan bahwa ketiga konsentrasi ekstrak etanol 96% daun Mimba mampu menghambat pertumbuhan bakteri Staphylococcus aureus.

"Panton-Valentine leukocidine"-producerende Staphylococcus aureus als belangrijke pathogeen voor purulente huidinfecties

“Panton-Valentine leukocidin”- producing Staphylococcus aureus is an important pathogen of purulent skin and soft-tissue infections Staphylococcus aureus (S. aureus) colonises the skin, nose or throat in 20% to 30% of the adult population and is the most common pathogen causing mild to moderate skin infections. Panton-Valentine leukocidin (PVL) is an important virulence factor for S. aureus and plays a potential role in the pathogenesis of dermal necrosis. PVL is strongly associated with recurrent purulent skin infections and frequent need for surgical drainage. It is comparatively less common in colonisation and invasive infections (such as pneumonia, musculoskeletal disease and bacteraemia). The number of community-acquired PVLP-SA clones in Belgium remains stable since 2014. PVL-toxin detection in Belgium is limited to the National Reference Centre for S. aureus (LHUB-ULB, Brussels). Because of the limited indications for toxin testing and lack of impact on antibiotic therapy, there is currently no need for PVL-toxin detection outside the reference laboratory. On the other hand, increased awareness can lead to more efficient and systematic decolonisation policies and thereby reduce the risk of recurrent skin infections or outbreaks in (healthcare) institutions. In this case report followed by a literature review, we would like to inform all interested and involved clinicians (general practitioners, dermatologists, internists, paediatricians) about the national guidelines for PVL-toxin detection and the associated approach.

Activity and components of the granulocyte colony-stimulating factor pathway in hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease, characterized by painful, purulent and destructive skin alterations in intertriginous areas. We investigated the expression and role in HS of granulocyte colony-stimulating factor (G-CSF), the regulator of neutrophil biology, as clinical signs of a neutrophilic granulocyte-driven inflammation are distinctive in the disease. Skin and blood samples obtained from different cohorts of patients with HS and control individuals were assessed by RNA sequencing, quantitative polymerase chain reaction on reverse transcribed mRNA, and/or enzyme-linked immunosorbent assay. Mechanistic studies using keratinocytes, dermal fibroblasts, immune cell populations and skin biopsies were performed. G-CSF was abundant in HS skin, particularly in inflamed nodules and abscesses. Its levels even exceeded those found in other inflammatory skin diseases. Interleukin (IL)-1 and IL-17, respectively, induced G-CSF production by fibroblasts and keratinocytes. These effects were enhanced by tumour necrosis factor (TNF)-α and IL-36. Accordingly, fibroblasts separated from HS lesions expressed G-CSF, and IL-1 receptor antagonist reduced G-CSF levels in explanted HS skin. G-CSF blood levels positively correlated with severity of HS. Elevated lesional G-CSF receptor levels were linked to upregulation of molecules that contribute to prolonged activation of neutrophils by components of bacteria and damaged host cells [formyl peptide receptor 1 (FPR1), FPR2 and free fatty acid receptor 2 (FFAR2)], neutrophil survival [TNF receptor superfamily member 10C (TNFRSF10C/TRAIL-R3) and TNF receptor superfamily member 6B], kinases (tyrosine-protein kinase HCK and hexokinase 3), and skin destruction [MMP25 (matrix metalloproteinase 25) and ADAM8 (disintegrin and metalloproteinase domain-containing protein 8)]. G-CSF elevated the expression of FPR1, FFAR2, and TNFRSF10C/TRAIL-R3 in neutrophils and synergized with bacterial components to induce skin-destructive enzymes. The G-CSF pathway engages both tissue and immune cells, is strongly activated in HS lesions, and offers the opportunity to target the neutrophil-driven inflammation.

