Ántrax gigante

Introducción: Se denomina ántrax a la infección de varios folículos pilosos contiguos y es provocada por gérmenes patógenos muy invasivos. Es causado, generalmente, por el Staphylococcus aureus y puede tener repercusión sistémica. Los factores de riesgo para desarrollar esta lesión son: diabetes, obesidad, falta de higiene, inmunosupresión, hiperhidrosis, dermatitis preexistentes. Objetivo: Presentar un paciente con diagnóstico de ántrax gigante. Caso clínico: Paciente femenina de 66 años de edad, con antecedentes de diabetes mellitus tipo 2 en tratamiento, que asistió al servicio de Cirugía General por presentar una picadura de insecto en la región inferior de la espalda, la cual fue tratada en el área de salud con antimicrobianos y no resolvió. Se ingresó con el diagnóstico de ántrax gigante y con la administración de anestesia general endovenosa se realizó necrectomía. El postoperatorio transcurrió sin complicaciones y egresó a los siete días. Conclusiones: La rápida atención médica fundamentada en la administración de antimicrobianos de amplio espectro de forma parenteral, las curas locales y el seguimiento ininterrumpido en consulta externa de la paciente con ántrax gigante, asegura la eficacia del tratamiento quirúrgico con total recuperación, sin tener que aplicar injertos.

Introduction: Anthrax is the name given to the infection of several contiguous hair follicles and is caused by highly invasive pathogenic germs. It is generally caused by Staphylococcus aureus and can have systemic repercussions. The risk factors for developing this lesion are: diabetes, obesity, lack of hygiene, immunosuppression, hyperhidrosis, pre-existing dermatitis. Objective: To make the clinical presentation of a patient diagnosed with giant anthrax. Case report: This is a 66-year-old woman, with a history of type 2 diabetes mellitus under treatment, who attended the General Surgery service for presenting an insect bite in the lower region of the back, which was treated in the health area with antimicrobials and did not resolve. She was admitted with a diagnosis of giant anthrax and with the administration of general intravenous anesthesia, a necrectomy was performed. The postoperative period was uncomplicated and she was discharged after seven days. Conclusions: The immediate medical care based on the parenteral administration of broad-spectrum antimicrobials, local cures and uninterrupted follow-up in the outpatient clinic of the patient with giant anthrax, ensures the effectiveness of the surgical treatment with full recovery, without having to apply grafts.

Treatment Features and Clinical Thought of Pro. WU Xuesu Treating Subclinical Thyroid Inflammation / 浙江中医药大学学报

[Objective] To summarize treatment ideas for subclinical thyroid inflammation by Professor WU Xuesu.[Methods] By learning from Professor WU Xuesu, studying relevant literature cases;collecting and reporting the case of her clinical characteristics for the treatment of subclinical thyroid inflammation, analyzed and summarized treatment experience. [Results] It is argued that the root of subclinical thyroid inflammation is turbid-phlegm, nitrogen stasis cardiac knoting in the anterior portion, it should be treated by resolving phlegm mainly,and secondary promoting Qi activating blood. [Conclusion] The treatment ideas of Professor WU Xuesu for subclinical thyroid inflammation has a good curative effect.

Analysis of the Guizhi Tang in Clinical Application / 浙江中医药大学学报

Objective]To study the discipline of Guizhi Tang in clinical application, understand further indication of Guizhi Tang to improve clinical efficacy. [Method]After consulting medical cases about Guizhi Tang that are from different medical practitioners, analysis on the discipline of Guizhi Tang in clinical application with the help of six meridian syndrome differentiation, zang-fu differentiation and drug efficacy of Guizhi Tang. [Result]Guizhi Tang can be used to cure urticaria, coronary heart disease, nape carbuncle, high fever, half sweating and diarrhea. The cases of urticaria, diarrhea and nape carbuncle all contain symptoms of tai yang disease.The case of high fever is due to discord of ying-wei. The case of half sweating is due to discord of yin-yang. The case of coronary heart disease reflects Guizhi Tang can regulate spleen-stomach. [Conclusion] The medical cases about Guizhi Tang involve the departments of internal medicine, surgery, gynaecology and pediatrics,such as urticaria, coronary heart disease and so on. Using Guizhi Tang should get help from six meridian syndrome differentiation or zang-fu differentiation. When using six meridian syndrome differentiation, doctors should pay attention to difference of tai yang disease and other five meridian diseases. When using zang-fu differentiation, doctors should attach importance to the feature of Guizhi Tang that involves regulating yin-yang, spleen-stomach and ying-wei.

