Skin and Soft Tissue Infections in the Surgical Area at the Kara Teaching Hospital

Objective: To report the management of skin and soft tissue infections in the surgical area of Kara University Hospital in Togo. Material and Methods: This study was conducted retrospectively from January 1, 2021, to December 31, 2022, in the general surgery and orthopedic trauma departments. The study focused on soft tissue infections of the pelvic and thoracic limbs and analyzed epidemiological, clinical, paraclinical, therapeutic, and evolutionary data. Results: We registered 165 patients, comprising 109 men and 56 women.The sex ratio (F/H) were 0.51. The mean age was 45 years with extremes ranging from 23 to 90 years. Farmers (64.8%) followed by housewives (34.0%) were the social strata most affected. The consultation period varied between 1 and 90 days. The pathologies found were necrotizing fasciitis (53.3%), erysipelas (18.2%), infected limb wounds (12.1%), pyomyositis (9.7%), and necrotizing dermo-hypodermitis (1.8%). The main procedures performed were necrosectomy and grafting (62.9%), sample necrosectomy (18.8%), drainage (9.7%), and pelvic limb amputation (1.2%). Follow-up was favorable in 86.7% of cases. The study noted a death rate of 13.3% due to septic shock secondary to a delay in consultation. Conclusion: Skin and soft tissue infections were a common reason for surgical hospitalization at Kara University Hospital, with a high mortality rate due to delayed consultations.

Chronic Pain Management after Necrotizing Soft Tissue Infection (NSTI): A Case Report

Background: Necrotizing soft tissue infections (NSTIs) are potentially life threatening medical emergencies associated with devastating and rapidly spreading destruction of soft tissues. Atypical presentations and delayed early diagnosis can be significant challenges in managing NSTIs. The infectious process can start at any part of the body with rapid progression leading to limb amputation and high mortality rate. We present a case of a patient with NSTI, the sequelae and management of the chronic pain that developed. Aim: This case report looks to shed light on the importance of a plan for management of subacute and chronic pain in treating patients who present with Necrotizing soft tissue infection. Case presentation: A 53-year-old female who presented with septicemia and was subsequently admitted and treated for NSTI in 2014 resulting in amputation of her distal foot, toe digits, and now with ongoing chronic wound of the lower extremities along with chronic pain. Conclusion: Chronic pain as part of the sequelae of Necrotizing soft tissue infections needs to be anticipated by the health care management team in order to optimize patient care post operatively.

Necrotizing Soft Tissue Infections of the Male and Female Breast: A Literature Review

Background: Within the spectrum of necrotizing soft tissue infections (NSTI), necrotizing fasciitis (NF) has been characterized by tissue and fascial necrosis with systemic toxicity. The objective was to determine and summarize the frequency and characteristics of breast NF and NSTI in the literature. Methods: Cases were obtained through PubMed, Google Scholar, Google, and from published article reference sections. One hundred twenty-three cases were gleaned from 96 articles that reported NF and NSTI of the breast (1924 through 2021). Results: NF was reported in 70 and NSTI in 53 cases (111 women and 12 men). Patients presented with swollen, painful breasts, erythema, bullae, crepitus, necrosis, gangrene, fever, tachycardia, and neutrophilia. Fifty-nine of 123 (48.4%) patients were septic on admission. The most frequent microorganisms were β hemolytic Group A Streptococcus, and Staphylococcus aureus. Treatment consisted of antibiotics, mastectomy and debridement with flaps, skin grafts or primary and secondary closure. Forty-four (63.0%) of the NF cases had chest wall involvement;of these, 18 (14.6%) involved the breast secondarily, P < 0.0001. There were twelve mortalities (9.8%): eleven (9.0%) with NF and one (0.8%) with NSTI, P = 0.007. Conclusions: Men and women with breast NF and NSTI presented with similar signs and symptoms and required the same emergent treatment as provided for NF and NSTI of the more common sites. As a time-sensitive disease, patients treated within 12 hours of admission had a better survival. Patients with NF were more likely to have sepsis on admission, a higher mortality, and fascial chest wall/muscle involvement than patients with NSTI.

