Disseminated Mycobacterium kansasii infection due to surgical site infection following allogeneic hematopoietic stem cell transplantation: A case report and literature review.

This report details a rare case of surgical site infection (SSI) caused by Mycobacterium kansasii following allogeneic hematopoietic stem cell transplantation (allo-HSCT) in a 53-year-old patient with IgA-κ type multiple myeloma. After undergoing multiple chemotherapy regimens and two stem cell transplants, the patient developed an SSI 31-month post-transplantation, manifesting as an intracranial abscess at the site of a previous craniotomy. M. kansasii was isolated from the drainage fluid, marking this instance as a unique case in the literature of nontuberculous mycobacteria (NTM) infection post-allo-HSCT with such a delayed onset. The patient's treatment included targeted antimicrobial therapy based on susceptibility testing, resulting in eventual resolution of the infection, although the patient later succumbed to multiple myeloma relapse. This case underscores the critical need to consider NTM infections in the differential diagnosis of persistent fevers and SSIs in immunocompromised patients, particularly those with chronic graft-versus-host disease. It highlights the importance of early diagnostic and therapeutic interventions to manage these infections effectively. This report contributes to the limited but growing body of literature on NTM infections post-allo-HSCT and emphasizes the need for vigilance in monitoring postoperative patients, especially those with prolonged immunosuppression.

Effect of chemical surface treatment of contaminated CAD-CAM resin composite blocks on surface free energy and bond strength.

PURPOSE: To evaluate the effects of four chemical treatment methods on the contaminated surfaces of VITA ENAMIC (EN) and CERASMART (CS) resin composite computer-aided design-computer-aided manufacturing blocks (RCBs). METHODS: Each RCB was contaminated with a handpiece oil for 1 minute. These contaminated surfaces were then chemically treated by Gel Etchant (PA), Ivoclean (IC), Monobond Etch & Prime (MB), or Ceramics Etch (HF) reagents (n= 12), after which their shear bond strengths, morphologies, failure modes, and surface free energies were examined. RESULTS: The shear bond strengths of the HF-treated surfaces significantly exceeded those of the specimens treated with the other reagents. Adhesive fractures were observed for both the EN and CS blocks after 24 hours of treatment with lubricating oil, PA, and IC. The largest numbers of mixed and cohesive fractures were detected for the MB- and HA-treated specimens. The HF-treated EN and CS blocks possessed the highest surface free energies. The bonding strengths of the resin composites decreased after the contamination of their surfaces; however, the adhesion properties of both blocks were considerably improved by chemical treatment. CLINICAL SIGNIFICANCE: The lubricating oil contamination of dental handpieces significantly reduces the adhesion between the CAD-CAM resin composite block and the resin composite. Therefore, it is necessary to remove contamination and improve the adhesiveness using an optimal chemical surface treatment.

Effect of various resin cements and immediate dentin sealing on tooth fracture resistance of zirconia inlay restorations.

PURPOSE: To compare the effect of the immediate dentin sealing (IDS) and resin cement type on fracture resistance of Class II mesio-occluso-distal (MOD) zirconia inlay restorations. METHODS: 90 Class II MOD cavities on freshly extracted human mandibular third molars, prepared with a high-speed handpiece, were divided into two groups: those with IDS (CR+) and without IDS (CR-). The CEREC system was used to prepare zirconia inlays from Katana super translucent multi-layered blocks. The inlays were cemented with one of three resin cements: RelyX Unicem 2 (RU), Multilink Automix (MA), or Super-Bond (SB). These specimens were stored in water at 37°C for 24 hours and exposed to 5,000 thermal cycles. A vertical load was applied with a metal sphere (Φ 6-mm) on a material testing system, with a crosshead speed of 0.5 mm/minute, until the specimen fractured. Fracture resistance was measured for each tooth, and the fractures were categorized according to Burke's classification. Statistical analyses were conducted using two-way ANOVA and Tukey's honest significant difference tests (P< 0.05). RESULTS: No significant differences in tooth fracture resistance were identified between the CR+ and CR- groups. The SB group had a significantly higher fracture resistance compared to that of the MA group. Fracture morphology showed many mode IV fractures in all groups. IDS did not affect tooth fracture resistance, although there was a significant difference in tooth fracture resistance for different resin cement types used with Class II MOD zirconia inlay restorations. CLINICAL SIGNIFICANCE: Zirconia inlay restorations provide excellent mechanical performance, morphology, and esthetic appearance. In vitro, zirconia inlays cemented with any luting resin cement restored tooth fracture resistance to levels similar to that of intact teeth. Fracture resistance varied among the different resin cements.

[Case of the abscess type cutaneous nocardiosis].

A 58-year-old woman, who had write infull (ITP) and angina, developed a rash similar to an insect bite on the left Achilles tendon one week before visiting our hospital. The rash evolved into pustule. Three or 4 days later she had redness and swelling on her left leg, which was pain full.She went to a clinic, where she was given cefdinir (CFDN) and referred to our hospital.When she came to our hospital, she had an abscess on her left heel, and linear redness and heat along lymph ducts in her left leg and lymph node swelling in her left groin.We diagnosed bacterial lymphangitis, and gave her cefcapene (CFPN-PI) and gentamicin (GM) ointment. Six days later, she recovered.Later abscess culture yielded an organism which was suspected to be Nocardia sp. We identified the organism as Nocardia brasiliensis and diagnosed abscess-type cutaneous nocardiosis. We administered sulfametthoxazole / trimethoprim for one week and checked her whole body on CT, which revealed no lesions.This case was considered to be cutaneous nocardiosis, for which beta-lactam antimicrobial drug or external application of GM ointment would be effective, and abscess-type cutaneous nocardiosis, which recovered with medical treatment for a general bacterial infection was suggested.