Lumps and bumps: late postsurgical inflammatory and infectious lesions

Late postsurgical infectious or inflammatory complications after facial surgery present a difficult challenge. These complications occur at least 2 weeks after surgical procedures and are often attributable to unique causes, in contrast to complications within the first postoperative week. The most worrisome complications in this period are caused by mycobacterial infections, because these infections can be severe and require a protracted treatment course. A high degree of suspicion is required early in presentation because these lesions can be subtle and similar to other infectious or inflammatory lesions. The authors discuss the clinical manifestations and diagnostic and treatment rationale for late postoperative infectious and inflammatory lesions. The authors also demonstrate and compare the clinical manifestations of mycobacterial infections, bacterial infections, and sterile inflammatory reactions. In addition, the treatment rationale for mycobacterial infections is reviewed. Late postoperative infections caused by mycobacteria are reported with increasing frequency in the cosmetic literature. These cases illustrate diverse challenges in the identification and treatment of late postoperative lesions.     

Clinical characteristics and epidemiology of pulmonary pseudallescheriasis

BackgroundSome members of the Pseudallescheria (anamorph Scedosporium) have emerged as an important cause of life-threatening infections in humans. These fungi may reach the lungs and bronchial tree causing a wide range of manifestations, from colonization of airways to deep pulmonary infections. Frequently, they may also disseminate to other organs, with a predilection for the brain. In otherwise healthy patients, the infection is characterized by non-invasive type involvement, while invasive and/or disseminated infections were mostly seen in immunocompromised patients.AimsWe reviewed all the available reports on Pseudallescheria/Scedosporium pulmonary infections, focusing on the geographical distribution, immune status of infected individuals, type of infections, clinical manifestations, treatment and outcome.Results and conclusionsThe main clinical manifestations of the 189 cases of pulmonary pseudallescheriasis reviewed were pneumonia (89), followed by fungus ball (26), and chest abscess (18). Some patients had more than one type of invasive pulmonary manifestations. Among patients with pneumonia, several cases of pneumonia associated with near-drowning (10/89, 11.2%) have also been reported in immunocompetent hosts. Major underlying conditions for non-invasive pulmonary infection were preexisting lung cavities and medical immunosuppression for invasive pulmonary infection. Saprobic airway colonization was mostly seen in patients with mucosal dysfunction, i.e. patients with cystic fibrosis. The mortality rate was closely related to the infection type, being 26.8% in non-invasive type (fungus balls) and 57.2% in invasive type.     

Symptomatic infections by toscana virus in the Modena province in the triennium 1999-2001

We report nine cases of clinical manifestations by Toscana virus (TOSV) diagnosed at the Centre for the Diagnosis of Viral Diseases of the University of Modena and Reggio Emilia, in the inhabitants of Modena province (Emilia Romagna region), in the triennium 1999-2001. TOSV was involved in six cases of meningitis, two of meningoencephalitis and one case of febrile erythema without meningeal manifestations. Six TOSV-infected patients had stayed for a few days in a different area of the Tuscany region before the onset of clinical manifestations so, only three cases of infections by TOSV had an autochthonous origin.     

Significance of Salmonella serovars and the biological properties of the causative agents in the epidemic process in salmonelloses

Analysis of the manifestations of the epidemic process of Salmonella infections with regard to the serovar and biological properties of salmonellae has made it possible to find out the specific epidemiological properties of salmonellosis caused by S. typhimurium and to suggest that under present-day conditions salmonellosis of this etiology frequently acquires the features of a human disease, which is necessary to take into consideration in planning the measures for controlling these infections.     

重症单核细胞增多性李斯特菌脑膜脑炎1例

李斯特菌脑膜脑炎是单核细胞增多性李斯特菌(LM)引起的细菌性脑膜脑炎,通常发生于免疫功能低下者.LM是人畜共患致病菌,通过污染的食物传播.欧美国家报道较多,国内报道较少.李斯特菌脑膜脑炎病死率高,临床表现与其他细菌性脑膜炎类似.脑脊液检查与结核性脑膜炎亦难鉴别,确诊依赖于脑脊液涂片及培养.本文报道1例重症李斯特菌脑膜脑...     

