Abscess In Infant Research Articles

Natural course of perianal abscess in infants: a real-world study

Natural course of perianal abscess (PA) in infancy remains obscure. This study aimed to investigate the natural course of infants with PA after conservative treatment. A retrospective cohort study was conducted in infants with PA who were treated conservatively (due to the parents’ refusal of surgery), for more than 2 months between 2014 and 2020 at a single tertiary center. 153 patients (149 boys and 4 girls) were identified. The median follow-up was 5.3 years (range 3–8.2 years). Initially, 119 patients (77.8%) were completely cured by conservative treatment, and 34 (22.2%) failed. Among the 34 patients, 23 continued conservative treatment (20 cure, 3 fistula formation) and 11 underwent surgery. After conservative treatment, the rate of fistula formation, abscess recurrence, and new-onset abscess were 15.0%, 4.6%, and 6.5%, respectively. Overall, 139 patients (90.8%) were cured conservatively without surgery, and 11 (7.2%) underwent surgical management. In addition, 3 (2.0%) patients developed fistula-in-ano (under observation). PA in infants may be a time-limited and self-limited condition. Conservative management should be the first choice of treatment in most cases. Longer periods of conservative treatment may achieve better clinical outcomes in selected cases. There will be a percentage of patients (about 10%) that would require surgical treatment.

Iliopsoas abscess in infants: A case report

Introduction. Iliopsoas abscess is a rare condition, which may be categorized as primary or secondary. Primary iliopsoas abscess is caused by lymphohematogenous spread of infectious agents from a distant site, unlike secondary iliopsoas abscess that is a result of direct spread of a nearby infectious or inflammatory process. The diagnosis and treatment of primary iliopsoas abscess are often prolonged, due to the rarity of the disease and the nonspecific signs and symptoms. Case Report. This study presents a case of a onemonth old infant with a left-sided iliopsoas abscess. The physical examination revealed a swelling with a pronounced vascular pattern in the area of the left groin. Laboratory findings showed leukocytosis and increased inflammatory markers. An abscess within the left hemiabdomen and inguinofemoral region was diagnosed by ultrasonography and computerized tomography. The main therapeutic approach included antibiotic therapy, as well as surgical drainage of the abscess. Staphylococcus aureus was isolated from a 100 ml sample of the drained abscess. The treatment outcome was good. Conclusion. Given the frequency of iliopsoas abscess in infants, which is far less common than other primary diseases, greater attention must be paid to symptoms and signs during clinical examination, along with the appropriate choice of diagnostic procedures. Timely diagnosis, as well as adequate treatment of iliopsoas muscle abscess, is imperative in order to prevent the development of complications, such as systemic inflammation and sepsis.

Infantile orbital abscess: clinical presentation, microbiological profile, and management outcomes

ABSTRACT Purpose Orbital abscesses in children are not uncommon. Unless managed in a timely fashion, they can potentially lead to vision-threatening as well as life-threatening complications. The objective of this study is to report the clinical and microbiological profile and management outcomes in infants presenting with orbital abscesses. Materials and Methods A retrospective review of electronic medical records of children younger than 1 year with a diagnosis of an orbital abscess was done. The data was collected from a time period of 12 years (2007–2019). The data collected included mode of presentation, radiological, microbiological and histopathological features, and the final outcome. Results A total of nine patients met the inclusion criteria. The mean age at presentation was19 weeks. Three patients had upper respiratory tract infection, one had a congenital nasolacrimalduct obstruction, two had sinusitis, and one patient had neonatal sepsis. All patients underwentimaging following which abscess drainage was performed. Methicillin-sensitive Staphylococcusaureus was the most common organism, which was isolated in five patients, Methicillin-resistantS. aureus was isolated in three, while one patient had Entomophthorales fungal infection. Themedian follow-up period was 10 months (range 5 days to 89 months). There was no recurrencein the cohort. At least one patient had visual impairment at the last follow up. Conclusion Orbital abscesses in infants are rare. Imaging and prompt drainage of the abscess supplemented by appropriate antimicrobial regimen leads to a successful outcome.

Management of perianal abscesses in infants without general anaesthesia: a systematic review of the literature.

