Microbiologic characteristics and antibiotic resistance rates of diabetic foot infections / Perfil microbiológico e de resistência bacteriana no pé diabético infectado

ABSTRACT Purpose: the purpose of this research was to identify the sociodemographic and microbiological characteristics and antibiotic resistance rates of patients with diabetic foot infections, hospitalized in an emergency reference center. Methods: it was an observational and transversal study. The sociodemographic data were collected by direct interview with the patients. During the surgical procedures, specimens of tissue of the infected foot lesions were biopsied to be cultured, and for bacterial resistance analysis. Results: the sample consisted of 105 patients. The majority of patierns were men, over 50 years of age, married and with low educational level. There was bacterial growth in 95 of the 105 tissue cultures. In each positive culture only one germ was isolated. There was a high prevalence of germs of the Enterobacteriaceae family (51,5%). Gram-negative germs were isolated in 60% of cultures and the most individually isolated germs were the Gram-positive cocci, Staphylococcus aureus (20%) and Enterococcus faecalis (17,9%). Regarding antibiotic resistance rates, a high frequency of Staphylococcus aureus resistant to methicillin (63,0%) and to ciprofloxacin (55,5%) was found; additionally, 43,5% of the Gram-negative isolated germs were resistant to ciprofloxacin. Conclusions: the majority of patients were men, over 50 years of age, married and with low educational level. The most prevalent isolated germs from the infected foot lesions were Gram-negative bacteria, resistant to ciprofloxacin, and the individually most isolated germ was the methicillin resistant Staphylococcus aureus.

RESUMO Objetivo: identificar o perfil sociodemográfico, microbiológico e de resistência bacteriana em pacientes com pé diabético infectado. Métodos: tratou-se de estudo observacional, transversal que avaliou os perfis sóciodemográfico e microbiológico de pacientes portadores de pé diabético infectado internados em Pronto Socorro de referência. Os dados sociodemográficos foram coletados por meio de entrevista. Foram colhidos, durante os procedimentos cirúrgicos, fragmentos de tecidos das lesões podais infectadas para realização de cultura/antibiograma. Resultados: a amostra foi composta por 105 pacientes. O perfil sociodemográfico mais prevalente foi o de pacientes do sexo masculino, acima dos 50 anos, casados e com baixa escolaridade. Das 105 amostras de fragmentos de tecidos colhidos para realização de cultura e antibiograma, 95 foram positivas, com crescimento de um único germe em cada um dos exames. Houve predomínio de germes da família Enterobacteriaceae (51,5%). Germes Gram-negativos foram isolados em 60,0% das culturas e os espécimes mais isolados individualmente foram os cocos Gram-positivos, Staphylococcus aureus (20,0%) e Enterococcus faecalis (17,9%). Considerando-se os perfis de resistência bacteriana, verificou-se alta taxa de Staphylococcus aureus resistente à meticilina (63,0%) e à ciprofloxacino (55,5%); verificou-se, também, que 43,5% dos germes Gram-negativos eram resistentes à ciprofloxacino. Conclusões: o perfil sociodemográfico majoritário, foi o de homens, com mais de 50 anos e com baixa escolaridade. Concluímos que os germes mais prevalentes nas lesões podais dos pacientes diabéticos foram os Gram-negativos, resistentes ao ciprofloxacino e que o germe mais isolado individualmente foi o Staphylococcus aureus resistente à meticilina.

Cutaneous manifestations of bartonellosis

Abstract Bartonellosis are diseases caused by any kind of Bartonella species. The infection manifests as asymptomatic bacteremia to potentially fatal disorders. Many species are pathogenic to humans, but three are responsible for most clinical symptoms: Bartonella bacilliformis, Bartonella quintana, and Bartonella henselae. Peruvian wart, caused by B. bacilliformis, may be indistinguishable from bacillary angiomatosis caused by the other two species. Other cutaneous manifestations include maculo-papular rash in trench fever, papules or nodules in cat scratch disease, and vasculitis (often associated with endocarditis). In addition, febrile morbilliform rash, purpura, urticaria, erythema nodosum, erythema multiforme, erythema marginatus, granuloma annularis, leukocytoclastic vasculitis, granulomatous reactions, and angioproliferative reactions may occur. Considering the broad spectrum of infection and the potential complications associated with Bartonella spp., the infection should be considered by physicians more frequently among the differential diagnoses of idiopathic conditions. Health professionals and researchers often neglected this diseases.

