Emphysematous Infection Research Articles

Mucosal emphysematous head and neck infections: Scoping review and a case of emphysematous tonsillitis.

This scoping review seeks to understand the existing research in otolaryngological mucosal emphysematous infections and to elucidate gaps in knowledge in the field. We also present a case of bilateral necrotizing tonsillitis in an immunocompromised patient with the first reported imaging findings of emphysematous abscess of the tonsils. PubMed, Embase, Web of Science. We conducted our review according to the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews. Patient presentation, management, and outcomes were summarized. We also describe the case of a patient with aplastic anemia found to have emphysematous tonsillitis, managed with intubation, broad spectrum intravenous antibiotics and bilateral tonsillectomy. We identified seven case reports or series, involving nine total patients, who presented with emphysematous epiglottitis, supraglottitis, or tonsillitis. The hallmark imaging characteristic was submucosal "gas bubble" on computed tomography. Presenting symptoms included dysphagia, odynophagia, dysphonia, cough, and fever. Both immunocompetent and immunocompromised patients were affected. All patients were treated with broad spectrum antibiotics, and most with steroids. Patients at risk of airway compromise also underwent intubation and surgical drainage or debridement of the emphysematous infection. Emphysematous pharyngeal infections are rare but potentially life-threatening infections that can progress rapidly, resulting in airway compromise and sepsis in both immunocompetent and immunocompromised individuals. We highlight the importance of swift intervention, with intubation and surgical intervention often required for severe cases. More research is needed on common pathogens and patient risk factors to guide future medical and surgical management.

Emphysematous epididymo-orchitis with involvement of the prostate, seminal vesicles, and the scrotum: a case report

Emphysematous epididymo-orchitis is a rare clinical entity. Up until July 2020, only 9 cases have been reported in PubMed and Scopus platforms, one of which also had scrotal involvement. Therefore, we are reporting the second case with prostate, seminal vesicle, and scrotal involvement. The condition represents an aggressive form of infection caused by gas-forming microbes. The radiological detection of air within the organs involved in the characteristic diagnostic sign. The case we are reporting is a 47 years old diabetic, chronic renal failure patient on regular hemodialysis who had a fulminant emphysematous infection in the left testis, epididymis, spermatic cord, the prostate, seminal vesicles, and the scrotum. Emergency orchiectomy has been carried out. The most significant part of the case is the pictures showing ballooning scrotum and gas bubbles in abnormal anatomical locations.

Atypical infectious spondylitis with reduced bone marrow enhancement: "black vertebra sign".

A few patients suspected of having infectious spondylitis exhibited a reduced enhancement pattern on postcontrast T1-weighted (T1W) magnetic resonance imaging (MRI). To investigate the characteristics of infectious spondylitis patients who exhibited reduced vertebral enhancement. From January 2010 to November 2017, 456 patients with findings suspicious for infectious spondylitis on 706 postcontrast T1W imaging were retrospectively evaluated. When an affected vertebra exhibited markedly reduced enhancement compared to normal bone marrow (BM), the vertebra was termed a "black vertebra." MRI and computed tomography (CT) imaging findings within two-week intervals and the patients' clinical characteristics were reviewed. Ten patients (5 men, 5 women; mean age 66.4 years) whose MRI scans revealed the black vertebra sign were included. Among the 10 patients with black vertebrae, six patients exhibited signal voids in or around the affected vertebral bodies on T2-weighted (T2W) images. Eight patients showed air bubbles on CT images, suggestive of emphysematous infection. However, the typical image findings of infectious spondylitis were uncommon, namely, low BM signal intensity (SI) on T1W images (n=1) and intradiscal fluid-equivalent SI on T2W images (n=5) at an early stage. On follow-up MRI (average interval 7.2 weeks from initial MRI), available for five patients, marked progression of infection was evidenced by increased numbers of affected segments (n=3), low T1 SIs of the affected vertebrae (n=5), and increased contrast enhancement (n=3). Five patients underwent surgery to treat infections not controlled by antibiotics. A black vertebra sign on postcontrast T1W imaging seems to reflect an early emphysematous infection.

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Emphysematous infections of the urinary tract - an audit of 20 patients with review of literature.

