Bone Abscess Research Articles

Bone abscess from human bite report of a case

Bone abscess from human bite report of a case

Pott's puffy tumour

A 10-year-old girl presented with an episode of seizure following osteomyelitis of the frontal bone and subperiosteal abscess due to frontal sinusitis. CT scan confirmed osteomeyelitis of the frontal bone and subperiosteal abscess. At surgery, the subperiosteal abscess and contiguous subdural abscess was drained and sequestrectomy of the affected frontal bone done. Broad spectrum antibiotics and anticonvulsant were given for 4 weeks. The patient recovered without residual problems and has remained well at 5 years of follow up. Pott’s puffy tumor is now relatively uncommon and associated seizure is unusual. Early diagnosis and prompt treatment is necessary to avoid severe neurological complications and sequelae.

Suppurative Complications of Frontal Sinusitis in Children

A retrospective review of children diagnosed and treated for suppurative complications of paranasal sinusitis was undertaken to describe clinical presentation, microbiology, and treatment. This review includes children with subgaleal abscess and osteomyelitis of the frontal bone, subdural empyema, frontal lobe abscess, meningitis, and encephalitis. Staphylococcus aureus and group C beta-hemolytic Streptococcus were isolated agents. All children were treated with intravenous antibiotics with drainage of both the sinus and extracranial and intracranial suppurations. Results of treatment in the series support the opinion that combined aggressive surgical and antibiotic treatment is a preferred method in complicated sinusitis in children.

Tetanus and other clostridial and anaerobic infections

Abstract Recently, cases of clinical tetanus in the UK are more likely to be associated with injecting drug abuse, presumably from a contaminated batch of heroin currently in circulation. Other clostridial species such as Clostridium botulinum and C. histolyticum are also causing infections such as wound botulism and gangrene respectively in this population. Health-care workers should be alerted to intravenous drug-users presenting with neurological symptoms indicative of tetanus or botulism, and be aware that gangrenous injection-site wounds can lead to serious illness and death. C. difficile continues to cause increasing levels of nosocomial antibiotic-associated diarrhoea and colitis in UK hospitals and is a significant drain on health-care resources. It affects mainly the elderly. The Communicable Disease Surveillance Centre recorded more than 28,000 positive tests for C. difficile toxins in stool samples in hospital in-patients in 2002. Other anaerobic infections remain relatively common, affecting soft tissues in the form of abscess or infections of joints and bone from breaches of mucosal surfaces by surgery or accidental trauma to the gastrointestinal, genitourinary ore respiratory tract. Anaerobes also commonly infect superficial ulcers (eg. genital, decubitus, varicose, diabetic). Fusobacterium necrophorum may cause a serious condition known as Lemierre's disease that classically affects previously healthy young adults. The first symptom is a severe sore throat that progresses to septic thrombophlebitis, metastatic lung abscess and septicaemia, which can be fatal if untreated.

Severe staphylococcal knee arthritis responding favourably to linezolid, after glycopeptide-rifampicin failure: A case report and literature review

A puzzling case report of a septicaemic post-surgical staphylococcal knee arthritis which did not respond to long-term courses of associated rifampicin and teicoplanin or vancomycin, despite apparently favourable in vitro susceptibility assays, but which rapidly resolved after i.v. followed by oral administration of linezolid is presented, and discussed in the context of the most recent literature evidence. The lack of response to a 14-d-long course of glycopeptides does not find explanation from the in vitro minimum inhibitory concentrations (MIC90) of involved organisms, which showed full susceptibility of Staphylococcus aureus to vancomycin and teicoplanin, and sensitivity of an accompanying Staphylococcus epidermidis isolated from blood cultures to vancomycin and rifampicin, with borderline 'intermediate' values found for teicoplanin. Since neither bone involvement nor abscess formation was of concern, effective glycopeptide and rifampicin penetration into infectious tissue should have been assured. From a clinical viewpoint, the introduction of a 2-week i.v. linezolid followed by 1 further week of oral linezolid led to complete clinical and microbiological cure, and an unexpected functional success.

Adductor insertion avulsion syndrome, “thigh splints”: relevance of radiological follow-up

We present a case of chronic osteomyelitis in a 13-year-old girl which was originally diagnosed as adductor insertion avulsion syndrome ("thigh splints") on the basis of the clinical presentation, patient history, initial radiographs and MRI examination. However, at follow-up with persistent pain and altered radiographic and MRI appearances, surgical biopsy was indicated. Histopathological findings confirmed a bone abscess. This case underlines the necessity of clinical follow-up and imaging in certain patients with apparent thigh splints.