Perianal abscesses are a common surgical presentation in infants. Historically, general anaesthesia (GA) has been used to facilitate incision and drainage, with or without exploration for a fistula-in-ano (FIA). This review aims to assess outcomes following management of perianal abscesses without GA in infants less than 24months old. We aim to identify the success of management without GA. Using PRISMA guidelines, studies were identified from MEDLINE, EMBASE and PubMed. Studies including infants less than 24months with perianal abscesses managed without GA were reviewed. The primary outcome was the number of patients requiring GA following initial management without GA. Secondary outcomes included rates of recurrent perianal abscesses, rates of progression to FIA and time to cure. Nine studies, involving 1049 infants less than 24months old met inclusion criteria. A total of 1039 (99.0%) were males. Study design consisted of one prospective case series of 18 patients, and eight retrospective cohort studies. There were no randomized control trials. A total of 1037 (98.9%) patients were initially managed without GA. Of these, 59 (5.6%) were documented to subsequently require a general anaesthetic. Treatment modalities included antibiotics, regular baths, needle aspiration, incision and drainage under local anaesthesia, hainosankyuto and fibroblast growth factor. A total of 790 (75.3%) healed primarily without further intervention. A total of 243 (23.2%) were documented to have a recurrence or progression to FIA. All patients who required a subsequent general anaesthetic had progressed to FIA. Despite the lack of well-designed prospective studies, existing evidence supports management of perianal abscesses without initial GA in infants, with more than 75% healing completely. Further research aimed at standardizing care and confirming the safety and efficacy of initial non-operative management are warranted, and may potentially reduce the number of unnecessary initial and subsequent clinical interventions.

Perianal abscess in infants: Amenable to conservative treatment in selected cases.

Perianal abscess is a common surgical condition in daily pediatric practice. Management is a subject of controversy and a variety of approaches are practiced. While the most frequent approach is drainage with/without fistulotomy, the superiority of this approach and the place of conservative approach has not been established. The aim of this study was to evaluate the outcomes of conservative approach in selected cases of perianal abscesses in infants. Data of 19 patients aged <24months treated conservatively for perianal abscess at a tertiary hospital in 2014-2018 were retrospectively reviewed. Criteria for a conservative approach were: spontaneous drainage into the anal canal (n = 8) or perianal skin (n = 4), and phlegmonous infiltrate with fluid collection detected on ultrasound (n = 7). Mean age at symptom onset was 8.4months. Twelve patients were managed for the first time. Previous care in seven patients included 1-4 drainage procedures (n = 4), spontaneous drainage (n = 1) and antibiotics (n = 2). Five patients were on oral antibiotics at presentation. After diagnosis, 18 patients received i.v. antibiotics and one, oral antibiotics. Three patients (15.7%) ultimately required surgical drainage; two were lost to follow up. During follow up (mean, 22.4months) four patients (28.5%) had a single recurrent episode; abscess in three (managed conservatively in two and surgically in one) and fistula-in-ano in one patient that healed spontaneously. Thus, surgical intervention was prevented in 13/17 patients (76.4%) available for follow up. Perianal abscess in infants is amenable to conservative management in selected cases. Avoiding surgical intervention is advantageous, especially given the high recurrence rate.

Deep neck space abscesses in children: 15 years of experience in a children's ENT referral unit

IntroductionDeep neck space abscesses in infants are clinical entities of great importance due to their severity and possible complications. The aim of the study is to review our experience in the diagnostic and therapeutic management of deep neck space abscesses, and compare it with published literature. Material and methodsRetrospective study was carried out on all patients diagnosed and treated for deep neck space abscesses over a 15-year period (2002–2016), including an analysis of the demographic, clinical, diagnostic and therapeutic characteristics. ResultsA total of 72 cases were diagnosed. An increase was observed in their incidence in recent years. The most frequent locations were peri-tonsillar (30.6%), followed by swollen lymph nodes (18.1%), parapharyngeal (16.7%), and retropharyngeal (16.7%). The least frequent were submandibular abscesses (12.5%) and parotid abscesses (5.6%). The distribution was different according to age (P<.001). The most frequent clinical symptom was fever (70.8%), followed by odynophagia (55.56%). The most used imaging tests were CT (50.7%) and ultrasound (28.2%). The treatment used was pharmacological in 11.1%, all of them abscessed swollen lymph nodes of less than 1.5cm in maximum size. The other 88.9% underwent surgery. There was recurrence in 12.5% of the cases. ConclusionsThe performance of tonsillectomy and/or early cervicotomy in abscesses larger than 2cm or lesions of deep location decreases the number of serious complications and does not have recurrences. When using more conservative surgery, there were 12.5% of recurrences.

Perianal Abscesses in Infants Are Not Associated With Crohn's Disease in a Surgical Cohort.