Infección por Serratia marcescens: una inusual causa de lesiones cutáneas / Serratia marcescens infection: an unusual cause of skin lesions

Serratia marcescens corresponde a un bacilo gram negativo, miembro de la familia Enterobacteriaceae. Este microorganismo tiene una alta capacidad de supervivencia en condiciones hostiles y ha sido implicado en infecciones del tracto respiratorio, vía urinaria, meningitis, endocarditis y sistema musculoesquelético. No obstante, es considerado una causa rara de infecciones cutáneas. Esta última tiene distintas presentaciones clínicas, la más frecuente es fascitis necrotizante seguida de celulitis. Los nódulos, las pápulas después de inyecciones de rellenos, las erupciones papulares diseminadas, las placas eritematosas, las pústulas y las úlceras son parte del amplio espectro de formas clínicas descritas en la literatura. Presentamos el caso de una paciente de 50 años, con historia de compromiso del estado general, lesiones cutáneas polimorfas y fiebre. Se confirmó una infección cutánea por Serratia marcescens mediante cultivos. Se destaca el polimorfismo y la coexistencia de distintas manifestaciones en una misma paciente, incluyendo celulitis, nódulo, ulceras y necrosis cutánea y la importancia del estudio microbiológico para el adecuado tratamiento antibiótico.

Serratia marcescens corresponds to gram negative bacillus, a member of the Enterobacteriaceae family. This microorganism has a high survival capacity in hostile conditions and has been implicated in respiratory tract, urinary tract, meningitis, endocarditis and musculoskeletal system infections. However, it is considered a infrequent cause of cutaneous infections. Has different clinical presentations, the most frequent is necrotizing fasciitis followed by cellulite. Nodules, papules after filler injections, disseminated papular eruption, erythematous plaques, pustules and ulcers are part of the broad spectrum of clinical forms described in the literature. We present the case of a 50 year old patient with a history of compromised general condition, polymorphic cutaneous lesions and fever. Serratia marcescens cutaneous infection was confirmed by cultures. The polymorphism and the coexistence of different manifestations in the same patient, including cellulitis, nodule, ulcers and skin necrosis, and the importance of the microbiological study for the adequate antibiotic treatment are highlighted.

Cutaneous atypical mycobacteriosis with sporotrichoid clinical presentation caused by automotive accident

Abstract: Atypical mycobacterial infections are caused by mycobacteria other than those from the M. tuberculosis complex and M. leprae. Its incidence has increased progressively, with considerable increase of scientific publications on the subject. Only 10% of the cases present with cutaneous infections, most of them related to surgical interventions and aesthetic procedures. We present a case of mycobacteriosis due to automotive accident that presented a diagnostic challenge due to its clinical presentation with lesions of sporotrichoid progression in the lymphatic system.

Ántrax cutáneo, último brote diagnosticado en Chile / Cutaneous anthrax, the last outbreak diagnosed in Chile

Resumen El ántrax, es una zoonosis causada por una bacteria generadora de esporas, llamada Bacillus anthracis. En forma natural tiene una distribución global, con una predilección en zonas agrícolas con pocas normativas de sanidad pública veterinaria. El contagio humano ocurre por el consumo de carnes de animales enfermos, por contacto a través de una puerta de entrada en la piel o por la inhalación de esporas de productos derivados del animal afectado (lana, cuero, huesos). La infección en los seres humanos compromete con mayor frecuencia la piel, seguido por el tracto gastrointestinal y los pulmones. El control de la enfermedad se basa en la prevención, de allí la importancia de la vigilancia en la detección de casos y brotes. Presentamos el último brote de ántrax cutáneo diagnosticado en Chile con descripción de dos primeros casos clínicos del brote.

