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PubMed1959

[Various aspects of iron in the organism. I. Ferritin and ferruginous micelles].

Des cellules réticulaires remplies de molécules de ferritine et d'hémosidérine se trouvent au centre "d'ilots érythroblastiques." Dans la zone de contact entre la cellule réticulaire chargée de ferritine et les érythroblastes, on voit des invaginations et des petites vacuoles au bord desquelles adhérent des molécules de ferritine. Il est postulé que la ferritine passe de la cellule réticulaire centrale dans les érythroblastes par ce mécanisme, apparenté à la pinocytose (rhophéocytose). Dans tous les érythroblastes normaux, il existe du fer sous forme de ferritine. Celle-ci peut se trouver à l'état dispersé ou agglomérée en amas. Lorsque ces amas sont assez gros, ils sont visibles au microscope optique: ce sont les granules des sidéroblastes. On trouve du fer dans les mitochondries, mais rarement à l'état normal. Il est soit sous forme de granules ferritiniques soit sous forme de micelles ferrugineuses. Dans les thalassémies et d'autres maladies s'accompagnant d'un trouble de l'hémoglobinogénèse, on trouve, en grande quantité, du fer visible au microscope électronique, dans les érythroblastes. Il s'y trouve sous forme de ferritine, en amas ou dispersé. Il existe parfois en grande quantité dans les mitochondries soit sous forme de ferritine, soit sous forme de micelles ferrugineuses. Il semble que soit objectivé ainsi le trouble de la synthèse de l'hémoglobine: le fer inutilisé s'accumule dans des érythroblastes hypochromes. Il est probable qu'à l'etat normal, le fer est métabolisé dans les mitochondries. Dans le thalassémies et les anémies hypochromes hypersidérémiques, il semble souvent bloqué dans ces organites.

Ferritins↗
PubMed1991

Orbital complications of ethmoiditis: B.C. Children's Hospital experience, 1982-89.

Orbital complications of ethmoiditis primarily affect children. Infection proceeds through contiguous spread to the orbit. We undertook a retrospective analysis of all children admitted to British Columbia Children's Hospital in Vancouver with a diagnosis of periorbital and orbital cellulitis due to ethmoiditis between 1982 and 1989. The majority of children presented with periorbital cellulitis, which resolved with aggressive parenteral antibiotic therapy. Five children (17%) progressed to subperiosteal abscess formation as documented by CT scan and required external ethmoidectomy as a drainage procedure. We conclude that early hospitalization and aggressive parenteral antibiotics are effective in resolving periorbital cellulitis. Surgical drainage is indicated when subperiosteal abscess is documented by CT scan. In our series, there were no cases of permanent visual deficit resulting from complications of ethmoiditis.

Anti-Bacterial Agents↗
PubMed1986

[Fundamental and clinical evaluation of imipenem/cilastatin sodium in the field of pediatrics].

A combination drug of imipenem (MK-0787), a new carbapenem antibiotic, and cilastatin sodium (MK-0791) at a ratio of 1:1 was used to treat infections in 8 children, and the concentrations of MK-0787 were determined in plasma, urine and pus of 1 patient and in cerebrospinal fluid of another patient. Eight patients, aged 2 months to 12 years (males: 3, females: 5), were treated with MK-0787/MK-0791. They consisted of 3 with urinary tract infections (causative organisms: E. coli, K. oxytoca plus E. faecalis, and unknown), and 1 patient each with pneumonia (H. influenzae), enteritis (Salmonella C1), cellulitis (S. aureus), purulent lymphadenitis (unknown) and purulent meningitis (E. coli). The dose, ranging from 7.4 mg/7.4 mg/kg to 11.8 mg/11.8 mg/kg, 3 or 4 times daily, was administered by a 30-minute or 60-minute intravenous drip infusion for 5 to 11 days. To the patient with purulent meningitis, however, 25.85 mg/25.85 mg/kg on the 1st day and 12.9 mg/12.9 mg/kg from the 2nd day were administered 4 times daily. Clinical responses in urinary tract infections were excellent in 2 and good in 1, and responses in pneumonia, enteritis, cellulitis, purulent lymphadenitis and purulent meningitis were excellent, good, good, excellent and poor, respectively. The efficacy rate in a total of 8 patients was 87.5%. As adverse reactions, a rash was observed in one patient and a convulsion in another. The rash disappeared after discontinuation of the administration of the drug and the convulsion stopped after a reduction of the dosage. As abnormal laboratory findings, slight prolongation of the prothrombin time was observed in 1 patient, but no bleeding tendency was noted. When MK-0787/MK-0791 (500 mg/500 mg, or 8.7 mg/8.7 mg/kg) was given by a 60-minute intravenous drip infusion to a 12-year-old boy with cellulitis, the peak plasma concentration of MK-0787 was 31.4 micrograms/ml occurring at the end of the infusion, and then the concentration decreased to 13.9 micrograms/ml in 0.5 hour, 8.9 micrograms/ml in 1 hour, 2.8 micrograms/ml in 2 hours, 0.63 microgram/ml in 4 hours and 0.14 microgram/ml in 6 hours. The half-life was 0.83 hour. These plasma levels provided concentrations exceeding MIC90's against major infective bacteria for 2 hours. The urinary recovery in the first 7 hours was 75.0%, and the urinary concentration was greater than 100 micrograms/ml for 5 to 7 hours.(ABSTRACT TRUNCATED AT 400 WORDS)