Fractionated stereotactic conformal radiotherapy in the management of large chemodectomas of the skull base

<h2>Abstract</h2><h3>Purpose</h3> To evaluate the role of fractionated stereotactic conformal radiotherapy (FSRT) as a noninvasive method in the management of large chemodectomas of the skull base. <h3>Methods and materials</h3> Twenty-two patients with chemodectomas of the skull base were treated with FSRT at our institution. Ten patients received primary RT, and 12 patients were treated for recurrent or progressive disease after primary surgery (8 patients) or embolization (4 patients). The median total dose was 57.6 Gy, with a median of 1.8 Gy/fraction. The median target volume was 71.8 cm³ (range, 10.5–212.2 cm³). The most common symptoms at the initial diagnosis were pulsatile tinnitus (16 patients), hearing loss (14 patients), and balance disturbance (14 patients). Twelve patients had additional cranial nerve deficits. <h3>Results</h3> The median follow-up was 5.7 years (range, 19–177 months). The actuarial overall survival rate was 89.5% at 5 and 10 years. The actuarial local control rate was 90.4% at 5 and 10 years. Seven patients (32%) had a partial response and 13 (59%) had stable disease of the irradiated chemodectoma. Two symptomatic patients developed recurrence after 19 and 32 months. Neurologic dysfunction improved or completely resolved in 59% and stabilized in 32%; 9% of patients experienced impairment of preexisting neurologic dysfunction. No patient developed new neurologic deficits after FSRT. RT was interrupted in 1 patient because of a maxillary bone abscess. In all other patients, no acute or late adverse reactions greater than Common Toxicity Criteria Grade 2 were seen. <h3>Conclusion</h3> Fractionated stereotactic conformal radiotherapy is an effective and well-tolerated noninvasive treatment for chemodectomas, with excellent tumor control rates and a low risk of morbidity. It is an option for patients at greater risk of microsurgical resection or with residual and recurrent tumors.

Fractionated stereotactic conformal radiotherapy in the management of large chemodectomas of the skull base

Purpose To evaluate the role of fractionated stereotactic conformal radiotherapy (FSRT) as a noninvasive method in the management of large chemodectomas of the skull base. Methods and materials Twenty-two patients with chemodectomas of the skull base were treated with FSRT at our institution. Ten patients received primary RT, and 12 patients were treated for recurrent or progressive disease after primary surgery (8 patients) or embolization (4 patients). The median total dose was 57.6 Gy, with a median of 1.8 Gy/fraction. The median target volume was 71.8 cm 3 (range, 10.5–212.2 cm 3). The most common symptoms at the initial diagnosis were pulsatile tinnitus (16 patients), hearing loss (14 patients), and balance disturbance (14 patients). Twelve patients had additional cranial nerve deficits. Results The median follow-up was 5.7 years (range, 19–177 months). The actuarial overall survival rate was 89.5% at 5 and 10 years. The actuarial local control rate was 90.4% at 5 and 10 years. Seven patients (32%) had a partial response and 13 (59%) had stable disease of the irradiated chemodectoma. Two symptomatic patients developed recurrence after 19 and 32 months. Neurologic dysfunction improved or completely resolved in 59% and stabilized in 32%; 9% of patients experienced impairment of preexisting neurologic dysfunction. No patient developed new neurologic deficits after FSRT. RT was interrupted in 1 patient because of a maxillary bone abscess. In all other patients, no acute or late adverse reactions greater than Common Toxicity Criteria Grade 2 were seen. Conclusion Fractionated stereotactic conformal radiotherapy is an effective and well-tolerated noninvasive treatment for chemodectomas, with excellent tumor control rates and a low risk of morbidity. It is an option for patients at greater risk of microsurgical resection or with residual and recurrent tumors.