Absceso renal estafilocócico trasforunculosis cutánea / Staphylococcus renal abscess after cutaneous furunculosis

Los abscesos renales son patologías infrecuentes, pero de alta morbi-mortalidad si no son diagnosticados temprano y tratados precozmente. Su vaga e inespecífica sintomatología: dolor abdominal o lumbar, fiebre o mal estado general hacen que su diagnostico sea a veces tardío. La ecografía y/o la TAC dan el diagnóstico en el 100 por ciento de los casos lo que hace posible su tratamiento temprano. El objetivo de este artículo es poner de relieve que el absceso renal es una causa de urgencia urológica a tener presente en pacientes fundamentalmente del sexo femenino, con síntomas de dolor abdominal o fiebre sin clara focalidad urológica.MATERIAL Y MÉTODOS: Se presenta el caso de una adolescente de 16 años con antecedente reciente de forunculosis cutánea supurada en rodilla derecha, que acudió a urgencias por dolor en flanco derecho y fosa iliaca derecha de 10 días de evolución sin fiebre ni síntomas miccionales. Se nos consultó para su valoración, siendo la ecografía el método diagnóstico que se utilizó para la localización de un absceso renal derecho subcapsular de 44 mm en polo superior, y posteriormente para su drenaje percutáneo al no responder porcompleto al tratamiento antibiótico i.v. El cultivo del material purulento del drenaje percutáneo aisló un Staphyloccocus aureus no meticilin resistente. El tratamiento antibiótico i.v asociado a drenaje percutáneo seguido de cloxacilina oral a su alta, curó a la paciente. A raíz de este caso se revisan las series y revisiones sobre abscesos renales de los últimos 10 años, con un total de 179 pacientes, y las publicaciones sobre abscesos renales por Staphyloccocus aureus con tan sólo 13 casos. CONCLUSIONES: Los abscesos renales han de tenerse en cuenta entre las urgencias urológicas. Su diagnóstico y tratamiento percutáneo es mayormente radiológico, reservándose la cirugía abierta o la nefrectomía para abscesos > de 5 cm o pacientes sépticos...

Renal abscesses are infrequent pathologies, but with a high morbidity-mortality if they are not diagnosed and treated early. Its vague and unspecific symptomatology: abdominal or lumbar pain, fever or poor general state, make its diagnosis late sometimes. The ultrasound and/or TAC provide a 100 percent diagnosis of the cases where its early treatment is possible. The objective of this article is to give importance to the fact that renal abscess is a cause of an urological emergency to keep in mind in patients, particularly females with symptoms of abdominal pain or fever without a clear urological focus. MATERIAL AND METHODS: The case of a 16-year-old adolescent is presented with a recent history of festered cutaneous furunculosis on the right knee. She went to the emergency room due to pain on the right side and right illiac fosa with 10 days evolution without fever or urinary symptoms. She came to us for its evaluation, an ultrasound was used for diagnosis to locate a right subcapsular renal abscess of 44 mm on the superior pole, and later for its percutaneous drainage when it did not completely responded to I.V. antibiotic treatment. The culture of the purulent material of the percutaneous drainage isolated a resistant non-methicillin Staphyloccocus aureus. The I.V. antibiotic treatment associated to percutaneous drainage followed by oral cloxacillin upon release cured the patient. CONCLUSIONS: Renal abscesses have to be taken into account among the urological emergencies. Their diagnosis and percutaneous treatment is mainly radiological, leaving open surgery or nephrectomy for abscesses > 5cm or with septic patients...

Ántrax cutáneo complicado con fascitis necrotizante y síndrome compartimental / Cutaneous anthrax complicated by necrotizing fasciitis and compartment syndrome

El ántrax o carbunco cutáneo es una zoonosis producida por el Bacillus anthracis, caracterizado por una úlcera necrótica, indolora, que cura generalmente espontáneamente y sin complicaciones. Presentamos el caso de un paciente varón agroganadero que presentó una úlcera necrótica rodeada de lesiones ampollares serohemáticas en cara ventral del antebrazo derecho y múltiples vesículas satélites purulentas, asociada a un edema extenso y dolor incapacitante del miembro afectado. Al ingreso, los exámenes revelaron leucocitosis (15 000/mL), CPK total (1 730 U/L) y prueba positiva de reacción en cadena de polimerasa (PCR) para Bacillus anthracis. Se diagnosticó síndrome compartimental y se realizó fasciotomía de emergencia. El reporte quirúrgico fue fascitis necrotizante, por finger test. En el seguimiento se evidenció contractura isquémica de Volkmann leve. Se debe plantear como diagnóstico el síndrome compartimental ante el dolor incapacitante, porque nos permitirá una intervención quirúrgica oportuna a fin de evitar perder la extremidad comprometida.