Bacterial Infections↗
PubMed1996

Early diagnosis of necrotizing fasciitis by utilization of ultrasonography.

Necrotizing fasciitis is a rare and rapid progression soft tissue infection. The only identifiable feature is tissue necrosis along a single fascia plane. Because the skin is initially spared, it is difficult for early recognition prior to extensive tissue destruction. Ultrasonography was used for early diagnosis of this infection in five cases. All 5 patients presented with severe cellulitis. Under the suspicion of necrotizing fasciitis, ultrasonography was performed before surgical debridement. Tissue biopsy was done for histological confirmation of the diagnosis. Three patients were proven to have necrotizing fasciitis and two cellulitis only. The ultrasonographic findings of necrotizing fasciitis included: 1) irregularity of the fascia; 2) abnormal fluid collections along the fascia plane; and 3) diffuse thickening of the fascia when compared with the control site in the normal limb. However, in severe infectious cellulitis, the above mentioned findings were not observed. Our results indicate the usefulness of the ultrasonography for early diagnosis of necrotizing fasciitis.

Adult↗
PubMed1998

Lymphedema as a cause of unilateral leg swelling: a case report with 6-yr follow-up.

OBJECTIVE: To discuss a case of unilateral lower extremity swelling caused by an uncommon condition, lymphedema praecox. An emphasis is placed on diagnostic imaging. CLINICAL FEATURES: A 48-yr-old man suffered from low back and left leg pain. The left leg was swollen with evidence of cellulitis. Orthopedic evaluation separated the low back pain from the leg pain, and a diagnosis of sacroiliac syndrome concurrent with lymphedema was made. Further evaluation led to a diagnosis of congenital lymphedema, specifically lymphedema praecox, because of the age of onset. INTERVENTION AND OUTCOME: Because of active cellulitis, direct treatment of the lymphedema was contraindicated. The patient was advised in techniques to keep the leg clean and to help decrease pooling of lymph by placing the limb in an elevated position. The patient was also referred to a medical facility for antibiotics. The low back pain was addressed using chiropractic. CONCLUSION: Congenital lymphedema is an uncommon condition that causes unilateral limb swelling. The differential diagnosis includes other uncommon entities that should be ruled out so that proper treatment may be administered. Congenital lymphedema is best treated conservatively and only after any cellulitis has been controlled.

Follow-Up Studies↗
PubMed2001

Early discharge of infected patients through appropriate antibiotic use.

BACKGROUND: Patients with infections are usually discharged from the hospital with antibiotics when afebrile and clinically improved. OBJECTIVES: To compare outcomes of early vs conventionally discharged patients and to examine the role of antibiotic use in the discharge process. METHODS: One hundred eleven patients hospitalized with cellulitis, community-acquired pneumonia, or pyelonephritis (urinary tract infection) discharged from the hospital early in their clinical course before defervescence by an infectious diseases hospitalist (L.J.E.) were compared in a case-controlled study with 112 patients discharged from the hospital according to conventional standards of care by internal medicine (IM) hospitalists. Patients were matched for age, sex, diagnosis, and comorbidities. Outcomes were determined for average lengths of stay, readmission to the hospital within 30 days with the same diagnosis, satisfaction with their discharge program, and time to return to their normal activities of daily living. RESULTS: Patients cared for by the infectious diseases hospitalist had a shorter average length of stay (mean difference, 1.7 days), no readmissions, higher satisfaction scores, and a shorter time to return to their activities of daily living, compared with those cared for by the IM hospitalists. Analysis of the antibiotics that patients were discharged with revealed that the infectious diseases hospitalist used outpatient parenteral antibiotic therapy more frequently than IM hospitalists in the treatment of cellulitis, and switched from intravenous to oral antibiotics sooner than IM hospitalists for patients with community-acquired pneumonia and urinary tract infection. CONCLUSIONS: The infectious diseases hospitalist discharged patients from the hospital earlier than the IM hospitalists by more efficient use of antibiotics. The earlier discharge did not adversely affect outcomes.

