scholarly journals 1389. Nontuberculous Mycobacterial Infections of the Upper Extremity

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S779-S780
Author(s):  
Thomas M Polveroni ◽  
Kelly Scott ◽  
Kevin J Renfree ◽  
Holenarasipur R Vikram ◽  
Carolyn Mead-Harvey
Keyword(s):  
Upper Extremity ◽  
Antimicrobial Therapy ◽  
Organ Transplant ◽  
Surgical Debridement ◽  
Symptom Duration ◽  
Mycobacterial Infections ◽  
Delay In Diagnosis ◽  
Prolonged Duration ◽  
Immunosuppressed Patients ◽  
Culture Identification

Abstract Background Although uncommon, nontuberculous mycobacterial infections (NTMI) of the upper extremity cause significant morbidity based on their natural history, delay in diagnosis, prolonged duration of antimicrobial therapy often combined with surgical debridement, and functional loss. Herein we describe our experience with such infections. Methods Records for adult patients from two academic, tertiary facilities with culture-proven NTMI involving the upper extremity were retrospectively reviewed. Demographic information, co-morbidities, laboratory and microbiological evaluation, management, and outcomes were extracted. Patients were analyzed based on pathogen identified and immune suppression. Results 77 patients were identified. The mean age was 59 years and 65% of patients were male. 48% reported a preceding injury, with the hand being most frequently involved (58%). 41% were considered immune compromised; 19% of them were organ transplant recipients. Mean symptom duration prior to presentation was 203 days. Mean time to culture identification was 33 days, and 25 different species of NTM were identified (subcategorized as rapid or slow growers). 77% had solitary lesions, with cutaneous/subcutaneous location as the most common site. All patients underwent surgical debridement with four undergoing amputation to control infection. 69% received combination antimicrobial therapy for a mean duration of 184 days. Immunosuppressed patients were treated with antimicrobial therapy for a longer duration (mean 243 vs 155 days). One-third of patients experienced complications and/or recurrence regardless of organism type. Conclusion NTMI of the upper extremity is often misdiagnosed leading to significant delays in appropriate management. Knowledge of its protean manifestations and early consideration in the differential diagnosis of chronic, painful swelling of the hand or wrist, nodular or inflammatory lesions, or septic arthritis is crucial. A low threshold for surgical or biopsy with specimens sent for histopathology as well as microbiologic analysis is warranted. A combined approach with surgical debridement and prolonged combination antimicrobial therapy is necessary for optimal outcomes; however, adverse reactions from such therapy are commonly encountered. Disclosures All Authors: No reported disclosures

scholarly journals Atypical Mycobacterial Infections of the Upper Extremity

Hand ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 188-192 ◽  
Author(s):  
Mariela Lopez ◽  
Julie Croley ◽  
Kevin D. Murphy
Keyword(s):  
Upper Extremity ◽  
Immune Dysfunction ◽  
Common Species ◽  
Mycobacterium Abscessus ◽  
Symptom Duration ◽  
Mycobacterium Fortuitum ◽  
Mycobacterial Infections ◽  
Total Incidence ◽  
Clinical Awareness ◽  
Insect Bites

Background: Atypical mycobacterial infections are uncommon and characterized by a chronic, indolent course before diagnosis. Historically, these infections are associated with marine-related injury and/or immune dysfunction. Our institution has successfully diagnosed and treated an increasing number of these infections. The objective of this study is to review our experience with these rare infections and verify the developing trends encountered. Methods: A retrospective review was performed for patients with positive nontuberculous mycobacterial cultures of the upper extremity from 2000 to 2013. Patient demographics, source of transmission, symptom duration, mycobacterial species, operative and antibiotic treatments, and outcomes were recorded. Results: Thirty-four patients were identified. The mean symptomatic period before diagnosis was 9 months (range, 1-60 months). Fourteen patients had identifiable causes of immune dysfunction while the rest appeared immune competent. Patients were infected by Mycobacterium marinum (n = 14), Mycobacterium abscessus (n = 8), Mycobacterium fortuitum (n = 7), and other less common species (n = 5). Although most patients had unidentifiable causes of infection (n = 15), some could correlate infection to marine injury, lacerations, insect bites, animal bites, and tattoos. All patients received operative intervention including debridement. Antibiotics were given for a mean duration of 5 months. Ninety-seven percent had complete resolution of disease. Conclusions: Although M. marinum infections make up the majority of infections at our institution, we report a higher total incidence of nonmarinum infections. These infections are occurring in seemingly healthy individuals with no history of exposure with marine water. Successful treatment relies on having a heightened clinical awareness and adequate diagnosis.

