Infection Of Subcutaneous Tissue Research Articles

The relationship between mental health problems and risk of infectious diseases: A Mendelian randomization analysis.

The causal effects of mental health problems on the risk of infectious diseases remain vague. Investigating them via observational study is challenging as it presents possible confounding factors. Therefore, the objective of this study was to utilize Mendelian randomization (MR) techniques to evaluate the causal relationship between mental health problems and the risk of infectious diseases. Multivariable MR analyses were performed using genome-wide association data for sleep disorders (N = 216,700), depression (N = 500,199), anxiety (N = 290,361), nervous feelings (N = 450,700), unspecified mental disorder (N = 218,792), pneumonia (N = 486,484), skin and subcutaneous tissue infection (SSTI; N = 218,792), intestinal infectious diseases (IIDs; N = 218,792), urinary tract infection (N = 463,010), and central nervous system (CNS) infections (N = 218,792) among individuals of European ancestry. Independent genetic variants significantly (P < 10-8) associated with each exposure were considered instruments. The primary analysis used an inverse variance-weighted method, followed by a series of sensitivity analyses. Genetically predicted sleep disorders were associated with an increased risk of SSTI (odds ratio [OR], 1.29 [95% confidence interval (CI), 1.05-1.59]; P = .017). Genetically predicted depression was linked with an increased risk of CNS infections (OR, 1.59 [95% CI, 1.00-2.53]; P = .049) and SSTI (1.24 [95% CI, 1.03-1.49]; P = .024). Genetically predicted anxiety was associated with IIDs (OR, 1.19 [95% CI, 1.03-1.37]; P = .017) and SSTI (OR, 1.21 [95% CI, 1.02-1.43]; P = .029). There was no significant causal evidence for genetic prediction of nervous feelings and unspecified mental disorders in IIDs, CNS infections, SSTI, pneumonia, or urinary tract infection. Sensitivity analyses showed that the above causal association estimates were robust. In this MR study, we demonstrated a causal relationship between sleep disorders, depression, anxiety, and the risk of infectious diseases. However, no evidence was found to support causality between nervous feelings, unspecified mental disorders, and the risk of infectious diseases.

Chromoblastomycosis: A Single Centre Clinical Laboratory Experience of Seven Years (2016-2022) and Literature Review From Pakistan.

Chromoblastomycosis (CBM) is a chronic infection of skin and subcutaneous tissue. CBM cases have been reported in local literature from Pakistan with heterogenous demographic, diagnostic and therapeutic information. The objective of this study is to share the experience of CBM from a large tertiary care hospital laboratory in Pakistan. This was a retrospective observational study. Histopathology and microbiology data of suspected CBM between 2016 and 2022 was retrieved. Patients' demographics, site of involvement, histopathological findings and positive microbiology cultures were assessed. Literature search on Google Scholar, PubMed and PakMediNet was done between 1990 and 2023 with multiple terms. A total of 16 CBM cases were identified; 14 were histopathology positive and two were both histopathology and culture positive. The median age was 21 years, and 11 patients were male. The predominant site was lower extremities followed by the face. Severe acanthosis, hyperkeratosis and granuloma with sclerotic bodies were observed in all histopathology slides. Alternaria spp. and Phialophora spp. were isolated from two culture-positive cases. A total of nine cases of CBM were reported from Pakistan in PubMed non-indexed journal. CBM is not a commonly thought of disease when evaluating skin lesions in Pakistan. A high index of suspicion when assessing patients who may have a history of trauma, exposure to soil and suggestive lesions is reasonable. An integrated approach between clinicians, histopathologist and microbiologist is required to do early identification and therapeutic interventions.

Comparative safety of oral Janus kinase inhibitors and dupilumab in patients with atopic dermatitis: a population-based cohort study

