Buttock Abscess Research Articles

MRSA Found in Third of Vulvar, Buttock Abscesses

MRSA Found in Third of Vulvar, Buttock Abscesses

MRSA Is Common in Perineal, Buttock Abscesses

MRSA Is Common in Perineal, Buttock Abscesses

Increasing rates of community-acquired methicillin-resistant Staphylococcus aureus infections among HIV-infected persons

Community-acquired (CA) methicillin-resistant Staphylococcus aureus (MRSA) rates have rapidly increased in the general population; however, little data on recent incidence rates and risk factors of CA-MRSA infections among HIV patients appear in the literature. A retrospective study was conducted from 1993 through 2005 among patients at a large HIV clinic. Trends in CA-MRSA infection incidence rates, clinical characteristics and risk factors for CA-MRSA were evaluated. Seven percent of our cohort developed a CA-MRSA infection during the study period. The rate of CA-MRSA infections among HIV-infected population significantly increased since 2003, with an incidence of 40.3 cases/1000 person-years in 2005, which was 18-fold higher than the general population served at our facility. In all, 90% of infections were skin/soft tissue infections with a predilection for buttock or scrotal abscess formation; 21% of patients experienced a recurrent infection. Risk factors included a low CD4 count at the time of infection (odds ratio [OR] per 100 CD4 cells 0.84, P = 0.03), high maximum log(10) HIV viral load (OR 4.54, P<0.001), recent use of beta-lactam antibiotics (OR 6.0 for receipt of two prescriptions, P<0.001) and a history of syphilis (OR 4.55, P = 0.01). No patient receiving trimethoprim-sulfamethoxazole prophylaxis developed a CA-MRSA infection. Over the study period, CA-MRSA accounted for an increasing percentage of positive wound cultures and Staphylococcus aureus isolates, 37% and 65%, respectively, during 2005. In conclusion, CA-MRSA infections have rapidly increased among HIV-infected patients, a group which has a higher rate of these infections than the general population. Risk factors for CA-MRSA among HIV-infected patients include low current CD4 cell count, recent beta-lactam antibiotic use and potentially high-risk sexual activity as demonstrated by a history of syphilis infection.

Civilian Extraperitoneal Rectal Gunshot Wounds: Surgical Management Made Simpler

Rectal injuries are associated with significant morbidity and mortality. Controversy persists regarding routine presacral drainage, distal rectal washout (DRW), and primary repair of extraperitoneal rectal injuries. This retrospective review was performed to determine the outcome of rectal injuries in an urban trauma center with a high incidence of penetrating trauma where a non-aggressive surgical approach to these injuries is practiced. The records of all patients with a full-thickness penetrating rectal injury admitted to the Trauma Center at Groote Schuur Hospital over a 4-year period were reviewed. These were reviewed for demographics, injury mechanism and perioperative management, anatomical site of the rectal injury, associated intra-abdominal injuries and their management. Infectious complications and mortality were noted. Intraperitoneal rectal injuries were primarily repaired, with or without fecal diversion. Extraperitoneal rectal injuries were generally left untouched and a diverting colostomy was done. Presacral drainage and DRW were not routinely performed. Ninety-two patients with 118 rectal injuries [intraperitoneal (7), extraperitoneal (59), combined (26)] were identified. Only two extraperitoneal rectal injuries were repaired. None had presacral drainage. Eighty-six sigmoid loop colostomies were done. Two (2.2%) fistula, one rectocutaneous, and one rectovesical, were recorded. There were nine (9.9%) infectious complications: surgical site infection (4), buttock abscess (1), buttock necrosis (1), pubic ramus osteitis (1), septic arthritis (2). No perirectal sepsis occurred. Extraperitoneal rectal injuries due to low-velocity trauma can be safely managed by fecal diversion alone.

Sacroiliac joint tuberculosis

Infections of the sacroiliac joint are uncommon and the diagnosis is usually delayed. In a retrospective study, 17 patients who had been treated for tuberculosis sacroiliitis between 1994 and 2004 were reviewed. Two patients were excluded due to a short follow-up (less than 2 years). Low back pain and difficulty in walking were the most common presenting features. Two patients presented with a buttock abscess and spondylitis of the lumbar spine was noted in two patients. The Gaenslen's and FABER (flexion, abduction and external rotation) tests were positive in all patients. Radiological changes included loss of cortical margins with erosion of the joints. An open biopsy and curettage was performed in all patients; histology revealed chronic infection and acid-fast bacilli were isolated in nine patients. Antituberculous (TB) medication was administered for 18 months and the follow-up ranged from 3 to 10 years (mean: 5 years). The sacroiliac joint fused spontaneously within 2 years. Although all patients had mild discomfort in the lower back following treatment they had no difficulty in walking. Sacroiliac joint infection must be included in the differential diagnosis of lower back pain and meticulous history and clinical evaluation of the joint are essential.