The clinical characteristics and risk factors for necrotizing soft tissue infection in children

Importance:Necrotizing soft tissue infection(NSTI)is a serious infectious disease.However,the early clinical manifestations and indicators of NSTI in children are still unclear.Objective:The purpose of this study was to analyze the clinical characteristics and risk factors of NSTI in pediatric patients.Methods:A total of 127 children with skin and soft tissue infection(SSTI)were treated at our hospital and divided into two groups:the NSTI group and the non-NSTI group,based on their discharge diagnosis from January 2011 to December 2022.Then,we collected and analyzed the clinical characteristics and risk factors of all patients,including sex and age,disease inducement,admission temperature,local skin manifestations,infection site,the presence of sepsis,bacterial culture,and laboratory indicators.Results:In our study,there was a statistical difference in the age distribution and disease inducement between NSTI and non-NSTI groups.The occurrence of local skin manifestations(blisters/bullae and ecchymosis)and the presence of sepsis significantly increased in the NSTI group compared to the non-NSTI group.Additionally,only the platelet count on laboratory tests was statistically different between the NSTI and non-NSTI groups.Finally,the logistic regression analysis suggested that local skin manifestations such as blisters/bullae,and ecchymosis,as well as the presence of sepsis,were identified as risk factors for NSTI.Interpretation:Children with SSTI and skin manifestations such as blisters/bullae,ecchymosis,and the presence of sepsis are at a higher risk of developing NSTI.These symptoms serve as useful indicators for early detection of NSTI.

Molecular Epidemiology of Staphylococcus aureus among Patients with Skin and Soft Tissue Infections in Two Chinese Hospitals

Background：Staphylococcus aureus is one of the predominant causes of skin and soft tissue infections （SSTIs）,but limited data were available regarding the characterization of S.aureus from SSTIs patients in Jiangsu Province in China.We aimed to investigate the molecular epidemiology ofS.aureus among SSTIs patients in two hospitals of Jiangsu Province.Methods：Sixty-two patients with SSTIs from two Chinese hospitals in Jiangsu Province were enrolled in this study,and 62 S.aureus isolates were collected from February 2014 to January 2015.S.aureus isolates were characterized by antimicrobial susceptibility testing,toxin gene detection,and molecular typing with sequence type,Staphylococcus protein A gene type,accessorygeneregulator（agr）group,and Staphylococcal cassette chromosome mec type.Results：Sixteen （25.8%） methicillin-resistant S.aureus （MRSA） isolates were detected,and there was no isolate found resistant to vancomycin,teicoplanin,sulfamethoxazole-trimethoprim,and linezolid.The sei was the toxin gene most frequently found,and no lukS/F-PV-positive isolates were detected among the SSTIs＆#39; patients.Molecular analysis revealed that ST398 （10/62,16.1%;2 MRSA and 8 methicillin-susceptible S.aureus） to be the dominant clone,followed by ST5 （8/62,12.9%） and ST7 （8/62,12.9%）.Conclusions：The livestock ST398 was the most common clone among patients with S.aureus SSTIs in Jiangsu Province,China.Surveillance and further studies on the important livestock ST398 clone in human infections are necessarily requested.

Soft tissue tuberculosis detected by next-generation sequencing:A case report and review of literature

BACKGROUND Soft tissue tuberculosis is rare and insidious,with most patients presenting with a localized enlarged mass or swelling,which may be factors associated with delayed diagnosis and treatment.In recent years,next-generation sequencing has rapidly evolved and has been successfully applied to numerous areas of basic and clinical research.A literature search revealed that the use of next-generation sequencing in the diagnosis of soft tissue tuberculosis has been rarely reported.CASE SUMMARY A 44-year-old man presented with recurrent swelling and ulcers on the left thigh.Magnetic resonance imaging suggested a soft tissue abscess.The lesion was surgically removed and tissue biopsy and culture were performed;however,no organism growth was detected.Finally,Mycobacterium tuberculosis was confirmed as the pathogen responsible for infection through next-generation sequencing analysis of the surgical specimen.The patient received a standardized anti-tuberculosis treatment and showed clinical improvement.We also performed a literature review on soft tissue tuberculosis using studies published in the past 10 years.CONCLUSION This case highlights the importance of next-generation sequencing for the early diagnosis of soft tissue tuberculosis,which can provide guidance for clinical treatment and improve prognosis.

Risk stratification system for skin and soft tissue infections after allogeneic hematopoietic stem cell transplantation:PAH risk score

Skin and soft tissue infections(SSTIs)refer to infections involving the skin,subcutaneous tissue,fascia,and muscle.In transplant populations with hematological malignancies,an immunocompromised status and the routine use of immunosuppressants increase the risk of SSTIs greatly.However,to date,the profiles and clinical outcomes of SSTIs in hematopoietic stem cell transplantation(HSCT)patients remain unclear.This study included 228 patients(3.67%)who developed SSTIs within 180 days after allogeneic HSCT from January 2004 to December 2019 in Peking University People’s Hospital.The overall annual survival rate was 71.5%.We compared the differences between survivors and non-survivors a year after transplant and found that primary platelet graft failure(PPGF),comorbidities of acute kidney injury(AKI),and hospital-acquired pneumonia(HAP)were independent risk factors for death in the study population.A PPGF-AKI-HAP risk stratification system was established with a mortality risk score of 1×PPGF+1×AKI+1×HAP.The areas under the curves of internal and external validation were 0.833(95%CI 0.760–0.906)and 0.826(95%CI 0.715–0.937),respectively.The calibration plot revealed the high consistency of the estimated risks,and decision curve analysis showed considerable net benefits for patients.

