Aeromonas hydrophila infection complicating digital replantation and revascularization

Two cases of thumb replantation and one of finger revascularization complicated by Aeromonas hydrophila infection are reported. Two digits were lost because of infection in soft tissue and osteomyelitis. One thumb had extensive necrosis. In all cases the infection was difficult to eradicate, probably because of ischemia. All three patients sustained their injuries while cutting meat or fish. These infection sources have not been previously reported. Note is made of Aeromonas hydrophila in medicinal leeches that are used in microvascular surgery and the potential for iatrogenic infection.     

Haemolytic-uraemic syndrome associated withAeromonas hydrophila enterocolitis

Haemolytic-uraemic syndrome (HUS) associated withAeromonas hydrophila enterocolitis is reported in a 23-month-old female infant. TheA. hydrophila strain isolated from the patient's stool sample produced cytotoxin against verocells; increasing levels of cytotoxinneutralizing antibody in the patient's sera were demonstrated, suggesting a recent infection. This report indicates thatA. hydrophila should be suspected as a possible cause of HUS, and that this pathogen should be looked for in cases of post-diarrhoeal HUS.     

Haemolytic-uraemic syndrome in an adult male with Aeromonas hydrophila enterocolitis.

Key words: Aeromonas hydrophila; cytotoxin; haemolytic-uraemic syndrome      

Considerations on infectious complications using a drowned lung for transplantation

Recently, the applicability of lungs from drowned victims for transplantation has been anecdotically described in literature. However, no data exist about hazards or limitations. Herein, we describe a case of lung transplantation from a submersion victim and the subsequent development of an Aeromonas hydrophila infection in the implanted organ. Based on this case we propose standard procedures, which should be followed when considering drowned donor lungs, in order to minimize risks for infectious complications.     

Triparesis caused by gas-containing extensive epidural abscess secondary to Aeromonas hydrophila infection of a thoracic vertebroplasty: a case report

Background context

Aeromonas hydrophila is a motile gram-negative non-sporeforming rod with facultative anaerobic metabolism. Except for gastrointestinal disease, skin and soft-tissue infections represent the second most common site of human Aeromonas infections. However, to our knowledge, A. hydrophila infection of the spine has not been reported to date.

Purpose

To report the first case of A. hydrophila spinal infection of the T7 vertebra after vertebroplasty.

Study design

Case report.

Methods

A 72-year-old man was transferred to our emergency department with chief complaints of severe midthoracic pain and triparesis. He had undergone vertebroplasty for a painful vertebral fracture at T7 5 weeks before transfer. Magnetic resonance imaging showed an infection of the T7 vertebroplasty and an extensive epidural abscess. The epidural abscess originating from the infected T7 vertebroplasty extended from the T8 to the C4 epidural space. Computed tomography demonstrated sparsely scattered gas in the epidural abscess, strongly suggestive of an anaerobic infection.

Results

Emergency multilevel laminectomies from C5 to T8 and a posterior instrumentation from T3 to T10 were performed. A. hydrophila was isolated from the blood cultures. The patient was treated with intravenous ampicillin/sulbactam. Posterior decompression and stabilization in combination with appropriate antibiotic treatment completely resolved the neurologic deficit and infection without the need for further anterior corpectomy of the infected T7 vertebroplasty.

Conclusions

This is the first reported case of spine infection caused by A. hydrophila. The infection developed after vertebroplasty for the management of a painful vertebral fracture. Triparesis occurred rapidly due to an extensive epidural abscess containing gas. Emergency decompression and stabilization in combination with appropriate antibiotic treatment achieved a successful clinical outcome.     