Commentary

Spondylodiscitis is an infection of the vertebral body or disc and may also involve the epidural space, posterior elements, and paraspinal soft tissues. It is a cause of morbidity and mortality, and warrants early diagnosis and prompt treatment. Diagnosis can be difficult because of nonspecific signs and symptoms. Magnetic resonance imaging is sensitive and specific and is the imaging modality of choice for spondylodiscitis. Gadolinium contrast can show the extent of soft tissue and bone phlegmon and abscess. The test is less useful for evaluating treatment response. When magnetic resonance imaging cannot be performed or is not diagnostic, radionuclide imaging is a useful alternative. Although bone scintigraphy frequently is used as a screening test, false-negative results can occur, especially in the elderly. This test is not useful for detecting soft tissue infections that accompany or mimic spondylodiscitis. Gallium-67 citrate improves the specificity of the bone scan, can detect infection earlier than the bone scan, may be more sensitive, especially in elderly patients, and identifies accompanying soft tissue infection. Performing SPECT and SPECT/CT improves accuracy. The 2- to 3-day delay between radiopharmaceutical administration and the relatively poor image quality are significant disadvantages of gallium-67. Indium-111 biotin, alone or in combination with streptavidin, accurately diagnoses spondylodiscitis; unfortunately, this agent is not widely available. Currently, 18F-FDG imaging is the radionuclide test of choice for spondylodiscitis. The procedure, which is completed in a single session, is sensitive, has a high negative predictive value, and reliably differentiates degenerative from infectious vertebral body end plate abnormalities. In comparative investigations, 18F-FDG has outperformed bone and gallium-67 imaging. Preliminary data suggest that 18F-FDG may be able to provide an objective means to measure response to treatment. Gallium-68 citrate and 99mTc-radiolabeled antimicrobial peptides have been investigated, but their role in spondylodiscitis has yet to be established.

Síndrome do abscesso pituitário em bezerros associada ao uso de tabuleta nasal para desmame interrompido

Descrevem-se surtos e casos esporádicos de síndrome do abscesso pituitário em bovinos no Estado do Rio Grande do Sul. A doença ocorreu em 8 propriedades de gado de corte, nos municípios de Cachoeira do Sul, Lavras do Sul, Bagé, Osório e Vila Nova do Sul, no período de 1998 a 2002. De um total de 2.438 bezerros submetidos ao desmame interrompido com o uso da tabuleta nasal, aproximadamente 35 (1,4%) animais adoeceram e 24 (0,98%) morreram. A idade dos bezerros afetados variava entre 3 e 12 meses. Os animais doentes apresentavam corrimento nasal, depressão, febre, incoordenação motora, andar em círculos, desvio lateral da cabeça, hipermetria, exoftalmia, disfagia, mandíbula caída, protusão lingual, dificuldade de mastigação e sialorréia. Em alguns casos, observou-se também cegueira, acompanhada ou não de turvação dos humores do globo ocular, exoftalmia e opacidade da córnea. Nas fases terminais, ocorriam decúbito lateral, convulsões, nistagmo, opistótono, coma e morte. Os principais achados de necropsia consistiam em abscessos únicos pituitários ou parapituitários que comprimiam dorsalmente o tronco encefálico e nervos cranianos próximos à pituitária. Em alguns casos, havia osteomielite envolvendo o osso baso-esfenóide com a formação de abscessos na substância encefálica, leptomeningite na superfície ventral do encéfalo e medula espinhal cervical e rinite necrosante ou abscedativa associada às lesões traumáticas provocadas pela colocação da tabuleta nasal. Histologicamente, os abscessos correspondiam a grandes agregados de neutrófilos e restos celulares circundados por células mononucleares e proliferação de tecido conjuntivo. Meningite fibrinopurulenta nas leptomeninges do cerebelo, tronco encefálico e medula espinhal cervical também foi observada. Em alguns casos, a inflamação purulenta se estendia para o parênquima da pituitária. Arcanobacterium (Actinomyces) pyogenes foi isolado dos abscessos. O diagnóstico de síndrome do abscesso pituitário foi baseado nos dados epidemiológicos, sinais clínicos, achados macroscópicos, histológicos e microbiológicos.

A variant of osteoid osteoma of the mandible: Report of a case

Osteoid osteoma is a benign, self-limiting tumor of bone. The incidence is about 2% to 3% of all primary bone tumors. The femur, tibia, and vertebrae are most often involved.1 Because osteoid osteoma rarely occurs in the jaw bones, it is easily misdiagnosed.2,3 Clinically, due to pain being major symptom of osteoid osteoma, it is easily confused with sclerosing osteomyelitis and chronic periapical abscess of the jaw bone. Radiographically, osteoid osteoma is not easily differentiated from cementoma and ossifying fibroma.

