[Epidemiological study of obligatory reportable diseases of low incidence in Spain. I. Carbuncle].
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Animals↗
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[Human carbuncle (anthrax) Presentation of a case].
A case of human anthrax in a 12-month-old child is presented. Most recent literature and pathophysiology of this disease was reviewed. Our attention was called upon patient's age, rarity of this disease in our country and mainly, the form of presentation which difficulted the clinical and laboratory diagnosis. It was characterized by the presence of pustules over the entire surface of the body, with respiratory and neurological manifestations. Diagnosis was made on the basis of cultures of skin lesions and treatment was done with sodium crystalline penicillin and later, potassium V penicillin. Progress was satisfactory and the patient was discharged after 24 days of hospital stay.
Anthrax↗
[Pathomorphosis of renal carbuncle].
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Adult↗
Association of furunculosis and familial deficiency of mannose-binding lectin.
BACKGROUND: Polymorphisms in the mannose-binding lectin gene reduce serum mannose-binding lectin levels and are associated with enhanced risk of infection. In a family with recurrent staphylococcal disease presenting as furunculosis or carbuncles, an association with mannose-binding lectin deficiency was investigated. MATERIALS AND METHODS: Levels of functional mannose-binding lectin were estimated and the genotypes of the mannose-binding lectin gene were analysed on blood samples, collected from the members of one particular family with a high prevalence of furunculosis. RESULTS: Functional mannose-binding lectin levels in sera of 13 of the 28 members of one family showed deficiency. Furunculosis or carbuncles appeared to be present in nine of the 28 family members, seven of which showing the pBly allele and mannose-binding lectin deficiency. Four young family members of the second generation were pBly positive and mannose-binding lectin deficient, but had not shown furunculosis yet. CONCLUSION: Members of a particular family suffering from furunculosis differ from their 'healthy' relatives as to mannose-binding lectin genotypes, indicating the relevance of normal mannose-binding lectin levels in the defence against staphylococcal disease.
Adolescent↗
[A historical survey of diphtheria in Europe, China and Japan. Part I: ancient and medieval age].
The history of diphtheria has not yet been fully studied. The author presents two cases of diphtheria from the Hippocratic collection. It is presumed that a tracheotomy was performed in one of them. The author presents the ancient Chinese names of diphtheria, Houbi (Kōhi) which means "laryngeal obstruction", Mengju (Mōso) which means "fulminant carbuncle" and Yaoju (Yōso) which means "children-killing carbuncle", from Chinese medical classics, and suggests that Shaoyinbing (Shōinbyō) which means "small negative disease", in Shanghanlun (Shōkanron) is possible to be diphtheria. In the Medieval Age (6-15c.), so many records and commentaries are found in Chinese medical books, which describe diphtheria by many different names, such as Mabi (Bahi), Chanhoufeng (Tenkōfū), Datoubing (Daitōbyō) and so on. Mabi means fulminant diphtheria. Chanhoufeng means strangling disease, which coincides with the old Spanish name of diphtheria "Garrotillo." Datoubing means "big head disease" which represents the swelling of face and neck in malignant diphtheria, and which coincides with the English vulgar name "Bull-neck." Japan also has some descriptions about diphtheria in medical books and chronicles of the Kamakura-Muromachi Age (13-15c.), which use the words Houbi (Kōhi), Houzhong (Kōshu) etc. for diphtheria.
China↗
[On the traditional surgery of Choson period (II)].
In this paper, authors discussed the classification of swelling (Chong), swelling-treatment methods (Chi-Chong) in Choson period, traditional notions about the natural history, treatment principles, popular healing methods of swelling, and depicted specially designed acupuncture instruments applied to it. Among the six professional guide books at that time, A Secret Recipe of Swelling Treatment (16th century) introduced the invasive surgical method into the narrow disease category i.e. carbuncle and furuncle, cellulitis, erysipelae, and gravitation abscess. The writer named these diseases as 'fire, stone, water, hemp, silk carbuncle', following each specific characteristics. Another surgical book, Orientation to Swelling Treatment (16th century) extended the surgical method to 'non-external' but 'looks-like swelling' diseases, such as pleurisy, tympanitis, testicular swelling, sequestrum of osteomyelitis. It is natural that some researchers doubted whether the book was used in real practice. However, the content of the book is too detailed to be regarded as an imaginary product. From these books and other materials, we found that the traditional notion of swelling was closely related with the notions of 'knotted' or 'pent in'. So 'pent-up rancor' or grudge was thought to aggravate any kind of swelling, and was tabooed or contraindicated in swelling treatment. 'Knotting in mind' was regarded as one of the principal etiologies of 'swelling and abscess formation in the body'. 'Fire in mind' was also regarded as one of the causes of phlegm aggregation resulting in swelling.
