Management of a patient with small-area burns, severe sepsis and superficial vein thrombosis

Shao, Huawei; Luo, Ronghua; Wang, X.; Pan, Xuanliang; Chen, G.

doi:10.12968/jowc.2015.24.2.73

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…All these Corynebacterium spp. can cause invasive disease in patients with compromised skin or mucosal barrier function (e.g., patients suffering from burn wounds or carrying intravascular devices) or in immunocompromised patients (e.g., diabetics and cancer patients) (7)(8)(9)(10)(11)(12)(13).…”

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confidence: 99%

Toll-Like Receptor 2 and Mincle Cooperatively Sense Corynebacterial Cell Wall Glycolipids

et al. 2017

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Nontoxigenic Corynebacterium diphtheriae and Corynebacterium ulcerans cause invasive disease in humans and animals. Host sensing of corynebacteria is largely uncharacterized, albeit the recognition of lipoglycans by Toll-like receptor 2 (TLR2) appears to be important for macrophage activation by corynebacteria. The members of the order Corynebacterineae (e.g., mycobacteria, nocardia, and rhodococci) share a glycolipid-rich cell wall dominated by mycolic acids (termed corynomycolic acids in corynebacteria). The mycolic acid-containing cord factor of mycobacteria, trehalose dimycolate, activates the C-type lectin receptor (CLR) Mincle. Here, we show that glycolipid extracts from the cell walls of several pathogenic and nonpathogenic Corynebacterium strains directly bound to recombinant Mincle in vitro. Macrophages deficient in Mincle or its adapter protein Fc receptor gamma chain (FcR␥) produced severely reduced amounts of granulocyte colony-stimulating factor (G-CSF) and of nitric oxide (NO) upon challenge with corynebacterial glycolipids. Consistently, cell wall extracts of a particular C. diphtheriae strain (DSM43989) lacking mycolic acid esters neither bound Mincle nor activated macrophages. Furthermore, TLR2 but not TLR4 was critical for sensing of cell wall extracts and whole corynebacteria. The upregulation of Mincle expression upon encountering corynebacteria required TLR2. Thus, macrophage activation by the corynebacterial cell wall relies on TLR2-driven robust Mincle expression and the cooperative action of both receptors.KEYWORDS C-type lectin receptor, Mincle, Toll-like receptor, macrophage, Corynebacterium diphtheriae, cell wall lipids, mycolate, mycolic acid, corynomycolate D iphtheria caused by toxin-producing Corynebacterium diphtheriae is a severe, life-threatening infection, which has become rare in Europe due to the efficacy and coverage of toxoid immunization but still causes a considerable burden of disease globally. Corynebacterium ulcerans and Corynebacterium pseudotuberculosis can also harbor the tox gene encoding diphtheria toxin (1) and in addition may secrete the exotoxin phospholipase D, a virulence factor involved in caseous lymphadenitis of sheep and goats (2, 3). Rates of infections with nontoxigenic strains of C. diphtheriae, including bloodstream infections and endocarditis, appear to be increasing in Europe (4,5). Of the 90 species that comprise the genus Corynebacterium, many inhabit the human skin or mucosa as commensals (6), with C. striatum, C. tuberculostearicum, C. amycolatum, and C. jeikeium being typical examples of skin inhabitants, whereas C. urealyticum and C. glucuronolyticum are frequently found in the urogenital tract. All

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Toll-Like Receptor 2 and Mincle Cooperatively Sense Corynebacterial Cell Wall Glycolipids

et al. 2017

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“…Diabetes was among the predisposing factors. This pathogen has been known to cause wound infections earlier also [11,12]. Superti et al reported a case of C. striatum skin and soft tissue infection of a malignant skin lesion in a 27 y old male patient.…”

Section: Discussionmentioning

confidence: 99%

Cornyebacterium striatum : an Emerging Bug

Lalani¹,

Khan²,

Tayyab³

et al. 2017

Clin Microbiol

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The increasing prevalence of chronic infections, with frequent exposure to broad-spectrum antibiotics for repeated and prolonged hospitalizations, favors the emergence of nosocomial infection by Gram-positive bacteria, such as outbreaks of Corynebacterium striatum. Cornyebacteria are gram-positive non spore forming rods. Many species are part of the normal skin and mucosal flora of humans. The clinical significance of C. striatum has recently been established. C. striatum has recently been reported to cause a variety of infections including pneumonia, endocarditis, septic arthritis, cerebrospinal fluid infection, surgical site infections and septicemia. In this study, describing three cases of Corynebacterium striatum that are attributed to health care associated infections and presented as post-surgical wound infection and hospital acquired pneumonia. The three cases include a case of a 68 years old lady who was readmitted with fever, pain and purulent discharge from surgical wound of the lower back, a 57 years old man who was readmitted 2 months after a road traffic accident with surgical wound infection of forearm and a 25 years old man on respiratory support after a head injury with ventilator associated pneumonia.

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“…Thermal-crush injuries of the hand often involve severe composite injuries and defects of bones and soft tissues that require the bone and soft tissue reconstruction (6). Free tissues are usually used for reconstruction, especially free toe transplantation and free skin flap repair (7). Notably, an external fixation using Ilizarov external frame and bone transport technology is preferred to the reconstruction of bones and soft tissues in patients with thermal-crush injuries of the hand due to the fragile structure of the soft tissues of the hand (8).…”

Section: Introductionmentioning

confidence: 99%

Role of microsurgical techniques combined with Ilizarov techniques in limb salvage and functional reconstruction of thermal‑crush injuries of the hand: A case report

Yang,

Yu,

Meng

et al. 2024

Exp Ther Med

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The Ilizarov technology was proposed by Former Soviet orthopedic physician Ilizarov. It is a medical method to reconstruct missing tissues. Ilizarov technology combined with soft tissue stretching technology is of great significance in the treatment of common orthopedic problems like bone defects, finger absence, joint contracture and joint stiffness following thermal-crush injuries of the hand. In the present study a 25-year-old male patient sought for limb salvage treatment 1 month after sustaining thermal-crush injuries of the right hand and forearm. The patient had been treated by another hospital with multiple procedures of debridement, and recommended for forearm amputation. The patient was diagnosed with: i) Postoperative infection of thermal-crush injuries of the right hand and right forearm; ii) comminuted open fractures of the proximal and distal phalanges of the right thumb; iii) osteomyelitis; iv) palm skin defects with exposed tendons; and v) skin defects of the opisthenar and the forearm. After a series of treatments including debridement, removal of necrotic tissue, tissue transplantation, skin pedicle, bone lengthening, external shaping, tissue release, joint fusion, traction and rehabilitation exercises, the patient recovered some hand function. Overall, thermal-crush injuries of the hand are severe, complicated combined injuries composed of both heat burn and compression injury and their treatment is challenging. Overall, microsurgery combined with Ilizarov technology can effectively reconstruct the function of complex thermal-crush injuries of the hand.

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Management of a patient with small-area burns, severe sepsis and superficial vein thrombosis

Abstract: None of the authors have any financial interest to declare.

Cited by 4 publications

References 16 publications

Toll-Like Receptor 2 and Mincle Cooperatively Sense Corynebacterial Cell Wall Glycolipids

Toll-Like Receptor 2 and Mincle Cooperatively Sense Corynebacterial Cell Wall Glycolipids

Cornyebacterium striatum : an Emerging Bug

Role of microsurgical techniques combined with Ilizarov techniques in limb salvage and functional reconstruction of thermal‑crush injuries of the hand: A case report

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