The aim of this study was to assess the prevalence and proportions of antimicrobial‐resistant species in patients with endodontic infections. A systematic scoping review of scientific evidence was accomplished involving different databases. Nine investigations were selected including 651 patients. Enterococcus faecalis was resistant to tetracycline (30%–70%), clindamycin (100%), erythromycin (10%–20%), ampicillin (9%) and azithromycin (60%). On the contrary, Prevotella spp., Fusobacterium spp., Peptostreptococcus spp. and Streptococcus spp. were resistant to penicillin, tetracycline, doxycycline, ciprofloxacin, amoxicillin, erythromycin, metronidazole and clindamycin in different proportions. Fusobacterium nucleatum showed high resistance to amoxicillin, amoxicillin plus clavulanate and erythromycin. Prevotella oralis presented a predisposition to augment its resistance to clindamycin over time. Tanerella forsythia exhibited resistance to ciprofloxacin and rifampicin. Lactococcus lactis presented robust resistance to cephalosporins, metronidazole, penicillin, amoxicillin and amoxicillin–clavulanic acid. It was observed high levels of resistance to antimicrobials that have been utilised in the local and systemic treatment of oral cavity infections.
Necrotizing fasciitis is a serious infectious condition that may compromise the patient's life. In the present case study, a 42-year-old male patient was reported. The condition manifested as the presence of subjective fever, general malaise, myalgia, non-productive cough, dysphagia and neck pain ~1 week prior to hospital admission. Vascular dissection was considered as the initial diagnostic suspicion, and thus, angiotomography of neck vessels was performed, ruling out aortic and neck vessel dissection. Radiology indicated negativity for aortic syndrome and cervical vascular disease, but the presence of cervical-mediastinal edema, lamellar fluid between muscular and fatty planes and posterior pulmonary atelectasis, absence of pleural fluid or consolidations, and tonsillar hypertrophy without abscesses. Due to the rapid evolution of the condition, the presence of dyspnea with the need for supplemental oxygen, and the disproportion between the intensity of the pain described by the patient and the external findings observed, the presence of necrotizing fasciitis was considered. Point-of-care ultrasonography was performed, indicating a cobblestone pattern of the subcutaneous cellular tissue, with diffuse thickening of the anterior cervical fascia and increased echogenicity with soft tissue edema posterior to the fascia. Magnetic resonance imaging confirmed the inflammatory findings in the fascia and other cervical soft tissues, without exhibiting any signs of necrosis, but with the presence of abscesses in the visceral and carotid space.
Kounis syndrome (KS) is defined as an acute coronary syndrome triggered by the release of inflammatory mediators after an allergic attack. It usually occurs secondary to allergic injuries from foods, medications, and insect bites. However, there are no known reports of KS secondary to the intake of laxatives. This article reports the case of a 43-year-old woman who, after ingesting a dose of sodium phosphate monobasic/sodium phosphate dibasic, presented a maculopapular rash on the trunk and extremities. The electrocardiogram showed ST depression in V4-V5-V6 and signs of prolonged QTc; troponin I uptake was positive. Due to presumed myocardial injury and high suspicion of coronary disease, coronary angiography was requested, which showed epicardial coronary arteries, without angiographically significant stenosis, thus confirming the presence of KS secondary to the ingestion of a laxative.
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