Activities of Daily Living↗
PubMed1996

Stenotrophomonas maltophilia ocular infections.

OBJECTIVES: To determine if the number of ocular infections associated with Stenotrophomonas maltophilia is increasing, to identify predisposing factors, and to evaluate antimicrobial susceptibility. METHODS: Retrospective review of ocular microbiology laboratory records from January 1, 1972, through December 31, 1995. RESULTS: Stenotrophomonas maltophilia was recovered from 15 cases of ocular infection, at a rate of one in every 1339 ocular specimens in the 1970s, one in 413 in the 1980s, and one in 363 in the 1990s through 1995. The organism was the predominant isolate in five cases and was part of a polybacterial infection in the remaining 10 cases. Eight of the 15 cases had bacterial keratitis, including one with infectious crystalline keratopathy. Of the remaining seven infections, S maltophilia was recovered from two cases of acute conjunctivitis, two infected scleral buckles (one with orbital cellulitis), two cases of infantile dacryocystitis, and one case of preseptal cellulitis. Ocular isolates of S maltophilia were resistant to the aminoglycosides and most beta-lactams, and showed variable susceptibility to the fluoroquinolones. CONCLUSIONS: Stenotrophomonas maltophilia is emerging as an important opportunistic ocular pathogen. Most infections by this organism occur in patients with ocular compromise, and the characteristically resistant antibiogram of S maltophilia limits the therapeutic options.

Adult↗
PubMed1981

Clinical efficacy of cefoxitin in the treatment of head and neck infections.

Cefoxitin sodium, a new cephamycin antibiotic, is active against many aerobic and anaerobic bacteria. Four patients with infections of the head and neck (otitis externa with cellulitis, parotiditis, tracheitis, and facial cellulitis), who had failed to respond to initial antibiotic regimens, responded satisfactorily to cefoxitin therapy. No adverse effects were noted in any of these patients. Results of this report suggest cefoxitin is a safe and well-tolerated antibiotic that is efficacious in the treatment of head and neck bacterial infections that are sensitive to this drug.

Adult↗
PubMed1975

Severe Haemophilus influenzae infections.

From May 1973 thorugh April 1974, a total of 83 children with severe Haemophilus influenzae infections were treated in three Denver pediatric hospitals. Although meningitis was the most common clinical manifestation (45 cases), other foci of infection were also noted (pneumonia, 12 cases; cheek cellulitis, eight cases; epiglottitis, eight cases; empyema, seven cases; pericarditis, three cases; arthritis, one case; periorbital cellulitis, one case; and abscess, one case). Nine children had positive blood cultures with H influenzae without an initial detectable focus of infection. Two patients developed clinically apparent sites of infection (osteomyelitis and scalp abscesses).

Abscess↗
PubMed1985

Cefuroxime therapy for bacteremic soft-tissue infections in children.

Although it is used extensively in Europe, there is a limited amount of published data concerning pediatric clinical experience with cefuroxime in the United States. Thirty-six children, ranging from 3.5 to 57 months of age, received intravenous cefuroxime (75 mg/kg/day in three divided doses) for soft-tissue infections of the face or epiglottis. Infections treated included preseptal (19 patients) and buccal (13 patients) cellulitis and epiglottitis (four patients). Blood cultures were positive in 22 patients, yielding Haemophilus influenzae type b in 17 (four were beta-lactamase-positive), Streptococcus pneumoniae in four; and beta-lactamase-positive, nontypable H influenzae in one. An additional five patients with buccal cellulitis had negative blood cultures but H influenzae type b antigenuria. A satisfactory clinical response was noted in all patients, and repeated blood cultures performed in initially bacteremic patients were sterile. Cefuroxime therapy was well tolerated, and abnormal laboratory results were infrequent, except for absolute granulocytopenia (granulocytes, less than 1,500/cu mm), which occurred in six patients but could not be ascribed to a drug effect because of the uncontrolled design of our study. Treatment with cefuroxime appears to be a safe and effective therapy for pediatric soft-tissue infections due to H influenzae and S pneumoniae.

