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Necrotising fasciitis (NF), commonly referred to as ‘flesh-eating disease’, is a rare but life-threatening infection. It rapidly affects subcutaneous tissue, leading to necrosis of the overlying skin. Though primarily seen in the abdomen, perineum and lower limbs, periorbital involvement is rare. This case report presents an elderly male with periorbital NF following a minor head injury. The patient presented with bilateral periorbital swelling, purulent discharge and necrotic tissue. Microbiological analysis revealed a rare Enterococcus species as the causative pathogen. MRI and microbiological analysis confirmed the diagnosis. Treatment included intravenous antibiotics, surgical debridement and skin grafting. The patient showed significant improvement post-treatment. This case underscores the importance of prompt diagnosis and treatment to prevent severe complications.

Mycoplasma arginini is a bacterium primarily found in animals and is seldom reported in human infections. We identified M. arginini infection in a severely immunocompromised kidney transplant recipient in Slovenia. Clinicians should be aware of M. arginini's potential as a pathogen in immunocompromised persons with animal contact.

The ancient Chinese medical literature, as well as our prior clinical experience, suggests that fecal microbiota transplantation (FMT) could treat the inflammatory mass. We aimed to evaluate the efficacy and safety of multiple fresh FMTs for Crohn’s disease (CD) complicated with intraabdominal inflammatory mass. The \"one-hour FMT protocol\" was followed in all patients. Twenty-five patients were diagnosed with CD and related inflammatory mass by CT or MRI. All patients received the initial FMT followed by repeated FMTs every 3 months. The primary endpoint was clinical response (improvement and remission) and sustained clinical remission at 12 months. Secondary endpoints were improvement in size of phegmon/abscess based upon cross-sectional imaging and safety of FMT. 68.0% (17/25) and 52.0% (13/25) of patients achieved clinical response and clinical remission at 3 months post the initial FMT, respectively. The proportion of patients at 6 months, 12 months and 18 months achieving sustained clinical remission with sequential FMTs was 48.0% (12/25), 32.0% (8/25) and 22.7% (5/22), respectively. 9.5% (2/21) of patients achieved radiological healing and 71.4% (15/21) achieved radiological improvement. No severe adverse events related to FMT were observed. This pragmatic study suggested that sequential fresh FMTs might be a promising, safe and effective therapy to induce and maintain clinical remission in CD with intraabdominal inflammatory mass.

Cellulitis, an infection involving the deep dermis and subcutaneous tissue, is the most common reason for skin-related hospitalization and is seen by clinicians across various disciplines in the inpatient, outpatient, and emergency room settings, but it can present as a diagnostic and therapeutic challenge. Cellulitis is a clinical diagnosis based on the history of present illness and physical examination and lacks a gold standard for diagnosis. Clinical presentation with acute onset of redness, warmth, swelling, and tenderness and pain is typical. However, cellulitis can be difficult to diagnose due to a number of infectious and non-infectious clinical mimickers such as venous stasis dermatitis, contact dermatitis, eczema, lymphedema, and erythema migrans. Microbiological diagnosis is often unobtainable due to poor sensitivity of culture specimens. The majority of non-purulent, uncomplicated cases of cellulitis are caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus , and appropriate targeted coverage of this pathogen with oral antibiotics such as penicillin, amoxicillin, and cephalexin is sufficient. Even with rising rates of community-acquired methicillin-resistant Staphylococcus aureus , coverage for non-purulent cellulitis is generally not recommended.

Background. Skin and soft tissue infections are common reasons for medical care. Use of broad-spectrum therapy and costs have increased. Assessment of early treatment response has been given a central role both in clinical trials and everyday practice. However, there is a paucity of data on the dynamics of response, causes of early nonresponse, and how early nonresponse affects resource use and predicts outcome. Methods. We prospectively enrolled 216 patients hospitalized with cellulitis. Clinical and biochemical response data during the first 3 days of treatment were analyzed in relation to baseline factors, antibiotic use, surgery, and outcome. Multivariable analysis included logistic lasso regression. Results. Clinical or biochemical response was observed in the majority of patients the day after treatment initiation. Concordance between clinical and biochemical response was strongest at days 2 and 3. Female sex, cardiovascular disease, higher body mass index, shorter duration of symptoms, and cellulitis other than typical erysipelas were predictors of nonresponse at day 3. In contrast, baseline factors were not predictive of clinical failure assessed posttreatment. Among cases with antibiotic treatment escalation by day 2, 90% (37/41) had nonresponse at day 1, but only 5% (2/40) had inappropriate initial therapy. Nonresponse at day 3 was a predictor of treatment duration >14 days, but not of clinical failure. Conclusions. Nonpharmacological factors had a major impact on early response dynamics. Delayed response was rarely related to inappropriate therapy but strongly predictive of early treatment escalation, suggesting that broadening antibiotic treatment may often be premature.