Nontyphoidal Salmonellosis

Nontyphoidal Salmonella are important foodborne pathogens that cause gastroenteritis, bacteremia, and subsequent focal infection. These hardy bacteria are especially problematic in a wide variety of immunocompromised individuals, including (but not limited to) patients with malignancy, human immunodeficiency virus, or diabetes, and those receiving corticosteroid therapy or treatment with other immunotherapy agents. Endovascular infection and deep bone or visceral abscesses are important complications that may be difficult to treat. The site of infection and the individual's immune status influence treatment choices. The harbingers of resistance of nontyphoidal Salmonella to both fluoroquinolones and third-generation cephalosporins have been reported recently, and such resistance is likely to be a therapeutic problem in the future. The current report presents a brief overview of the problems and trends associated with salmonellosis that are of interest to the infectious diseases clinician.

MR imaging evaluation of subacute and chronic bone abscesses in children

The aim of the present study was to assess the value of magnetic resonance (MR) imaging in subacute and chronic bone abscesses in children. Seventy-four patients underwent MR imaging because of suspected musculoskeletal infections between January 1996 and January 1999 in Montreal Children's Hospital. The clinical, radiographic, scintigraphic and MR imaging features of patients with a bone abscess were studied. Eleven patients had osteomyelitis with no bone abscess and six had osteomyelitis with a subacute or chronic bone abscess. Although the lucency was eventually seen on plain radiographs in all cases, MR imaging made a significant contribution, as it helped narrow the differential diagnosis and showed better delineated medullary involvement and extension into the epiphysis. MR imaging is valuable in the diagnostic evaluation of children with bone infection and abscess. It reveals the extent of subperiosteal and epiphyseal involvement not seen on plain radiographs. The extent of the medullary involvement around the abscess is best visualized with MR imaging, which can also distinguish between isolated soft tissue infection adjacent to bone and true bone infection.

Dental Imaging

Radiography continues to be the initial test of choice in equine dental imaging for reasons of availability and ability to detect bone and tooth changes. Contrast radiography may be useful to characterize dental involvement in cases with draining tracts. For radiographically occult lesions, other modalities are useful. CT is better than plain radiography due to the inherent avoidance of superimposition of the opposite dental arcade, excellent bone density characterization, and good spatial resolution. Nuclear medicine may be useful to verify bone involvement in the dental region in cases in which the signs are particularly vague or not readily localized. Ultrasonography is an excellent test for soft tissue characterization and may assist with the characterization of suspected bone lysis, pathologic fractures, and abscesses.

The role of computed tomography in evaluation of subchondral osseous lesions in seven horses with chronic synovitis

Seven horses with severe, persistent lameness of sudden onset were evaluated with scintigraphy and/or computed tomography. The lameness was localised to the front fetlock joint in 2 horses and to the tibiotarsal joint in 5 horses. Five of the horses had a history of intra-articular injections of the involved joint prior to presentation. All horses had effusion of the affected joint and were positive to flexion tests. Intraarticular anaesthesia eliminated or improved the lameness in 4 cases and a nerve conduction block proximal to the affected joint improved the lameness in another. Cytology examination of fluid from affected joints identified normal joint fluid (one horse) or elevations in nucleated cell counts of 0.9 x 10(9)/l-36.8 x 10(9)/l and total protein 20-42 g/l (6 horses). The joint fluid of 2 of these horses cultured positive for bacteria. Initial radiographs were either normal (4 cases) or the changes seen were not sufficient to explain the degree of lameness. In the 6 cases where scintigraphy was performed, intense focal isotope uptake was found in the suspected region, which corresponded to the proximal portion of the first phalanx (2 cases), distal tibia (2 cases), or talus (3 cases). Computed tomography (CT) was performed because occult fracture or osteomyelitis was suspected; and knowledge of the precise anatomical location of the lesion was considered necessary to assess the need for surgery and to plan the surgical approach. Hypodense focal lesions with hyperdense haloes were found in the subchondral bone deep to the sagittal groove of the first phalanx (P1) (2 cases) in the cochlea of the distal tibia (2 cases), and in the intertrochlear portion of the talus (3 cases). Communication between the lesion and the joint space was demonstrated by CT in 5 cases. Post mortem examination of one case revealed synovitis and a chronic bone abscess (Brodie's abscess) communicating with the joint space.

Pott's puffy tumor: the forgotten entity

Pott's puffy tumor is a subperiosteal abscess of the frontal bone associated with underlying frontal osteomyelitis. The introduction of antibiotic medications has diminished the incidence of complications of frontal sinusitis. As a result, Pott's puffy tumor has become a rarity. In this communication a case of Pott's puffy tumor secondary to antecedent frontal sinusitis in an otherwise healthy adult man is described.

