Erysipelas after surgery for breast cancer: a real-world cohort

Erysipelas is often related to lymphedema, which can occur in up to 60% of cases, with advanced age, radiotherapy, tumor extension, surgical approach, and infections as risk factors. The aim of this study was to present and discuss a series of cases of erysipelas after breast cancer surgery treated in a private mastology clinic over the past ten years. This is a retrospective horizontal cohort study in which we selected all cases of erysipelas after breast cancer surgery from 2009 to 2019. The following were evaluated: number of patients treated with a diagnosis of breast carcinoma with axillary approach, age, surgery performed, adjuvant treatment and treatment of erysipelas, presence of lymphedema, and measurement of circumferences between both arms and associated diseases. A total of 12 cases of breast cancer were treated. In 66.66% of cases, a radical axillary lymphadenectomy was performed, and in 16.66% of cases, only a sentinel lymph node investigation was performed. The average age was 67.6 years. Erysipelas appeared, on average, 43 months after cancer diagnosis. Two deaths were reported due to severe erysipelas leading to sepsis. More studies are still needed on the subject. Of the 12 cases in this study, eight (66.66%) were associated with lymphedema. Only two (16.66%) of the patients in this group who developed erysipelas were not submitted to axillary dissection. The treatment for 50% of the participants in this research was with penicillin G benzathine. There were three relapses, and two patients died during the research period

Potenciais fatores associados a maior chance de recidiva de erisipela / Posibles factores asociados a mayor probabilidad de recidiva de erisipela / Potential factors associated with increased chance of erysipelas recurrence

Resumo Objetivo Analisar os fatores relacionados à recidiva de erisipela em adultos e idosos. Métodos Estudo de coorte retrospectivo com 235 adultos e idosos admitidos em um hospital com diagnóstico de erisipela entre 2012 e 2019. Investigaram-se fatores sociodemográficos e clínicos relacionados a maior chance de recidiva de erisipela no período por meio de análises uni e bivariada, com p<0,05 considerado significativo. Resultados A prevalência de recidiva de erisipela foi de 25,5% (n=60). Os fatores significativamente associados à recidiva foram insuficiência venosa (p= 0,002; OR= 2,597; IC= 1,4-4,7) e uso de penicilina (p< 0,000; OR= 7,042; IC= 2,5-19,7). Conclusão a insuficiência venosa se associa a chance duas vezes maior de recidiva de erisipela e o uso de penicilina se associa a risco sete vezes maior para sua recidiva.

Resumen Objetivo Analizar los factores relacionados con la recidiva de erisipela en adultos y adultos mayores. Métodos Estudio de cohorte retrospectivo con 235 adultos y adultos mayores ingresados en un hospital con diagnóstico de erisipela entre 2012 y 2019. Se investigaron factores sociodemográficos y clínicos relacionados con una mayor probabilidad de recidiva de erisipela en el período mediante análisis uni y bivariados, con p<0,05 considerado significativo. Resultados La prevalencia de recidiva de erisipela fue del 25,5 % (n=60). Los factores significativamente asociados con la recidiva fueron insuficiencia venosa (p= 0,002; OR= 2,597; IC= 1,4-4,7) y uso de penicilina (p< 0,000; OR= 7,042; IC= 2,5-19,7). Conclusión La insuficiencia venosa está relacionada con una probabilidad dos veces mayor de recidiva de erisipela, y el uso de penicilina está relacionado con un riesgo siete veces mayor de recidiva.

Abstract Objective To analyze factors related to erysipelas recurrence in adults and older adults. Methods Retrospective cohort study with 235 adults and older adults admitted to a hospital diagnosed with erysipelas between 2012 and 2019. Sociodemographic and clinical factors related to a greater chance of erysipelas recurrence in the period were investigated through uni and bivariate analyses, with p<0.05 considered significant. Results The prevalence of erysipelas recurrence was 25.5% (n=60). Factors significantly associated with recurrence were venous insufficiency (p= 0.002; OR= 2.597; 95%CI= 1.4-4.7) and use of penicillin (p< 0.000; OR= 7.042; 95%CI= 2.5-19.7). Conclusion venous insufficiency is associated with a twice greater chance of erysipelas recurrence and the use of penicillin is associated with a seven times greater risk for its recurrence.