Amber therapy effect on the inflammatory process severity in purulent wounds in dogs

Studying the amount of fibrinogen in the blood plasma of dogs is essential in determining the severity of the inflammatory process. In this regard, the aim of this work was to establish the level of fibrinogen in animals with the purulent-inflammatory process. The studies were performed by spectrophotometric method according to the generally accepted method. During the studies, the content of fibrinogen in the blood plasma of clinically healthy dogs was determined before medical care and during the wound process on the 3rd, 7th, 10th and 14th days of treatment. The results of the study on dogs with purulent skin wounds revel that the amount of fibrinogen before treatment was 2 times higher (p<0.001) compared with clinically healthy animals. On the 3rd day of the study, the content of fibrinogen in blood plasma in the animals of experimental group 1 and experimental group 2 was, respectively, 1.6 (p<0.001) and 1.5 (p<0.001) times higher than in the clinically healthy animals; the amount of fibrinogen was 1.7 times (p<0.001) higher in the control group of animals than in the clinically healthy dogs. On the 7th day of treatment, the level of fibrinogen in animals of the experimental group 1 was 1.2 times (p<0,01) higher than in clinically healthy dogs, while in the experimental group 2 its content was 1.1 times (p<0.05) higher. In contrast, it was 1.4 times (p<0.001) higher the control group dogs than in clinically healthy animals. Studies have shown that the administration of succinic acid and intravenous 1.5% solution of reamberin, a drug based on succinic acid, restores the level of fibrinogen in the plasma of dogs with purulent wounds on the 10th day of the wound process, compared with intravenous introduction of 5% glucose solution. The best therapeutic effect was obtained in the group of animals treated with 1.5% solution of reamberin

Oral administration of Jumihaidokuto inhibits UVB-induced skin damage and prostaglandin E2 production in HR-1 hairless mice

This study was conducted to investigate whether and how Jumihaidokuto (JHT), a traditional Chinese medicine, prevents UVB-induced skin damage in male HR-1 hairless mice. JHT has been traditionally prescribed for patients presenting skin disorders with redness and swelling, and, in Japan, it is approved for prescription to patients with acute and/or purulent skin disorders, hives, acute eczema, and athlete’s foot. Considering the traditional use of JHT, we hypothesized that oral administration of JHT might emerge as an effective strategy to prevent UVB-induced skin damage, such as edema and erythema. Here, we pretreated mice with JHT (1000 mg/kg, p.o.) for 3 weeks and then administered a single dose of UVB irradiation (250 mJ/cm2) on the dorsal skin. UVB irradiation increased the erythema index and transepidermal water loss (TEWL) and decreased the skin water content in the epidermis at 72 h post-irradiation. JHT treatment inhibited the increase of TEWL and the loss of water content in the epidermis, but not the elevation of the erythema index. Moreover, administration of JHT suppressed UVB-induced epidermal hyperplasia by blocking the proliferation of keratinocytes and also inhibited irradiation-triggered reduction of collagen fibers and infiltration of immune cells into the dermis. Lastly, administration of JHT suppressed UVB-induced production of proinflammatory mediators, such as prostaglandin E2 and interleukin-1β. These results suggest that JHT prevents UVB-induced skin damage and that the underlying mechanism involves the inhibition of proinflammatory mediators.

Vacuum therapy in complex treatment of neuropathic form of diabetic foot syndrome in Ghana

