Paronychia: Practice Essentials, Background, Epidemiology

Author

Elizabeth M Billingsley, MD Professor of Dermatology, Pennsylvania State University College of Medicine; Director, Mohs Micrographic Surgery, Penn State Hershey Medical Center

Elizabeth M Billingsley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, Association of Professors of Dermatology, Council for Nail Disorders, Pennsylvania Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Allison T Vidimos, MD, RPh Chair, Department of Dermatology, Vice Chair, Dermatology and Plastic Surgery Institute, Staff Physician, Department of Dermatology and Dermatologic Surgery and Cutaneous Oncology, Cleveland Clinic; Professor of Dermatology, Department of Medicine, Case Western Reserve University School of Medicine

Allison T Vidimos, MD, RPh is a member of the following medical societies: American Academy of Dermatology, Association of Professors of Dermatology, International Transplant and Skin Cancer Collaborative, American College of Mohs Surgery, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery

Disclosure: Partner received grant/research funds from Genentech for none.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Acknowledgements

Yelena Bogdan Stony Brook University Health Sciences Center School of Medicine (SUNY)

Disclosure: Nothing to disclose.

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

webmd.com”>David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Pamela L Dyne, MD Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

webmd.com”>Noah Elise Gudel, DO Resident in Internal Medicine, University of Tennessee Medical Center at Knoxville

Disclosure: Nothing to disclose.

Micelle J Haydel, MD Associate Clinical Professor of Medicine, Residency Director, Section of Emergency Medicine, Louisiana State University Health Science Center

Micelle J Haydel, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Sigma Theta Tau International, Society for Academic Emergency Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

Mark F Hendrickson, MD Chief, Section of Hand Surgery, Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation

webmd.com”>Disclosure: Nothing to disclose.

Steve Lee, MD Physician in Plastic, Reconstructive, and Hand Surgery, Plastic Surgery, PLLC

Steve Lee, MD is a member of the following medical societies: American College of Surgeons and American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Mohamad Marouf, MD Consulting Staff, Department of Emergency Medicine, University Hospitals Health System, Richmond Heights Medical Center

Disclosure: Nothing to disclose.

Heather Murphy-Lavoie, MD, FAAEM Assistant Professor, Assistant Residency Director, Emergency Medicine Residency, Associate Program Director, Hyperbaric Medicine Fellowship, Section of Emergency Medicine and Hyperbaric Medicine, Louisiana State University School of Medicine in New Orleans; Clinical Instructor, Department of Surgery, Tulane University School of Medicine

webmd.com”>Heather Murphy-Lavoie, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Jerome FX Naradzay, MD, FACEP Medical Director, Consulting Staff, Department of Emergency Medicine, Maria Parham Hospital; Medical Examiner, Vance County, North Carolina

Jerome FX Naradzay, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Julia R Nunley, MD Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center

webmd.com”>Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, and Women’s Dermatologic Society

Disclosure: Nothing to disclose.

Richard K Scher, MD Adjunct Professor of Dermatology, University of North Carolina; Professor Emeritus of Dermatology, Columbia University

Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American Dermatological Association, American Medical Association, Association of Military Surgeons of the US, International Society for Dermatologic Surgery, Noah Worcester Dermatological Society, and Society for Investigative Dermatology

webmd.com”>Disclosure: Nothing to disclose.

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jeter (Jay) Pritchard Taylor III, MD Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

webmd.com”>Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Management of Chronic Paronychia

Abstract

Chronic paronychia is an inflammatory disorder of the nail folds of a toe or finger presenting as redness, tenderness, and swelling. It is recalcitrant dermatoses seen commonly in housewives and housemaids. It is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens. Repeated bouts of inflammation lead to fibrosis of proximal nail fold with poor generation of cuticle, which in turn exposes the nail further to irritants and allergens. Thus, general preventive measures form cornerstone of the therapy. Though previously anti-fungals were the mainstay of therapy, topical steroid creams have been found to be more effective in the treatment of chronic paronychia. In recalcitrant cases, surgical treatment may be resorted to, which includes en bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail plate removal. Newer therapies and surgical modalities are being employed in the management of chronic paronychia. In this overview, we review recent epidemiological studies, present current thinking on the pathophysiology leading to chronic paronychia, discuss the challenges chronic paronychia presents, and recommend a commonsense approach to management.

Keywords: Chronic paronychia, en bloc excision of nail fold, hand dermatitis

Introduction

What was known?

Chronic paronychia was considered a form of fungal infection affecting the nail folds with anti-fungals being the mainstay of treatment. Surgical management like eponychial marsupialization and en bloc excision of nail fold was done in recalcitrant cases without nail plate removal.

Chronic paronychia is an inflammatory recalcitrant disorder affecting the nail folds. It can be defined as an inflammation lasting for more than 6 weeks and involving one or more of the three nail folds (one proximal and two lateral).[1] This review aims to throw a light on the current concepts in etiopathogenesis of chronic paronychia and brings in detail the past and present management strategies with special focus on newer therapies.

Structure of nail

The nail is a complex unit composed of five major modified cutaneous structures: The nail matrix, nail plate, nail bed, cuticle (eponychium), and nail folds.[2] The nail bed, which consists of 2 portions, is primarily involved in the production, migration, and maintenance of the nail. The proximal portion, called the germinal matrix, contains active cells that are responsible for generating new nail. Damage to the germinal matrix results in malformed nails. The distal portion, the sterile matrix, adds thickness, bulk, and strength to the nail. The nail arises from a mild proximal depression called the proximal nail fold. The nail divides the nail fold into 2 components: The dorsal roof and the ventral floor, both of which contain germinal matrices. Cuticle is an outgrowth of the proximal nail fold (PNF) and is situated between the skin of the digit and the nail plate, fusing these structures together. This configuration provides a waterproof seal from external irritants, allergens, and pathogens. In chronic paronychia, this seal is broken; the irritants enter the space thus created.

Clinical features

The patient presents with complaint of redness, tenderness, swelling, fluid under the nail folds, and thick discolored nail []. Morphologically, it is characterized by induration and rounding off of the paronychium, recurring episodes of acute eponychial inflammation and drainage. Nail plate may show thickening and longitudinal grooving. Onychomadesis, transverse striation, pitting, hypertrophy can be present and are probably due to inflammation of nail matrix.[3] Nail plate may present a green discoloration of its lateral margins due to Pseudomonas aeruginosa colonization.

A case of paronychia with rounding off of peronychium and thick, discoloured nails

Pathogenesis

Repeated bouts of inflammation, persistent edema, induration, and fibrosis of proximal and lateral nail folds causes the nail folds to round up and retract, thereby exposing the nail grooves further. This loss of an effective seal leads to a persistent retention of moisture, infective organisms and irritants within the grooves, in turn exacerbating the acute flare-ups. This vicious cycle goes on, compromising the ability to regenerate the cuticle. The inflamed and fibrosed PNF progressively loses its vascular supply []. This is responsible for failure of medical treatment measures. Topical drugs fail to penetrate chronically inflamed skin, and systemic drugs cannot be delivered to areas of decreased vascular supply.[4]

Pathogenesis of chronic paronychia

Etiology

It has a complex pathogenesis and is caused by multifactorial damage to the cuticle, thereby exposing the nail fold and the nail groove.[5] Previously, it was believed that chronic paronychia is caused by Candida.[6] However, recent data reveals that it is a form of hand dermatitis caused by environmental exposure. Candida is often isolated; however, in many cases, Candida disappears when the physiologic barrier is restored.[7] Hence, the recent view holds that chronic paronychia is not a mycotic disease but an eczematous condition with a multifactorial etiology. For this reason, topical and systemic steroids may be used successfully, whereas systemic anti-fungals are of little value. Tosti et al.[7] discovered that topical steroids are more effective than systemic anti-fungals in the treatment of chronic paronychia. Although Candida was frequently isolated from the PNF of their patients with chronic paronychia, Candida eradication was not associated with clinical cure in most patients.

In a study conducted by Rigopoulos D et al.,[8] tacrolimus 1% ointment and betamethasone 17-valerate cream was found to be more effective in patients of chronic paronychia than just emollient application, confirming allergens and irritants have indeed an important contribution to the pathogenesis of chronic paronychia.