Anthrax is a zoonosis caused by a spore-forming bacterium, called Bacillus anthracis. Naturally it is of global distribution, with a predilection in agricultural zones with few norms of public veterinary health. Human contagion occurs through the consumption of diseased animal's meat or through a doorway into the skin or through the spores inhalation of products derived from the affected animal (wool, leather, bones). The most frequent infection in humans occurs in the skin, followed by the gastrointestinal tract and lungs. We present the last outbreak of cutaneous anthrax diagnosed in Chile with a description of the first two clinical cases of the outbreak. Control disease is based on prevention, hence the importance of surveillance in detecting cases and outbreaks.

Dermatologic manifestations of infective endocarditis

Abstract Despite advances in diagnosis and treatment, infective endocarditis still shows considerable morbidity and mortality rates. The dermatological examination in patients with suspected infective endocarditis may prove very useful, as it might reveal suggestive abnormalities of this disease, such as Osler’s nodes and Janeway lesions. Osler’s nodes are painful, purple nodular lesions, usually found on the tips of fingers and toes. Janeway lesions, in turn, are painless erythematous macules that usually affect palms and soles. We report a case of infective endocarditis and highlight the importance of skin examination as a very important element in the presumptive diagnosis of infective endocarditis.

Activity of ceftaroline and comparators against pathogens isolated from skin and soft tissue infections in Latin America - results of AWARE surveillance 2012

ABSTRACT As part of the Assessing Worldwide Antimicrobial Resistance Evaluation (AWARE) surveillance program in 2012 the in vitro activity of ceftaroline and relevant comparator antimicrobials was evaluated in six Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico and Venezuela) against pathogens isolated from patients with hospital associated skin and soft tissue infections (SSTIs). The study documented that ceftaroline was highly active (MIC90 0.25 mg/L/% susceptible 100%) against methicillin-susceptible Staphylococcus aureus, methicillin-resistant S. aureus (MIC90 2 mg/L/% susceptible 83.3%) and ß-hemolytic streptococci (MIC90 0.008-0.015 mg/L/% susceptible 100%). The activity of ceftaroline against selected species of Enterobacteriaceae was dependent upon the presence or absence of extended-spectrum ß-lactamases (ESBLs). Against ESBL screen-negativeEscherichia coli, Klebsiella pneumoniae, andKlebsiella oxytoca the MIC90 and percent susceptible for ceftaroline were (0.5 mg/L/94.1%), (0.5 mg/L/99.0%) and (0.5 mg/L/91.5%), respectively. Ceftaroline demonstrated potent activity against a recent collection of pathogens associated with SSTI in six Latin American countries in 2012.

Acinetobacter baumannii resistente a carbapenémicos causante de osteomielitis e infecciones de la piel y los tejidos blandos en hospitales de Medellín, Colombia / Carbapenem-resistant Acinetobacter baumannii causing osteomyelitis and infections of skin and soft tissues in hospitals of Medellín, Colombia