Diabetic foot syndrome (DFS) is a serious public health problem in developing countries, where medical resources are limited, and the vast majority of patients turn to medical facilities too late with severe forms of the disease and often in advanced stages.Objective: to evaluate the effectiveness of negative pressure wound therapy (NPWT) in treating patients with a neuropathic form of DFS compared with traditional methods to reduce the number of high amputations and overall mortality in Ghana.Materials and research methods. A prospective, non-randomized, comparative clinical study of the results of examination and treatment of 59 patients with type 2 diabetes mellitus (DM) was performed at the Seventh-day Adventist City Hospital (Ghana, West Africa), Kumasi University Hospital and the Effiduase District Hospital (Ghana, West Africa) in the period from January 1, 2011 to December 31, 2013, there were 37 female patients (63.3 %), 22 male patients (36.7 %). The volume of foot tissue damage varied from II to IV degree according to Wagner classification (II degree was diagnosed in 55.6 % of cases). The average age of patients was 31.5 ± 7.3 (20–72) years. The average duration of DM was 7.3 ± 4.2 years. Bacteriological examination of wounds showed that Staphylococcus aureus was most often an isolated pathogen. All microorganisms identified from patients’ wounds had high resistance to commonly used antibiotics. Patients were randomly assigned to groups. NPWT is the only topical treatment in the main group; traditional dressings with antiseptic solutions (iodophors) were used in the comparison group.Study results. Comprehensive treatment of patients in both groups included surgical debridement of purulent foci, local treatment (NPWT or dressings with antiseptic solutions) and skin grafting or healing by secondary intention after the transition of the wound process to the reparative stage. None of the patients in both groups had a high amputation. Not a single fatal outcome has been recorded. In patients of the main group, the transition of the wound process to the reparative stage was carried out in a shorter time compared with those treated without NPWT.Conclusion. Treatment of the neuropathic form of DFS with the NPWT (for example, patients in Ghana) reduces the hospital stay and the number of high amputations of the lower extremities, and improves the quality of life of patients.

Odontogenic Infections with Cutaneous Involvement in Children: a Case Series

Cutaneous involvement of dental sepsis is a rare occurrence in children. It often presents as a diagnostic dilemma, especially in the absence of oral symptoms, with initial presentation to non-dental professionals. This article discusses three cases of children presenting with cutaneous involvement of odontogenic origin to two paediatric dentistry departments in the UK. All cases had delayed presentations and were initially submitted to ineffective treatment, with significant impact on the children’s well-being. Final management included antibiotic therapy, drainage and extraction of the septic tooth. These three cases highlight the importance of considering a dental aetiology for localized inflammatory and purulent skin lesions of the mandible. Prompt diagnosis and early treatment are determinant for early resolution and avoidance of systemic or psychological complications. CPD/Clinical Relevance: This article discusses diagnosis and management of three different presentations of odontogenic sepsis with cutaneous involvement in children.

Diagnosis of Papillon-Lefèvre syndrome: review of the literature and a case report.

Papillon-Lefëvre syndrome (PLS), classified as ectodermal dysplasia, is an autosomal recessive condition related to the cathepsin C (CTSC) gene mutation. The first clinical symptoms, occurring most commonly between the ages of 1 and 4, are palmoplantar hyperkeratosis and also periodontitis resulting in the loss of most or all teeth in the same sequence in which they erupted. Most often the redness of palms and soles precede the occurrence of keratoderma. Moreover, excessive sweating, moderate mental retardation, the tendency to purulent skin and internal organs infection may occur. Lack of cathepsin seems to have a crucial role in the intensity of symptoms. In most of the patients, there can be observed impairment of phagocytosis and chemotaxis of neutrophils, granulocytes, leukocytes and cytotoxic lesion of fibroblasts and macrophages. Also, functional impairment of lymphocytes, neutrophils, and monocytes is observed. The study, using flow cytometry, showed a decreased percentage of T cells CD8+ and increased CD4:CD8 ratio.

Sub-Inhibitory Concentrations of Sodium Houttuyfonate in Combination with Erythromycin Inhibit Biofilm Formation and Expression of IcaA in Staphylococcus epidermidis

