• Archives of Plastic Surgery
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• 제47권3호
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• pp.228-234
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• 2020

Background A patient's overall condition sometimes does not allow for the complete removal of a dead eschar or injured slough in cases involving a pressure-injury skin lesion. This frequently occurs in clinical practice, particularly in bedridden and older patients receiving home care or intensive care. Even after debridement, it is also difficult to manage open exudative wounds in these patients. Nevertheless, when a mature or immature eschar is treated without proper debridement, liquefaction necrosis underneath the eschar or slough tends to reveal a large, open wound with infectious exudates. We hypothesized that if the presence of any bacteria under the eschar can be evaluated and the progression of the presumed infection of the subeschar can be halted or delayed without creating an open wound, the final wound can be small, shallow, and uninfected. Methods Using a punch instrument, we performed 34 viable subeschar tissue cultures with a secure junction between the eschar and the normal skin. Results The bacterial study had 29 positive results. Based on these results and the patient's status, appropriate antibiotics could be selected and administered. The use of suitable antibiotics led to relatively shallow and small exposed wounds. Conclusions This procedure could be used to detect potentially pathogenic bacteria hidden under black or yellow eschars. Since subeschar infections are often accompanied by multidrug-resistant bacteria, the early detection of hidden infections and the use of appropriate antibiotics are expected to be helpful to patients.

• 대한두개안면성형외과학회지
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• 제13권2호
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• pp.147-150
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• 2012

Purpose: Varicella-zoster virus (VZV) infection is a common childhood disease. However, old and immune compromised patients are also at risk. Necrotizing fasciitis is a life threatening infection of the subcutaneous tissues, rapidly extending along the fascial planes. It is associated with a significant mortality rate, reported between 20% and 50%, and is therefore regarded as a surgical emergency. The authors treated a patient, who developed skin necrosis of her nose and left hemifacial area, following VZV infection. There are few literatures concerning this case; therefore, we present a rare case with review of literature. Methods: A 39-year-old woman had shown a localized, painful, multiple bullae and eschar formation in her nose and left hemifacial area for several days. Her skin lesion had rapidly worsened in size and morphology. Results: We diagnosed her as a necrotizing fasciitis, following herpes zoster, and then we performed a debridement of necrotic tissue and took a full thickness skin graft on her nose and left hemifacial area. Now, she was followed up with acceptable aesthetic result after 6 months. Conclusion: Secondary bacterial skin infection following VZV, can cause a result in a higher risk of complications. Among the complication, a necrotizing fasciitis of the head and neck is uncommon, and involvement of the nose is even more rare. Through this uncommon case report, we intend to emphasize the fact that early diagnosis of necrotizing fasciitis is very important, since it frequently necessitates surgical treatment which improves morbidity and leads to good recovery.

• The Korean Journal of Legal Medicine
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• 제42권4호
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• pp.153-158
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• 2018

Staphylococcus aureus is an important cause of human infections, and it is also a commensal that colonizes the nose, axillae, vagina, throat, or skin surfaces. S. aureus has increasingly been recognized as a cause of severe invasive illness, and individuals colonized with this pathogen are subsequently at increased risk of its infections. S. aureus infection is a major cause of skin, soft tissue, respiratory, bone, joint, and endovascular disorders, and staphylococcal bacteremia may cause abscess, endocarditis, pneumonia, metastatic infection, foreign body infection, or sepsis. The authors describe a case of a fisherman who died of sepsis on a fishing boat during sailing out for fish. The autopsy shows paravertebral abscess, pus in the pericardial sac, infective endocarditis with vegetation on the aortic valve cusp, myocarditis, pneumonia and nephritis with bacterial colonization, and also liver cirrhosis and multiple gastric ulcerations.

• Pediatric Infection and Vaccine
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• 제9권1호
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• pp.104-109
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• 2002

녹농균은 면역질환이 있거나, 기저의 악성질환이 있을 때 주로 감염되며, 건강한 환아에서 감염되는 경우는 흔하지 않다. 저자들은 특별한 면역질환이나 기저질환 없이 녹농균감염이 간, 신장, 피부 등에 다발적으로 발생하여 간농양과 신농양, 신우신염을 동반한 괴저성 농창으로 진단된 1례를 경험하였기에 보고하는 바이다. 괴저성 농창은 조기 진단과 조기 치료가 예후에 중요한데, 본 증례에서는 비교적 조기 진단과 치료가 이루어져 좋은 예후를 보인 것으로 사료된다.