Aeromonas hydrophila infection in acute myeloid leukemia: A case report

Rationale:Aeromonas hydrophila,a bacterium commonly found in a variety of soils,aquatic habitats,and other natural environments,is known for causing infections and hemorrhagic diseases in both aquatic and terrestrial animals.Patients with leukemia,when infected by Aeromonas hydrophila following chemotherapy,face an increased risk of developing necrotizing fasciitis.Patient concerns:A 48-year-old male with a history of acute myeloid leukemia presented with swelling and pain in his right hand after being stabbed by a grass carp two days ago.The injury occurred on the fifth day after his last chemotherapy session when he was accidentally punctured in the right thumb and ring finger by a carp while fishing.Two days following the injury,the skin isurrounding the wound turned black immediately,while the rest of his hand was reddened,swollen,and bleeding.Diagnosis:Aeromonas hydrophila infection in the soft tissue of the right hand.Interventions:Intravenous antibiotics and local debridement.Outcomes:The patient experienced an alleviation of systemic poisoning symptoms,effective control of the local wound infection.Lessons:It is important for physicians to appreciate the potential for highly unusual and life-threatening infections in patients with acute myeloid leukemia.Early diagnosis and prompt treatment can prevent the development of necrotizing fasciitis and save patients’lives.

Sepsis after Administering an Intramuscular Iron Injection in the Arm of an Elder Patient with Multiple Comorbidities: A Case Report

Background: Skin reactions and musculoskeletal injuries caused by intramuscular injection are an increased risk for skin and soft tissue infections and may culminate in sepsis. Objective: To describe the history of an elderly patient who developed a lesion in her right arm after home administration of intramuscular iron injection in this arm and its outcome. Methods: This is a case report of a patient who participated in a study in an intensive care unit. Results: This study describes a 65-year-old patient with multiple comorbidities who was admitted to the hospital complaining of pain for two months and difficulty in moving her right shoulder associated with skin and soft tissue infections in her right arm after intramuscular iron administration by a relative for the treatment of multifactorial anemia and refractory melena. The patient worsened her general condition and was transferred to the intensive care unit. Despite the therapy instituted, the patient developed sepsis of cutaneous origin, multiple organ dysfunction, and death. Conclusions: The administration of intramuscular medication requires the participation of qualified professionals, such as nurses, mainly within the scope of the Brazilian public health system which commonly comprises patients in a context of vulnerability.

The ever-changing microenvironment of Staphylococcus aureus in cutaneous infections

Background:Staphylococcus aureus is responsible for the majority of skin and soft tissue infections,which are often diagnosed at a late stage,thereby impacting treatment efficacy.Our study was designed to reveal the physiological changes at different stages of infection by S.aureus through the combined analysis of variations in the skin microenvironment,providing insights for the diagnosis and treatment of S.aureus infections.Methods:We established a murine model of skin and soft tissue infection with S.aureus as the infectious agent to investigate the differences in the microenvironment at different stages of infection.By combining analysis of the host immune status and histological observations,we elucidate the progression of S.aureus infection in mice.Results:The results indicate that the infection process in mice can be divided into at least two stages:early infection(1–3 days post-i nfection)and late infection(5–7 days post-i nfection).During the early stage of infection,notable symptoms such as erythema and abundant exudate at the infection site were observed.Histological examination revealed infiltration of numerous neutrophils and bacterial clusters,accompanied by elevated levels of cytokines(IL-6,IL-10).There was a decrease in microbial alpha diversity within the microenvironment(Shannon,Faith's PD,Chao1,Observed species,Simpson,Pielou's E).In contrast,during the late stage of infection,a reduction or even absence of exudate was observed at the infected site,accompanied by the formation of scabs.Additionally,there was evidence of fibroblast proliferation and neovascularization.The levels of cytokines and microbial composition gradually returned to a healthy state.Conclusion:This study reveals synchrony between microbial composition and histological/immunological changes during S.aureus-i nduced SSTIs.

Multi-limb necrotizing fasciitis in a patient with rectal cancer

Necrotizing fasciitis is a devastating soft tissue infection affecting fascias and subcutaneous soft tissues. Literature reviews have identified several related risk factors, including malignancy, alcoholism, malnutrition, diabetes, male gender and old age. There are only scanty case reports in the literature describing its rare association with colorectal malignancy. All published cases are attributed to bowel perforation resulting in necrotizing fasciitis over the perineal region. Isolated upper or lower limb diseases are rarely identified. Simultaneous upper and lower limb infection in colorectal cancer patients has never been described in the literature. We report an unusual case of multi-limb necrotizing fasciitis in a patient with underlying non-perforated rectal carcinoma.