Introducción. Acinetobacter baumannii es una bacteria oportunista que infecta a pacientes gravemente enfermos, principalmente con neumonía asociada al uso del respirador y bacteriemia. La aparición de resistencia a los carbapenémicos limita las opciones terapéuticas para el manejo de las infecciones ocasionadas por esta bacteria. Objetivo. Describir las características clínicas y moleculares de las infecciones ocasionadas por A. baumannii resistente a carbapenémicos en hospitales de Medellín. Materiales y métodos. Durante dos años se llevó a cabo un estudio descriptivo de corte transversal en cinco hospitales de Medellín. La información clínica provenía de las historias clínicas. La presencia de carbapenemasas se evaluó mediante el test tridimensional y la técnica de reacción en cadena de la polimerasa. La tipificación molecular se hizo con electroforesis en gel de campo pulsado y tipificación de secuencias de múltiples locus. Resultados. Se incluyeron 32 pacientes, 13 de los cuales presentaban infecciones de la piel y los tejidos blandos (n=7, 21,9 %), y osteomielitis (n=6, 18,7 %). Los porcentajes de resistencia fueron superiores a 80 % para todos los antibióticos evaluados, excepto para la colistina y la tigecilina. Las carbapenemasas OXA-23 y OXA-51, así como la secuencia de inserción IS Aba1 , se detectaron en todos los aislamientos. La electroforesis en gel de campo pulsado reveló una gran diversidad genética en los aislamientos, y la tipificación de secuencias de múltiples locus evidenció la circulación de los clones ST229 y ST758 en la ciudad. Conclusión. Contrario a lo reportado previamente, los resultados del estudio revelaron que la osteomielitis y las infecciones de la piel y los tejidos blandos eran los principales cuadros clínicos causados por A. baumannii resistente a carbapenémicos en instituciones de Medellín, y resaltan su importancia como agente etiológico de este tipo de infecciones.

Introduction: Acinetobacter baumannii is an opportunistic bacterium which infects seriously ill patients, particularly those with ventilator-associated pneumonia and bacteremia. The emergence of resistance to carbapenem limits the options for the treatment of infections caused by this bacterium. Objective: To describe the clinical and molecular characteristics of infections caused by carbapenem-resistant A. baumannii in Medellín hospitals. Materials and methods: A cross-sectional descriptive study was carried out in five Medellín hospitals over a 2-year period. Clinical information was obtained from medical histories of patients. The presence of carbapenemases was evaluated by three-dimensional test and PCR. Molecular typing was performed using PFGE and MLST. Results: The study included 32 patients, 13 of whom presented skin and soft tissue infections (n=7, 21.9%) or osteomyelitis (n=6, 18.7%). Resistance rates of the isolates exceeded 80% for all the antibiotics evaluated except colistin and tigecycline. Carbapenemases OXA-23 and OXA-51, as well as the insertion sequence IS Aba1 , were detected in all the isolates. PFGE revealed high genetic diversity in the isolates and MLST showed clones ST229 and ST758 are circulating in the city. Conclusion: In contrast to previous reports, the results of the present study showed osteomyelitis and infections of skin and soft tissues to be the main infections caused by carbapenem-resistant A. baumannii in Medellín hospitals and revealed its importance as an etiological agent for this type of infections.

Mycobacterium fortuitum-related lymphadenitis associated with the varicella-zoster virus

Lymphadenitis caused by non-tuberculous mycobacteria is an uncommon manifestation in immunocompetent individuals. Here, we report a case of Mycobacterium fortuitum infection in a previously healthy 9-year-old patient who developed cervical lymphadenitis evolving to a suppurative ulcer associated with a varicella-zoster virus infection. We discuss the relationship between the varicella-zoster virus and the immune response of the host as an explanation for the unusual progression of the case.

Detection of Corynebacterium bovis infection in athymic nude mice from a research animal facility in Korea

Corynebacterium (C.) bovis infection in nude mice causes hyperkeratosis and weight loss and has been reported worldwide but not in Korea. In 2011, nude mice from an animal facility in Korea were found to have white flakes on their dorsal skin. Histopathological testing revealed that the mice had hyperkeratosis and Gram-positive bacteria were found in the skin. We identified isolated bacteria from the skin lesions as C. bovis using PCR and 16S rRNA sequencing. To the best of our knowledge, this is the first report of C. bovis infection in nude mice from Korea.

