RESUMO
Musculoskeletal soft tissue infections are not uncommonly encountered in both the clinic and Emergency Department setting. The clinical diagnosis is not always evident as these infections can have variable presentations depending on the duration and depth of disease extension through the soft-tissue layers. Imaging often plays an important role in diagnosing the infection, defining the extent of involvement, directing tissue sampling, and in monitoring treatment response. After initial radiographs, ultrasound (US) is often the next modality utilized to evaluate patients with suspected soft tissue infections given its low cost, availability, portability, and potential for real-time guidance of fluid aspiration. The widespread use of cross-sectional imaging with magnetic resonance imaging (MRI) and computed tomography (CT) has greatly increased the radiological diagnosis in conditions where US may be limited. In addition, CT and MRI allow a thorough evaluation of disease extension, including assessment of joint spaces, tendons, and osseous changes indicative of bone involvement. This review will focus on the radiological findings of soft tissue infections on US, CT, and MRI.
Assuntos
Doenças Musculoesqueléticas/diagnóstico por imagem , Infecções dos Tecidos Moles/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Doenças Musculoesqueléticas/microbiologia , Infecções dos Tecidos Moles/microbiologiaRESUMO
Objective Leprosy has rarely been the subject of health psychology research despite its substantial impact. Our aim was to explore illness perceptions in patients and their health care providers in Surinam. The Common Sense Model (CSM) was the guiding theoretical model. Design Patients with biomedically cured leprosy and their health care providers completed the B-IPQ and took part in semi-structured interviews. The literature on illness perceptions in patients with leprosy was reviewed. Main outcome measures Patients' B-IPQ scores were compared with samples of patients with other (chronic) illnesses, and with health care providers completing the questionnaire as if they were visibly disfigured patients. Quotations from the semi-structured interviews were used to contextualise the illness perceptions. Results Patients' B-IPQ scores reflected the chronic nature of leprosy and were comparable with those with other chronic illnesses. Health care providers perceived leprosy to have a greater negative impact than did the patients. Perceived understanding of causes differed considerably between patients and health care providers. Conclusion Leprosy continues to be experienced as an illness with major psychological and social consequences such as stigmatisation, even after biomedical cure. Interventions that target patients, health care providers, and society at large may help reduce perceived shame and stigma. The CSM is a helpful theoretical model in studying this population.
Assuntos
Doença Crônica/psicologia , Hanseníase/psicologia , Efeitos Adversos de Longa Duração/psicologia , Doenças Musculoesqueléticas/psicologia , Adulto , Idoso , Feminino , Humanos , Hanseníase/complicações , Hanseníase/terapia , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/microbiologia , Percepção , Pesquisa Qualitativa , Estigma Social , Suriname , Inquéritos e Questionários , Fatores de TempoRESUMO
BACKGROUND: Infections of the musculoskeletal system are a devastating complication for patients, due to it's long rehabilitation process and even sometimes the removal of the implant, the chronicity of infection, is often due to lack of coverage in empirical antibiotics. METHODS: A retrospective, observational, descriptive cohort study was performed. All cultures form musculoskeletal system infected patients reported of sensitivity and resistance of germs isolated were analyzed. RESULTS: A total of 143 positive results were included. Reported more frequent germ Staphylococcus aureus accounted for 75 positive cases, followed by Escherichia coli with 31 positive results. Antibiotics with better sensitivity according to the type of microorganisms were trimethoprim-sulfamethoxazole and vancomycin, levofloxacin and linezolid, gentamicin, erythromycin and amikacin. Regarding antibiotic resistance, those reported with the highest percentage were penicillin G, amoxicillin with clavulanic acid and ampicillin. CONCLUSIONS: We recommend using empirical treatments in musculoskeletal system infections, trimethoprim-sulfamethoxazole are the best choice because they have the same sensitivity compare with vancomycin and a resistance rate of 7.6%. Betalactamics have a high percentage of resistance and low sensitivity so we must consider alternatives.