Emphysematous infection of the urinary tract is a rapidly progressive, necrotizing infection which results into collection of gas and subsequent destruction of the tissues. Although very rare among general population, such necrotizing infection is common, particularly among those with compromised immune status. With the rising trend of people afflicted with diabetes mellitus globally, this fulminating infection may pose a serious threat to the medical fraternity. A high index of suspicion and abdominal CT scan usually helps to establish the diagnosis at an early stage and thereby facilitating aggressive antimicrobial therapy and percutaneous drainage where indicated. Although, extirpation of infected renal unit was the treatment of choice earlier, with the advent of modern imaging, endourological procedures and broad spectrum antibiotics, majority of such patients can be treated with minimal morbidity and mortality even with salvaging of the renal units. We present here the outcome of management of 20 cases with varied spectrum of emphysematous infection.

Bacterial emphysematous prostatic abscess – A case report

s / Urological Science 26 (2015) 301e310 310 Materials and Methods: An 82 years old female patient presented to the Emergency Department with feeling unwell, pyrexia, gross hematuria, nausea and abdominal pain. She gave a history of type 2 Diabetes mellitus with regular follow-up in our hospital. A large right renal mass was detected near 4 years ago. However, she and family refused operation since then due to old age. On examination she looked weakness. A mass was palpable in the right upper quadrant and lumbar region. Liver and spleen were not palpable. There were no signs of peritonitis. Her pulse rate was 121/minute, BP 189/104 and temp 39.3 degree. She had blood tests in the Emergency Department which revealed the following: Hb 15.6 g/dL, WBC 11,400 and platelets 202,000. Electrolytes were as follows: Na 136 mmol/ litre, K 3.3 mmol/litre, BUN: 12, creatinine: 0.8, blood sugar: 213. Chest X ray showed 1) Mild coarse and crowding lung markings, some infiltration in bilateral lungs; but no focal active lung lesion. 2) Borderline cardiomegaly and mild tortuosity of aorta with some calcified atheroma plaques of aortic arch wall.. The patient had ultrasound scanwhich showed mass in the right kidney. Computerised tomography (CT) scan image of abdomen showed anterior upper pole tumor 9.5 x 12 x9.0 cm in size with heterogeneous enhancement and area of necrosis. Extension to perirenal fat and renal sinus fat but not Gerota fascia. Positron emission tomography (PET) revealed: 1. F-18 FDG avid lesion in the left thyroid, malignancy should be considered. 2. Right paraaortic lymph node metastases should be considered. She underwent right-side radical nephrectomy after full staging procedures and appropriate investigations. NDP32: BACTERIAL EMPHYSEMATOUS PROSTATIC ABSCESS e A CASE REPORT Chih-Cheng Lu, Wen-Chou Fan. Division of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan, Taiwan Purpose: We present a case of emphysematous prostatic infection complicated with multiple organs abscess by Klebsiella pneumoniae. Materials and Methods: A 47 year-old male patient suffered from uncontrolled diabetes. Four days before admission, he had fever and general weakness. He visited our emergent department after empirical treatment at local clinic. After admission, intensive care was given due to diabetic ketoacidosis and septic shock. Although multiple drains for liver and lung, spiking fever persisted. Sequential CT showed air and abscess in the prostate region. Urgent transurethral prostate incision was done to drain the abscess. Afterwards, the general condition became stable. He was discharged with oral antibiotics and antidiabetic drugs. After one year followup, the patient kept uneventful condition with tight diabetic control. Conclusion: Emphysematous prostatic abscess is an unusual acute disease with high morbidity and mortality. The predisposing factors include diabetes mellitus, hepatic cirrhosis, and intravesical obstruction. CT provides a good tool for immediate diagnosis. Treatment of prostatic abscess includes parenteral antibiotics and abscess drainage. Transperineal needle aspiration, transrectal needle aspiration, open perineal incision, and transurethral resection or unroofing are available routes for drainage.

Ascending necrotizing mediastinitis secondary to emphysematous pyelonephritis

Mediastinal infections usually originate from postoperative complications or in a descending manner from a cervical infectious process; few reports have emerged describing an ascending trajectory. A 56-year-old woman with a Huang class 1 left emphysematous pyelonephritis was referred due to a progression of an ascending necrotizing mediastinitis. A left posterolateral thoracotomy was performed, drainage and thorough lavage were carried out with a successful outcome. We believe this is the first reported case of ascending necrotizing mediastinitis secondary to an emphysematous renal infection.