scholarly journals Bacterial pneumonia coinfection and antimicrobial therapy duration in SARS-CoV-2 (COVID-19) infection

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Liam Townsend ◽  
Gerry Hughes ◽  
Colm Kerr ◽  
Mary Kelly ◽  
Roisin O’Connor ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Antimicrobial Treatment ◽  
Respiratory Pathogens ◽  
Factors Associated ◽  
Reactive Protein ◽  
Prolonged Duration ◽  
Bacterial Coinfection ◽  
Tract Infections ◽  
Culture Positivity Rate

Abstract Background Bacterial respiratory coinfection in the setting of SARS-CoV-2 infection remains poorly described. A description of coinfection and antimicrobial usage is needed to guide ongoing antimicrobial stewardship. Objectives To assess the rate of empirical antimicrobial treatment in COVID-19 cases, assess the rate and methods of microbiological sampling, assess the rate of bacterial respiratory coinfections and evaluate the factors associated with antimicrobial therapy in this cohort. Methods Inpatients with positive SARS-CoV-2 PCR were recruited. Antibiotic prescription, choice and duration were recorded. Taking of microbiological samples (sputum culture, blood culture, urinary antigens) and culture positivity rate was also recorded. Linear regression was performed to determine factors associated with prolonged antimicrobial administration. Results A total of 117 patients were recruited; 84 (72%) were prescribed antimicrobial therapy for lower respiratory tract infections. Respiratory pathogens were identified in seven (6%) patients. The median duration of antimicrobial therapy was 7 days. C-reactive protein level, oxygen requirement and positive cultures were associated with prolonged duration of therapy. Conclusions The rate of bacterial coinfection in SARS-CoV-2 is low. Despite this, prolonged courses of antimicrobial therapy were prescribed in our cohort. We recommend active antimicrobial stewardship in COVID-19 cases to ensure appropriate antimicrobial prescribing.

scholarly journals Mycobacterial infections in solid organ transplant recipients

2014 ◽  
Vol 20 ◽  
pp. 89-101 ◽  
Author(s):  
Y. Meije ◽  
C. Piersimoni ◽  
J. Torre-Cisneros ◽  
A.G Dilektasli ◽  
J.M Aguado
Keyword(s):  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Mycobacterial Infections ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

Abstract W P172: Prevalence of Positive Dwi Findings in Relation to Tia Etiology

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Yasufumi Gon ◽  
Manabu Sakaguchi ◽  
Syuhei Okazaki ◽  
Hideki Mochizuki ◽  
Kazuo Kitagawa
Keyword(s):  
Symptom Onset ◽  
Clinical Symptoms ◽  
Motor Symptom ◽  
Unknown Etiology ◽  
Symptom Duration ◽  
Motor Symptoms ◽  
Duration Of Symptoms ◽  
Prolonged Duration ◽  
History Of ◽  
Toast Classification

Objective: Previous studies have shown that the prolonged duration of TIA symptoms or ABCD2 score are associated with DWI abnormality, and the presence of DWI abnormality is associated with an increased early risk of stroke. However, there are few reports that show the relation between TIA clinical etiology and DWI abnormality. Our aim of this study is to clarify the prevalence of positive DWI in relation to characteristics of patients and TIA. Methods: The subjects were enrolled from patients who were admitted to our stroke unit within 7 days after symptom onset from January 2006 to July 2013. The diagnosis of TIA was done by NINDS criteria, and we classified TIA etiology by TOAST classification based on clinical symptoms, ECG monitoring, carotid ultrasound, MR angiography and transesophageal echocardiography. All patients underwent DWI-MRI within 7 days after symptom onset. We examined an association between TIA etiology, symptom, duration of symptoms and DWI abnormality. Results: A total of 141 patients (mean 64 years; 63% men) were admitted with TIA during this period. Those included lacuna TIA (n=17, 12.1%), atherothrombotic TIA (n=32, 22.7%), cardioembolic TIA (n=23, 16.3%), TIA due to other causes (n=35, 24.8%), and TIA with unknown etiology (n=34, 24.1%). Prevalence of positive DWI findings were 47.1% in lacunar TIA, 43.7% in atherothrombotic TIA, 52.1% in cardioembloic TIA, 42.8% in TIA due to other causes, and 23.5% in TIA with unknown etiology. DWI abnormality was the most frequent in cardiogenic TIA. In relation to symptom duration, the prevalence of DWI positive findings were 45.2% in less than 1 hour (N=53), 36.6% in 1-3 hour (N=41), 25.0% in 3-6 hour (N=12) and 42.9% in 6-24 hours (N=35). In relation to motor symptoms, there was no difference in prevalence of DWI abnormality between patient with motor symptoms (39.8%, N=113) and without (42.8%, N=28). There was no relation between DWI abnormalities and age, a history of stroke/TIA episode or vascular risk factors. Conclusion: Prevalence of DWI positive findings was high in cardiogenic TIA, and low in TIA with unclassified etiology. There were no relation between DWI abnormality, duration of symptom, and motor symptom.

