Association of Necrotizing Wounds Colonized by Maggots with Ignatzschineria-Associated Septicemia.
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ABSTRACT:
SUBMITTER: Le Brun C
PROVIDER: S-EPMC4593450 | biostudies-literature | 2015 Oct
REPOSITORIES: biostudies-literature
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Association of Necrotizing Wounds Colonized by Maggots with Ignatzschineria-Associated Septicemia.
Le Brun Cécile C Gombert Martin M Robert Sylvie S Mercier Emmanuelle E Lanotte Philippe P
Emerging infectious diseases 20151001 10
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Project description:Myiasis is caused by the presence of dipterous larvae in humans and animals. It is usually associated with poor hygienic conditions. A urologist rarely comes across myiasis. We report a case of myiasis around a recently placed nephrostomy tube. A 55-year-old male farmer from a rural area underwent right percutaneous nephrolithotomy. The procedure was terminated because of bradycardia and arrhythmia. There were residual calculi. A nephrostomy was kept. His relook nephroscopy was planned, but he was not willing. Hence, he was discharged with an indwelling nephrostomy tube. Two weeks later, he presented with severe pain around the right nephrostomy tube with surrounding pruritus. The wound hygiene was poor. He was found to have maggots around the nephrostomy tube. These were treated by local instillation of turpentine oil and oral and topical ivermectin, followed by manual removal of the maggots.
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Project description:BackgroundChronic kidney disease, including end-stage renal disease, has been identified as a possible risk factor for primary septicemia and wound infection by Vibrio vulnificus. However, cases of severe septicemia, necrotizing fasciitis, and peritonitis caused by V. vulnificus in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) have not been described. We report a case of severe septicemia, necrotizing fasciitis, and peritonitis due to V. vulnificus in a patient undergoing CAPD after ingesting raw seafood.Case presentationA 37-year-old woman undergoing CAPD was admitted to the emergency room due to general weakness, fever, diarrhea, and abdominal pain. Although empirical intraperitoneal antibiotics were administered for the diagnosis of CAPD-related peritonitis, her fever did not subside. On hospital day 3, she had hemorrhagic bullae on both lower legs. We evaluated her recent food history, and found that she ate raw seafood before admission. She underwent emergency fasciotomy on the suspicion of necrotizing fasciitis by V. vulnificus infection. Finally, V. vulnificus was confirmed by 16S ribosomal ribonucleic acid gene sequencing using blood and peritoneal effluent fluid cultures. The administration of intraperitoneal ceftazidime and intravenous ciprofloxacin/ceftriaxone was continued for 4 weeks, and the patient completely recovered.ConclusionsSuspicion of V. vulnificus infection in vulnerable patients who ingest raw seafood is essential for prompt diagnosis, which could significantly improve patient outcomes.
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