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Infectious Complications From Body Piercings—A Narrative Review 人体穿刺引起的传染性并发症--叙述性评论
Pub Date : 2024-04-25 DOI: 10.1097/ipc.0000000000001366
Christopher J. Peterson, Benjamin Lee, Mark Lacy
Body piercings are common methods of self-expression and cultural identity and have existed for millennia. However, breaching the dermis and insertion of a foreign object entails risk, including infectious complications. Although serious complications are typically rare, especially in environments where proper piercing techniques and sanitation are practiced, the general public and healthcare professionals may be unaware of the risk for these complications. Serious complications may include tissue necrosis, endocarditis, and brain abscesses. Selection of a proper piercing locale and professional, and the use of personal hygiene practices and piercing site care can go a long way toward preventing infections. Avoidance of especially risky piercing sites or techniques may also be advisable.
身体穿孔是自我表达和文化认同的常用方法,已经存在了几千年。然而,突破真皮层并插入异物会带来风险,包括感染性并发症。虽然严重的并发症通常很少发生,尤其是在采用正确穿刺技术和保持卫生的环境中,但一般公众和医疗保健专业人员可能没有意识到这些并发症的风险。严重的并发症可能包括组织坏死、心内膜炎和脑脓肿。选择合适的穿孔地点和专业人员,并采用个人卫生习惯和穿孔部位护理,可以大大预防感染。此外,避免使用特别危险的穿刺部位或技术也是明智之举。
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引用次数: 0
A Woman With Persistent Oral Ulcers 一名患有顽固性口腔溃疡的妇女
Pub Date : 2024-04-25 DOI: 10.1097/ipc.0000000000001368
Julia Fischer, Jasmine Mutti, Sumi Piya, Kritika Gunachelvan, Esteban DelPilar-Morales
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引用次数: 0
An Atypical Presentation of Pulmonary Mucormycosis 肺粘液瘤病的非典型表现
Pub Date : 2024-04-25 DOI: 10.1097/ipc.0000000000001370
K. Divyashree, Harpreet Singh, Vikas Suri, Ashish Bhalla, M. Valliapan, Aman Sharma, Harkant Singh, Sreedhar B. Chaluvashetty, Amanjit Bal
Mucormycosis is a life-threatening invasive fungal infection caused by fungi belonging to mucorales order. Manifestations vary from localized disease to disseminated infection. Various types of mucormycosis are rhino-orbito-cerebral, pulmonary, cutaneous, gastrointestinal, renal, and disseminated. Pulmonary form is more common in patients with solid organ transplant and post hematopoietic stem cell transplantation. Multimodality treatment is used in the form of aggressive antifungals, surgery where possible, and control of underlying disease/factors. Here, we present an unusual presentation of pulmonary mucormycosis successfully managed with liposomal amphotericin B and surgical lobectomy.
粘孢子菌病是由粘孢子菌目真菌引起的一种危及生命的侵袭性真菌感染。表现形式从局部发病到播散感染不等。粘孢子菌病有多种类型,如鼻-轨道-脑型、肺型、皮肤型、胃肠型、肾型和播散型。肺型粘孢子菌病更常见于实体器官移植和造血干细胞移植后的患者。多模式治疗的形式包括积极的抗真菌药物、尽可能进行手术以及控制潜在的疾病/因素。在此,我们介绍一种不寻常的肺粘孢子菌病,通过使用脂质体两性霉素 B 和外科肺叶切除术成功治愈。
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引用次数: 0
Precision Medicine for COVID-19 Based on the Inflammatory Response 基于炎症反应的 COVID-19 精准医疗
Pub Date : 2024-04-17 DOI: 10.1097/ipc.0000000000001371
A. D. Kothalkar, Dipali Jambhale, Vinayak Hingane, Satish Gore, Sudeep Deshpande
The threat due to the global pandemic of the coronavirus disease 2019 (COVID-19) demands a search for effective treatments to combat the severity of the infections and their associated morbidity and mortality in vulnerable populations. One of the medications with putative antiviral, anti-inflammatory, and immunomodulatory effects is fluvoxamine, a selective serotonin reuptake inhibitor and σ-1 receptor agonist. A few studies have reported doses of 100–300 mg/day to be effective. This retrospective study evaluates the outcomes of an individually tailored dosing strategy for fluvoxamine, based on measurements of inflammatory status, in treating COVID-19-positive individuals in India. This study included patients with severe acute respiratory syndrome coronavirus 2 infection visiting the outpatient department of a super speciality hospital in India from February to July 2021. Fluvoxamine was initiated at 50 mg or 100 mg twice daily based on their individual C-reactive protein (CRP) and D-dimer status. By day five, patients with rising or static levels of CRP and D-dimer were up-titrated. In a population of 104 individuals infected with COVID-19, 10 required up-titration of dose, and 94 patients did not need up-titration. Overall, there was very low mortality (N = 1) and hospitalization rate (8.7%). Those individuals who required an up-titration on day five had significantly elevated CRP and D-dimer levels compared to those who were maintained at the initial dose of 50 mg twice daily. In such patients, up-titration of the dose on day 5 appeared to offer better treatment benefits and outcomes. In our study population, there was only one mortality during the course of COVID-19. Given the individual variability in the host immune response to severe acute respiratory syndrome coronavirus 2 infection, tailoring the dose of a drug such as fluvoxamine based on the inflammatory status of the individual may be beneficial. Individually tailored dosing could combat disease progression while reducing side effects.