Spectrum and potency of ceftaroline against leading pathogens causing community-acquired respiratory tract and skin and soft tissue infections in Latin America, 2010

Ceftaroline, the active metabolite of the prodrug ceftaroline fosamil, is a cephalosporin with in vitro bactericidal activity against Gram-positive organisms, including methicillinsusceptible and -resistant Staphylococcus aureus, β-haemolytic and viridans group streptococci, and Streptococcus pneumoniae, as well as common Gram-negative organisms. In this study a total of 986 isolates collected in 2010 from patients in 15 medical centers in five Latin American countries from the Assessing Worldwide Antimicrobial Resistance Evaluation Program were identified as community-acquired respiratory tract or skin and soft tissue infection pathogens. Ceftaroline was the most potent agent tested against S. pneumoniae with a MIC90 value (0.12 µg/mL) that was eight-fold lower than ceftriaxone, levofloxacin, and linezolid. Its spectrum of coverage (100.0% susceptible) was similar to tigecycline, linezolid, levofloxacin and vancomycin. Against Haemophilus influenzae and Moraxella catarrhalis, ceftaroline was the most active agent tested. The activity of ceftaroline against S. aureus (including MRSA) was similar to that of vancomycin and tetracycline (MIC90,1 µg/mL) and linezolid (MIC90,2 Jg/mL). The 1-haemolytic streptococci exhibited 100.0% susceptibility to ceftaroline. Ceftaroline activity against Escherichia coli, Klebsiella spp., and Enterobacter spp. was similar to that of ceftriaxone and ceftazidime. These parenteral cephalosporin agents have potent activity against non-extended-spectrum These parenteral cephalosporin agents have potent activity against non-extended-spectrum-lactamase-phenotype strains, but are not active against extended-spectrum β-lactamase-phenotype strains. These results confirm the in vitro activity of ceftaroline against pathogens common in communityacquired respiratory tract and skin and soft tissue infection in Latin America, and suggest that ceftaroline fosamil could be an important therapeutic option for these infections.

Un caso de melioidosis en la Argentina / A case of melioidosis in Argentina

Se describe el caso de un varón de 17 años oriundo de República Dominicana, con antecedente de linfoma de Hodgkin, que presenta tumoraciones blandas con supuración espontánea. En sus cultivos desarrolló Burkholderia pseudomallei, agente etiológico de la melioidosis. El paciente recibió tratamiento antibiótico con imipenem y luego con amoxicilina-ácido clavulánico con muy buena evolución clínica del proceso infeccioso. En razón de la baja incidencia de Burkholderia pseudomallei en nuestro continente el diagnóstico de melioidosis pudo haber sido subestimado. Su diagnóstico definitivo depende del aislamiento e identificación del agente causal en la muestra clínica.

We describe a case of 17-year- old man native of Dominican Republic, with Hodgkin´s lymphoma, who presented soft espontaneous draining nodules. In the clinical samples grew Burkholderia pseudomallei; the etiological agent of melioidosis. He received antimicrobial treatment with imipenem and amoxicillin/clavulanic with very good clinical evolution of the infectious process. Melioidosis diagnosis could be underestimated due to the low incidence of Burkholderia pseudomallei in our continent. The definitive diagnosis depends of the isolation and identification in the clinical sample.

Nocardia brasiliensis primary pulmonary nocardiosis with subcutaneous involvement in an immunocompetent patient.

This is a report of an unusual case of Nocardia brasiliensis causing primary pulmonary nocardiosis with disseminated subcutaneous lesions in an immunocompetent patient. This case highlights the importance of considering nocardiosis as a differential diagnosis in patients with pulmonary and cutaneous lesions and the need for vigorous management for complete cure.