Chronic paronychia commonly afflicts house and office cleaners, laundry workers, food handlers, cooks, dishwashers, bartenders, chefs, nurses, swimmers, diabetes, and patients on HIV-ART. Hypersensitivity to foodstuff is responsible for an increased incidence in food handlers.[9]

There are many rare causes of chronic paronychia, which should always be kept in mind and some of which include the following:

• Infections (Bacterial, mycobacterial, or viral)

• Raynaud’s disease

• Metastatic cancer, subungual melanoma, squamous cell carcinoma. Benign and malignant neoplasms should always be excluded when chronic paronychia does not respond to conventional treatment

• Papulosquamous disorders like psoriasis, vesicobullous disorders-pemphigus

• Drug toxicity from medications such as retinoids, epidermal growth factor-receptor inhibitors (cetuximab), and protease inhibitors. Indinavir- induces retinoid-like effects and remains the most frequent cause of chronic paronychia in patients with HIV disease. Retinoids also induce chronic paronychia. The mechanism can be -nail fragility and minor trauma by small nail fragments.[10] Paronychia has also been reported in patients taking cetuximab (Erbitux), an anti-epidermal growth factor-receptor (EGFR) antibody used in the treatment of solid tumors.[11]

Differential diagnosis

The differential diagnosis of chronic paronychia includes squamous cell carcinoma of the nail, malignant melanoma, metastases from malignant tumors. The clinician should consider the possibility of the carcinoma when a chronic inflammatory process is unresponsive to treatment. Any suspicion for the aforementioned entities should prompt biopsy.

Treatment of chronic paronychia

Various treatment options for management of chronic paronychia have been enlisted in .

Table 1

Treatment options for management of chronic paronychia

General measures

These measures help in prevention as well as work synergistically with other active measures in improving the healing time and decreasing further recurrences. The basic aim is avoidance of aggravating factors and minimizing further injury by reducing the manipulation of the nail. The former may be achieved by avoiding exposure to moist environments and contact irritants such as soaps and detergents. The affected area should be kept dry, and moisturizers should be applied after washing hands. Rubber gloves should be used, preferably with inner cotton glove or cotton liners while performing any work with probable exposure to irritants.[12] Further injury may be minimized by keeping the nails short and avoiding any manipulation of the nail, such as manicuring, finger sucking, or self attempt to incise and drain the lesion. The footwear should be properly chosen to avoid unnecessary damage to the nail. The patients with diabetes should maintain a strict glycemic control.[12]

Medical management of chronic paronychia

Initially, organisms such as Candida and intestinal bacteria were causally related to this condition.[13,14] Thus, anti-fungals played an important role in the management of chronic paronychia in the past, and several studies using topical or systemic anti-fungals have reported encouraging results. Wong et al.[15] compared the therapeutic effect of ketoconazole tablets and econazole lotion in the treatment of chronic paronychia and found them comparable in efficacy. However, they continued to isolate Candida species in cured patients, thus suggesting that total elimination of organisms is not necessary for complete recovery. Likewise, bacteria including micrococci, diphtheroids, and gram-negative organisms were recovered from nail-folds throughout the treatment period proving the multifactorial origin of the condition. Daniel et al. assessed the efficacy of ciclopirox 0.77% topical suspension in combination with a strict irritant-avoidance regimen in patients with simple chronic paronychia and/or onycholysis and showed excellent therapeutic outcomes.[16]

Though anti-fungals were the mainstay of therapy in the past, some investigators have suggested that the therapeutic potential of anti-fungals in chronic paronychia might be attributed equally to the anti-fungal and to the anti-inflammatory properties of these agents.[1] Even in studies showing a good therapeutic effect, some of the patients reported unsuccessful anti-fungal therapy in the past.[17] Thus, the accumulating evidence indicates that chronic paronychia is an eczematous condition as discussed above.[18,19] For this reason, topical and systemic steroids have become the first line of therapy, whereas topical and systemic anti-fungals are of little value now, being used only when there is an associated fungal infection.

Tosti et al. [7] conducted a randomized, double-blind study to compare the efficacy of systemic anti-fungals (itraconazole 200 mg daily or terbinafine 250 mg daily) versus a topical corticosteroid (methylprednisolone aceponate cream 0.1%, 5 mg daily) in the treatment of 45 adult patients with chronic paronychia over 3 weeks. The follow-up period was of 6 weeks. The statistical analysis showed a significant difference between the number of nails improved or cured by methylprednisolone aceponate (41 out of 48) and that of nails improved or cured with terbinafine (30 out of 57) or itraconazole (29 out of 64). Presence of Candida was not strictly linked to disease activity, and Candida eradication was associated with clinical cure in only 2 of the 18 patients who carried Candida.

Tacrolimus has been used successfully in treatment of atopic and allergic contact dermatitis. Based on this fact and that irritants and allergens play a pivotal role of in the development of chronic paronychia, Rigopoulos et al. [8] conducted a randomized, unblinded, comparative study to compare the efficacy of tacrolimus ointment 0.1% vs. betamethasone 17-valerate 0.1% vs. emollient application for 3 weeks in the treatment of 45 patients with chronic paronychia. Both betamethasone and tacrolimus groups presented statistically significantly greater cure or improvement rates when compared with the emollient group, and tacrolimus ointment appeared to be a more efficacious than betamethasone 17-valerate or placebo for the treatment of chronic paronychia. Possible effect of tacrolimus was explained by its role in the elicitation phase of allergic contact dermatitis through inhibition of dendritic cell migration into the draining lymph node[20] and suppression of both irritant and contact patch test reactions.[21] In addition, the ointment formulation of the tacrolimus might offer increased benefit on the impaired barrier function of the inflammatory perionychium.

Surgical management of chronic paronychia

Surgical management is only indicated in recalcitrant cases of chronic paronychia, which does not respond to medical management and proper use of general measures. Surgical treatment is required in such cases to remove the chronically inflamed tissue, which aids in effective penetration of topical as well as oral medications and regeneration of the cuticle.

Various surgical techniques with modifications have been described in literature. Keyser et al.[22] in 1975 suggested simple eponychial marsupialization as the treatment of chronic paronychia. In this technique, after anesthesia and tourniquet control, a crescent-shaped incision parallel and proximal to the distal edge of eponychium and extending from the radial to ulnar borders was made []. The width of the crescent was 3 mm from proximal to distal edge. All affected tissue within the boundaries of the crescent and extending down to, but not including, the germinal matrix is excised and packed with gauze pieces. Thus, this procedure exteriorizes the infected and obstructed nail matrix and allows its drainage. Epithelialization of the excised defect occurs over the next 2-3 weeks.

Eponychial marsupilization in a case of chronic paronychia

Bednar et al.[4] in 1991 treated 7/28 fingers with marsupialization alone and found recurrences in two of these patients who had nail plate irregularities. The 16 patients with nail irregularities were treated with marsupialization plus nail removal, and there were no recurrences with statistically significant difference. The two patients treated with marsupilization alone who showed recurrence were retreated with marsupialization and nail removal and both improved significantly. Thus, they further confirmed that eponychial marsupialization is an effective means of treating chronic paronychia and suggested that nail removal should also be done when concurrent nail irregularities are seen as eponychial marsupialization only drains the dorsal surface of the dorsal roof of germinal matrix, whereas nail removal more thoroughly debrides the entire nail fold by permitting drainage of the volar portion of the dorsal roof as well as the ventral floor.

Eponychial marsupilization preserves the ventral surface of the PNF, which forms the dorsal roof or surface of the nail plate, thus the authors claimed that it produces a cosmetically more acceptable result as compared to en bloc excision of PNF (complete removal of the dorsal roof including the eponychium), since it prevents any subsequent roughness or lack of shininess over the nail plate surface.

Baran et al.[23] Suggested en bloc excision of proximal nail fold as a treatment option for chronic paronychia based on their observation that sites of biopsies from proximal nail fold in cases of collagen disorders healed uneventfully without scarring or distortion in about three weeks. In this procedure, they excised a crescent-shaped piece of full thickness skin, 5-6 mm wide at greatest diameter that extends from one lateral nail fold to the opposite one and includes the entire proximal nail fold []. Complete healing and restoration occurred in three months. They postulated that this method was simpler, curative, and cosmetically and functionally more satisfactory than eponychial marsupialization.

En bloc excision of the proximal nail fold in a case of chronic pronychia

Grover et al.[24] treated 30 patients of chronic paronychia with nail plate irregularities by en bloc excision of PNF with or without nail plate removal. Of these, 70% of patients were cured in group, in which en bloc excision with nail avulsion was performed, whereas only 41% were cured in group where en bloc excision without nail avulsion was performed; however, the difference was not significant statistically. Thus, they concluded that though en bloc excision of the PNF is a useful method in recalcitrant paronychia, simultaneous nail avulsion improves the surgical outcome.

The authors also claimed that a fibrosed, avascular distal eponychium would not contribute effectively towards a normal nail plate surface or produce a new cuticle as postulated by supporters of eponychial marsupilization, and thus preserving the eponychium does not offer any added advantage. Moreover, all these patients of en bloc excision of PNF showed an effective regeneration of eponychium and cuticle with normal attachment to nail plate and no loss of post-op shininess.