Introducción: las infecciones de sistema musculoesquelético son una complicación grave para el paciente, debido a que prolongan el tiempo de recuperación y pueden llegar al retiro del implante o a la cronicidad de la infección con gasto excesivo para la institución y desgaste para el paciente y su familia. Métodos: estudio observacional en cirugías limpias programadas por patología crónicadegenerativa en el 2015. Se seleccionaron 225, que fueron reportadas como infectadas, a las que se les realizó cultivo. Se revisó la sensibilidad y resistencia de los microorganismos aislados con mayor frecuencia. Resultados: se incluyeron los cultivos y antibiogramas realizados a 225 pacientes, cumpliendo criterios de selección 143 resultados positivos. Se reportó Staphylococcus aureus, y Escherichia coli. Los antibióticos con mejor sensibilidad de acuerdo al tipo de microorganismos fueron trimetoprim-sulfametoxazol y vancomicina, levofloxacino y linezolid, gentamicina, eritromicina y amikacina. Respecto a la resistencia antibiótica, los de mayor porcentaje fueron la penicilina, amoxicilina con ácido clavulánico y ampicilina. Conclusiones: en las infecciones del sistema musculoesquelético estudiadas con cultivo y antibiograma, los dos microorganismos con mayor incidencia fueron S. aureus y E. coli, mostrando una mayor sensibilidad antibiótica para el trimetoprim-sulfametoxazol, muy similar a la vancomicina, así también el TMP-SMX mostró una resistencia baja. Los betalactámicos mostraron un alto porcentaje de resistencia y baja sensibilidad.
Assuntos
Antibacterianos/farmacologia , Resistência Microbiana a Medicamentos , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/microbiologia , Bactérias Gram-Positivas/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/microbiologia , Doenças Musculoesqueléticas/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/tratamento farmacológico , Estudos RetrospectivosRESUMO
CONTEXT: The incidence of staphylococcal infection has been increasing during the last 20 years. OBJECTIVE: Report a case of staphylococcal endocarditis preceded by musculoskeletal manifestations, which is a rare form of clinical presentation. DESIGN: Case report. CASE REPORT: A 45-year-old-man, without addictions and without known previous cardiopathy, was diagnosed as having definitive acute bacterial endocarditis due to Staphylococcus aureus. Its etiology was community-acquired, arising from a non-apparent primary focus. In addition, the musculoskeletal symptoms preceded the infective endocarditis (IE) by about 1 month, which occurred together with other symptoms, e.g. mycotic aneurysms and petechiae. Later, the patient showed perforation of the mitral valve and moderate mitral insufficiency with clinical control.
Assuntos
Endocardite Bacteriana/complicações , Dor Lombar/microbiologia , Doenças Musculoesqueléticas/microbiologia , Infecções Estafilocócicas/complicações , Endocardite Bacteriana/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Staphylococcus aureus/crescimento & desenvolvimentoRESUMO
CONTEXT: The incidence of staphylococcal infection has been increasing during the last 20 years. OBJECTIVE: Report a case of staphylococcal endocarditis preceded by musculoskeletal manifestations, which is a rare form of clinical presentation. DESIGN: Case report. CASE REPORT: A 45-year-old-man, without addictions and without known previous cardiopathy, was diagnosed as having definitive acute bacterial endocarditis due to Staphylococcus aureus. Its etiology was community-acquired, arising from a non-apparent primary focus. In addition, the musculoskeletal symptoms preceded the infective endocarditis (IE) by about 1 month, which occurred together with other symptoms, e.g. mycotic aneurysms and petechiae. Later, the patient showed perforation of the mitral valve and moderate mitral insufficiency with clinical control
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/complicações , Doenças Musculoesqueléticas/microbiologia , Dor Lombar/microbiologia , Endocardite Bacteriana/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/crescimento & desenvolvimento , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/tratamento farmacológico , Dor Lombar/diagnóstico , Dor Lombar/tratamento farmacológico , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológicoRESUMO
A case of phaeohyphomycosis with subcutaneous abscesses involving skin, muscle and bone was caused by Exophiala spinifera. This is the first report of E. spinifera causing bone degeneration in Recife-PE, Brazil.