Severe Lactational Mastitis With Complicated Wound Infection Caused by Streptococcus pyogenes

2020 ◽  
pp. 089033442096514
Author(s):  
Josefine Theresia Maier ◽  
Julia Daut ◽  
Elisabeth Schalinski ◽  
Toni Fischer-Medert ◽  
Lars Hellmeyer
Keyword(s):  
Wound Healing ◽  
Streptococcus Pyogenes ◽  
Acute Otitis Media ◽  
Interdisciplinary Approach ◽  
Invasive Disease ◽  
Left Breast ◽  
Upper Respiratory Tract ◽  
Wound Healing Problems ◽  
Lactating Breast ◽  
Skin Erosion

Introduction Puerperal mastitis, a complication occurring during the breastfeeding period, is often caused by Staphylococcus aureus. Here we report on severe streptococcal mastitis in a lactating breast, with subsequent invasive disease and wound healing problems. Main issue The 41-year-old woman (G2, P2) presented at 2 weeks postpartum to our hospital with painful swelling and reddening of the left breast, in addition to fever and malaise, and complained about a nipple fissure on the left breast. Previously, her 4-year-old son was treated for an acute otitis media and her husband experienced flu-like symptoms. Management Due to the severity of the symptoms, Clindamycin antibiotic treatment was initiated intravenously. Streptococcus pyogenes was isolated in the milk. This strain is commonly known to cause infections of the upper respiratory tract, skin, and soft tissue, but rarely mastitis. Furthermore, the participant developed invasive disease with abscess formation and skin erosion with a milk fistula. Special dressing was applied to promote wound healing. The participant continued breastfeeding well into the child’s 2nd year of life. Conclusion This rare form of complicated mastitis with invasive disease caused by Streptococcus pyogenes called for an interdisciplinary approach. We want to draw attention to other pathogens causing mastitis and to alert health care workers to promote hygiene in lactating women to prevent transmission.

scholarly journals EndoS and SpeB from Streptococcus pyogenes Inhibit Immunoglobulin-Mediated Opsonophagocytosis

2002 ◽  
Vol 70 (12) ◽  
pp. 6646-6651 ◽  
Author(s):  
Mattias Collin ◽  
Mikael D. Svensson ◽  
Anders G. Sjöholm ◽  
Jens C. Jensenius ◽  
Ulf Sjöbring ◽  
...  
Keyword(s):  
Streptococcus Pyogenes ◽  
Ex Vivo ◽  
Adaptive Immune System ◽  
Invasive Disease ◽  
Classical Pathway ◽  
Bacterial Survival ◽  
Upper Respiratory Tract ◽  
Human Pathogen ◽  
Adaptive Immune ◽  
Upper Respiratory

ABSTRACT The human pathogen Streptococcus pyogenes primarily infects the upper respiratory tract and skin, but occasionally it disseminates and causes severe invasive disease with high mortality. This study revealed that the activity of extracellular EndoS, which hydrolyzes the functionally important N-linked oligosaccharides on opsonizing immunoglobulin G (IgG), contributes to increased survival of S. pyogenes in human blood ex vivo. The inability to kill the bacteria is due to reduced binding of IgG to Fc receptors and impaired classical pathway-mediated activation of complement. In addition, the activity of extracellular SpeB, which cleaves IgG into Fc and Fab fragments, also increases bacterial survival. This suggests that S. pyogenes expresses two enzymes, EndoS and SpeB, which modulate IgG by different mechanisms in order to evade the adaptive immune system.

scholarly journals Abdominal Panniculectomy Can Simplify Kidney Transplantation in Obese Patients

2021 ◽  
pp. 1-8
Author(s):  
Dominik Promny ◽  
Theresa Hauck ◽  
Aijia Cai ◽  
Andreas Arkudas ◽  
Katharina Heller ◽  
...  
Keyword(s):  
Wound Healing ◽  
Kidney Transplantation ◽  
Postoperative Complications ◽  
Kidney Transplant ◽  
Interdisciplinary Approach ◽  
Wound Complications ◽  
Obese Patients ◽  
Patient Cohort ◽  
Transplant Candidates ◽  
Stage Renal Disease