Erisipela em mulheres com câncer de mama seguidas em um serviço de reabilitação / Erysipelas in women with breast cancer followed in a rehabilitation service

Estudo transversal que buscou analisar a ocorrência de erisipela em mulheres com câncer de mama. Foi desenvolvido em um núcleo de reabilitação e incluídas, por conveniência, 84 mulheres com câncer de mama. Observou-se que 19% das participantes apresentaram sinais e sintomas de erisipela. Os sinais mais prevalentes foram hiperemia da pele, calor local e dor (100%). Além disso, observou-se que 75% das participantes com erisipela também apresentavam linfedema (p<0,005). Entre as mulheres com linfedema e erisipela, observou-se que 83,3% apresentavam o linfedema previamente ao primeiro episódio de erisipela. A prevalência de erisipela entre mulheres com câncer de mama em reabilitação, apontou que dentre os fatores predisponentes desta patologia houve associação com a presença de linfedema. Dados que justificam a inclusão de medidas de prevenção do linfedema, como hidratação do membro superior homolateral à cirurgia e evitar traumas nos cuidados prestados às mulheres com câncer de mama, prevenindo também a erisipela.

A cross-sectional study that analyzed the occurence of erysipelas in women with breast cancer. It was conducted in a rehabilitation center, and 84 women with breast cancer were included by convenience. It was observed that 19% of women had signs and symptoms of erysipelas. The most prevalent signs were skin hyperemia, local heat, and pain (100%). Moreover, 75% of participants with erysipelas also had lymphedema (p<0.005). Among women with lymphedema and erysipelas, 83.8% had the lymphedema before erysipelas. The prevalence of erysipelas among women with breast cancer in rehabilitation pointed that within the predisposing factors of this pathology, there was an association with the presence of lymphedema. This data justify the inclusion of prevention measures for lymphedema, such as hydration of the superior limb homolateral to the surgery and to avoid trauma in the care provided to women with breast cancer, also preventing erysipelas.

Evaluation de la prise en charge de l'érysipèle par les médecins généralistes de la ville de Marrakech

Introduction: l'érysipèle est la plus fréquente des dermohypodermites bactériennes non nécrosantes (DHBNN).L'objectif de notre travail est d'évaluer l'adéquation des connaissances des médecins généralistes avec les données de la littérature sur la prise en charge diagnostique et thérapeutique de l'érysipèle.Méthodes: nous avons réalisé une enquête transversale à visée descriptive et analytique auprès de 167 médecins généralistes des secteurs public et privé de Marrakech du 19 Mai au 20 Octobre 2014.Résultats: les 114 questionnaires qui nous ont été retournés ont révélé que des facteurs de risque locaux et généraux étaient souvent retrouvés en cas d'érysipèle. Le diagnostic positif des formes typiques était clinique pour 92(80,7%) médecins. La prise en charge devrait se faire en ambulatoire pour 97(85,1%), le recours à l'hospitalisation et aux examens para-cliniques ne s'avérait nécessaire que pour les formes sévères, atypiques ou compliquées. L'amoxicilline orale a été préconisée par 25 médecins (21,9%). La bi-antibiothérapie incluant une molécule antistreptococcique a été préconisée par 15(13,2%) médecins. Le recours aux anti-inflammatoires a été préconisé par 16 médecins (14%). Les préventions primaires et secondaires ont rencontré l'intérêt de nos médecins dont 108 (94,7%) ont été favorables au traitement des portes d'entrée cutanées et 53 (46,5%) à l'antibioprophylaxie à partir de la deuxième récidive.Conclusion: d'après notre étude, l'érysipèle semble relativement fréquent en pratique de ville, les éléments du diagnostic clinique devraient faire l'objet d'une vulgarisation visant à améliorer les attitudes diagnostiques et thérapeutiques de nos médecins

Evaluation of safety and immunogenicity of a new octavalent inactivated vaccine containing porcine parvovirus, erysipelas, and leptospira

Porcine parvovirus, Erysipelothrix (E.) rhusiopathiae, and Leptospira (L.) interrogans are considered major etiologic agents of reproductive failure in pigs, causing economic loss in the swine industry. In this study, the safety and immunogenicity of a new octavalent inactivated vaccine were evaluated. The vaccine contained inactivated porcine parvovirus, E. rhusiopathiae, and six L. interrogans serovars (Bratislava, Canicola, Grippotyphosa, Hardjo, Icterohaemorrhagiae, and Pomona). Safety test results showed no notable side effects or clinical signs after vaccination in mice, guinea pigs, and sows. In addition, we assessed immunogenicity of the vaccine in 25 sows under field conditions. The vaccinated group (n = 20) had a significantly higher antibody level than the non-vaccinated group (n = 5). Moreover, the stillbirth rate decreased in piglets born from vaccinated sows, resulting in an increased fertility rate. The results of this study demonstrate that the new octavalent inactivated vaccine can be applied safely and effectively to improve reproductive performance in sows.

