Clinicobacteriological study of chronic dacryocystitis in adults

Chronic dacryocystitis is the inflammation of lacrimal sac, frequently caused by bacteria. Obstruction of nasolacrimal duct converts the lacrimal sac a reservoir of infection. It is a constant threat to cornea and orbital soft tissue. Moreover, it causes social embarrassment due to chronic watering from the eye. This study was conducted to find out the current clinicobacteriological profile of chronic dacryocystitis in adults. A total of 56 adult patients were selected from ophthalmology OPD. Detail history and clinical examinations were carried out. All patients underwent either dacryocystorhinostomy or dacryocystectomy. A part of the sac was collected for culture and sensitivity. This study revealed that chronic dacryocystitis is more common in females and left eye is more frequently involved than right eye. It is common among lower socioeconomic strata with habit of pond-bathing. Some form of nasal pathology like hypertrophied inferior turbinate, deviated nasal septum, nasal polyp and allergic rhinitis werefound in 19.6% of the patients. Complications of chronic dacryocystitis like conjunctivitis, corneal ulcer, acute on chronic dacryocystitis, lacrimal abscess and fistula were seen in 25.0% of these patients; 53.6% of the culture samples were positive for bacterial growth. Gram-positive organisms were most common isolate. Unlike other studies, Staphylococcus aureus (40.0%) was found to be most common Gram-positive organism, followed by Staphylococcus epidermidis (10.0%) and Steptococcus pneumoniae (10.0%). Among the Gram-negative organisms, Pseudomonas aeruginosa (16.6%) was the most common, followed by Klebsiella pneumoniae (6.6%) and Haemophilus influenzae (6.6%). Antibiotic sensitivity tests were done. Most of the organisms were resistant to penicillin. Chloramphenicol was effective against most of the Gram-positive organisms. Aminoglycosides, tobramycin in particular, was effective against Staphylococcus epidermidis. Fluoroquinolones, namely ciprofloxacin and ofloxacin were effective against Pseudomonas aeruginosa and Klebsiella pneumoniae.     

Aortitis due to metastatic gas gangrene

Clostridium septicum bacteremia and its association with hematologic malignancy and colorectal cancer have been well recognized. Panwalker, in a recent review, discussed clostridial sepsis and other unusual infections associated with colorectal tumors, including streptococcal bovis and Bacteroides. He reports the coexistence of colorectal cancer and metastatic Clostridium septicum infections at multiple sites. We describe a case in which a patient with an occult cecal carcinoma develops Clostridium septicum sepsis and thoracic aortitis secondary to metastatic gas gangrene. This dramatic and unusual complication has not previously been documented. The necessity of colonic evaluation with Clostridium septicum bacteremia is discussed.     

Endogenous gas gangrene after laparoscopic cholecystectomy

Clostridial gas gangrene of the abdominal wall is rare, and it is usually associated with organ perforation, immunosuppression or gastrointestinal malignancies. In this paper we present a case of fulminant, endogenous gas gangrene in a 58-year old diabetic female with arterial hypertension and atherosclerosis, following uneventful laparoscopic cholecystectomy. She developed gas gangrene of the abdominal wall 12-hours after cholecystectomy and died 24-hours after the onset of the first symptoms, in spite of treatment.     

Management of gas gangrene in Wenchuan earthquake victims

Gas gangrene is an emergency condition,which usually develops after injuries or surgery.This study was designed to investigate clinical characteristics,appropriate therapy,and effective control of nosocomial cross-infection of gas gangrene in Wenchuan earthquake victims.Data on diagnosis,treatment,and prevention of confirmed,suspected,or highly suspected gas gangrene were collected.Sixty-seven(2.41%) cases of suspected gas gangrene were found,in which 32 cases were highly suspected of gas gangrene and 5 cases were confirmed by culture of Clostridium perfringens.Thereof,injury sites were mainly located on the limbs,and typical indications,including crepitation,severe localized pain,swelling,wound discoloration,dark red or black necrotic muscle,foul smell as well as different degrees of systemic toxic performance were common among them.After hospitalization,all patients were isolated and had surgery quickly to remove dead,damaged or infected tissue.The wounds were also exposed for drainage and washed or padded with 3% liquid hydrogen peroxide for disinfection before all diagnostic test results were available.Additionally,high doses of antibiotics(mainly penicillin) were given for the prevention of infection,and supportive therapy was applied for corresponding symptoms control.Among those cases,no fatality was reported.In summary,in post-disaster emergency relief,the diagnosis of gas gangrene should be primarily based on clinical manifestations;while patient isolation,wound debridement and disinfection,as well as antibiotics treatment,is the main measures for proper treatment and control of nosocomial infection for gas gangrene.     

