Bed bugs: clinical relevance and control options.

Jan 2012

Doggett SL, Dwyer DE, Peñas PF, Russell RC.

Source

Department of Medical Entomology, ICPMR, Westmead Hospital, Westmead, New South Wales, Australia. Stephen.Doggett@swahs.health.nsw.gov.au

Abstract

Since the late 1990s, bed bugs of the species Cimex lectularius and Cimex hemipterus have undergone a worldwide resurgence. These bed bugs are blood-sucking insects that readily bite humans. Cutaneous reactions may occur and can start out as small macular lesions that can develop into distinctive wheals of around 5 cm in diameter, which are accompanied by intense itching. Occasionally, bullous eruptions may result. If bed bugs are numerous, the patient can present with widespread urticaria or eythematous rashes. Often, bites occur in lines along the limbs. Over 40 pathogens have been detected in bed bugs, but there is no definitive evidence that they transmit any disease-causing organisms to humans. Anemia may result when bed bugs are numerous, and their allergens can trigger asthmatic reactions. The misuse of chemicals and other technologies for controlling bed bugs has the potential to have a deleterious impact on human health, while the insect itself can be the cause of significant psychological trauma. The control of bed bugs is challenging and should encompass a multidisciplinary approach utilizing nonchemical means of control and the judicious use of insecticides. For accommodation providers, risk management procedures should be implemented to reduce the potential of bed bug infestations.

Clinical Microbiology Reviews

**Very serious infective event for lymphedema patients**

Google Images

Bedbugs - Mayo Clinic

Tick bite and early Lyme borreliosis.

Christopher J A Duncan, research fellow12, George Carle, general practitioner3, R Andrew Seaton, consultant in infectious diseases and general (internal) medicine1

Author Affiliations

1Brownlee Centre for Infection, Tropical Medicine and Counselling, Gartnaval Hospital, Glasgow G12 0YN, UK

2Sir William Dunn School of Pathology, Oxford OX1 3RE, UK

3Kyles Medical Centre, Tighnabruaich, Argyll PA21 2BE, UK

Correspondence to: C J A Duncan chrisduncan@doctors.net.uk

Accepted 6 February 2012

A 48 year old man removed two ticks attached to his leg while walking in the Scottish Highlands. A week later he develops a rash and consults you worried about Lyme disease.

Link only to article:  BMJ

Most Important Chronic Complications of Arteriovenous Fistulas for Hemodialysis.

Nov 2012

Stolic R.

Source

Faculty of Medicine, University of Pristina, Kosovska Mitrovica, Serbia.

Abstract

The aim of this review was to highlight the most important complications of arteriovenous fistulas (AVFs) for hemodialysis (HD). The quality of vascular access for HD should be suitable for repeated puncture and allow a high blood flow rate for high-efficiency dialysis with minimal complications. The dialysis staff must be well versed in manipulation of the AVF, and there should be a minimal need for corrective interventions. Construction of an AVF creates conditions for increasing the flow of blood through the venous system. Fulfillment of these conditions reduces the risk of turbulence and endothelium injury, which, in turn, minimizes the potential for stenosis. An AVF is closest to the ideal model of vascular access. The most important complications of fistulae for HD are lymphedema, infection, aneurysm, stenosis, congestive heart failure, steal syndrome, ischemic neuropathy and thrombosis. In HD patients, the most common cause of vascular access failure is neointimal hyperplasia. It is important to gain information about early clinical symptoms of AVF dysfunction in order to prevent and adequately treat potential complications.

Karger

Incidence of deep vein thrombosis in erysipelas or cellulitis of the lower extremities.

Aug 2012

Mortazavi M, Samiee MM, Spencer FA.

Source

Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

Abstract

The incidence of deep vein thrombosis (DVT) in patients with erysipelas and cellulitis of the lower extremities is unknown. As such, the indication and efficacy of prophylactic anticoagulation for prevention of DVT in these patients is unclear. The main goal of this review is to provide an estimate of the incidence of DVT in erysipelas and cellulitis based on existing literature. A comprehensive search of the electronic sources: MEDLINE, EMBASE, CINAHL, LILAC and Cochrane without any language limitation was performed from 1950 to April 2011 for articles focused on the occurrence of DVT in cellulitis or erysipelas of the lower extremities. The selected studies were divided into two groups according to presence or absence of systematic investigation for DVT. Those studies in which the patients received prophylactic or therapeutic anticoagulants before a diagnosis of DVT were excluded. The reported incidence rate of DVT in patients with erysipelas or cellulitis of the lower extremities is highly variable, ranging from 0 to 15%. In this review, the overall incidence rates of DVT in studies with and without systematic investigation for thromboembolism were 2.72% (95% CI: 1.71-3.75%) and 0.68% (95% CI: 0.27-1.07%), respectively. Given the low reported overall incidence of DVT, neither routine prophylactic anticoagulation nor systematic paraclinical investigation for DVT is indicated in low risk patients with erysipelas or cellulitis of the lower extremities. DVT should still be considered in patients with high pretest probability or other thromboembolic risk factors.

