Rol de los estreptococos del grupo Streptococcus anginosus en infecciones de piel y partes blandas: reporte de 3 casos / Role of streptococci of the Streptococcus anginosus group in skin and soft tissue infections: report of 3 cases

Los estreptococos del grupo Streptococcus anginosus (GSA) comprenden uno de los grupos que conforman el grupo viridans de estreptococos y son parte de la microbiota humana habitual de la cavidad oral, del tracto respiratorio superior y del tracto gastrointestinal. Pueden producir colecciones purulentas de órganos sólidos, abscesos cutáneos y celulitis, entre otras infecciones. Este grupo posee numerosos factores de virulencia como hialuronidasa, adhesinas, enzimas extracelulares y hemolisinas. El objetivo de este trabajo fue presentar tres casos clínicos de infecciones asociadas a traumatismos vinculados con la cavidad oral como golpes de puño o mordeduras humanas. En todos ellos, los GSA desarrollaron como germen único, lo que pone de manifiesto su importante rol en este tipo de infecciones.

The Streptococcus anginosus group (SAG) is part of the viridans group streptococci and they belong to the normal human microbiota of the oral cavity, the upper respiratory tract and the gastrointestinal tract. It can produce purulent collections of solid organs, cutaneous abscesses and cellulitis, among other infections. This group has numerous virulence factors such as hyaluronidase, adhesins, extracellular enzymes and hemolysins. The objective of this work is to present three clinical cases of infections associated with trauma related to the oral cavity such as fist bumps or human bites. In all of them, the SAG developed as a single organism, which highlights its important role in this type of infection.

Os estreptococos do grupo do Streptococcus anginosus (GSA) são parte de um dos grupos que constituem o grupo viridans e fazem parte da microbiota normal da cavidade oral, do trato respiratório superior e do trato gastrointestinal dos seres humanos. Podem produzir coleções purulentas de órgãos sólidos, abscessos cutâneos e celulite, entre outras infecções. Este grupo possui numerosos fatores de virulência, como hialuronidases, adesinas, enzimas extracelulares e hemolisinas. O objetivo desse trabalho foi apresentar três casos clínicos de infecções associadas a traumatismos associados à cavidade oral, decorrentes de socos ou mordidas humanas. Em todos eles os GSA se desenvolveram como germe único, o que põe de manifesto seu papel importante nesse tipo de infecções.

Stability analysis of bitemarks in different conditions of time and temperature and its reliability as evidence in criminal investigations

Abstract The objective of this study was to evaluate the stability of bite marks in foods in different conditions of time and temperature and their reliability as evidenced in criminal investigations. Sampling came from 20 subjects, who were instructed to bite five pieces of cheese and five pieces of chocolate. Bites were produced by the anterior teeth, from canine to canine, and the volunteers had their dental arches molded to obtain plaster models that were used for later comparison. The samples produced by each participant were stored and analyzed according to the temperature (room and refrigerator) and time period (immediately after, three days, seven days). The linear model with mixed effects using R Core Team and SAS Statistical Software were used for the statistical analysis. The results of this study reveal that the storage temperature of these materials does not exert a significant influence. Both chocolate and cheese showed better results when measurements were made shortly after, however the chocolate showed to be more stable in longer periods of time. By means of this study, it was possible to demonstrate that the storage temperature does not exert a significant influence. However, the bite marks found in foods with greater dimensional stability and short time intervals, are more reliable and allow their use as evidence in criminal investigations. Still, due to the limitations presented, we recommend its use for the exclusion of possible suspects and not for the suspects identification.