Recently, Pabari et al.[25] described Swiss roll technique for chronic and severe acute paronychia with run around infection involving both nail folds. In this technique, the nail fold is elevated by making an incision on either side using a no. 15 scalpel blade with the scalpel tip pointed away from the nail bed to prevent iatrogenic deformity of the nail []. The elevated nail fold is reflected proximally over a non-adherent dressing [] that is rolled up like a Swiss roll and secured to the skin with 2 anchoring non-absorbable sutures. The exposure of the nail bed allows drainage of any residual infection. The finger is subsequently dressed with a simple finger dressing. If the wound is clean at 48 hours, the anchoring sutures are removed, and the nail fold is allowed to fall back to its original position and heal by secondary intention. In chronic paronychia, the fold may be kept open for up to 7 days to allow adequate drainage. This technique has the advantage of retaining the nail plate and allowing rapid healing without creating a defect in the skin.

Swiss roll technique: Incision made on either side of nail fold for nail fold elevation (adapted from Pabari A, Iyer S, Khoo CT. Swiss roll technique for treatment of paronychia. Tech Hand Surg 2011;15:75-7)

Swiss roll technique: Elevated nail fold is reflected proximally over a non-adherent dressing (adapted from Pabari A, Iyer S, Khoo CT. Swiss roll technique for treatment of paronychia. Tech Hand Surg 2011;15:75-7)

Paronychia in a Neonate | Pediatrics

AUTHORS:
Jennifer Cueto, MD¹ • Allison W. Brindle, MD²

AFFILIATIONS:
¹ Warren Alpert Medical School of Brown University
² Hasbro Children’s Hospital

CITATION:
Cueto J, Brindle AW. Paronychia in a neonate. Consultant. 2021;61(10):e31-e32. doi:10.25270/con.2021.02.00002

Received July 31, 2020. Accepted January 18, 2021. Published online February 4, 2021.

DISCLOSURES:
The authors report no relevant financial relationships.

CORRESPONDENCE:
Allison W. Brindle, MD, Pediatrics Department, Hasbro Children’s Hospital, 593 Eddy Street, Potter 200.1, Providence, RI 02903 ([email protected])

A 3-week-old boy, born at 40 weeks and 6 days, presented to our pediatric primary care urgent care clinic on day 26 of life with maternal concern that the patient had not had a bowel movement in 3 days. The patient was feeding well and not vomiting.

The patient’s mother also asked the physician to examine the patient’s finger for a hang nail. The mother denied cutting, clipping, or filing the patient’s nails. She also denied using her teeth to bite the patient’s nails as a means to shorten them or remove a hang nail.

History. The patient had a medical history significant for neonatal abstinence syndrome (NAS) due to perinatal methadone exposure and perinatal hepatitis C virus exposure. The patient’s mother noted that the patient had been fussier than usual, which she attributed to the change in bowel pattern.

Both parents had a history of skin infections, though those were in the past and not temporally related to the infant’s presentation. The patient’s mother had had a skin infection in 2016, which required surgical incision and drainage and treatment with intravenous antibiotics. The patient’s father also had a history of skin infections requiring antibiotics. He did not have an infection at the time of the patient’s presentation.

Physical examination. The patient’s vital signs were within normal limits, and findings from an abdominal examination were normal. Physical examination findings were significant for swelling and erythema with purulent drainage from the nail bed on the patient’s left distal thumb. The nail beds of the third and fourth digits of the patient’s right hand also had purulent fluid collections, though they were not draining, and the digits were not swollen or erythematous (Figures 1 and 2). Although he was afebrile and well-appearing, the patient was referred to the emergency department (ED), due to his young age, for further work up of this localized infection.

Figure 1. The patient’s left distal thumb was swollen and erythematous with purulent drainage from the nail bed.

Figure 2. The nail beds of the third and fourth digits of the patient’s right hand also had purulent fluid collections.

Diagnostic Tests. In the ED, the following tests were performed: a gram stain, wound culture, blood culture, herpes simplex virus (HSV) polymerase chain reaction (PCR) test of the wound drainage, and complete blood cell count (CBC). The results of the CBC were reassuring, with no elevation in white blood cells. The results of the HSV PCR test of the wound drainage were negative. The blood culture did not grow any organisms. The wound culture grew Staphylococcus aureus. Susceptibilities showed that it was methicillin-sensitive Staphylococcus aureus (MSSA). The patient was subsequently admitted to the hospitalist service and received intravenous clindamycin and was observed for 24 hours.

Discussion. Although the infant initially presented with a change in bowel patterns, additional historical information such as his feeding patterns and lack of vomiting, as well as his excellent weight gain and normal abdominal examination, suggested that this was a normal newborn bowel pattern and was not cause for concern. No intervention was required. However, it was the incidental finding of paronychia that warranted additional work up.

Paronychia is an inflammation of the fingers or toes in 1 or more of the 3 nail folds. Paronychia can be acute or chronic, with chronic paronychia being present for longer than 6 weeks. Acute paronychia usually involves 1 digit at a time, whereas chronic paronychia typically involves multiple digits. Risk factors for paronychia include accidental trauma, artificial nails, manicures, manipulating a hang nail, occupational trauma, ingrown nails, and nail biting.¹ Oral trauma in the pediatric population from finger sucking is a predisposing factor. However, paronychia is uncommon among infants younger than age 1 month.²

In our case, the patient was only 3 weeks old at the time of presentation, and he presented with multiple fingers affected. There is a paucity of literature that describes paronychia in neonates. For example, one case study describes a 10-day-old girl who had been diagnosed with NAS at birth and had paronychia of the second and third digits on the left hand. Her paronychia was attributed to prolonged finger sucking as a source for self-soothing for NAS, which is also a possible predisposing factor in our case.² There are other case reports of paronychia in neonates as well.^3,4

The differential diagnosis for paronychia is broad, but the most common diagnoses include eczema, herpetic whitlow, and psoriasis. Although acute paronychia can lead to felons, they are differentiated by the site of infection.¹ The most common causes of acute bacterial paronychia in the adult population are S aureus and Staphylococcus pyogenes. In the pediatric population, mixed aerobic and anaerobic infections are more common, which could be due to differing routes of inoculation, with pediatric nail biting and finger sucking being the primary route in that population.²

Treatment of acute paronychia is based on the severity of presentation. If only mild inflammation is present and there is no overt cellulitis, treatments include warm soaks, topical antibiotics (with or without topical steroids), or a combination of topical therapies. If an abscess is present, it should be drained. Antibiotics are not generally needed after successful drainage, but oral antibiotics are warranted in patients with overt cellulitis and possibly those who are immunocompromised or severely ill.¹

Outcome of the case. In our case, the patient was successfully treated with systemic antibiotics due to his young age, presence of cellulitis of the left thumb, and the fact that he had multiple fingers affected. He was discharged from the ED after 24 hours of observation to complete a 7-day course of oral clindamycin. At a follow-up appointment 6 days after discharge, the paronychia had completely resolved.

References

1. Leggit JC. Acute and chronic paronychia. Am Fam Physician. 2017;96(1):44-51.
2. Grome L, Borah G. Neonatal acute paronychia. Hand (N Y). 2017;12(5):NP99-NP100. doi:10.1177/1558944717692092
3. Russo F, Collantes C, Guerrero J. Severe paronychia due to zidovudine-induced neutropenia in a neonate. J Am Acad Dermatol. 1999;40(2 Pt 2):322-324. doi:10.1016/s0190-9622(99)70476-7
4. Bansal N, Walters HL 3rd, Kobayashi D. Purulent pericarditis due to paronychia in a 16-month-old child: a nail-biting story. World J Pediatr Congenit Heart Surg. 2020;11(4):NP125-NP128. doi:10.1177/2150135117742651

Hand Infections Sydney, NSW | Tendon Sheath Infection Randwick

Hands become infected more frequently as it is one of the commonly injured parts of our body. Hand infections, if left untreated or treated improperly can cause disabilities such as stiffness, contracture, weakness, and loss of tissues (skin, nerve and bone) that persist even after the infection resolves. Therefore, prompt treatment of hand infections is important.

Infections of the hand include:

Paronychia

Paronychia is an infection of the nail fold or cuticle area present around the fingernail. Paronychia may be acute or chronic infection. Acute paronychia is a bacterial infection and causes pain, redness, and swelling around the nail. It is caused by superficial trauma that may occur during nail biting or finger sucking. It can be treated with antibiotics and if pus forms, it needs to be drained. Chronic paronychia is a result of fungal infection and it causes milder symptoms such as mild pain, redness or swelling, with little or no pus. It occurs most commonly in people whose hands are often wet or are immunocompromised. The treatment for chronic paronychia consists of avoiding constant exposure to moisture and application of topical steroid and antifungal ointments.

