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Abstract
Mucormycosis, also known as black fungus, is a rare but aggressive fungal disease with high morbidity and mortality rates that tends to affect patients who are severely immunocompromised. Early recognition of the infection and prompt intervention is critical for treatment success. In recent years the COVID-19 pandemic has resulted in a surge in the number of cases of mucormycosis. This study aims to report an unfortunate event involving an immunocompromised elderly male with mucormycosis of the foot who expired from sepsis due to COVID-19. It is important to have a high clinical suspicion for mucormycosis when a clinical lesion develops, and to appropriately biopsy the lesion in question, particularly in a context of COVID-19. Raising awareness of COVID-19-associated mucormycosis may allow for early detection of the disease, thus enabling the initiation of rapid treatment, ultimately saving lives.
Acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV) were first noticed in the US in 1981 and continue to spread today. Initially a disease associated completely with homosexual males, it is increasing in incidence and prevalence among heterosexual males and females, particularly, but not limited to, injection drug users. This disease is much more prevalent among blacks and Hispanics. Podiatric physicians are at risk of acquiring the disease as a result of their frequent use of injections and surgical intervention, particularly involving bone. In addition, the foot is a potential portal of entry for HIV infection because of contamination by blood on the feet of podiatric surgeons and their assistants during surgery.
Osteopetrosis congenita is invariably a fatal disease that is diagnosed within the first decade of the child's life. Although some steps have been taken to overcome this disease by bone marrow transplantation, further research is needed to determine the long-term effectiveness of this treatment. Osteopetrosis tarda is often detected as an incidental finding. Many cases are asymptomatic, yet many patients do suffer from general bone pain, infections, and repeated incidents of pathologic fractures. Such cases may present within the bones of the foot. Treatment is directed at addressing the pathology that may have resulted from the disease state. Osteopetrosis tarda, although rare, can affect the foot. Steps toward treatment of the primary disease entity are still being taken; however, recognition and treatment of the pathology is the primary goal in the adequate treatment of these patients.
Osteoid osteoma is a primary benign bone tumor that consists of a central area (nidus), surrounded by sclerotic bone. The most relevant symptom is pain that increases during the night and improves after salicylates or nonsteroidal anti-inflammatory drug administration. Osteoid osteoma is frequently misdiagnosed because it mimics juvenile idiopathic arthritis, bone infection, or malignancy. A 14-year-old girl presented to our department with a history of chronic pain in her left ankle. Juvenile idiopathic arthritis was diagnosed and anti-inflammatory treatment was prescribed. Because of persistence of ankle pain, the patient underwent further examinations, in particular, bone scintigraphy and computed tomography. As a result, osteoid osteoma of the talar neck was diagnosed. The patient underwent surgical treatment and her condition improved. Osteoid osteoma should also be considered in patients with chronic ankle pain to avoid misdiagnosis and start adequate treatment. This condition should be suspected in a patient with chronic bone pain and normal complete blood count and inflammatory parameters.
The impact of magnetic resonance imaging (MRI) on the clinical management of patients with foot inflammation and suspected osteomyelitis was evaluated in 44 patients with 47 foot MRI exams. Twenty-nine patients were diabetic. Bone biopsy or bone culture was obtained in 34 patients, and routine radiographs and bone scan studies were available in most patients for comparison. Magnetic resonance imaging showed reliable identification of bone infection with a sensitivity of 100% and specificity of 95%. Plain radiographs were inaccurate and, as expected, bone scans were highly sensitive (90%) but not specific (33%). The high accuracy of MRI allowed for better identification of patients with osteomyelitis and, therefore, improved targeting of potential operative candidates.
Spinal anesthetic is a common form of surgical anesthetic used in foot and ankle surgery. Spinal morphine anesthetic is less common, but has the advantage of providing postoperative analgesia for 12 to 24 hr. A number of complications can occur with spinal anesthesia, including urinary retention that may be a source of severe and often prolonged discomfort and pain for the patient. Management of this problem may require repeated bladder catheterization, which may lead to urinary tract infections or impairment of urethrovesicular function. This study reviews the incidence of urinary retention in 80 patients (40 after general anesthesia and 40 after spinal anesthesia) who underwent foot and ankle surgery at Saint Joseph's Hospital, Philadelphia, PA. Twenty-five percent of the patients who had spinal anesthesia experienced urinary retention, while only 7 1/2% of the group who had general anesthesia had this complication. Predisposing factors, treatment regimen, and recommendations for the prevention and management of urinary retention are presented.
Understanding the physiology and function of the nail unit and its potential avenues of invasion, and properly identifying invading organisms are two key aspects of using the newer therapies available for the treatment of onychomycosis. This article discusses the most common pathologies of onychomycosis, as classified by the sites of entry of the invading fungi. Susceptibility factors leading to infection are also discussed. Obtaining proper tissue samples, using appropriate tests and culture media, and accurately interpreting test results are all paramount to correct identification of the invading organism and, in turn, to effective prescribing. When fungal-growth results do not support the clinical symptoms, or if a more specific identification of the organism is required, additional diagnostic tests are available and are outlined here.
This article presents a critical review of the Dockery procedure (autogenous peroneus longus free graft technique) for the treatment of lateral ankle instability. Those patients with gastrocnemius equinus were treated with gastrocnemius recession during surgery. The authors reviewed 33 stabilizations performed over a period of 7 years to analyze the effectiveness of the procedure with and without the addition of the gastrocnemius recession. Assessed were the type and length of conservative therapy, the time to return to regular activity, complications experienced, and the recurrence rate. The results show a reinjury rate of 3%. The complications included infection, prolonged healing, and occasional screw irritation requiring screw removal. In light of the low incidence of reinjury, this technique is a valid procedure for treating lateral ankle instability.
Plantar verrucae, caused by human papillomavirus (HPV), are commonly found in patients who have tested positive for the antibodies to human immunodeficiency virus (HIV). A better understanding of the characteristics of plantar verrucae in HIV+ patients in needed. A pilot study was conducted concentrating on three characteristics--the size, the number, and the clinical type--of verrucae present in this population. These parameters were studied in HIV+ and HIV- populations, and they were evaluated in relation to the CD4 levels of HIV+ individuals. The HIV+ individuals presented with plantar verrucae that were larger and more numerous than those found in HIV- individuals. The HIV+ population presented with all three clinical types of plantar verrucae and had significantly more mosaic-type warts than did HIV- individuals. The three characteristics did not correlate with CD4 cell counts, suggesting that the severity and extent of HPV infection do not depend on the level of immunosuppression of the HIV+ patient.
A 10-month, hospital-based, open-label clinical study was undertaken of a unique antimicrobial nail solution containing surfactant, allantoin, and benzaikonium chloride to determine its effectiveness, in conjunction with periodic debridement, against pedal onychomycosis. Forty patients with microbial infection of the nails were enrolled in this study, in which a new, objective nail-scoring system was used. At the start of the study, the mean nail score was 8.3, and 79.8% of the nails scored had severe disease (on a scale of 0 to 10, with 10 defined as total nail involvement, accompanied by pain and thickening). By the conclusion of the study, the mean score had decreased to 2.5, 32.6% of the patients' nails were scored 0 or 1, and 90% of the patients subjectively judged their improvement as excellent or good.