Comment on “Emphysematous Infections of the Prostate and Scrotum in an Older Adult in a Nursing Home”

We would like to thank Dr. Cheung and Dr. Tsang1 for sharing their interesting case report, “Emphysematous Infections of the Prostate and Scrotum in an Older Adult in a Nursing Home,” in which they reported a rare case of emphysematous infection (EI) of the prostate and scrotum occurring in an older adult in a nursing home. This is the first reported case in the English literature of EI of the prostate and the scrotum with abscess formation. The patient had multiple morbid conditions and was chronically bedridden. He was admitted to a nursing home for long-term care. As mentioned in the case report, the individual was referred to the emergency department of Far Eastern Memorial Hospital, where, upon physical examination, he was found to have an enlarged scrotum with some skin discoloration (Figure 1). We think that the healthcare workers at the nursing home were responsible for the delayed referral to the hospital, because they should have been alert to such clinical manifestation during diaper changes for this individual. We agree that older residents in nursing homes are at risk of infection because of physiological changes, aging, underlying chronic diseases, poor institutional environment, impaired cognition of most older adults in terms of addressing their basic hygienic needs, difficulties in diagnosis of some infections with subtle presentations, presence of comorbid conditions obscuring the symptoms of infection, and lack of on-site diagnostic facilities.2, 3 The diagnosis of emphysematous prostatic and scrotal abscesses is based on clinical history, physical examination, and imaging modalities. The authors should present the educational image (Figure 1) of such clinical signs. Computed tomography of the pelvis is the medical imaging of choice for confirming its diagnosis.4 To reduce the morbidity and mortality of EI of the prostate and scrotum, early detection in the nursing home, aggressive surgical and medical management using appropriate broad-spectrum antibiotics, and good blood glucose control are mandatory. We agree that EI of the genitourinary tract is a life-threatening condition requiring aggressive surgical management and antibiotic therapy and is usually related to diabetes mellitus.5 The reporting authors should emphasize using appropriate broad-spectrum antibiotics. We think that this condition is related to lower urinary tract infection (UTI), especially in elderly adults with comorbidities. Surgical drainage of emphysematous prostatic abscesses can be done using a transrectal, transperineal, or transurethral approach.6 In individuals with diabetes mellitus, the gas formed is usually carbon dioxide, which results from a high concentration of sugar that bacteria ferment in the urine or tissues.7 Like emphysematous cystitis and emphysematous pyelonephritis, EI of the prostate and scrotum is a rare complication of UTI that can easily progress to a life-threatening condition and cause a prolonged hospital stay. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Concept and design: Min-Po Ho. Acquisition of participant and data: Kaung-Chau Tsai, Min-Po Ho. Analysis and interpretation of data: Kaung-Chau Tsai, Min-Po Ho. Preparation of manuscript: Min-Po Ho. Critical review and approval: Kaung-Chau Tsai, Min-Po Ho. Sponsor's Role: None.

Emphysematous cyst infection in autosomal dominant polycystic kidney disease

A 51-year-old man was admitted to our hospital with flank pain and fever. Peritoneal dialysis had been started for endstage renal failure secondary to autosomal dominant polycystic kidney disease (ADPKD) at the age of 45 years, and he was switched to hemodialysis because of ultrafiltration failure after 4 years. Two years later, he suffered from right flank pain and fever (38.5 C). Magnetic resonance imaging revealed marked enlargement of both kidneys with multilocular complicated cysts bilaterally (Fig. 1). Although blood culture did not identify a pathogenic organism, his fever subsided after 3 months of antibiotic therapy. Transcatheter arterial embolisation (TAE) was performed to reduce kidney volume bilaterally according to the previously reported method [1]. Severe bilateral flank pain and fever occurred from 12 h after TAE, but subsided by the fourth day. At 7 days after TAE, right flank pain and high fever recurred. Computed tomography disclosed multiple lesions (arrows) with airfluid levels throughout the right kidney (Fig. 2). Fluid aspirated from these cysts grew Escherichia coli that was resistant to multiple antibiotics except meropenem. However, his fever persisted despite treatment with meropenem. The white blood cell (WBC) count rose to 29,900/lL and C-reactive protein was 24.8 mg/dL. His albumin was 1.4 mg/dL, total cholesterol was 96 mg/dL, and he was not diabetic. Finally, right nephrectomy was performed. After surgery, his fever subsided, WBC declined to 6,700/lL, and CRP decreased to 1.1 mg/dL. Emphysematous infection of renal cysts in ADPKD is a potentially lethal condition that requires nephrectomy, like emphysematous pyelonephritis. This was the first case among a total of 812 patients receiving renal TAE from 1996. When gas-forming infection occurs in the collecting system as well as the renal parenchyma, emphysematous pyelonephritis is diagnosed, which is a life-threatening disorder. Sooraj et al. used the term emphysematous polycystic renal infection (EPRI) for emphysematous infection in ADPKD patients. It is also common in diabetics and post-transplant patients [2]. Escherichia coli and Clostridium perfringens have been reported to be the causative organisms. Hyperglycemia or an impaired host response to sepsis are considered to result in EPRI [2, 3]. The present patient was not diabetic, but had malnutrition with hypoalbuminemia and hypocholesteremia. His immunocompromized status due to malnutrition may have contributed to the occurrence of this condition. M. Yamanouchi (&) Y. Ubara K. Takaichi Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan e-mail: masayuki.y@coast.ocn.ne.jp

