Cervical Necrotizing Fasciitis: An Uncommon Fulminant Disease Entity

Cervical necrotizing fasciitis is an uncommon fulminant disease of single or polymicrobial infectious origin characterized by rapid necrosis of the subcutaneous tissue and fasciae. The disease has high mortality rate. Early identification, timely surgical debridement, broad spectrum antibiotic therapy, aggressive wound care and intensive medical care of the patient are of paramount importance for better prognosis. We present a case report and review of literature of cervical necrotizing fasciitis with a thorough insight into its epidemiology, etiology, pathogenesis, diagnosis and management.

Ring-shaped erythema and herpetic infections in children

Exanthema in children accompanies various diseases. Often, polymorphic elements on the skin occur against the background of infectious diseases. Until the second part of the XXth century, children’s classical infectology described only 6 diseases in children characterized by spotty and maculopapular rash. Now there are more than two dozen exanthemes in children with an “infectious origin”. The article considers 2 clinical cases of a relatively rare annular erythema in patients of 1 year 2 months and 11 months associated with chronic herpetic infections. The article presents photo documents of the dynamics of the skin process and laboratory parameters against the background of antiviral therapy.

Use of Computed Tomography (CT)-Scan in the Current Coronavirus Pandemic

CT is a medical imaging technique that uses X-rays to provide three-dimensional reconstructed images of the explored anatomical region. Its sensitivity has already been demonstrated in the exploration of pulmonary lesions of traumatic, neoplastic and especially infectious origin. In this chapter we present and highlight the usefulness of CT-scan imaging for diagnosis and management of the thoracic involvement of the COVID-19 pandemic. We also present the use of CT in extra-thoracic involvement, in particular, the angio-CT of the limbs in cases of suspected arterial thrombosis of the limbs during COVID-19. Finally, we evoke the other tools such as artificial intelligence which coupled with the CT-scan allows a greater accuracy and thus are to popularize in order to reinforce the CT as a tool of first plan in the fight against future pandemics with thoracic tropism.

Essential Oils in Periodontics. What is the Interest?

Periodontal diseases are inflammatory diseases of infectious origin. Their initial treatment is based on a mechanical debridement associated with a chemical approach; through antiseptics and/or antibiotics. Currently, natural products based on essential oils are increasingly used as a new alternative chemical therapy in the treatment of periodontal diseases, due to their innumerable medicinal properties.

Forms of infectious complications after use of metal foreign bodies of the auricle and determination of the ability of detected microorganisms to biofilm formation

Ear or nose are quite vulnerable to foreign bodies. Foreign bodies cause various side effects in the body. A special category consists of foreign bodies that are introduced for aesthetic purposes, in particular piercing products. Decoration implanted in the tissues of the ear or nose is a foreign body and is a field of increased contamination and reproduction of pathogenic and opportunistic microorganisms. The aim of the study was to determine the infectious forms of complications that occurred after prolonged use of metal foreign bodies and to study the ability of biofilms by microorganisms isolated from the pathological contents of the foreign body of the auricle. 93 patients who applied to the ENT department of Kharkiv Regional Hospital for complications after implantation of metal foreign bodies and 10 people, control group, which had no foreign bodies, and were randomly selected from healthy individuals, were examined, to determine the qualitative composition of the microbiocenosis of the auricle skin. The material for the study was pathological discharge from a foreign body of the auricle. The microbiological study was performed using MICRO-LA-TEST identification kits. Studies of the formation of biofilms were studied by determining the ability of bacterial strains to adhere to the surface of polystyrene. The obtained cultures were washed with suspension media individual for each family of bacteria. The optical density of bacterial suspensions was measured using a microplate reader "MultiskanEX" (type 355). Statistical analysis of the obtained data was performed using MSExcel, Statisica 10 software. As a result of the conducted researches the dependence between the development of infectious complications of the auricle in the presence of metal foreign bodies and the microbiocenosis of the pathological focus was revealed. The study allowed to establish the structure of the microbial landscape of the skin of the auricle in the area of the metal foreign body, to determine the dominant forms of complications of infectious origin, after prolonged use of metal foreign bodies and to study the ability to form biofilms by microorganisms from different metals. The ability of various types of microorganisms to form biofilms when using products from different types of metals has been studied. It is established that the use of metal foreign bodies made of silver and gold reduces the risk of purulent-inflammatory process. It is proved that the optical density of biofilms of most microorganisms isolated from the pathological contents of the area of foreign bodies made of silver and gold is significantly lower than when using steel and titanium products.

