Coccidioides immitis osteomyelitis in a 12-month-old child

The case of a 12-month-old Mexican-American boy with Coccidioides immitis osteomyelitis of the little finger metacarpal and os calcis is presented in which a "cure" was obtained. The child received treatment with high doses of amphotericin B in conjunction with debridement and packing the lesions with calcium sulfate pellets. Recommended treatment for C. immitis infection of the bone would be debridement and packing with graft combined with systemic antifungal medical therapy.     

Primary sternal osteomyelitis: a case series and review of the literature

Purpose

Primary sternal osteomyelitis is rare in the pediatric population.

Methods

We present 4 recent cases that demonstrate a wide range in age, presenting features, and clinical course, and we performed a literature review.

Result

A combination of diagnostic aspiration with prolonged appropriate antibiotic therapy led to successful resolution in all cases. Surgical debridement should be reserved for cases that do not respond to medical therapy.

Conclusion

Sternal osteomyelitis is a rare condition in children that usually resolves with aspiration and prolonged antibiotic therapy.     

Extensor tendon rupture due to Coccidioides immitis. Report of a case

In a 60-year-old man, extensor tendon rupture was associated with coccidioidal tenosynovitis. Dissemination of Coccidioides immitis to the tenosynovium in the wrist is an unusual complication following pulmonary coccidioidomycosis.     

Primary subacute osteomyelitis of the talus in children: a case series and review

Subacute haematogenous osteomyelitis of the talus in children is a rare condition. All previously reported cases have been managed by hospital admission with surgical debridement and antibiotics or by intravenous antibiotic therapy followed by oral antibiotics. This case series documents the management of the condition at our institution and reviews the current published literature. We conclude that with appropriate patient selection, primary subacute haematogenous osteomyelitis of the paediatric talus can be managed on an out-patient basis with oral antibiotic therapy.     

Flexor tenosynovitis caused by Coccidioides immitis

Coccidioidomycosis is a rare disease and dissemination of the pulmonary infection occurs in less than 0.1% of cases. A case report of coccidioidal tenosynovitis in association with immunosuppressive chemotherapy is described. Recommended management includes both intravenous amphotericin B and surgical synovectomy.     

Squamous cell carcinoma complicating chronic osteomyelitis: A systematic review and case series

IntroductionSquamous cell carcinoma (SCC) is a rare but serious complication of chronic osteomyelitis. This study aimed to determine an optimum approach to diagnosis and management.MethodsA systematic review was performed using Medline, Embase, CINAHL and Web of Science, from 1999-present. Additional cases, meeting the eligibility criteria, were added from our hospital database. Patient demographics (age, gender, co-morbidities), osteomyelitis diagnosis (location, duration), diagnosis of SCC (method, imaging, extent of disease) and management (amputation versus wide local excision versus palliation) as well as outcome at one and five years were collected.ResultsNineteen studies involving 106 patients met strict inclusion criteria. All published studies were case reports or case series. Chronic osteomyelitis had been present for a mean of 31 years (range 3–67) prior to SCC diagnosis. SCC was most commonly treated by amputation (81%). A poorer outcome occurred in those with metastatic disease (p = 0.006 at one year; p = 0.032 at five years), an incidental diagnosis at surgery for osteomyelitis (p = 0.052; p = 0.021) and SCC after pelvic osteomyelitis (p < 0.001; p = 0.002).ConclusionsSCC should be suspected in all cases of chronic osteomyelitis with skin changes, particularly if the duration of sinus drainage exceeds 3 years. Histological biopsy for malignancy should be taken in all suspected cases, as well as routinely during excision of osteomyelitis when chronic skin changes are present. Staging computed tomography (CT) scanning is recommended to guide adjunctive therapy. Amputation, where possible, may be considered as the definitive surgical management, after discussion with the patient.     

Coccidioides immitis in the gallbladder and biliary tree.

