ObjectiveTo identify factors that may influence outcomes in patients with severe skin
and soft tissue infections in the intensive care unit.MethodsA retrospective observational study was conducted in a cohort of 1,123
critically ill patients admitted to an intensive care unit with a primary or
secondary diagnosis of severe skin and soft tissues infection between
January 2006 and December 2014.ResultsThirty patients were included, 20 (66.7%) of whom were diagnosed with
necrotizing fasciitis; in these patients, perineal area involvement was most
commonly identified. Abscess was diagnosed in 8 (26.7%) patients, most
commonly involving the cervical area. Risk factors such as immunosuppression
and previous surgical trauma were commonly observed in this population. The
most commonly isolated microorganism was Escherichia coli.
Multidrug resistant microorganisms were commonly detected, even in the
absence of traditional risk factors; among these patients, previous use of
antibiotics was the most common risk factor for drug resistance. The rate of
mortality was significantly higher in patients with necrotizing fasciitis
(55%, p = 0.035) and associated with disease severity, presence of septic
shock, cardiac arrest and leucocytosis.ConclusionDifferent risk factors and etiologies of severe skin and soft tissue
infections were identified. Necrotizing fasciitis and drug-resistant
bacteria were significant predictors of mortality, even in the absence of
traditional risk factors. Obtaining a better understanding of trends in the
risk factors and microorganisms associated with severe skin infections may
help in the determination of prompt treatment and antibiotic choices.
Infections of central nervous system (CNS) include a broad group of conditions and pose a particular challenge to physicians, especially in immunocompromised individuals.This case refers to a 26-year-old male patient with a history of smoked hashish and drug abuse admitted to the infectious disease department with hemiballismus of left hemibody and a positive HIV serologic test. A magnetic resonance imaging (MRI) study showed lesions at lower left and right cerebellar hemisphere, one of them thalamus – mesencephalic suggesting an opportunistic infection or an HIV associated encephalopathy. Lumbar puncture, brain biopsy and successive neuroimaging were not conclusive for one disease and despite the use of directed therapy for cerebral toxoplasmosis, meningeal tuberculosis, anti-retrovirals and sedative medication, after over 6 weeks of hospitalization pallidotomy was performed. After 5 months of oral and surgical treatment the patient showed clinical, immunological and radiological recovery.
Candida albicans osteomyelitis is a rare disease that occurs in immunocompromised individuals, sometimes with a late diagnosis related to the mismatch between symptoms and candidemia. This case refers to a 36-year-old male patient with a history of oesophageal surgery for achalasia with multiple subsequent surgeries and hospitalisation in the intensive care unit for oesophageal fistula complication. Four months after discharge, the patient was admitted to the infectious diseases department with pain in the 10th-12th left ribs, swelling of the 4th-6th costal cartilage and decreased visual acuity. An MRI study showed thickening and diffuse enhancement, with no defined borders in the cartilage and ribs, compatible with infection. After performing a CT-guided bone biopsy, isolated C. albicans sensitive to antifungal agents was detected. The patient started therapy with liposomal amphotericin B and maintenance fluconazole for 6 months and showed clinical and radiological improvement within this time.
Tuberculosis (TB) is one of the top 10 causes of death worldwide. Multidrug-resistant tuberculosis (MDR-TB) occurs when at the minimum there is resistance to isoniazid and rifampin. Prevention of new infections of Mycobacterium tuberculosis and progression to TB disease is critical to reduce the burden and mortality of this disease. We present the case of a 73-year-old human immunodeficiency virus (HIV)-negative female who presented with cervical lymphadenopathy and who was diagnosed with MDR-TB.
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