植入性真菌病

植入性真菌病或称皮下组织真菌病,常见于热带和亚热带地区。此类感染有许多共同特征,包括相似的流行病学和感染方式等,有些还有明显的地域性。其临床表现形态各异,治疗困难,如不及时治疗常会导致畸形甚至致残,严重影响患者的生活质量。本文旨在对临床上重要的植入性真菌病,如孢子丝菌病、足菌肿、着色芽生菌病、暗色丝孢霉病和接合菌病的流行病学特征、临床表现、诊断和治疗进展做一复习。     

Oral manifestations in chikungunya patients: A systematic review

BackgroundChikungunya fever is considered an abrupt onset arbovirus transmitted by mosquitoes, mainly Aedes aegypti and Aedes albopictus. The disease has a significant impact on the quality of life of affected persons, and many of its numerous symptoms have not yet been properly clarified, such as the manifestations that can occur in the oral cavity. The aim of this study was to identify the main oral manifestations related to chikungunya fever, as well as describe the demographic characteristics of patients, by conducting a systematic review of the literature.Methods and findingsSearches were performed in MEDLINE (PubMed), Embase (Elsevier), LILACS (VHL), Cochrane Library, Scopus, and CAPES electronic databases for theses and dissertations published up to January 16, 2021 without language and date restrictions. Additional manual searches of gray literature, reference list, and Google Scholar were carried out. We included 27 studies highlighting mainly oral manifestations that cause masticatory discomfort such as ulcers and oral thrush, gingival bleeding, pain and burning of the oral mucous membranes, temporomandibular joint (TMJ) arthralgia, opportunistic infections, and changes in taste.ConclusionsThere seems to be a predominance of oral manifestations that cause discomfort when chewing, such as ulcerations in the acute phase of the disease, with complete remission within 3 to 10 days after the onset, apparently mostly affecting women and older persons. These oral manifestations can be compatible with basic viral infections related to inflammatory response and transitory immunosuppression.     

Neglected and emerging fungal infections: review of hyalohyphomycosis by Paecilomyces lilacinus focusing in disease burden, in vitro antifungal susceptibility and management

Paecilomyces lilacinus is an emerging pathogenic fungus that can cause different clinical manifestations ranging from cutaneous and sub-cutaneous infections to severe oculomycosis. This review discusses infections caused by P. lilacinus, as well as their symptoms and correlates of immune responses, morphological characteristics of the fungus, therapies, in vitro susceptibility tests, laboratory diagnosis and the experimental models available.     

Human oncogenic viruses: Hepatitis B and hepatitis C viruses and their role in hepatocarcinogenesis

Chronic infections caused by hepatitis B virus (HBV) and/or hepatitis C virus (HCV) are the main risk factors for the development of hepatocellular carcinoma (HCC) in humans. Both viruses cause a wide spectrum of clinical manifestations ranging from healthy carrier state to acute and chronic hepatitis, liver cirrhosis, and HCC. HBV and HCV belong to different viral families (Hepadnoviridae and Flaviviridae, respectively); they are characterized by different genetic structures. Clinical manifestations of these viral infections result from the interaction between these viruses and host hepatocytes (i.e. between viral and cell genomes). Proteins encoded by both viruses play an important role in processes responsible for immortalization and transformation of these cells. Chronic inflammation determined by host immune response to the viral infection, hepatocyte death and their compensatory proliferation, as well as modulation of expression of some regulatory proteins of the cell (growth factors, cytokines, etc.) are the processes that play the major role in liver cancer induced by HBV and HCV.     

Lytic manifestations in the bacterial strains of Pseudomonas aeruginosa (bacteriophages bacteriocines, autoplaques).

Ps. aeruginosa strains--a frequement resuet of an irresponsible antibiotic therapy--represent a common agent of nosocomial infektions. At the same time, gravity of Pseudomonas diseases is also increasing. Lysogeny, bacteriocinogeny and frequent occurrence of autoplaques are the lytic manifestations of Pseudomonas aeruginosa strains which play a great role in the complexity of solving diagnostic, epidemiological end therapeutical problems connected with infections induced by these microbes. A survey is presented of the importance and utilization of the lytic properties of bacterial strains of Pseudomonas aeruginosa during the differentiation, epidemiological typing and further expansion of therapeutical possibilities in infections caused by Pseudomonas aeruginosa bacteria.     