Background: Staphylococcus epidermidis is an important opportunistic pathogenic bacterium causing infections on implanted medical devices by biofilm formation. Sodium houttuyfonate (SH), which is the active modified compound of Houttuynia cordata is commonly applied for treating chronic bronchitis, purulent skin infections, and respiratory tract infections in China. Objectives: We aimed to investigate the in vitro effects of SH in combination with erythromycin on the production of IcaA and expression of icaA to shed the light on the mechanism of SH and erythromycin in inhibiting biofilm formation of S. epidermidis. Methods: The morphology of the biofilm of S. epidermidis was examined under a scanning electron microscope. Furthermore, inhibitory effects of SH and erythromycin on the production of IcaA and the expression of icaA were detected by Western blotting and quantitative reverse transcription PCR, respectively. Results: First, the morphological results indicated that combing SH and erythromycin at sub-MIC concentrations can effectively inhibit biofilm formation of S. epidermidis. Furthermore, our presented results showed that combing SH and erythromycin at sub-MIC concentration can significantly downregulate the expression of icaA and repress the protein production of IcaA at irreversible attachment and maturation stages of biofilm formation of S. epidermidis. Conclusions: Therefore, our findings suggest that the potent antibiofilm activity of SH in combination with erythromycin against S. epidermidis may be partially due to inactivation of icaA.

National Trends in Incidence of Purulent Skin and Soft Tissue Infections in Patients Presenting to Ambulatory and Emergency Department Settings, 2000-2015.

Nationally representative data from 2000-2015 demonstrated a rise in the incidence of outpatient visits for skin infections, peaking in 2010-2013, followed by a plateau. While cephalexin was the most frequently prescribed antibiotic at the beginning, trimethoprim-sulfamethoxazole was most frequently prescribed by the end of the study period.

Prevalence of Community-Acquired Pyoderma in Dermatological Outpatient Department of A Tertiary Care Hospital

Pyoderma is defined as any purulent skin disease and represents infections in epidermis and dermis or hair follicles. This study aims to find out the prevalence of community-acquired pyoderma in dermatological outpatient department of a tertiary care hospital. A descriptive cross-sectional study was carried out among patients who presented at dermatology outpatient department of Kathmandu Medical College Teaching Hospital between December 2018 and March 2019 after ethical clearance from institutional review committee. Convenience sampling method was done. Data was collected and analysis was done using SPSS software, point estimate at 95% CI was calculated along with frequency and proportion for binary data. Out of 385 cases, 72 (18%) cases were of community-acquired pyoderma. Prevalence of community-acquired pyoderma is 72 (18%). Primary pyoderma was seen in 49 (12.72%) mainly folliculitis 17 (4.41%), furunculosis 16 (4.15%), impetigo 6 (1.55%), abscess 6 (1.55%) and bacterial paronychia 4 (1.03%). Staphylococcus aureus was the most common organism isolated in 42 (58.3%) cases and Staphylococcus epidermidis was isolated in 3 (4.17%) cases. Staphylococcus aureus was most sensitive to Vancomycin 42 (100%) followed by Gentamycin 40 (95.2%), Ciprofloxacin 40 (95.2%) and Ceftriaxone 40 (95.2%). Highest resistance was seen to Azithromycin in 13 (30.95%), followed by Cloxacilllin in 11 (26.19%). Males were affected predominantly in 49 (68.06%) as compared to females in 23 (31.94%). Prevalence of community-acquired pyoderma is high among patients visiting dermatological outpatient departments of a tertiary care hospital compared to other studies. Antibiotic resistance of commonly used antibiotics are increasing and thus proper culture and sensitivity reports may be required to guide our treatment.

Prevalence and Risk Factors for Positive Nasal Methicillin-Resistant Staphylococcus aureus Carriage Among Orthopedic Patients in Korea.

Methicillin-resistant Staphylococcus aureus (MRSA) causes purulent skin and soft tissue infections as well as other life-threatening diseases. Recent guidelines recommend screening for MRSA at the time of admission. However, few studies have been conducted to determine the prevalence and risk factors for MRSA colonization. A prospective data collection and retrospective analysis was performed. MRSA screening tests were performed using nasal swabs in patients enrolled between January 2017 and July 2018. Demographic data, socio-economic data, medical comorbidities, and other risk factors for MRSA carriage were evaluated among 1577 patients enrolled in the study. The prevalence of MRSA nasal carriage was 7.2%. Univariate regression analysis showed that colonization with MRSA at the time of hospital admission was significantly related to patient age, body mass index, smoking, alcohol, trauma, recent antibiotic use, and route of hospital admission. Multiple logistic regression analysis for the risk factors for positive MRSA nasal carriage showed that being under- or overweight, trauma diagnosis, antibiotic use one month prior to admission, and admission through an emergency department were related to MRSA colonization. This study highlights the importance of a preoperative screening test for patients scheduled to undergo surgery involving implant insertion, particularly those at risk for MRSA.

