ABSTRACT
Aquatic-based infections can present a treatment challenge for primary care physicians because of the likely polymicrobial nature of the infection and the possibility of uncommon pathogenic organisms. Although Staphylococcus and Streptococcus species that colonize the skin are the most common etiologic agents associated with saltwater and freshwater skin and soft tissue infections, other significant pathogens can include Vibrio, Aeromonas, Edwardsiella, Erysipelothrix, and Mycobacterium. Early detection and appropriate management of aquatic infections can significantly decrease morbidity and mortality. This article reviews the pathophysiology, presentation, and management for the most common water-borne pathogens causing skin and soft tissue infections.
Subject(s)
Skin Diseases, Infectious/diagnosis , Water Microbiology , Aeromonas hydrophila , Anti-Bacterial Agents/therapeutic use , Edwardsiella tarda , Enterobacteriaceae Infections/diagnosis , Enterobacteriaceae Infections/etiology , Enterobacteriaceae Infections/therapy , Erysipelothrix , Erysipelothrix Infections/diagnosis , Erysipelothrix Infections/etiology , Erysipelothrix Infections/therapy , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/etiology , Gram-Negative Bacterial Infections/therapy , Humans , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/etiology , Mycobacterium Infections, Nontuberculous/therapy , Mycobacterium marinum , Skin Diseases, Infectious/etiology , Skin Diseases, Infectious/therapy , Soft Tissue Infections/diagnosis , Soft Tissue Infections/etiology , Soft Tissue Infections/therapy , Vibrio , Vibrio Infections/diagnosis , Vibrio Infections/etiology , Vibrio Infections/therapyABSTRACT
Chronic leg ulcers are a significant cause of morbidity and mortality and account for considerable healthcare and socioeconomic costs. Leg ulcers are a recognised complication of immune disease, and the purpose of this study was to establish the prevalence of immune disease in a cohort of patients with chronic wounds, and to compare wound outcomes in the subjects with and without immune disease. Retrospective chart review was completed on consecutive patients scheduled with the plastic surgeon in the Georgetown University Center for Wound Healing between 1 January 2009 and 31 March 2009. Of the 520 patients scheduled for appointments, 340 were eligible for inclusion. The prevalence of immune disease was higher than expected with 78 of 340 patients (23%) having associated immune disease. At presentation, wounds in patients with immune disease had a significantly larger mean surface area [33·4 cm(2) (69·05) compared to 22·5 cm(2) (63·65), P = 0·02]. Split thickness skin graft (STSG) and bioengineered alternative tissue (BAT) graft data was available on 177 grafts from 55 subjects. There was a significantly lower response rate to STSG in subjects with immune disease (50% compared to 97%, P = 0·0002), but response rates to BAT were not different. The association between immune diseases and chronic wounds may provide unique insights into pathways of wound healing, and warrants further study.