Clinical Guidelines for the Antibiotic Treatment for Community-Acquired Skin and Soft Tissue Infection

Skin and soft tissue infection (SSTI) is common and important infectious disease. This work represents an update to 2012 Korean guideline for SSTI. The present guideline was developed by the adaptation method. This clinical guideline provides recommendations for the diagnosis and management of SSTI, including impetigo/ecthyma, purulent skin and soft tissue infection, erysipelas and cellulitis, necrotizing fasciitis, pyomyositis, clostridial myonecrosis, and human/animal bite. This guideline targets community-acquired skin and soft tissue infection occurring among adult patients aged 16 years and older. Diabetic foot infection, surgery-related infection, and infections in immunocompromised patients were not included in this guideline.

Assistência de enfermagem a um paciente com integridade da pele prejudicada relacionada à erisipela: relato de experiência / Nursing assistance to a patient with impaired skin integrity related to erysipelas: experience reporting

Erisipela é um processo infeccioso cutâneo causado por uma bactéria que se propaga pelos vasos linfáticos. Há a veemência em realizar uma orientação adequada quanto ao reconhecimento do problema, ao seguimento do tratamento e aos cuidados com a prevenção das complicações. Este é um relato de experiência de Enfermeiras residentes em Alta Complexidade de um Hospital Universitário do Nordeste do Brasil, na assistência a um paciente com integridade da pele prejudicada relacionada à erisipela. Foi realizado acompanhamento do paciente no período de maio a agosto de 2015, em que foi utilizado diferentes técnicas para tratamento e o mesmo evoluiu com cicatrização e cura da lesão. Possibilitou o crescimento técnico-científico dos profissionais assim como da abordagem da experiência para demais equipes promotoras de cuidado com o paciente. Descritores: Cuidado de Enfermagem; Erisipela; Lesão de Pele.

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Un proceso de la erisipela de Ia piei y infecciosa causada por una bacteria se propaga cola para los vasos linfáticos. Hay una vehemencia de conducta orientación adecuada para el reconocimiento por hacer problema, ao seguimiento de tratamiento y atención a la prevención de complicaciones. Esto y a enfermeras relato de experiencia residentes de alta dei hospital dei noreste de Brasil, mantenimiento universidad complejidad zumbido y zumbido con el paciente integridad de la piei relacionados con la erisipela con discapacidad. Se Ilevó a cabo la monitorización dei paciente cualquier período de mayo a agosto, 2015, estábamos en que diferentes técnicas utilizadas tratamiento párrafo e incluso evolucionamos con la formación de cicatrices y la curación de la lesión. El posible crecimiento de los profesionales científicos técnicos, así como enfoque experiencia párrafo también equipos que promueven el cuidado dei paciente.

Typical Sweet Syndrome at the Site of Postmastectomy Lymphedema: Two Cases and a Literature Review / 대한피부과학회지

Sweet's syndrome (SS) or acute febrile neutrophilic dermatosis has been reported to occur in association with many conditions. We report two cases of SS at the site of a postmastectomy lymphedema. A localized variant of SS restricted to an area of postmastectomy lymphedema is an often unrecognized complication of breast cancer. Moreover, attempts to treat SS using various methods might prolong the duration of treatment. Therefore, SS should not be confused with other disorders such as erysipelas, cellulitis, herpes zoster, and contact dermatitis.