BackgroundSystemic Janus kinase inhibitors (JAKi) and dupilumab both have emerged as promising therapeutics for atopic dermatitis (AD). While dupilumab has a favorable safety profile, use of oral JAKi has been established in other diseases that carry potential comorbid susceptibilities that influence safety. ObjectiveTo provide real-world evidence of the safety of oral JAKi in AD patients. MethodsThe study used observational data from TriNetX (Cambridge, Massachusetts). Patients with AD treated with either oral JAKi (upadacitinib, abrocitinib, and baricitinib) or dupilumab were enrolled. The two treatment groups were propensity-score matched 1:1 based on demographics, comorbidities, and prior medications. Safety outcomes within two years after the initiation of medications were measured by hazard ratios with 95% confidence intervals. ResultsA total of 14,716 patients were included, with 942 patients treated with oral JAKi and 13,774 with dupilumab. The two treatment groups included 938 patients after matching. Treatment with oral JAKi was not associated with increased risks of mortality, malignancies, major adverse cardiovascular events, venous thromboembolism, renal events, or serious gastrointestinal events. However, patients receiving oral JAKi showed significantly higher risks of skin and subcutaneous tissue infection, herpes infection, acne, cytopenia, and hyperlipidemia, whereas the risk of ophthalmic complications was higher in those receiving dupilumab. ConclusionThis study found that oral JAKi did not exhibit concerning safety issues in treating patients with AD but increased the risk of infections and laboratory abnormalities. Long-term follow-up data are required to validate these findings

PET/CT Recognition of Costal Cartilage Infection After Breast Implant Surgery.

Postoperative infection of breast implants can lead to implant removal and other complications. This study aimed to investigate the presence of costal cartilage infection following breast implant surgery and the diagnostic role of PET/CT in identifying this rare complication. A retrospective study included 16 patients with persistent infections after breast implant removal surgery. Patients underwent PET/CT scans before surgery, and surgical plans were made based on PET/CT findings. Surgical procedures were guided by PET/CT, and specimens were collected for pathological examination and microbiological culture. Follow-up assessments were performed at 1, 3, and 12 months postoperatively. Among the 16 patients, 11 were diagnosed with costal cartilage infection, whereas 5 had subcutaneous soft tissue infections. PET/CT accurately identified costal cartilage infection in all cases and localized the infected costal cartilage in the majority of cases. Microbiological culture results showed various pathogens. All patients were cured with one or staged surgery. Costal cartilage infection following breast implant surgery is a significant concern. PET/CT plays a crucial role in the accurate diagnosis and localization of infected costal cartilage, aiding in appropriate surgical management. Patients should be closely monitored for the possibility of costal cartilage infection when experiencing persistent symptoms after breast implant surgery.

To assess the diagnostic accuracy of LRINEC Score for prediction of necrotizing fasciitis in patients presenting with clinical skin and subcutaneous tissue infections

To assess the diagnostic accuracy of LRINEC Score for prediction of necrotizing fasciitis in patients presenting with clinical skin and subcutaneous tissue infections

Enhancing Early Detection of Necrotizing Soft Tissue Infections: The Role of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score.

Background There is great variation in the etiology, predisposing organisms, incidence, clinical characteristics, severity, and consequences of skin and/or subcutaneous tissue infections. Extensive necrosis of the subcutaneous tissues and fascia is a characteristic of necrotizing soft tissue infections, which are frequently deadly. To change the course of treatment, this study highlights the need to find a tool that can quickly and accurately identify patients with necrotizing fasciitis (NF) and assist in making an early treatment decision. Methodology A prospective evaluation of 30 individuals with soft tissue infections was conducted using the laboratory risk indicator for necrotizing fasciitis (LRINEC). The patients were classified as low, intermediate, and high risk for the start of NF based on their LRINEC score. To assess the importance of the LRINEC score in forecasting the start of NF and its clinical consequences, patients in each group underwent appropriate management and statistical analysis. Results This study included 28 males (93.3%) and two females (6.7%). The associated p-value, recorded as 0.039, signifies statistical significance in the observed area under the receiver operating characteristic (ROC) curve. The p-value in risk categorization was found to be 0.296, which suggests that LRINEC helps in risk categorization with 100% sensitivity when used as a screening tool. Conclusion The early detection of necrotizing soft tissue infections, such as NF, is vital. The LRINEC score, based on routine lab tests, accurately distinguishes these infections. With high sensitivity and significant p-values, it helps stratify patients, guiding timely interventions and saving lives.

Tocilizumab for advanced non-small cell lung cancer with concomitant inflammatory cachexia: A single-centre study.

