Microbiological diagnosis of gas gangrene caused by Clostridium septicum (a clinical case)

Microscopy of gram-stained impression smears is used for the rapid diagnosis of microorganisms in the wound. The shin tissues of patient P. with suspected gas gangrene of lower extremity soft tissues were microscopically found to have gram-positive spore-forming bacteria that were morphologically similar to C. bifermentans that were identified as C. septicum on cultural diagnosis. The pathogenic C. septicum strain spores were likely to be formed in the macroorganism upon exposure of the pathogen to a patient's defense factors and to a package of therapeutic measures. Microbiological data should be used only in combination with clinical and instrumental findings and the results of other laboratory studies when the optimal technology is chosen to treat gas infection. By keeping in mind that there may be clostridial gangrene in the patients and the experience of clinicians and bacteriologists may be insufficient in diagnosing this pathology, it is necessary to strengthen the training of physicians in the diagnosis of this pathology.     

低分子右旋糖酐致皮肤瘙痒的临床观察及护理

笔对31例低分子右旋糖酐致皮肤瘙痒的病例进行了临床观察，总结了瘙痒的发生与持续时间、好发部位及特点治疗情况等，并采取针对性护理措施如：加强心理护理，观察瘙痒变化，皮肤护理等，取得良好效果。     

Hydrops foetalis caused by anti-Mur in first pregnancy--a case report

Anti-'Mia' is the most common alloantibody of potential clinical significance in the Taiwanese population. The Mi.III phenotype is rare among Caucasians but has a high incidence in various Oriental populations. We describe a nulliparous woman with no history of transfusions, who had hydrops foetalis at 28 weeks gestation. Foetal haemoglobin was 4.4 g dL-1, and a positive direct antiglobulin test was positive in the foetal blood. Intrauterine intravascular transfusion was given, and the baby was discharged healthy. Anti-'Mia' was identified in the maternal serum, the cord blood serum and the eluate from red cells of the cord blood. Anti-'Mia' in the maternal serum was confirmed to be anti-Mur. The polymerase chain reaction-restriction fragment length polymorphism method confirmed that both the baby and her father had the Mi.III gene. Therefore, our report documents that anti-Mur has the potential to cause hydrops foetalis.     

局部封闭致皮肤发绀1例

1 病例介绍 病人，女，34岁，2月前右手外伤，桡侧肿痛，外用麝香舒活精后肿胀消退，但疼痛未缓解。查体：右侧“虎口”偏食指侧明显压痛，食指屈伸功能差，“八字”试验阳性，右掌指关节无异常，血沉、抗“O”、类风湿因子均正常。故确诊为食指骨间背侧筋膜损伤，采用醋酸泼尼松龙0．05g加利多卡因0．02g局部注射：局部皮肤常规消毒，从压痛点垂直进针，注射药物约0．5mL，针头退出皮下，换方向注射，抽无回血即拔针。注射点用碘酒棉球压迫止血，无出血倾向，约3min病人右手发白，拇指、食指、中指明显，未做处理。1d后复诊，右手拇指、食指、中指出现大小不等淤点、淤斑，食指呈片状紫色，手指末端发凉，掌、指关节肿胀，屈伸、握力差。     

牛黄解毒片致皮肤过敏一例

<正>牛黄解毒片是有800年历史的清热解毒的名方,因其疗效较好,至今仍为临床常用药物。但近年来,有关牛黄解毒片引发安全性问题的报道屡屡出现。1病例资料患者,女,65岁。因发热、全身皮疹就诊于我门诊     