Felon

Felon is a serious infection of the fatty tissues of finger tips which results in throbbing pain. It is caused due to direct entry of bacteria during a penetrating injury or by spread of infection from untreated paronychia. If there is an abscess, surgical drainage is done following which antibiotics will be prescribed.

Herpetic Whitlow

Herpetic whitlow is a herpes simplex virus infection of the fingers. It is more common in healthcare workers whose hands are exposed to the patient’s saliva which may carry the virus. Herpetic whitlow presents small, swollen, painful blisters. Conservative treatment for herpetic whitlow involves application of a dry gauze dressing to the affected finger to avoid spread of infection.

Septic Arthritis/Osteomyelitis

Septic arthritis is a severe infection of the joint caused by a wound or a draining cyst. The bacterial infection may cause destruction of the joint by eroding away the joint cartilage. Surgical drainage should be done as soon as possible because the condition may get complicated if the infection spreads to the bone causing osteomyelitis.

Deep Space Infections

Deep fascial spaces are the potential spaces in between the different structures of the hand.  These spaces tend to get infected through penetrating wounds or spread of infection from blood. Deep space infections may occur in the thumb, the palm or in the area between the bases of fingers. Treatment for deep space infections includes antibiotic therapy, pain relieving medications, and surgical drainage.

Tendon Sheath Infection

Tendon sheath infection is the infection of the flexor tendon which occurs because of a small laceration or penetrating wound on the finger, near a joint. It causes severe stiffness of the finger accompanied by redness, swelling and pain. This condition may also lead to destruction and rupture of the tendon. Therefore, it demands the immediate surgical drainage.

Atypical Mycobacterial Infections

Atypical mycobacterial infections are tendon sheath infections caused by an atypical mycobacterium. These infections cause stiffness and swelling without much pain and redness. Antibiotic treatment is given for several months following which surgical removal of the infected tendon sheath may be done.

Infections from Bite Wounds

Infections from animal or human bite are associated with bacteria such as Streptococcus and Staphylococcus, Eikenella corrodens (human bite injuries) and Pasteurella multocida (dog and cat bite injuries). These wounds are given initial treatment and left open to allow the infection to drain out. Surgical trimming of infected or crushed tissue may be done.

Necrotizing Soft Tissue Infection | Johns Hopkins Medicine

What is necrotizing soft tissue infection?

A necrotizing soft tissue infection is a serious, life-threatening condition that requires immediate treatment to keep it from destroying skin, muscle, and other soft tissues. The word necrotizing comes from the Greek word “nekros”, which means “corpse” or “dead”. A necrotizing infection causes patches of tissue to die.

These infections are the result of bacteria invading the skin or the tissues under the skin. If untreated, they can cause death in a matter of hours.

Fortunately, such infections are very rare. They can quickly spread from the original infection site, so it’s important to know the symptoms. 

What causes necrotizing soft tissue infection?

News stories often use the phrase “flesh-eating bacteria.” But, many types of bacteria can invade an open wound, even a small cut. Sometimes a necrotizing infection can be caused by a bacteria called Streptococcus, the same bacteria that causes strep throat. However, more often, many different types of bacteria are involved in a necrotizing infection including:

• Enterococci
• Staphylococcus aureus
• Clostridium perfringens
• Anaerobic and gram negative bacteria such as E. coli

It can take time to find out which bacteria are present. For this reason, your healthcare providers may recommend a treatment that can fight many different infections. Delaying treatment increases your risk for a more serious problem.

Who is at risk for necrotizing soft tissue infection?

The bacteria that cause necrotizing soft tissue infections are usually introduced when a small cut or scrape becomes contaminated with soil or saliva so anyone can be infected. Those at greater risk are those with an open wound, even a small cut, especially if it has been in contact with dirt or bacteria in the mouth. Other risk factors include having peripheral artery disease, diabetes, obesity, and lifestyle habits such as heavy alcohol use and injection drug use.

What are the symptoms of a necrotizing soft tissue infection?

These are the most common symptoms of a necrotizing soft tissue infection. See your healthcare provider right away for any of these symptoms:

• Pain that hurts more than you think it should, based on the size of the wound or sore 
• A wound accompanied by a fever (higher than 100. 4°F or 38°C) and a rapid heartbeat (usually more than 100 beats a minute)
• Pain that extends past the edge of the wound or visible infection
• Pain, warmth, skin redness, or swelling at a wound, especially if the redness is spreading rapidly
• Skin blisters, sometimes with a “crackling” sensation under the skin
• Pain from a skin wound that also has signs of a more severe infection, such as chills and fever
• Grayish, smelly liquid draining from the wound
• A small sore or pus-filled bump that is unusually painful to the touch
• An area around the sore that is hot to the touch
• Difficulty thinking clearly
• Excessive sweating
• Areas of skin at or near the wound that feel numb
• A sore that won’t heal, especially if you are obese, have diabetes, or have a weak immune system as a result of using a steroid regularly, if you are taking chemotherapy for cancer, if you are on dialysis, or if you have peripheral artery disease, heavy alcohol use, or HIV/AIDS

People with some of these symptoms are surprised to learn that they have a necrotizing soft tissue infection because it did not seem to be especially severe at first. But these infections can progress rapidly if they are not aggressively treated. If you have a skin infection with a warm, red area, you should use a marker or pen and outline the red area so that you and the healthcare provider can see how far and how quickly it spreads outside the line.

The symptoms of a necrotizing soft tissue infection may look like other medical conditions or problems. Always see your healthcare provider for a diagnosis.

How is a necrotizing soft tissue infection diagnosed?

Your healthcare provider will likely ask you about:

• Your medical and travel history
• If you’ve recently been bitten by an animal or spider
• If there was an injury to the affected area which was soiled or contaminated with saliva from the mouth
• If you’ve been exposed to slightly salty (brackish) water or saltwater
• Whether you’ve eaten raw seafood
• Whether you have a history of intravenous (IV) drug use

If you’ve developed a necrotizing soft tissue infection as a result of surgery, it may be slower moving and your skin at the wound site may even look normal at first.

Because your healthcare provider may not be able to tell how far the infection has spread with only a physical exam, he or she might order tests to get more information. These could include:

• Blood tests, including a complete blood cell count
• X-rays to detect air in soft tissues
• MRI scan
• Tissue culture to determine which type of bacteria is present

Your medical team will check test results for unsuspected organisms and also for bacteria that are hard to treat with the usual antibiotics, which may prompt a change in medicine.

How is a necrotizing soft tissue infection treated?

Treatment must be aggressive and started quickly to be effective. It might include most or all of the following:

• Removal of the infected tissue. This is to prevent the spread of the infection. The process is known as surgical debridement.
• Antibiotics or antifungal treatments. These medicines fight the infection at its source.
• Hyperbaric oxygen therapy. With this therapy you will spend time in a pressurized chamber that increases the amount of oxygen available for you to breathe and for your red blood cells to take in. This is thought to help in wound healing.
• Tetanus immunization. Your healthcare provider might also recommend a tetanus shot to protect against additional infection.

What are the complications of a necrotizing soft tissue infection?

A necrotizing soft tissue infection can destroy skin, muscle, and other soft tissues, and, if untreated, lead to death.

Can a necrotizing soft tissue infection be prevented?

Your best approach to necrotizing soft tissue infections is to do your best to avoid them. To help prevent these infections:

• Do foot checks and skin checks. If you have diabetes or a weak immune system, always check your feet and skin so that you can find and treat any small sores as soon as they appear. Do not let them enlarge and become more vulnerable to infection.
• Care for wounds and surgical sites carefully. Follow your healthcare provider’s instructions when caring for wounds and surgical sites to prevent infection and keep the area clean.
• Wash and cover small cuts and scrapes. Rigorously clean even small cuts with soap and water. Cover with an adhesive bandage.
• Avoid sharing personal items. This can include towels and razors.
• Wash your hands regularly. This is especially important before preparing food, after coughing or sneezing, and after caring for people with strep throat or wounds from injury or surgery.
• Know your risk factors. You are at increased risk for these infections if you have peripheral artery disease, diabetes, are obese, or have lifestyle habits such as heavy alcohol use and injection drug use. Manage your risk factors to reduce the risk of infection.
• See a healthcare provider immediately if you develop symptoms of the infection. 

Key points about necrotizing soft tissue infection

• A necrotizing soft tissue infection is a serious, life-threatening condition.
• It can destroy skin, muscle, and other soft tissues.
• A wound infection that is especially painful, hot, draining a gray liquid, or accompanied by a high fever, or other systemic symptoms needs immediate medical attention.
• Treatment must be aggressive and started quickly to be effective.
• Prevention includes immediately caring for any cuts or sores.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Hand Infections Treatment Waco, TX | Paronychia

Hands become infected more frequently as it is one of the commonly injured parts of our body. Hand infections, if left untreated or treated improperly can cause disabilities such as stiffness, contracture, weakness, and loss of tissues (skin, nerve and bone) that persist even after the infection resolves. Therefore, prompt treatment of hand infections is important.