2647 Background: Cancer cachexia significantly contributes to morbidity and mortality in patients with non-small cell lung cancer (NSCLC). Inflammatory pathways mediated by interleukin-6 play a crucial role in the development of cancer cachexia. This study aimed to investigate the use of tocilizumab, an anti-interleukin-6 receptor inhibitor, in the management of NSCLC with coexisting inflammatory cachexia. Methods: Data were collected from patients with NSCLC and concurrent inflammatory cachexia who received either tocilizumab plus anti-tumour therapy or anti-tumour therapy alone. The primary endpoints were overall survival (OS) and improved modified Glasgow Prognostic Score (mGPS) at week 12, while secondary endpoints included changes from baseline over 12 weeks in body weight, albumin, C-reactive protein and mGPS. Qualitative improvements in patient self-rated appetite and fatigue were reported as exploratory analysis. Results: The study included 49 patients diagnosed with NSCLC and coexisting inflammatory cachexia, of which 26 received tocilizumab in combination with anti-tumour therapy, and 23 received anti-tumour therapy alone. The tocilizumab group demonstrated a significantly longer median OS compared to the control group (15.1 vs. 3.2 months; hazard ratio 0.18, 95% confidence interval 0.08-0.38; p &lt; 0.001). The rate of patients surviving with mGPS improvement at week 12 was significantly higher in the tocilizumab group than in the control group (OR 168.7, 95% CI 16.3-1746.5; p &lt; 0.001). Over the 12-week period, significant improvements were observed in body weight, albumin, C-reactive protein, and mGPS in the tocilizumab group compared to the control group. Additionally, the tocilizumab group displayed significantly higher rates of improvement in appetite and fatigue. The incidence of grade 3 or higher adverse events was 34.6% in the tocilizumab group compared to 78.3% in the control group. Tocilizumab-related adverse events were observed in three patients (11.5%), including two cases of neutropenia and one case of skin and subcutaneous tissue infection. Conclusions: Tocilizumab demonstrated significant benefits in survival and various clinical parameters, including body weight, albumin, C-reactive protein, mGPS, and symptom burden in patients with NSCLC and concurrent inflammatory cachexia. Given the existing unmet medical need for effective interventions for cancer cachexia, tocilizumab may be considered as a potential treatment option.

A case report on eumycetoma: An uncommon disease in the suburban areas of Maharashtra

Mycetoma is an uncommon chronic granulomatous infection of cutaneous and subcutaneous tissues. The causal agents are soil saprophytes with around 33 species identified, namely bacteria or fungi. The World Health Organization categorized mycetoma as a neglected tropical disease. In India, the southern states have a high prevalence. Our case report presents the case of a 37-year-old male patient who presented to the hospital for diagnosis and treatment of foot swelling in his right foot region. Initially, the cause of the lesion was unknown. After radiology and laboratory investigations, the case was diagnosed with Mycotic Mycetoma or Eumycetoma. Although this study reports a single case, the findings might expand our understanding of mycetoma and its prevalence, even in the uncommon suburban regions of Maharashtra. Reporting neglected tropical diseases can alert healthcare about their spread and global burden, even in uncommon areas.

P15 UK Antimicrobial Registry Study: progress to date

Abstract Background Effective antimicrobial stewardship is key in the fight against antimicrobial resistance, a key element of which is the surveillance of antimicrobial use and antimicrobial resistance. In addition to quantitative analysis of antibiotic use trends it is also important to understand qualitative aspects of how antimicrobials are used in routine clinical settings. Objectives The UK Antimicrobial Registry (UKAR) Study, a 5 year collaboration between BSAC and the University of Aberdeen, aims to determine how recently licensed antimicrobial agents are being used, their effectiveness and safety. The study is included in the NIHR portfolio in England with similar arrangements in Scotland and Wales. Here, we present brief information on the first few months of participant recruitment. Methods The study commenced recruiting patients prescribed selected antibiotics in May 2023. The intention was to commence with a small number of pilot hospital sites then to expand to a larger number of hospitals. Adult patients are potentially eligible if they have been prescribed any drug on the eligible drug list within their current stay in hospital unless the drug is actively withdrawn after less than 24 h. Data are collected from the medical records of participants who have given informed consent. Clinical data, including infection, microbiology susceptibility testing, eligible drug and dosing regimens are collected as well as prior and concurrent antibiotic therapy. Results As of November 2023, the study is open to recruitment in nine sites across the UK. There are a further 22 sites across the UK in study set-up and a further 15 sites who have submitted an expression of interest to join the registry. Fifty-two patients have been recruited as of November 2023. Five of the 11 study drugs were prescribed; the majority of the participants (N=29) were prescribed dalbavancin, the remainder received various Gram-negative agents (Table 1). Study drugs were used to treat bone and joint infections (33%) and lower respiratory tract infections (33%), with other disease areas including skin and subcutaneous tissue infections and urinary tract infections. Conclusions A key objective for UKAR pilot sites was to verify that the data collection process was feasible and address any issues around clarity of responses. Very few issues were identified, and all were resolved quickly. Early data show that participants are most likely to be female with a median age above 60 years. There is also, currently, a preponderance of patients commencing dalbavancin, although the study is still in its infancy. As more sites recruit participants to the UKAR Study, more detailed analyses can be performed on the clinical usage and outcomes being achieved. Also, follow-up data including clinical outcomes and adverse events will be collected 56 days after commencing therapy, and 28 days after last administration of an eligible study drug. In addition, clinical outcomes and relapse of the initial infection will be recorded at 6 and 12 months.