The aim of this study is to search for an association between infantile perianal abscesses and [development of] Crohn's disease in a surgical population of children. Patients who were surgically treated in the Amsterdam UMC between January 2000 and December 2014 were included in this retrospective cohort study. Data collected include: sex, date of birth, underlying conditions, age of onset, additional symptoms, pus cultures, endoscopic examination, histological examination, magnetic resonance imaging, faecal calprotectin levels, antibiotic treatment, surgical treatment strategy, and number of recurrences. Follow-up data were gathered from medical records and by contacting the patients and/or parents or the general practitioner. The study consisted of 62 patients of whom 60 were boys. Median age was 5 months [range 0-17 months]; 92% were under 1 year of age at diagnosis. A minority of patients had accompanying symptoms. In total, 72 abscesses were treated, 19 fistulas and 23 abscesses with fistula-in-ano. Follow-up data of 46 patients [74%] were available; none of the patients developed Crohn's disease. We found no association between isolated perianal abscesses as presenting symptom in early childhood and [development of] Crohn's disease. In young infants with isolated perianal disease, risk for inflammatory bowel disease seems low. In this specific population there seems no place for routine performance of endoscopic investigations. One should always take the risk of very-early-onset inflammatory bowel disease into account. Further research with a larger cohort of children and a longer follow-up time is required.

Infants Are More Likely Than Older Children to Have Surgery for Cervical Infections

Objectives To identify differences in cervical infection management in infants versus older children. Methods Charts of patients 0–18 years, diagnosed with a cervical infection at our institution between 2004 and 2015, were included. Age, gender, presenting symptoms, comorbidities, CT scan findings and management including admission, procedures, antibiotics, cultures, length of stay, readmission rates, and complications were included. Results 239 patients were included: mean age was 4.6 years, with 55.6% boys and 44.4% girls. Mean length of stay was 3.2 days, with no significant difference between age categories. 12.55% were readmitted within 30 days with no significant difference when stratified for age (p = 0.268). The most common presenting symptoms were fever (74.3%), swelling (71.4%), and neck pain (48.2%). Infants had fewer symptoms documented than older children. 51% has lateral neck infections, and these were more common in younger children (p < 0.001). The most common antibiotic used was amoxicillin-clavulanic acid in 53.96% of inpatients and 48.05% of outpatients. Infants were most likely to have MRSA isolates (29.2% versus 11.7% of older children, p = 0.011). 70.0% went to the operating room for incision and drainage procedures. Younger children were more likely to undergo surgery, with an odds ratio of 2.38 for children under 1 year. (p = 0.029). 90.9% of infants underwent surgery with radiolucencies of at least 1 cm diameter in contrast to 50% of children over 8 years old. Conclusions This study emphasizes the importance of considering early operative treatment of cervical abscesses in infants despite fewer symptoms and smaller radiolucencies on CT.

Brain Abscesses: An Overview in Children

AbstractBrain abscesses in infants and children might be life threatening if not managed properly. They occur more frequently in the first two decades of life despite the reduced incidence of sinus and ear infections in pediatrics. The features of brain abscess in terms of location, pathogens, and symptoms depend on age and thus on predisposing factors. In infants and toddlers, bacterial meningitis or bacteremia is the major cause, and in older children, immunosuppression and cyanotic congenital heart diseases are common predisposing factors. The therapeutic management of brain abscesses involves a multidisciplinary team, including infectious disease specialist, neurosurgery, neuroradiology, and neurology. A prompt and long-term antimicrobial therapy is the mainstay of treatment, often associated with surgical drainage. These changes in the management have significantly improved the prognosis of patients with brain abscesses over the past 50 years.

Methicillin-resistant staphylococcus aureus (MRSA) brain abscess in a well appearing premature infant

Brain abscesses in infants are extremely rare and occur as an uncommon complication of bacterial meningitis or sepsis. This case is of a 29 week male premature infant with a diagnosis of a brain abscess at 63 days of life secondary to methicillin-resistant staphylococcus aureus bacteria (MRSA) which evolved after a fairly unremarkable neonatal intensive care unit course. Cultures of the cerebrospinal fluid and blood yielded no growth. He was found to be colonized with methicillin- resistant staphylococcus aureus on routine surveillance cultures after transfer from an outside hospital. The infant required a temporary external ventricular drain for hydrocephalus and compression of the brainstem secondary to the mass effect. He is currently developing favorably at 14 months after undergoing prolonged treatment with Vancomycin and Rifampin.

Evaluation of the efficacy of incision and drainage versus hainosankyuto treatment for perianal abscess in infants: a multicenter study.