Infections of the hand include:

Paronychia

Paronychia is an infection of the nail fold or cuticle area present around the fingernail. Paronychia may be an acute or chronic infection. Acute paronychia is a bacterial infection that causes pain, redness and swelling around the nail. It is caused by superficial trauma that may occur during nail biting or finger sucking. It can be treated with antibiotics. If pus forms, it needs to be drained. Chronic paronychia is a result of a fungal infection and causes symptoms such as mild pain, redness or swelling, with little or no pus. It occurs most commonly in people whose hands are often wet or are immunocompromised. The treatment for chronic paronychia consists of avoiding constant exposure to moisture and application of topical steroids and antifungal ointments.

Felon

Felon is a serious infection of the fatty tissues of the finger tips, which results in throbbing pain. It is caused due to direct entry of bacteria during a penetrating injury or by spread of infection from untreated paronychia. If there is an abscess, surgical drainage is performed following by the administration of antibiotics.

Herpetic whitlow

Herpetic whitlow is a herpes simplex virus infection of the fingers. It is more common in healthcare workers whose hands are exposed to patients’ saliva, which may carry the virus. Herpetic whitlow presents small, swollen and painful blisters. Conservative treatment for herpetic whitlow involves the application of a dry gauze dressing to the affected finger to avoid spread of infection.

Septic arthritis/osteomyelitis

Septic arthritis is a severe infection of the joint caused by a wound or a draining cyst. The bacterial infection may cause destruction of the joint by eroding the joint cartilage. Surgical drainage should be done as soon as possible because the condition may get complicated if the infection spreads to the bone, causing osteomyelitis.

Deep space infections

Deep fascial spaces are the potential spaces in between the different structures of the hand. These spaces tend to get infected through penetrating wounds or spread of infection from blood. Deep space infections may occur in the thumb, the palm or in the area between the bases of fingers. Treatment for deep space infections includes antibiotic therapy, pain relieving medications and surgical drainage.

Tendon sheath infection

Tendon sheath infection is the infection of the flexor tendon, which occurs because of a small laceration or penetrating wound on the finger near a joint. It causes severe stiffness of the finger, accompanied by redness, swelling and pain. This condition may also lead to destruction and rupture of the tendon. Therefore, it demands the immediate surgical drainage.

Atypical mycobacterial infections

Atypical mycobacterial infections are tendon sheath infections caused by an atypical mycobacterium. These infections cause stiffness and swelling without much pain and redness. Antibiotic treatment is administered for several months, following which surgical removal of the infected tendon sheath may be performed.

Infections from bite wounds

Infections from animal or human bite are associated with bacteria such as Streptococcus and Staphylococcus, Eikenella corrodens (human bite injuries) and Pasteurella multocida (dog and cat bite injuries). These wounds are treated with initial therapy and left open to allow the infection to drain out. Surgical trimming of infected or crushed tissue may be done.

Lymphedema & Infection | Breastcancer.org

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Infection is a special concern after you’ve had any lymph nodes removed — whether or not you’ve ever had any symptoms of lymphedema. This is because of two key roles those lymph nodes play for the hand, arm, and upper body.

1. Lymph nodes take care of “foreign invaders” from specific regions of the body and signal the body to launch an immune response. “I liken the lymph node to a taxi dispatcher who gets a call from someone at an address and then says, ‘Hey taxi, go there,’” says Kathryn Schmitz, Ph.D., MPH, FACSM, professor of public health sciences and physical medicine and rehabilitation at the Penn State Cancer Institute. “So let’s say you have an underarm lymph node or nodes that serve your hand. You get a cut in your finger and dirt and debris get into the body. The lymph carries the debris up to the lymph nodes, which strain the debris out and then tell the immune system to respond, to stop the infection. So what happens if you no longer have all of those nodes? A cut that wasn’t a big deal before has the potential to turn into an infection that, left unchecked, can spread throughout the body.”

2. Lymph nodes filter out bacteria and toxins so they can’t get into the blood. In the case of this cut finger, the lymph is trying to carry the bacteria and debris out of the finger tissue, but some of the lymph nodes and vessels you had before aren’t there to filter it out. The remaining nodes and vessels may not be able to keep up with all the lymph that needs to be filtered. Bacteria can then start to multiply in the lymph. Because lymph is rich in nutrients, it provides a great environment for bacteria to hang out and reproduce.

The more lymph nodes that have been removed or damaged, the harder it may be for your lymphatic system to deal with injury. Cuts or even small breaks in the skin — sometimes not even visible to the naked eye — can get infected, causing local symptoms such as redness, tenderness, and warmth. In some cases, these symptoms can spread from the original injury up the arm or into the upper body. A spreading rash that is warm and tender indicates cellulitis, a serious bacterial infection of the skin and underlying tissue. Cellulitis requires immediate medical attention and treatment with antibiotics. Left untreated, cellulitis tends to spread rapidly and can even become life-threatening. If you can’t get in to see your doctor right away, go to the nearest emergency room for treatment.

What to do if you notice a cut or break in the skin

For many women, infection is the trigger for their first episode of lymphedema. If you notice a cut or break in the skin anywhere in the hand, arm, chest, or upper body on the side of your surgery — no matter how minor — be sure to:

• Wash the area with soap and water.




• Apply an over-the-counter antibiotic ointment, such as Neosporin, Polysporin, Bactroban, or the store-brand equivalent.




• Cover with a clean, dry bandage and change it regularly, keeping the area clean and covered until it heals.




• Check every day for signs of infection, such as redness, swelling, increased heat, or tenderness in the area, or chills, fever, and/or fatigue. You may feel ill — almost like you have the flu coming on — before you notice any changes in the skin.




• Call your doctor if you think you have an infection.

Note: If you get a cut, it doesn’t mean it will definitely become infected, or that you will develop lymphedema. Just use good common sense to reduce the risk of infection and take quick action if any symptoms appear.

If you develop infection or recurrent infections

Any infection should be treated right away with an antibiotic, whether or not it has progressed to cellulitis. Your doctor may recommend that you rest in bed and elevate the affected area. If you already have lymphedema, you can continue wearing your compression sleeve if it’s not too painful to do so. (If the area is inflamed and sore, you may need to take a break until symptoms improve — see your doctor for more guidance.) Any massaging of the area with manual lymphatic drainage should stop until the infection has resolved.

Typically, your doctor will need to see you within a few days to make sure the antibiotic is working. Symptoms of infection should start clearing up within a few days, although you’ll likely need to continue taking the medication for longer than that. If your infection doesn’t respond, you may need to be admitted to the hospital to receive antibiotics intravenously, which means the medicine is delivered directly into your bloodstream through an IV or a port. Just be sure the IV isn’t inserted into the arm or hand on the side of your body that has the infection.

Let your lymphedema therapist know that you’ve had an infection. He or she can monitor you for any signs of lymphedema if you’ve never been diagnosed, or for symptom flare-ups if you already have it. Since infection can trigger lymphedema, it’s important to take action quickly if symptoms develop.

Some people go on to experience recurrent infections. If this happens to you, ask your doctor about getting an emergency supply of antibiotics to be taken at the first sign of trouble. If you have persistent lymphedema and get frequent infections, you may need to take antibiotics whenever you get a cut or break in the skin. Your doctor might recommend taking a low-dose antibiotic regularly as a preventive measure, even without any signs of injury or associated infection. Or you may only need to take an antibiotic before any medical procedure that could introduce outside bacteria into your body, such as dental work or surgical procedures. Your doctor is the best judge of what’s right for you.

If you’ve had problems with infection and are planning a trip or an extended out-of-town stay, see your doctor. He or she may advise that you can take a prescription for antibiotics or a medication supply with you.

Another important step is ramping up your current treatment plan, advises Nicole Stout, MPT, CLT-LANA, Senior Rehabilitative Services Practice Leader at Kaiser Permanente, Mid Atlantic Region. “With my own patients, I find that when we find ways to manage their lymphedema more consistently, they tend to have fewer infections. This may mean more consistent nighttime bandaging or compression, or more compression during the day.”

Be sure to review and follow all of the guidelines for protecting your skin. See Reducing the Risk of Lymphedema and Lymphedema Flare-Ups for more information.

