Debridement Of Abscess Research Articles

Successful surgical intervention for acute pyothorax caused by methicillin-resistant Staphylococcus aureus thoracic pyogenic spondylitis: a case report

BackgroundPyogenic spondylitis or intervertebral discitis rarely spreads into the thoracic cavity, resulting in pyothorax. Moreover, no study has reported methicillin-resistant Staphylococcus aureus (MRSA) as a cause. Conservative and surgical treatments are reportedly effective for the above-mentioned situations; however, there have been no comprehensive reports owing to the disease’s rarity. This report described a case of acute pyothorax due to MRSA-caused pyogenic spondylitis in which surgical intervention with curettage of the intrapleural abscess and simultaneous thoracic vertebral debridement and anterior fixation were effective.Case presentationA 60-year-old female with Parkinson’s disease was diagnosed with pyogenic spondylitis caused by MRSA and managed with antibiotics. Subsequently, a right encapsulated pleural effusion was observed, and thoracentesis was performed. No bacteria were identified in the pleural fluid culture; nonetheless, the leukocytes in the fluid increased, and the patient was diagnosed with right acute pyothorax caused by pyogenic spondylitis. Management of the spondylitis and pyothorax before the disease became severe was necessary.We performed curettage of the intrapleural abscess and vertebral debridement and anterior fixation using an autogenous rib through open thoracotomy. The inflammation or accompanying symptoms did not worsen 3 months after hospital discharge.ConclusionsAcute pyothorax is rare but may develop from pyogenic spondylitis, for which MRSA is a rarer causative agent. Simultaneous vertebral debridement and anterior fixation, with curettage of the thoracic cavity abscess, may be useful in its management.

Nanosecond pulsed electric fields increase antibiotic susceptibility in methicillin-resistant Staphylococcus aureus.

We have found that treatment with short electric pulses potentiates the effects of multiple antibiotics against methicillin-resistant Staphylococcus aureus. By reducing the dose of antibiotic necessary to be effective, co-treatment with electric pulses could amplify the effects of standard antibiotic dosing to treat S. aureus infections such as skin and soft-tissue infections (SSTIs). SSTIs are accessible to physical intervention and are good candidates for electric pulse co-treatment, which could be adopted as a step-in wound and abscess debridement.

October 2023 Critical Care Case of the Month: Multi-Drug Resistant K. pneumoniae

No abstract available. Article truncated after 150 words. History of Present Illness: A 75-year-old man presented from a skilled nursing facility with altered mental status and hypotension. He had a seven-year-long history of steroid-dependent myasthenia gravis, but had previously declined Covid vaccination, and subsequently experienced a severe case of COVID-19 pneumonia five months prior to admission. This resulted in chronic respiratory failure and renal failure for which he subsequently underwent tracheostomy, tunneled subclavian vein dialysis catheter placement and percutaneous endoscopic gastrostomy (PEG). He had resided in a skilled nursing facility since then, requiring four subsequent hospital readmissions for complications. These sequentially included septic shock due to a catheter associated blood stream infection, an intra-abdominal abscess due to PEG migration into the peritoneum resulting in fungal blood stream infection, recurrent intra-abdominal infection with multiple organisms, and bacterial pneumonia. Treatment of these infectious complications included replacement of the tunneled dialysis catheter and exploratory laparotomy with debridement of multiple abscesses. The …

Long-term systemic antibiotics and surgical treatment can be an effective treatment option for retrobulbar abscesses in rabbits (Oryctolagus cuniculus): 21 cases (2011-2022).