<b><i>Background:</i></b> Obesity is frequently present in patients suffering from end-stage renal disease (ESRD). However, overweight kidney transplant candidates are a challenge for the transplant surgeon. Obese patients tend to develop a large abdominal panniculus after weight loss creating an area predisposed to wound-healing disorders. Due to concerns about graft survival and postoperative complications after kidney transplantation, obese patients are often refused in this selective patient cohort. The study aimed to analyze the effect of panniculectomies on postoperative complications and transplant candidacy in an interdisciplinary setting. <b><i>Methods:</i></b> A retrospective database review of 10 cases of abdominal panniculectomies performed in patients with ESRD prior to kidney transplantation was conducted. <b><i>Results:</i></b> The median body mass index was 35.2 kg/m<sup>2</sup> (range 28.5–53.0 kg/m<sup>2</sup>) at first transplant-assessment versus 31.0 kg/m<sup>2</sup> (range 28.0–34.4 kg/m<sup>2</sup>) at panniculectomy, and 31.6 kg/m<sup>2</sup> (range 30.3–32.4 kg/m<sup>2</sup>) at kidney transplantation. We observed no major postoperative complications following panniculectomy and minor wound-healing complications in 2 patients. All aside from 1 patient became active transplant candidates 6 weeks after panniculectomy. No posttransplant wound complications occurred in the transplanted patients. <b><i>Conclusion:</i></b> Abdominal panniculectomy is feasible in patients suffering ESRD with no major postoperative complications, thus converting previously ineligible patients into kidney transplant candidates. An interdisciplinary approach is advisable in this selective patient cohort.

Post-Bariatric Abdominoplasty: Analysis of 406 Cases With Focus on Risk Factors and Complications

2020 ◽  
Vol 41 (1) ◽  
pp. 59-71 ◽  
Author(s):  
Torsten Schlosshauer ◽  
Marcus Kiehlmann ◽  
Diana Jung ◽  
Robert Sader ◽  
Ulrich M Rieger
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Surgical Technique ◽  
Significant Risk ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Wound Healing Problems ◽  
Bariatric Patients

Abstract Background Post-bariatric patients present a surgical challenge within abdominoplasty because of residual obesity and major comorbidities. In this study, we analyzed complications following abdominoplasty in post-bariatric patients and evaluated potential risk factors associated with these complications. Objectives The authors sought to determine the complications and risk factors following abdominoplasty in post-bariatric patients. Methods A retrospective study of patients who underwent abdominoplasty was performed from January 2009 to December 2018 at our institution. Variables analyzed were sex, age, body mass index (BMI), smoking, surgical technique, operative time, resection weight, drain output, and complications. Results A total of 406 patients were included in this study (320 female and 86 male) with a mean age of 44.4 years and a BMI of 30.6 kg/m2. Abdominoplasty techniques consisted of traditional (64.3%), fleur-de-lis technique (27.3%), and panniculectomy without umbilical displacement (8.4%). Overall complications recorded were 41.9%, the majority of these being wound-healing problems (32%). Minor and major complications were found in 29.1% and 12.8% of patients, respectively. A BMI value of ≥30 kg/m2 was associated with an increased risk for wound-healing problems (P = 0.001). The frequency of total complications was significantly related to age (P = 0.007), BMI (P = 0.004), and resection weight (P = 0.001). Abdominoplasty technique tended to influence total complications. Conclusions This study demonstrates in a fairly large sample of post-bariatric patients (n = 406) that abdominoplasty alone can be performed safely, with an acceptable complication rate. Age, BMI, and resection weight are shown to be significant risk factors for total complications. The role of surgical technique needs to be evaluated further. Level of Evidence: 4

Otitis Media

PEDIATRICS ◽  
1984 ◽  
Vol 74 (5) ◽  
pp. 948-949
Author(s):  
Charles M. Ginsburg
Keyword(s):  
Otitis Media ◽  
Viral Infections ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Medical Personnel ◽  
Medical Attention ◽  
Common Symptom ◽  
Upper Respiratory Tract ◽  
Primary Responsibility ◽  
Printed Materials

Earache, a common symptom in children, causes many parents to seek medical attention. Aside from trauma and the discomfort that often accompanies viral infections of the upper respiratory tract, acute otitis media with effusion is the commonest cause of otalgia in infants and children. Proper management requires a team effort between the physician and the child's parents or caretaker. The physician must transmit to the parents a concise but thorough overview of the problem and a plan for management. This should include information on the pathophysiology of ear disease, its incidence, therapy and the potential adverse effects, and any measures that the parents may take to prevent recurrence. The primary responsibility for transmittal of this information lies with the physician. Ancillary medical personnel and communication aids (videotapes, computers, printed materials) should be utilized, if available, to reinforce the physician's "message.'

scholarly journals Comparison between the Effects of Oral and Intramuscular Administration of Shin’iseihaito (Xinyiqingfeitang) in a Streptococcus pyogenes-Induced Murine Sinusitis Model