2019 年冠状病毒病(COVID-19)在全球大流行所带来的威胁要求人们寻找有效的治疗方法,以应对感染的严重性以及易感人群的相关发病率和死亡率。氟伏沙明是一种选择性5-羟色胺再摄取抑制剂和σ-1受体激动剂,是具有抗病毒、抗炎和免疫调节作用的药物之一。有几项研究报告称,100-300 毫克/天的剂量有效。 这项回顾性研究评估了根据炎症状态的测量结果单独定制氟伏沙明剂量策略在治疗印度 COVID-19 阳性患者方面的效果。 这项研究纳入了2021年2月至7月在印度一家超级专科医院门诊部就诊的严重急性呼吸综合征冠状病毒2感染患者。根据患者的C反应蛋白(CRP)和D-二聚体状况,氟伏沙明的剂量为50毫克或100毫克,每天两次。到了第五天,CRP 和 D-二聚体水平上升或保持不变的患者则需要增加剂量。 在感染 COVID-19 的 104 人中,有 10 人需要增加剂量,94 人不需要增加剂量。总体而言,死亡率(1 例)和住院率(8.7%)都非常低。与维持初始剂量(50 毫克,每天两次)的患者相比,需要在第五天增加剂量的患者的 CRP 和 D-二聚体水平明显升高。对于这些患者,在第 5 天加大剂量似乎能带来更好的治疗效果和结果。在我们的研究人群中,只有一人在 COVID-19 治疗期间死亡。 鉴于宿主对严重急性呼吸道综合征冠状病毒2感染的免疫反应存在个体差异,根据个体的炎症状态来调整氟伏沙明等药物的剂量可能会有所帮助。量身定制的药物剂量可以在减少副作用的同时遏制疾病进展。
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引用次数: 0
Serpiginous Skin Lesions Under Baricitinib Therapy 巴利替尼治疗下的浆液性皮肤病变
Pub Date : 2024-04-17 DOI: 10.1097/ipc.0000000000001356
E. Bularca, Sara Martínez Cisneros, P. Villagrasa-Boli, Andrea Montes-Torres, Francesc Felipo-Berlanga
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引用次数: 0
An Elderly Veteran With New Urinary Incontinence and Pelvic Pain 一名患有新发尿失禁和骨盆疼痛的老年退伍军人
Pub Date : 2024-04-17 DOI: 10.1097/ipc.0000000000001364
David Ziya-Karal Kenison, G. Psevdos
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引用次数: 0
Hematuria Due to Possible Histoplasma-Associated Urinary Bladder Pseudotumor With Negative Serologic and Urine Antigen Testing 血清学和尿液抗原检测阴性的可能与组织胞浆菌相关的膀胱假瘤引起的血尿
Pub Date : 2024-04-17 DOI: 10.1097/ipc.0000000000001369
Abhimanyu Aggarwal, Corey Mills, Kyle Frankenberger, Adam Greenstein, Benjamin Nelson, Fadi Hatem, Deborah E. Blue, L. J. Wheat, Alexandra Yamshchikov
Histoplasma capsulatum is a ubiquitous dimorphic fungus causing multiple infectious syndromes, ranging from subclinical to severe disseminated disease. We present an unusual case of hematuria due to pedunculated urinary bladder mass in an immunocompetent host. Although the gold standard for diagnosis of histoplasmosis is through demonstration of characteristic yeast forms on histopathologic examination of infected tissue, or observation of typical mycelial growth in culture of clinical specimens, investigational multiplex polymerase chain reaction of formalinized tissue was helpful in this case due to conflicting serologic testing, equivocal morphologic findings on histopathologic examination and, surprisingly, a negative urine Histoplasma antigen despite anatomically proximal location within the urinary bladder. Although antigen immunoassay and serology are commonly used proxy diagnostics in Histoplasma-associated disease, varying performance characteristics in certain disease states, such as cases of locally proliferative infection mimicking neoplastic growth similar to this report, may lead to elusive diagnosis.
