Fatal fulminant sepsis due to a cat bite in an immunocompromised patient

Pasteurella multocida infections in humans can present as localized infections of soft tissues surrounding the lesions, as respiratory tract infections or as systemic infections with slow or fulminant development. Over 90% of human infections are cases of wound infections or abscesses related to a bite, scratch, or licking of skin lesions by a cat or dog. Severe systemic diseases such as pneumonia, lung abscess, peritonitis, endocarditis, meningitis and sepsis are also well known, especially in patients with underlying medical conditions. In this paper we report on an immunocompromised patient who was bitten by an unknown cat and very quickly developed fulminant sepsis, dying 70 hours after the cat bite, despite all the intensive care, therapy and reanimation he was given. Unfortunately, he asked for medical help too late. We emphasize the need for primary healthcare to provide more information to patients at risk of infections from contact with animals and to warn them about the possible consequences of injuries, even when the animals are pets.     

Tick bites. Poisoning

Various aspects related to lesions and infections produced in humans due to the bites of ticks which live in our country are focused on in this article. Some kinds of ticks found here are described and identified. The author also points out the possible infections these ticks can transmit, mentioning their symptoms, the corresponding treatment in situ as well as in health centers along with preventive measures one can take to avoid at risk situations.     

Identification of Acanthamoeba sp. in paraffin-embedded CNS tissue from an HIV+ individual by PCR

The opportunistic pathogens, Acanthamoeba and Balamuthia, are the causative agents of the fatal central nervous system (CNS) infection granulomatous amoebic encephalitis. We report an infection of Acanthamoeba in an HIV+ individual. In the present case, multiple lesions were observed in the skin, brain, lung, liver, and bone. A polymerase chain reaction (PCR) assay specific for Acanthamoeba was positive on tissue from a brain biopsy that had been embedded in paraffin. This report demonstrates the need for the consideration of Acanthamoeba infections in HIV+ individuals with skin lesions and multiple lesions throughout the body with CNS involvement. The results of the present study demonstrate that opportunistic amoebic infections can be diagnosed by PCR from paraffin-embedded biopsy material.     

Fungal skin infections associated with animal contact

Zoophilic dermatophytes are fungal organisms that primarily infect animals but occasionally infect humans. The most common of these are Microsporum canis and Trichophyton mentagrophytes. The clinical lesions of zoophilic fungal infections are more inflammatory than those caused by the typical anthropophilic fungi normally transmitted from person to person. To diagnose zoophilic fungal infections, a potassium hydroxide preparation of the skin scrapings may be examined microscopically or a culture may be obtained. Small lesions located anywhere except on the scalp may be treated with a topical antifungal agent. Oral griseofulvin is preferred for the treatment of scalp infections and extensive cutaneous infections.     

Diagnosis and treatment of Neisseria gonorrhoeae infections

The most common site of Neisseria gonorrhoeae infection is the urogenital tract. Men with this infection may experience dysuria with penile discharge, and women may have mild vaginal mucopurulent discharge, severe pelvic pain, or no symptoms. Other N. gonorrhoeae infections include anorectal, conjunctival, pharyngeal, and ovarian/uterine. Infections that occur in the neonatal period may cause ophthalmia neonatorum. If left untreated, N. gonorrhoeae infections can disseminate to other areas of the body, which commonly causes synovium and skin infections. Disseminated gonococcal infection presents as a few skin lesions that are limited to the extremities. These legions start as papules and progress into bullae, petechiae, and necrotic lesions. The most commonly infected joints include wrists, ankles, and the joints of the hands and feet. Urogenital N. gonorrhoeae infections can be diagnosed using culture or nonculture (e.g., the nucleic acid amplification test) techniques. When multiple sites are potentially infected, culture is the only approved diagnostic test. Treatments for uncomplicated urogenital, anorectal, or pharyngeal gonococcal infections include cephalosporins and fluoroquinolones. Fluoroquinolones should not be used in patients who live in or may have contracted gonorrhea in Asia, the Pacific islands, or California, or in men who have sex with men. Gonorrhea infection should prompt physicians to test for other sexually transmitted diseases, including human immunodeficiency virus.     

Oral manifestations of HIV infection

All physical examinations of HIV-infected individuals should include a detailed examination of the mouth, since oral lesions are common. There are about 40 oral manifestations of HIV infections that may be the first clinical features of the disease. HIV-related cancers, such as Kaposi's sarcoma or lymphoma, may present as oral lesions. A variety of bacterial infections may be found in the mouth, including linear gingival erythema, necrotizing ulcerative periodontitis, tuberculosis, Mycobacterium avium complex, and bacillary angiomatosis. Viral infections include herpes infections, cytomegalovirus ulcers, hairy leukoplakia, and warts. Among fungal infections, various types of candidiasis are common, and histoplasmosis or cryptococcosis may also cause lesions. Other manifestations include recurrent aphthous ulcers, immune thrombocytopenic purpura, HIV-salivary gland disease, and pigmentation disorders. Treatments are available for many of these disorders.     