3例气性坏疽病人的护理体会

[背景 ]探讨气性坏疽病人的护理体会 .[病例报告 ]3例气性坏疽病人中男 2例 ,女 1例 ,均为下肢开放伤 ,其中 2例合并糖尿病 ,经过积极、有效的治疗及护理均临床痊愈出院 .[讨论 ]气性坏疽的护理应以预防并控制感染及消毒隔离为主     

Monoplace hyperbaric oxygen therapy for gas gangrene.

Untreated gas gangrene is a fulminating infection that can lead to extensive tissue necrosis and death. Hyperbaric oxygen, when used with antibiotics and surgical debridement, can lead to decreased mortality. Nine patients with gas gangrene proven by positive clostridial cultures have been treated at St Luke's Hospital of Kansas City with a mortality of 11.1%. A case of gas gangrene developing from a perirectal abscess is presented.     

Comprehensive treatment for gas gangrene of the limbs in earthquakes

Background Mortality rates for patients with gas gangrene from trauma or surgery are as high as 25%, but they increase to 50%-80% for patients injured in natural hazards. Early diagnosis and treatment are essential for these patients. Methods We retrospectively analyzed the clinical characteristics and therapeutic results of 19 patients with gas gangrene of the limbs, who were injured in the May 2008 earthquake in the Wenchuan district of China＇s Sichuan province and treated in our hospital, to seek how to best diagnose and treat earthquake-induced gas gangrene.     

地震伤并发气性坏疽的创面处理

目的总结地震伤并发气性坏疽的创面处理方法。方法回顾性分析18例地震伤并发气性坏疽患者的早期临床表现、诊断、创面处理及预后情况。结果18例中16例截肢患者未再行第2次截肢术,2例行清创及肢体局部切开减压,未行截肢术,所有患者临床治愈出院。结论早诊断,旱治疗,全面管理患者创面,尽可能缩小组织坏死范围,提高临床救治水平,可减低病死率,同时还可避免院内交叉感染的发生。     

小鼠气性坏疽动物模型的建立

目的建立产气荚膜梭菌感染小鼠的后肢的气性坏疽动物模型,为早期诊断、了解气性坏疽的致病机理及治疗方法提供依据。方法小鼠随机分成4组,每组10只。三个实验组分别肌肉注射3.5×109、3.5×108和3.5×107cfu/ml浓度的产气荚膜梭菌(ATCC13124)菌液0.1ml,空白对照组肌肉注射生理盐水0.1ml,72h后观察小鼠感染情况,取伤口分泌物作革兰氏染色涂片,细菌血平板厌氧培养和荧光定量PCR方法定量检测。结果 3.5×109、3.5×108、3.5×107cfu/ml实验组和对照组在肌肉注射72h内的死亡率为90%、70%、10%和0%。各组平均存活时间依次为(20:43±11:12)h、(37:24±25:39)h、(68:36±10:45)h和(72:00±0:00)h,死亡小鼠出现了气性坏疽的症状,分泌物培养和镜检出产气荚膜梭菌;未死亡小鼠康复;空白对照组无任何症状。各组Ct值均值为21.21±2.69、28.45±2.74、32.49±2.87和0.00±0.00,组间P值均<0.05。结论成功建立了不同浓度的产气荚膜梭菌在不同时间段内感染小鼠的后肢气性坏疽的动物模型,为了解气性坏疽的致病机理及治疗方法奠定基础。     

我院地震伤员气性坏疽防控措施与实施

目的 探讨在5.12大地震后前沿医院短时间集中收治大量地震伤员的特殊情况下,采取及时正确医院感染管理,预防控制伤员气性坏疽发生和院内感染.方法 (1)医院感染管理部门和医院医务人员提高对气性坏疽的认识,制定气性坏疽相关的医院感染院预防控制措施;(2)院前对地震伤员按伤口情况分诊,对伤员去污染处理;(3)加强气性坏疽的筛查;(4)对气性坏疽患者早诊断、早隔离、早治疗,采取严格消毒措施.结果 本院收治1 400多地震伤员只发现1例气性坏疽患者,后无第2代病例发生.结论 在5.12大地震后,医院短时间集中收治大批地震伤员,本院采取医院感染消毒隔离预防控制气性坏疽的措施是及时正确的.