We retrospectively compared the short-term outcomes between incision and drainage (ID) and hainosankyuto (TJ-122, Tsumura & Co, Tokyo, Japan) treatment for perianal abscess (PA) in infants. We retrospectively examined 48 consecutive patients (median age 129 days; range 19-330 days) who presented with PA over a 3 year period. Group 1 comprised 26 patients who were treated with ID at presentation, and Group 2 comprised 22 patients who were treated with oral TJ-122 at presentation; oral treatment was continued until the disappearance of purulent discharge and resolution of induration at the abscess site. PAs were identified in all 48 patients at presentation. The median duration of follow-up was 26 months (range 13-40 months). At presentation, there were no differences in the gender, age, birth weight, duration of symptoms, skin erosion or prevalence of diarrhea between the two groups. Purulent discharge resolved within a median period of 26 days (range 7-42 days) in Group 2, but persisted for 40 days (range 4-196 days) in Group 1. The induration resolved within a median period of 39 days (range 7-91 days) in Group 2, but persisted for 70 days (range 4-308 days) in Group 1 (p = 0.04). TJ-122 treatment was more beneficial than ID in treating PA in infants.

Recurrent lacrimal abscess in infant

Acute dacryocystitis at or shortly after birth is uncommon and its main complication, formation of lacrimal sac abscess, is rare. Uniform and standard treatment protocol for this condition has not been established till date. We report on a 2 month old infant with an abscess of the lacrimal sac. He was treated for similar condition on day 6 of his life by incision and drainage; unfortunately, the condition recurs. This time, he was managed with incision and drainage under systemic antibiotic cover; and an early probing of the nasolacrimal duct (NLD) was done on 7th post-operative day. The patient was followed up for a period of one year without any further recurrence and complication. Pathophysiology of the condition and possible treatment options in children have been discussed.DOI: http://dx.doi.org/10.3126/ajms.v6i2.10458Asian Journal of Medical Sciences Vol.6(2) 2015 121-123

English

Reporting 40 day old child referred from a private clinic to our hospital with CT Brain showing intracranial space occupying lesion. Child had fever since day 7 of birth and was evaluated for sepsis in the nearby hospital and CSF study showed features of bacterial Meningitis and was treated for 14 days with inj. cefotaxime and amikacin. After 3 days of IV medication fever subsided. CSF culture outside did not shown any growth. We have not got the detail of blood investigation outside. CT brain was taken in that private clinic to rule out post meningitic complication. Surprisingly they found intracranial space occupying lesion. So the child was referred to our hospital for further management. On examination child was alert, active feeding well, no any neurological deficit anterior fontanelle was level. Blood investigation showed normal total count (13,000 with polymorphs predominance 70%), CRP was 7 and blood culture has not grown any bacteria. Serum calcium 8mg/dl, potassium 4meq, sodium 130 mEq. CT Brain (taken outside) showed well encapsulated calcified mass in right temporal lobe 3x3 cm with no midline shift. So child was operated (open surgery) and biopsy of the lesion showed abscess with calcification. Pus culture revealed pseudomonas aeruginosa. Child was treated with IV ceftazidime for 10 days. Child went home with no neurological deficit. On follow up he is doing well. DISCUSSION: Calcified brain abscess 1 in infancy is rare and only few cases were reported with abscess and calcification. Brain abscesses can occur in children of any age but are most common in children between 4 and 8 yr and neonates. The cause of brain abscess include embolization due to congenital heart disease with right to left shunts, meningitis, chronic otitis media, sinusitis, orbital cellulitis, dental infection, immunodeficiency and infection of ventriculoperitoneal shunts. Our patient had CSF proven meningitis treated with antibiotic for 14 days. He did not have any neurological symptoms inspite of this large lesion. Intrauterine viral infection followed by calcification has been very well documented, but bacterial infection followed by calcification is very rarely reported. In literature only few cases of brain abscess with calcification is reported and pseudomonas brain abscess in infants has not been reported till now as per available literature, so we are reporting this rare case, from our institution. Auvichayapat et al 2 reviewed the clinical features and outcomes of treatments of 107 infants and children with brain abscesses. Congenital heart diseases and chronic otitis media were the most common predisposing factors. The common signs and symptoms were fever, headache, vomiting, alteration of consciousness, and focal neurologic deficit. The overall mortality rate was 10.7%. Calcified brain abcess in a 6 year old child reported by Kabre et al3. Pus culture showed staph

Unusual cause of thigh abscess in infant following hepatitis B vaccine administration

A 30 days old healthy male infant with left thigh swelling was presented to our clinic by his family. Parents gave no history of diseases or trauma and was administered hepatitis B vaccine from left thigh one week before. Physical exam revealed approximately 3x2 cm, erythematous, indurated, tender to palpation, fluctuating soft tissue swelling over the anterolateral left thigh. During needle puncture, 15 cc purulent liquid was aspirated. As the liquid was purulent, irrigation and debridement were performed. Following six weeks of antibiotic treatment, the patient was completely recovered.