Abscess↗
Skin and soft tissue infection.
Abstract. Normal skin is heavily colonized by bacterial flora. The most common are the various nonpathogenic gram-positive bacteria such as Staphylococcus epidermidis (coagulase-negative). Skin and soft tissue infections are usually caused by Staphylococcus aureus (S. aureus) and Streptococcus pyogenes. This article discusses common and some not so common bacterial skin infections, including impetigo, folliculitis, furncles and carbuncles, cellulitis and erysipelas, gangrenous cellulitis, staphylococcal scalded skin syndrome and scarlet fever. Impetigo and ecthyma are common bacterial infections of the skin commonly caused by S. aureus and / or Group A streptoccus. In mild and localized impetigo topical antibiotics whereas in widespread or severe one and in ecthyma systemic antibiotics like, cloxacillin, erythromycin, azithromycin or cephalexin should be used. Folliculitis, furunculosis and carbuncle are folliculocentric infections caused by S. aureus involving the variable depth and extent of the follicle(s) and surrounding tissue. These conditions can be treated with topical or systemic antibiotics like cloxacillin, cephalexin, erythromycin, amoxicillin/clavulanic acid or vancomycin. Staphylococcal scalded skin syndrome is a toxin mediated exfoliative dermatosis caused by S. aureus of phase group II. Intravenous penicillinase-resistant anti-staphylococcal antibiotics like methicillin, cloxacillin, cephalosporin or erythromycin are required. Erysipelas and cellulitis are acute infections of dermal and subcutaneous tissues caused most frequently by Group A beta-hemolytic streptococci (erysipelas) or S. aureus requiring systemic antibiotics like oral or intravenous penicillin, erythromycin, cephalexin, cloxacillin, vacomycin, minocycline or ciprofloxacin depending upon the severity, suspected causative organism and culture/sensitivity results. Gangrenous cellulitis is characterized by infection with necrosis of skin and underlying subcutaneous tissue due to various pathogens occurring at different site. Ampicillin, gentamicin, and either metronidazole or clindamycin intravenously in standard doses are recommended for the treatment.
Cellulitis↗
Common bacterial skin infections.
Family physicians frequently treat bacterial skin infections in the office and in the hospital. Common skin infections include cellulitis, erysipelas, impetigo, folliculitis, and furuncles and carbuncles. Cellulitis is an infection of the dermis and subcutaneous tissue that has poorly demarcated borders and is usually caused by Streptococcus or Staphylococcus species. Erysipelas is a superficial form of cellulitis with sharply demarcated borders and is caused almost exclusively by Streptococcus. Impetigo is also caused by Streptococcus or Staphylococcus and can lead to lifting of the stratum corneum resulting in the commonly seen bullous effect. Folliculitis is an inflammation of the hair follicles. When the infection is bacterial rather than mechanical in nature, it is most commonly caused by Staphylococcus. If the infection of the follicle is deeper and involves more follicles, it moves into the furuncle and carbuncle stages and usually requires incision and drainage. All of these infections are typically diagnosed by clinical presentation and treated empirically. If antibiotics are required, one that is active against gram-positive organisms such as penicillinase-resistant penicillins, cephalosporins, macrolides, or fluoroquinolones should be chosen. Children, patients who have diabetes, or patients who have immunodeficiencies are more susceptible to gram-negative infections and may require treatment with a second- or third-generation cephalosporin.
Cellulitis↗
[Syndrome differentiation and typing of traditional Chinese medicine and the clinical efficacy in 148 cases of acne vulgaris].
To differentiate and type the acne vulgaris patients and to treat them with our own recipes for dissipating heat and detoxifying in traditional Chinese medicine 148 cases were typed and trated as: carbuncles and stasis (84 cases), carbuncles and damp 'toxins' (16) and damp 'toxins' and stasis (48) as well as the contrast groups of 60 patients that treated with chemical medicines. The results were: cured 86 cases (58%); significantly effective 38 cases (26%); effective 18 cases (12%); and ineffective 6 cases (4%). The contrast groups had the results of: cured 10 (17%), significantly effective 14(23%), effective 21(35%) and ineffective 15(25%). The total effective rates of both groups were 96 and 75% (P < 0.01). Following the principles of traditional Chinese medicine in differentiating and typing the acne vulgaris patients and treating them accordingly with recipes of dissipating heat and detoxifying, dissipating heat and drying the dram, eliminating the stagnant and detoxifying is an effective treatment for clinic application.
