Inflamación mixta severa con pérdida del techo del canal mandibular: una variación de las infecciones odontogénicas asociada a pericoronaritis / Severe mixed inflammation with loss of the mandibular canal roof: a variation in odontogenic infections associated with pericoronaritis

Las infecciones cuando pasan a ser crónicas y recurrentes como puede ser el caso de una pericoronaritis medicada, mas no tratada una y otra vez, traen como consecuencia resistencia y proliferación bacteriana. Se da el caso de formaciones de tejidos patológicos e imágenes radiográficas que orientan a posibles diagnósticos, que hasta no ser tratadas por medio de diferentes técnicas como la marsupialización o enucleación, con el complemento de la biopsia insicional o exicional que determina el tipo de patología presente. Esto lleva al objetivo general: determinar el tipo de lesión patológica presente en el ángulo y cuerpo mandibular asociado a la ud: 48 Objetivos específicos: Identificar la lesión patológica presente en Angulo y parte del cuerpo mandibular asociada a la ud: 48. Muestra: paciente de 30 años de edad, masculino, caso clínico de una inflamación mixta severa, la clínica y sus hallazgos radiográficos, se sospechaba de un posible queratoquiste, quiste dentígeros o quiste odontogénico ortoqueratinizado, extracción dental ud: 48, retiro y legrado del tejido circundante, toma de biopsia exicional, exámenes de laboratorio, ortopantomografia, tomografía, fotografías clínicas. Metodología: paradigma positivista, enfoque cuantitativo, diseño no experimental. Modalidad de campo, tipo estudio de caso. La entrevista, el instrumento guión de las preguntas para la historia clínica fueron la técnica y el instrumento. Resultados: inflamación mixta severa, lo cual procede de una infección asociada a pericoronaritis recurrente, esto mediante resultado histopatológico. Conclusiones: el estudio histopatológico es quien determina el diagnóstico final a pesar que la clínica induzca a posibles diagnósticos diferenciales(AU)

When infections become chronic and recurrent, such as a medicated pericoronitis, but not treated repeatedly, they result in resistance and bacterial proliferation. There is the case of pathological tissue formations and radiographic images that guide possible diagnoses, which until they are not treated by means of different techniques such as marsupialization or enucleation, with the complement of the incitional or exicional biopsy that determines the type of pathology present. This leads to the general objective: to determine the type of pathological lesion present in the mandibular angle and body associated with ud: 48. Specific objectives: Identify the pathological lesion present in Angle and part of the mandibular body associated with ud: 48. Sample: 30-year-old male patient, clinical case of severe mixed inflammation, clinical symptoms and radiographic findings, suspected of a possible keratocyst, dentigerous cyst or orthokeratinized odontogenic cyst, tooth extraction ud: 48, removal and curettage of the surrounding tissue, exicional biopsy, laboratory tests, orthopantomography, tomography, clinical photographs. Methodology: positivist paradigm, quantitative approach, non-experimental design. Field modality, case study type. The interview, the instrument script the questions for the clinical history were the technique and the instrument. Results: severe mixed inflammation, which comes from an infection associated with recurrent pericoronitis, this through histopathological result. Conclusions: the histopathological study is the one who determines the final diagnosis, despite the fact that the symptoms lead to possible differential diagnoses(AU)

Infecciones graves de piel y partes blandas. Puesta al día / Severe skin and soft tissue infections. An update

Resumen Las infecciones graves de piel y partes blandas presentan una elevada morbimortalidad y requieren un complejo tratamiento quirúrgico. Su incidencia anual está estimada en 0.3 a 5 casos por 10 000 personas. Los agentes etiológicos más comunes son Streptococcus pyogenes, Staphylococcus aureus, anaerobios y bacilos Gram negativos. El diagnóstico precoz y el tratamiento oportuno, tanto empírico antibiótico como quirúrgico, determinan el pronóstico. Existen nuevas opciones terapéuticas para estas infecciones, especialmente las producidas por gérmenes multirresistentes. Un enfoque terapéutico multidisciplinario es fundamental para su correcto manejo.