Emerging helminth zoonoses

As our ability to recognise and diagnose human disease caused by helminth parasites has improved, so our understanding of the epidemiology and clinical manifestations of these diseases has improved. Humans can develop patent infection with a wide range of helminth parasites, whose natural host is another vertebrate. Rather than focusing on a comprehensive review of zoonotic helminth infections, this review describes in detail examples of zoonotic helminth infections that have newly appeared in human populations, or have existed but are increasing in incidence or geographic range. Examples include intestinal capillariasis, anisakidosis, eosinophilic enteritis, oesophagostomiasis and gnathostomiasis. Potential reasons for the emergence of these infections, including changes in social, dietary or cultural mores, environmental changes, and the improved recognition of heretofore neglected infections often coupled with an improved ability to diagnose infection are discussed.     

Clinical presentations of nosocomial aspergillosis

Aspergillus is a very ubiquitous fungal in our environment, including hospitals, being the second in frequency in colonization and infection, just after Candida spp. Aspergillus nosocomial infections have increased, because the number of immunocompromised patients has also increased. Nosocomial infections can be caused by different species of Aspergillus, being pulmonary manifestations the most frequent. Primary or secondary nonpulmonary infections can affect the brain, heart, kidney, eyes and other organs. The mortality due to invasive aspergillosis is very high, and a clinical-radiological suspicion and, specially the instauration of a rapid treatment with high doses of amphotericin B or its new formulations (associated with surgery in many times) may modify the mortality observed in this patients.     

Inherited MST1 Deficiency Underlies Susceptibility to EV-HPV Infections

Epidermodysplasia verruciformis (EV) is characterized by persistent cutaneous lesions caused by a specific group of related human papillomavirus genotypes (EV-HPVs) in otherwise healthy individuals. Autosomal recessive (AR) EVER1 and EVER2 deficiencies account for two thirds of known cases of EV. AR RHOH deficiency has recently been described in two siblings with EV-HPV infections as well as other infectious and tumoral manifestations. We report here the whole-exome based discovery of AR MST1 deficiency in a 19-year-old patient with a T-cell deficiency associated with EV-HPV, bacterial and fungal infections. MST1 deficiency has recently been described in seven patients from three unrelated kindreds with profound T-cell deficiency and various viral and bacterial infections. The patient was also homozygous for a rare ERCC3 variation. Our findings broaden the clinical range of infections seen in MST1 deficiency and provide a new genetic etiology of susceptibility to EV-HPV infections. Together with the recent discovery of RHOH deficiency, they suggest that T cells are involved in the control of EV-HPVs, at least in some individuals.     

镰刀菌所致皮肤感染的文献回顾

镰刀菌主要为植物致病菌,但也可引起严重人类感染。镰刀菌病临床表现形式多样,本文主要综述相关的皮肤感染,分为局限性皮肤感染及播散性感染,诊断多较困难。由于该属真菌对抗真菌药物存在天然耐药,播散性镰刀菌病死亡率可达80%-90%。本文对Medline和中文文献数据库中的相关文献进行了系统查阅和分析,综合归纳了镰刀菌所致皮肤感染的致病种、地域分布、危险因子、临床表现形式、药物敏感性及其诊疗方案等,该综述对全面了解镰刀菌病的特征及对临床医师对本病的诊断具有重要的意义。     

Use of ospen (a drug form of phenoxymethylpenicillin) in pediatric practice

Ospen is a dosage form of phenoxymethylpenicilin. As a therapeutic and prophylactic agent it was shown efficient in treatment of patients with diseases of the otorhinolaryngological organs due to primary and secondary coccal infections. High antiinflammatory activity of ospen was observed in acute and aggravated chronic tonsillitis, otitis, sinusitis and acute respiratory virus infections as well as in prevention of complications after adenotonsillectomy and various manipulations connected with penetration into the inner cavities. Ospen was highly active as a prophylactic agent against hospital respiratory infections. It prevented its distribution and aggravation of the main diseases. Adverse reactions to the use of ospen were minimal and no toxic manifestations were recorded.     

