This retrospective review of a methicillin-resistant Staphylococcus aureus decolonization protocol using CHG bath/shower and PI-SNA nasal painting revealed a significant decrease in the infection rate of patients undergoing lower extremity fracture repairs. We recommend its use without contraindications, but recognize that additional investigations are necessary.
Introduction
Scabies is a well – known, commonly recognized, and frequently diagnosed pathology especially in children, close quarters, living facilities, and immunocompromised patients. An accelerated severe infestation of traditional scabies with limited treatment options is known as the rare entity of Norwegian or Crusted Scabies.
Case presentation
We present the history, clinical manifestations, medical treatments and surgical interventions of a patient with Norwegian Scabies of his hands, which rendered them nonfunctional prior to intervention. The patient was initially misdiagnosed and underwent inappropriate treatments for several years prior to our assessment, and ultimately required surgical intervention that was therapeutic.
Discussion
Norwegian, or Crusted, Scabies is a severe infestation of S. scabiei in which the mite load is extreme in comparison to traditional scabies. This manifests as scaly plaques that are often misdiagnosed for other hyperkeratotic skin lesions. With this misdiagnosis, improper treatments are often recommended, and can even accelerate the manifestation. Traditional scabies therapies can be effective, however often due significant disease progression due to diagnostic delay, invasive measures, such as surgical debridement like presented here, are the only option.
Conclusion
The patient presented in this case harbored a rare infection, known as Norwegian Scabies, for several years, with inappropriate medical therapy. Due to his prolonged inadequate treatments, his disease became so pronounced that the recommended medical treatments were no longer adequate, thus he required surgical debridements which ultimately allowed him to regain function in his hands.
Background: Cutaneous mucormycosis, while less common than sinonasal or pulmonary infections, can cause widespread tissue necrosis after seemingly innocuous encounters. The most common location of cutaneous mucormycosis is the extremities, and extensive infection has been reported after trauma or orthopedic procedures. Case Report: A 60-year-old female with poorly controlled type 2 diabetes mellitus sustained an open patella fracture after a fall. She underwent washout and internal fixation with cannulated screws and cable tension band wiring. The patient's recovery was complicated by asymptomatic coronavirus disease 2019 (COVID-19) infection and repeated wound dehiscence, with growth of Mucor species initially presumed to be a contaminant. Despite serial washout and debridement, repeat dehiscence and patella exposure were noted. Free tissue transfer to the genicular vessels was selected for coverage of the extensor tendon, patella, and fracture line. In repeat skin cultures, Mucor indicus and Staphylococcus epidermidis grew from the wound. Topical voriconazole and a 6-week course of intravenous isavuconazole and oral doxycycline were started when the Mucor cultures were identified. Conclusion: This case highlights an approach to an indolent mucormycosis infection in the skin over a patella fracture in a patient with poorly controlled diabetes mellitus, including the sequence of surgical care, debridement, and selection of antimicrobials. Major amputation and orthopedic revision were avoided. This patient also underwent successful free tissue transfer after testing positive for COVID-19.
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Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.
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