• Clinical and Experimental Pediatrics
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• 제61권6호
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• pp.200-204
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• 2018

Atopic dermatitis (AD) is a chronic inflammatory skin disease in children. Patients with AD experience a high rate of colonization of the skin surface by Staphylococcus aureus. Because of a skin barrier defect, there is a potential risk of staphylococcal invasive infection in patients with AD. Here, we present 2 cases of breast abscess caused by S. aureus in 2 adolescent girls with severe AD. Methicillin-sensitive S. aureus was identified from the breast abscess material. They were treated with appropriate antibiotics, however surgical drainage of the abscess was needed in case 1. Identical strains were found from the breast abscess material as well as the lesional and the nonlesional skin of the patients through matrix-assisted laser desorption/ionization time-of-flight analysis. We characterized the differential abundance of Firmicutes phylum in patients' skin in microbiota analysis. In particular, S. aureus, a member of Firmicutes, differed significantly between the lesional and the normal-appearing skin. Our cases demonstrate the potential severity of bacterial deep tissue infection in AD and the dysbiosis of skin microbiota may be involved in inflammation in AD.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.372-379
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• 2009

Purpose: The purpose of this study was to compare the effect on antibacterial activities and wound healing effect of silver containing dressings with which of Betadine against Staphylococcus aureus and Pseudomonas aeruginosa. Methods: One full thickness skin defects in rats(n=72) were developed on the back and were given rise to infection with S. aureus(n=36) and P. aeruginosa(n=36). The 72 mice were divided into 6 groups : Acticoat$^{(R)}$, Aquacel$^{(R)}$-Ag, Medifoam silver$^{(R)}$, Polymen silver$^{(R)}$, Ilvadon$^{(R)}$ and Betadine(control group) dressing groups. Five silver containing dressings and Betadine were assesed on infected wound. Measurement of wound size change, bacterial colonies count and histologic findings was applied. Antibacterial activity was analyzed with bacterial restricted zone in Mueller Hinton agar. Results: On S. aureus, wound size was more decreased in all treated groups as compared with betadine, however Ilvadon$^{(R)}$ was less decreased on P. aeruginosa. In histologic findings, experimental group showed more effective findings than others on S. aureus, however on P. aeruginosa, which was showed similar. Acticoat$^{(R)}$ was best effective in wound healing against S. aureus and P. aeruginosa. The bacterial colonies count was increased in all treated groups except Acticoat$^{(R)}$ as compared with the control group on S. aureus, which was decreased in Acticoat$^{(R)}$ and Ilvadon$^{(R)}$ group on P. aeruginosa. There were not statistical differences. The restricted zone was shown in Mueller - Hinton agar of all groups except Medifoam silver$^{(R)}$ group on S. aureus, which was shown of all groups on P. aeruginosa. There were statistical differences. Conclusion: This study suggests that silver containing dressings may have not better potential than Betadine in assisting management of wounds at risk of infection on S. aureus and P. aeruginosa. However, which have better antibacterial activity on S. aureus and P. aeruginosa.

• Archives of Plastic Surgery
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• 제34권5호
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• pp.551-556
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• 2007