Introduction: Cutaneous anthrax is a zoonosis caused by Bacillus anthracis characterized by painless necrotic ulcer that usually heals spontaneously and without complications. The case of a farmer and cattle breeder male patient who presented a bullous serosanguineous ulcer surrounded by necrotic lesions in the ventral right forearm and multiple purulent satellite vesicles associated with extensive edema and disabling pain in the affected limb is reported. On admission, examinations revealed leukocytosis (15 000/ mL), total CPK (1 730 U/L) and positive test for Bacillus anthracis by polymerase chain reaction (PCR). Compartment syndrome was diagnosed and emergency fasciotomy was performed. Surgical report was necrotizing fasciitis by finger test. Mild Volkmann ischemic contracture was found during follow-up. Diagnosis of compartment syndrome should be considered when disabling pain is present to decide prompt surgical intervention in order to avoid losing the limb involved.

First Imported Case of Skin Infection Caused by PVL-positive ST30 Community-Associated Methicillin-Resistant Staphylococcus aureus Clone in a Returning Korean Traveler from the Philippines

Although pandemic community-associated (CA-) methicillin-resistant Staphylococcus aureus (MRSA) ST30 clone has successfully spread into many Asian countries, there has been no case in Korea. We report the first imported case of infection caused by this clone in a Korean traveler returning from the Philippines. A previously healthy 30-yr-old Korean woman developed a buttock carbuncle while traveling in the Philippines. After coming back to Korea, oral cephalosporin was given by a primary physician without any improvement. Abscess was drained and MRSA strain isolated from her carbuncle was molecularly characterized and it was confirmed as ST30-MRSA-IV. She was successfully treated with vancomycin and surgery. Frequent international travel and migration have increased the risk of international spread of CA-MRSA clones. The efforts to understand the changing epidemiology of CA-MRSA should be continued, and we should raise suspicion of CA-MRSA infection in travelers with skin infections returning from CA-MRSA-endemic countries.

Abordaje terapéutico en las forunculosis recidivantes. Consulta de inmunología. Pinar del Río / Therapeutic approach in relapsing furunculosis. Immunology clinic, Pinar del Rio

Se realizó un estudio en dos etapas: una primera de casos y controles, analítica y transversal, y una segunda de etapa de intervención longitudinal, prospectiva en los pacientes con forunculosis recidivante. El universo lo constituyeron los pacientes menores de 20 años que asistieron a la consulta de inmunología en el periodo 2006-2010. La muestra fue de 89 pacientes con forunculosis que accedieron a participar en el estudio, y un grupo control de 182 pacientes con síntomas respiratorios ligeros. Se precisó la edad, género, color de la piel y los valores de inmunoglobulinas. Se realizó un exudado nasofaríngeo a convivientes. Se impuso el tratamiento en tres grupos: uno solamente con antibióticos específico para la forunculosis, un segundo grupo recibió tratamiento de convivientes y un tercero del abordaje del segundo grupo, recibió el uso de inmunomoduladores. Los resultados mostraron una asociación de la forunculosis a los niños de mayor edad y de color de piel blanca, además de mostrar una asociación estadística muy significativa entre la presencia de al menos un conviviente con exudado positivo a Staphylococcus aureus (S. aureus) y la posibilidad de desarrollar la forunculosis recidivante. Se hace necesario el uso de antibióticos específicos combinados, el abordaje terapéutico de los convivientes y el uso de inmunomoduladores para lograr el éxito en el tratamiento.

