Journal of Clinical Immunology Research

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Abstract - Journal of Clinical Immunology Research (2019) Volume 2, Issue 3

Antimicrobial resistance-mediated complications in wound infections in Accra, Ghana


Introduction: Systemic Lupus Erythematosus has several presentations and cutaneous lesion is the second most frequent presentation of SLE. Toxic Epidermal Necrolysis-like cutaneous lupus erythematosus was considered as a rare variant of Acute Cutaneous Lupus Erythematosus with different presentation with the classical drug-induced TEN. Differentiating the two entities will be useful in the management and determining the outcome of the patient.

Objectives: In this report, we present a rare presentation of a newly diagnosed case of Systemic Lupus Erythematosus presenting with Toxic Epidermal Necrolysis-Like skin lesions. Specifically, to present the clinical manifestations, approach to management and correlate it with previous case reports.

Case: A 37 years old female who presented with 6 years history of multiple joint pains, alopecia, photosensitivity, and intermittent undocumented fever. She was admitted due to appearance of TEN-like skin lesions. This case was diagnosed with SLE based on SLICC Criteria: hematologic, mucocutaneous and autoimmune criteria. TEN- like cutaneous lupus erythematosus was considered by using Naranjo and Hartwig scoring system. Patient was managed with steroids and hydroxychloroquine wherein lesions resolved.

Conclusion: This case highlighted that TEN is not always due to drug reaction hence, may be attributed to other disease. This concluded that TEN like cutaneous lupus erythematousus does exist and it is a rare manifestation of SLE. Early recognition, proper physical examination, and diagnostic procedure should be done in a prompt manner to aid in the diagnosis and treatment.

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The bacterial contaminations that win in the consumed patients keep on being a basic complexity in the consumed patients and differ with time and spot. Recognizable proof of bacterial pathogens with data of their antimicrobial vulnerability of consume wounds can assist clinicians with selecting proper medicine strategy as in giving them reasonable anti-toxin for exact treatment. Diseases persevere as a significant inconvenience and reason for mortality in the consume patients. Upset skin hindrance, inclusion of bigger consumed territory, immunocompromised impacts of consumes and delayed remains at the emergency clinics were significant hazard factors for starting contamination . The copy wound disease is described by the adjustment in the appearance of copy wounds, for example, fast eschar partition, dim earthy colored, dark or violaceous staining of the eschar or edema at wound edge. It is likewise delineated by the living being secluded from blood culture without other recognizable disease with following trademark: fever (>37.5 °C) or hypothermia (<35.5 °C), hypotension (systolic weight beneath 90 mmHg), oliguria (<20 mL/h), hyperglycemia or mental disarray. Albeit a noteworthy improvement like haemodynamic adjustment, treatment of aviation route and serious consideration for consume casualties has been set up, 75% of all passings following warm wounds are identified with disease. Wound contamination is the intrusion of an injury by multiplying microorganisms to a level that conjures a nearby as well as fundamental reaction in the host. The nearness of microorganisms inside the injury causes nearby tissue harm and obstructs wound healing.3, 11 Intervention is commonly required to help have guards in annihilating the attacking microorganisms. The injury contamination continuum gives a structure through which the effect organisms have on an injury and wound recuperating can be conceptualized.Utilization of anti-microbials as foundational prophylactic is a typical practice with consumed patients. Medication safe microscopic organisms with inborn opposition towards anti-infection agents, capacity to endure longer in the clinic condition and hand to hand transmission of microorganisms mirrors their simple spread and cause episodes. Broad medication opposition (XDR) and pandrug safe (PDR) strains were named non-defenseless to at any rate one specialist in everything except two or less antimicrobial classes and non-powerless to all operators in every single antimicrobial classification individually by ECDC and CDC. The bacterial contaminations in consumed patients fluctuate both with time and spot. Therefore, a ceaseless reconnaissance and update of anti-microbial obstruction example of smaller scale life forms is basic for disease control programs and precise anti-toxin treatment in the consumed patients.