To characterize the epidemiologic features of rabbits with retrobulbar abscesses, including the clinical signs, diagnosis, treatment, and outcome. 21 client-owned rabbits. The medical record database of a veterinary teaching hospital was searched from 2011 to 2022 for records of rabbits diagnosed with retrobulbar abscesses by CT. Data reviewed included age, breed, presenting complaint, association with an odontogenic infection, aerobic and anaerobic culture results, treatment, and outcome. The primary presenting complaint was exophthalmos (19/21 [90%]). Most cases (15/21 [71%]) were associated with an odontogenic infection. Dental disease, not associated with a retrobulbar abscess (14/21 [67%]), was a common comorbidity on CT. The most common aerobic and anaerobic isolates were Streptococcus intermedius (5/12 [42%]) and Fusobacterium nucleatum (2/12 [17%]), respectively. Surgical treatment combined with long-term systemic antibiotic therapy was performed in 9 of 21 (43%) cases. It included intraoral tooth extraction (4/9 [44%]) versus extraoral peribulbar abscess lancing with either abscess packing with antibiotic-soaked gauze (3/9 [33%]) or surgical abscess debridement (2/9 [22%]). Resolution of the clinical signs with no recurrence for at least 6 months occurred in 7 of 9 (78%) surgically treated cases. Medical treatment with long-term systemic antibiotic therapy was performed in 4 of 21 (19%) cases, and 3 of 4 (75%) resolved. Due to poor prognosis or financial concerns, euthanasia was performed or recommended in 8 of 21 (38%) cases. On the basis of the data from this study, retrobulbar abscesses in rabbits carry a guarded prognosis. When intraoral and extraoral surgical treatment options combined with systemic antibiotic therapy were used, it resolved clinical disease in most cases.

A novel Canadian multidisciplinary acute care pathway for people hospitalised with a diabetic foot ulcer.

This manuscript describes the implementation and initial evaluation of a novel Canadian acute care pathway for people with a diabetic foot ulcer (DFU). A multidisciplinary team developed and implemented an acute care pathway for patients with a DFU who presented to the emergency department (ED) and required hospitalisation at a tertiary care hospital in Canada. Processes of care, length of stay (LOS), and hospitalisation costs were considered through retrospective cohort study of all DFU hospitalizations from pathway launch in December 2018 to December 2020. There were 82 DFU-related hospital admissions through the ED of which 55 required invasive intervention: 28 (34.1%) minor amputations, 16 (19.5%) abscess drainage and debridement, 6 (7.3%) lower extremity revascularisations, 5 (6.1%) major amputations. Mean hospital LOS was 8.8 ± 4.9 days. Mean hospitalisation cost was $20 569 (±14 143): $25 901 (±15 965) when surgical intervention was required and $9279 (±7106) when it was not. LOS and hospitalisation costs compared favourably to historical data. An acute care DFU pathway can support the efficient evaluation and management of patients hospitalised with a DFU. A dedicated multidisciplinary DFU care team is a valuable resource for hospitals in Canada.

Ultrasound‐guided parasternal block in a cat undergoing median sternotomy for pulmonary lobectomy

AbstractA 3.25‐kg, 1‐year‐old, European shorthair cat was referred for acute respiratory distress. A thoracic computed tomography revealed the presence of multiple pulmonary abscesses, and a median sternotomy for pulmonary lobectomy was scheduled. The cat was premedicated with methadone and dexmedetomidine, anaesthesia was induced with alfaxalone and maintained with isoflurane in 100% oxygen. Ultrasound‐guided parasternal block was performed before surgery with ropivacaine 0.5% (total dose 3 mg/kg). Rescue analgesia was needed only during abscess debridement and lung lobectomy. Postoperative pain was assessed every hour, using the short‐form Glasgow Feline Composite Measure Pain Scale. The cat required rescue analgesia (0.2 mg/kg methadone) 7 hours after the completion of the block. This case report describes the feasibility of ultrasound‐guided parasternal block in a cat undergoing median sternotomy, suggesting that it can usefully be added to a multimodal analgesic plan in the perioperative period.

Disseminating MSSA Infection in a Preterm Infant With Rare Finding of Spinal Epidural Abscess: A Case Report.