Causal effects and immune cell mediators between prescription analgesic use and risk of infectious diseases: a Mendelian randomization study.

Clinical observations have found that prolonged use of analgesics increases the incidence of infection. However, the direct causal relationship between prescription analgesic use (PAU) and risk of infection (ROI) remains unclear. This study used Mendelian randomization (MR) design to estimate the causal effect of PAU on ROI, as well as their mediating factors. Genetic data on prescription analgesics use and immune cells were obtained from published GWAS. Additionally, data on ROI were extracted from the FinnGen database. Two-sample MR analysis and multivariate MR (MVMR) analysis were performed using inverse variance weighting (IVW) to ascertain the causal association between PAU and ROI. Finally, 731 immune cell phenotypes were analyzed for their mediating role between analgesics and infection. Using two-sample MR, IVW modeling showed that genetically predicted opioid use was associated with increased risk of pulmonary infection (PI) (OR = 1.13, 95% CI: 1.05-1.21, p< 0.001) and upper respiratory infection (URI) (OR = 1.18, 95% CI: 1.08-1.30, p< 0.001); non-steroidal anti-inflammatory drugs (NSAIDs) were related to increased risk of skin and subcutaneous tissue infection (OR = 1.21, 95% CI: 1.05-1.39, p = 0.007), and antimigraine preparations were linked to a reduced risk of virus hepatitis (OR = 0.79, 95% CI: 0.69-0.91, p< 0.001). In MVMR, the association of opioids with URI and PI remained after accounting for cancer conditions. Even with a stricter threshold (p< 0.05/30), we found a significant causal association between opioids and respiratory infections (URI/PI). Finally, mediation analyses found that analgesics influence the ROI through different phenotypes of immune cells as mediators. This MR study provides new genetic evidence for the causal relationship between PAU and ROI, and the mediating role of immune cells was demonstrated.

Causal relationship between blood metabolites and risk of five infections: a Mendelian randomization study

ObjectiveInfectious diseases continue to pose a significant threat in the field of global public health, and our understanding of their metabolic pathogenesis remains limited. However, the advent of genome-wide association studies (GWAS) offers an unprecedented opportunity to unravel the relationship between metabolites and infections.MethodsUnivariable and multivariable Mendelian randomization (MR) was commandeered to elucidate the causal relationship between blood metabolism and five high-frequency infection phenotypes: sepsis, pneumonia, upper respiratory tract infections (URTI), urinary tract infections (UTI), and skin and subcutaneous tissue infection (SSTI). GWAS data for infections were derived from UK Biobank and the FinnGen consortium. The primary analysis was conducted using the inverse variance weighted method on the UK Biobank data, along with a series of sensitivity analyses. Subsequently, replication and meta-analysis were performed on the FinnGen consortium data.ResultsAfter primary analysis and a series of sensitivity analyses, 17 metabolites were identified from UK Biobank that have a causal relationship with five infections. Upon joint analysis with the FinGen cohort, 7 of these metabolites demonstrated consistent associations. Subsequently, we conducted a multivariable Mendelian randomization analysis to confirm the independent effects of these metabolites. Among known metabolites, genetically predicted 1-stearoylglycerol (1-SG) (odds ratio [OR] = 0.561, 95% confidence interval [CI]: 0.403–0.780, P < 0.001) and 3-carboxy-4-methyl-5-propyl-2-furanpropanoate (CMPF) (OR = 0.780, 95%CI: 0.689–0.883, P < 0.001) was causatively associated with a lower risk of sepsis, and genetically predicted phenylacetate (PA) (OR = 1.426, 95%CI: 1.152–1.765, P = 0.001) and cysteine (OR = 1.522, 95%CI: 1.170–1.980, P = 0.002) were associated with an increased risk of UTI. Ursodeoxycholate (UDCA) (OR = 0.906, 95%CI: 0.829–0.990, P = 0.029) is a protective factor against pneumonia. Two unknown metabolites, X-12407 (OR = 1.294, 95%CI: 1.131–1.481, P < 0.001), and X-12847 (OR = 1.344, 95%CI: 1.152–1.568, P < 0.001), were also identified as independent risk factors for sepsis.ConclusionsIn this MR study, we demonstrated a causal relationship between blood metabolites and the risk of developing sepsis, pneumonia, and UTI. However, there was no evidence of a causal connection between blood metabolites and the risk of URTI or SSTI, indicating a need for larger-scale studies to further investigate susceptibility to certain infection phenotypes.