Intraabdominal coccidioidomycosis is a very rare entity and usually responds to medical therapy. Operative intervention is reserved for diagnosis or drainage of localized collections. With biliary coccidioidomycosis, medical treatment appears to be ineffective, and biliary tract drainage is necessary for optimal management. A case of coccidioidomycosis in the gallbladder and biliary tree is described and the literature reviewed.     

Coccygodynia review: coccygectomy case series

Background

Coccygodynia is a pain of the coccyx that is typically exaggerated by pressure. Management includes anti-inflammatory medications, physiotherapy, and coccyx manipulation. Coccygectomy is the surgical approach for treating coccygodynia when the conservative management fails. Generally, coccygectomy yields good results. Its most common complication is wound infection.

Objective

To determine the effectiveness of coccygectomy in patients with coccygodynia.

Methods

A retrospective review of 70 patients (52 females and 18 males) with coccygodynia at King Khalid University Hospital in Riyadh was carried out, and the outcomes were studied. Twenty patients did not respond to conservative management; therefore, bimanual coccyx manipulation was done. Eleven were identified with instability and did not respond to coccygeal manipulation. Coccygectomy was performed on 8 patients while 3 declined.

Results

All patients who underwent coccygectomy showed improvement of their symptoms. One case of superficial wound infection and delayed wound healing was encountered.

Conclusion

Coccygectomy provides effective pain relief to patients not responding to conservative therapies.

     

Candidial osteomyelitis: a case report

Candidial osteomyelitis is rare but becoming more common. The spinal column is most affected in adults and one such patient is presented. The condition should be suspected if bone infection has followed long intensive care, parenteral feeding with central venous cannulation, the use of many antibiotics in combination and/or concomitant severe eye infection. If diagnosed, correct treatment with antifungal agents is curative.     

Multiple intracranial aneurysms due to Coccidioides immitis infection. Case report

True mycotic (fungal) aneurysms are distinctly uncommon. The case of a young woman with multiple intracranial aneurysms of Coccidioides immitis origin is presented. Coccidioides immitis organisms are not uncommon central nervous system pathogens and usually cause basilar meningitis and hydrocephalus. There are no previous reports of a coccidioidal mycotic aneurysm. The management of intracranial coccidioidomycosis and fungal aneurysms is reviewed.     

Thoracic mural thrombi: a case series and literature review

Thoracic mural thrombi (TMT) are rare but an important source of distal emboli. Treatment options are dynamic, ranging from open, endovascular to conservative therapies. We report two cases of TMT, one successfully treated with thoracic aortic endoluminal stent placement for visceral and peripheral embolization, the second treated conservatively for digital embolization secondary to TMT in the innominate artery.     

Tetanus in developing countries: a case series and review

Purpose

Few anesthesiologists have expertise in the diagnosis and treatment of tetanus, a disease that remains prevalent in developing countries. We report on a series of four cases of tetanus cases recently encountered in Rwanda. We review the clinical epidemiology, pathophysiology, diagnosis and the treatment of tetanus, and provide implications for anesthesiologists and critical care physicians.

Clinical features

We report four cases, two involving adults who were inadequately vaccinated and experienced injuries, and two involving neonates, both of whom underwent umbilical cord transection using unsterilized equipment. All patients required tracheal intubation, and were mechanically ventilated when equipment was available. One adult and one neonate succumbed to the disease. These cases highlight the difficulties of diagnosis and management of complicated diseases in the resource-challenged health care setting of developing countries.

Conclusions

The differential diagnosis of tetanus may be confusing, and survival depends on the rapidity of treatment with antitoxin, as well as adequate supportive care. High doses of sedatives and muscle relaxants, as well as prolonged mechanical ventilation, are usually necessary. Mortality remains high, usually resulting from late respiratory failure and cardiovascular collapse, associated with autonomic instability. Anesthesiologists and critical care physicians have an important role to play in the management of these patients. Increased involvement in humanitarian health organizations, immigration from developing countries, and emergence of high risk groups in developed countries will likely result in more exposure of anesthesiologists to the complexities of this disease.