[An erysipelas revealing infection by Dermatobia hominis]. / Un érysipèle révélant une infection àDermatobia hominis.

Myiases are parasitic infections by larvae of flies. The development of intercontinental travels increases the incidence of tropical myiasis in travellers. We report the case of a patient, having recently stayed in Peru, presenting with an inflammatory plate of the right shoulder, covered with small papules with a hole inside. The initial aspect seemed like an erysipelas. Considering the resistance to the antibiotic treatment, the diagnosis of myiase was suspected. The local application of petroleum jelly allowed the exit of nine larvae of Dermatobia hominis and a fast good outcome. In human beings, the number of larvae usually infecting the same individual varies from one to four. This observation is original because of the number of implied larvae, which explains the intensity and the extent of the local inflammatory signs, which first looked like erysipelas. This diagnosis must be suspected in cases of erysipelas resistant to antibiotics in patients back from an endemic area.

Priorities for surveillance and cost-effective control of postoperative infection.

We estimated costs of major postoperative infections (wound infection, 1.2%; bacteremia, 0.2%; pneumonia, 0.9%; and symptomatic urinary tract infection, 0.2%) in patients with common elective operations done in 22 community hospitals during 1985 to mid-1987 by review of 3936 medical records randomly drawn from 17,500 postoperative patients. Calculations based on observed rates of major infection by class of operation and hospitalization days beyond diagnosis related group assignments assumed that daily costs for infection management would be $750. Potential savings per 100 patients from infection control efforts was $13,230 to $47,970 for large-bowel operations, laminectomy, total hip prosthesis, other hip prosthesis, and hip fixation operations and $480 to $4455 for cholecystectomy, hysterectomy, and transurethral prostatectomy. Determination of infection surveillance and control priorities should include consideration of differences in prolongation of hospitalization among various operations by similar infections.