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1/12. Infection of a knee prosthesis with Tsukamurella species.

    A 69-year-old woman with a history of multiple infections of a postoperative wound from a knee replacement was diagnosed with an infection with Tsukamurella sp. The infection was treated with a course of vancomycin and pipercillin/tazobactam, followed by a course of clarithromycin, ciprofloxacin, and ethambutol. The patient responded well. This represents the first report of a Tsukamurella infection of an artificial joint.
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2/12. mediastinitis due to Gordona sputi after CABG.

    Genus Gordona is included in mycolic acid containing bacteria. This genus infection is very rare and occurs classically in immuno-compromised patients. We report a patient who developed mediastinitis due to Gordona sputi after coronary artery bypass grafting (CABG) using left internal mammary artery. Immunocompromised factors were not noticed in this case but postoperative bleeding, the most important risk factor of mediastinitis, was found in his course. The treatment was antibiotic therapy, surgical soft tissue debridement and open irrigation with dilute povidone-iodine solution. However, infectious reaction continued and Gordona sputi repeated cultured from wound. Next procedure, debridement of sternal bone and omental transfer, was performed and skin was closed primarily. Inflammatory reaction was attenuated and the wound was healed Broad debridement and omental transfer were very effective for mediastinitis due to Gordona sputi after CABG.
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3/12. Three cases of arcanobacterium haemolyticum associated with abscess formation and cellulitis.

    arcanobacterium haemolyticum has been described as an unusual pathogen causing pharyngotonsillitis and systemic disease in patients with predisposing conditions. A case of soft tissue abscess with no apparent portal of entry is reported in a healthy 31-year-old man who presented with a breast tumor. A second case of abscess formation in a 50-year-old patient with complicated wound healing is presented. In addition, a case of arcanobacterium haemolyticum cellulitis in a 25-year-old female is reported. Due to its innocuous, coryneform appearance, this pathogen is probably underreported; therefore, the diagnostic evaluation of this organism is emphasized.
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4/12. Chronic scalp wound infection due to rhodococcus equi in an immunocompetent patient.

    A case of chronic scalp wound infection due to rhodococcus equi in an immunocompetent individual following heavily contaminated traumatic injury was successfully treated by combining antibiotics and surgery. The agents used were erythromycin and rifampicin.
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keywords = wound infection, wound
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5/12. bacteremia by Dermabacter hominis, a rare pathogen.

    Dermabacter hominis is a gram-positive, catalase-positive, glucose-fermenting rod, which, as it grows forms small greyish-white colonies with a characteristic pungent odor. Previously known as coryneform Centers for disease Control and Prevention groups 3 and 5, it was catalogued as D. hominis in 1994. Various strains isolated in blood cultures, abscesses, or wounds in the 1970s were retrospectively characterized in referral centers as D. hominis. In this report we describe two patients with severe underlying pathology who developed bacteremias by D. hominis within the context of their clinical pictures.
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6/12. Implantable cardioverter-defibrillator infection caused by Tsukamurella.

    Human infections with Tsukamurella are very rare with only 13 reported cases in the literature. Certain conditions, such as immunosuppression, an indwelling foreign body, and postoperative wounds predispose humans to Tsukamurella infections. The rarity of Tsukamurella infection in humans makes its diagnosis and treatment very difficult. This article describes the first case of implantable cardioverter-defibrillator (ICD) infection related to Tsukamurella in the literature.
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7/12. rhodococcus equi--an emerging human pathogen in immunocompromized hosts: a report of four cases from malaysia.