Evaluation of the efficacy of modern wound care dressings in the complex treatment of purulent wounds

Objective. Evaluate the efficacy of the treatment of purulent skin and soft tissue wounds using modern interactive dressings and conventional wound care dressings. Material and methods. The study included 160 patients, who were treated at the outpatient department of the Clinic of the SamGMU for the period from September 2018 to January 2019 after an autopsy, necrosectomy and drainage of purulent foci in the surgical hospital. Group I (n = 82) included patients, who applied Sorbalgon® interactive dressing (Paul Hartmann, Germany) during the first phase of the wound healing and Branolind® N atraumatic mesh dressing (Paul Hartmann, Germany) during the second phase of the wound healing for topical treatment of wounds in the postoperative period. Patients of Group II (n = 78) applied ointment dressings using Levomekol ointment during the first phase of the wound healing and Methyluracil ointment during the second phase of the wound healing. Patients in both groups received the same broad spectrum antibacterial therapy. In Group I, the dressings were applied once per 2 days, in Group II the dressings were applied on a daily basis. The researchers studied the following indicators: the nature of the wound discharge; the presence of edema and hyperemia of tissues; timing of the wound defect cleansing; temperature and leukocyte reactions of the body; crops on microflora and sensitivity to antibiotic therapy. Results. The study showed more pronounced dynamics of the temperature reaction normalization, reduction of the local inflammatory reaction and the leukocytosis level in patients of Group I. The wound cleansing from pus and fibrin, the development of granulation tissue on Day 5 were reported in 87.8% of patients of Group I and in 35.9% of patients of Group II, on Day 10 in 100% and 88.5% of patients, respectively. Conclusion. The use of Sorbalgon® and Branolind® N dressings improves the results of treatment of patients with purulent soft tissues pathology and reduces the risk for secondary infection, and improves the quality of life due to increase of interval between the dressings.

Determination of daptomycin in human plasma and breast milk by UPLC/MS-MS

During the lactation, the choice of a proper antibiotic is crucial since the drug can cross into breast milk causing toxicity to the infant. Therefore, an extraction protocol and LC/MS-MS method for the determination of daptomycin in human milk and plasma were developed, validated and applied to a case of a breastfeeding mother affected by a purulent acute soft skin infection treated with daptomycin. Because of daptomycin high protein binding and its high molecular weight, the optimisation of the extraction protocol and analytical conditions were deeply investigated, and several parameters were taken into account: in particular the type of extraction, internal standard, the type of organic modifier, pH of the aqueous solution, and gradient. The use of a protein precipitation protocol coupled to a C8-reverse phase LC-MS/MS allows for a reliable quantification of daptomycin in both plasma (in the range of 19–199 μg/mL) and breast milk (in the range of 0.12–0.32 μg/mL). The determination of milk/plasma (M/P) ratio, which ranged from 0.002 to 0.006, allowed to assess that daptomycin, effective for the mother, was contemporarily safe for the breastfed newborn.

Морфофункциональная характеристика репаративного гистогенеза при лечении гнойных ран кожи

Морфофункциональная характеристика репаративного гистогенеза при лечении гнойных ран кожи

The IL-1 Pathway Is Hyperactive in Hidradenitis Suppurativa and Contributes to Skin Infiltration and Destruction