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90,000 There were photos of an atypical manifestation of coronavirus

https://ria. ru/20201101/koronavirus-1582543872.html

Photos of an atypical manifestation of coronavirus appeared

Photos of an atypical manifestation of coronavirus appeared – RIA Novosti, 01.11. coronavirus

Doctors have published photos of atypical manifestations of coronavirus: red and purple bumps on the fingers and toes of patients. Reported by Huffington… RIA Novosti, 01.11.2020

2020-11-01T16: 02

2020-11-01T16: 02

2020-11-01T16: 18

The spread of coronavirus

health

covid-19 coronavirus

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MOSCOW, November 1 – RIA Novosti.Doctors have published photos of an atypical manifestation of coronavirus: red and purple bumps on the fingers and toes of patients. According to the Huffington Post, these bumps on the legs and arms were believed to be due to frostbite before the pandemic. However, as the number of people infected with coronavirus increases, more and more people began to complain of this symptom even in the warmer months, which alarmed doctors. Researchers found 12 thousand people infected with COVID-19 with bumps on their fingers and toes. The doctors asked them to provide photographs of the skin manifestations of the infection.Patients interviewed noted that red and purple bumps may hurt, but usually do not itch. When the rash passes, the upper layers of the skin can “peel off.” Despite the negative COVID test they passed, the virus was found in endothelial cells, as well as in sweat glands. The International League of Dermatological Societies and the American Academy of Dermatology found that “covid fingers” can persist in patients for 15 days, but sometimes they appear even up to 130-150 days.The researchers added that such a symptom could be key to detecting the virus, especially in those who carry COVID-19 without other symptoms.

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health, covid-19 coronavirus

MOSCOW, November 1 – RIA Novosti. Doctors published photos of an atypical manifestation of coronavirus: red and purple bumps on the fingers and toes of patients.Reported by the Huffington Post.

Before the pandemic, such bumps on the legs and arms were considered the result of frostbite. However, with the increase in the number of people infected with coronavirus infection, more and more people began to complain of this symptom even in the warm season, which alarmed doctors.

Researchers have found 12,000 people infected with COVID-19 with bumps on their fingers and toes. The doctors asked them to provide photographs of the skin manifestations of the infection.

1 of 2

Hands of people with COVID-19

2 of 2

Hands of people with COVID-19

1 of 2

Hands of people with COVID-19

2 of 2

Hands of people with COVID -19

Patients interviewed noted that red and purple bumps may hurt, but usually do not itch.When the rash heals, the top layers of the skin can peel off.

The doctors clarified that the connection between such inflammation of the skin and the coronavirus was revealed thanks to skin biopsies of children with “covid fingers”. Despite the negative COVID test they passed, the virus was found in endothelial cells, as well as in sweat glands.

“Damage to the endothelium may be a key mechanism causing these lesions,” notes specialist Nino Jesus.

The International League of Dermatological Societies and the American Academy of Dermatology have found that “covid fingers” can persist in patients for 15 days, but sometimes appear up to 130-150 days.

The researchers added that such a symptom could be key for detecting the virus, especially in those who carry COVID-19 without other symptoms.

November 1, 2020, 06:06 Spread of coronavirus Doctors warned vegetarians about the high risk of infection with coronavirus 90,000 Tungiosi

Key facts

• Tungiosis is a disease carried by female sand fleas, which penetrate the skin and lay eggs there.
• Tungiosis can lead to the formation of abscesses, secondary infections and gangrene, as well as disfigurement.
• The disease occurs in most tropical and subtropical regions of the world; the poorest people suffer the most.
• Both animals and humans are susceptible to this disease.

Overview

Tungiasis is a skin parasitic disease caused by an infection carried by the female sand flea Tunga penetrans (and in some areas T. trimamillatain ). She is also commonly known as “pulga de areia”, “niguá”,
“Pique”, “bicho do pé”, “bichodo porco” or “jatecuba”, and in English-speaking countries as “jigger”, “sand flea” or “chigoe”.Tungiosis is a zoonosis that
affects both humans and animals.

Transmission mechanism

The female sand flea invades the skin epidermis, feeds on the victim’s blood and lays eggs. The life cycle of a flea is usually 4-6 weeks, after which the eggs are laid and fall from the wound to the ground. Toes, soles,
the edges of the foot and heel, while in 99% of cases the lesions are concentrated in the area of ​​the foot. Severe itching and pain occurs as female fleas grow, whose body size increases 2000 times within one week.Bacterial infections developing
in the lesions, can cause abscesses, suppuration and lymphangitis. Numerous wounds and severe focal lesions of the skin aggravate pain and limit mobility.

Several species of mammals can serve as natural reservoirs of infection for humans. In rural areas, these are mainly pigs and cattle; in poor urban communities, these are dogs, cats and rats. In some areas, infection can
transmitted in the absence of such animals in cases where there is direct skin contact with the soil or floor on which adult sand fleas live.Infection often occurs in homes, in the vicinity of homes, or in school classrooms, not
having insulated floors.

Burden of disease

Disease T. penetrans occurs in most tropical and subtropical regions of the world. According to unconfirmed reports, T. penetrans infection was introduced to Africa from American countries at the end of the 19th century. Since then it has spread
almost all countries in sub-Saharan Africa.In the WHO Region of the Americas alone, it is estimated that more than 20 million people are at risk.

Tungiosi finds fertile ground to spread where living conditions are difficult, such as coastal villages in remote areas, rural communities and slums in large cities. In these conditions, the poorest strata
populations bear the heaviest burden of disease.

In poorly resourced urban areas and rural communities, the prevalence of the disease can be as high as 60% in the general population and up to 80% in children.Elderly people and children aged 5-14 are at greatest risk, especially
boys. Persons with disabilities are in an extremely vulnerable position in the face of this disease.

Consequences

Repeated infections disfigure and deform the legs, ultimately leading to impaired mobility. The weakened physical condition of adult household members negatively affects the quality of life and the economy of households. Tungiosis often
associated with stigma and social exclusion.Tungiosis has been reported to have a significant impact on the quality of life of affected children, including absenteeism from school, and appropriate treatment can change
the situation for the better. Bacterial superinfection can cause life-threatening complications such as post-streptococcal glomerulonephritis, tetanus, and gangrene.

Symptoms and diagnostics

Tungiosis becomes acute and chronic under the influence of an inflammatory reaction around the sites of penetration into the skin of female sand fleas, which is aggravated by bacterial superinfection.In the acute phase, redness, swelling, peeling of the skin, pain
and itching are chronic. Itching causes a reflex scratching of the lesions, which, in turn, facilitates the development of bacterial superinfection. Abscesses often develop, sometimes involving large areas.

Feet accounts for most of the localization of infection, but the infection can affect any part of the human body. In addition, there is information about the possibility of the occurrence of foci of lesions of the bullous type.Chronic pathologies include cracks,
ulcers, lymphangitis, lymphatic edema, radiating neuritis, deformation and loss of nails, and tissue necrosis. The disease leads to pain, disability, disfigurement and disfigurement of the legs, causing characteristic changes in the gait of the sufferers
tungiosis of people.

Tungiosis is diagnosed in the presence of various stages of development of signs of the disease, as a rule, when a whitish halo of any size appears on the skin with a dark dot in the center, which eventually turns black completely, and the skin in this place dies off.V
in areas endemic for the disease, people suffering from it, and even children, usually know that they have tungiasis.

Treatment

In endemic areas, standard treatment is surgical removal of embedded sand fleas, which is usually done by the patient or caregiver. Parasites that have penetrated the skin are removed under non-sterile conditions
using tools such as sticks, hairpins, sewing needles and scissors.It is a painful procedure and is not well tolerated by children. Removing fleas can cause focal inflammation of the skin if the integrity of the
parasite and bring in pathogenic bacteria, which will lead to the appearance of superinfection in the wound. In the future, such devices are often used by several people, which is associated with the risk of transmission of diseases such as hepatitis B virus (HBV), hepatitis virus
C (HCV) and HIV.

Surgical retrieval of the parasite should only be performed in an appropriately equipped medical facility or by an experienced community health worker using sterile instruments.After removing sand fleas on the wound
an appropriate bandage should be applied and a tetanus vaccine checked and, if indicated, an accelerated vaccination should be carried out. Long-term protective effects can be achieved by expanding tetanus vaccination coverage in the population
areas endemic for tungiosis.

Metriphonate, thiabendazole and ivermectin were tested as topical preparations; however, they all proved to be insufficiently effective ¹ .High efficiency of two-component dimethicone used in the treatment of head lice
corresponding viscosity has been confirmed in the case of its topical application with tungiosa ^2.3 .

Prevention and control

Regular use of coconut oil based repellent effectively prevents fleas from entering the epidermis of the skin. When applied to legs twice daily, the risk of tungiosis-related disease is rapidly reduced and after
8-10 weeks
approaches zero ⁴ .The risk of morbidity is significantly reduced even in the case of interruptions in the use of repellent.