荚膜组织胞浆菌(Histoplasma capsulatum)是一种无处不在的二形真菌,可引起从亚临床到严重播散性疾病的多种感染综合征。我们介绍了一例免疫功能正常的宿主因膀胱有蒂肿块而出现血尿的罕见病例。虽然诊断组织胞浆菌病的金标准是在受感染组织的组织病理学检查中发现特征性的酵母形态,或在临床标本的培养中观察到典型的菌丝生长,但由于血清学检测结果相互矛盾,组织病理学检查的形态学结果模棱两可,而且令人惊讶的是,尽管解剖学上位于膀胱内的近端,尿液中的组织胞浆菌抗原却呈阴性,因此对福尔马林化组织进行多重聚合酶链反应的研究在本病例中很有帮助。虽然抗原免疫测定和血清学是组织胞浆相关疾病的常用替代诊断方法,但在某些疾病状态下,如本报告中类似的模仿肿瘤生长的局部增殖性感染病例,其表现特征各不相同,可能会导致诊断难以确定。
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引用次数: 0
Fosfomycin Susceptibility Among Multidrug-Resistant Extended-Spectrum β-Lactamase and Metallo-β-Lactamase–Producing Uropathogens in a Tertiary Care Hospital 一家三级医院中产多药耐药性广谱β-内酰胺酶和金属β-内酰胺酶的泌尿道病原体对磷霉素的敏感性
Pub Date : 2024-04-04 DOI: 10.1097/ipc.0000000000001348
Aditi Kothari, Parul Chaturvedi, Upasana Bhumbla
Urinary tract infections (UTIs) affect an estimated 150 million people each year worldwide involving women more than men. Because of unrestricted use of antimicrobials and accelerating antimicrobial resistance, therapeutic options for treatment of UTIs are becoming limited. Fosfomycin, a broad-spectrum, rapidly absorbable, antimicrobial agent with good bioavailability and substantial activity against multidrug-resistant (MDR) isolates has antimicrobial activity against a substantial percentage of these MDR isolates. A cross-sectional study over a period of 20 months on urine samples of all patients of all age groups clinically suspected of UTI was conducted in a tertiary care center of southern Rajasthan. Samples were processed immediately as per standard microbiological techniques, followed by culture by a semiquantitative method and antimicrobial susceptibility testing using the Kirby-Bauer disk diffusion method. All gram-negative pathogens were screened for extended-spectrum β-lactamase and further metallo-β-lactamase production using standard disk diffusion tests. Of the 1858 positive samples isolated, the most common uropathogen was Escherichia coli (59.96%), with 8.97% confirmed extended-spectrum β-lactamase–producing isolates. Fosfomycin had susceptibility of 96.69%, with its sensitivity and specificity being 98.15% and 6.98% more than nitrofurantoin, respectively. Among the metallo-β-lactamase producers, fosfomycin had susceptibility of 78.58%, with sensitivity and specificity being 91.67% and 25% more than nitrofurantoin, respectively. With an increasing threat due to MDR uropathogens in both hospitals and in the community, fosfomycin, with its unique mechanism of action, appears to be a better oral, effective, and safe therapeutic option and a viable potential alternative over other drugs for treatment of UTIs.