The Challenge of Acute Rheumatic Fever Diagnosis in a High-Incidence Population: A Prospective Study and Proposed Guidelines for Diagnosis in Australia's Northern Territory

Accurate diagnosis of acute rheumatic fever (ARF) remains problematic in high-incidence settings and especially in the Aboriginal population of Australia's Northern Territory. Previous investigators have demonstrated that strict application of the 1992 Updated Jones Criteria results in under-diagnosis. This study's objectives were to review use of the Jones Criteria (1992 Update) in diagnosing ARF in Australian Aboriginal patients presenting with suspected rheumatic fever, and formulate a locally relevant algorithm to improve diagnosis. Patients presenting to Royal Darwin Hospital with suspected ARF were prospectively assessed during a 15-month period. Demographic information, clinical history, examination, laboratory and echocardiographic findings were documented in order to determine whether the Jones Criteria were fulfilled, and to identify alternative diagnoses. The hospital discharge diagnosis was recorded and patients were followed up 18-33 months later. Out of 35 patients with suspected ARF, all were Aboriginal Australians, 17 (49%) had a discharge diagnosis of definite ARF, 7 (20%) had definite non-rheumatic fever diagnoses (disseminated gonococcal infection, systemic lupus erythematosis, buttock abscess and other febrile illnesses in children with cardiac murmur due to previously undiagnosed RHD). The remaining 11 (31%) posed diagnostic difficulties because of mild symptoms that failed to fulfil Jones Criteria (attracting diagnoses such as 'unexplained arthralgia') or atypical features such as older age. Two patients whose illness initially failed to fulfil the Jones Criteria, who were neither diagnosed with ARF nor commenced on secondary benzathine penicillin prophylaxis, were found on follow-up to have definite and probable ARF, respectively. At least 29% (8/28) of patients without prior recognised ARF/RHD had echocardiographic evidence of established RHD, indicating that previous episodes were missed. Individual mild episodes of ARF may be overlooked, with patients missing out on the timely institution of secondary prophylaxis. The Jones Criteria should be supplemented by active exclusion of differential diagnoses and vigilant follow-up including echocardiography. 'Probable' and 'possible ARF' should be recognised as diagnostic categories applying to patients not fulfilling the Jones Criteria but who nevertheless should be offered prophylactic penicillin at least until further follow-up. A set of diagnostic guidelines is proposed.

Syndrome toxinique staphylococcique, forme atypique de syndrome de Kawasaki ou scarlatine staphylococcique ?

Case report. – A three-year-old girl was admitted for persistent fever, erythematous rash with subsequent desquamation, stomatitis, cheleitis and cervical lymphadenopathy following development of a buttock abscess secondary to an insect bite. A TSS-positive Staphylococcus aureus strain was isolated from the abscess. Comments. – Both clinical and bacteriological features led to discuss a “toxic shock syndrome without shock”, an atypical form of Kawasaki syndrome without thrombocytosis and coronary arteritis or a staphylococcal skin syndrome. An early treatment with antibiotics could have limited the toxin production explaining both symptomatology and favourable course of the disease.

The case report is not dead

We write to congratulate Rosemary Mason on her excellent Editorial on the decline of the case report (Mason. Anaesthesia 2001; 56: 99–103) and to provide support for her argument that the case report ‘occupies a more central role in the continuing education of anaesthetists’. The same issue of Anaesthesia contained an article presenting two case histories of wound botulism in UK drug addicts (Mulleague et al. Anaesthesia 2001; 56: 120–4). Both articles were read by one of the authors (J.D.) before the start of a routine general anaesthetic MRI list. Following the routine cases, an emergency was added to the list. On being told the patient was a 50-year-old heroin user who was transferred to our hospital with profound muscle weakness resulting in a respiratory arrest, with a presumed diagnosis of Miller fisher variant of Guillain–Barré syndrome, the anaesthetist in question immediately supplied the diagnosis of botulism on the strength of the two case reports. The reference laboratory has subsequently confirmed this diagnosis. The patient has been treated with benzyl penicillin, botulinum antitoxin and a previously unnoticed buttock abscess drained. There has been a clinical improvement as a result of the prompt diagnosis. The consultant has been awarded a gold star for clinical acumen. In view of this we would reiterate the value of the case report as a diagnostic and teaching tool, and hope it will continue in its current form in Anaesthesia and all other anaesthetic journals of repute.