The Immunocompromised Surgical Patient and Opportunistic Infections

2017 ◽  
Author(s):  
Kiran Gajurel ◽  
Aruna K Subramanian
Keyword(s):  
De Novo ◽  
Opportunistic Infections ◽  
Organ Transplant ◽  
Surgical Excision ◽  
Suppressive Therapy ◽  
Surgical Patient ◽  
Solid Organ ◽  
Fungal Sinusitis ◽  
Delay In Diagnosis ◽  
Immunosuppressive Medications

Immunosuppressive medications used to prevent allograft rejection render solid-organ transplant recipients vulnerable to various opportunistic infections. These infections include bacteria, viruses, fungi, and parasites and occur either via reactivation of previously acquired latent infection or de novo acquisition from the donor organ itself or the environment after the transplantation. The type and clinical course of the infection depend on various factors, including the transplanted organ, nature of immunosuppressive regimens, timing of infection relative to the organ transplant, and type and duration of prophylaxis. Proper donor and recipient screening for preventable infections and posttransplantation prophylaxis are instrumental in preventing morbid infections. Posttransplantation infections may present with subtle findings and thus may cause a delay in diagnosis and treatment, resulting in a poor outcome. Appropriate pathogen-specific tests should be requested promptly for early diagnosis. Since these infections may have overlapping clinical and radiologic features, tissue biopsy, if feasible, should be done to establish a definitive diagnosis. Surgical excision or débridement should be attempted in patients presenting with abscesses or invasive fungal sinusitis along with antimicrobial therapy. After the completion of treatment, suppressive therapy may be required in certain infections to prevent a relapse as long as the patient remains immunosuppressed. This review contains 3 tables, and 82 references. Key words: allograft, donor, immunocompromised, infection, opportunistic, organ, transplant 

scholarly journals Dexamethasone added to Bupivacaine prolongs the duration of analgesia for supraclavicular brachial plexus block

2018 ◽  
Vol 17 (2) ◽  
pp. 296-301
Author(s):  
Naimul Hoq ◽  
Abdullah Al Maruf
Keyword(s):  
Brachial Plexus ◽  
Upper Extremity ◽  
Brachial Plexus Block ◽  
Medical Science ◽  
Local Anaesthetics ◽  
Distilled Water ◽  
Dexamethasone Group ◽  
Prolonged Duration ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: Local anaesthetics alone for supraclavicular brachial plexus block provide good operative conditions but have shorter duration of postoperative analgesia. Numerous adjuncts have been added to enhance the efficacy of the block. Steroids have anti-inflammatory as well as analgesic effects.Objectives: This study has been undertaken with a view to find out the efficacy of dexamethasone to increase the duration of analgesia when used as an adjuvant to bupivacaine in supraclavicular brachial plexus block in upper extremity surgery.Methods: Total 60 patients of ASA I and II undergoing upper extremity surgery under brachial plexus block were randomly divided into two equal groups of 30 each; Bupivacaine group-‘’A’’ received 0.5% bupivacaine 2 mg/kg with distilled water 15 ml and Dexamethasone group-‘’B’’ received 0.5% bupivacaine 2 mg/kg with dexamethasone (0.2mg/kg) with distilled water 15 ml. The duration of analgesia in the two groups were compared.Results: There was markedly prolonged duration of analgesia in dexamethasone group. The mean duration of analgesia in bupivacaine group was 455 ± 17.09 minutes, whereas in dexamethasone group it was 864.50 ± 25.19 minutes. The results were statistically highly significant.Conclusion: Dexamethasone when added to bupivacaine in brachial plexus block it results significantly prolonged duration of post-operative analgesia, which was significantly higher in comparison to bupivacaine when it is used alone.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.296-301