Answer to Case of the Month #162: Emphysematous Infection of the Liver Parenchyma

Answer to Case of the Month #162: Emphysematous Infection of the Liver Parenchyma

Emphysematous polycystic renal infection

Autosomal dominant polycystic kidney disease (ADPKD) is one of the commonest hereditary disorders. Urinary tract infection is a common complication of this disease. However emphysematous infections in ADPKD have seldom been reported. We report a case of emphysematous polycystic renal infection with Gram negative (Escherichia coli) septicemia in a nondiabetic patient with ADPKD who succumbed to his illness despite aggressive management including early nephrectomy.

Predictors of surgical site infection in dirty urological surgery

Risk factors for surgical site infection (SSI) following urologic dirty operations have not been clearly identified. This study was conducted to describe incidence, potential risk factors and common causative pathogens of the SSI in such operations. Medical records of patients who had undergone simple nephrectomy or lumbotomy for suppurative renal infection at our institutions from 1999 to 2006 were retrospectively evaluated. The following data were retrieved: presence of SSI, demographic data, laboratory findings, comorbidities, microbiological data, type of renal suppuration, type of urological surgery and antibiotic regimen. Risk factors for SSI were evaluated using the multiple logistic regression model. Sixty-five patients (mean age 55.6 +/- 13.1 years) were eligible for data analysis. In 20 of them (30.8%) a SSI was identified. The most common isolated pathogens were gram-negative bacteria. At univariate logistic regression analysis risk factors significantly associated with SSI included: presence of emphysematous infection, hypoalbuminemia, number of predisposing conditions, emergency operations, isolation of Enterobacteriaceae, positive pus culture. The use of trimethoprim/sulfamethoxazole was associated with a decreased risk for SSI. Multiple logistic model identified only the emergency operations and isolated Enterobacteriaceae as independent predictors of SSI (odds ratio [OR] = 11.1) (95% confidence interval [CI] = 3.0-40.8) and OR = 3.9 (1.0-14.8), respectively. Patients with suppurative renal infections are submitted to life-saving emergency surgery. Urological surgeons should keep in mind that this carries a high risk for subsequent SSI. Effective preventive measures in these circumstance cannot be identified. Further research in this area is necessary to clarify this issue.

Gas-Producing Infection of the Spleen in a Super-Super-Obese Patient

Gas-producing bacteria are known to selectively colonize a variety of abdominal viscera, but gas-producing infection limited to the spleen until now has not been reported. A gas-producing (emphysematous) infection of the spleen was diagnosed in a super-super-obese diabetic patient with abdominal pain and signs of sepsis. The patient presented a serious diagnostic challenge because massive abdominal obesity did not enable her to pass through the aperture of a standard computerized tomography unit. Therapeutic options were limited because computerized tomography-guided drainage or splenectomy were technically not feasible or were considered too risky.

CLOSTRIDIUM SEPTICUM MYOSITIS IN A WESTERN LOWLAND GORILLA (GORILLA GORILLA GORILLA)

A 10-yr-old male gorilla (Gorilla gorilla gorilla) with a history of conspecific bite wounds was evaluated for acute onset of depression, anorexia, and right hemiparesis. The animal was immobilized for diagnostic examination and treatment for suspected toxic shock from a necrotizing, emphysematous wound infection, but was euthanized due to complications during recovery. Gross and histopathologic examination revealed acute necrotizing myositis, fasciitis, cellulitis, and emphysema in the affected wound area, with large numbers of large Gram-positive rods among necrotic muscle fibers. Severe pulmonary edema with airways containing fibrin, acute hemorrhage in multiple body sites, thrombosis in blood vessels in the skeletal muscle, liver, and lung, and lymph node hyperplasia with lymphoid necrosis and hemorrhage. Immunohistochemical fluorescent antibody staining of muscle from the wound site was positive for