敗血症性両殿部膿ように腎膿ようが合併した一症例

敗血症性両殿部膿ように腎膿ようが合併した一症例

非定型抗酸菌による脊椎炎の１例

Atypical mycobacterium infection of spine is very rare. It is often misdiagnosal and treated unsatisfactory. We report a case of spondylitis due to atypical mycobacterium.A man, seventy years old, had a 1-month history of back pain and right buttock pain. He has abscess discharging pus on right buttock. Radiographs of the thoracic spine were suggestive of inflammatory disease such as pyogenic or tuberculous, with destrucion of the T10 and T11 vertebral bodies. Laboratory findings included a white blood cell count of 10, 600, erythrocyte sedimentation rate of 125mm per hour and C reactive protein of 13.7mg/dl. We found E. coil and Staphylococcus milleri from the culture of the buttock's abscess. We diagnosed the patient as pyogenic spondylitis, and we gave him antibiotic drugs. Spondylitis persisted and resulted in more destruction of vertebral body. After 2 months, we performed anterior intervertebral fusion with iliac bone graft. We found mycobacterium kansasii from the culture of granulation sent at operation. After the operation, we gave him antitubercular drugs, but he has had numbness of lower fegs and spasticity. Laboratory findings have suggested mild inflammation, indicating the weed for careful observation.It is important to discriminate spondylitis cannd by atypical mycobacterium from pyogenic or tuberculous spondylitis.

METASTATIC CROHN'S DISEASE INVOLVING PENILE SKIN

A 35-year-old man presented with nonhealing moist ulcers with granulation tissue on the subcoronal area of the penis 4 to 5 months in duration (fig. 1). In addition, he had noticed gradually worsening penile edema. He stated that he was sexually active with 1 female partner and denied a history of sexually transmitted disease or condom, lubricant and spermicide use. Medical history was significant for Crohn’s disease, which was currently quiescent and not under treatment. He had previously undergone proctectomy, and incision and drainage of recurrent buttock abscesses. Penile biopsy revealed squamous epithelium with parakeratosis and hyperplasia, as well as underlying chronic (lymphocyte and plasma cell) and granulomatous (epitheliod histiocyte and giant cell) inflammation consistent with Crohn’s disease (fig. 2). Tissue cultures for fungus and acid-fast bacilli were negative. ARer the biopsy a regimen of topical steroids was started. The patient returned 6 months later with marked improvement of the lesions.

Cutaneous Crohn's disease in children

Although cutaneous Crohn's disease is well recognized in adults, in children it is extremely rare. Our purpose was to describe five children with cutaneous Crohn's disease and to review the literature. The medical records of five children with cutaneous Crohn's disease were retrospectively reviewed for clinical features and laboratory data. An extensive review of the literature was conducted. Five children, one boy and four girls, 6 to 12 years of age at onset, had cutaneous manifestations of Crohn's disease. Three had genital swelling, and the other 2 had buttock abscesses. Most were seen before the diagnosis of gastrointestinal Crohn's disease was made. There have been 80 cases of cutaneous Crohn's disease described, including our series. Only 14 were in children. Two thirds of children with cutaneous Crohn's disease had genital involvement compared with about half of the adult cases. Sixteen of the 80 patients had cutaneous lesions without preceding gastrointestinal Crohn's disease. Of these, approximately 70% had genital lesions. Although Crohn's disease is common in children, cutaneous manifestations are rarely a presenting sign. However, when cutaneous Crohn's disease is present in children, it commonly precedes the gastrointestinal disease.

Clinical significance of extraintestinal Hafnia alvei isolates from 61 patients and review of the literature.

Hafnia alvei is a gram-negative bacterium that is rarely isolated from human specimens and is rarely considered to be pathogenic. It has been associated with gastroenteritis, meningitis, bacteremia, pneumonia, nosocomial wound infections, endophthalmitis, and a buttock abscess. We studied 80 H. alvei isolates recovered from 61 patients within a period of 30 months. H. alvei was cultured from sites that included the respiratory tract (n = 38), the gastrointestinal tract (n = 16), and the urogenital tract (n = 12); the organism was found in blood cultures (n = 8), on central venous catheters (n = 3), and on the skin (n = 3). Only 25% of H. alvei isolates were recovered in pure cultures. Fifty-seven (93.4%) of the patients had an underlying illness. H. alvei proved to be the etiologic agent in two episodes of septicemia and in one episode of peritonitis and was probably responsible for septicemia in two other patients and pneumonia in one. All six of these patients recovered after receiving antibiotic treatment and/or standard surgical treatment, when needed. Three of these infections were nosocomial, and three were community acquired. Of the strains of H. alvei tested in our study, 100% were susceptible to netilmicin, ciprofloxacin, and imipenem; 92% were susceptible to piperacillin; 90% were susceptible to co-trimoxazole; and 88% were susceptible to ceftriaxone and ceftazidime. In this study, we found H. alvei to be a rare significant etiologic agent of nosocomial and community-acquired infections.