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Masaaki Minami ◽  
Toru Konishi ◽  
Hiroshi Takase ◽  
Toshiaki Makino
Keyword(s):  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Streptococcus Pyogenes ◽  
Kampo Medicine ◽  
Intramuscular Administration ◽  
Nasal Discharge ◽  
Thymidine Uptake ◽  
Nasal Colonization ◽  
Upper Respiratory Tract ◽  
Tract Infections

Streptococcus pyogenes (S. pyogenes) is a species of Gram-positive coccoid bacteria having many virulence factors. Its capsule and exotoxins can cause upper respiratory tract infections such as sinusitis. The general treatment for S. pyogenes-induced sinusitis is administration of antibiotics such as penicillin and macrolides; however, a serious problem associated with these antibiotics is their attenuated effect. Shin’iseihaito (Xinyiqingfeitang), a formula of Japanese traditional Kampo medicine and traditional Chinese medicine, has been used for the treatment of sinusitis. In general, formulas of Japanese traditional Kampo medicine are orally administered. This is in contrast to certain formulas of traditional Chinese medicine, which are being recently administered intramuscularly or intravenously. Regarding these traditional Chinese medicine formulas, the injection methodology is reported to be more effective than oral intake. In this study, we compared the efficacy between orally and intramuscularly administered Shin’iseihaito against S. pyogenes-induced sinusitis. We evaluated the antibacterial effect of Shin’iseihaito extract (SSHT) against S. pyogenes by K-B disk diffusion assay. Furthermore, we investigated the nasal colonization of S. pyogenes, determined cytokine (TNF-α, IL-1β, and IL-6) levels, and conducted a splenocyte proliferative assay in a murine sinusitis model. SSHT displayed direct anti-S. pyogenes activity. Intramuscular administration of SSHT decreased the nasal colonization of S. pyogenes compared with oral administration. Thymidine uptake analysis revealed that the proliferation of splenocytes from S. pyogenes-infected mice under intramuscular SSHT treatment was upregulated compared to that of splenocytes from S. pyogenes-infected mice under oral SSHT treatment. We also found that TNF-α, IL-1β, and IL-6 levels in the nasal discharge from intramuscularly treated S. pyogenes-infected mice were lower than those from orally treated mice. Our findings suggest that intramuscular administration of Shin’iseihaito may be useful for the treatment of murine S. pyogenes-induced sinusitis.

Comparative Results of Percutaneous Calcaneal Osteotomy in Correction of Hindfoot Deformities

2018 ◽  
Vol 40 (3) ◽  
pp. 276-281 ◽  
Author(s):  
Natalia Gutteck ◽  
Alexander Zeh ◽  
David Wohlrab ◽  
Karl-Stefan Delank
Keyword(s):  
Wound Healing ◽  
Standard Technique ◽  
Percutaneous Technique ◽  
Level Of Evidence ◽  
Calcaneal Osteotomy ◽  
Scale Scores ◽  
Oblique Incision ◽  
Hindfoot Deformities ◽  
Wound Healing Problems ◽  
The Difference

Background: Calcaneal osteotomies are often required in the correction of hindfoot deformities. The traditional open techniques, which include a lateral or oblique incision, are occasionally associated with wound healing problems and neurovascular injury. Methods: A total of 122 consecutive patients who underwent a calcaneal osteotomy for hindfoot realignment treatment were included. Fifty-eight patients were operated using an open incision technique and 64 patients (66 feet) using a percutaneous technique. Clinical and radiologic assessments were performed preoperatively, at 6 weeks, and 1 year postoperatively. Results: The American Orthopaedic Foot & Ankle Society scale scores and visual analog scale pain scores improved in both groups postoperatively. The difference between the groups was not significant. The results of the radiologic measurements pre- and postoperatively were not significantly different. No pseudarthrosis occurred in either group. The comparison of both groups showed a significantly lower risk for wound healing problems in the percutaneous group. The hospitalization time was significantly shorter in the percutaneous group. Conclusion: Because of the excellent results with the percutaneous calcaneal osteotomy, the authors feel encouraged to establish this procedure as a standard technique for calcaneus osteotomy, especially patients at high risk for wound healing problems. Level of Evidence: Level III, comparative series.

scholarly journals Silent Mastoiditis Associated with Pneumococcal Meningitis

2021 ◽  
Vol 27 (2) ◽  
pp. 1-6
Author(s):  
Ashikin Mohd Nordin ◽  
Jean Jun Ong ◽  
Juriza Ismail ◽  
Norazlin Kamal Nor ◽  
Sau Wei Wong ◽  
...  
Keyword(s):  
Brain Imaging ◽  
Pneumococcal Meningitis ◽  
Wide Spectrum ◽  
Clinical Signs ◽  
Invasive Disease ◽  
Upper Respiratory Tract ◽  
Slow Recovery ◽  
Acute Mastoiditis ◽  
Focus Of Infection ◽  
Upper Respiratory