The lymphatic system is fundamentally important to cardiovascular disease, infection and immunity, cancer, and probably obesity--the four major challenges in healthcare in the 21st century. This Review will consider the manner in which new knowledge of lymphatic genes and molecular mechanisms has demonstrated that lymphatic dysfunction should no longer be considered a passive bystander in disease but rather an active player in many pathological processes and, therefore, a genuine target for future therapeutic developments. The specific roles of the lymphatic system in edema, genetic aspects of primary lymphedema, infection (cellulitis/erysipelas), Crohn's disease, obesity, cancer, and cancer-related lymphedema are highlighted.

Background This study documents a rare instance of post-traumatic orbital cellulitis attributed to Eikenella corrodens. It underscores the significance of precise identification of this pathogen and prompt management of orbital cellulitis. Case presentation A 59-year-old male presented with a 3-day history of redness, swelling, and pain in his left eye, accompanied by increased secretions for 1 day after exposure to terrazzo ingredients. Initially diagnosed with left orbital cellulitis, he was treated with intravenous cefuroxime for 3 days without symptom improvement. Treatment was then shifted to intravenous ceftazidime and ornidazole, and secretions were cultured. As symptoms worsened, the patient underwent ultrasound-guided puncture and aspiration of the left orbital abscess, followed by cavity irrigation. This resulted in reduced eyelid swelling and secretions. Culture results confirmed the presence of Eikenella corrodens. Antibiotics were subsequently switched to intravenous amoxicillin-clavulanate potassium, but symptoms relapsed. A second debridement with drainage strip placement led to symptom resolution within 4 days, and the patient was discharged with amoxicillin-clavulanate tablets. Conclusions This report details a unique case of orbital cellulitis due to Eikenella corrodens infection. The treatment strategy, combining targeted antibiotics with ultrasound-guided abscess management, proved effective.

Helicobacter cinaedi bacteremia caused recurring multifocal cellulitis in a patient in France who had chronic lymphocytic leukemia treated with ibrutinib. Diagnosis required extended blood culture incubation and sequencing of the entire 16S ribosomal RNA gene from single bacterial colonies. Clinicians should consider H. cinaedi infection in cases of recurrent cellulitis.

Cutaneous anthrax is a zoonotic bacterial infection that mostly involves the head, neck, and upper extremities. Periorbital involvement of cutaneous anthrax is a rare presentation that can lead to severe irreversible complications. Herein, we describe a 2.5‐year‐old girl with periorbital anthrax cellulitis. She presented with a severe swelling on the right side of her face and an ulceronecrotic lesion above the right eyebrow. After receiving an appropriate antibiotic regimen, her condition improved and she was discharged without any intraocular complications.

Background Cellulitis due to infection with clostridia has not been documented in horses in Iceland. However, clostridia are well-known pathogens in Icelandic sheep, which have traditionally shared grazing land with horses. Clostridial infections of equine muscle or subcutis following injection with medicinal products have been described in other countries but have never been reported in Iceland. In this case report, we present the first documented outbreak of subcutaneous clostridial infection in horses in Iceland following subcutaneous injection. Case presentation In November 2022, 16 out of 32 horses, that some days earlier had received a subcutaneous injection of Noromectin ® 1% injectable solution, developed clinical signs indicating malignant oedema. The clinical signs included pyrexia, depression, swollen limbs, chest and neck, reluctance to move and dyspnoea, leading to the death or euthanasia of five horses. In addition, one horse was found dead with no previously noted clinical signs. Necropsy of one of the five horses revealed severe, acute cellulitis in the neck region, as well as lymphadenitis in regional lymph nodes. Abscesses, some with subsequent spontaneous drainage of seropurulent material, were observed at the presumed injection site on eight surviving horses approximately 2 weeks post-injection. Bacterial culture of samples from the necropsied horse and from abscesses from three surviving horses yielded the growth of C. septicum . Analysis of water samples from the pasture where the herd was kept also revealed the presence of C. septicum . Whole genome sequencing suggested that the isolates from the diseased horses contained the same C. septicum strain, whereas the strain isolated from the water samples differed from the disease-causing isolates. Conclusions Clinical signs compatible with serious subcutaneous C.   septicum infection were seen in over half of 32 horses injected with an ivermectin product, with the subsequent death of six of the horses. In the absence of other obvious sources, the outbreak suggests that C. septicum spores on the skin of these horses were introduced under the skin when they were injected. Such infections have not been reported in Iceland, although ivermectin products formulated for subcutaneous injection have been widely used for more than 30 years. The outbreak warrants further investigation into C. septicum in the environment of grazing horses in Iceland.