The role of leech water sampling in choice of prophylactic antibiotics in medical leech therapy

Medical leech therapy (MLT) with Hirudo medicinalis is well established as a treatment for venous congestion of tissue flaps, grafts, and replants. Unfortunately, this treatment is associated with surgical site infections with bacterial species, most commonly Aeromonas hydrophila, which is an obligate symbiot of H. medicinalis. For this reason, prophylactic antibiotics are recommended in the setting of MLT. After culturing Aeromonashydrophila resistant to ciprofloxacin from a tissue specimen from a patient with a failed replant of three digits post‐MLT, we performed environmental surveillance cultures and antibiotic susceptibility testing on water collected from leech tanks. This surveillance was performed twice weekly for 2.5 months. Fourteen surveillance cultures demonstrated 21 isolates of Aeromonas species, 71.4% of which were ciprofloxacin susceptible. All isolates were sulfamethoxazole‐trimethoprim (SXT) susceptible. The prophylactic antibiotic regimen of choice for leech therapy at our institution is SXT, with culture of tank water to refine antimicrobial choice if necessary. This study demonstrates the importance of regular surveillance to detect resistant Aeromonas species in medical leeches; however optimal practice has not been established. © 2013 Wiley Periodicals, Inc. Microsurgery, 2013.     

CELLULITE OWING TO AEROMONAS HYDROPHILIA: TREATMENT WITH HYPERBARIC OXYGEN

Aeromonas hydrophilia, a Gram-negative facultative anaerobe, is a rare cause of cellulitis. We review the literature and report a case of Aeromonas hydrophilia cellulitis which failed to respond to the conventional management of surgical debridement and antibiotics. Hyperbaric oxygen therapy was used successfully to control the infection. As far as we are aware this is the first case in world literature of Aeromonas hydrophilia cellulitis treated with hyperbaric oxygen.     

Septic arthritis caused by Aeromonas hydrophila

Septic arthritis caused by Aeromonas hydrophila is a rare clinical entity in common practice. Herein, we describe one case of A. hydrophila-associated septic knee after a traumatic injury. The clinical condition gradually improved after appropriate antibiotic and surgical debridement.     

Fracture of the thumb sesamoid bones

Two cases of sesamoid fracture of the thumb are reported. The condition is presumably underdiagnosed because of incomplete ossification of the bone. If pain persists after immobilization, excision of the bone is curative.     

Bacterial sepsis following prostatic biopsy

Purpose

Despite the recent innovations, complications of prostate biopsy can occur. The aim of this study was a prospective monitoring of major septic complications occurring after transrectal prostate biopsy, to describe their causing agents, to report the clinical course of these patients, and to give guidelines based on our personal experience.

Methods

This prospective study was carried out between January 2009 and September 2010. Complications were evaluated by telephone interviews.

Results

Between January 2009 and September 2010, 447 (96.5%) completed the telephone interview. Urosepsis occurred in ten patients (2.2%) and in three cases evolved into septic shock. Of these ten patients, nine had a positive blood culture, of whom eight for Escherichia coli and one for Aeromonas hydrophila, Aeromonas caviae, and Aeromonas sobria. In seven cases, the E. coli isolated were resistant to fluoroquinolone and six produced an extended spectrum beta-lactamase. Six E. coli were classified as multidrug-resistant organisms. Of the 10 patients, one died after the onset of multiorgan failure. For the other nine, the mean time spent in the hospital was 9?days (range, 6?C15?days).

Conclusions

Escherichia coli are developing new drug resistances. Early recognition of patients who harbor MDRO E. coli in their rectum or in the urine could be an important strategy for preventing sepsis. If a patient who has recently undergone transrectal prostate biopsy shows clinical signs of sepsis in the 48?h, a multiresistant E. coli infection must be suspected. The patient must be admitted urgently to the hospital, and carbapenem antibiotic therapy should be started.     

Alternatives to thumb replantation in three cases of traumatic amputation of the thumb

Three cases of complete amputation of the thumb are reported in which the amputated distal parts were not suitable for replantation. In all cases there were either complete or incomplete amputations of other digits. Two different techniques were used for thumb reconstruction: 1) pollicization of a partially amputated digit with transposition microsurgery in case 1; and 2) replantation of a less important amputated digit to the thumb stump for cases 2 and 3. These microsurgical efforts successfully restored thumb function in all three patients.     