    rhodococcus equi, a recognized pathogen in horses, is emerging as a human opportunistic pathogen, especially in immunocompromized hosts. We describe four immunocompromized patients who had serious R. equi infections with an overall mortality of 75%. The natural habitat of R. equi is soil, particularly soil contaminated with animal manure. Necrotizing pneumonia is the commonest form of infection but extrapulmonary infections, such as wound infections and subcutaneous abscess, have also been described in humans. R. equi is cultured easily in ordinary non-selective media. Large, smooth, irregular colonies appear within 48 hours. It is a facultative, intracellular, nonmotile, non-spore forming, gram-positive coccobacillus, which is weakly acid-fast staining and bears a similarity to diphtheroids. It forms a salmon-colored pigment usually after 48 hours incubation. A particular characteristic of this organism is that it undergoes synergistic hemolysis with some bacteria on sheep blood agar. R. equi may be misidentified as diphtheroids, mycobacterium species, or nocardia. in vitro R. equi is usually susceptible to erythromycin, ciprofloxacin, vancomycin, aminoglycosides, rifampin, imipenem and meropenem. The organism can be difficult to eradicate, making treatment challenging. Increased awareness of the infection may help with early diagnosis and timely treatment.
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ranking = 169.661460033
keywords = wound infection, wound
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8/12. Infected wounds and repeated septicemia in a case of factitious illness.

    During 19 years an assistant nurse, now 35 years old, has been repeatedly treated for several malingered and self-induced disorders escalating to self-mutilation. An ulcer of her right leg never epithelialised in spite of various local treatments and surgical intervention. During repeated attacks of self-induced septicemia altogether 11 different bacterial species were isolated; on 8 occasions rhodococcus equi. The septicemias were successfully treated with antibiotics. The underlying psychiatric problem, a borderline personality disorder, has not been possible to treat in a conventional manner. Probably due to collaboration between the plastic surgeon and the psychiatrist she has had fewer attendances and shorter hospital stays lately. Her prognosis is still dubious as regards further self-mutilation and other expressions of self-destructive behaviour.
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keywords = wound
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9/12. Characterization of rhodococcus equi-like bacterium isolated from a wound infection in a noncompromised host.

    A case of superficial wound infection in a noncompromised host due to a rhodococcus equi-like organism, acquired from soil, is described. The strain grew poorly at 37 degrees C and showed several differences from wild-type R. equi in biochemical tests and in its fatty acid and mycolic acid compositions.
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ranking = 848.30730016502
keywords = wound infection, wound
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10/12. rhodococcus equi infections of humans. 12 cases and a review of the literature.

    Increased recognition of rhodococcus equi as a human pathogen has occurred since 1983, when the first review article summarized the world's literature of 12 cases. In this article, we present 12 cases from the University of oklahoma health Sciences Center and review 60 from the literature. Most cases occur in immunocompromised hosts and present as chronic cavitary pneumonias. Associated extrapulmonary disease is seen at diagnosis in 7% of patients with pneumonia, and relapse occurs at extrapulmonary sites in 13%, often without reappearance of pulmonary disease. Relapse may follow a course of antimicrobial therapy that is too brief, but can also occur during treatment. Infections also occur in the gastrointestinal tract, causing enteritis and regional adenitis with abscesses. Contaminated wounds may become infected. Isolated bacteremias may be a manifestation of latent infection recurring during a period of immune suppression. A common feature of human R. equi infection is delay in diagnosis. The insidious course of disease contributes to delay, as does failure to identify the organism. R. equi is easily cultured on nonselective media but commonly mistaken for a diphtheroid or occasionally for a mycobacterium based on acid-fast appearance. Form and duration of treatment are closely related to host immune status. Immunocompromised patients require prolonged or indefinite therapy with multiple antibiotics. Infections in immunocompetent hosts are easily treated with short courses of single agents. Infections related to contaminated wounds are treated primarily by irrigation and debridement. Infections in immunocompromised hosts are increasing in frequency largely due the AIDS epidemic. Infections in immunocompetent hosts, reported rarely before this series, may be underdiagnosed, perhaps because R. equi resembles common commensals and has limited virulence in this population. This report demonstrates that R. equi infections, including community-acquired pneumonias, occur in immunocompetent hosts.
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