Abstract Severe skin and soft tissue infections present a high morbidity and mortality and require a complex surgical treatment. Its estimated annual incidence is 0.3 to 5 cases per 10 000 people. The most common etiologic agents are Streptococcus pyogenes, Staphylococcus aureus, anaerobes and gram-negative bacilli. A prompt diagnosis and the timely initiation of an empirical antibiotic scheme and repeated surgical debridement can avert a worrisome outcome. New therapeutic options are promising, especially for infections caused by multidrug resistant germs. A multidisciplinary approach is fundamental for the correct management of these conditions.

Caracterización fenotípica de variantes pequeñas de Staphylococcus aureus: un nuevo desafío / Phenotypic characterization of small colony variants of Staphylococcus aureus: a new challenge / Caracterizaçao fenotípica de pequenas variantes de Staphylococcus aureus: um novo desafio

En infecciones crónicas y recurrentes por Staphylococcus aureus se han descripto subpoblaciones de colonias pequeñas (VCPSa). El objetivo de este trabajo fue reconocer las características fenotípicas de VCPSa para optimizar su detección y caracterización a partir de materiales clínicos provenientes de infecciones crónicas. Se analizaron n=3 VCPSa de pacientes adultos con infecciones crónicas de tejidos blandos. Las muestras se inocularon en agar nutritivo, agar sangre, agar chocolate y agar Schaedler suplementado. Se realizaron tinción de Gram, catalasa, coagulasa libre, pruebas de dependencia para hemina, menadiona y timidina y, desarrollo/ataque del manitol en agar manitol salado. La sensibilidad antibiótica se efectuó en agar Mueller Hinton suplementado, según las pruebas de dependencia. Se investigó la presencia de proteína ligadora de penicilina anómala (PBP2´) por aglutinación con látex. Las VCPSa se detectaron en los medios de cultivo enriquecidos. Estas bacterias dieron positivas las pruebas de catalasa y coagulasa, y eran dependientes de menadiona y hemina. En los tres aislamientos se observó resistencia a cefoxitina y se detectó la PBP2´.

In chronic and recurrent infections, small colonies of Staphylococcus aureus subpopulations (SCVSa) have been observed. The objective of the present study was to recognize the phenotypic characteristics of SCVSa isolated from patients with chronic infections to optimize their detection. SCVSa of adult patients n=3 with chronic soft tissue infections were analyzed. Samples were inoculated on nutritive agar, blood-agar, chocolate agar and supplemented Schaedler agar. Subsequently, Gram stain, catalase, free coagulase, dependence tests for hemin, menadione and thymidine, and growth/fermentation of mannitol on salt mannitol agar were performed. Antibiotic susceptibility tests were performed by the agar diffusion method on supplemented Mueller Hinton agar, according to dependence assays results. Anomalous penicillin binding protein (PBP2') was investigated by latex agglutination. SCVSa were detected in all enriched culture media. They showed catalase and coagulase activities, and menadione and hemin dependence. By the agar diffusion test, cefoxitin resistance was found in all isolates; PBP2' was detected as well.

Nas infecções crônicas e recorrentes por Staphylococcus aureus, subpopulações de pequenas colônias (VCPSa) foram descritas. O objetivo desse trabalho foi reconhecer as características fenotípicas de VCPSa para otimizar sua detecção e caracterização a partir de materiais clínicos provenientes de infecções crônicas. Foram analisados n=3 VCPSa de pacientes adultos com infecções crônicas de tecidos moles. As amostras foram inoculadas em agar nutritivo, agar sangue; agar chocolate e agar Schaedler enriquecido. Foram realizados testes de coloração de Gram, catalase, coagulase livre, testes de dependência para hemina, menadiona e timidina, e desenvolvimento/fermentação do manitol em agar manitol salgado. A sensibilidade antibiótica foi realizada em agar Mueller Hinton suplementado, de acordo com os testes de dependência. Foi investigada a presença de proteína ligante de penicilina anômala (PBP2´) por aglutinação com látex. Os VCPSa foram detectados em meios de cultura enriquecidos. Estas bactérias deram positivas nos testes de catalase e coagulase positivos e eram dependentes de menadiona e hemina. A resistência à cefoxitina foi detectada nos três isolados e detectou-se a PBP2'.