STUDIES ON A-AVITAMINOSIS IN CHICKENS : II. LESIONS OF THE UPPER ALIMENTARY TRACT AND THEIR RELATION TO SOME INFECTIOUS DISEASES

When fowls are placed on a diet lacking in vitamin A lesions appear in the upper alimentary tract which are confined largely to the mucous glands and their ducts. Histologically it is shown that the original epithelium becomes replaced by a stratified squamous keratinizing epithelium and that secondary infections are relatively common. The ducts of the glands may be blocked leading to distention with secretions and necrotic materials. These lesions macroscopically resemble very closely certain stages of fowl-pox and the two conditions can be separated only by histological examination. It is pointed out that these lesions produced by a lack of vitamin A may enable bacteria and other viruses to enter the body.     

How I Treat Herpes Simplex

Treatment for herpes simplex, a viral disease, remains nonspecific and symptomatic. Yet there are some measures the physician can take. He can prevent secondary infections with antibiotics, give analgesics and antipyretics, use drying liquids or ointments to relieve local lesions, try the new drug idoxuridine, or remove or modify circumstances that bring on an attack.     

Oral health & HIV/AIDS

Oral lesions are common in women and children with HIV/AIDS and may decrease the overall quality of life in these patients because of pain, dry mouth, and difficulty in eating. An oral cavity screening is an easy, noninvasive, quick, and inexpensive procedure that provides nurses with invaluable information about the need for referral, treatment, and health education. Nurses can use the information obtained from a careful oral screening to decrease the symptoms experienced with oral lesions and optimize a patient's ability to chew and enjoy food. Common oral manifestations of HIV infection include fungal, viral, and bacterial infections, although neoplasms, periodontal disease, salivary gland disease, and lesions of uncertain origin are also seen. Oral lesions such as candidiasis, oral hairy leukoplakia, herpetic ulcers, and Kaposi's sarcoma are often among the first symptoms of HIV infection.     

Human papillomavirus: clinical manifestations and prevention

Human papillomaviruses cause the most common sexually transmitted infection in the world and are responsible for nearly all cases of cervical cancer. Genital human papillomavirus infection can be divided into low-risk infections (causing genital warts) and high-risk infections (causing cervical intraepithelial neoplasia, and cervical and other cancers). Exposure to human papilloma- virus typically produces a sexually transmitted infection that may progress to a clinically apparent process, such as genital warts and cervical intraepithelial neoplasia lesions of the lower genital tract. Although most human papillomavirus infections resolve spontaneously within two years, some high-risk infections persist and are considered cancer precursors. Risk factors for persistent infection include multiple sex partners, sex at an early age, history of sexually transmitted infections, and smoking. Condom use is only partially protective against human papillomavirus infection. The two human papillomavirus vaccines are most effective if given to girls before the onset of sexual activity.     

深圳市罗湖区女性HPV筛查阳性感染与宫颈病变关系

目的探讨女性人乳头瘤病毒(HPV)感染与宫颈病变的关系,为宫颈病变的防治提供依据。方法对本院2016年11月1日至2018年10月31日筛查HPV阳性病例资料进行回顾性分析,同时行TCT(液基细胞学)检查,以病理检查结果作为诊断标准。结果 2622例HPV阳性患者纳入本研究,病理检查结果阳性有204例。有2030例单一HPV感染,592例多重感染,单一感染中病理阳性的病例均为高危型HPV感染;HPV感染最多的是31-40岁组,为38.98%(1022/2622),最少的是>60岁组,是2.02%(53/2622),但是,>60岁患者中宫颈阳性病变最多,达22.6%;TCT检查616例为阳性,其中宫颈病理阳性有131例(131/616,21.3%);高危HPV诊断准确度为8.3%(144/1742),TCT准确度为21.3%(131/616),两者比较差异有统计学意义(P<0.01)。结论深圳罗湖区女性HPV高危型感染宫颈病变率高,不同年龄组宫颈病变阳性最多的HPV亚型不同,TCT对于宫颈病变的诊断准确度高于HPV筛查。     