Candida species lens abscesses in infants with a history of neonatal Candida sepsis

We report 3 patients who were delivered prematurely and who developed a lens opacity with signs of ocular inflammation at a postgestational age of 10-52 weeks. All patients had been treated for Candida sepsis as neonates. Each patient underwent lensectomy and anterior vitrectomy. In 2 infants Candida albicans was cultured from the lens/anterior chamber membrane; in 1 Candida parapsilosis was cultured from a lens aspirate. Despite eradication of the fungal infection, outcomes were poor: 2 eyes developed glaucoma, and 1 developed a retinal detachment with subsequent phthisis.

Citrobacter freundii Brain Abscess in a Preterm Infant: A Case Report and Literature Review

Intracranial abscesses are serious conditions but uncommon in preterm neonates. Citrobacter species are an uncommon cause of bacterial meningitis in neonates, but are associated with brain abscesses in a majority of cases. We report a preterm infant who developed Citrobacter freundii meningitis with brain abscess, who was successfully treated with antibiotics and surgical drainage. The infant had normal neurological outcome at follow-up. We report this case to highlight the importance of serial neuroimaging in the diagnosis of cerebral abscess in infants with Citrobacter meningitis.

873 ’Brain Abscess in Infants and Children: A Retrospective Study of 52 Patients in Pediatric’s Hospital of Casablanca, Morocco

Brain abscess is a serious disease of the central nerve system, it’s a rare pathology in children; to review the clinical manifestation, and predisposing factors, causative organism and outcomes of...

A Case of Infantile Urinary Tract Infection that Progressed to Renal Abscess Despite Early Antibi otic Treatment

방광요관역류(5등급)가 동반된 요로감염영아(4개월)에서 발열 초기(15시간)에 민감한 항생제로 치료하였음에도 불구하고 신농양으로 진행되었고 장기 항생제 치료(6주)와 초음파 감시하 세침 흡인으로 경도의 신반흔을 남기고 호전된 1례를 경험하였기에 보고하는 바이다. 【Urinary tract infection (UTI) is most commonly diagnosed bacterial infection in febrile infants. Renal abscess is a very rare complication of UTI in children. Early diagnosis and treatment with appropriate antibiotics are important because renal scar correlates positively with the time of treatment. Renal ultrasonography and abdominal computerized tomography facilitates an earlier diagnosis and is also useful in establishing percutaneous drainage. Extended broad spectrum antibiotics therapy alone can be effective in most types of renal abscesses in infant, but some antibiotics-resistant cases need surgical drainage or nephrectomy. We report a case of a infant UTI, that progressed to renal abscess despite early antibiotic treatment and was treated with US guided percutaneous needle aspiration.】

MRSA as a Cause of Postpartum Breast Abscess in Infant and Mother

This report describes the unusual occurrence of mastitis and breast abscess in both mother and infant, both caused by methicillin-resistant Staphylococcus aureus (MRSA). Mother and child were both immunocompetent, and their only risk factor was routine confinement. The case highlights the importance of considering MRSA as a cause for mastitis in mothers and infants. MRSA is increasingly common, and failure to consider it as a cause for mastitis will lead to delays in treatment (as it did in this case). The case also demonstrates the role of Hospital in the Home in the treatment of postnatal infections, where hospitalization can be extremely disruptive.

An unexpected intracranial pressure crisis: infant brain abscess of unusual aetiology

Brain abscess in infants is extremely rare in the developed world. Often, these children have a predisposing history and are infected with certain bacterial aetiology. A 3-month-old boy presented to the hospital emergently with an increased intracranial pressure crisis. All predisposing factors such as maternal history, family history or the infant's medical history were entirely free of suggestive aetiological pathology. Neuroimaging revealed a complex mass lesion for which differential diagnosis included neoplasm and brain abscess. We will report on the surgical and medical intervention as well as patient outcome. A focus will be placed on the rare pathology discovered and a short review of the literature on the aetiology of this child's brain lesion will be included as well as support for the management steps taken. Brain abscess in infants is often extremely serious and overwhelming. Concluding topics will focus on contradictions to expected outcome as well as prognostic prospects for patients with this type of devastating disease.