Complex Limb Salvage with Placental-Based Allografts: A Pilot Study

Background: Commercially available human placental amnion/chorion tissue allografts have been successfully used as protective treatment barriers for wounds and diabetic ulcers. Burn and traumatic limb injuries with exposed bone or tendon generally require surgical flaps or amputations for healing. The purpose of this study was to determine if dehydrated human amnion/ chorion membrane allografts (dHACM) with decellularized human collagen matrix (dHCM) could be used to salvage injured human extremities. Methods and Materials: dHACM/dHCM was topically applied to the wounds after debridement. Negative Pressure Wound Therapy (NPWT) was concurrently initiated, primarily to bolster the tissue with moisture and contamination control. Approximately every seven days, wounds were re-evaluated for granulation tissue growth response. As needed, patients received dHACM/ dHCM and NPWT in the outpatient or home care settings after discharge. Results: Fifteen males and two females (26 extremities) were treated for fourteen burn and three Necrotizing Soft Tissue Infections (NSTI) injuries. Closure was observed in patients after two to five dHACM/dHCM applications. The dHACM/dHCM treatment was initiated: (median) 17-days after injury;NPWT for 17-days;autograft or primary closure after 21-days;discharge 25-days after the first application. Conclusion: Treatment with human placental-derived allografts provided a protective covering that enabled the healing cascade to generate granulation tissue formation in extremity wounds with exposed tendon and/or bone. In select limb salvage cases, dHACM/dHCM treatment may be a promising alternative to amputations, tissue rearrangements, free tissue flaps or other techniques for resolution of extremity wounds with bone and tendon exposure.

Three novel homozygous ITGB2 mutations among two patients with leukocyte adhesion defect type-1:Two case reports

BACKGROUND A leukocyte adhesion defect(LAD) is a rare primary immunodeficiency disorder. LAD type 1(LAD-1) is the most common, which is caused by ITGB2 mutation resulting in dysfunction of β2 integrin, which impairs leukocyte adherence to the endothelium.CASE SUMMARY The first two cases of LAD-1 in Thailand presented with recurrent omphalitis, soft tissue infection, marked leukocytosis, and neutrophilia. One patient experienced delayed umbilical cord separation. Mutation analysis was performed by direct DNA sequencing of the ITGB2 gene. The results revealed two novel homozygous missense mutations, c.920C>T(p.Leu307Pro) in exon 8 and c.758G>A(p.Arg-253His) in exon 7, and one novel homozygous nonsense mutation, c.262C>T(p.Gln88Ter) in exon 4, in the genomic DNA of the first and second patients, respectively. Heterozygous mutations were identified in the parents of both patients, suggesting a carrier status. The patients were administered intravenous antibiotics for infections with good clinical responses. Hematopoietic stem cell transplantation could not be performed due to the unavailability of matched donors. However, a significant decline in infections was observed after antibiotic prophylaxis. Several follow-up visits were conducted for both patients. They are currently 6 years old.CONCLUSION Molecular analysis is essential for definitive diagnosis, early treatment implementation, and prevention of LAD-1 in future pregnancy.

Formulation and Evaluation of Yemeni Potash Alum as Hydrophilic Topical Preparations against Candidiasis and Aspergillosis

Background:Skin and soft tissue infections are frequent.Candidiasis and Aspergillosis are the most common cutaneous fungal infections.Yemeni alum(Aluminium Potassium Sulphate)is a natural mineral with antifungal and antibacterial properties.Objective:This study aimed to confirm Yemeni alum’s antifungal effectiveness against selected fungal strains and develop useful topical formulations.Methods:Using different alum concentrations,we prepared twenty-three formulations,including four non-adjusted aqueous solutions,eight adjusted pH aqueous solutions,eight glycerite solutions,and three Oil/Water cream formulations.Then,we examined the antifungal activity against the suggested fungus.The animal skin irritation test evaluated the local skin sensitivity reactions that might happen upon using the formulations we pre-pared on the intact animal’s skin.Additionally,this study also included six weeks of stability testing to estimate the expected shelf life(t90)of the selected formulations.Results:Alum exerted antifungal effect against Candida albicans,Aspergillus niger,and Aspergillus flavus.The animal’s skin was not irritated by any of the formulations examined.The 5%alum aqueous solution and the 10%alum Oil/Water cream exhibited promising results among all tested formulations.The approximate formulation’s shelf-lives(t90)were 2 and 1.52 years with alum content(%)ranging between 105.75%to 106.02%,respectively.Conclusion:Based on the results we found,10%alum Oil/Water cream is a promising formulation for large-scale manufacture.