Candida infections in non-neutropenic children after the neonatal period

There are a variety of diseases, from local mucous membrane infections to invasive systemic infections, that are caused by Candida species. As a causative agent, Candida albicans is the most common; however, the other Candida species can also cause the same clinical syndromes. Most invasive fungal infections in children occur in the hospital setting. Candidemia is a serious condition associated with high morbidity and mortality and increased healthcare costs in pediatric patients. Children at the highest risk are those with prolonged intensive care unit stays, reduced immune function, recent surgery, prior bacterial infection, prior use of antibiotics and/or corticosteroids and other immunosuppressive agents, as well as use of a central venous catheter, total parenteral nutrition, mechanical ventilation and dialysis. Positive blood culture is the gold standard of candidemia; it should not be accepted as contamination or colonization in children with an intravascular catheter. However, in oropharyngeal or vulvovaginal candidiasis, culture of lesions is rarely indicated unless the disease is recalcitrant or recurrent. Recovery of Candida from the sputum should usually be considered as colonization and should not be treated with antifungal therapy. Antigen and antibody detecting tests are evaluated in invasive Candida infections; however, there are no published results in children, and their roles in diagnosis are also unclear. For the therapy of invasive Candida infections in non-neutropenic patients, fluconazole or an echinocandin is usually recommended. Alternatively, amphotericin B deoxycholate or lipid formulations of amphotericin B can also be used. The recommended therapy of Candida meningitis is amphotericin B combined with flucytosine. The combination therapy for Candida infections is usually not indicated. Prophylaxis in non-neonatal, immunocompetent children is not recommended.     

Staphylococcal and streptococcal infections of the skin.

Acute pyogenic infections of the skin, caused by hemolytic streptococci and S. aureus, account for the vast majority of bacterial infections of the skin seen in ambulatory practice. In preschool children the principal manifestation is pyoderma, which is usually caused by Group A Streptococcus. In this age group pyoderma regularly responds to systemic penicillin therapy plus adjunctive local care to the lesions. However, in older age groups, the ability to distinguish streptococcal from staphylococcal skin infections on the basis of clinical features alone is poor, and penicillin treatment failures are more common. Safe, effective antibiotics that are effective against both staphylococci and streptococci are readily available. For this reason penicillinase-resistant semisynthtic penicillins and or erythromycin can be used to treat acute pyogenic skin infections in older age groups.     

The incidence and pathogenesis of myocarditis in rabbits after group A streptococcal pharyngeal infections

Rabbits subjected to single pharyngeal infections with group A streptococci developed cardiac lesions characterized by myofiber necrosis and a non-granulocytic cellular reaction with histiocytes, lymphocytes, and Anitschkow myocytes. The histopathologic changes were demonstrable in some animals within 24 hours of inoculation, apparently were maximal 72 hours after induction of infection (at which time they were seen in the hearts of all nine rabbits studied), and thereafter healed in the course of the following 2 weeks. The extent of involvement was variable, and with healing the necrotic areas were replaced by fibrous tissue. When intradermal infections with the same organisms were produced in rabbits, cardiac lesions, indistinguishable from those observed in the pharyngeally infected group, appeared in a much smaller number of animals. The hearts of five of six rabbits sacrificed a month or more following the last of a series of streptococcal pharyngeal infections exhibited lesions characterized chiefly by fibrosis, although mononuclear cellular infiltrations were also noted. In these repetitively infected animals the presence of occasional multinucleated giant cells and a few small foci of calcification were features not encountered in the single infection group. In a second series of rabbits sacrificed 3 days after the last of three pharyngeal infections with different strains of streptococci, acute as well as more chronic changes were observed. In none of the lesions in rabbits subjected to single or multiple streptococcal infections were bacteria demonstrable, either in histologic sections or in cultures of myocardial tissue. A large number of control animals was studied concomitantly, and in only one instance was a lesion, considered comparable to those described in the streptococcal series, encountered. The implications of these findings, particularly in terms of the non-suppurative sequelae of streptococcal infections in man, are discussed.     

