ABSTRACT
Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions. Lemierre's syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection. Although the literature about either of them is rich, there is no report about co-appearance of the two syndromes. We present the case of a young healthy female patient who suffered concomitantly from Fournier's gangrene and Lemierre's syndrome after minor surgery.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Candidiasis/drug therapy , Fournier Gangrene/drug therapy , Klebsiella Infections/drug therapy , Lemierre Syndrome/drug therapy , Staphylococcal Infections/drug therapy , Acetamides/therapeutic use , Candida albicans/isolation & purification , Candidiasis/complications , Candidiasis/microbiology , Caspofungin , Debridement , Drug Therapy, Combination , Echinocandins/therapeutic use , Female , Fournier Gangrene/complications , Fournier Gangrene/microbiology , Humans , Klebsiella Infections/complications , Klebsiella Infections/microbiology , Klebsiella pneumoniae/isolation & purification , Lemierre Syndrome/complications , Lemierre Syndrome/microbiology , Linezolid , Lipopeptides , Oxazolidinones/therapeutic use , Staphylococcal Infections/complications , Staphylococcal Infections/microbiology , Staphylococcus epidermidis/isolation & purification , Young AdultABSTRACT
BACKGROUND: Traumatic brain injury (TBI) results in a hypermetabolic and hypercatabolic status in which adequate nutrition support is essential to improve clinical outcome. The endocrine system of a patient with TBI is also affected and may play a critical role in either the metabolic or the immunologic response to the trauma. In the present study, the effect of standard, delayed enteral feeding (DEF), compared with early (within 24-48 hours) enteral feeding (EEF), on the endocrine function of patients with TBI was investigated. METHODS: This comparative, prospective, open-labeled, randomized study included TBI patients admitted to the intensive care unit (ICU). Injury severity was assessed by the Glasgow Coma Scale and predicted mortality by the Acute Physiology and Chronic Health Evaluation II. Twenty-five patients received DEF and 34 patients received EEF. The effect of the onset of nutrition on pituitary, thyroidal, gonadal, and adrenal function was investigated on days 6 and 12 after admission to the hospital. RESULTS: Levels of thyroid-stimulating hormone, free triiodothyronine, free thyroxine, and testosterone (in males) of DEF patients declined in comparison to levels of the day of admission to the ICU. The decrease of hormonal values was less pronounced in the EEF group. Cortisol concentrations rose in the DEF group; a lesser hormonal change was found in the EEF group. Deaths during the study for the DEF group and EEF group were 2 and 3, respectively. CONCLUSIONS: EEF may exert beneficial effects on the hormonal profile of TBI patients, possibly contributing to a better clinical outcome in this patient group.
Subject(s)
Brain Injuries/physiopathology , Endocrine System/drug effects , Enteral Nutrition/methods , APACHE , Adolescent , Adult , Aged , Brain Injuries/therapy , Endocrine System/physiopathology , Female , Humans , Hydrocortisone/blood , Intensive Care Units , Male , Middle Aged , Prospective Studies , Testosterone/blood , Thyrotropin/blood , Thyroxine/blood , Time Factors , Triiodothyronine/blood , Young AdultABSTRACT
We present a case of Ludwig's angina in a 48-y-old immunocompetent male caused by an unusual pathogen, Gemella morbillorum. The infection was complicated with mediastinitis and despite aggressive management of the disease the patient died after 12 d of hospitalization. This is the first reported case of Ludwig's angina caused by G. morbillorum and emphasizes that the disease remains a potentially lethal infection.