High frequency of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in children under 1 year old with skin and soft tissue infections / Alta frequência de S. aureus (MSSA-MRSA) em crianças com menos de um ano deidade com infecções de pele e do tecido mole

Abstract Objective: Staphylococcus aureus is responsible for a large number of infections in pediatric population; however, information about the behavior of such infections in this population is limited. The aim of the study was to describe the clinical, epidemiological, and molecular characteristics of infections caused by methicillin-susceptible and resistant S. aureus (MSSA-MRSA) in a pediatric population. Method: A cross-sectional descriptive study in patients from birth to 14 years of age from three high-complexity institutions was conducted (2008-2010). All patients infected with methicillin-resistant S. aureus and a representative sample of patients infected with methicillin-susceptible S. aureus were included. Clinical and epidemiological information was obtained from medical records and molecular characterization included spa typing, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). In addition, staphylococcal cassette chromosome mec (SCCmec) and virulence factor genes were detected. Results: A total of 182 patients, 65 with methicillin-susceptible S. aureus infections and 117 with methicillin-resistant S. aureus infections, were included in the study; 41.4% of the patients being under 1 year. The most frequent infections were of the skin and soft tissues. Backgrounds such as having stayed in day care centers and previous use of antibiotics were more common in patients with methicillin-resistant S. aureus infections (p ≤ 0.05). Sixteen clonal complexes were identified and methicillin-susceptible S. aureus strains were more diverse. The most common cassette was staphylococcal cassette chromosomemec IVc (70.8%), which was linked to Panton-Valentine leukocidin (pvl). Conclusions: In contrast with other locations, a prevalence of infections in children under 1 year of age in the city could be observed; this emphasizes the importance of epidemiological knowledge at the local level.

Resumo Objetivo: O Staphylococcus aureus é responsável por um grande número de infecções na população pediátrica; contudo, as informações sobre o comportamento dessas infecções nessa população são limitadas. O objetivo do estudo foi descrever as características clínicas, epidemiológicas e moleculares de infecções causadas por Staphylococcus aureus suscetíveis e resistentes à meticilina (MSSA-MSRA) em uma população pediátrica. Método: Um estudo transversal descritivo foi realizado em pacientes entre 0 e 14 anos de idade de três instituições de alta complexidade (2008-2010). Todos os pacientes infectados com S. aureus resistentes à meticilina e uma amostra representativa de pacientes infectados com S. aureus suscetíveis à meticilina foram incluídos. As informações clínicas e epidemiológicas foram obtidas de prontuários médicos, e a caracterização molecular incluiu tipagem spa, Eletroforese em Gel de Campo Pulsado (PFGE) e Tipagem de sequências multilocus (MLST). Além disso, o Cassete Cromossômico Estafilocócico mec (SCCmec) e genes de fatores de virulência foram detectados. Resultados: 182 pacientes, 65 com infecções por S. aureus suscetíveis à meticilina e 117 com infecções por S. aureus resistentes à meticilina, foram incluídos no estudo; 41,4% dos pacientes com menos de um ano de idade. As infecções mais frequentes foram da pele e dos tecidos moles. Os históricos como internações em centros de atendimento e o uso prévio de antibióticos foram mais comuns em pacientes com infecções por S. aureus resistentes à meticilina (p ≤ 0,05). Dezesseis complexos clonais foram identificados, e as cepas de S. aureus suscetíveis à meticilina foram mais diversificadas. O cassete mais comum foi o Cassete Cromossômico Estafilocócicomec IVc (70,8%), relacionado à leucocidina de panton-valentine (pvl). Conclusões: Em comparação a outros locais, observamos uma prevalência de infecções em crianças com menos de um ano de idade na cidade; o que enfatiza a importância de conhecer a epidemiologia em nível local.