Purpose: Pseudomonas aeruginosa is an etiologic agent in serious wound infection. Pseudomonas aeruginosa infection is problematic because this organism is resistant to many antimicrobial drugs. The purpose of this study was to compare the bactericidal effect of commonly used topical agents and their effect on wound healing. Methods: Pseudomonas aeruginosa-infected full-thickness skin defect was developed on the mouse to compare 3 commonly used topical agents-Betadine, 2% Gentamicin solution and 0.3% Acetic acid with the control group. Wound size change, bacterial colony counts and histologic findings of each groups were analyzed. Results: The wound size decreased in all treated groups as compared with the control group. However, there was no statistical difference. Gentamicin solution group was showed the lowest bacterial colony count and statistically significant difference compared with the control group(p=0.032). Other treated groups were also effective against Pseudomonas aeruginosa, but not different statistically. Histologic findings revealed that epithelialization, granulation tissue formation and microvessel proliferation were increased and necrosis and inflammation were decreased in all treated groups compared to the control group, but not different statistically. Betadine group significantly increased granulation tissue formation compared to the control group (p= 0.041). Conclusion: There is no universal topical agent that enhances most aspects of wound healing while simultaneously decreasing the bacterial concentration. However, Gentamicin solution may be an optimal topical agent for Pseudomonas aeruginosa infected wound. Further study should experiment on human with Gentamicin solution to confirm a effect on Pseudomonas aeruginosa infected wound for clinical applications.

• Pediatric Infection and Vaccine
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• 제12권2호
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• pp.208-212
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• 2005

포진상 습진(eczema herpeticum)은 헤르페스의 가장 심한 양상 중 하나로서, 아토피 피부염 등이 있는 피부에 HSV가 감염되어 발생하며 치명적일 수 있다. 포진상 습진은 HSV의 1차 감염 뿐만 아니라 2차 감염에 의해서도 발생할 수 있다. 포진상 습진에서 2차성 세균 감염은 흔하게 발생하는데, 황색포도상구균이 가장 흔하게 분리되는 호기성 균주이다. 포진상 습진의 치료에 중요한 점은 전신적인 항바이러스 치료를 빨리 시작하고 2차적인 세균 감염을 줄이기 위해 항균제를 사용하는 것이다. 저자들은 지속적인 아토피 피부염으로 인해 한방 치료를 받던 환아에게서 중증 포진상 습진이 발생한 2례를 화상 드레싱 및 항바이러스제 치료로 호전을 보인 경험을 하여 이를 보고하는 바이다.

• 한국임상수의학회지
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• 제32권5호
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• pp.445-448
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• 2015

5개월령 코리안 숏헤어 새끼 고양이(몸무게 1.7 kg)가 상부호흡기 증상, 얼굴과 발/발바닥의 궤양과 부종 및 파행을 주증으로 내원하였다. 실험실 검사상, 백혈구감소증, 림프구 감소증, 췌장염 및 칼리시바이러스 감염증이 확인되었다. 진단은 고독성 칼리시바이러스 감염증에 대한 특이 임상증상과 PCR을 통한 칼리시바이러스 동정 및 다른 상부호흡기 감염을 배제함으로써 내려졌다. 상부호흡기 증상완화와 이차 감염에 대한 처치 및 보조요법을 약 한 달간 실시하였고, 환자는 이러한 치료를 통해 임상증상이 크게 개선되었다. 본 증례는 고독성 고양이 칼리시바이러스에 대한 첫 번째 발병증례이다.

• 한국어병학회지
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• 제30권2호
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• pp.97-105
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• 2017

Parasitic leeches could directly (through causing poor growth, anemia and wound in the fish) and indirectly (by predisposition of the fish to secondary bacterial and fungal infections) affects their hosts. In the present study, fishes that were attacked by leeches in natural and experimental environment were studied. Pathologic samples were obtained from damages at the site of leech bite, as well as kidney and liver of the fish. Histopathological examination revealed numerous lesions at the site of leech bite including tissue demolition, detachment at the site of leech bite in the epidermis of epithelial tissue in the skin, destructed nucleus in epithelial cells of the skin plus necrosis in the damaged skin and weak inflammatory penetration to acute necrotic damages along with piercing dermis layer. Pathologic lesions in the kidney included some changes such as proliferation by increasing glomerular cells and membrane cells in capillary vein of the kidney, blood cell necrosis in kidney with infiltration of white blood cells mainly mononuclear and less polymorphonuclear which are the symptoms of anemia due to blood feeding and sucking by leeches. There was also a chronic kidney infection probably originated from another part of body such as skin. Moreover, leeches caused hemorrhagic anemia due to blood consumption of the hosts, which led to observation of immature red blood cells. Also results showed that diseases induced by leeched in fish could be acute or chronic, which depends on size of fish, species of leech and severity of infection.