Tainting Wound pollution is the nearness of non-multiplying organisms inside an injury at a level that doesn't inspire a host response.2, 3 Virtually from the hour of injuring, every single open injury are defiled with microorganisms. Incessant injuries become tainted from endogenous discharges (for example characteristic vegetation) and exogenous microbial sources, including poor hand cleanliness rehearsed by human services clinicians and ecological exposure.17 Unless traded off, the host safeguards react quickly to annihilate microscopic organisms through a procedure called phagocytosis.18 Colonization alludes to the nearness inside the injury of microbial living beings that experience constrained expansion without bringing out a host reaction.3, 11 Microbial development happens at a non-basic level, and wound mending isn't hindered or delayed.18, 19 Sources for microorganisms might be common greenery, exogenous sources or because of natural introduction. Nearby contamination Wound disease happens when microorganisms or different organisms move further into the injury tissue and multiply at a rate that summons a reaction in the host.2, 11 Local contamination is contained in one area, framework or structure. Particularly in ceaseless injuries, nearby twisted disease frequently presents as unobtrusive signs that can be viewed as secret indications of infection20, 21 that may form into the work of art, clear indications of contamination. This is talked about in more detail inverse and Spreading contamination Spreading disease portrays the attack of the encompassing tissue by infective life forms that have spread from an injury. Microorganisms multiply and spread, to a degree that signs and indications stretch out past the injury border.22, 23 Spreading contamination may include profound tissue, muscle, sash, organs or body holes

Stages in the injury contamination continuum: The connection between the host, the injury and microorganisms in the advancement of wound disease has been very much depicted in the writing. In any case, the idea of wound microbial parity and the movement from a condition of twisted sullying to foundational disease is yet to be built up completely. It is all around recognized that it is more than the nearness of microbes that prompts unfriendly occasions in wounds. The injury disease continuum has been refreshed to mirror that organisms other than microscopic organisms are related with wound contamination, and microbial destructiveness (just as numbers) adds to the advancement of wound infection.2, 3, 11, 14-16 The phases in the injury contamination continuum portray the progressive increment in the number and harmfulness of microorganisms, along with the reaction they conjure inside the host.

Background: Wound disease is a significant worldwide medical issue since it presents genuine confusions that bring about trouble in treatment and wounds bacterial pollution are normal emergency clinic procured contaminations causing over 80% of mortality. The point of this investigation was to recognize basic microscopic organisms tainting five distinct sorts of wounds and their protection from regularly utilized anti-infection agents.

Methodology: Clinical swabs were received from hospitals and/ or clinics and some were obtained directly from patients visiting the G2 Medical Laboratory from 2015 to 2018. Specimens were obtained from wounds including Buruli ulcer, lupus, surgical, diabetes and burns. Conversional method of culturing on CLED, BLOOD AND CHOCLATE AGAR, incubated in an aerobic and anaerobic condition between 18 and 24 hours at 37°C. The microbial were identified through the gram staining and various biochemical reactions. Antibiotics sensitivity test was done for both gram negative and positive microbial.

Results: A total of 10629 specimen were analyzed and different types of bacteria were isolated, Pseudomonas aeruginosa was the most predominant pathogen isolated from all wound type infection: Buruli ulcer =3493 (32.9%); lupus =2180 (20.5%); surgical =2911 (27.4%); diabetes =1503 (14.1%); and burn =609 (5.7%). A total of microbial resistance n=9657. P. aeruginosa showed the highest rate of resistance to the tested antibiotics of n=5396 (55.9%): Gentamicin=963 (17.8%); amikacin=960 (17.8%); cefotaxime=813 (15.1%), ceftriaxone=850 (15.8%); ciprofloxacin=947 (17.6%) and levofloxacin=863 (16.0%) and other multidrug resistance strains identified were Enterobacter spp., n=2105 (21.8%); S. aureus, n=974 (10.1%); Klebsiella spp., n=571 (5.9%); Proteus spp., n=356 (3.7%) and E. coli, n=255 (2.6%).


Biography: Estherly Grace M. Gonzales has completed her pre medical degree of Bachelor of Science in Nursing at the age 20 from Universidade de Sta. Isabel as cum laude and had her medical degree at the age of 26 years from Far Eastern University- Dr. Nicanor Reyes Medical Foundation. She is currently on resident training in the Department of Internal Medicine in Bicol Medical Center, a premier hospital of Bicol Region in the Philippines.

15th International Conference on Allergy and Clinical Immunology, August 13-14, 2020 (Webinar)

Abstract Citation:

Estherly Grace M. Gonzales, I’ve Got You Under My Skin: A Case of Toxic Epidermal Necrolysis-like Cutaneous Manifestation of Systemic Lupus Erythematosus, Allergy 2020, 15Th International Conference on Allergy and Clinical Immunology, August 13- 14, 2020 (Webinar) (

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