Clinical and microbiologic findings in cellulitis in Thai patients.

BACKGROUND: Cellulitis is an inflammation of subcutaneous tissue in which infective, generally bacterial cause is proven or assumed. However, attempts to culture bacteria from lesions are often unsuccessful. METHOD: One hundred and fifty cases diagnosed as cutaneous cellulitis at Siriraj Hospital between 1992 and 1995 were retrospectively studied. RESULTS: Our study in 150 adult Thai patients with cellulitis showed that the most common site of infection was the lower extremity. Forty two per cent of the patients had history of preceding local trauma. Fever and regional lymphadenopathy were detected in 77.3 per cent and 22.6 per cent respectively. Sixty nine per cent of patients had leukocytosis with a mean neutrophil ratio of 79.7 per cent of patients with underlying diseases predisposed to the infection, 61.6 per cent had positive lesional culture results in contrast to 31.6 per cent in patients without. Needle aspiration and blood gave low positive culture yields. The common organisms detected were S.aureus and Streptococcus group A (83%) in immunocompetent patients. Of immunocompromised patients, in one half of the cases gram negative bacteria were found. CONCLUSIONS: This study showed that in immunocompetent patients, the major bacterial isolated in cellulitis were S.aureus and Streptococcus group A. In immunocompromised patients, gram negative bacteria were found in one half. These findings may help in the selection of antimicrobials before the results of bacterial cultures are available or in culture negative cases.

An outbreak of Norwegian scabies in a surgical ward.

An outbreak of Norwegian scabies in a surgical ward of a teaching hospital was reported. The source of infestation was an elderly diabetic. The epidemic involved 28 of 32 medical personnel in the ward and 3 family contacts. All infected individuals were given a two-course treatment with hexachlorcyclohexane gel. Control of the outbreak was achieved by strict handwashing after patient contact, application of gowns and gloves for contact with skin lesions and the treatment of infected persons. Norwegian scabies in institutions is on the rise, vigilance for its occurrence is needed.

Intranasal leprosy granuloma: The first case report in Thailand.

One male patients presenting with symptoms and signs of atrophic rhinitis and chronic sinusitis for one year, there was also a small red mass at anterior end of right middle turbinate. Histopathological section showed that the mass was covered by stratified squamous mucosa with diffuse cellular infiltration of mostly macrophages with clear vacuolated cytoplasm (= foam cells) with few lymphocytes in submucosa. Acid fast stain (modified Fite Feraco stain) showed numerous acid fast bacilli in scatter and in clumps, known as globi pattern mucosa. This is the first case reported in Thailand. Multidrug therapy was given to the patient which conprised of rifampicin 450-600 mg. Once a month, lamprene 300 mg start and then 100 mg. in alternate day with dapsone 100 mg. OD. The aim of this report is to remind the otolaryngologists of the existence of leprosy in the nose and they should be aware of the highly contagious nasal secretion from these patients.

Use if touch preparation as a rapid diagnosis of cutaneous leishmaniasis.

The definite diagnosis of cutaneous leishmaniasis depends on demonstration of the parasites in tissue fluid or pus from the nodule of ulcer. The touch preparation from the skin biopsy specimen is among methods of demonstration of the tissue parasites. This method could be done easily along with skin biopsy for histopathological study. Geimsa’s Wright’s stain were the appropriate staining technique. We have reported one case of cutanous leishmaniasis which showed that touch preparation was more sensitive than the scraping technique in detecting parasites in tissue. Touch preparation could be used as a diagnostic tool and adjuvant method to follow up the course of cutaneous leishmaniasis patient.