Hidradenitis suppurativa (HS) (also designated acne inversa) is a chronic inflammatory disease characterized by painful purulent skin lesions and progressive destruction of skin architecture. Despite the high burden for the patients, pathogenetic pathways underlying HS alterations remain obscure. When we examined the HS cytokine pattern, IL-1β turned out to be a highly prominent cytokine, overexpressed even compared with psoriatic lesions. Analyses of IL-1β-induced transcriptome in various cell types showed overlapping profiles, with upregulations of molecules causing immune cell infiltration and extracellular matrix degradation, and of specific cytokines including IL-6, IL-32, and IL-36. Matching cellular IL-1 receptor levels, dermal fibroblasts showed both the strongest and broadest IL-1β response, which was not clearly shared or strengthened by other cytokines. The IL-1β signature was specifically present in HS lesions and could be reversed by application of IL-1 receptor antagonist. Search for blood parameters associated with IL-1β pathway activity in HS identified serum amyloid A, which was synergistically induced by IL-1β and IL-6 in hepatocytes. Consequently, strongly elevated blood serum amyloid A levels in HS correlated positively with the extent of inflammatory skin alterations. In summary, the IL-1β pathway represents a pathogenetic cascade, whose activity may be therapeutically targeted and monitored by blood SAA levels.

Scrofuloderma with disseminated tuberculosis in an Ethiopian child: a case report

BackgroundCutaneous tuberculosis represents only 1–2% of extrapulmonary forms of tuberculosis. Scrofuloderma is an endogenous form of cutaneous tuberculosis and can present as isolated or coexist with pulmonary and disseminated forms of tuberculosis. Pathologically confirmed scrofuloderma coexisting with disseminated tuberculosis with a good treatment response is presented and discussed.Case presentationA 12-year-old African Ethiopian girl presented with bilateral neck swelling with purulent discharge and skin ulceration of 3 months’ duration. Dry cough, low-grade fever, decreased appetite, drenching night sweats, global throbbing headache, and a significant amount of weight loss were also reported. Biopsy of the skin identified scrofuloderma, and Mycobacterium tuberculosis was also identified by Xpert MTB/RIF assay. Cerebrospinal fluid analysis and brain computed tomographic scans showed tuberculous meningitis and tuberculoma. Antituberculosis therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol; prednisolone; pyridoxine; and wound care were provided. The patient was discharged for outpatient directly observed antituberculosis therapy in a nearby health center after acute complications were treated and once the skin lesion had started to dry or heal.ConclusionsCutaneous tuberculosis should be considered in a child presenting with a skin lesion or discharge. Cutaneous tuberculosis cases should be investigated for coexisting pulmonary and extrapulmonary forms of tuberculosis. Histopathologic diagnosis should be considered to rule out other skin pathologies and also to prevent delay in treatment. Better tuberculosis prevention strategies, including vaccination scale-up, are warranted.

Ultrasound features of purulent skin and soft tissue infection without abscess.

Ultrasound (US) aids clinical management of skin and soft tissue infection (SSTI) by differentiating non-purulent cellulitis from abscess. However, purulent SSTI may be present without abscess. Guidelines recommend incision and drainage (I & D) for purulent SSTI, but US descriptions of purulent SSTI without abscess are lacking. We retrospectively reviewed pediatric emergency department patients with US of the buttock read as negative for abscess. We identified US features of SSTI with adequate interobserver agreement (kappa > 0.45). Six independent observers then ranked presence or absence of these features on US exams. We studied association between US features and positive wound culture using logistic regression models (significance at p < 0.05). Of 217 children, 35 patients (16%) had cultures positive for pathogens by 8h after US and 61 patients (32%) had cultures positive by 48h after US. We found kappa > 0.45 for focal collection > 1.0cm (κ = 0.57), hyperemia (κ = 0.57), swirling with compression (κ = 0.52), posterior acoustic enhancement (κ = 0.47), and cobblestoning or branching interstitial fluid (κ = 0.45). Only cobblestoning or interstitial fluid was associated with positive wound cultures in logistic regression models at 8 and 48h. Cobblestoning or interstitial fluid on US may indicate presence of culture-positive, purulent SSTI in patients without US appearance of abscess. Although our study has limitations due to its retrospective design, this US appearance should alert imagers that the patient may benefit from early I & D.