Cefuroxime↗
PubMed1992

Uses and technique of pediatric lumbar puncture.

OBJECTIVES: To review diagnostic and therapeutic indications, contraindications, complications, and technique of pediatric lumbar puncture with emphasis on diagnosis of bacterial meningitis in bacteremia, cellulitis, and fever with seizures and to discuss cerebrospinal fluid findings in partially treated infection and traumatic blood-contaminated spinal tap. RESEARCH DESIGN: Literature review. CONCLUSIONS: We recommend lumbar puncture for children younger than 1 year with bacteremia, children with Haemophilus influenzae type B cellulitis, and children with fever and seizures not classified as simple. Pretreatment with antibiotics rarely changes cerebrospinal fluid characteristics such that a diagnosis of bacterial meningitis would be obscured. In a traumatic spinal tap, the equation to predict cerebrospinal fluid pleocytosis based on the peripheral blood cell count is invalid. When used together, cerebrospinal fluid glucose level, Gram's staining, and observed-to-expected ratio of white blood cells are highly reliable in diagnosing bacterial meningitis.

Bacteremia↗
PubMed1988

Soft-tissue infections caused by halophilic marine vibrios.

Marine Vibrio bacteria can cause illness and occasionally death to people who are exposed to seawater. These gram-negative bacteria can be found in ocean water and estuaries and in uncooked marine animals; they can cause primary sepsis, gastroenteritis, and soft-tissue infections. During a five-year period from 1981 to 1986, we encountered 51 patients with primary soft-tissue infections caused by marine vibrios. Thirty-nine patients developed cellulitis after direct exposure to ocean water, nine had eaten raw oysters, and three had no obvious exposure to seawater. Twenty-two patients (44%) had an underlying illness that might have made them compromised hosts and predisposed them to infection. Twelve patients developed necrotizing infections. Thirteen patients ultimately died. These infections are susceptible to many antibiotics. Débridement is necessary when tissue necrosis occurs. Surgeons should suspect a marine vibrio infection if cellulitis occurs in a patient who has been near ocean water or has eaten raw oysters. These infections may not become apparent until a traveler has returned home, a place that may be far from the ocean.

Cellulitis↗
PubMed1990

Current hypotheses on synergistic microbial gangrene.

We have reviewed spreading infections of the dermis, with special reference to the importance of synergy in their causation. Evidence for this is accumulating from both clinical studies and from studies in laboratory animals. Necrotizing fasciitis (rapid spread over 24 h) can be caused by beta-haemolytic streptococci, sometimes with Staphylococcus aureus, or by mixed infections of aerobes and anaerobes, often of gut origin. Animal studies provide good evidence that S. aureus can potentiate the beta-haemolytic streptococcal infection in necrotizing fasciitis. There is also evidence that mixtures of aerobes and anaerobes can act synergistically, but animal models for necrotizing fasciitis have not been developed. Anaerobic cellulitis (variable rate of spread from hours to days) can be caused by mixed aerobes and anaerobes or by mixed clostridia. Animal studies provide good evidence for synergy in the former. Meleney's synergistic postoperative gangrene (slow spread over weeks) may be cutaneous amoebiasis: the animal model of Brewer and Meleney relates to the more rapid infections of anaerobic cellulitis.

Animals↗
PubMed2004

Soft tissue enhancement on time-resolved peripheral magnetic resonance angiography.

PURPOSE: To evaluate the incidence and locations of soft tissue enhancement on time-resolved two-dimensional projection magnetic resonance angiography (MRA) of the calf and foot. MATERIALS AND METHODS: Time-resolved two-dimensional projection MRA of the knee, calf, and foot, performed at 1.5 Tesla using the head coil, was retrospectively reviewed in 326 patients. Soft tissue enhancement of the foot was identified and graded by blinded review. Subsequently, patient medical records were reviewed to determine the presence or absence of diabetes, cellulitis, gangrene, and ulceration of the foot and presence of neuropathic joints. RESULTS: Enhancing spots were identified in 228 patients. For those feet without clinical abnormalities, diabetic patients had an average of 1.2 enhancing spots per foot, while nondiabetics had only 0.6 (P < 0.001). Higher-grade lesions were more prevalent in diabetics and in heavier patients. Of 64 patients with follow-up, 8 (13%) developed cellulitis (N = 4) or ulceration (N = 4) at the location of an enhancing spot, including 5 diabetic and 3 nondiabetic patients. CONCLUSION: Pedal soft tissue enhancement frequently occurs on time-resolved gadolinium (Gd):MRA of the feet. The etiology is uncertain, but the high frequency in diabetic patients and observation of progression to cellulitis/ulceration suggest this soft tissue enhancement may identify sites of subclinical pedal soft tissue injury.

