Janice was seen in the Infectious Diseases Clinic on December 4, 2013. As you recall, she was being treated for a very complicated methicillin-sensitive Staphylococcus aureus infection which was multifocal in nature. She had several skin lesions including a carbuncle on the right lower leg, a septic right knee and a large subpectoral and subdeltoid collection on the left. Despite a history of penicillin allergy she was given a staged challenge with cloxacillin and tolerated this well. She has been on antimicrobial therapy since her initial presentation to hospital in early October. This constitutes approximately 9 weeks of IV antibiotic treatment as of today's visit. I have received several reports from the CCAC that Janice has not …show more content…
The skin appears well healed. The heart sounds are normal with no murmurs or extra heart sounds. Her lung fields are clear to auscultation and percussion. The previous carbuncle is completely healed although there is some residual scar. The previous areas of vasculitis do still have some superficially open areas of skin, but there is no purulent drainage and these do not look frankly infected at this time. The right knee is slightly swollen when compared with the left; however, there is no joint line tenderness and she is able to perform range of motion of approximately 70-80 degrees. She is not able to extend completely. SUMMARY AND IMPRESSION: Janice appears to have improved with respect to her systemic infections. In fact, she does not appear to have ongoing systemic infection at this time. Given her inadherence I am worried with regards to the ongoing nature of indwelling prosthetic material. Specifically, she continues to have a PICC line and a percutaneous drain and I am worried that these may serve as sources of secondary infection in the future. I have therefore discontinued not only her antibiotics but as well her PICC line and her subdeltoid drain at today's clinic visit. I believe that the ongoing skin erosions from the previous areas of vasculitis can be managed with topical therapy alone. I note that she is not particularly adherent with her prednisone therapy and yet does not seem to have
SKIN: She has some mild ecchymosis on her skin, and some erythema. She has patches but no obvious skin breakdown. She has some fissuring in the buttocks crease. PULMONARY: Clear to percussion and auscultation bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, nontender, protuberant, no orgonomegaly, and positive bowel sounds. NEUROLOGIC EXAM: Cranial nerves II through XII are grossly intact. Diffuse hyporeflexia. MUSCULOSKELETAL: Erosive, destructive changes in the elbows, wrists, and hands consistent with rheumatoid arthritis. Has bilateral total knee replacements with stovepipe legs, and perimalleolar pitting edema 1 +. I feel no pulses distally in either leg. PSYCHIATRIC: Patient is a little anxious about these new symptoms and their significance. We discussed her situation and I offered her psychologic services. She refused for now.
Wound odour is often a complication of bacterial infection and the presence of infection explained why Mrs. Smith had experienced a worsening of the odour in recent weeks (Hack, 2003).
M. H. states that she is generally in good overall health. No cardiac, respiratory, endocrine, vascular, musculoskeletal, urinary, hematologic, neurologic, genitourinary, or gastrointestinal problems.
Methicillin-resistant Staphylococcus aureus, or more commonly, MRSA, is an emerging infectious disease affecting many people worldwide. MRSA, in particular, is a very interesting disease because although many people can be carriers of it, it generally only affects those with a depressed immune system; this is why it is so prevalent in places like nursing homes and hospitals. It can be spread though surgeries, artificial joints, tubing, and skin-to-skin contact. Although there is not one specific treatment of this disease, there are ways to test what antibiotics work best and sometimes antibiotics aren’t even necessary.