Diagnosis

The diagnosis was emphysematous cholecystitis (note the air-fluid level in the lumen of the gallbladder with a gaseous ring in its wall on the radiograph).Emphysematous cholecystitis is an uncommon but life-threatening variant of acute cholecystitis that requires early recognition and prompt surgical intervention. There is a male predominance and approximately 35% of cases occur in diabetic patients.1Joshi N. Caputo G.M. Weitekamp M.R. et al.Infections in patients with diabetes mellitus.N Engl J Med. 1999; 341: 1906-1912Crossref PubMed Scopus (758) Google ScholarClostridium perfringens, E. coli, and Klebsiella are the most common gas-forming bacteria that cause the disease. It is diagnosed by radiographic demonstration of gas bubbles within the gallbladder wall or lumen on plain films, and frequently is complicated by gallbladder gangrene or perforation.2Grayson D.E. Abbott R.M. Levy A.D. et al.Emphysematous infections of the abdomen and pelvis: a pictorial review.Radiographics. 2002; 22: 543-561Crossref PubMed Scopus (236) Google Scholar Clinical presentation and physical findings may be similar to acute cholecystitis, but mortality is substantially higher in the emphysematous infection. All diabetic patients with symptoms of acute cholecystitis should have a plain radiograph of the abdomen to search for emphysema. The treatment of choice is rapid surgical removal of the gallbladder, in addition to broad-spectrum antibiotic therapy.In our patient, emergency cholecystectomy was performed and E. coli was isolated from the bile culture. He had an uneventful postoperative recovery. The diagnosis was emphysematous cholecystitis (note the air-fluid level in the lumen of the gallbladder with a gaseous ring in its wall on the radiograph). Emphysematous cholecystitis is an uncommon but life-threatening variant of acute cholecystitis that requires early recognition and prompt surgical intervention. There is a male predominance and approximately 35% of cases occur in diabetic patients.1Joshi N. Caputo G.M. Weitekamp M.R. et al.Infections in patients with diabetes mellitus.N Engl J Med. 1999; 341: 1906-1912Crossref PubMed Scopus (758) Google ScholarClostridium perfringens, E. coli, and Klebsiella are the most common gas-forming bacteria that cause the disease. It is diagnosed by radiographic demonstration of gas bubbles within the gallbladder wall or lumen on plain films, and frequently is complicated by gallbladder gangrene or perforation.2Grayson D.E. Abbott R.M. Levy A.D. et al.Emphysematous infections of the abdomen and pelvis: a pictorial review.Radiographics. 2002; 22: 543-561Crossref PubMed Scopus (236) Google Scholar Clinical presentation and physical findings may be similar to acute cholecystitis, but mortality is substantially higher in the emphysematous infection. All diabetic patients with symptoms of acute cholecystitis should have a plain radiograph of the abdomen to search for emphysema. The treatment of choice is rapid surgical removal of the gallbladder, in addition to broad-spectrum antibiotic therapy. In our patient, emergency cholecystectomy was performed and E. coli was isolated from the bile culture. He had an uneventful postoperative recovery.

Gas-Forming Infection of the Urinary Tract: An Investigation of Fermentation As a Mechanism

Most gas-forming infections occur in patients with diabetes. Carbon dioxide formation, resulting from fermentation of the high concentration of sugar in the urine and tissue by infecting organisms, was regarded as the key factor of gas formation in previous reports. Gas from an emphysematous infection of a polycystic kidney was analyzed to understand better the mechanisms involved in gasforming infections of the urinary tract. The term emphysematous renal polycystic infection is proposed for this particular condition. Gas from the cysts contained 4.1% carbon dioxide, 10.5% oxygen, 67.3% nitrogen and 18.1% unknown gas. This finding is astonishingly similar to that of Wheeler in 1954 and cannot be fully explained by the sugar fermentation theory. Therefore, we propose a new hypothesis. Impaired transportation of gas produced by rapid catabolism leads to gas accumulation in the tissue, which will gradually expand and create chambers to form gas bubbles. Gas of adjacent tissues will attempt to come into equilibrium with the gas bubbles. Positive equilibrium will lead to continuous expansion of the lesion bubble. However, if the chamber is unable to withstand the increasing pressure then rupture or spontaneous drainage of the gas bubble may occur. During negative equilibrium gas in the bubble gradually simulates tissue gas with eventual shrinkage of the bubble. If the chamber is unable to sustain the pressure it collapses and the bubble disappears. However, if the chamber is capable of sustaining the pressure the bubble still may persist even when the gas content is equivalent to tissue gas. This hypothesis may lead to better understanding of emphysematous infections of the urinary tract and also may cast light on emphysematous infections of other organ systems. (J. Urol, 143: 960–964, 1990)