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REFERENCES 1. Osguthorpe JD, Hochman M. Inflammatory sinus diseases affecting the orbit. Otolaryngol Clin North Am 1993;26:657-71. 2. Rahbar R, Robson CD, Petersen RA, et al. Management of orbital subperiosteal abscess in children. Arch Otolaryngol Head Neck Surg 2001;127:281-6. 3. Connell B, Raral S, McNob AA. Fulminant orbital cellulitis with complete visual loss. Clin Exp Ophthalmol 2001;29:260-1. 4. Gans H, Sekula J, Wlodyka J. Treatment of acute orbital complications. Arch Otolaryngol 1974;100: 329-32. 5. Morgan PR, Morrison WV. Complications of frontal and

Abstract Background: Vibrio vulnificus infection is prevalent among tropical coastal regions and septicemia due to this bacterium is often rapidly fatal. Our review of V. vulnificus cases in Thailand included microbiological and clinical analyses which have rarely been documented. They included a rare complication of rhabdomyolysis which has never been reported in this country.

Objective: We reported a case series of V. vulnificus septicemia at a university hospital in Thailand during a 12-year period including two fatal cases with rhabdomylysis due to V. vulnificus infection.

Methods: Our case series of patients with V. vulnificus septicemia was retrospectively reviewed to determine clinical presentations, risk factors, microbiologic data, hospital courses, treatment, and outcomes.

Results: Twenty-nine patients, predominantly male, were identified. Most patients had underlying cirrhosis or related chronic liver diseases and 20 cases (69%) died rapidly. Cellulitis and necrotizing fasciitis were common presenting symptoms. Consumption of undercooked shellfish may be a local risk factor. Inadequate surgical intervention may be related to a high mortality rate. Two fatal cases with autopsy-proven acute massive rhabdomyolysis were described, which emphasized urgent appropriate management.

Conclusion: This 29-case series identified that V. vulnificus septicemia had a high mortality rate. Chronic liver diseases are known underlying factors. Acute massive rhabdomyolysis is very rare as a fatal complication of V. vulnificus infection.

References 1. Wells GC. Recurrent granulomatous dermatitis with eosinophilia. Trans St Johns Hosp Dermatol Soc. 1971;57(1):46-56. 2. Wells GC, Smith NP. Eosinophilic cellulitis. Br J Dermatol. 1979;100(1):101-9. 3. España A, Sanz ML, Sola J, Gil P. Wells’ syndrome (eosinophilic cellulitis): correlation between clinical activity, eosinophil levels, eosinophil cation protein and interleukin-5. Br J Dermatol. 1999;140(1):127-30. 4. Moossavi M, Mehregan DR. Wells’ syndrome: a clinical and histopathologic review of seven cases. Int J Dermatol. 2003;42(1):62-7. 5

Descending Necrotizing Mediastinitis of Odontogenic Origin - Personal Experience and Literature Review

Descending necrotizing mediastinitis is the most severe form of mediastinal infection. The aim of the study was to present the optimal diagnostic and treatment approach to this severe, life-threatening condition.

Patients and methods: Three patients (men, aged 75, 73, and 63) with descending necrotizing mediastinitis hospitalised between April 2007 and February 2009 have been included in the study. The diagnosis of the condition was made based on cervico-thoracic computed tomography and surgical findings. The surgical treatment in each of the cases included bilateral longitudinal cervicotomy, transversal suprasternal cervicotomy and posterior-lateral thoracotomy.

Results: The period between the initiation of ambulatory treatment of the dental infection and diagnosing the mediastinitis was 9, 8 and 11 days, respectively. Engagement of all cervical spaces and mediastinal sections with polybacterial (three or more agents) dental infection, originating from third and fourth lower molars was present in each of the patients. Chronic alcoholism and diabetes are factors influencing the course of mediastinitis. The outcome in all the three patients was lethal (within 72 hours).

Conclusion: Success in the treatment of descending necrotic mediastinitis of odontogenic origin may be expected only in case of early diagnose and aggressive cervical and mediastinal drainage, performed by bilateral longitudinal cervicotomy and posterior-lateral thoracotomy.


Diabetic foot ulcers (DFUs) are a very common cause of mortality and morbidity. The distinction between infected and non-infected DFU remains a very challenging task for clinicians in everyday practice. Even when infection is documented, the spectrum of diabetic foot infection is wide, ranging from cellulitis and soft tissue infection to osteomyelitis. Procalcitonin (PCT), a well-established sepsis biomarker, has been used in the diagnosis of several infections including osteomyelitis in patients with diabetes mellitus. This review gathers and presents all the relevant data, up until now, regarding the use of PCT as an assessment tool in diabetic patients with foot infection. Current evidence suggests that PCT levels could aid clinicians in distinguishing infected from non-infected DFUs as well as in the distinction between soft tissue infection and bone involvement, but further and larger studies are warranted to confirm these findings.