No scalp lesions. Dry eyes with conjunctival injection. Mild exophthalmos. Dry nasal mucosa. Marked cracking and bleeding of her lips with erosions of the mucosa. She has a large ulceration of the mucosa at the bite margin on the left. She has some scattered ulcerations on her hard and soft palette. She has difficulty opening her mouth because of pain. Tonsils not enlarged. No visible exudate. SKIN: She has some mild ecchymosis on her skin and some erythema, she has some patches but no obvious skin breakdown. She had some fissuring in the buttocks crease. PULMONARY: Clear to precussion and auscultation, bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, non-tender, protuberant, no organomegaly, and positive bowel sounds. NORALOGIC EXAME: Cranial nerves ii – xii are grossly intact, diffuse hyporeflexia. MUSCULAR SKELETAL: Erosive destructive changes in elbows, wrist, and hands consistent with rheumatoid arthritis. Has had bilateral total knee replacements with stovepipe legs and perimalledal pitting edema 1+. I feel no pulse distally in either leg. PHYCIATRIC: Patient is a little anxious about these new symptoms and there significance. We discussed her situation and I offered her psychiatric services, she refused for now.
This particular bacterium is not one that inhabits a specific geographical region as it colonizes within the human body. The disease is
She has also been taking Minocin for rosacea, 50 mg twice weekly. She has been on higher doses of Tetracycline in the past with out problem.
The bacteria spread fast, leaving the leg unsalvageable. The question on all of our minds was why the patient had waited so long to seek treatment. Surely she was in a lot of pain, and that odor... why wait? The answer was purely financial. Money deterred her from seeking treatment which caused a
My second clinic rotation is internal medicine and I’ve had many encounters, both with patients and colleagues, which have made me pause and reflect. One of those encounters, in particular, will still be on my mind long after I finish typing this reflective journal. The patient at the center of it all is a lady I’ll refer to from here on as “Mrs. Flowers.” Mrs. Flowers is an 81 year old female with dementia and diabetes. She arrived on our unit with a diabetic foot infection that had progressed from a simple toe ulcer to wet gangrene. Over the last 2-3 months, gangrenous changes encompassed the distal half of her left foot. During pre-rounds, our medical team unanimously agreed that we would contact surgery for a consult. At time, it was obvious
In 2000, Eloisa Casas was diagnosed with colon cancer. She went through the stages of surgery, radiation, and chemotherapy and one year later with considered to be cancer free and placed in remission. On July 10, 2001, she was addmitted to the hospital with abdominal pain, as well as a fever and an elevated white blood count, which could indicate a possible infection. Her primary physisian and surgeon, Dr. Garcia-Cantu, consulted infectious disease specialist, Dr. Jelinek, who then prescribed her Maxipime as a general antibiotic and Flagyl as an antibiotic for anaerobic bacteria on July 11.
Skin- she has some mild equimosis on her skin and some anathema. She has patches but no obvious skin breakdown. She has no fissuring in the buttocks crease.
Methicillin resistant Staphylococcus aureus (MRSA) has been a type of multidrug resistant organism and staph bacteria known to cause serious infection that can lead to long hospitalizations and death. It can begin as a simple infection on skin or in the lungs, and if left untreated, can lead to traveling to the bloodstream and causing sepsis (“Methicillin-resistant Staphylococcus aureus (MRSA), 2015”). The Centers for Disease Control and Prevention reports that 33 percent of individuals carry the staph bacteria intranasally and two percent of individuals carry MRSA (“Methicillin-resistant Staphylococcus aureus (MRSA), 2015”). Even though this is a serious issue among healthcare settings all over the country, the number of people affected
Life History and Characteristics: Staphylococcus aureus is a gram positive bacterium that is usually found in the nasal passages and on the skin of 15 to 40% of healthy humans, but can also survive in a wide variety of locations in the body. This bacterium is spread from person to person or to fomite by direct contact. Colonies of S. aureus appear in pairs, chains, or clusters. S. aureus is not an organism that is contained to one region of the world and is a universal health concern, specifically in the food handling industries.
A 67year old female patient was scheduled for a laparoscopic hysterectomy. However 5 weeks prior to hospitalization she was hospitalized and the case was converted to an open procedure due to excessive bleeding. After being discharged she developed fever and drainage and was readmitted again for possible postoperative infection seven days ago. On day two of admission she underwent surgery for post operative abscess and insertion for a central line for long-term antibiotics.