Resumo O objetivo deste estudo foi avaliar a estabilidade das marcas de mordida em alimentos em diferentes condições de tempo e temperatura e sua confiabilidade como evidência em investigações criminais. A amostragem foi composta por 20 indivíduos, que foram instruídos a morder cinco pedaços de queijo e cinco pedaços de chocolate. As mordidas foram produzidas pelos dentes anteriores, de canino a canino, e os sujeitos da pesquisa tiveram seus arcos dentais moldados para obter modelos que foram usados para posterior comparação. As amostras produzidas por cada participante foram armazenadas e analisadas de acordo com a temperatura (ambiente e geladeira) e período de tempo (imediatamente, após três dias e sete dias). Para a análise estatística, utilizou-se o modelo linear com efeitos mistos, utilizando R Core Team e SAS Statistical Software. Os resultados deste estudo revelam que a temperatura de armazenamento desses materiais não exerce influência significativa. Tanto o chocolate quanto o queijo apresentaram melhores resultados quando as mensurações foram feitas logo após, porém o chocolate mostrou-se mais estável em períodos mais longos. Por meio deste estudo, foi possível demonstrar que a temperatura de armazenamento não exerce influência significativa. Entretanto, as marcas de mordida encontradas em alimentos com maior estabilidade dimensional e intervalos de tempo curtos são mais confiáveis e permitem seu uso como evidência em investigações criminais. Ainda assim, devido às limitações apresentadas, recomendamos seu uso para a exclusão de possíveis suspeitos e não para a individualização dos mesmos.

Management of human bite injury of the upper and lower eyelids: a rare case report

Human bite injury to the eyelid is extremely rare and poses a significant challenge in surgical reconstruction. We report an extremely rare case of human bite injury to the eyelid in a 43-year-old male with approximately 60% full thickness loss of the upper eyelid and 80% to 90% full thickness loss of the lower eyelid and its successful reconstruction using the local advancement cheek flap.

Acute Wound and Management

Acute wounds are a common presenting complaint of patients in the primary care setting. These can result from a variety of mechanisms ranging from lacerations and abrasions to stings, bites or burns. The management of acute wounds involves a proper evaluation with history, physical examination, and adequate management with local wound care, and consideration for the need for specialist review or systemic treatment. The general principles of wound management and special wounds like bite wounds and stings will be discussed.

A Case of Liver Abscess due to Eikenella corrodens Caused by Human Bites

Eikenella corrodens is a slow growing, facultatively anaerobic gram-negative rod that is part of the normal flora of the oral cavity and upper respiratory tracts. In most patients with E. corrodens infections, host defenses are compromised due to surgery, or chronic debilitating illness such as malignancies, or immunosuppressive therapy. This organism causes abscesses and infections that are at times fatal. We experienced a case of E. corrodens isolated from liver abscess in an immunocompetent patient. A 50-year-old man who is a dentist, was hospitalized because of fever and myalgia of 10 days' duration. Abdominal ultrasonography showed non-septated, 3.8x4.6 cm sized abscess in the segment 6/7 of the liver. E. corrodens was isolated from aspiration of liver abscess. This organism was presumably acquired from his patient's oral cavity during dental procedure. We hope that increased awareness to E. corrodens will raise the index of suspicion, and contribute to optimal management of these infections, minimizing the significant morbidity associated with this organism.

A Case of Liver Abscess due to Eikenella corrodens Caused by Human Bites

Eikenella corrodens is a slow growing, facultatively anaerobic gram-negative rod that is part of the normal flora of the oral cavity and upper respiratory tracts. In most patients with E. corrodens infections, host defenses are compromised due to surgery, or chronic debilitating illness such as malignancies, or immunosuppressive therapy. This organism causes abscesses and infections that are at times fatal. We experienced a case of E. corrodens isolated from liver abscess in an immunocompetent patient. A 50-year-old man who is a dentist, was hospitalized because of fever and myalgia of 10 days' duration. Abdominal ultrasonography showed non-septated, 3.8x4.6 cm sized abscess in the segment 6/7 of the liver. E. corrodens was isolated from aspiration of liver abscess. This organism was presumably acquired from his patient's oral cavity during dental procedure. We hope that increased awareness to E. corrodens will raise the index of suspicion, and contribute to optimal management of these infections, minimizing the significant morbidity associated with this organism.