Therapeutic effect of heating and bandage treatment for chronic lymphedema of extremities accompanied with erysipelas: a report of 80 cases / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effect of heating and bandage treatment for chronic lymphedema of extremities accompanied with erysipelas.</p><p><b>METHODS</b>From March 2004 to March 2013, 80 patients with chronic lymphedema of extremities accompanied with erysipelas were analyzed retrospectively. The patients underwent heating treatment (42 degree centigrade) with infrared light machine made by Shanghai Ninth People's Hospital, 2 hours a day, 20 hours for a session. Bandage treatment was adopted after heating treatment. 1 or 2 sessions were performed for each patient every year. The erysipelas occurring frequency, patients subjective feeling, treatment sessions and elastic material usage was recorded during the follow-up period. The erysipelas occurring frequency was tested by the method of rank and inspection. SPSS 17. 0 was used for statistical analysis.</p><p><b>RESULTS</b>After heating and bandage treatment, the occurrence frequency of erysipelas was obviously controlled (Z = 7.598, P = 0.000). Erysipelas was not occurred any more in 60 (75%)patients. Remarkable reduction of occurrence frequency of erysipelas caused by various reasons was showed after treatment. Primary and secondary lymphedema after treatment were compared with those before treatment respectively, showing statistical difference (Z = 3.417 and 5.009, P = 0.001 and 0.000). Most of patients felt better subjectively. The relapse rate of erysipelas and lymphedema was lower if keeping using elastic material to give more pressure on extremities after therapy.</p><p><b>CONLUSIONS</b>Heating and bandage treatment can obviously reduce the occurrence frequency of erysipelas. It can improve the quality of patients' lives. Simultaneously, the subsequent elastic material pressure therapy is essential.</p>

In Vitro Activity of Tedizolid Against Gram-Positive Bacteria in Patients With Skin and Skin Structure Infections and Hospital-Acquired Pneumonia: A Korean Multicenter Study

We compared the activities of tedizolid to those of linezolid and other commonly used antimicrobial agents against gram-positive cocci recovered from patients with skin and skin structure infections (SSSIs) and hospital-acquired pneumonia (HAP) in Korean hospitals. Gram-positive isolates were collected from 356 patients with SSSIs and 144 patients with HAP at eight hospitals in Korea from 2011 to 2014. SSSIs included impetigo, cellulitis, erysipelas, furuncles, abscesses, and infected burns. Antimicrobial susceptibility was tested by using the CLSI agar dilution method. All of the gram-positive isolates were inhibited by < or =1 microg/mL tedizolid. The minimum inhibitory concentration [MIC]90 of tedizolid was 0.5 microg/mL for methicillin-resistant Staphylococcus aureus, which was 4-fold lower than that of linezolid. Tedizolid may become a useful option for the treatment of SSSIs and HAP caused by gram-positive bacteria.

Infecciones de piel y partes blandas en pediatría: consenso sobre diagnóstico y tratamiento: Parte 1 / Skin and soft tissue infections in children: consensus on diagnosis and treatment

Las infecciones de piel y partes blandas son una causa frecuente de consulta en los centros de atención primaria de la salud. Los datos de la epidemiología local de estas infecciones son escasos; el Staphylococcus aureus y el Streptococcus pyogenes son los principales agentes etiológicos. La emergencia, en los últimos años, de cepas de S. aureus meticilino resistentes provenientes de la comunidad y S. pyogenes resistentes a eritromicina plantea controversias en la elección del tratamiento empírico inicial. Este consenso nacional está dirigido a médicos pediatras, de familia, dermatólogos, infectólogos y otros profesionales de la salud. Trata el manejo clínico, especialmente el diagnóstico y tratamiento, de las infecciones de piel y partes blandas de origen bacteriano provenientes de la comunidad en pacientes inmunocompetentes menores de 19 años de edad.

Skin and soft tissue infections are a common reason for consultation in primary health care centers. Data from the local epidemiology of these infections are rare, but Staphylococcus aureus and Streptococcus pyogenes are known to be the major etiologic agents. The appearance in recent years of community-originated strains of methicillin-resistant S. aureus and erythromycin-resistant pyogenes raises controversy in the choice of initial empirical treatment. This national consensus is for pediatricians, dermatologists, infectologists and other health professionals. It is about clinical management, especially the diagnosis and treatment of commu-nity-originated skin and soft tissue infections in immunocompetent patients under the age of 19.