Methicillin-susceptible Staphylococcus aureus (MSSA) occurs more frequently in the neonatal intensive care unit (NICU) than methicillin-resistant S. aureus (MRSA) and can result in comparable morbidity and mortality in the neonatal population. MSSA infection may present as pustulosis or cellulitis and evolve into bacteremia, pneumonia, endocarditis, brain abscesses, and osteomyelitis. There is a paucity of literature regarding the treatment and long-term outcomes in the premature infant. A 32-week twin developed MSSA sepsis with presentation of pain, decreased movement of upper extremities, and global hypotonia. Blood cultures remained positive despite antibiotic coverage. The infant was admitted to the level IV NICU with the diagnosis of MSSA bacteremia, with concern for dissemination and osteomyelitis. Diagnostic studies included laboratory testing for sepsis evaluation, radiologic studies to evaluate for dissemination, immunologic testing to rule out complement deficiency, and hematology testing to rule out hypercoagulable conditions. Diagnostic testing showed extensive cellulitis, osteomyelitis, multiple liver abscesses, and epidural abscesses suggestive of spinal epidural abscess (SEA). Abscess debridement and irrigation on the left distal femur, left elbow, and right tibia were performed. The infant completed 8 weeks of IV antibiotic therapy. Immunologic and hematology testing was within normal limits. Prompt recognition and follow-up for clinical signs of sepsis are vital when caring for premature infants. Inclusion of pediatric subspecialist recommendations to assure all diagnostic studies and treatments are completed can significantly impact the patient's outcome. Long-term follow-up is needed for premature infants with the diagnosis of SEA.

Pancreatic cancer presenting with acute pancreatitis complicated by Wernicke’s encephalopathy and a colonic fistula: a case report

As previously noted, this is the case of a 39-year-old male patient with a BMI of 46kg/m2 who presented with acute necrotizing hemorrhagic pancreatitis. Complications developed as noted above. Multiple diagnostic imaging methods were utilized but failed to detect the presence of metastatic pancreatic adenocarcinoma. After a course of antimicrobial and nutritional therapy, we attempted surgical intervention for the pancreatic-colonic fistula and pancreatic abscess debridement. Unfortunately, during that procedure, we observed extensive carcinomatosis, at which point we did a gastrojejunostomy. Subsequently, the patient's condition did not permit chemoradiotherapy. After completion, we transferred the patient to palliative care, where he died. This case was complex due to the previously recounted results of the underlying condition, pancreatic adenocarcinoma, and the complications of Wernicke's encephalopathy and pancreatic-colonic fistula. The presence of risk factors in patients increases the need to perform appropriate diagnostic tests. Even with tests and multiple imaging modalities, these particular events remain challenging to diagnose, given the nature of the development and presentation of the disease condition. It was only after the surgical intervention that the carcinoma became evident. Early screening and imaging could improve detection rates and prevent disease progression. In this case report of acute hemorrhagic necrotizing pancreatitis and its complications, we discuss the factors making this disease process particularly difficult to diagnose, detect, and manage. Even though the complications detailed herein are rare, in this case, the significance is the need to evaluate all patients with acute pancreatitis and acute confusion for Wernicke's encephalopathy, which is preventable. In addition, suggestive findings on computed tomography signal the need for further investigation of the colonic fistula. Finally, at this time, there are no clear guidelines for the surgical management of these complications. We hope that this case report will contribute to their development.

Treatment of infected thoracic aortic aneurysm with combined abscess debridement and stent-graft wrapping using pedicled latissimus dorsi muscle flaps after thoracic endovascular aortic repair

BackgroundOpen thoracic surgery (with infected lesion removal, prosthetic graft replacement, and pedicled tissue flap) has remained the main treatment for infected thoracic aortic aneurysms to date. Recent reports have highlighted good prognostic outcomes with thoracic endovascular aortic repair. However, thoracic endovascular aortic repair for infected thoracic aortic aneurysms is associated with an exacerbation of infection due to residual infected tissues. We discuss the control of refractory infections following endovascular treatment of infected thoracic aortic aneurysms.Case presentationAn 81-year-old man, with a history of insulin-dependent diabetes mellitus and pancreaticoduodenectomy, presented to our emergency department with a fever. Blood tests revealed a markedly elevated leukocyte count, and contrast-enhanced computed tomography suggested a descending thoracic aortic pseudoaneurysm. We diagnosed the patient with an infected descending thoracic aortic aneurysm, and performed urgent thoracic endovascular aortic repair; he was started on an intravenous antibiotic treatment. Postoperatively, blood tests revealed a decreased leukocyte count and the patient remained afebrile. However, computed tomography revealed temporal enlargement of the abscess cavity; therefore, an abscess debridement and stent graft wrapping with pedicled latissimus dorsi muscle flaps were performed, which successfully controlled the infection. Six weeks after abscess debridement, the patient was switched to an oral antibiotic therapy. There was no evidence of recurrence of infection 8 months after the surgery.ConclusionsA combined abscess debridement and pedicled tissue flap approach is useful for patients with poor surgical tolerance in whom infection control is difficult after thoracic endovascular aortic repair for infected thoracic aortic aneurysms. Pedicled latissimus dorsi muscle flaps are useful when using the omentum for pedicled tissue flap is difficult.