Genital infection with human papillomavirus in adolescents

Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections in adolescents. Such infection is associated with substantial health risks and is unpredictable in its resolution. Genital warts are the most common clinical manifestations of genital HPV infections. Most genital warts are caused by low-risk HPV types (notably HPV-6 and -11). The majority of genital HPV infections are latent or subclinical. Although the outcome of a genital HPV infection is variable, the infection is usually transient and complete resolution is common. However, persistent infections with high-risk HPV types (notably HPV-16 and -18) are associated with the development of cervical intraepithelial dysplasia (CIN), which may progress to cervical cancer. Genital warts, generally diagnosed in the clinic, can be treated with imiquimod, podofilox, podophyllin, liquid nitrogen, bichloroacetic or trichloroacetic acid, or surgery. Cervical cytology screening is an ideal screening test for subclinical HPV infection with resultant CIN. Annual cervical cytology screening should begin approximately 3 years after initiation of sexual intercourse but no later than age 21 years. Because of the high rate of regression of low-grade squamous intraepithelial lesions (LSIL) in adolescents, the cytologic study should be repeated within 6 to 12 months. Colposcopy should be reserved for persistent LSIL. Patients with high-grade squamous intraepithelial lesions (HSIL) should be referred for colposcopy and biopsy. Confirmed HSIL should be treated with cryotherapy, laser therapy, or loop electrosurgical excisional procedure. The use of therapeutic vaccines is still experimental. HPV infection can be prevented, to a certain extent, by delaying the initiation of sexual activity, limiting the number of sexual partners, and using latex condoms. Several viruslike particle candidate vaccines are under development for the prevention of HPV. These vaccines have been proven safe, well tolerated, highly immunogenic, and highly efficacious. Such vaccines are urgently needed and ultimately may be an important preventive measure.     

Color and duplex Doppler sonographic investigation of in utero spontaneous regression of pulmonary sequestration.

Bronchopulmonary sequestration is a congenital abnormality of nonfunctional pulmonary tissue that lacks normal connections with the bronchial tree. The sequestered tissue typically receives the majority of its blood supply from systemic vessels, most often the distal thoracic or upper abdominal aorta. These lesions often are associated with fetal hydrops, polyhydramnios, and persistent masses postnatally. Bronchopulmonary sequestrations are thought to require resection owing to their predisposition for chronic pulmonary infections later in life. However, spontaneous in utero resolution of these lesions can occur. This report describes the real time, color Doppler, and duplex Doppler ultrasonographic investigation of an intrathoracic bronchopulmonary sequestration that resolved spontaneously. Our investigation of this case provides new insight into a possible mechanism for spontaneous regression of bronchopulmonary sequestration.     

An overview of molluscum contagiosum: a viral skin condition

Molluscum contagiosum is a virus that causes characteristic pearly lesions on the surface of the skin. Small clusters of mollusca are a nuisance rather than a serious health problem. However, the mollusca can be more widespread and disfiguring in people with impaired cell-mediated immunity. Molluscum contagiosum virus is common in children. In adults it can also be contracted during sexual activity and might indicate a need for diagnostic testing for other, more serious sexually transmitted infections in young, sexually active adults.     

Molluscum contagiosum and warts

Molluscum contagiosum and warts are benign epidermal eruptions resulting from viral infections of the skin. Molluscum contagiosum eruptions are usually self-limited and without sequelae, although they can be more extensive in immunocompromised persons. Spontaneous disappearance of lesions is the norm, but treatment by local destruction (curettage, cryotherapy, or trichloroacetic acid) or immunologic modulation can shorten the disease course, possibly reducing autoinoculation and transmission. Warts result from a hyperkeratotic reaction to human papillomavirus infection; nongenital warts are classified as common, periungual, flat, filiform, or plantar, based on location and shape. Warts are treated by local destruction (acids, cryotherapy, electrodesiccation-curettage), chemotherapy, or immunotherapy. The choice of treatment varies with the age and wishes of the patient, the potential side effects of the treatment, and the location of the lesions.     

Antiviral drugs in the immunocompetent host: part I. Treatment of hepatitis,cytomegalovirus, and herpes infections

Since the release of amantadine in 1966, other agents designed to fight a diverse range of viral infections have been released. Part I of this two-part article focuses on agents used to manage hepatitis, cytomegalovirus, and herpes infections. In patients with chronic hepatitis B, interferon alfa-2b or lamivudine is the treatment of choice. Pegylated interferon alfa-2a or -2b, along with ribavirin, is standard treatment for patients with chronic hepatitis C. Although treatment of cytomegalovirus infections generally is supportive, there have been reports of severely ill patients who improved after receiving ganciclovir or foscarnet. Oral antiviral agents for initial and recurrent herpes simplex virus infections have been shown to shorten the duration of lesions. Treatment of herpes zoster infections with antiviral drugs shortens the course of infection and decreases symptoms. Studies have shown that antiviral treatment can prevent prolonged post-herpetic neuralgia, although this use remains controversial.     

Cavitary pneumonia and skin lesions

Tularemia is a worldwide zoonosis caused by Francisella tularensis. The most frequent forms of tularemia are ulceroglandular, followed by typhoidal forms, glandular, and oculoglandular. Respiratory involvement is an uncommon presentation. Cutaneous lesions secondary to respiratory infections occur in 30% of cases. We present a case of tularemia with cavitary pneumonia and skin lesions.