A Case Series of Staphylococcus lugdunensis Infection in Cancer Patients at an Academic Cancer Institute in the United States / 감염과화학요법

BACKGROUND@#Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CoNS) that is a part of the normal human skin flora. Even though it belongs to CoNS family, it can cause severe and destructive infections in a similar fashion to Staphylococcus aureus. Skin and soft tissue infections (SSTI), bacteremia and endocarditis are amongst the most common clinical presentations. Diagnosis and clinical presentation of infections caused by S. lugdunensis in cancer patients is limited.@*MATERIALS AND METHODS@#We performed a retrospective chart review of 24 patients who had cultures positive for S. lugdunensis. Out of 24 patients, 14 patients were diagnosed with a true infection and 10 other patients were considered to be colonized with this pathogen. We analyzed clinical manifestation, treatment and response to therapy.@*RESULTS@#SSTI was the most common presentation in our study patients. All patients diagnosed with SSTI had a prior surgery or an invasive procedure at the affected site. Five urinary tract infections (UTIs), one catheter-associated bloodstream infection, and a deep pelvic abscess were other reported infections in our study. We observed that S. lugdunensis remains susceptible to a variety of antibiotics, with all isolates susceptible to vancomycin and linezolid and most remain susceptible to fluoroquinolone and trimethoprim/ sulfamethoxazole. All 14 patients received antibiotics and improved.@*CONCLUSION@#In our case series, SSTI was common and diagnosed in 50% of the patients with clinically significant isolates for S. lugdunensis. This is consistent with prior studies indicating that S. lugdunensis is a significant pathogen in SSTIs. UTI was the second most common infection type in our patient population.

The red face: Erysipelas versus, Parvovirus B19, SLE, and Rosacea

Background: Several conditions can lead to the red face, including Erysipelas, Erythema infectiosum, Systemic Lupus Erythrematosus, and Rosacea.Objective: To describe a case of facial Erysipelas in a patient and discuss the differential comparison with parvovirus B19, Systemic Lupus Erythrematosus, and Rosacea based mainly on the visual appearance of the rash and associated signs and symptoms.Patient and method: A 50 years old female with a history of breast cancer in remission after lumpectomy and radiation therapy completed three years ago, developed fever to 102 F and painful warm red cheeks and periorbital edema.Results: The patient improved after two days of intravenous penicillin G two million units four times a day; both redness and fever resolved.Conclusion: Although erysipelas of the ipsilateral upper limb, following breast cancer have been described, no reports have been found of facial erysipelas following breast cancer.

Successful treatment of multi-drug resistant Pseudomonas aeruginosa, causing bilateral malignant otitis externa, media and mastoiditis

Background: Malignant external otitis (MEO) is a relatively uncommon infection caused by Pseudomonas aeruginosa seen primarily in immunocompromised patients, classically, diabetics. MEO is treated effectively with antibiotics but can be associated with significant morbidity including cranial nerve palsies. Objective: To report a case of MEO seen in a patient with myelodysplastic syndrome and prolonged neutropenia whose infection was resistant to all of the commonly used antibiotics, including fluoroquinolones, third generation cephalosporins, aminoglycosides, aztreonam, imipenem, and extended spectrum penicillins. Although there have been reports of ciprofloxacin resistant P. aeruginosa causing MEO infections, we were unable to locate any cases in the literature resistant to both ciprofloxacin and third generation cephalosporins. Method: To treat our patient’s MEO, we employed colistin, an antibiotic seldom used since the early 1980’s due to its nephrotoxicity. Results: The infection responded well to colistin, and with intermittent dosing, the patient did not suffer from deterioration of renal function and colistin resistance did not develop. Unfortunately, the case was also complicated by bilateral facial palsy and long-term bilateral hearing loss, two complications, which although common in this disease, are rarely seen in a bilateral fashion.

Cutaneous Curvularia infection in a neutropenic patient

Background: Cutaneous Curvularia is a rare fungal infection which presents itself as erythematous, non-tender, non-pruritic, ulcerative lesions. To the best of our knowledge, only a few cases reported in the literature have occurred in immunocompromised and/or neutropenic patients, none of which have been published within the past five years.Objective: We report the case of a 53-year-old man diagnosed with diffuse large B cell non-Hodgkin’s lymphoma and associated neutropenia who developed several erythematous macular lesions with central excoriations and crusting on his bilateral anterior tibiae, and whose fungal culture was positive for Curvularia sp.

Pseudomonas aeruginosa infections of cartilaginous structures

Background: Pseudomonas aeruginosa is a gram negative facultative anaerobe and well-documented scourge of immunocompromised patient populations. Objective: To study the prevalence and predisposing conditions for Pseudomonas aeruginosa infections of cartilaginous structures. Method and results: We conducted an exhaustive search of the current literature using PubMed, Ovid, and Google Scholar. The various clinical entities of pseudomonal chronditis are discussed with respect to their epidemiology, clinical manifestations, diagnosis, and treatment.

Surgical Maggots

Surgical maggots have been used successfully for wound debridement over the past millennium. At Johns Hopkins University in 1929, Baer introduced maggots into the wounds of 21 patients with chronic intractable osteomyelitis. The development of methicillin-resistant Staphlococcus aureus has been a major impetus to resurgent interest in maggot debridement. In January of 2004, the US Food and Drug Administration gave Dr. Ronald Sherman permission to produce and market surgical maggots for debriding non-healing necrotic skin and soft tissue wounds. Given an uncooperative patient with non-healing wounds, our medical team obtained insectary-reared sterile surgical maggots, Phaenicia sericata, to promote debridement of necrotic tissue and development of granulation tissue.