Application of arthroscopic system in the treatment of lactational breast abscess

PurposeOptimal treatment of breast abscesses has been controversial. Herein, we report an innovative method for the operative treatment of lactational mammary abscesses.MethodsNineteen lactating patients diagnosed with breast abscesses were enrolled in the study, and abscess debridement and drainage were performed using an arthroscopic system. The clinical characteristics of the patients were recorded to evaluate the feasibility, efficacy, and cosmetic results of arthroscopic surgery for breast abscesses.ResultsAll 19 patients were cured and did not relapse within the 6-month-follow-up period. One patient stopped breastfeeding due to breast leakage. All patients were satisfied with the postoperative appearance of the breast.ConclusionArthroscopic debridement and drainage are effective treatment methods for lactational breast abscesses, with a high cure rate, few complications, and satisfactory cosmetic outcomes.

TUBERCULAR TESTICULAR ABSCESS: A CASE REPORT

Objective: This study aims to provide fellow physicians a better insight in diagnosing and managing similar cases. Case(s) Presentation: A 36 year old male presented to the emergency department with a chief complaint of red, painful, and progressively enlarging swelling of the left scrotal pouch since 1 week ago. The patient had a history of similar complaint and recurrent cloudy urine which were left untreated 1 year before. Based on physical examination and ultrasonography findings, the patient was diagnosed with left scrotal abscess and was treated by incisional drainage of abscess and necrotomy debridement under spinal anesthesia. Discussion: Tuberculosis infection of scrotal contents is rare and occurs in approximately 7% of the patients with tuberculosis, although tuberculosis itself is a global epidemic with more than 2 billion of the world population infected. In patients with genital tuberculosis, pulmonary and renal tuberculosis can be documented in 50% and 80-85% respectively. It is often secondary to the pre-existing tuberculosis of the urinary tract, which may be confirmed by the culture of early morning urine specimens. Conclusion: Treatment of testicular abscess is administration of appropriate antibiotics according to its causative organism accompanied by surgical drainage. Early diagnosis and prompt treatment of testicular abscess is necessary, since chronic and severe cases, as happened in this patient, usually resulted in nonviable testicular tissue and necessitate orchidectomy. This may be due to cumulative ischemia of the testicles from multiple mechanisms: inflammatory infiltration causing compression of the spermatic cord, thrombosis secondary to venous congestion and/or bacterial exotoxins.

Paraplegia secondary to disseminated mucormycosis: case report and literature review

BackgroundWe report a case of spine infection with mucormycosis that manifested signs of paraplegia in a patient suffering from disseminated mucormycosis. Timely and effective surgery was performed. A review of the literature is included.Case presentationA patient with diabetic ketoacidosis complained of back pain and fatigue for one month, and his right lower extremity activity had been limited for 10 days. T4–T6 vertebral and paravertebral soft tissue-involved infections were identified by MRI, which were derived from right lung pneumonia. He underwent abscess debridement, spinal canal decompression, pedicle screw fixation and amphotericin B liposome injection. Histopathological examination revealed broad aseptate hyphae suggestive of invasive mucormycosis. There was improvement in neurological function after surgical and medical treatment. Three months after the surgery, the patient died of uncontrollable massive bleeding of the urinary system. Mucormycosis is characterized by rapid development and a high mortality rate. This case shows the significance of a multidisciplinary team in the diagnosis and treatment of patients with mucormycosis. In addition, orthopedic surgeons should design appropriate surgery plans for spine-involved mucormycosis patients.ConclusionThis case present a patient with paraplegia caused by the spread of pulmonary mucormycosis to the vertebral and paravertebral soft tissue of levels T4–T6. After medical treatment, surgical debridement and internal fixation, the patient recovered well but later patient died of possible disease dissemination to the renal or urinary tract which resulted in massive haemorrhage.

