A NOSOCOMIAL INFECTION MANIFESTED AS ERYSIPELAS IN PEMPHIGUS FOLIACEUS PATIENT UNDER INTRAVENOUS DEXAMETHASONE TREATMENT

Achmad Yudha Pranata, Hendra Gunawan, Endang Sutedja, Oki Suwarsa, Hartati Purbo Dharmaji

= http://dx.doi.org/10.20473/ijtid.v6i2.1992
Abstract views = 494 times | views = 161 times

Abstract


Introduction: Puncture wound in diagnostic interventions permits the entry of bacteria into the skin or soft tissue, thus precipitating nosocomial infection, such as erysipelas. There are other risk factors of nosocomial infections including old age, immunosuppressive drugs, and underlying diseases. Pemphigus foliaceus (PF) is an autoimmune disease with corticosteroid treatment as the mainstay therapy, which could cause immunosuppression and predispose patients to infection. The objective of this paper was to report erysipelas as one of the manifestations of nosocomial infection in patients under immunosuppressive therapy. Case: A case of erysipelas acquired on the 9th day of hospitalization in a PF patient underwent intravenous dexamethasone injection, with history of puncture wounds on the previous day on the site of erysipelas was reported. The clinical findings of erysipelas were well defined, painful erythema and edema that felt firm and warm on palpation, with blisters and pustules on top. Gram staining from the pustules and blisters fluid revealed Gram (+) cocci. Patient was given 2 grams intravenous ceftriaxone for 7 days and saline wet compress. Improvement on the erysipelas was seen the day after ceftriaxone injection. The patient was discharged after 12 days of hospitalization with improvement both on the PF and the erysipelas. On the next visit 7 days later, the erysipelas lesion disappeared. Conclusion: Puncture wound and immunosuppresive treatment are the factors that could cause erysipelas as a nosocomial infection, and an appropriate treatment of the infection would decrease the functional disability of the patient.


Keywords


erysipelas; nosocomial infection; immunosuppresive; pemphigus foliaceous; ceftriaxone

Full Text:

PDF

References


Epidemiology of nosocomial infections. Dalam: Prevention of hospital-acquired infections a practical guide. 2nd edition. World Health Organization. WHO/CDS/EPH/2002.12. Page 4–8.

Saavedra A, Weinberg A, Swartz MN, Johnson RA. Soft-tissue infections: erysipelas, cellulitis, gangrenous cellulitis, and myonecrosis. Dalam: Wolff K, Goldsmithe LA, Katz SI, dkk., editor. Fitzpatrick’s dermatology in general medicine. 8th edition. New York: McGraw-Hill; 2012. Page 1720–31.

Ki V, Rotstein C. Bacterial skin and soft tissue infections in adults: A review of their epidemiology, pathogenesis, diagnosis, treatment and site of care. Can J Infect Dis Med Microbiol. 2008 Mar; 19(2): 173–84.

Esmaili N, Mortazavi H, Normohammadpour P, dkk. Pemphigus vulgaris and infections: a retrospective study on 155 patients. Hindawi Autoimun Dis. 2013: 1–5.

Payne AS, Stanley JR. Pemphigus. Dalam: Wolff K, Goldsmithe LA, Katz SI, et al., editor. Fitzpatrick’s dermatology in general medicine. 8th edition. New York: McGraw-Hill; 2012. Page 586–99.

Celestin R, Brown J, Kihiczak G, Schwartz RA. Erysipelas: a common potentially dangerous infection. Acta Dermatoven APA. 2007; 16(3): 123–7.

James WD, Berger TG, Elston DM. editor. Bacterial infections. Dalam: Andrew’s diseases of the skin. 10th edition. Philadelphia. WB Saunders Company; 2006. Page 258–63.

Chong FY, Thirumoorthy T. Blistering erysipelas: not a rare entity. Singapore Med J. 2008; 49(10): 809–13.

Ribeiro A, Oliveira AL, Batigalia F. The in-hospital treatment of erysipelas using cephalosporin, ciprofloxacin or oxacillin. J Phleb Lymph. 2012; 5: 6–8.

Sadick NS. Systemic antibacterial agents. Dalam: Wolverton SE, editor. Comprehensive dermatologic drug therapy. Indianapolis: WB Saunders;2001. Page 28–54.

Kepekaan bakteri terbanyak di instalasi rawat inap dari berbagai spesimen terhadap antibiotika periode Januari-Juni 2013. Dalam: Peta bakteri dan kepekaannya terhadap berbagai antibiotika di rumah sakit Dr. Hasan Sadikin Bandung semester I tahun 2013. Tim Program Pengendalian Resistensi Antimikroba. SMF/Departemen Patologi Klinik RS. Dr. Hasan Sadikin Bandung.

Pavlov S, Slavova M. antibiotic therapy and prophylaxy of patients with erysipelas. J of IMAB. 2004; 10(1): 31–3.

Prevention of nasocomial infection. Dalam: Prevention of hospitalacquired infections a practical guide. 2nd edition. World Health Organization. WHO/CDS/EPH/2002.12. Page 30–7.


Refbacks

  • There are currently no refbacks.




Copyright (c) 2016 Indonesian Journal of Tropical and Infectious Disease

View My Stats



IJTID (pISSN 2085-1103eISSN 2356-0991is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Institute of Tropical Disease - Airlangga University

Gd. Lembaga Penyakit Tropis Lt.1, Kampus C Universitas Airlangga

Jln. Mulyorejo Surabaya 60115, Indonesia

E-mail: ijtid@itd.unair.ac.id