A 13-year-old girl presented with multiple skin abscesses. She was diagnosed as having juvenile dermatomyositis (DM) at the age of 7 years. She had suffered from recurrent skin infections, atypical pruritic dermatitis and pneumonia since the age of 8 years. Bacteriologic and fungal cultures for skin abscesses and oral mucosa were positive S. aureus and C. albicans, respectively. Chemotactic defect in peripheral blood neutrophils was observed. The level of serum IgE was markedly elevated, and anti-S.aureus specific IgE was found. A diagnosis of hyperimmunoglobulin E-recurrent infection syndrome (HIE) was made and she was successfully treated with surgical drainage and antibiotics. To our knowledge, this is the first case report of HIE in a patient with juvenile dermatomyositis.
Adolescence ; Case Report ; Dermatomyositis/complications* ; Female ; Human ; IgE/blood ; Job's Syndrome/immunology ; Job's Syndrome/diagnosis ; Job's Syndrome/complications* ; Staphylococcal Infections/immunology ; Staphylococcal Infections/complications ; Staphylococcus aureus/immunology

Methicillin resistant Staphylococcal aureus (MRSA) enterocolitis is characterized by high fever, abdominal distension, and watery diarrhea that leads to severe dehydration, shock, a sharp decrease in the white cell counts and sometimes multiple organ failure. Clinically, it can be an another cause of nosocomial diarrhea. If MRSA enteritis is suspected from the clinical symptoms, prompt treatment and strict prophylactic measures including vancomycin, are most important for its management. We recently observed a case of MRSA enterocolitis as a nosocomial infection in a patient with acute pancreatitis. This patient showed uncontrolled massive diarrhea, fever, and multiple organ failure. We report a case of MRSA enterocolitis with a review of literatures.
Cross Infection/diagnosis/*microbiology ; Diarrhea/etiology/*microbiology ; Enterocolitis/complications/diagnosis/*microbiology ; Humans ; Male ; *Methicillin Resistance ; Middle Aged ; *Staphylococcal Infections/diagnosis

We report a case of eczema herpeticum associated with secondry staphylococcal infection in a 19 year-old male patient with Dariers disease during tratment with etretinate. Diagnosis was made by the history, clinical feature and histologic examination with light microscope & electron microscope. This patients condition was improved by the treatment with systemic and topical antibiotics within 1 week of admission.
Acitretin* ; Anti-Bacterial Agents ; Darier Disease ; Diagnosis ; Eczema* ; Etretinate* ; Humans ; Kaposi Varicelliform Eruption* ; Male ; Staphylococcal Infections ; Young Adult

Primary community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) endocarditis has rarely been reported in healthy individuals without risk factors, such as skin and soft tissue infections, and intravenous drug abuse. We describe a case of infective endocarditis by CA-MRSA (ST72-PVL negative-SCCmec IVA) in previously healthy individuals with no underlying medical condition and CA-MRSA colonization in the family.
Adult ; Community-Acquired Infections/microbiology/transmission ; Endocarditis/*microbiology ; Family ; Female ; Humans ; *Methicillin Resistance ; Staphylococcal Infections/*diagnosis/drug therapy/*transmission ; Staphylococcus aureus/*drug effects

INTRODUCTIONCommunity-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged worldwide. In contrast to healthcare-associated MRSA (HA-MRSA), CA-MRSA isolates are usually susceptible to multiple non-beta-lactam antibiotics and cause a distinct spectrum of infections in epidemiologically disparate populations - in particular, cutaneous abscesses, necrotising fasciitis and necrotising pneumonia. They arise from a broader genetic background, and possess differing virulence genes. We aim to describe the distribution of different molecular subtypes of CA-MRSA among various regions and discuss briefly the implications of CA-MRSA from a local perspective.

METHODSLiterature review of articles on CA-MRSA, focusing mainly on reports where the genetic background of isolates had been analysed using multi-locus sequence typing (MLST). Singapore data were obtained from the local CA-MRSA database.

RESULTSMLST analysis demonstrated the presence of epidemic subtypes of CA-MRSA within most geographic areas. In parts of the United States, community MRSA infections currently exceed those caused by their methicillin-susceptible counterparts. In Singapore, CA-MRSA infections are increasing, predominantly as a result of the spread of ST30 clones.

CONCLUSIONAvailable evidence suggests that the emergence of MRSA from the community is not going to be a transient phenomenon. Local guidelines for dealing with this phenomenon at both therapeutic and preventive levels are needed prior to the potential development of a situation mirroring that of meso-endemic HA-MRSA in local hospitals or CA-MRSA epidemics in parts of USA.

Bacterial Typing Techniques ; Community-Acquired Infections ; epidemiology ; microbiology ; Cross Infection ; diagnosis ; microbiology ; Humans ; Methicillin Resistance ; Risk Factors ; Singapore ; epidemiology ; Staphylococcal Infections ; epidemiology ; microbiology ; Staphylococcus aureus ; classification ; drug effects