Epidemiological and clinical aspects of sporotrichosis in patients seen at a reference hospital in Madagascar.

Sporotrichosis is a subacute to chronic fungal infection of skin and subcutaneous tissues, caused by dimorphic fungi belonging to the genus Sporothrix, commonly seen in tropical and subtropical regions like Madagascar. This study describes the epidemiological, clinical, and the treatment outcomes with itraconazole for sporotrichosis. A descriptive retrospective study on patients suffering from sporotrichosis, from March 2013 to January 2019, was conducted, in the reference center for endemic mycoses. Patients with sporotrichosis who received itraconazole for at least 3 months were included in the study. Patients received itraconazole 200 mg daily for 3 to 6 months. Therapeutic responses were evaluated at months 3 and 6 after treatment. Outcomes were classified as minor response, major response, cure, and failure. Forty-three cases of sporotrichosis were included. The median age of patients was 40 years. Most of them (62.8%) were rural workers. Men were more frequently infected (72%). At the end of 6th month of treatment, 20 patients (46.5%) were cured and a major response to itraconazole was observed in 8 patients (18.6%). The cure rate was higher in 12 patients (27.9%) who had disease durations of less than to one year than in those who had more time of disease (18.6%) (p = 0.01). Thirteen patients (30.2%) were lost to follow up. The rate of lost to follow-up was also higher (39.5%) in patients who had sporotrichosis of less than to one year than in those who had more time of disease. The cure rate found in this study was inferior to that reported in the literature. However, it was higher in patients with early symptomatology.

Necrotizing Fasciitis of Breast: A Rare but Fatal Entity

Necrotising fasciitis is a rapidly developing, fatal bacterial infection of deep subcutaneous tissues. It may occur at any site in the body; breast being a rare site. We describe a case of necrotizing fasciitis in the breast that was diagnosed on the basis of ultrasound and CT scan findings.

Statistical modeling based on structured surveys of Australian native possum excreta harboring Mycobacterium ulcerans predicts Buruli ulcer occurrence in humans.