Paravertebral abscess and bloodstream infection caused by Burkholderia pseudomallei after acupuncture: a case report

BackgroundVarious pathogenic bacterial infections caused by acupuncture have raised widespread concern, but paravertebral abscesses and bloodstream infections of Burkholderia pseudomallei (B.pseudomallei) after acupuncture have not been reported.Case presentationA 49-year-old man was admitted to hospital with recurrent back pain and fever for 1 month, along with the finding of undiagnosed diabetes. He was considered to have tuberculosis because of unrelieved high fever and pulmonary nodules. Bilateral blood culture suggested B.pseudomallei infection, MRI of the lumbar spine suggested paravertebral abscess, and the final diagnosis was paravertebral abscess and bloodstream infection after acupuncture combined with migrating lung infection. He was discharged after abscess debridement and intensive anti-infective therapy, but no further oral antibiotics were administered because of his poor adherence. More than 5 months later, he was readmitted with the urine culture findings of B.pseudomallei. No other abscess formation was observed and he received oral antibiotics for more than 3 months without recurrence.ConclusionsAcupuncture may lead to B.pseudomallei infection in high-risk groups, and inadequate treatment can lead to recurrent infections.

Long Cervicothoracolumbal Rigid Bracing Stabilization on Incomplete Spinal Cord Injury of Post-Operated Multi-Focal Upper Cervical-Thoracic Spinal Tuberculosis: A Unique Case Report

Background and aim: Spinal tuberculosis (STB) is a hazardous type of bone tuberculosis that could affect the entire spine, with predilection towards the lower thoracic level. Upper cervical spondylitis occurred only at 0.3 – 1% of all STB cases, but this rare type leads to severe consequences, including tetraplegia, autonomic dysfunction, and respiratory impairment. This case reported long CTLSO rigid external stabilisation reasoning to boost protection whilst recovering tuberculosis despite stable internal stabilisation. Methods: A 34-year-old male came with one year of worsening low-back pain, unintentional weight loss, and gradual loss of power and sensation of both feet within a month. Physical examination showed kyphotic deformity, tenderness, key-muscle-strength 3, and sensory impairment for lower extremities, with no autonomic disturbances. Laboratory works showed chronic ongoing infection. Whole-spine MRI showed multiple spondylodiscitis with multi-focal paravertebral abscesses at C3 – C5, C7 – T3, T9 – T12, L1, severe canal stenosis and anterior segment destruction of T12. Results: The patient was diagnosed with SCI AIS D with a neurological level of L3 secondary to T12 vertebra destruction from STB. He underwent abscess evacuation, debridement, and posterior stabilisation at T10 – L3 and debridement of abscess at C3 – C5 without the need for stabilisation. After procedures, the spine was further stabilised by a CTSLO brace with flexion, extension, lateral flexion, rotation stop. Inward rehabilitation includes incremental mobilisation, upper-limb-extensor-group-strengthening-programme, balance-exercise with ambulation training. Patient discharged with status: ambulate independently with a walker. To date, the patient has returned to work with independent ambulation. Conclusion: Type-III STB was indicated for surgical procedures. Instability of upper cervical prevented patient to performed loadbearing activity thus lowering patient functional outcomes. CTLSO supplementation was given to compensate for 3 lesion sites, the upper cervical, mid-thoracic, and lower-thoracic. For the C3 – C5 lesion, there was no internal stabilisation, so a proper external mode of stabilisation should be given. However, for the thoracic level, CTLSO was given due to (1) incomplete SCI lesion in the absence of deteriorating neurological deficit,c(2) porous nature of STB, and (3) good prognostic recovery of STB with anti-TB medication leading to the reversible neurological deficit.