Infección por Staphylococcus aureus meticilino-resistente comunitario en un grupo familiar / Community meticiline resistant Staphylococcus aureus skin infection in a family setting

Staphylococcus aureus es un patógeno que causa infecciones de diversa gravedad en niños y adultos. Su frecuencia es alta (28,4 casos por cada 100.000 personas). En los últimos años reemerge como patógeno de infecciones severas de piel y partes blandas en pacientes de la comunidad, con características feno y genotípicas diferentes; se lo denomina Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMRAC). En nuestro país constituye un patógeno emergente subdiagnosticado. Se presenta una familia que durante 1 año consultó por múltiples episodios de infecciones cutáneas recidivantes, tratadas con esquemas antibióticos empíricos, sin aislamiento microbiológico y fracaso terapéutico. Se observaron nódulos eritematosos, algunos con centro necrótico y ulcerados, en diversas localizaciones. El cultivo de las lesiones de los 3 pacientes confirmó el diagnóstico de SAMRAC. Los hisopados nasales fueron negativos. Realizaron tratamiento con trimetoprima-sulfametoxazol 800/160 mg cada 12 hs y clindamicina 300 mg cada 6hs por 14 días, con curación total de las lesiones

Staphylococcus aureus is a pathogen responsible for infections of variableseverity both in children and adults. Its prevalence is high (about28.4 cases per 100.000 persons). Nowadays this pathogen cause severeskin and soft tissue infections in the community setting. Neverthelessits features are different and has been denominated communityacquired meticiline resistant S. aureus (CA-SAMR). In our countrythis pathogen is under diagnosed.We describe a family with multiple episodes of recidivate skin infectionswhich were treated empirically and without success. The clinical featurewas the presence of eritemathous nodules, some of them ulcerated andnecrotic, in diff erent sites. CA-SAMR was isolated in all patients. Nasalsamples were negative in all family members. They were treated with trimetoprimsulfamethoxazol 800/160 mg each 12 hours and clindamicine300 each 6 hours for 14 days with complete cure of the lesions. (DermatolArgent 2010;16(2):126-128).

Estudio prospectivo, descriptivo y multicéntrico acerca de la infección de piel y partes blandas por Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMRAC) / Multicentric prospective and descriptive study about community-acquired methicillin-resistant Staphylococcus aureus cutaneous and sof tissue infection (CA-MRSA)

El Staphylococus aureus meticilino-resistente adquirido en la comunidad (SAMRAC) es uno de los principales patógenos emergentes de la última década, y en algunos países es la principal causa de infecciones de piel y partes blandas. El objetivo de este estudio es describir las características epidemiológicas, clínicas y microbiológicas de las infecciones de piel y partes blandas producidas por SAMRAC en pacientes ambulatorios. Materiales y métodos. Estudio descriptivo, prospectivo, multicéntrico realizado en seis Servicios de Dermatología de la ciudad de Buenos Aires entre julio de 2008 y junio de 2009. Se incluyeron pacientes con infección de piel y partes blandas por SAMRAC documentada por cultivo. La definición de adquisición en la comunidad se basó en criterios epidemiológicos. Resultados. Se reclutaron 114 pacientes, de los cuáles 49% fueron hombres y 51 % mujeres. La media de la edad fue 27 años. El 74% recibió tratamiento con ß lactámicos previo al diagnóstico. Los forúnculos representaron la forma clínica más frecuente (59%), seguido de los abscesos (20%). El antibiótico más indicado fue trimetoprima-sulfametoxasol (68,4%).Las resistencias más frecuentes fueron eritromicina (21,7%) y clindamicina (16,2%), 6 pacientes requirieron internación, 18 pacientes presentaron recurrencias y no se registró ninguna muerte. Conclusiones. Los datos demográficos y clínicos obtenidos en este estudio son similares a los comunicados previamente. La mayoría de los pacientes recibieron tratamiento antibiótico previo, lo que denota una baja sospecha diagnóstica. El impétigo representó una forma de presentación frecuente en la población pediátrica y la celulitis sólo comprometió a mujeres. La resistencia a clindamicina fue mayor al 15%, por lo que no debería ser considerado un antibiótico de primera línea. Las infecciones de piel y partes blandas por SAMRAC son frecuentes en nuestro medio, por lo que debe considerarse en pacientes con lesiones supurativas o falta de...