据估计,全世界每年有 1.5 亿人受到尿路感染(UTI)的影响,其中女性患者多于男性患者。由于抗菌药的使用不受限制以及抗菌药耐药性的加速,治疗尿路感染的方法越来越有限。磷霉素是一种广谱、可快速吸收的抗菌药,具有良好的生物利用度,对耐多药(MDR)分离株有很强的抗菌活性。 拉贾斯坦邦南部的一家三级医疗中心对所有年龄组临床疑似尿毒症患者的尿样进行了为期 20 个月的横断面研究。样本按照标准微生物学技术立即进行处理,然后采用半定量法进行培养,并使用柯比-鲍尔盘扩散法进行抗菌药敏感性测试。所有革兰氏阴性病原体都经过了扩展谱β-内酰胺酶筛查,并使用标准盘扩散试验进一步检测了金属-β-内酰胺酶的产生。 在分离出的 1858 份阳性样本中,最常见的尿路病原体是大肠埃希菌(59.96%),其中 8.97% 证实分离出产扩展谱β-内酰胺酶的菌株。磷霉素的敏感性为 96.69%,其敏感性和特异性分别比硝基呋喃妥因高出 98.15%和 6.98%。在金属-β-内酰胺酶产生者中,磷霉素的敏感性为 78.58%,其敏感性和特异性分别比硝基呋喃妥因高出 91.67% 和 25%。 随着医院和社区中 MDR 尿路病原体的威胁日益增加,具有独特作用机制的磷霉素似乎是一种更好的口服、有效和安全的治疗选择,是治疗 UTIs 的其他药物的可行替代品。
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引用次数: 0
Superinfections in COVID-19 COVID-19 中的超级感染
Pub Date : 2024-04-04 DOI: 10.1097/ipc.0000000000001362
Arunava Saha, Michelle Siew, Sirshendu Chaudhuri, Varun Agiwal, George M. Abraham
Bacterial superinfection rates in SARS-CoV-2 (COVID-19) range from 8% to 49.6%, but the diagnosis remains a challenge. We conducted a study to determine the utility of the Pneumonia Severity Index (PSI) to predict the risk of superinfections and outcomes in COVID-19 patients. A cross-sectional retrospective study was conducted on COVID-19 positive patients admitted during 2020–2022. The PSI scores were calculated at admission and at every 72-hour intervals. Data regarding clinical course, antibiotic use and overall outcome were collected. A total of 149 patients were included, with a mean age of 67 years. The PSI score at admission and the mean PSI score were higher for those who required antibiotics, intensive care unit (ICU) admission, or succumbed. Patients with a PSI score >107 at admission had a high risk of ICU admission, >113 had a high risk of antibiotic requirements, and >110 had a higher risk of death. An increase in PSI score ≥25 between the day of admission and day 3 of hospitalization; or between day 3 and day 6 of hospitalization, predicted a higher chance of mortality; but had no association with the development of superinfections. The PSI score at admission can be used to predict the severity of disease requiring ICU admission, antibiotic requirement, and overall mortality, with serial monitoring of the score predicting possible clinical deterioration and increased mortality. However, it was not helpful in predicting the chances of developing superinfections and the need for antibiotic therapy. The PSI score can be used to prognosticate the outcome in patients admitted with COVID-19, but further studies are needed to determine its utility in predicting the risk of superinfections.
SARS-CoV-2(COVID-19)的细菌超级感染率从 8% 到 49.6% 不等,但诊断仍是一个难题。我们开展了一项研究,以确定肺炎严重程度指数(PSI)在预测 COVID-19 患者的超级感染风险和预后方面的实用性。 我们对 2020-2022 年期间收治的 COVID-19 阳性患者进行了横断面回顾性研究。入院时和每隔72小时计算一次PSI评分。研究还收集了有关临床病程、抗生素使用和总体疗效的数据。 共纳入 149 名患者,平均年龄为 67 岁。需要使用抗生素、入住重症监护室(ICU)或死亡的患者入院时的 PSI 评分和平均 PSI 评分均较高。入院时 PSI 评分大于 107 分的患者入住重症监护室的风险较高,大于 113 分的患者需要使用抗生素的风险较高,大于 110 分的患者死亡风险较高。入院当天到住院第 3 天之间,或住院第 3 天到第 6 天之间,PSI 评分增加≥25 分,预示着死亡几率较高;但与超级感染的发生无关。 入院时的 PSI 评分可用于预测需要入住重症监护室的疾病严重程度、抗生素需求量和总死亡率,连续监测评分可预测可能出现的临床恶化和死亡率上升。但是,该评分无助于预测发生超级感染的几率和抗生素治疗的需求。 PSI 评分可用于预测 COVID-19 患者的预后,但还需要进一步的研究来确定其在预测超级感染风险方面的实用性。
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引用次数: 0
An Unusual Case of Back Pain 一个不寻常的背痛病例
Pub Date : 2024-04-04 DOI: 10.1097/ipc.0000000000001353
Colleen Marie Burgoyne, Damien Dawson, Ted Louie
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引用次数: 0
期刊
Infectious Diseases in Clinical Practice
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