Streptococcus pneumoniae (S pneumoniae) can cause a wide spectrum of diseases which includes upper respiratory tract infection as well as more severe invasive disease such as meningitis. Meningitis may be caused by invasion of the organism through the blood brain barrier, either via haematological spread or from an adjacent focus of infection such as the ears. We describe two infants with pneumococcal meningitis and silent mastoiditis. They both presented with a classical history to suggest meningitis with no apparent focus of infection. A brain imaging was done in the first infant to look for the underlying cause of his focal seizure and in the second infant, to assess for complications of meningitis, as he had a slow recovery. While they did not have any clinical signs to point towards the diagnosis, they were both diagnosed to have acute mastoiditis from brain imaging. We would like to highlight the importance of brain imaging in excluding silent mastoiditis in infants with meningitis, particularly in those whose clinical course appears atypical.

scholarly journals Effectiveness of Tympanic Thermometry for diagnosing Acute Otitis Media

2019 ◽  
Vol 8 (2) ◽  
pp. 74-78
Author(s):  
Muhammad Zubair ◽  
Ghulam Saqulain ◽  
Arfat Jawaid
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Temperature Difference ◽  
Acute Otitis Media ◽  
P Value ◽  
Upper Respiratory Tract ◽  
Mean Temperature ◽  
Ear Wax ◽  
The Mean ◽  
Group B

Background: Acute Otitis Media (AOM) is a common upper respiratory tract infection (URTI) in children and usually presents with fever and otalgia. AOM is characterized by congested tympanic membrane and possible increase in temperature, which might be picked up by infrared tympanic thermometry. The objective of this study was to compare the temperature difference of tympanic membrane of affected ear with the unaffected ear and axilla in unilateral acute otitis media, and compare it with the control group.Material and Methods: This case control study comprised of 200 cases of both genders, aged up to 5 years. They were divided into two groups; Group A included 100 clinically diagnosed cases of acute otitis media (AOM), who reported in the ENT Outpatient Department (OPD) and Group B included 100 controls who presented in General Filter Clinic with no ear complaints. Cases with chronic ear disease, ear discharge, and use of local drugs including ear drops, impacted ear wax, tragal tenderness and congenital malformations of the ear were excluded by taking a detailed history. Clinical examination including otoscopy by an expert was done before subjecting patients to axillary and tympanic thermometry measurements and data recording. Data was collected and tabulated using Microsoft Excel Worksheet and analyzed by SPSS 16. Qualitative data like gender were presented as percentage and ratio, while means and standard deviation were calculated for the quantitative data. Difference between the means of experimental and control groups were analyzed by independent sample t-test and P value of less than or equal to 0.05 was taken as significant.Results: This study included 100 cases of unilateral AOM and 100 normal controls without AOM. In patients with AOM, the mean temperature difference between the affected ear and axilla was 1.41ºF as compared to 0.075ºF in controls (p=0.026). While the mean temperature difference between the affected ear and other ear was 0.65ºF as compared to 0.19ºF in controls (p=0.069).Conclusion: In acute otitis media, the temperature of affected ear is significantly higher than axilla but was not significantly higher than the other ear. The finding may help establish thermometry as a diagnostic tool in clinics manned by doctors not competent to do otoscopy.

scholarly journals Evidence Update for Clinicians: Narrow- versus Broad-Spectrum Antibiotics for Common Infections in Children

2018 ◽  
Author(s):  
Keyword(s):  
Respiratory Tract ◽  
Broad Spectrum ◽  
Respiratory Tract Infections ◽  
Acute Otitis Media ◽  
Streptococcal Pharyngitis ◽  
Upper Respiratory Tract ◽  
Broad Spectrum Antibiotics ◽  
Group A ◽  
Tract Infections ◽  
Common Infections

Comparing Narrow- vs. Broad-Spectrum Antibiotics for Common Infections in Children. The choice of antibiotic to treat acute bacterial upper respiratory tract infections in children can affect both symptom resolution and the risk of side effects such as diarrhea and vomiting. The findings of a PCORI-funded study published in JAMA can help clinicians treating children for acute respiratory tract infections (ARTIs)—including acute otitis media, Group A streptococcal pharyngitis, and acute sinusitis—make decisions with parents about the medicine that is best for the child. The study, led by Jeffrey Gerber, a pediatrician and researcher at the Children’s Hospital of Philadelphia, included 30,086 children ages 6 months to 12 years taking narrow- and broad-spectrum antibiotics to treat ARTIs.

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