Operative Management of Liver Abscess and Intra-hepatic Migration of Gallstones due to Perforated Cholecystitis

We report a rare case and an atypical presentation of acute cholangitis and cholecystitis complicated by intrahepatic gallbladder perforation, forming a multilocular liver abscess with stones embedded within the abscess cavity in a forty-six-year-old gentleman. He presented with painless jaundice, pale stools, and dark urine. His initial investigations revealed leukocytosis, obstructive liver function tests and computerised tomography of the abdomen revealed a perforated gallbladder with segment 5/6 liver abscess containing multiple dependent calculi in segment 6 and distal CBD calculi. Endoscopic-Retrograde-Cholangiopancreatography was performed, with endoscopic sphincterotomy and retrieval of common bile duct stones. This was followed by ultrasound-guided percutaneous cholecystectomy. He was then treated with la[aroscopic cholecystectomy, deroofment and debridement of abscess and retrieval of intrahepatic stones. In the setting of hepatic abscess, percutaneous drainage and antibiotic treatment for abscess before an interval cholecystectomy, however the retained calculi within the abscess cavity in this case continue to be a nidus for infection. With decompression of the abscess by drainage and regeneration of scar tissue, the difficulty of retrieving the stones requires resection of the involved liver segments. The early timing and conduct of the operation allowed the use of a minimally invasive parenchymal-sparing approach to address the intrahepatic stones along with the cholecystectomy. While perforated gallbladder with cholecystohepatic fistula and abscess is a rare condition on its own; we believe this to be the first time an abscess from a perforated gallbladder has been complicated by migration of gallstones beyond the adjacent pericholecystic liver tissues and into non-continuous segments.

Fournier Gangrene and Retroperitoneal Abscess Secondary to Perforated Appendicitis: A Case Report

Fournier’s gangrene and retroperitoneal abscess are rare complications of late presentation of perforated acute appendicitis. This case report discusses the case of a 46-year-old male patient who presented with 5 days history of progressive abdominal pain and was admitted to our department as a case of complicated perforated acute appendicitis followed by retroperitoneal abscess formation and Fournier’s Gangrene few days later. The patient had a hospital stay of 53 days, during which he underwent diagnostic laparoscopy and appendectomy, computerized tomography guided percutaneous abscess incision and drainage for the retroperitoneal abscess and multiple scrotal debridement surgeries for the Fournier’s gangrene, in addition to the drain care and intravenous antibiotic course he received. Diabetes mellitus is one of the most common risk factors of Fournier’s gangrene, which was newly detected in our patient six months earlier. Fournier’s gangrene is ten times more common in males than in females, especially in their third and sixth decade of life. It is life-threatening and has unfavorable prognosis that indicates early detection and aggressive surgical and medical intervention with a multidisciplinary approach, including fluid resuscitation, immediate initiation of broad-spectrum antibiotics and aggressive debridement of the necrotic tissue; in addition to the respiratory and hemodynamic support to improve the prognosis and overall outcome and to maximize the chances of survival.

Haematogenous synovial sepsis of the digital flexor tendon sheath following contralateral limb foot abscessation in a horse

AbstractA 5‐year‐old Shire mare was presented for investigation of severe right hindlimb lameness and was diagnosed with extensive right hind subsolar and submural foot abscessation. The mare developed severe contralateral limb lameness 11 days following right hind abscess debridement, with investigation revealing synovial sepsis of the left hind digital flexor tendon sheath. Synovial sepsis persisted despite aggressive surgical and medical treatment, resulting in euthanasia. Microbial culture of synovial fluid isolated Bacteroides sp., consistent with haematogenous synovial sepsis. This is the first report to describe haematogenous synovial sepsis as a cause of contralateral limb lameness during the management of foot abscessation in the horse.

Treatment of HeartMate III-LVAD driveline infection by negative pressure wound therapy: Result of our case series.