Buruli ulcer (BU) is a neglected tropical disease caused by infection of subcutaneous tissue with Mycobacterium ulcerans. BU is commonly reported across rural regions of Central and West Africa but has been increasing dramatically in temperate southeast Australia around the major metropolitan city of Melbourne, with most disease transmission occurring in the summer months. Previous research has shown that Australian native possums are reservoirs of M. ulcerans and that they shed the bacteria in their fecal material (excreta). Field surveys show that locales where possums harbor M. ulcerans overlap with human cases of BU, raising the possibility of using possum excreta surveys to predict the risk of disease occurrence in humans. We thus established a highly structured 12 month possum excreta surveillance program across an area of 350 km2 in the Mornington Peninsula area 70 km south of Melbourne, Australia. The primary objective of our study was to assess using statistical modeling if M. ulcerans surveillance of possum excreta provided useful information for predicting future human BU case locations. Over two sampling campaigns in summer and winter, we collected 2,282 possum excreta specimens of which 11% were PCR positive for M. ulcerans-specific DNA. Using the spatial scanning statistical tool SaTScan, we observed non-random, co-correlated clustering of both M. ulcerans positive possum excreta and human BU cases. We next trained a statistical model with the Mornington Peninsula excreta survey data to predict the future likelihood of human BU cases occurring in the region. By observing where human BU cases subsequently occurred, we show that the excreta model performance was superior to a null model trained using the previous year's human BU case incidence data (AUC 0.66 vs 0.55). We then used data unseen by the excreta-informed model from a new survey of 661 possum excreta specimens in Geelong, a geographically separate BU endemic area to the southwest of Melbourne, to prospectively predict the location of human BU cases in that region. As for the Mornington Peninsula, the excreta-based BU prediction model outperformed the null model (AUC 0.75 vs 0.50) and pinpointed specific locations in Geelong where interventions could be deployed to interrupt disease spread. This study highlights the One Health nature of BU by confirming a quantitative relationship between possum excreta shedding of M. ulcerans and humans developing BU. The excreta survey-informed modeling we have described will be a powerful tool for the efficient targeting of public health responses to stop BU. This research was supported by the National Health and Medical Research Council of Australia and the Victorian Government Department of Health (GNT1152807 and GNT1196396).

A homoeopathic approach on cellulitis

The most frequent reason for hospitalisation for skin-related conditions is cellulitis, a deep dermal and subcutaneous tissue infection. To reduce the clinical features, non-steroidal anti-inflammatory capsules and antibiotics are recommended. However, these drugs cause complications and unintended side effects. Therefore, homoeopathy, which aids in permanent treatment barring the use of antibiotics, can be used to choose a safer course of treatment.

Gram-negative Cellulitis in an Immunocompromised Covid-19 Positive Patient

Cellulitis is a commonly presenting acute bacterial infection of dermal and subcutaneous tissue, which typically presents as a warm, erythematous, and poorly demarcated area with tenderness to palpation and associated edema. Cellulitis typically is caused by Streptococcus pyogenes or Staphylococcus aureus, but as seen in this case cellulitis can be due to an underlying Escherichia coli infection. It is vital for clinicians to take a detailed history and perform a thorough physical exam when diagnosing cellulitis, as several inflammatory and neoplastic diseases present similarly. Though the use of blood cultures or needle aspirations in the diagnosis of the underlying bacteria involved in cellulitis is usually inconclusive, it is imperative that clinicians properly assess symptoms necessitating their use. This case also presents possible correlations between COVID-19 and cellulitis, however further research is prompted to determine whether cellulitis is a clinical manifestation of COVID-19, especially in immunocompromised patients.

Cellulitis With Ulcer on Diabetes Mellitus : A Case Report

Cellulitis is deep dermal and subcutaneous tissue infections. Cellulitis typically manifests as a warm, erythematous area that is poorly defined, edematous, and tender to palpation. Cellulitis may act as a trigger for the diagnosis of diabetes mellitus, and occult diabetes may be a significant actor in the development of cellulitis.

Antimicrobial Peptide MPX with Broad-Spectrum Bactericidal Activity Promotes Proper Abscess Formation and Relieves Skin Inflammation.

Bacteria have developed antibiotic resistance during the large-scale use of antibiotics, and multidrug-resistant strains are common. The development of new antibiotics or antibiotic substitutes has become an important challenge for humankind. MPX is a 14 amino acid peptide belonging to the MP antimicrobial peptide family. In this study, the antibacterial spectrum of the antimicrobial peptide MPX was first tested. The antimicrobial peptide MPX was tested for antimicrobial activity against the gram-positive bacterium S. aureus ATCC 25923, the gram-negative bacteria E. coli ATCC 25922 and Salmonellaenterica serovar Typhimurium CVCC541, and the fungus Candida albicans ATCC 90029. The results showed that MPX had good antibacterial activity against the above four strains, especially against E. coli, for which the MIC was as low as 15.625μg/mL. The study on the bactericidal mechanism of the antimicrobial peptide revealed that MPX can destroy the integrity of the cell membrane, increase membrane permeability, and change the electromotive force of the membrane, thereby allowing the contents to leak out and mediating bacterial death. A mouse acute infection model was used to evaluate the therapeutic effect of MPX after acute infection of subcutaneous tissue by S. aureus. The study showed that MPX could promote tissue repair in S. aureus infection and alleviate lung damage caused by S. aureus. In addition, skin H&E staining showed that MPX treatment facilitated the formation of appropriate abscesses at the subcutaneous infection site and facilitated the clearance of bacteria by the skin immune system. The above results show that MPX has good antibacterial activity and broad-spectrum antibacterial potential and can effectively prevent the invasion of subcutaneous tissue by S. aureus, providing new ideas and directions for the immunotherapy of bacterial infections.