A two- stages study was conducted: the first included the cases and controls, analytical and cross-sectional; and the second stage with a longitudinal and prospective intervention in patients suffering from relapsing furunculosis. The target group was comprised of patients under 20 years old attending to immunology clinic during 2006-2010; the sample, 89 patients with furunculosis who agreed to participate in the study, and a control group of 182 patients with mild respiratory symptoms. Age, gender, skin colour, immunoglobulin levels and nasopharyngeal smear in those presenting coexistence were the variables analyzed. A treatment in three groups was followed: one (1) only with specific antibiotic therapy for furunculosis, besides a second group followed the treatment of those with coexistence, and a third one, with the approach of the second group receiving immunomodulators. Results showed furunculosis in association with children of older ages and white skin, besides a very significant statistical association with at least, one of them, showing coexistence with a positive smear of Staphylococcus aureus (S. aureus) and the possibility to develop relapsing furunculosis. Combined-specific antibiotics are required, as well as the use of the therapeutic approach of those presenting coexistence and immunomodulators to achieve a successful treatment.

Ántrax cutáneo: reporte de un caso / Cutaneous anthrax: a case report

Introducción: ántrax o carbunco, es una enfermedad infecciosa causada por bacterias llamadas bacillus anthracis. La infección en los humanos compromete con mayor frecuencia la piel, el tracto gastrointestinal o los pulmones. La infección en humanos ocurre por contacto directo con carne, restos o productos de animales contaminados como: cuero, pelo, lana o huesos, es un contacto generalmente ocupacional. Caso clínico: paciente masculino, de 64 años de edad, raza negra y de profesión obrero agrícola. Durante un periodo de 8 días, previos a su ingreso, presentó fiebre, sin precisar gradación, con escalofríos, decaimiento, cefalea universal pulsátil y pérdida del apetito; notó además aumento local del volumen en la región peri orbitaria derecha con secreción purulenta, acompañándose de adenopatías submaxilares dolorosas y movibles. Con estos elementos se decidió su hospitalización. Al segundo día de estar en sala apareció una lesión costrosa de alrededor de cuatro centímetros de diámetro con un color negruzco, de bordes bien definidos, con halo eritematoso que le impedía la abertura palpebral. Se concluyó que este paciente estuvo en contacto con carnes de ganado vacuno. Conclusiones: se diagnóstico al paciente ántrax cutáneo, se tuvo en cuenta los elementos clínicos epidemiológicos y de laboratorio. Al duodécimo día de tratamiento con penicilina cristalina, se desprendió de forma espontánea la costra, sin dejar secuelas. En este caso no se presentó ninguna complicación clínica. El paciente es egresado con diagnóstico confirmado por el laboratorio, de infección por el bacillus anthracis.

Introduction: anthrax or carbuncle is an infectious disease caused by Bacillus anthracis bacteria. In humans the infection most frequently affects the skin, the gastrointestinal tract or the lungs; it direct contact with parts of infected animals or by consuming their meat, in a occupational contact generally. Clinical case: a 64 years old, masculine, black race patient, agricultural worker as profession. During a period of 8 days, previous to his admission, presented fever, without specifying gradation, with shivers, declining, and pulsatile universal headache and lost of appetite; the patient also noticed local increase of the volume in the right periorbital region with purulent secretion, accompanying by painful and movable submaxilla. With these elements was decided his hospitalization. To the second day of being admitted a crustosus lesion appeared around four centimeters of diameter with a blackish color, of well-defined rims, with erythematous halo impeded him the palpebral opening. It was concluded this patient was in contact with meats of cattle. Conclusions: it was diagnosed him cutaneous anthrax; it was taking into account the epidemiologic, clinical and laboratory elements. To the twelfth day of treatment with crystalline penicillin, the crust came off in a spontaneous way, without any sequelae. In this case any clinical complication was not presented. The patient was discharged with a diagnostic confirmed by the laboratory, of infection by bacillus anthracis.

A Case of Renal Carbuncle / 대한비뇨기과학회지

A case of carbuncle of the left kidney is reported with a review of literature. The patient reported herewith was 19 years old student, who complained of fever, vomiting and the tenderness in the left flank. His urine specimen showed numerous pus cells and hematological studies revealed leucocytosis. On intravenous pyelography the left kidney appeared normal. However, dye excretion by the right idney was delayed and there was a compression deformity of the lower calyx and extravasation of the dye into the renal parenchyma of the lower pole. The history and clinical findings seemed consistent with a renal carbuncle. A nephrectomy was performed as the procedure of choice. The specimen revealed, on cut surface, a large necrotic area measuring 2.1 cm in diameter, which communicated with the lower calyx. Culture of the abscess disclosed colonies of staphylococcus.