Alveolar osteitis and osteomyelitis of the jaws

Postoperative bone healing after oral surgical procedures occurs uneventfully in most cases. However, in certain patients, the normal process of healing can be delayed and, in some cases, often because of multiple coexisting factors, the sites can become infected, with extension of the infection into medullary bone. This process is termed osteomyelitis. This article outlines the pathogenesis, microbiology, and surgical and medical therapies of this condition and specifically addresses osteomyelitis cases related to patients with no documented history of radiation or bisphosphonate exposure and in whom the principal factor in the development of the condition is infection by pyogenic microorganisms.     

Evaluation of the diagnostic performance of the rapid test VIKIA HIV1/2 in a highly complex HIV-1 epidemic

The rapid test VIKIA HIV1/2 was evaluated in 210 Angolan subjects infected with multiple HIV-1 subtypes and complex recombinant forms and 225 seronegative individuals. All infected subjects tested positive (100% sensitivity); all seronegative subjects tested negative (100% specificity). VIKIA HIV1/2 is highly specific and sensitive even in highly complex epidemics.     

Can Paronychia Cause a Remote Necrotizing Soft Tissue Infection?

Remote necrotizing soft tissue infection (NSTI) resulting from paronychia is very unusual but potentially lethal. We report a case of a 39-year-old woman affected by this unusual infection. The paronychia completely resolved in less than 2 weeks, however, a NSTI involved the right chest and flank and the left thigh. The patient required intensive care and multiple surgical debridements. This recent experience and literature data suggest that paronychia can cause a remote NSTI that can rapidly spread and become life-threatening. Broad spectrum antibiotics and aggressive surgical debridement are essential to a successful outcome.     

High mid-term mortality following successful lead extraction for infection

Background: Transvenous lead extraction patients tend to have multiple medical problems complicated by prolonged infections that may result in high‐mortality rates following a successful procedure. Methods: All adult patients referred for lead extraction for infection over a 4‐year period were included in this study. Mortality following the procedure was assessed using hospital records and the Social Security Death Index. Results: Indications for extraction were systemic infection (n = 34) and isolated pocket infection (n = 33). Of the 67 patients, 47 (70%) were still alive at follow‐up (6–55 months). No patient died during or within 24 hours of the procedure, and two were sent to emergent surgery and did well. However, five died during prolonged hospitalizations, and two were discharged to hospice care and died shortly thereafter. The remaining 13 deaths occurred after discharge from the hospital at a mean interval of 15 months (range, 24 days to 35 months) following the procedure. Notably, six of seven patients who died in the hospital, and nine of 13 who died after discharge, had bacteremia as their indication for extraction, for an overall mortality risk of 44% in patients with systemic infection. Conclusions: True risk assessment for lead extraction patients is underestimated and may be related to the focus on the procedural risks, while the underlying illness and physiologic state may account for the excess mortality following a successful extraction. In most cases, the infected hardware contributed to the length and severity of the illness, and thus earlier consideration for extraction may be warranted. (PACE 2011; 32–36)     

Prospective randomized controlled trial investigating the type of sutures used during hepatectomy

AIM: To determine whether absorbable sutures or non-absorbable sutures are better in preventing surgical site infection (SSI), in this paper we discuss the results of a randomized clinical trial which examined the type of sutures used during hepatectomy. METHODS: All hepatic resections performed from January 2007 to November 2008 at the Department of Surgery at Iizuka Hospital in Japan were included in this study. There were 125 patients randomly assigned to an absorbable sutures (Vicryl) group or non-absor...     

Cellular immune responses and occult infection in seronegative heterosexual partners of chronic hepatitis C patients

It is unknown whether hepatitis C virus (HCV)-specific cellular immune responses can develop in seronegative sexual partners of chronically HCV-infected patients and whether they have occult infection. Thirty-one heterosexual partners of patients with chronic HCV were studied, fifteen of them with HCV transmission risks. Ten healthy individuals and 17 anti-HCV seropositive patients, without viremia, were used as controls. Virus-specific CD4+ and CD8+ T-cell responses were measured by flow cytometry against six HCV peptides, situated within the nonstructural (NS) proteins NS3, NS4 and NS5, through intracellular detection of gamma interferon (IFN-γ) or interleukin 4 (IL-4) production and CD69 expression. Sexual partners had a higher production of IFN-γ and IL-4 by CD4+ cells against NS3-p124 (P = 0.003), NS5b-p257 (P = 0.005) and NS5b-p294 (P = 0.012), and CD8+ cells against NS3-p124 (P = 0.002), NS4b-p177 (P = 0.001) and NS3-p294 (P = 0.004) as compared with healthy controls. We observed elevated IFN-γ production by CD4+ T cells against NS5b-p257 (P = 0.042) and NS5b-p294 (P = 0.009) in the sexual partners with HCV transmission risks (sexual, professional and familial altogether) than in those without risks. RNA was extracted from peripheral blood mononuclear cells (PBMC), and detection of HCV-RNA positive and replicative (negative) strands was performed by strand-specific real-time PCR. In four sexual partners, the presence of positive and negative HCV- RNA strands in PBMC was confirmed. Hence, we found an HCV-specific cellular immune response as well as occult HCV infection in seronegative and aviremic sexual partners of chronically HCV-infected patients.     

Chlamydia trachomatis ompA genotypes in male patients with urethritis in Greece: conservation of the serovar distribution and evidence for mixed infections with Chlamydophila abortus

PCR amplification and nucleotide sequencing of the ompA gene of Chlamydia trachomatis were used to determine the prevalence and distribution of genotypes in 51 urine and urethral specimens from Greek male patients with urethritis, that were positive by the COBAS Amplicor test. A single C. trachomatis serovar was identified in 43 of the 51 amplified samples. Serovars F and E were the most prevalent (both 12, 28%), followed by D (9, 21%), G (4, 9%), B and K (both 2, 5%) and H and J (both 1, 2%). Over one third of the samples bared a variant ompA genotype that had been previously identified in other areas worldwide. Two results in this study, both observed for the first time, were of particular interest. First, the emergence of the unique variant genotype D/Ep6 (X77364.2) identified in 3 urethral samples. Second, the ompA genotype OCLH196 of the animal pathogen Chlamydophila abortus as well as a 23S rRNA gene fragment of this species detected by the assay ArrayTube™ was found in 7 urethral samples. The implications resulting from this observation for the health of the general population are discussed.