An automated retrospective VAE-surveillance tool for future quality improvement studies

Ventilator-associated pneumonia (VAP) is a frequent complication of mechanical ventilation and is associated with substantial morbidity and mortality. Accurate diagnosis of VAP relies in part on subjective diagnostic criteria. Surveillance according to ventilator-associated event (VAE) criteria may allow quick and objective benchmarking. Our objective was to create an automated surveillance tool for VAE tiers I and II on a large data collection, evaluate its diagnostic accuracy and retrospectively determine the yearly baseline VAE incidence. We included all consecutive intensive care unit admissions of patients with mechanical ventilation at Bern University Hospital, a tertiary referral center, from January 2008 to July 2016. Data was automatically extracted from the patient data management system and automatically processed. We created and implemented an application able to automatically analyze respiratory and relevant medication data according to the Centers for Disease Control protocol for VAE-surveillance. In a subset of patients, we compared the accuracy of automated VAE surveillance according to CDC criteria to a gold standard (a composite of automated and manual evaluation with mediation for discrepancies) and evaluated the evolution of the baseline incidence. The study included 22′442 ventilated admissions with a total of 37′221 ventilator days. 592 ventilator-associated events (tier I) occurred; of these 194 (34%) were of potentially infectious origin (tier II). In our validation sample, automated surveillance had a sensitivity of 98% and specificity of 100% in detecting VAE compared to the gold standard. The yearly VAE incidence rate ranged from 10.1–22.1 per 1000 device days and trend showed a decrease in the yearly incidence rate ratio of 0.96 (95% CI, 0.93–1.00, p = 0.03). This study demonstrated that automated VAE detection is feasible, accurate and reliable and may be applied on a large, retrospective sample and provided insight into long-term institutional VAE incidences. The surveillance tool can be extended to other centres and provides VAE incidences for performing quality control and intervention studies.

P059 Etiological profile of childhood uveitis in a Tunisian population: a 12-year retrospective study

Background Uveitis in children represents 10% of all cases of uveitis. It is a serious condition with an often-insidious onset and evolution, and has a negative impact on visual prognosis with a risk of amblyopia or even blindness. The etiologies are varied. the aim of this study is to describe the epidemiological, clinical, and etiological characteristics of childhood uveitis during a period of 12 years. Methods A descriptive retrospective study including 138 children (276 eyes) with uveitis, was conducted at the Ophthalmology Department of Fattouma Bourguiba University Hospital in Monastir Tunisia between 1 January 2006 and 31 December 2017. Results The patients average age was 10.2 ± 3,58. A female predominance was noted (sex ratio: 0.91). Uveitis was bilateral in 2/3 of cases and unilateral in 1/3 of cases. Vision loss was the most common reason for consultation (52.2%). The mean initial visual acuity was 3,3/10 ± 3,24. Intermediate uveitis was the most common anatomical form (42,02%), followed by anterior uveitis (28,26%), panuveitis (26,08%), and posterior uveitis (3,6%). The infectious origin was the most common aetiology, followed by uveitis related to general condition (13,72%), and uveitis in context of a specific ocular condition (12,3%). Uveitis was idiopathic in 79 patients (57.24%). Periocular injection of triamcinolone acetonide was performed in (29 patients, 21%). The use of immunosuppressives agents was noted in 38 patients (27,5%) (methotrexate: 23 patients, azathioprine: 16 patients, and ciclosporin: 10 patients). The use of intravitreous injections of bevacizumab was noted in 6 patients (4.33%). Anti TNF alpha treatment was used for 2 patients. Post-uveitic complications were noted in 84.3% of cases. They were dominated by cataract (31,88%) at the anterior segment level. Cystoid macular oedema (31,88%) and retinal serous detachment (15,9%) were the major complications in the posterior segment. Mean final visual acuity was 5.98/10 ± 3,54. It was <1/10 in 14 eyes. Conclusion In our study a female predominance was noted. Intermediate uveitis was the most common anatomical form. The infectious origin was preponderant. Post-uveitic complications was dominated at the anterior segment level by cataract and cystoid macular oedema at the posterior segment.

Epidural fever

Epidural analgesia (EPA) is the most eff ective method of intrapartum pain relief and is considered to be very safe. Recently, it has been used in up to 34% of parturients with EPA and is also associated with maternal temperature elevations during labor. The mechanism of this epidural-associated fever remains incompletely understood. The most likely etiology seems to be non-infectious infl ammation caused by an epidural catheter. However, some authors deny this association. They theorize it is caused by selection bias only, as EPA is more often required by women with more painful and prolonged or more complicated labor, where temperature elevation is due to other causes. They point out that in some studies, fever was correlated to EPA only with concurrent placental infl ammation. Maternal fever, despite the cause, either infectious or non-infectious origin, carries important clinical and public health implications. Further research that evaluates maternal epidural status and its infl uence on maternal or neonatal fever could improve sepsis evaluation and lead to worldwide decrease of unnecessary antibio tic exposure. Key words: epidural fever – epidural analgesia – thermoregulation

Bacteremia after Bacillus clausii administration for the treatment of acute diarrhea: A case report

Bacillus clausii is a gram-positive rod used as a probiotic to treat diarrhea and the side effects of antibiotics such as pseudomembranous colitis. We report a case of B. clausii bacteremia in a non-immunocompromised patient with active peptic ulcer disease and acute diarrhea. The probiotic was administered during the patient´s hospitalization due to diarrhea of infectious origin. B. clausii was identified in the bloodstream of the patient through Matrix-Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) days after her discharge.Given the wide use of probiotics, we alert clinicians to consider this microorganism as a causative agent when signs of systemic infection, metabolic compromise, and hemodynamic instability establish after its administration and no pathogens have been identified that could explain the clinical course.