局部封闭致皮肤发绀1例

1病例介绍病人,女,34岁,2月前右手外伤,桡侧肿痛,外用麝香舒活精后肿胀消退,但疼痛未缓解。查体:右侧“虎口”偏食指侧明显压痛,食指屈伸功能差,“八字”试验阳性,右掌指关节无异常,血沉、抗“O”、类风湿因子均正常。故确诊为食指骨间背侧筋膜损伤,采用醋酸泼尼松龙0.05g加利多卡因0.02g局部注射:局部皮肤常规消毒,从压痛点垂直进针,注射药物约0.5mL,针头退出皮下,换方向注射,抽无回血即拔针。注射点用碘酒棉球压迫止血,无出血倾向,约3min病人右手发白,拇指、食指、中指明显,未做处理。1d后复诊,右手拇指、食指、中指出现大小不等淤点、淤…     

70%酒精皮肤消毒液致接触性皮炎的临床观察

目的 区分70%酒精皮肤消毒所致接触性皮炎与抗生素过敏试验阳性反应的差异,以减轻患者痛苦,合理选用抗生素.方法 通过询问过敏史、自觉症状、观察局部皮肤变化及生理盐水对照试验,排除抗生素皮试的假阳性反应.结果 应用70%酒精皮肤消毒进行皮试,可引起接触性皮炎.结论 皮试前详细询问用药史、过敏史、自觉症状、观察局部表现,可有效鉴别酒精所致接触性皮炎与皮试假阳性反应,从而避免盐水对照试验所致痛苦,并可通过及时选用其它皮肤消毒液防止接触性皮炎的发生.     

70%酒精皮肤消毒液致接触性皮炎的临床观察

目的区分70%酒精皮肤消毒所致接触性皮炎与抗生素过敏试验阳性反应的差异,以减轻患者痛苦,合理选用抗生素。方法通过询问过敏史、自觉症状、观察局部皮肤变化及生理盐水对照试验,排除抗生素皮试的假阳性反应。结果应用70%酒精皮肤消毒进行皮试,可引起接触性皮炎。结论皮试前详细询问用药史、过敏史、自觉症状、观察局部表现,可有效鉴别酒精所致接触性皮炎与皮试假阳性反应,从而避免盐水对照试验所致痛苦,并可通过及时选用其它皮肤消毒液防止接触性皮炎的发生。     

The first case of human protothecosis caused by Prototheca zopfii in Japan

This report describes a fatal case Prototheca zopfii genotype 2 infection in an immunosuppressed patient. The patient was a 62-year-old housewife who presented general malaise in April 2011. Hairy cell leukemia was highly suspected. Chemotherapy was started because the patient developed severe pancytopenia in October 2011. Itraconazole capsules (100 mg/day) and trimethoprim (320 mg/day) plus sulfamethoxazole (1600 mg/day) combinations were orally administered for prophylaxis of fungal infections.Of BacT/ALERT 3D FA aerobic culture bottles and FN anaerobic culture bottles, only FA aerobic blood culture bottles produced positive reactions when the patient developed fever in January 2012. Gram-staining of blood culture bottles revealed Gram-negative elliptical sporangia. Culturing on Sabouraud dextrose agar produced smooth and creamy white, yeast-like colonies. Partial DNA sequences of the nuclear 18S rDNA and 28S rDNA D1/D2 domains of the isolated strain were identical to those of P. zopfii genotype 2. The MICs and minimal lethal concentrations of antifungals revealed that it was susceptible to amphotericin B and itraconazole. The patient died, at which time plasma (1 → 3)-β-D-glucan was positive (131 pg/mL).     

皮炎芽生菌致肺部及皮肤感染一例

患者男,21岁.因"咳嗽、咳痰、发热伴皮肤脓肿破溃10个月余"入院.患者于2008年11月底无诱因出现咳嗽、咳痰,咳少量白色黏痰,感咽喉不适,口服咽炎片无缓解.2008年底12月在当地医院查X线胸片后诊断为"大叶性肺炎",使用头孢菌类抗生素治疗5 d,症状无改善,并出现发热,伴畏寒,最高体温39 ℃.     