The Effects of Tertiary and Quaternary Infections on the Epidemiology of Dengue

The epidemiology of dengue is characterised by irregular epidemic outbreaks and desynchronised dynamics of its four co-circulating virus serotypes. Whilst infection by one serotype appears to convey life-long protection to homologous infection, it is believed to be a risk factor for severe disease manifestations upon secondary, heterologous infection due to the phenomenon of Antibody-Dependent Enhancement (ADE). Subsequent clinical infections are rarely reported and, since the majority of dengue infections are generally asymptomatic, it is not clear if and to what degree tertiary or quaternary infections contribute to dengue epidemiology. Here we investigate the effect of third and subsequent infections on the transmission dynamics of dengue and show that although the qualitative patterns are largely equivalent, the system more readily exhibits the desynchronised serotype oscillations and multi-annual epidemic outbreaks upon their inclusion. More importantly, permitting third and fourth infections significantly increases the force of infection without resorting to high basic reproductive numbers. Realistic age-prevalent patterns and seroconversion rates are therefore easier reconciled with a low value of dengue''s transmission potential if allowing for more than two infections; this should have important consequences for dengue control and intervention measures.     

Factors determining prognosis in streptococcal toxic shock-like syndrome: results of a nationwide investigation in Japan

Since the first report of streptococcal toxic shock-like syndrome (TSLS) in Japan, the numbers of reported patients have been increasing. However, clinical manifestations remain somewhat unclear, and factors potentially defining prognosis remain to be identified. We conducted a retrospective nationwide postal survey of major Japanese hospitals concerning clinical manifestations of invasive streptococcal infections including necrotizing fasciitis and TSLS. We evaluated 30 patients who died and 36 survivors. The overall mortality rate was 45%. Physical and laboratory findings on admission were compared statistically between fatal cases and surviving patients. Most laboratory results from the patients who died showed greater abnormality than results from the survivors. Patients who died had significantly fewer leukocytes and platelets, although their C-reactive protein concentrations were similar to those in survivors. Creatinine was significantly higher, and temperature and blood pressure were significantly lower, in patients who died. Patients with invasive streptococcal infections should be managed aggressively when the above features are present.     

Mechanisms of development of immunosuppression during Trypanosoma infections

Acute infection with Trypanosoma cruzi or its African relatives, including T. brucei rhodesiense, T. b. gambiense, T. b. brucei and T. congolense, is frequently accompanied by manifestations of immunological dysfunction. Initially investigators catalogued the ensuing immunologic alterations and identified a number of modifications in lymphoid or accessory cell properties. More recently, the emphasis has switched towards the molecular underpinnings of immunosuppression in these infections. In this article, Marcelo Sztein and Felipe Kierszenboum focus on recent progress made in the quest to delineate the mechanisms behind altered lymphocyte functions in tryponosomal infections, point out particular and common features of immunosuppression induced by T. cruzi and African trypanosomes, and outline possible directions for future research.     

The Epidemiology,Virology and Clinical Findings of Dengue Virus Infections in a Cohort of Indonesian Adults in Western Java

Background

Dengue has emerged as one of the most important infectious diseases in the last five decades. Evidence indicates the expansion of dengue virus endemic areas and consequently the exponential increase of dengue virus infections across the subtropics. The clinical manifestations of dengue virus infection include sudden fever, rash, headache, myalgia and in more serious cases, spontaneous bleeding. These manifestations occur in children as well as in adults. Defining the epidemiology of dengue in a given area is critical to understanding the disease and devising effective public health strategies.

Methodology/Principal Findings

Here, we report the results from a prospective cohort study of 4380 adults in West Java, Indonesia, from 2000–2004 and 2006–2009. A total of 2167 febrile episodes were documented and dengue virus infections were confirmed by RT-PCR or serology in 268 cases (12.4%). The proportion ranged from 7.6 to 41.8% each year. The overall incidence rate of symptomatic dengue virus infections was 17.3 cases/1,000 person years and between September 2006 and April 2008 asymptomatic infections were 2.6 times more frequent than symptomatic infections. According to the 1997 WHO classification guidelines, there were 210 dengue fever cases, 53 dengue hemorrhagic fever cases (including one dengue shock syndrome case) and five unclassified cases. Evidence for sequential dengue virus infections was seen in six subjects. All four dengue virus serotypes circulated most years. Inapparent dengue virus infections were predominantly associated with DENV-4 infections.

Conclusions/Significance

Dengue virus was responsible for a significant percentage of febrile illnesses in an adult population in West Java, Indonesia, and this percentage varied from year to year. The observed incidence rate during the study period was 43 times higher than the reported national or provincial rates during the same time period. A wide range of clinical severity was observed with most infections resulting in asymptomatic disease. The circulation of all four serotypes of dengue virus was observed in most years of the study.