Medicinal leeches and the microsurgeon: a four-year study, clinical series and risk benefit review

Background: There are case reports and small series in the literature relating to the use of medicinal leeches by plastic surgeons; however, larger series from individual units are rare. The aim of this article is to present a comprehensive 4‐year case series of the use of medicinal leeches, discuss the current evidence regarding indications, risks, and benefits and highlight the recent updates regarding leech speciation. Methods: Patients prescribed leeches in a 4‐year period (July 2004–2008) were collated from hospital pharmacy records (N = 35). The number of leeches used, demographic, clinical, and microbiological details were retrospectively analyzed. Results: Thirty‐five patients were treated with leeches. The age range was 2 to 98 years (mean = 49.3). Leeches were most commonly used for venous congestion in pedicled flaps and replantations. Blood transfusions were necessary in 12 cases (34%) [mean = 2.8 units, range 2–5 units]. Our infection rate was 20% (7/35) including five infections with Aeromonas spp. (14.2%). The proportion of patients becoming infected after leech therapy was significantly greater in the group of patients that did not receive prophylactic antibiotic treatment (Fisher's Exact test P = 0.0005). In total, 14 cases (40%) were salvaged in entirety, in 7 cases 80% or more, in 2 cases 50 to 79%, and in 1 case less than 50% of the tissues were salvaged. In 11 cases (31%), the tissues were totally lost. Conclusion: Our study highlights both the benefits and the risks to patients in selected clinical situations and also the potential risks. The routine use of antibiotic prophylaxis is supported. In view of the emerging evidence that Hirudo verbana are now used as standard leech therapy, and the primary pathogen is Aeromonas veronii, until a large prospective multicenter study is published, large series of patients treated with leeches should be reported. © 2011 Wiley‐Liss, Inc. Microsurgery, 2011.     

Acute postoperative infection with Aeromonas hydrophila after using medical leeches for treatment of venous congestion

Introduction

Venous convulsion after reconstructive microsurgery procedures is one major complication a surgeon has to deal with. Today, especially in the field of reconstructive microsurgery, medicinal leech therapy enjoys a renaissance. The potential risks such as infections associated with leech therapy are generally underestimated and not sufficiently discussed in literature.

Method/patients

We present five male patients with an average age of 47 years. All patients suffered from a trauma incident, which had to be treated as an emergency. Three patients showed, postoperatively, a venous congestion after the reconstructive procedures. Another two patients with flap reconstruction and flap training developed venous problems after 12 and 14 days. In all five cases, the indication was given to use medical leeches (Hirudo medicinalis). In all the patients, a local infection of the injured extremity could be regarded after beginning with the leech treatment. The treatment duration with medical leeches for postoperative venous congestion was an average of 6 days.

Results

The reconstructive procedures in all five cases were unfortunately unsuccessful as major local infections were observed. Microbiological analyses showed, in all cases, an infection with Aeromonas hydrophila.

Conclusion

We recommend making a considered indication for leech therapy, to diagnose wound infections early and to think about prophylactic antibiotics in patients with leech application.     

Arthrite temporo-maxillaire à staphylocoque

Two cases of temporo-mandibular joint infection with several blood cultures positive for Staphylococcus aureus are reported. Positive diagnosis depended on the importance of the pain and trismus, as well as the lack of abscess formation. The rapid development of ankylosis requires treatment to be started as soon as the first signs appear.     

尺侧指固有动脉与桡动脉腕背支桥接的断拇再植

目的:介绍一种治疗近端动脉严重损伤的拇指离断再植术的方法,并评价其疗效。方法:2007年2月至2009年3月,采用前臂掌侧静脉移植,桥接鼻咽窝处桡动脉腕背支与尺侧指固有动脉的远侧断端,治疗13例近端动脉严重损伤的拇指离断。男11例,女2例;年龄16～50岁,平均34.5岁。左侧7例,右侧6例。完全离断8例,不全离断5例。急诊再植10例,按常规步骤再植术后动脉危象探查修复3例。结果:13例拇指全部成活。所有患者获得随访,时间8～17个月,平均11个月。再植拇指外形满意,根据中华医学会手外科学会断指再植功能评定试用标准:优9指,良3指,差1指。指腹两点辨别觉58mm,平均6.5mm。结论:静脉移植桥接鼻咽窝桡动脉腕背支与尺侧指固有动脉远端的方法修复拇指动脉,行复杂拇指离断再植,手术体位舒适,不影响手部血供,扩大了再植适应证,提高了再植成功率。     