静脉输注林可霉素引起局部水疱1例

林可霉素是临床上较常用的抗生索，适用于敏感金黄色葡萄球菌属、溶血性链球菌、肺炎球菌所致的呼吸道感染、败血症及慢性骨髓炎等。对厌氧菌有抗菌作用。现将1例静脉输注林可霉素引起局部水疱病人的护理报告如下。     

静脉输注林可霉素引起局部水疱1例

林可霉素是临床上较常用的抗生素,适用于敏感金黄色葡萄球菌属、溶血性链球菌、肺炎球菌所致的呼吸道感染、败血症及慢性骨髓炎等。对厌氧菌有抗菌作用。现将1例静脉输注林可霉素引起局部水疱病人的护理报告如下。1病例介绍病人,男,75岁,因反复出现头晕、头痛两周,来我院就诊,门诊以原发性高血压收入病房。住院期间,病人因受凉感冒,主诉头痛、畏寒、发热,伴乏力、食欲缺乏。查体:体温39℃,心率84/min,呼吸20/min,血压17.33/10.67kPa。急查血常规:白细胞10.2×109/L,中性粒细胞8.3×109/L。给予双氯酚酸钠塞肛,5%葡萄糖250mL加林可霉素1.2g…     

Purulent lymphadenitis caused by Staphylococcus argenteus,representing the first Japanese case of Staphylococcus argenteus (multilocus sequence type 2250) infection in a 12-year-old boy

Staphylococcus argenteus is a novel species separated from a strain of coagulase-positive, non-pigmented S. aureus. Although S. argenteus has been reported to occur globally, multilocus sequence type (ST) 2250 is mainly found in Northeastern Thailand. Because conventional biochemical testing misidentifies this pathogen as S. aureus, multilocus sequence typing (MLST) or nucA sequencing is recommended to distinguish between S. argenteus and S. auereus.The patient was a previously healthy 12-year-old boy who was admitted because of right inguinal lymphadenitis and cellulitis. Although intravenous cefazolin was administered, his lymphadenitis worsened and formed an abscess on day 6 of hospitalization. Incision and drainage were performed on day 7 of hospitalization. Cefazolin was changed to oral cefaclor, and the patient was successfully treated over a period of 5 weeks. No recurrence was observed throughout 12-months of follow-up. He had a history of right axillary lymph node abscess 2 months before this admission, which was successfully treated with incision, drainage, and antibiotic therapy. He has lived in Japan since birth and never traveled abroad. He had no opportunity to interact with foreigners. His immune function, especially neutrophil function, was tested and we did not find any dysfunction. First, methicillin-sensitive S. aureus was misidentified from the abscess culture. Subsequently, the causative agent was re-identified as S. argenteus ST2250 based on MLST.To our knowledge, this is the first case of S. argenteus ST2250 infection in Japan. This pathogen should be taken into consideration in the diagnosis if the patient has atypical non-pigmented S. aureus.     

A case of sepsis caused by Streptococcus canis in a dog owner: a first case report of sepsis without dog bite in Japan

A 91-year-old dog-owning woman with a history of hypertension and femoral neck fracture consulted our hospital with fever and femur pain with redness. Laboratory test results showed leukocytosis with 85 % neutrophils and high values of C-reactive protein and procalcitonin. In addition, growth of Gram-positive streptococcus was observed in two independent blood culture sets. The isolated bacterium was identified as Streptococcus canis on the basis of biochemical properties and sequencing analyses of the 16S rRNA gene. The patient recovered completely without critical illness following prompt antimicrobial treatment with ceftriaxone. S. canis, a β-hemolytic Lancefield group G streptococcus, is in general isolated from various animal sources, but its isolation from a human clinical sample is extremely rare. Since β-hemolytic streptococci can cause severe infectious diseases such as necrotizing fasciitis, it is absolutely necessary to start antimicrobial treatment immediately. It is necessary to identify pathogenic bacteria carefully and to obtain information on a patient’s background, including history of contact with an animal, when S. canis is isolated.