Community acquired methicillin-resistant Staphylococcus aureus is oneof the main emergent pathogens of the last decade, being the fi rstcause of skin and soft tissue infections in some countries. The purposeof this study is to describe the epidemiologic, clinical, and microbiologicalcharacteristics of CA-MRSA cutaneous and soft tissue infections inan ambulatory setting.Methods. We conducted a multuicentric, prospective, descriptive studyperformed in 6 dermatology units at Buenos Aires from july 2008 to june2009. Patients with documented CA-MRSA skin and soft tissue infectionswere included. Community acquisition was defi ned based on epidemiologiccriteria.Results. We included 114 patients, of which 49% were male and 51%were female. The median age was 27 years. Seventy four percent of the patientshad received beta-lactamic antibiotic treatment prior to inclusion.The main clinical presentation were furuncules (59%) followed by abscesses( 20%). The most frequently prescribed antibiotic was trimethoprim-sulfametoxazole(68,4%). The most frequently recovered isolates were erithromicin-(21,7%) and clindamycin-resistant (16,2%). Six patients requiredhospital admission, 18 had recurrent diseases, and no death was recorded.Discussion. Demographic and clinical data obtained in this study aresimilar to those previously reported. Most of the patients had received antibiotictreatment before inclusion, which shows the low CA-MRSA clinicalsuspicious. Impetigo was fecuently observed among children, and celulitiswas exclusively observed in females. As clindamycin resistance washigher than 15%, this antibiotic should not be considered a fi rst-line treatmentoption. CA-MRSA infections were frecuently observed in our patients,therefore its diagnosis should be considered on suppurative lesionsand non responding pyodermitis (Dermatol Argent 2010;16(2):110-116).

Manifestaciones muco-cutáneas de la infección por Mycoplasma pneumoniae: Presentación de cuatro casos / Mucocutaneous findings of the Mycoplasma pneumoniae infection: Presentation of four cases

The mucocutaneous manifestations oí Mycoplasma pneumoniae infection appear in approximately 20 percent of all the infections produced by this microorganism. Maculopapular rash, vesicular or urticarial exanthemas, are frequent manifestations that can constitute Erythema multiforme or more rarely, Stevens - Johnson syndrome or epidermal toxic necrolisis. We describe the clinical evolution, diagnosis and treatment of four children with mucous and cu-taneous manifestations associated to infection by Mycoplasma pneumoniae and a review of the medical literature.

El compromiso muco-cutáneo de la infección por Mycoplasma pneumoniae se presenta en aproximadamente 20 por ciento de todas las enfermedades producidas por este microorganismo. Frecuentemente se manifiesta con lesiones máculo-papulares, vesiculosas o urticariales, que pueden constituir el eritema multiforme, más raramente síndrome de Stevens-Johnson o necrosis epidérmica tóxica. Describimos la evolución clínica, diagnóstico y el tratamiento administrado a cuatro niños que presentaron manifestaciones de piel y mucosas en relación a la infección por Mycoplasma pneumoniae. Se efectuó además una revisión de la literatura médica.

Absceso cutáneo por Gemella morbillorum / Cutaneous abscess due to Gemella morbillorum

We report a cutaneous abscess due to Gemella morbillorum, a Gram positive coccus found in oropharyngeal flora, that rarely causes disease in humans. Infections associated to this agent are similar to those related to viridans streptococci. There have been reports of endovascular infections (predominantly endocarditis) and also of acute invasive infections. Few previous reports are available of cutaneous infection.

Presentamos un caso de absceso cutáneo por Gemella morbillorum, un coco gram positivo, comensal orofarín-geo habitual, que en contadas ocasiones causa patología en el hombre. Los procesos infecciosos asociados a este patógeno son similares a aquellos causados por la familia de Streptococci viridans en cuanto a espectro, describiéndose casos de infección endovascular (fundamentalmente endocarditis) así como infecciones agudas invasivas. Hay pocos casos descritos de infección cutánea.