Adult↗
PubMed2001

[Ocular myositis. A rare differential diagnosis of sinus-induced orbital complications].

Orbital myositis is an uncommon subgroup of the nonspecific orbital inflammatory syndromes (previously termed orbital pseudotumor) and presents with eyelid swelling and redness, conjunctival chemosis, pain, proptosis, and diplopia. The disease is to date of unknown origin; autoimmune processes are suspected for the etiology. In the case of an otherwise healthy young male patient (age 28 years), the coexistence of chronic sinusitis primarily led to the diagnosis of sinugen orbital cellulitis. Despite antibiotic drug administration and surgical drainage of the paranasal sinuses the symptoms persisted. A second computed tomography revealed fusiform, inflammatory enlargement of the m. rectus lateralis. This muscle showed a restrictive paresis so that initially the m. rectus medialis was suspected to be paretic. The patient responded dramatically to administration of prednisolone within 2 days. The differential diagnosis between a sinugen orbital complication and orbital myositis is significant because corticosteroids are contraindicated for orbital cellulitis whereas they remain the therapy of choice for orbital myositis.

Adult↗
PubMed2002

Appropriate indications for venous duplex scanning based on D-dimer assay.

Because of the rapid growth in requests for lower extremity duplex scanning, we tested a new rapid D-dimer assay method, the Miniquant test, for its ability to rule out deep vein thrombosis (DVT) in patient subgroups with the following risk factors: malignancy, postoperative state, and cellulitis. One hundred twenty-six consecutive patients with suspected DVT underwent clinical assessment, D-dimer testing with quantitative Miniquant D-dimer assay, and duplex scanning according to standard criteria for the diagnosis of DVT. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated versus duplex scanning for the various risk factor subgroups. Our results showed that the Miniquant D-dimer assay is useful preselection procedure (high NPV) in selected patient subgroups with suspected proximal DVT, including patients with cellulitis and those without malignancy or postoperative state. This preselection procedure has the potential for avoiding a large proportion of unnecessary duplex scanning, thus saving time and reducing costs.

Aged↗
PubMed2005

Determining optimum management of descending necrotizing mediastinitis with CT; experience with 32 cases.

To determine the value of helical computed tomography (CT) in the diagnosis, management and outcome of patients suspected of having descending necrotizing mediastinitis (DNM). Thirty-two patients with suspected DNM were submitted to contrast-enhanced single detector-row helical CT, four detector-row CT and 16 detector-row CT of the neck and chest. In 10/32 patients (group 1) no abnormality was observed in the neck or in the chest spaces on CT scan. These patients were all treated non-operatively. In 12/32 patients (group 2) CT showed the presence in the neck spaces of fluid collections, fasciitis, cellulitis, myositis, jugular vein thrombosis and lymphadenopathy; in all these patients the chest was unaffected. A cervical drainage was performed in ten patients. In the remaining ten patients (group 3), the neck infection involved the mediastinal spaces in all the cases and the pleural and pericardial spaces; CT findings included mediastinal cellulitis and fluid collections, pleural and pericardial effusions, venous thrombosis and lymphadenopathy. In these patients, a cervico-mediastinal drainage was performed and antibiotics were administered. The CT provides a highly accurate depiction of the presence and the spread of DNM. The CT findings and the extension of disease are important factors in order to predict for patient management and outcome.

Adult↗
PubMed1979

Infections due to group C streptococci in man.

Although a common cause of infection in animals, group C streptococci are rarely noted to be pathogenic in man. A total of 150,000 blood cultures obtained at the Mayo Clinic from 1968 to 1977 revealed group C streptococci in only eight patients. Acute bacterial endocarditis, meningitis, pheumonia, cellulitis and bacteremia due to group C streptococci are described in a host who had undergone immunosuppression (immunosuppressed host), and the relatively few cases previously reported are reviewed. Although severe, these infections may respond favorably to penicillin therapy. Endocarditis caused by group D streptococci is acute and destructive, and associated with early cardiac decompensation. The manifestations of cellulitis and pneumonia are similar to those when group A streptococci are causative organisms. Meningitis due to group C streptococci is acute and severe, and responds slowly to antimicrobial therapy. Colonization also occurs.

Adolescent↗

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