Osteomyelitis of the hand

2015 ◽  
Vol 41 (4) ◽  
pp. 431-440 ◽  
Author(s):  
R. Pinder ◽  
G. Barlow
Keyword(s):  
Antibiotic Therapy ◽  
Antimicrobial Therapy ◽  
Lower Limb ◽  
Hand Function ◽  
Surgical Debridement ◽  
Antibiotic Administration ◽  
Level Of Evidence ◽  
Hand Length

Osteomyelitis of the hand is uncommon, but if not adequately and promptly treated the detrimental effects on hand function can be devastating. The majority of literature on osteomyelitis relates to the lower limb, but the principles of management are applicable to the hand, with good surgical debridement and culture-guided antimicrobial therapy. For osteomyelitis in general, antibiotic therapy of 4–6 weeks’ duration (intravenous and/or oral) is typically recommended. In the hand, length and mode of antibiotic administration are still under study. Level of Evidence: V

Mycobacterial infections in solid organ transplant recipients

1999 ◽  
Vol 31 (8) ◽  
pp. 3197-3198 ◽  
Author(s):  
H Arslan ◽  
F.Öner- Eyüboḡlu ◽  
F Kalpaklioḡlu ◽  
K Gürdogan ◽  
S Akçay ◽  
...  
Keyword(s):  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Mycobacterial Infections ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

scholarly journals The Importance of Screening Strongyloides stercoralis Infection in Solid Organ Transplant Donors and Recipients

2021 ◽  
Vol 16 (4) ◽  
Author(s):  
Sara Abolghasemi ◽  
Farnaz Zolfaghari ◽  
Shahnaz Sali ◽  
Abdollah Ghaffari ◽  
Mehran Noori
Keyword(s):  
Organ Transplant ◽  
Gastrointestinal Symptoms ◽  
Strongyloides Stercoralis ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Kidney Transplant Recipients ◽  
Place Of Residence ◽  
Birth Place ◽  
Immunosuppressed Patients ◽  
History Of

Background: Strongyloides stercoralis is an intestinal nematode with worldwide distribution which is endemic in tropical and subtropical areas. It is unique in its ability to complete its entire life cycle and reinfect its human host via a phenomenon called autoinfection. The majority of infections are clinically asymptomatic or can manifest with gastrointestinal symptoms, such as heartburn, bloating, diarrhea, abdominal discomfort, gastroesophageal reflux disease (GERD), or symptoms related to the penetration of larvae through skin, including dermatitis and eosinophilia. Immunosuppressed patients, such as solid organ transplant patients with untreated strongyloidiasis are at great risk of hyperinfection, dissemination syndromes, and often fatal conditions associated with strongyloidiasis. Methods: In this retrospective single-center cross-sectional study, we evaluated 157 cases (131 heart, lung, and kidney transplant recipients and 26 kidney donors) in Tehran, Iran, from March 2020 to April 2021. Demographic information including age, gender, place of birth, place of residence, underlying disease, being the donor or recipient, history of previous transplant and type of transplant, travel history to endemic regions, and seropositivity for S. stercoralis were evaluated. Results: Among 157 cases with a mean age of 38.9 years, 40 (25.5%) cases tested positive for S. stercoralis antibodies. Out of 26 donors, eight cases were seropositive, and among 131 recipients, 32 cases were seropositive. There was no significant correlation between birth place and place of residence in endemic areas and seropositivity for S. stercoralis. None of the cases showed hypereosinophilia, hyperinfection, or disseminated syndrome. Also, we found no significant correlation between the type and time of transplant, history of previous transplants, and S. stercoralis infection. Conclusions: Universal screening for S. stercoralis latent infection is important in immunosuppressed patients, especially in solid organ transplants because of the high risk of hyperinfection and disseminated syndrome, which may culminate in death. Furthermore, screening for latent strongyloides infection in donors seems to be necessary because of the possibility of strongyloides infection being transmitted from donors to recipients.

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