Fusobacterium nucleatum inhibits human T-cell activation by arresting cells in the mid-G1 phase of the cell cycle.

Fusobacterium nucleatum has been implicated in the pathogenesis of several diseases, including urinary tract infections, bacteremia, pericarditis, otitis media, and disorders of the oral cavity such as pulpal infections, alveolar bone abscesses, and periodontal disease. We have previously demonstrated that sonic extracts of F. nucleatum FDC 364 were capable of inhibiting human T-cell responses to mitogens and antigens. In this study, we have further characterized this immunosuppressive protein (FIP) and initiated experiments to determine its mode of action. The purified FIP has an apparent molecular mass of 90 to 100 kDa; sodium dodecyl sulfate-polyacrylamide gel electrophoresis indicates that the FIP is actually composed of two subunits with molecular masses of 48 and 44 kDa. Purified FIP retained its biological activity and was capable of inhibiting mitogen-induced proliferation of human T cells. Inhibition was dose dependent, and the FIP exhibited a specific activity approximately 250-fold greater than that of the crude extract. Cell cycle analysis indicates that FIP-treated cells were prevented from exiting the G0/G1 phase of the cell cycle. However, FIP did not alter the expression of activation markers (CD69, CD25, and CD71) or interleukin-2 secretion. The latter observations suggest that the T cells did indeed become activated and had entered the G1 phase of the cell cycle. Analysis of the expression of cyclins indicates that the phase of the cell cycle that is FIP sensitive resides somewhere beyond the restriction point of cyclin D2 (early to mid-G1) but prior to that of cyclins D3 and E (mid- to late G1). Finally, analysis of the expression of the proliferating cell nuclear antigen indicates that this is the earliest detectable defect in T cells exposed to FIP. We propose that if a block in the G1 phase of the cell cycle occurs in vivo in lymphocytes, it may result in a state of local and/or systemic immunosuppression. These suppressive effects could alter the nature and consequences of host-parasite interactions, thereby enhancing the pathogenicity of F. nucleatum itself or that of some other opportunistic organisms.

CT evaluation of primary epiphyseal bone abscesses : Azouz EM, Greenspan A, Marton D (Department of Radiology, Montreal, Quebec, Canada H3H 1P3). Skeletal Radiol 1993;22:17–23.

CT evaluation of primary epiphyseal bone abscesses : Azouz EM, Greenspan A, Marton D (Department of Radiology, Montreal, Quebec, Canada H3H 1P3). Skeletal Radiol 1993;22:17–23.

CT evaluation of primary epiphyseal bone abscesses

We reviewed the clinical, radiographic, and computed tomographic (CT) findings in eight children with a histologically proven diagnosis of epiphyseal or apophyseal osteomyelitis. In all cases the femur was involved: in five the osteomyelitis was localized in the femoral condyle, in two it was in the greater trochanter, and in one it was in the femoral head epiphysis. In four of the six cases of epiphyseal involvement there was associated joint effusion or septic arthritis. CT examination may demonstrate a serpentine tract, a sequestrum, cortical destruction or adjacent soft tissue swelling and can differentiate osteomyelitis from other epiphyseal lucent lesions, particularly chondroblastoma and osteoid osteoma. CT yielded important new diagnostic information in seven of the eight patients, failing to do so in only one. In one case, CT showed a wooden splinter in an abscess cavity, which had been mistaken for a sequestrum. When combined with accurate clinical and laboratory information and good quality plain radiographs, CT can lead to an early diagnosis of epiphyseal infection. Early diagnosis helps avoid delays in initiating antibiotic or surgical treatment caused by the unusual (epiphyseal or apophyseal) location of the bone abscess.

Brodie abscess: MR imaging appearance in 10 patients.

The magnetic resonance (MR) imaging features of Brodie abscess have not yet been fully evaluated. Ten patients with Brodie abscess, eight of long bone and two of vertebra, were studied with MR imaging. Long bone abscess had a characteristic "target" appearance with four layers: (a) a center with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR (short-inversion-time inversion recovery) images, (b) an inner ring isointense to muscle on T1-weighted images and with high signal intensity on T2-weighted and STIR images, (c) an outer ring hypointense on all images, and (d) a peripheral halo hypointense on T1-weighted images. In six of eight cases, a soft-tissue mass was found. The two vertebral abscesses had a less specific appearance, with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR images. Only the peripheral halo was clearly identified in both cases.