A Clinical Study of Inpatients with Cellulitis over the Recent 5 Years / 대한피부과학회지

BACKGROUND: Cellulitis is an acute infection of the dermal and subcutaneous layers of the skin, which is commonly treated by a dermatologist but there are few reports about clinical data on cellulitis in Korean literature. OBJECTIVE: This study evaluated the clinical characteristics of inpatients diagnosed as cellulitis in the recent 5 years. METHODS: We reviewed the medical records of 77 patients who were diagnosed as cellulitis and hospitalized at the Kangbuk Samsung Hospital from March 2008 to February 2013. RESULTS: The study included data from 77 patients with cellulitis (mean age, 51.7 years; 44 men, 33 women). There was a positive correlation between age and hospitalized days (p0.05). Systemic steroid was administered in 21 patients (27.3%), and was not significantly related to hospitalized days (p>0.05). CONCLUSION: The clinical course of cellulitis was inversely correlated to the elevation of patient's age, WBC count, and CRP.

Erisipela e celulite / Erysipelas and cellulitis

Este artigo tem por objetivo fazer uma revisão a respeito de duas patologias de pele comuns na prática médica. Abordaremos manifestações clínicas, tratamento e principalmente o diagnóstico diferencial entre elas.

This article aims to review two commons skin diseases in medical practices. We will discuss clinical manifestations, treatment and especially the differential diagnosis.

Clinical Characteristics and Organisms Causing Erysipelas and Cellulitis

BACKGROUND: Although erysipelas and cellulitis are common soft tissue infectious diseases, there have been a few studies which investigate clinical characteristics and causative organisms in Korea. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had been diagnosed with erysipelas or cellulitis from ten general hospitals between January 2009 and February 2011. RESULTS: During the study period, a total of 144 patients with erysipelas and 735 with cellulitis were recruited. The mean age of erysipelas patients was 53.6 years, and that of cellulitis patients was 47.5 years. Diabetes mellitus was the most common underlying disease in both groups. The most common site of erysipelas was the face (80.6%) and that of cellulitis was the lower extremity (64.9%). Culture studies have been done in 31.9% (46/144) of patients with erysipelas, and 41.1% (302/735) with cellulites. Causative organisms were identified in 3 patients (2.1%) with erysipelas and 57 (7.8%) with cellulitis. Streptococcus pyogenes was isolated from two patients with erysipelas, and group G streptococcus from one. Staphylococcus aureus (44.0%) was the most common isolate in patients with cellulitis, followed by streptococci (27.1%), Enteobateriaceae (11.9%), and Vibrio species (6.8%). First-generation cephalosporin was the most commonly used antimicrobial agent in both groups. CONCLUSIONS: beta-hemolytic streptococcus and S. aureus were the most common causative organisms of patients with erysipelas and cellulitis.

Clinicopathologic Study for 10 Cases of Cutaneous Angiosarcoma / 대한피부과학회지

BACKGROUND: Cutaneous angiosarcoma (CAS) is occasionally difficult to differentiate with other benign dermatoses, clinically, because of various clinical manifestations. OBJECTIVE: The aim of this study is to examine the clinical and histopathologic findings of CAS, and investigate specific clinicopathologic features to aid in the early diagnosis. METHODS: We reviewed photographs, medical records and biopsy specimen of 10 cases diagnosed as CAS for 5 years at our clinic. RESULTS: The male and female numbers were 7 and 3, and the mean onset age was 69.7 years old. The mean duration of disease was 5.7 months. The site of involvement was scalp or face in all patients. The most common clinical feature was erythematous or purpuric nodule, with surrounding erythematous or purpuric patch, without symptoms. Initial impressions based on clinical findings on the first visit of our clinic were CAS (n=6), squamous cell carcinoma (n=2), basal cell carcinoma (n=1), and erysipelas (n=1). Histopathologically, irregular vascular channels lined by atypical endothelial cell dissect between the collagen bundles were seen in 6 cases, malignant endothelial cells forming continuous sheets with epithelioid morphology in 3 cases, and mild vascular hyperplasia in 1 case. CD31 was positive on atypical endothelial cells in all patients. CONCLUSION: CAS should be included in differential diagnosis when cutaneous lesions show erythematous to purpuric nodule or patch with rapid progression on scalp or face of elderly patients. Histopathologically, CAS had wide spectrum from mild vascular hyperplasia to spindle cell tumors. As such, immunohistochemical stain, using endothelial markers, is valuable to diagnosis of CAS.