Long-term reductions in the incidence of tungiosis and associated morbidity can only be achieved with an approach that links behavior change with the environment of animals as reservoirs of infection,
as well as people in general.

WHO activities

In May 2013, the Sixty-sixth World Health Assembly decided to intensify and integrate responses to neglected tropical diseases such as tungi, and invest in resources to improve
health and social well-being of the affected population groups.WHO is working with Member States and partners to ensure compliance with resolution WHA66.12.

Bibliography

• ¹ Heukelbach J, Eisele M, Jackson A, Feldmeier H (2003). Topical treatment of tungiasis: a randomized, controlled trial. Ann Trop Med Parasitol. 97 (7): 743-9.
• ² Thielecke M, Nordin P, Ngomi N, Feldmeier H (2014). Treatment of tungiasis with dimeticone: a proof-of-principle study in rural Kenya.PLoS Negl Trop Dis. 8 (7): e3058. doi: 10.1371 / journal.pntd.0003058.
• ³ Nordin P, Thielecke M, Ngomi N, Mudanga GM, Krantz I, Feldmeier H (2017). Treatment of tungiasis with a two-component dimeticone: a comparison between moistening the whole foot and directly targeting the embedded sand fleas. Trop Med Health.
  45: 6. doi: 10.1186 / s41182-017-0046-9 PMID: 28293130; PubMed Central PMCID: PMC5345134.
• ⁴ Thielecke M, Raharimanga V, Rogier C, Stauss-Gabo M, Richard V, Feldmeier H (2013).Prevention of tungiasis and tungiasis-associated morbidity using the plant-based repellent Zanzarin: a randomized, controlled field study in rural Madagascar.
  PLoS Negl Trop Dis. 2013 Sep; 7 (9): e2426. doi: 10.1371 / journal.pntd.0002426.

What is known about the coronavirus today – Rossiyskaya Gazeta

The first cases of unusual, untreatable pneumonia were recorded in the Chinese city of Wuhan in early December last year.A month later, Chinese virologists presented the world with the genome of a new, previously unknown coronavirus, which was officially named COVID-19.

Over the past 2.5 months, scientists from both China and other countries have learned a lot of important information about the new infection. Much data – about its source, distribution, methods of infection and protection – has changed many times and has been updated with new data. We have collected all the information that is relevant today. Although in Russia the situation with COVID-19 remains under control, the virus has already spread to three dozen countries, including, for example, Italy, Vietnam, the Philippines, which are so popular with Russian tourists.Therefore, advice on how to protect yourself remains relevant.

What are coronaviruses?

Coronaviruses are a family of viruses that primarily infect or live in animals without causing disease. But due to the high variability, strains can arise that are transmitted to humans. Usually, diseases caused by coronaviruses are mild without causing severe symptoms. But before the current outbreak, the world was faced with at least two cases where the mutated coronavirus became very dangerous for humans: the outbreak of the Middle East respiratory syndrome (MERS) (2009-2010) and the epidemic of severe acute respiratory syndrome (SARS), which took over the world in 2002-2003.

How to distinguish coronavirus from influenza?

– Feeling tired.

– Difficulty breathing.

– High temperature.

– Cough and / or sore throat.

Symptoms are very similar to many respiratory diseases, often mimic the common cold, and may resemble the flu.

A specific symptom of coronavirus infection: increasing shortness of breath – it may indicate that the patient is developing pneumonia.

One of the main measures in the fight against coronavirus is adherence to certain etiquette

The symptoms caused by the influenza virus and COVID-19 are similar, but the viruses themselves at the gene level differ significantly from each other.COVID-19 has much in common in its structure with the MERS and SARS viruses that caused the SARS epidemic in 2002-2003 and the camel flu outbreak in 2009-2010.

How is the coronavirus transmitted?

The main pathway is the tiny droplets of saliva and mucus that form when an infected person coughs or sneezes. They are contained in the air near the infected person and settle on any surfaces. Therefore, the virus can be picked up by touching any contaminated surface – handrails in vehicles, a doorknob, someone else’s mobile phone or computer.Infection occurs when a person touches his mouth, nose with contaminated hands, rubs his eyes.

Who became the source of the infection?

The outbreak is believed to have originated from animals that were traded at a seafood market in Wuhan. There were rows where you could buy and even try on the spot exotic dishes from snakes, bats and other animals. According to the latest reports from China, another version has appeared: “patient zero” (that is, the very first human case) is not associated with the market – the infection occurred earlier and in an unknown place.But this information needs to be double-checked. In the meantime, it has been established that the genome of the coronavirus contains part of the genome of bats and the exotic pangolin animal. And although there are a lot of assumptions about the “artificial” nature of the virus, that it was “created” in a laboratory, Russian scientists refute this conspiracy theories.

How to protect yourself from infection?

– The main rule is to keep your hands and surfaces clean.

– Wash your hands often with soap and water, use disinfecting gels and wipes, and carry them with you so that you do not depend on the ability to wash your hands.

– Avoid touching your face or eyes with unwashed hands.

– Carry hand sanitizer with you so you can clean your hands in any environment.

– Protective gloves may be worn in crowded places, airports, transport. And when you come home – wash them and iron them.

– Observe “epidemiological etiquette”: wear disposable wipes, cover your nose and mouth if you cough or sneeze, and be sure to dispose of them after use.

– If the napkin is not at hand, but you have an urge to sneeze or cough, do it in the bend of your elbow.

– Do not eat snacks (nuts, crackers, chips) from common packages or dishes together with other people – the virus may end up on someone’s hands.

– While there is a threat of an epidemic, it is better to refuse handshakes and welcome hugs and kisses. Now this is not impolite, but concern for one’s neighbor.

– At work, wipe the computer keyboard, telephone, smartphone screen, remotes, door handles and handrails with disinfectant solution.

Why not panic?

At the moment there is no specific antiviral drug for the new coronavirus – just like there are no “targeted” drugs for most other respiratory viruses that cause colds.

At the same time, viral pneumonia, the main and most dangerous complication of COVID-19, is cured by maintaining lung function with a ventilator and blood oxygenation.

But the most important thing is that the mortality rate from a new infection is 2-3 percent (that is, out of 100 infected people, two or three die), and this is comparable to seasonal flu.

Is there a vaccine for the new coronavirus?

Currently, there is no such vaccine, but in a number of countries, including Russia, in the scientific organizations of Rospotrebnadzor, its development has already begun. And Chinese experts said they plan to start testing a new vaccine at the end of April. However, most of the experts with whom RG spoke, say that the development of a vaccine and its clinical testing will take several years.

How to determine if you have a coronavirus?

There is no need to repeat the mistake of a St. Petersburg patient who escaped from quarantine under the pretext that “she passed the test and it is negative.”It is impossible to get a private test for COVID-19 coronavirus today. Test systems developed at the Vector Research Center are supplied only to specialized laboratories of Rospotrebnadzor. Therefore, when a patient is sent to a hospital with suspected coronavirus infection, a swab from the nasopharynx is taken from him on the spot. And then they send it to the laboratory or directly to the Scientific Center “Vector”, where the analysis is performed. Therefore, although the testing itself takes only 2-4 hours, sometimes you have to wait for the result for several days.

What can you do at home?

It is necessary not only to defend ourselves, but also to teach children the rules of prevention. They need to explain how germs spread and why good hand and face hygiene is important. By the way, there is a visual video on the Web that shows how drops of saliva and mucus scatter when coughing.

Everyone in the family should have their own towel, not to mention a toothbrush.

Ventilate the room often and do wet cleaning.

Interesting fact

Splashes of alcohol

Some infectious disease specialists recommend using diluted alcohol or vodka as a simple disinfectant: it can be sprayed with a simple spray bottle.

Interesting fact

Risk group

Of the huge number of people infected (about 80 thousand people at the moment), 80 percent of the disease is mild, 15-20 percent is in a state of moderate and high severity. It is not possible to save 2-3 percent of the sick, mainly people of older ages (over 65), as well as people with a weakened immune system, chronic diseases of the respiratory and cardiovascular systems.

Specifically

How to wear a medical mask correctly?

1.The mask should cover the nose and mouth and fit the sides of the face to reduce the gap between the face and the bandage.

2. Do not touch the worn mask. After touching a used bandage, for example, if you have removed it, be sure to wash your hands.

3. It is better to change the mask every 2 hours and more often. Once the mask is wet, a new, clean, dry bandage should be put on.

4. Do not reuse disposable masks. They should be thrown away after each use and disposed of immediately after removal.

5. If there is nowhere to throw the mask away, do not put it in your bag or pocket. As a last resort, temporarily place it in a plastic bag.

6. Masks should be worn in transport, public places or when caring for a sick person. You don’t need a mask outdoors.

By the way

What infections can be caught from animals

Ringworm (ringworm) – you can get infected from cats and dogs. It manifests itself as itching and red spots on the skin.