Driveline infection is one of the most frequent complications following left ventricular assist device (LVAD) treatment and there is no consensus for its management. The standard approach to treat foreign-body infection is complete device ablation, which is not always feasible and therefore not an elected method for LVAD driveline infections. Here we share the results from a series of cases successfully treated for driveline infection by negative pressure wound therapy (NPWT) therapy. Between 2016 and 2020, five male patients were hospitalized in our unit with a driveline infection of HeartMate III-LVAD®. Ultrasonography and/or thoraco-abdominal CT confirmed the diagnosis, infection localization, and abscess formation. Following an antibiotic treatment, an urgent surgical abscess drainage and debridement of the infected tissues were performed. At the end of the procedure, NPWT was applied. NPWT re-dressing and debridement of wound was performed every 3–4 days. The wound was closed surgically after obtaining negative culture results and good healing. The patients were discharged in good condition, without signs of infection. Two patients underwent successful heart transplantation after 1 and 13 months. Other patients did not show any residual or recurrent infection during the follow-up within 25 months. Driveline infection following LVAD implantation is a significant complication and a challenging in terms of management for both; the surgical team and the patient. These results from our case series report a successful and less invasive approach by using NPWT for the treatment of LVAD driveline infections.

A Rare Case of Burkholderia Pseudomallie Presenting as Brain Abscess

Rationale: Meiliodosis is an extremely rare condition in Neurosurgery which is caused by the gram negative organism Burkholderia pseudomallie. Burkholderia pseudomallei (also known as Pseudomonas pseudomallei) is a Gram-negative, bipolar, aerobic, motile rod-shaped bacterium. It is a soil-dwelling bacterium endemic in tropical and subtropical regions worldwide, particularly in Thailand and northern Australia. It infects humans and animals and causes the disease melioidosis. It is also capable of infecting plants. If treatment is below par or delayed, this infection can produce diverse clinical symptoms and result in death.
 Patient Concerns: A 52 year old female, known case of Type 2 Diabetes mellitus on insulin, presented with complaints of a swelling in the left parieto-occipital region since 2 months & headache since 1 month. She had a past history of a fall from scooter 7 months ago, which then was not radiologically imaged. Patient was, otherwise, conscious, oriented and had no focal neurological deficit.
 Diagnosis: left parieto-occipital space occupying lesion confirmed by Ct brain and [mri + mrv] brain and culture and sensitivity of fluid aspirate showed moderate growth of burkholderia pseudomallie.
 Interventions: Intravenous Ceftazidime [1 g/12 h] was administered in-hospital for 4 weeks (Intensive Phase) and Oral Cotrimoxazole (Trimethoprim + sulfomethoxazole) {TAB.BACTRIM DS} twice daily was administered out-hospital (Maintenance Phase).
 Patient underwent Left parieto-occipital abscess drainage and debridement [Pus sent for Culture and Sensitivity] – Abscess drainage and removal of irregular thinned out bone around the skull defect + Biopsies sent from small extradural collection near the skull defect.Intravenous Ceftazidime was continued and discharged with Oral Cotrimoxazole (Trimethoprim + sulfomethoxazole).

Recidiva e incidencia de fístula tras el drenaje urgente de un absceso anal. Resultados a largo plazo

IntroductionAnal abscess is the most frequent urgent proctological problem. The recurrence rate and reported incidence of fistula after drainage and debridement of an anal abscess is widely variable. The objective of this study is to analyse the long-term recurrence rate and the incidence of fistula after drainage and urgent debridement of an anal abscess. MethodsRetrospective observational study of a prospective cohort with anal abscess of cryptoglandular origin. All patients (n = 303) were evaluated two months and one year after the intervention. At the 5th year, all the medical records were reviewed and a telephone call or appointment was made for an assessment if necessary. Specific antecedents of anal pathology, abscess characteristics, time and type of recurrence, presence of symptoms in the first revision and presence of clinical and/or ultrasound fistula were recorded. ResultsMean follow-up 119.7 months. Recurrence rate 48.2% (82.2% in the first year). Two hundred twenty-two ultrasounds performed. Incidence of ultrasound fistula: 70% symptomatic vs. 2.4% asymptomatic (p < 0.001). Global incidence of fistula 40.3%. The history of anal pathology and the presence of symptoms in the postoperative review significantly increase the possibility of recurrence (p < 0.001). The fistula is statistically more frequent if the abscess recurs (p < 0.001) ConclusionAfter drainage and debridement of an anal abscess, half of the patients relapse and 40% develop fistula especially in the first year, so longer follow-ups are not necessary. Endoanal ultrasound for the evaluation of the presence of fistula is highly questionable in the absence of signs or symptoms.