Pedro Gargantilla

Recurrent infection in the left thumb

IntroductionInfections of the hand may be associated with lymphangitis and lymphadenitis. In most cases, bacterial infections are responsible but these may be also due to viral infections.Material and MethodsWe describe a clinical case of a recurrent infection in the left thumb of a health male. Bacterial and viral cultures were performed.ResultsHerpes simplex virus (HSV) type 2 was isolated on viral culture and on direct fluorescent antibody testing; so, the final diagnosis was herpetic whitlow.ConclusionsHerpetic whitlow should be considered in cases of recurrent finger infections.

Hand, foot and mouth disease in an adult

A 41-year-old healthy male presented with a 3-day history of high-grade fever (40 °C) followed by painful sores in his mouth, tongue and throat along with odynophagia. Two days after the fever appearance, he felt pain and burning sensation in the distal part of his fingers and toes with appearance of a macular rash in distal parts of both hands. He denied any significant medical or surgical history, having taken medications, and had no allergies. Family history revealed the patient’s 2-year-old daughter recently had H.F.M.D. from an outbreak at her daycare. On physical exam, he presented with an erythematous and swollen pharynx with some sores around the soft palate, tonsils and tongue (Fig. 1) and multiple reddish purpuric macules on the tips of fingers bilaterally (Fig. 2). There were no lesions found when his feet were examined. He was diagnosed with the hand, foot and mouth disease (HFMD) and received symptomatic therapy with NSAID. Skin lesions healed within 14 days with slight scaling (Fig. 3). Hand, foot and mouth disease (HFMD) or vesicular stomatitis exanthema is an acute viral infection produced by enteroviruses: mainly Coxsackievirus A16 (CV-A16) and Enterovirus 71 (EV-A71) [1]. In the recent years, other enteroviruses such as CV-A6 and CV-A10 have been widely associated with both sporadic cases and outbreaks of HFMD worldwide [2–4]. Children younger than 5 years are often affected, because they do not yet have immunity (protection) to those viruses. The main way of transmission of this infection is through nose and throat secretions (such as saliva, sputum, or nasal mucus), and blister fluid [1, 6]. In children, the disease usually presents with vesicles or ulcers in the oral cavity occurring chiefly on the buccal mucosa and tongue, and also blisters in hands, feet and buttocks. This illness is typically mild, and nearly all people recover in 7–10 days without medical treatment. Complications are uncommon [1, 6]. Only 1% of infected adults develop clinical manifestations. In the last decade, there have been several reports about HFMD happening in adults with atypical clinical manifestations. Vesiculobullous lesions are generally localized in the perioral and perinasal areas of the face, but also on the scalp. Palmar purpuric maculae is a typical feature in adult patients and it is the clinical expression of vesicles more deeply located in the epidermis, probably due to the greater thickness of the palmoplantar epidermis. [5, 7–9]. Virological confirmation of virus involved can be obtained either from saliva, throat and nasal secretion and feces [5]. Our patient’s differential diagnoses included herpangina, varicella and erythema multiforme. We considered that typical clinical manifestations and epidemiological history was

Early ventriculoperitoneal shunt infection

cultures were positive for Staphylococcus aureus. The isolates were susceptible to penicillin, co-trimoxazole, oxacillin, erythromycin, levofloxacin and vancomycin; resistant to gentamicin (determined by minimum inhibitory concentration in μg/mL). Empiric treatment was started with 600 mg of linezolid twice daily and 2 g IV every 8 h of meropenem which was changed to cloxacillin 2 g IV q 4 h after antibiogram results. After 15 days with antibiotics and 2 new CSF culture negatives, he underwent a new ventriculoperitoneal shunt without complications. Implantation of the ventriculoperitoneal shunt is the most widely used treatment for hydrocephalus. VP shunt infection is one of the most important and common complications [1]. Shunt infection rates per patient range from 10 to 22 % and around 6.0 % per procedure, with 90 % of infections occurring within 30 days of surgery. These events are mostly attributable to normal skin flora such as coagulase-negative staphylococci, S. aureus and Propionibacterium acnes, which are thought to be introduced at the time of surgery although Gram-negative organisms and Candida species have also been reported [2, 3]. In contrast to native meningitis, shunt-associated infections often presented with nonspecific clinical signs and symptoms (e.g., fever), whereas typical neurological manifestations—such as neck stiffness, headache, and nausea— were present in less than one-half of the episodes. Local signs of infection were present in half of episodes including erythema, local pain, swelling, and/or purulent wound discharge [3–5].

Reacción exantemática y conjuntivitis en inmigrante joven

tis. En ocasiones, en fases iniciales de la aparicion del exantema puede confundirse con la rubeola1. Aunque diferentes autores durante la segunda mitad del siglo XIX hacian referencias a lesiones blanquecinas en la mucosa oral en pacientes con sarampion, fue el pediatra americano Henry Koplik2 quien en 1896 publico un articulo sobre este tipo de lesiones que son patognomonicas del sarampion y que desde entonces se conocen como manchas de Koplik3,4. Estas manchas suelen aparecer en las fases iniciales de la infeccion5 y desaparecer poco despues que aparezca la erupcion cutanea. Ocasionalmente a nivel oral y gingival pueden aparecer otro tipo de lesiones6. En Espana, con el establecimiento de la vacunacion masiva contra el sarampion incluida en los calendarios vacunales a finales de la decada de 1980, la tasa de casos de sarampion ha ido disminuyendo de tal forma que en 2001 se inicia el plan de eliminacion del sarampion en Espana7. En los ultimos anos, se ha visto un ligero incremento en el numero de casos y en especial en la poblacion adulta joven8. Caso clinico