Wound infections secondary

Adverse reactions associated with administration of the corticosteroid ophthalmic preparations include elevated IOP with optic nerve damage, loss of visual acuity, cataract formation, delayed wound healing, secondary ocular infection, exacerbation of comeal infections, dry eyes, ptosis, blurred vision, discharge, ocular pain, foreign body sensation, and pruritus. 

Loteprednol 1 drop in affected eye(s) four times daily Elevated intraocular pressure, cataracts, decreased wound healing, secondary ocular infections, systemic side effects possible... 

Treatment of skin lesions also follows decontamination and removal of clothes. Decontamination should be completed within 15 min after exposure to minimize any systemic effects. Contaminated hair should be shaved off. The decontaminating solutions should be washed off within 3-4 min to prevent additional skin injury. Sodium hypochlorite (5%) or liquid household bleach can be used. If erythema is already present, soap and water are preferred. Blisters should be left intact, but if broken, should be debrided to prevent secondary infection. Cleansing with tap water or saline and the application of dressings is done when needed. Silver sulfadiazine or mafenide acetate can be applied and the wounds treated as burn wounds. Infected skin wounds require antibiotics as appropriate. 

Acute lymphangitis is an inflammation involving the subcutaneous lymphatic channels. Lymphangitis usually occurs secondary to punctme wounds, infected blisters, or other skin lesions. Most infections are caused by S. pyogenes. 

Pacemaker pocket erosion continues to be a problem (Fig. 4.104). This is best avoided by creating a pacemaker pocket that has maximum optimal tissue thickness. Occasionally, in extremely asthenic individuals, subpectorahs major muscle pulse generator placement should be considered to afford optimal tissue thickness. Patients can also present with preerosion secondary to pressure necrosis of the overlying tissue. Such situations represent a quasiemergency if one is to avoid complete erosion and wound infection. The patient should be reoperated, the old pocket abandoned, and new pacemaker pocket created away from the involved site. Sutton and Bourgeois incidence of pacemaker pocket complications are shown in Table 4.25 (17). 

Phenazines — This large class of compounds includes more than 6,000 natural and synthetic representatives. Natural phenazines are secondary metabolites of certain soil and marine microorganisms. The main phenazine producers are Pseudomonas and Streptomyces species. Pseudomonas strains produce the most simple phenazines tubermycin B (phenazine-1-carboxylic acid), chlororaphine, pyocyanin, and iodinine. Pyocyanin is a blue pigment while chlororaphine is green both are produced by Pseudomonas aeruginosa. They can be seen in infected wounds of animal and human skins. Iodinine is a purple phenazine produced by Pseudomonas aureofaciens. 

According to Coura and Dias (2009), the transmission mechanisms for Chagas infection can be divided into two groups (i) the principal mechanisms, by means of vectors (triatomines), blood transfusion, oral transmission, contaminated food and placental, or birth canal transmission and (ii) secondary mechanisms, by means of laboratory accidents, management of infected animals, organ transplants, sexual transmission, wounds, contact with sperm or menstrual fluid contaminated with T. cruzi and, hypothetically, deliberate criminal inoculation or contamination of food with the parasite (Coura and Dias, 2009). 

Bacitracin is indicated in prophylaxis and treatment of local infections, treatment of secondary pyodermas, as an adjunct in burn treatment, and as prophylaxis in operative wounds. However, it is not indicated in the treatment of chronic ulcers because of the increased risk of allergic reactions. There are several reports of delayed hypersensitivity, acute IgE-mediated allergic reactions, and anaphylactic reactions to bacitracin.51-53... 

A 56-year-old Caucasian developed acute delirium having taken diphenhydramine 300 mg/day for 2 days to treat a pruritic rash. He subsequently developed visual and auditory hallucinations with erratic aggressive behavior. The author concluded that the drug-induced delirium was associated with the combination of treatment for an infected wound with linezolid with diphenhydramine given for secondary drug-induced rash (74). 

The reactions leading to the induction and accumulation of phytoalexins with phenolic structures have been studied in molecular detail (4,17,22-24). These studies revealed that plants can detect and react rapidly to environmental problems, such as wounding or infection Within 20 min of elicitation, mRNAs coding for enzymes that catalyze the reactions leading to the respective defense compounds are increasingly generated, leading to the accumulation of the respective enzymes and consequently the production of the secondary metabolites (4,17,22-24). Similar processes are likely for alkaloids, but so far the mechanisms have not been elucidated. 

Vesicant wounds undoubtedly initiate an immune response due to the nature of the wounds. This response begins almost immediately when the initial events promote capillary permeability, and the interstitium becomes inundated with circulatory components. And the wound site itself is subject to secondary infections by pathogens that reach the open wound area. These pathogens may be responsible for the large number of infiltrating cells that are seen in the mouse ear vesicant model 7 days post-SM exposure (Figure 41.3). 

In the case of ocular hypotony and a positive Seidel s sign with a formed anterior chamber in the early postoperative period, the treatment of choice is to discontinue the steroid to encourage wound closure and avoid secondary infection. The patient should be placed on a third- or fourth-generation topical fluoroquinolone. A topical aqueous suppressant may also be used to ensure secure wound closure.The patient is asked to limit activities and is given an eye shield to wear at night. An alternative treatment may include the use of a topical antibiotic and a 24-hour pressure patch with an eye shield while sleeping. If the wound feils to seal after several days to 1 to 2 weeks, surgical repair should be considered. 

Delayed corneal epithelial wound healing, PSC, decreased resistance to infection, decreased tear lysozyme, eyelid and conjunctiva hyperemia/edema/angioneurotic edema, subconjunctival hemorrhage, translucent blue sclera, increased lOP, myopia, exophthalmos, intracranial hypertension causing papilledema, diplopia, EOM paresis and eyelid ptosis, retinal hemorrhages (secondary to injection), central serous choroidopathy, abnormal ERGA EP, retinal embolic phenomenon (injection). 

Bacterial impermeability has a dual role. The wound will not heal if it is heavily infected. The inflammatory phase will be extended, and, unless topical or systemic antibacterial agents are used, a more general infection could result. However, a limited number of microorganisms are tolerated by most wounds, and the destructive or cleansing phase produced by phagocytic activity should result in a self-sterilized environment. The wound should be protected from secondary infection or, if still contaminated, be prevented from transmitting the infective organisms. 

The wound environment may be optimally maintained with a product that has the preferred performance parameters but, nevertheless, is disrupted during the dressing change. The hazards of temperature change and secondary infection may be accompanied by a secondary trauma caused by the dressing adhering to the wound and, on removal, stripping newly formed tissue. 

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