Acne Vulgaris↗
[Retrospective diagnosis of anthrax by intradermal reaction].
The authors report a detailed study of utilization of a skin test with anthraxin to perform a retrospective diagnosis of anthrax in humans who suffered from anthrax 45 days to 31 years after recovery. For a total of 884 persons studied, 762 showed a positive skin test (86.2%). This index was 92.8% for persons tested 45 days to 3 years after convalescence, 82.8% 4 to 15 years after convalescence and 72.7% 16-31 years after recovery. The site of the primary carbuncle on the skin of the fingers, hands, face and neck gave an index of positivity (88.2%) statistically greater (p = 99%) than by localization of the carbuncle on arms, forearms, trunk and legs (77.3%).
Adult↗
[Unusual presentation of urinary tract infection in 6 cases].
Urinary tract infections may have different clinical presentations that may range from asymptomatic bacteriuria to purulent collections and severe sepsis. We report 6 diabetic patients, 3 presenting with a renal carbuncle and 3 with an emphysematous pyelonephritis. All required medical and surgical treatment and had a good evolution. Two carbuncles were caused by beta- hemolytic type B streptococcus. This is the second notification of this agent as causative of renal abscesses, probably reaching the kidney through hematogenous dissemination from cutaneous foci.
Abscess↗
[Pristinamycin versus oxacillin in the treatment of superficial pyoderma. A multicenter randomized study in 293 outpatients].
BACKGROUND: Superficial pyoderma occurs frequently. Generally, the benign infection is caused by Staphylococcus aureus and/or a group A streptococci. The subject is controversial, but treatment usually is based on narrow-spectrum antibiotics active against both germs. PATIENTS AND METHODS: A multicentric, randomized, double-blind, double-placebo study was conducted to compare pristinamycin (1 g b.i.d.) with a reference antibiotic, oxacillin (1 g b.i.d.) for 10 days. Inclusion criteria were: both sexes, age 15-80 years, clinical diagnosis of superficial pyoderma (impetigo, wound infection within the last 15 days, furunculosis, carbuncle, perionyxis), informed consent. The general practitioner investigators (n = 52) were assisted by 9 dermatologist-coordinators. Clinical diagnosis was validated by a committee of experts at the end of the study after analyzes of the photos and bacteriological results obtained on samples taken at the practitioner's office on visit 1 (D0), visit 3 (D14 +/- 3) and visit 4 (D25 +/- 3). Successful treatment was defined by clinical, bacteriological and photographic efficacy at visit 3 (equivalence analysis: one-way 95 p. 100 confidence interval). RESULTS: There were 293 included patients given pristinamycin (n = 151) or oxacillin (n = 142). Mean age of analyzed patients was 40 +/- 17 years. Diagnosis was confirmed in 255 patients in accordance with the protocol: furunculosis or carbuncle (n = 100), recently superinfected wound (n = 97), impetigo (n = 41), acute perionyxis (n = 17). Thirty-five patients (12 p. 100) were considered to have been wrongly included. The germs most often isolated were: Staphylococcus aureus (n = 126), group A streptococci (n = 13), group B streptococci (n = 5) and P. multocida (n = 3). At visit 3, the two treatments were found to be equivalent with a success rate of 86.7 p. 100 for pristinamycin and 89.8 p. 100 for oxacillin (CI [*9.97]). Tolerance was statistically comparable between the two treatments (27 to 32 percent minor side effects). DISCUSSION: This study is the first performed in outpatients attended by general practitioners with diagnostic confirmation on both bacteriological and photographic evidence of superficial pyoderma. The results obtained demonstrate the good reliability of such studies although 12 p. 100 of the patients were wrongly included, a factor which should be taken into account for future studies. The efficacy and tolerance of pristinamycin were statistically equivalent to those of oxacillin for all the patients with superficial pyoderma. Nevertheless, the subgroup of patients with folliculitis gave rather heterogeneous bacteriology and therapeutic results.
Adolescent↗
Percutaneous aspiration of renal cortical abscess.