Descripción de 3 casos de infecciones de piel y tejidos blandos por Streptococcus pneumoniae / Description of 3 cases of skin and soft tissue infections caused by Streptococcus pneumoniae

El papel de Streptococcus pneumoniae como agente causal de infecciones de piel y tejidos blandos (IPTB) es inusual y de difícil interpretación clínica. Describimos 3 casos documentados (años 2010, 2011 y 2015) en pacientes internados en el Hospital Provincial de Pediatría de Misiones, detectados durante 10 años de vigilancia de enfermedades invasivas (EI). Estos casos correspondieron a 2 niñas de 8 y 7 meses y a un varón de 2 años con diagnóstico de absceso glúteo, celulitis preseptal y piodermitis, respectivamente. Todos eran eutróficos, con buen estado general al ingreso, uno de ellos seropositivo para virus de la inmunodeficiencia humana. Los aislamientos presentaron características de sensibilidad a antimicrobianos y serotipos que se enmarcaron dentro de la epidemiología local de las EI neumocócicas. A pesar de la baja frecuencia, la etiología de S. pneumoniae en IPTB debe considerarse. Nuestros hallazgos revalorizan el papel del laboratorio en el diagnóstico por cultivo y contribuyen a documentar el comportamiento de este patógeno.

The role of Streptococcus pneumoniae as a causative agent of skin and soft tissue infections (SSTI) is unusual and its clinical interpretation is difficult. We describe here three cases of SSTI due to S. pneumoniae in patients admitted to the Provincial Pediatric Hospital of Misiones, Argentina that were detected during 10 years of invasive disease (ID) surveillance documented in 2010, 2011 and 2015. These cases involved two girls aged 8 and 7 months old, and a two-year-old male child with diagnoses of gluteal abscess, preseptal cellulites and pyoderma respectively. All the patients were eutrophic and in good general condition on admission; one of them was seropositive for HIV. Antimicrobial susceptibility and serotypes were framed within the local epidemiology of invasive pneumococcal disease. Despite its low frequency, S. pneumoniae as an etiological agent of SSTI must be considered. Our findings revalue the role of the diagnostic laboratory and contribute to document the behavior of this pathogen.

Identification of Pasteurella canis in a Soft Tissue Infection Caused by a Dog Bite: The First Report in Korea

No abstract available.

Infecciones de piel y partes blandas en pediatría: consenso sobre diagnóstico y tratamiento: Parte 2: Celulitis, ectima y ectima gangrenoso, celulitis necrotizantes. Consideraciones finales / 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 controversia 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 community-originated skin and soft tissue infections in immunocompetent patients under the age of 19.

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.

Myroides odoratimimus soft tissue infection in an immunocompetent child following a pig bite: case report and literature review

Members of the genus Myroides are aerobic Gram-negative bacteria that are common in environmental sources, but are not components of the normal human microflora. Myroides organisms behave as low-grade opportunistic pathogens, causing infections in severely immunocompromised patients and rarely, in immunocompetent hosts. A case of Myroides odoratimimus cellulitis following a pig bite in an immunocompetent child is presented, and the medical literature on Myroides spp. soft tissue infections is reviewed.

Phaeohyphomycosis.

Phaeohyphomycosis, caused by heterogeneous group of phaeoid fungi causes both subcutaneous and systemic infections. The disease is more of a histopathological than a clinical entity. We present a case of phaeohyphomycosis in a 29-year-old male who presented with the complaint of painful swelling of the right eye of 1-year duration. Computed tomography (CT) scan showed an abnormal hyper dense enhancing soft tissue in the extra coronal aspect of the right orbit along the superolateral and superomedial aspect. A provisional clinical diagnosis of lymphoma or fungal infection was entertained. Histopathology revealed granulomas with numerous multinucleated giant cells and fungal hyphae within and in between the giant cells. Per-iodic acid Schiff (PAS stain) was used to confirm the presence of hyphae. Based on the clinical, CT and histopathological features, a diagnosis of Phaeohyphomycosis was given.