Roundworms are parasites of cats and kittens that can become infected through the milk of a mother cat.Annually, these worms are diagnosed in about 10 thousand children.

Fever – bartonellosis – bacteria penetrate through scratches or bites of an infected cat, dog, guinea pig. It is manifested by inflammation at the site of the scratch, swelling of the lymph nodes, pain in the joints.

Rabies is a viral disease that ends in death if the vaccine is not administered. Sick wild animals – foxes, hedgehogs, can infect dogs and cats. A person can become infected with rabies even without visible damage to the skin – if saliva gets from a sick animal.

Ornithosis (“parrot” disease) – you can get infected by inhaling feather dust. Carriers – house birds (parrots, canaries), pigeons, chickens, wild birds. It manifests itself as ARVI (runny nose, temperature), as well as pneumonia.

Science

Ours are not dangerous

“You should not be afraid of bats living in Russia, they belong to other species than bats from China,” Vladimir Bolshakov, an academician of the Russian Academy of Sciences, an expert on animal ecology, told RG.

Species of bats living, in particular, in the Urals, feed exclusively on insects.They are very small in size and weigh a maximum of 25 grams. In winter, they either hibernate in caves or migrate south.

– According to one of the versions, the new coronavirus was transmitted to humans after consuming a bat. But our animals are tiny, they even have nothing to eat. They are not aggressive. There are only three known cases when bats have injured a person. One of them happened in Belgorod, when the girl, touched by the sight of the animal, decided to kiss him. In response, the mouse bit her lip, – Vladimir Bolshakov told RG.

There are 13 species of bats in the Urals; they are more diverse in the southern regions of Russia. They do not intersect with Chinese relatives: certain species of the Ural bats fly to the Caspian Sea for wintering, and those living in the south of the country sometimes reach North Africa. Scientists from the Ural Institute of Plant and Animal Ecology, Ural Branch of the Russian Academy of Sciences, headed by Academician Bolshakov, studied these animals and published the book “Bats in the Ural Caves”.

Prepared by Svetlana Dobrynina, Yekaterinburg

Infographics “RG” / Anton Perepletchikov / Irina Nevinnaya

Infographics “RG” / Alexander Chistov / Irina Nevinnaya

Do’s and don’ts

Burns ranks fifth among childhood injuries after road accidents, drowning, falls and poisoning, and the third most fatal among them.According to Rosstat, 62,000 children under 17 suffered from burns in 2018. We will tell you how to warn or how to help correctly if this happens.

What are and how they are manifested

• Thermal: flame, hot liquid and steam, heating radiators, hot water pipes and other incandescent objects.
• Chemicals: acids and alkalis – often found in household chemicals.
• Electrical: lightning, current.
• Beam: ultraviolet, radiation.
• Mixed: Several of the above.

Almost all burns are thermal: damage to the skin, and sometimes mucous membranes, muscles and bones, as a result of exposure to high temperatures. Most often, children suffer from them, and in 95% of cases, the cause is a flame.

According to Russian clinical guidelines, there are three degrees of depth of skin lesions in thermal burns:

• Only the epidermis is the topmost layer.
  The skin turns red and swells. The pain is usually minor because the nerve endings are deeper. After 2-4 days, the dead epithelium sloughs off. There are no scars.
• Epidermis and upper dermis – a layer rich in blood vessels and nerves between the epidermis and subcutaneous fat.
  In addition to redness and swelling, small blisters with cloudy or bloody contents appear – this exfoliates the epidermis and the void between it and the dermis is filled with blood and lymph.Second-degree burns hurt a lot, because the nerve endings were left without their protection – the epidermis. For 1-2 weeks, the lower one, closest to the subcutaneous fat, is renewed, the layer of the dermis and the wound is healed. Scars can remain when a large area of ​​skin is affected.
• Full thickness skin, subcutaneous fat, muscles and bones.
  A dense brown or black crust forms over the burn, which “sticks” to the tissues below. The bubbles merge with each other, and ulcers then appear in their place.Pain occurs only at the time of injury. Then pressure or slight discomfort is felt, and there is no pain even when touching the wound – because all the receptors have died. When the dead tissue begins to be replaced with new, pain reappears. Amputation of the burned limb and repair of the defects may be required. The scars always remain.

Why does it hurt so much

The skin is the largest organ: 4-6% of the total body weight. It contains up to 82% water and a third of the total blood volume.There are 2 million nerve endings in the skin, 1.5 million of them are pain receptors.

Temperatures above 44 ° C destroy the proteins of the skin – the integrity of the cell membranes is disrupted and water from the cells goes into the space between them. This can be illustrated with an example of an egg. It contains approximately 73% water, 13% protein, 12% fat and minerals. During cooking, the proteins in the cell membrane are destroyed and curtailed – the water comes out. The same thing happens with the skin, only the water goes into other tissues.Therefore, edema appears.

Then platelets stick together in the vessels of the dermis and clog the lumen. The blood supply to the burned area is reduced, which can lead to complete tissue death, if assistance is not provided in time. The burn also leads to the release into the blood of substances that provoke inflammation.

How to prevent

GMS Clinic pediatrician Maria Fadeeva recommends:

• Keep matches and lighters out of the reach of children
• Keep hot food and drinks away from the edge of the table
• included irons, curling irons position so that the child cannot reach
• to cook on the rear burners, turn the handles of pots and pans to the wall or to the side so that the child cannot accidentally grab them
• use safety devices-blockers for switching on plates
• Do not carry a child in your arms while cooking

The kitchen is not a place for a small child, especially when cooking.

• do not leave the child unattended in a room with operating heaters
• Check the temperature in the bathroom before bathing children
• Keep children away from bonfires or launch fireworks nearby
• to refuse inhalation over hot broths and boiled potatoes with ARVI – this is ineffective and creates a high risk of burns to the respiratory tract and face.

First aid

EMERCOM of Russia recommends not to panic, cool the burn, cover the affected area with a clean cloth, give an anesthetic and call an ambulance if necessary.

Maria Fadeeva tells in more detail:

The most important thing is to stop being exposed to the damaging factor: move the child away from fire, hot water or hot objects. For shallow burns, rinse the affected area of ​​the skin with running water, and if the skin looks purple and / or blisters appear, immerse it in cool water no higher than 15 ° C for no longer than 20 minutes. For extensive burns, cover the skin with a clean, non-stick cloth such as cotton.Small areas can be kept open. In case of severe pain, you can give the child ibuprofen or paracetamol and, if possible, raise the burned part of the body above the level of the heart – this slows down blood flow to this area, reduces swelling and the severity of pain. If itching is present, antihistamines can be taken.

What not to do

Pediatrician of the Fantasy Children’s Clinic, Ph.D. Svetlana Mukhortova does not recommend:

• lubricate the burn with vegetable oil, cream, sour cream and other fermented milk products.A film forms on the skin, air stops flowing to the wound – it overheats, and the depth of the lesion increases. Lactic acids and fermentation products can introduce germs into the wound
• Treat burnt skin with brilliant green, iodine, cosmetic lotions – alcohol dries out the skin and causes burning and pain
• Apply urine bandages to the wound. The effectiveness of urine therapy has not been proven
• Pierce blisters – microbes with fluid can enter the wound.The blisters will open on their own – as a rule, this happens when the skin has already been renewed and the wound has healed
• remove adhered clothing yourself so as not to injure the burn site
• Applying snow and ice for longer: burnt skin does not feel temperature changes – you can get frostbite
• sprinkle with baking soda, flour, mustard powder, starch or baby powder – the film prevents cooling, and small particles can fester
• Apply tight bandages and seal the wound with adhesive tape – air access is reduced
• rinse with running water if bubbles open – this is painful and can lead to the penetration of microbes deeper.

When to call an ambulance

“With extensive burns. In the first degree – only redness of the skin – you can seek medical help if pain and swelling increase, ”says Svetlana Mukhortova.

Maria Fadeeva also recommends to see a doctor if:

• the skin of the face, fingers and toes, feet, joints, genitals is burnt
• burn area over the palm of the child
• injured less than 5 years old
• body temperature rises, redness increases, sensitivity disappears at the site of the burn
• there is a suspicion of a burn of the respiratory tract or eyes – this is possible after fires, falling into a fire, inhalation over hot steam

What else can you do at home

To accelerate the healing of superficial burns, preparations with dexpanthenol are recommended – preferably in the form of sprays, so as not to create a film over the affected area.It is applied to the wound 2-4 hours after the burn and only at the first degree. Sometimes it is allowed to treat a child at home and with a burn with small blisters. In this case, it is necessary to change clean dressings in a timely manner and, if the doctor prescribes, treat the wound with chlorhexidine.