PubMed

A case of streptococcal toxic shock syndrome due to Group G streptococci identified as Streptococcus dysgalactiae subsp. equisimilis.

Feb 2012

Nei T, Akutsu K, Shima A, Tsuboi I, Suzuki H, Yamamoto T, Tanaka K, Shinoyama A, Kojima Y, Washio Y, Okawa S,Sonobe K, Norose Y, Saito R.

Source

Division of Intensive Care Unit and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan, takahitonei@gmail.com.

Abstract

A 79-year-old man with a 3-month history of lymphedema of the lower limbs, and diabetes mellitus, was admitted to our hospital for suspected deep venous thrombosis. Several hours after admission, leg pain and purpura-like skin color appeared. On the 2nd hospital day, he was referred to our department for possible acute occlusive peripheral artery disease (PAD) and skin necrosis with blisters; however, computed tomography with contrast showed no occlusive lesions. He had already developed shock and necrotizing deep soft-tissue infections of the left lower leg. Laboratory findings revealed renal dysfunction and coagulation system collapse. Soon after PAD was ruled out, clinical findings suggested necrotizing deep soft-tissue infections, shock state, disseminated intravascular coagulation, and multiple organ failure. These symptoms led to a high suspicion of the well-recognized streptococcal toxic shock syndrome (STSS). With a high suspicion of STSS, we detected Group G β-hemolytic streptococci (GGS) from samples aspirated from the leg bullae, and the species was identified as Streptococcus dysgalactiae subsp. equisimilis (SDSE) by 16S-ribosomal RNA sequencing. However, unfortunately, surgical debridement was impossible due to the broad area of skin change. Despite adequate antimicrobial therapy and intensive care, the patient died on the 3rd hospital day. The M-protein gene (emm) typing of the isolated SDSE was revealed to be stG6792. This type of SDSE is the most frequent cause of STSS due to GGS in Japan. We consider it to be crucial to rapidly distinguish STSS from acute occlusive PAD to achieve life-saving interventions in patients with severe soft-tissue infections.

Springerlink

Lower limb cellulitis and its mimics: part II. Conditions that simulate lower limb cellulitis.

Aug 2012

Hirschmann JV, Raugi GJ.

Source

Department of Dermatology, Veterans Affairs Puget Sound Health Care System and the University of Washington School of Medicine, Seattle, Washington 98108, USA. gregory.raugi@va.gov

Abstract

Several common conditions can mimic cellulitis, creating a potential for misdiagnosis and incorrect management. The most common disorders mistaken for lower limb cellulitis include venous eczema, lipodermatosclerosis, irritant dermatitis, and lymphedema. The dermatologist is often consulted when a patient has failed to respond to therapy, and a thorough knowledge of the differential diagnosis is essential. This article focuses on entities that can mimic cellulitis, with an emphasis of elements of the history and physical examination that can help to distinguish between lower limb cellulitis and its simulators.

J A A D 

Infections Associated with Lymphedema

BY JOACHIM ZUTHER, ON OCTOBER 29TH, 2010

There are numerous reasons why patients with lymphedema are at an increased risk for infections. Normally the body is protected by a fine acid layer on the surface of the skin, which prevents bacteria and other pathogens from entering. However, the skin in lymphedema tends to be dry and scaly, causing a disruption of the protective acid layer, or if deepened skin folds are present, moisture collecting in these folds may create a breeding ground for bacteria. The fact that the swelling present in lymphedema causes a disruption of the local immune defense in the affected tissues further complicates this situation. Once bacteria are able to enter lymphedematous tissue, protein and accumulated waste products present in lymphedema provide an ideal breeding ground for infection. Due to the swelling, even in minimal lymphedema, the body’s natural defense cells may not be able to fight these invaders sufficiently.

The initial onset of lymphedema, as well as the worsening of present lymphedema is frequently associated with the occurrence of infections. It is thought that these infections result in increased fibrosis of lymph vessels and lymph nodes, thus further complicating lymphedema.

Remainder of Article:

Lymphedema Blog

Editor's Note:  I am including this article not only because of the quality of the information, but as an introduction to one of the best lymphedema information sites available.  The blog was founded and is maintained by Joachm Zuther of the Academy of Lymphatic Studies.    You really need to include this blog in your list of reading sites.  Pat O'Connor