Deep neck infection is an infection in the potential space and fascial planes of the neck, either with abscess formation or cellulitis. Cervical fascias create space and plane, which define and limit the spread of infection. Danger space is the area of thin connective tissue extending from the skull base down to the diaphragm. This space is enclosed on all sides, therefore inflammation in this area arises from penetration and spreads of infection from surrounding structures. This risk is in the rapid spread of infection in the chest, due to the low resistance of thin connective tissue. Formation of the descending necrotizing mediastinitis is the most common and most feared complication of danger space. Authors describe a case of extensive dental infection that despite intensive surgical and antibiotic treatement spread to other anatomical areas and caused descending necrotizing mediastinitis.


Paranasal sinus mucoceles are benign cystic masses filled with mucous content. Mucoceles are locally destructive, causing pressure on sinus walls with their resorption, allowing them to spread on adjacent structures causing local, orbital or intracranial complications. They are most commonly found in frontal sinuses.

The aim of this report is to present case of oculo-orbital complications of frontal sinus mucocele, with focus on treatment using combined surgical approach.

A 75-year old female patient with frontal sinus mucocele which led to destruction of orbital roof and occurrence of complications in form of orbital cellulitis and palpebral abscess was successfully treated with a combination of external frontoethmoidectomy and endoscopic sinus surgery. After initial incision of the upper eyelid abscess with drainage of purulent content, modified external frontoethmoidectomy was performed using preformed defect of orbital roof. Finally, using endoscopic sinus surgery, natural drainage of anterior group of paranasal sinuses was achieved.

Various endoscopic and open approaches have been described in mucocele treatment. In this case we showed that the combined surgical approach in the treatment of frontal sinus mucoceles with destruction of sinus floor and appearance of oculo-orbital complications, provides an effective treatment and allows natural drainage of anterior group of sinuses.


Swimming-pool granuloma and fish tank granuloma refer to the infections caused by Mycobacterium marinum. After having been discovered in salt water fish in Philadelphia Aquarium and described in 1926, this skin infection was first reported in humans in 1951. It developed in people who had swum in contaminated swimming pools. M. marinum is a non-tuberculous, atypical mycobacterium, which is found on plants, soil and fish in freshwater and salt water worldwide. Humans become infected usually after trauma and contact with an aquatic environment. Infection is limited to the skin and usually occurs in healthy individuals, but in immunocompromised patients the infection may disseminate or spread to the subcutis and bone. The lesions usually appear as solitary nodules or plaques that may lead to suppurative ulcers after 2-3 weeks of incubation. Occasionally, there may be sporotrichoid spread along lymphatics. Its diagnosis is frequently delayed, probably because the infection is very rare and a history of aquatic exposure, which is present in the majority of cases, is often overlooked. Common misdiagnoses include fungal and parasitic infection, cellulitis, verrucous tuberculosis of the skin, gout, rheumatoid arthritis, a foreign body and a skin tumour. We present a case of a 39-year-old Caucasian male with a 12-month history of a single erythematous tender nodule on the right dorsal aspect of the right hand. Histopathological examination revealed longstanding suppurated granulomatous inflammation. The infection was not responsive to several courses of antibiotics until we introduced doxycycline capsules as monotherapy which led to complete remission after 5 months.

-by-step iconographic description of a prolonged but still favourable course of orbital cellulitis in a child with acute rhinosinusitis: an iconographic case study. Ital J Pediatr. 2014;40:25. DOI: 10.1186/1824-7288-40-25. 10. Noleto JW, Prado R, Rocha JF, DaCosta MA, Barbosa CU, Toscano MD. Intranasal inverted tooth: a rare cause of a persistent rhinosinusitis. Indian J Dent Res. 2013;24(6):762-4. DOI: 10.4103/0970-9290.127630. 11. Lee JT, Brunworth J, Garg R, Shibuya T, Keschner DB, Vanefsky M, et al. Intracranial mucocele formation in the context of longstanding chronic

. 16. Garrity GM, Brenner DJ, Krieg NR and Staley JT (Eds.). Bergey’s Manual of Systematic Bacteriology. 2nd ed. New York: Springer; 2005. 17. Murray PR, Baron EJ, Jorgensen JH, Landry ML and Pfaller MA (Eds.). Manual of Clinical Microbiology. 9th ed. Washington: ASM Press; 2007. 18. Buchanan BK. Moraxella, branhamella, Kingella and Aeikenella. In: Balows A. and Duerden BI (Eds). Topley and Wilson’s Microbiology and Microbial Infections. 1998. P1139-46. 19. Tritton D, Watts T, Sieratzki JS. Peri-orbital cellulitis and sepsis by Branhamella catarrhalis. Eur J Pediatr