Fusarium as a Cause of Mycetoma: A Case Report and Review of the Literature

Mycetoma is a chronic, slow progressive granulomatous infection of skin and subcutaneous tissue; is classified into Eumycetoma (caused by fungi) and Actinomycetoma (caused by Actinomycetes). Fusarium, is a known cause of mycetoma. This case report describes the isolation and identification of Fusarium sp. from a lesion on the right foot of a female patient. This case report is about a 23-year-old female with complaints of gradual enlarging nodular swelling with multiple discharging sinuses along with granules on the right foot, on and off for last seven years. The granules obtained from the lesions are the best specimen for culture as they contain microcolonies of causative agents and it’s a hallmark of mycetoma. Granules were collected aseptically, crushed and examined microscopically on 20% KOH preparation. Plenty of thin hyaline, septate hyphae were seen. Granules were washed with sterile saline and inoculated on Sabouraud’s Dextrose Agar (SDA) and potato dextrose agar and incubated aerobically at 25°C and 37°C in two sets of each. Colonies grew at inoculated site, pinkish in the centre and whitish in the periphery. The isolate was identified as Fusarium sp. on the basis of morphology. The patient was started on Itraconazole 200 mg and is currently on the same treatment, improving and under follow-up. Mycetoma is a rare disease caused by both fungal and bacterial microorganisms. Definitive diagnosis should be made on the basis of culture or histopathological examination. Once the diagnosis is made, use of appropriate anti-fungal therapy with or without surgical interventions can result in complete cure without recurrence.

Evaluation of Fine Needle Aspiration Cytology versus Culture for Laboratory Diagnosis of Subcutaneous Mycosis

Introduction: Subcutaneous swellings are commonly seen in clinical practice having varied pathology from epidermal inclusion cyst to malignancy. Subcutaneous mycosis is a fungal infection of subcutaneous tissue and dermis which is more prevalent in workers of rural, tropical, and subtropical regions. The subcutaneous infection mostly occurs due to minor trauma which goes unnoticed. Fine Needle Aspiration Cytology (FNAC) followed by microbiological analysis is a cost-effective and simple procedure and can be considered as one of the main modalities for early diagnosis. Moreover, it gives an early presumptive identification of fungus, which helps the clinician in a timely therapeutic approach. Aim: To study the efficacy of FNAC in the diagnosis of subcutaneous mycosis in comparison with culture method. Materials and Methods: A cross-sectional study, including clinically diagnosed cases of subcutaneous mycosis was evaluated between the periods of March 2019 to February 2021 in a tertiary care hospital in Northern Odisha. FNAC samples from all the cases of subcutaneous mycosis were studied cytologically and microbiologically. Cases were analysed and further evaluated on the basis of their age, sex, detailed clinical history, and presentation. FNAC showed the presence of fungal elements in 20 cases. Microbiological evaluation of these samples was carried out. Results: Out of the total 50 cases of subcutaneous mycoses, male (16): female (4) ratio was 4:1 and the commonest age group affected was 20-60 years of age (75%). The most common site of involvement was the lower limb (60%) followed by upper limb (30%). Almost all the cases were from rural areas with a history of trauma present in 11 cases (55%). Out of 50 clinically diagnosed cases, cytological examination revealed fungal element in 20 (40%) cases. The most common cytological diagnosis was abscess with neutrophilic infiltration seen in 13 cases (65%) followed by granuloma in 7 cases (35%). All the 20 samples were further evaluated in conventional methods like KOH mount and culture. Fungal agents were isolated in 13 (65%) cases. Cladosporium spp. was the commonest isolate in 5 cases (25%). Conclusion: Subcutaneous mycosis is a rare disease. FNAC can be used as a rapid and cost-effective screening tool in the diagnosis of such cases as it is more sensitive. Though culture is the gold standard test, it is less specific.