Aspergillus osteomyelitis of the thumb in a 5-year-old child

Aspergillus osteomyelitis is a rare condition and is a recognized infection of the immunosuppressed. The pediatric cases that were documented suggest that in children, chronic granulomatous disease is the major underlying disease [Tack et al.1982 73(2):295–300, Baez-Escudero et al. 2000 Case report—primary sternal Aspergillus osteomyelitis. Infect Med 17(7):505–516]. We report an interesting case of Aspergillus osteomyelitis of the thumb in a 5-year-old boy with aplastic anemia. The infection progressed despite a combination of antifungal therapy with Voriconazole and surgical debridement. The thumb was amputated and the child recovered. This case highlights the difficulty in diagnosing Aspergillus osteomyelitis and also the failure of conventional management in this child, which resulted in the amputation of the thumb as a life-saving measure. We believe this to be the first case report of Aspergillus osteomyelitis in the thumb.     

A fatal diarrhoea outbreak in farm‐raised Deinagkistrodon acutus in China is newly linked to potentially zoonotic Aeromonas hydrophila

Deinagkistrodon acutus is a venomous pit viper commonly used in traditional Chinese medicine; farming these snakes has become a major industry. In 2017, an outbreak of fatal diarrhoea among farm‐raised D. acutus in Hunan Province caused the deaths of 5,600 snakes within 3 weeks. We isolated a brand‐new sequence type of Aeromonas hydrophila (ST516) from lesions and confirmed that this bacterium was the causal agent of the outbreak. Snakes infected with the bacterium in the laboratory showed similar clinical symptoms to those of snakes in the original outbreak. We also tested bacterial virulence in Kunming mice to examine the likelihood of zoonosis. Isolates were pathogenic to mice, causing diarrhoea within 4 hr post‐challenge, which indicates that the bacterium can potentially infect mammals. Environmental analysis showed that polluted spring water likely caused the diarrhoea in snakes. This study is the first to report on a large‐scale outbreak of fatal diarrhoea in farm‐raised snakes, originating in a pathogen that can infect mammals. These results should raise awareness regarding potential anthropozoonosis among poikilotherms, mammals, and humans; appropriate prevention or control methods should be developed.     

Bilateral microvascular second toe transfer for bilateral post-traumatic thumb amputation

In bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally symmetric and aesthetically superior to the osteoplastic reconstruction. The technical details are discussed, and the long term functional and aesthetic results are presented.KEY WORDS: Microvascular transfer, second toe, thumb amputation     

Aeromonas hydrophila water-associated traumatic wound infections: a review

The bacterium Aeromonas hydrophila is commonly found in natural bodies of water, and is a potential invasive pathogen for those who suffer trauma while submerged in water. Five patients treated by the authors and 18 previously reported patients were reviewed to further define the characteristics of A. hydrophila wound infections. Although Aeromonas has been isolated from salt and brackish water, all 23 cases occurred following contact with fresh water. Signs of infection usually appeared 8-48 hours following puncture or laceration injury. The foot or leg were most commonly involved. Infection was frequently rapidly progressive; fascia, tendon, muscle, bone, or joint involvement occurred in 39% of cases. In addition to A. hydrophila, other aerobic and anaerobic bacteria were found in 48% of cases. Aeromonas infection should be suspected in cases of early and rapidly progressive wound infection following trauma in fresh water. Broad-spectrum antimicrobial therapy and appropriate surgical care should be promptly instituted.     

Trigger thumb of de Quervain's disease

Triggering of the thumb due to de Quervain's Disease has not been reported in an adult, and only one case in a child has been documented in the literature. Two cases of trigger thumb that were due to stenosing tenosynovitis in which the extensor pollicis brevis tendon triggered in a separate fibro-osseous tunnel within the first dorsal compartment are cited.