Anomalías en el desarrollo del cuarto aparato faríngeo como causa de infecciones profundas del cuello recidivantes / Anomalies in the fourth pharyngeal apparatus as cause of deep recidivant neck infections

La mayoría de las infecciones profundas del cuello se originan a partir de un foco en la mucosa aerodigestiva superior o a partir de un foco dental, las anomalías congénitas corresponden sólo a 2 por ciento de las causas. La presentación clínica es bastante similar independientemente de la etiología y en muchas ocasiones no basta con la clínica para llegar a un correcto diagnóstico etiológico. La presencia de una infección del espacio profundo del cuello (IEPC) a repetición es altamente sugerente de una anomalía congénita de las cuales aproximadamente el 58 por ciento derivan del aparato faríngeo. De éstas, las provenientes del IV aparato faríngeo son extremadamente raras siendo más frecuentes en la niñez, en el lado izquierdo del cuello y en pacientes de sexo femenino. Estas IEPC de causa congénita también tienen una buena respuesta a la terapia antibiótica y/o al drenaje por lo tanto ello lo enmascara como un factor etiológico. Realizar el diagnóstico de anomalía del desarrollo del IV aparato faríngeo es difícil. Ellas son poco frecuente (1-2 por ciento de las anomalías congénitas) y clínicamente se presentan como abscesos recurrentes del espacio profundo del cuello, al lado Izquierdo, generalmente en la niñez, acompañados o no de una tiroiditis aguda supurada izquierda asociado al hallazgo del orificio persistente (seno) en el ápex del seno piriforme. Se comunican 3 pacientes con absceso cervical izquierdo secundario a una anomalía en el desarrollo del IV aparato faríngeo.

Evaluación por imágenes de infecciones en el sistema musculoesquelético / Evaluation by images of infections in the musculo-skeletal system

Un diagnóstico temprano de infecciones musculoesqueléticas es importante para evitar la morbilidad y mortalidad asociada, la cronicidad del proceso y las secuelas subyacentes. Actualmente, los exámenes de imagenología juegan un rol importante en la evaluación de pacientes con sospecha o cursando una infección musculoesquelética. La radiografía simple continúa siendo el examen inicial en la evaluación, considerando su baja sensibilidad y especificidad en las infecciones agudas. La resonancia magnética es altamente sensible para la detección de osteomielitis aguda y artritis séptica. La tomografía computada es de mayor utilidad para procedimientos intervencionales, por ejemplo de drenaje o aspiración de muestras, y para la evaluación de infecciones subagudas o crónicas. El ultrasonido es útil para la detección de derrame en ciertas articulaciones o de colecciones líquidas en partes blandas, pero de limitada utilidad para el compromiso óseo. La medicina nuclear con los distintos radiomarcadores disponibles y en estudio, es altamente sensible para el diagnóstico de osteomielitis aguda, pero es menos específica. Se revisan los aspectos imagenológicos más característicos de cada método, su mejor utilidad en los distintos tipos de compromiso infeccioso, con presentación de casos de pacientes de nuestro Hospital.

Early diagnosis of musculoskeletal infections is important to avoid associated morbility and mortality, cronicity of the process andsecuelae. Imaging plays a key role in the evaluation of patients with known or suspected musculoskeletal infection. Conventional radiograph still remains as the initial imaging approach, but it has low sensitivity and specificity for acute infection. Magnetic resonance is highly sensitive for detection of acute osteomyelitis and septic arthritis. Computed tomography is usually reserved for guided interventional procedures and for evaluation of sinus tracts in chronic infections. Ultrasound is useful for fluid detection in joints and soft tissues but limited in bone assessment. Nuclear medicine, with the different radiotracers currently available, is highly sensitive for the diagnosis of acute osteomyelitis.

Non-ulcerative soft tissue mycosis of long duration mimicking soft tissue sarcoma--a case report.

Soft tissue mycosis usually presents with a triad of tumefaction, suppuration and ulceration. We report an unusual case of soft tissue mycosis in a 42-year-old male teacher who presented with painless swelling over the anterolateral aspect of the right shin for 4 years duration.