BACKGROUND AND OBJECTIVES: Abscess of neck is a life-threatening disease in children. Detection of abscess is important because it is essential for the determination of surgical drainage. However, clinical diagnosis is difficult, because children are seldom able to verbalize their symptoms or cooperate with physical examination. This study aims to review the clinical characteristics of 157 pediatric patients with neck inflammation and investigate the relative risk factors for abscess. SUBJECTS AND METHOD: Pediatric patients who were admitted to Dongguk University Hospital from January 2005 to July 2014 with acute neck inflammation were reviewed. All 157 pediatric patients were divided into two groups, based on radiologic findings with and without neck abscess. RESULTS: Of 157 patients, 53 children were diagnosed with neck abscess, and peritonsillar abscess was the most common type of neck abscess followed by submandibular abscess, retro·parapharyngeal abscess and posterior triangle & other abscess. The dominant pathogens, staphylococcal infection (≤2 yr) and streptococcal infection (>3 yr), was different for the different age group. The abscess group except for peritonsillar abscess was characterized by younger age, higher heart rate and WBC count, and longer hospital days than those without abscess (p=0.026, 0.026, <0.001, 0.007 respectively). Multivariate analysis revealed younger age (≤24 mo) and higher heart rate were independent predictors for abscess formation (odds ratio: 3.022, 2.923). CONCLUSION: Pediatric patients with high heart rate & younger age are at risk for abscess formation; meticulous care and early imaging work up are required in younger children with deep neck infection, and especially with higher heart rate.
Abscess* ; Child ; Diagnosis ; Drainage ; Heart Rate ; Humans ; Inflammation ; Methods ; Multivariate Analysis ; Neck* ; Peritonsillar Abscess ; Physical Examination ; Risk Factors ; Staphylococcal Infections ; Streptococcal Infections

Pyogenic spondylitis involving only the posterior element of a vertebra is rare. To the best of our knowledge, there have been no reports of osteomyelitis of the transverse process. We report here on a 45-year-old male with a one month history of swelling associated with lower back pain. The magnetic resonance imaging showed a paraspinal soft tissue mass, and computed tomography revealed a fine osteolytic lesion in the right transverse process of the 5th lumbar spine, and this was all consistent with chronic osteomyelitis. A mixed staphylococcal infection was identified. Open drainage, resection of the transverse process and intravenous injection of anti-staphylococcal antibiotics resolved the back pain and reduced the erythrocyte sedimentation rate to normal. Pyogenic osteomyelitis of the transverse process is extremely rare, which can cause a misdiagnosis or a delayed diagnosis. Careful consideration of this disease is needed when evaluating patients who complain of back pain.
Chronic Disease ; Humans ; *Lumbar Vertebrae ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteomyelitis/*diagnosis/therapy ; Spinal Diseases/*diagnosis/therapy ; Staphylococcal Infections/*diagnosis/therapy ; Tomography, X-Ray Computed

Facet joint injection is considered to be a safe procedure. There have been some reported cases of facet joint pyogenic infection and also 3 cases of facet joint infection spreading to paraspinal muscle and epidural space due to intra-articular injections. To the author's knowledge, paraspinal and epidural abscesses after facet joint injection without facet joint pyogenic infection have not been reported. Here we report a case in which extra-articular facet joint injection resulted in paraspinal and epidural abscesses without facet joint infection. A 50-year-old man presenting with acute back pain and fever was admitted to the hospital. He had the history of diabetes mellitus and had undergone the extra-articular facet joint injection due to a facet joint syndrome diagnosis at a private clinic 5 days earlier. Physical examination showed tenderness over the paraspinal region. Magnetic resonance image (MRI) demonstrated the paraspinal abscess around the fourth and fifth spinous processes with an additional epidural abscess compressing the thecal sac. The facet joints were preserved. The laboratory results showed a white blood cell count of 14.9x10(9) per liter, an erythrocyte sedimentation rate of 52mm/hour, and 10.88mg/dL of C-reactive protein. Laminectomy and drainage were performed. The pus was found in the paraspinal muscles, which was communicated with the epidural space through a hole in the ligamentum flavum. Cultures grew Staphylococcus aureus. Paraspinal abscess communicated with epidural abscess is a rare complication of extra-articular facet joint injection demonstrating an abscess formation after an invasive procedure near the spine is highly possible.
Abscess/*diagnosis/microbiology ; Epidural Abscess/*diagnosis/microbiology ; Humans ; Injections, Spinal/*adverse effects ; Male ; Middle Aged ; Staphylococcal Infections/*diagnosis ; *Zygapophyseal Joint/microbiology/pathology

No abstract available.
Adult ; Embolism/*complications/diagnosis/microbiology ; Eye Infections, Bacterial/*complications/diagnosis/microbiology ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Macula Lutea/drug effects/*pathology ; Male ; Retinal Perforations/diagnosis/*etiology ; Sepsis/*complications/diagnosis ; Staphylococcal Infections/*complications/diagnosis ; Staphylococcus aureus/isolation & purification

Considering the popular use of antibiotic-containing eyedrops in Korea, it is important to know the emerging antibiotic-resistant strains of bacteria before treating infectious eye diseases. This is especially important in high-risk groups because of the high incidence of resistant infections and the subsequent treatment requirements. We report two cases of methicillin-resistant Staphylococcus aureus (MRSA) corneal ulcers in high-risk groups. The first case involved a patient who had keratitis after using antibiotic- and steroid-containing eyedrops to treat a corneal opacity that developed after repeated penetrating keratoplasty. The second case involved a patient who used antibiotic-containing eyedrops and a topical lubricant on a regular basis for >1 month to treat exposure keratitis due to lagophthalmos. The second patient's problems, which included a persistent superficial infiltration, developed after brain tumor surgery. Both cases showed MRSA on corneal culture, and the corneal ulcers improved in both patients after the application of vancomycin-containing eyedrops. In conclusion, MRSA infection should be considered in corneal ulcers that have a round shape, mild superficial infiltration, and slow progression, especially in high-risk groups. This report includes descriptions of the characteristic features, antibiotic sensitivities, prevention, and successful treatment with vancomycin-containing eyedrops for MRSA corneal ulcers.
Cornea/*microbiology/pathology ; Corneal Ulcer/diagnosis/*microbiology ; Diagnosis, Differential ; Eye Infections, Bacterial/diagnosis/*microbiology ; Female ; Follow-Up Studies ; Humans ; Male ; Methicillin-Resistant Staphylococcus aureus/*isolation & purification ; Middle Aged ; Staphylococcal Infections/diagnosis/*microbiology