Miíase associada a erisipela bolhosa / Case report: myiasis associated to bullous erysipelas

Miíase é a presença de larvas de moscas em tecidos do homem ou de outros animais vertebrados, onde se nutrem e evoluem como parasitos. Erisipela é uma celulite superficial que apresenta comprometimento do plexo linfático subjacente, cujo principal agente etiológico é Streptococcus (Rosenbach,1884) beta hemolítico do grupo A de Lancefield. Caracteriza-se por placas eritematosas acompanhadas de dor e edema. Este é o relato de um caso raro de paciente idosa internada em hospital público para tratamento de erisipela bolhosa no membro inferior esquerdo, em cujas lesões, durante a internação, foi detectada a presença de miíase. Foram retiradas várias larvas vivas com auxílio de pinça e prescrita ivermectina para erradicar possíveis larvas remanescentes. O diagnóstico precoce e o tratamento correto das lesões primárias são fundamentais para evitar a ocorrência de afecções como a miíase, cuja instalação atrasa o tratamento e pode agravar o prognóstico.

Myiasis is the presence of fly larvae in tissues of humans or other vertebrates,where they feed and develop as parasites. Erysipelas is a superficial cellulitis with involvement of underlying lymphatic plexus, characterized by erythematous plaques accompanied by pain and swelling. We report a case of an aged patient admitted to a public hospital for treatment of bullous erysipelas in the left lower limb, who developed cutaneous myiasis during hospitalization. Several larvae wereremoved with the aid of forceps and ivermectin was prescribed to eradicate possible remaining larvae. Early diagnosis and correct treatment of the lesions are essential to prevent the occurrence of diseases such as myiasis.

Dermatologia comparativa: similaridade entre elefantíase nostra verrucosa e coral / Comparative dermatology: elephantiasis nostra in verrucous form comparable to coral

Demonstra-se quadro raro de Elefantíase Nostra, na sua forma verrucosa, no dorso de pé de homem de 80 anos por episódios prévios de erisipela de repetição. As lesões confluentes vegetantes e difusas em dorso de pé são comparáveis aos corais Trumpet Coral (Caulastrea curvata).

Study of a rare case of Elephantiasis Nostra in verrucous form on the dorsum of the foot of an 80year-old male with a history of recurrent erysipelas infection. The vegetant, confluent lesions on the foot resemble Trumpet Coral (Caulastrea curvata).

Las epidemias de erisipela en Chile / Erysipelas outbreaks in Chile

Historical antecedents of erysipelas outbreaks in Chile, registered by national bibliography at years 1822 and 1873 are reviewed. The first one, after an earthquake, with numerous severe ataxo-adynamic manifestations and the second, more attenuated with few severe cases. Remembers of treatments utilized at XIX Century for the disease and the beginning of sulphamides prescription at the thirty decade are presented. Afterwards penicillin and other antimicrobial agents treatments were implemented. Finally, we comment the severe presentation of soft tissues streptococcal diseases that appeared in the end of XX Century.

Se revisa los antecedentes históricos de las epidemias de erisipela en Chile, que anota la bibliografía nacional, en los años 1822 y 1873. La primera, a continuación de un terremoto, con numerosas formas graves ataxo-adinámicas y la segunda, más benigna, con pocos casos graves. Se recuerda los tratamientos de la enfermedad utilizados en el siglo XIX y la iniciación de los antimicrobianos sulfamidados, en la década de los años 30. Posteriormente penicilina y otros antimicrobianos. Finalmente, se comenta la gravedad emergente de las infecciones estreptocóccicas de tejidos blandos, en los últimos años del siglo XX.

Superficial Skin Infections and the Use of Topica and Systemic Antibiotics in General Practice

Superficial bacterial infections of the skin are very common. With the increasing burden of human immunodeficiency virus (HIV); this is likely to worsen. Examples of such infections include impetigo; erysipelas; cellulitis; ecthyma; furuncles; carbuncles and subcutaneous abscesses. Common causative organisms are staphylococci and streptococci. Generally; Staphylococcus aureus infections tend to spread locally; causing abscesses and carbuncles; while streptococci are apt to spread along tissue planes; and give rise to either cellulitis or erysipelas. However; this is not always the case. These infections cause a significant morbidity; and have to be diagnosed and treated promptly. Some result in serious complications