Infection

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Infection of an ingrown toenail; there is pus (yellow) and resultant inflammation (redness and swelling around the nail).

Infection is invasion of the body by organisms (pathogens) that have the potential to cause disease. The pathogen may be bacterial, fungal, or viral.[1]

The human foreskin has numerous functions that protect against infection.[2] Infection is a well-known possible complication of circumcision. Circumcised males have an increased risk of infection due to loss of the protective functions.

Circumcision infection

Neonatal circumcision is an elective, medically-unnecessary, non-therapeutic amputation of the healthy foreskin that is done only after parents sign a circumcision consent form. It exposes an infant to surgical risks, but does not treat or prevent disease.[3] Circumcision is a surgical operation and amputation that creates an open surgical wound on the penis. Rosemary Romberg (2021) described infection as a "fairly common complication."[4] The open wound does not heal immediately and is exposed to the feces (poop) in the diaper (nappie). For a period of time during and after the surgery it is subject to invasion by a wide variety of bacterial, viral, or fungal pathogens.[5] [6]

Maternity hospitals gather together newborn infants into a hospital nursery where they are cared for, which increases the risk of passing infection from one to the others. If an infant is compromised by an open surgical wound, then that infant is at greater risk of becoming infected. Male infants in America, where non-therapeutic infant circumcision remains popular, are more likely to become infected than female infants. Staphylococcus aureus is a common infection and is worse when a methicillin resistant strain (MRSA) is involved. Thompson et al. (1966) reported a higher risk of staphylococcus infection in newborn circumcised males.[7] Nelson et al. (1976) reported a prolonged case of hospital nursery infection in which the pathogen was streptococcus.[8]

Van Howe & Robson (2007) examined reports of three outbreaks of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in American maternity hospital nurseries. They found that boys, with 73 percent of the cases, are at greater risk due to the prevalence of non-therapeutic circumcision. The authors, observed that CA-MRSA can progress to bacteremia, osteomyelitis, pyelonephritis, perinephric abscess, lung abscess, empyema, shock, and death. They suggested minimizing newborn circumcisions to reduce the risk of infection.[9]

Infant non-therapeutic circumcisions do not cure disease and do not contribute to health. When infection occurs after a circumcision performed by a physician, then it may be considered to be iatrogenic as the infection would not have occurred if the circumcision had not been performed.

In cases of adult circumcision, erections may cause wound dehiscence (splitting open of the surgical wound) thereby increasing the risk of infection.[10]

Case reports

Rosenstein (1941) reported a case of diphtheria infection in the circumcision wound of a three-year-old child who died on the eighth day after surgery.[11]

Sauer (1943) reported a case of staphylococcus bronchopneumonia following infant circumcision in which death occurred on the 18th day of life.[12]

Kirkpatrick & Eitzman (1974) reported two cases of septicemia (infection in the blood) after non-therapeutic neonatal circumcision in which the patients almost died.[13]

Meningitis is a serious inflammation of the meninges, the thin, membranous covering of the brain and the spinal cord. Meningitis is most commonly caused by infection (by bacteria, viruses, or fungi).[14] Scurlock & Pemberton (1977) reported on four cases of meningitis which started with an infected circumcision wound that proceeded to septicemia and meningitis. One of the four patients died.[15]

Ritter's disease is now called Staphylococcal scalded skin syndrome' (SSSS). It is caused by infection with Staphylococcus aureus bacteria. The infection causes large sections of skin to peel away as occurs after burns.[16] Annuziato & Goldblum (1978) reported three cases of SSSS, which started with infected circumcision wounds. Death occurred with one case but the other two recovered.[17]

Cleary & Kohl (1979) reported the case of a six-week old infant boy who was circumcised in his mother's physician's office. Infection with streptococcus developed. The boy was hospitalized, but even with the best of antibiotic and other treatment, death resulted. The authors stated:

Significant infection is rarely solely attributed to circumcision because a clear-cut cause and effect relationship is difficult to establish. There have been reports of newborns5-7 who have been circumcised and then developed life threatening infection within several days of this procedure. However, the fact that in these infants infection has occurred at an age when the incidence of infection is high due to other factors complicates interpretation of these reports.[18]

Woodside (1980) reported the case of an infant boy who was circumcised with the Plastibell device. He developed necrotizing fasciitis after his non-therapeutic circumcision. His treatment required extensive debridement of tissue. The boy apparently survived.[19]

Curran & Al-Salihi (1980) reported an outbreak of staphylococcal scalded skin syndrome (SSSS) at the Margaret Hague Maternity Hospital in Jersey City, New Jersey. The outbreak affected 68 newborns over a 115 day period. The male to female ratio was 5.5 to one, which clearly indicated that the circumcision wound in boys was the entry point for the infection in most cases. The infants had generalized exfoliative disease with loses of large patches of skin. No deaths were reported.[20]

Necrotizing fasciitis is a life-threatening skin infection.[21] Bliss et al. (1997) reported two cases of necrotizing fasciitis after non-therapeutic infant circumcision with the Plastibell device. Extensive aggressive debridement of infected necrotic tissue was required.[22]

Ritual circumcision

Professor L. Emmett Holt (1913) reported 41 cases of tuberculosis in ritually circumcised boys who had been infected by tubercular mohels, of whom 16 had died at the time of writing.[23]

More recently, cases of infection of baby boys with herpes simplex have been reported. One death and brain damage in another has occurred.[24]

Ritual circumcision is a cause of urinary tract infection (UTI).[25][26][27][28]

Treatment

The usual treatment of infection is with antibiotics.