Two patients with renal cortical abscesses were treated successfully by an intensive antibiotic regimen together with percutaneous aspiration, rather than by the conventional treatment of open drainage, which often is followed by secondary nephrectomy. This adaptation of percutaneous aspiration to the management of renal carbuncle coincides with a change in the causative microorganism which today is often a gram-negative coliform rather than a hematogenously borne staphylococcus, which usually complicates some pre-existing abnormality in the urinary tract.
Abscess↗
Primary cutaneous nocardiosis in an immune-competent patient.
We present a patient who was hospitalized due to a purulent skin lesion with a surrounding erythematous area in the region of the right paranasal crease accompanied by a swelling of the right eyelid. Initially the diagnosis of a carbuncle caused by an infection with Staphylococcus aureus was supposed. A surgical debridement was performed and an antibiotic therapy was started. Only special microbial investigations requested by the clinician led to the diagnosis of a cutaneous infection with Nocardia brasiliensis. The presented case is remarkable because the nocardia infection was in an immune-competent patient and the patient showed a primary cutaneous nocardiosis without dissemination.
Amoxicillin↗
[A case of anthrax in a dog (author's transl)].
A case of anthrax in a dog is described. The origin of infection, clinical symptoms and post mortem changes are discussed. B. anthracis was found in the carbuncle of the stomach wall, mesenterial lymphnodes, blood, liver and kidney.
Animals↗
Surgical infection in art.
The earliest images of medicine and surgery in Western art are from the late Middle Ages. Although often attractive, at that time they were illustrative and mirrored the text on how to diagnose or treat a specific condition. These drawings in medieval manuscripts represent management of abscesses, perianal infection and fistulas, amputation, and wound dressings. With the Renaissance, art in all its forms flourished, and surgeons were represented at work draining carbuncles, infected bursae, and mastoiditis; managing ulcers, scrofula, and skin infections; and performing amputations. Specific diagnosis can be made, such as streptococcal infection in the discarded leg of the miraculous transplantation performed by Saints Cosmas and Damian and in the works of Rembrandt van Rijn and Frederic Bazille. Evocations of cytokine activity are evident in works by Albrecht Dürer, Edvard Munch, and James Tissot. The iconography of society's view of a surgeon is apparent and often not complimentary. The surgeon's art is a visual art. Astute observation leads to early diagnosis and better results in surgical infection and the septic state. Learning to see what we look at enhances our appreciation of the world around us but, quite specifically, makes us better clinicians.
Abscess↗
Occipital lesions: a possible cost of cradleboards.
This examination of a Mimbres-Mogollon pueblo skeletal sample reveals a surprising percentage of individuals with occipital lesions. Each lesion is located in the approximate center of the squama immediately superior to the external occipital protuberance. Notably, no child over the age of 1 year exhibits a lesion that would have been active at the time of death, but a number of older children and adults exhibit evidence of healed lesions in this same area on the occipital. The restricted nature of these lesions, in terms of both their locations and ages of those actively affected, suggests that the use of cradleboards may have been at least a contributing, if not initiatory, factor in their creation. Specifically, this study suggests that the pressure and friction of an infant's head against a cradleboard may have 1) produced ischemic ulcers, 2) produced the conditions favorable for bacterial infections such as impetigo or carbuncles, or 3) complicated the treatment of other infections appearing on the back of the scalp.
Anthropology, Physical↗
Cellular pharmacology studies of shikonin derivatives.
The naphthoquinone pigment, shikonin, isolated from Lithospermum erythrorhizon Sieb. et Zucc.(Boraginaceae) and its derivatives are the active components isolated from the Chinese herbal therapeutic, Zicao. Historically, Zicao root extracts have been used to treat macular eruption, measles, sore-throat, carbuncles and burns. Multiple pharmacological actions have been attributed to shikonin, e.g. antiinflammatory, antigonadotropic and anti-HIV-1 activity. In this review, several therapeutic applications of shikonin will be summarized including its pleiotropic, antiinflammatory and antitumour effects. Widely diverse and sometimes conflicting activities have been attributed to shikonin, e.g. wound healing, enhanced granuloma formation, suppression of local acute inflammatory reactions, inhibition of angiogenesis, inhibition of select chemokine ligands, inhibition of DNA topoisomerase activity, inhibition of platelet activation and antimicrobial activity. Comparison of the various reported mechanisms of action for shikonin lead us to hypothesize that shikonin is an effective inhibitor of protein-protein interaction with multiple targets in both the intracellular and extracellular compartments. This general inhibitory effect can account for the broad spectrum of shikonin biological and pharmacological activities.
Animals↗