Infecções de tecidos moles: erisipela, celulite, síndromes infecciosas mediadas por toxinas / Soft tissue infections: erysipela, cellulitis, infectious syndromes mediated by toxins

Pacientes com aids são freqüentemente atendidos em serviços de emergências. Com o objetivo de sistematizar o atendimento de urgência a tais pacientes, são apresentadas, no presente trabalho, as normas gerais de conduta para a abordagem inicial do caso, bem como as complicações mais comuns, verificadas em nosso meio. São abordados ainda os processos infecciosos mais freqüentes, com ênfase na apresentação clínica, no diagnóstico laboratorial e no tratamento

Periimplantite: um relato de um caso clínico / Periimplantes: a clinical report

O presente artigo visa analisar uma sequência de tratamento proposta a um paciente que se apresentou à clínica odontológica da disciplina de periodontia da Universidade Federal de Santa Catarina/SC, com um quadro de periimplantite já no estágio agudo de abscesso periimplantar. Seräo analisados os meios de diagnóstico, fatores etiológicos, terapêuticos, instrumentais utilizados, controle pós-tratamento, resultados e proservaçäo

Skin and soft tissue infection.

Abstract. Normal skin is heavily colonized by bacterial flora. The most common are the various nonpathogenic gram-positive bacteria such as Staphylococcus epidermidis (coagulase-negative). Skin and soft tissue infections are usually caused by Staphylococcus aureus (S. aureus) and Streptococcus pyogenes. This article discusses common and some not so common bacterial skin infections, including impetigo, folliculitis, furncles and carbuncles, cellulitis and erysipelas, gangrenous cellulitis, staphylococcal scalded skin syndrome and scarlet fever. Impetigo and ecthyma are common bacterial infections of the skin commonly caused by S. aureus and / or Group A streptoccus. In mild and localized impetigo topical antibiotics whereas in widespread or severe one and in ecthyma systemic antibiotics like, cloxacillin, erythromycin, azithromycin or cephalexin should be used. Folliculitis, furunculosis and carbuncle are folliculocentric infections caused by S. aureus involving the variable depth and extent of the follicle(s) and surrounding tissue. These conditions can be treated with topical or systemic antibiotics like cloxacillin, cephalexin, erythromycin, amoxicillin/clavulanic acid or vancomycin. Staphylococcal scalded skin syndrome is a toxin mediated exfoliative dermatosis caused by S. aureus of phase group II. Intravenous penicillinase-resistant anti-staphylococcal antibiotics like methicillin, cloxacillin, cephalosporin or erythromycin are required. Erysipelas and cellulitis are acute infections of dermal and subcutaneous tissues caused most frequently by Group A beta-hemolytic streptococci (erysipelas) or S. aureus requiring systemic antibiotics like oral or intravenous penicillin, erythromycin, cephalexin, cloxacillin, vacomycin, minocycline or ciprofloxacin depending upon the severity, suspected causative organism and culture/sensitivity results. Gangrenous cellulitis is characterized by infection with necrosis of skin and underlying subcutaneous tissue due to various pathogens occurring at different site. Ampicillin, gentamicin, and either metronidazole or clindamycin intravenously in standard doses are recommended for the treatment.

Fasceíte necrotizante do tórax em pós-operatório de cirurgia cardíaca / Postoperative necrotizing fasciitis of the thorax in cardiac surgery

Necrotizing fasciitis is a rare soft tissue infection and a life-threatening emergency, often fatal. Its incidence and management are described plentifully in the medical literature regarding the most common anatomical sites involved like the abdomen, lower and upper limbs, and perineum. However, available data and case reports of chest wall necrotizing fasciitis after thoracic procedures are scarce, mainly after major cardiac operations. We report and discuss a case of necrotizing fasciitis of the chest wall occurring in the immediate postoperative period of a cardiac procedure, and include a brief review of the concepts, pathophysiology, and treatment reported in the medical literature. We emphasize the need for early diagnosis and urgent and effective surgical debridement. Of importance is the fact that we have not found any references in the literature to cases similar or equal to the one we describe here, which occurred in the postoperative period of a cardiac procedure