See also

External links

References

  1. ↑ REFweb (2012). Infection, The Free Dictionary. Retrieved 8 January 2022.
  2. ↑ REFjournal Cold CJ, Taylor JR. The prepuce. BJU Int. January 1999; 83, Suppl. 1: 34-44. PMID. DOI. Retrieved 8 July 2021.
  3. ↑ REFjournal Deacon M, Muir G. What is the medical evidence on non-therapeutic child circumcision?. Int J Impot Res. 8 January 2022; PMID. DOI. Retrieved 2 February 2022.
  4. ↑ REFbook Romberg, Rosemary (2021): Infection, in: Circumcision — The Painful Dilemma. Ulf Dunkel (ed.). Edition: Second Edition, Revised. Kindle. P. 266. ISBN 23: 979-8683021252. Retrieved 31 August 2023.
  5. ↑ REFjournal Williams N, Kapilla, Leela. Complications of circumcision. Brit J Surg. October 1993; 80(10): 1231-6. PMID. DOI. Retrieved 8 January 2022.
  6. ↑ REFjournal Krill, Aaron J., Palmer, Lane S., Palmer, Jeffrey S.. Complications of circumcision. ScientificWorldJournal. 26 December 2011; 11: 2458-68. PMID. PMC. DOI. Retrieved 28 January 2022.
  7. ↑ REFjournal Thompson DJ, Gezon HM, Rogers KD, Yee RB, Hatch TF. Excess risk of staphylococcus infection and disease in newborn males.. Am J Epidemiol. September 1966; 84(2): 314-28. PMID. DOI. Retrieved 9 January 2022.
  8. ↑ REFjournal Nelson, JD, Dillon, Jr. HC, Howard, JB. A prolonged nursery epidemic associated with a newly recognized type of group A streptococcus. J Pediatr. November 1976; 89(5): 792-6. PMID. DOI. Retrieved 10 January 2022.
  9. ↑ REFjournal Van Howe RS, Robson LM, et al. The Possible Role of Circumcision in Newborn Outbreaks of Community-Associated Methicillin-Resistant Staphylococcal aureus. Clin Pediatr. 2007; 46(4): 356-8. PMID. DOI. Retrieved 14 January 2022.
  10. ↑ REFjournal Kaplan GW. Complications of circumcision. Urol Clin N Amer. 1983; 10(08): 543-9. Retrieved 15 June 2020.
  11. ↑ REFjournal Rosenstein JL. Wound diphtheria in the newborn infant following circumcision: report of a case. J Pediatr. 1941; 18: 657-8. Retrieved 9 January 2022.
  12. ↑ REFjournal Sauer LW. Fatal staphylococcus bronchopneumonia following ritual circumcision. Am J Obstetr Gynecol. 1943; 46: 583. Retrieved 10 January 2022.
  13. ↑ REFjournal Kirkpatrick BV, Eitzman DV. Neonatal septicemia after circumcision. Clin Pediatr. September 1974; 19(9): 767-8. PMID. DOI. Retrieved 10 January 2022.
  14. ↑ REFweb (2008). Meningitis, The Free Dictionary. Retrieved 12 January 2022.
  15. ↑ REFjournal Scurlock JM, Pemberton PJ. Neonatal meningitis and circumcision.. Med J Aust. 5 March 1977; 1(10): 332-4. PMID. DOI. Retrieved 12 January 2022.
  16. ↑ REFweb (2002). Ritter's disese, The Free Dictionary. Retrieved 13 January 2022.
  17. ↑ REFjournal Annunziato D, Goldblum LM. Staphylococcal scalded skin syndrome. A complication of circumcision. Am J Dis Child. December 1978; 132(12): 1187-8. PMID. DOI. Retrieved 13 January 2022.
  18. ↑ REFjournal Cleary, Kohl. Overwhelming infection with group B beta-hemolytic streptococcus associated with circumcision. Pediatrics. September 1979; 64(3): 301-3. PMID. Retrieved 13 January 2022.
  19. ↑ REFjournal Woodside, Jeffrey R.. Necrotizing fasciitis after neonatal circumcision. Am J Dis Child. March 1980; 134(3): 301-2. PMID. DOI. Retrieved 11 January 2021.
  20. ↑ REFjournal Curran JP, Al-Salahi FL. Neonatal staphylococcal scalded skin syndrome: massive outbreak due to an unusual phage type. Pediatrics. August 1980; 66(2): 285-90. PMID. Retrieved 13 January 2022.
  21. ↑ REFweb (31 December 2019). Necrotizing Fasciitis: All You Need to Know, Centers for Disease Control and Prevention. Retrieved 14 January 2022.
  22. ↑ REFjournal Bliss DP, Healey PJ, Waldhausen JH. Necrotizing fasciitis after Plastibell circumcision. J Pediatr. September 1997; 131(3): 459-62. PMID. DOI. Retrieved 14 January 2022.
  23. ↑ REFjournal Holt LE. Tuberculosis acquired through ritual circumcision. JAMA. 1913; LXI(2): 99-102. Retrieved January 2022.
  24. ↑ REFdocument Frieden, Thomas: An open letter to the Jewish Community from the New York City Health Commissioner PDF, City of New York. (13 December 2005). Retrieved 9 January 2022.
  25. ↑ REFjournal Smith RM. Recent contributions to the study of pyelitis in infancy. Am J Dis Child. 1916; XII: 235.243.
  26. ↑ REFjournal Cohen H, et al. Postcircumcision Urinary Tract Infection. Clinical Pediatrics. 1992; : 322-324.
  27. ↑ REFjournal Goldman M, Barr J, Bistritzer T, Aladjem M. Urinary tract infection following ritual jewish circumcision. Israel Journal of Medical Sciences. 1996; 32(11): 1098-1102.
  28. ↑ REFjournal Prais D, Shoov-Furman R, Amir J. Is circumcision a risk factor for neonatal urinary tract infections?. Arch Dis Child. 6 October 2008; DOI.
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