Focus Of Infection Research Articles

Critical reflection on the indication for computed tomography: an interdisciplinary survey of risk and benefit management in patients with sepsis

ObjectivesTo survey physicians’ views on the risks and benefits of computed tomography (CT) in the management of septic patients and indications for and contraindications to contrast media use in searching for septic foci.MethodsA web-based questionnaire was administered to physicians at a large European university medical center in January 2022. A total of 371 questionnaires met the inclusion criteria and were analyzed with physicians’ work experience, workplace, and medical specialty as independent variables. Chi-square tests were used for exploratory analysis.ResultsWhile physicians with all levels of work experience were included, the largest group (35.0%, n = 130/371) had 3–7 years of experience. Most physicians agreed that the benefits of CT outweigh its potential adverse effects in septic patients (90.5%, n = 336/371). Responders saw the strongest indication for contrast media administration in septic patients for (1) CT examinations of the abdomen (92.7%, n = 333/359) and (2) combined CT examinations of the chest, abdomen, and pelvis (94.1%, n = 337/358). While radiologists were most likely to consider manifest hyperthyroidism an absolute contraindication to contrast media administration (43.8%, n = 14/32), most other groups of physicians opted for appropriate preparation before contrast media administration in this subset of septic patients.ConclusionIn this survey, most participating physicians considered CT an essential diagnostic modality to detect an infectious focus in septic patients. Whereas the risk of ionizing radiation was regarded as justifiable by most physicians, different specialties varied in their assessment of the risks of contrast media administration.Key PointsPhysicians recognize CT as a relevant imaging modality in the diagnostic management of patients with sepsis.There is an interdisciplinary consensus that the use of ionizing radiation is justified in septic patients.There is disagreement about indications for and contraindications to contrast media administration among physicians from different medical specialties.Graphical

Epithelial-to-mesenchymal transition and live cell extrusion contribute to measles virus release from human airway epithelia.

Measles virus (MeV) is a highly contagious respiratory virus transmitted via aerosols. To understand how MeV exits the airways of an infected host, we use unpassaged primary cultures of human airway epithelial cells (HAE). MeV typically remains cell-associated in HAE and forms foci of infection, termed infectious centers, by directly spreading cell-to-cell. We previously described the phenomenon in which infectious centers detach en masse from HAE and remain viable. Here, we investigate the mechanism of this cellular detachment. Via immunostaining, we observed loss of tight junction and cell adhesion proteins within infectious centers. These morphological changes indicate activation of epithelial-to-mesenchymal transition (EMT). EMT can contribute to wound healing in respiratory epithelia by mobilizing nearby cells. Inhibiting TGF-β, and thus EMT, reduced infectious center detachment. Compared with uninfected cells, MeV-infected cells also expressed increased levels of sphingosine kinase 1 (SK1), a regulator of live cell extrusion. Live cell extrusion encourages cells to detach from respiratory epithelia by contracting the actomyosin of neighboring cells. Inhibition or induction of live cell extrusion impacted infectious center detachment rates. Thus, these two related pathways contributed to infectious center detachment in HAE. Detached infectious centers contained high titers of virus that may be protected from the environment, allowing the virus to live on surfaces longer and infect more hosts.IMPORTANCEMeasles virus (MeV) is an extremely contagious respiratory pathogen that continues to cause large, disruptive outbreaks each year. Here, we examine mechanisms of detachment of MeV-infected cells. MeV spreads cell-to-cell in human airway epithelial cells (HAE) to form groups of infected cells, termed "infectious centers". We reported that infectious centers ultimately detach from HAE as a unit, carrying high titers of virus. Viral particles within cells may be more protected from environmental conditions, such as ultraviolet radiation and desiccation. We identified two host pathways, epithelial-to-mesenchymal transition and live cell extrusion, that contribute to infectious center detachment. Perturbing these pathways altered the kinetics of infectious center detachment. These pathways influence one another and contribute to epithelial wound healing, suggesting that infectious center detachment may be a usurped consequence of the host's response to infection that benefits MeV by increasing its transmissibility between hosts.

Microbial analyses of infectious keloids on the anterior chest-a case-control study.

Some studies have confirmed that pathogens can cause infection through bacterial cultures on the surface of infectious keloids. However, further exploration of the comparison between infectious and non-infectious keloids and the bacterial flora of infectious foci is lacking. To investigate the differential flora of purulent secretions on the surface of infectious keloids compared to non-infectious keloids and to determine the microbial composition within the infectious foci. This case-control study involved 17 patients and obtained swab specimens from the surface of keloids in two groups, and from the infectious foci in the infectious group. Bacterial composition was analyzed using 16S ribosomal RNA sequencing. There were no statistical differences in the general condition of patients between the two groups. The presence of the phylum Actinobacteriota, and the orders Propionibacteriales and Corynebacteriales, as well as the genus Taibaiella, was greater on the surface of keloids in the infectious group. The most prevalent genera in infective sites were Staphylococcus, Peptoniphilus, and Cutibacterium. Microbial-associated gene pathways indicated a correlation with inflammation and tumor-like growth in keloids. There is a connection between infectious keloids and microorganisms, providing insights for predicting and treating keloid infections.

Pediatric Splenic Abscess: A Tertiary Care Centre Study

Splenic abscess is rare in children. Multiple splenic abscesses are much rarer in children. It is a fatal condition. Splenic abscess is more common in adults. Splenic abscess results from contiguous focus of infection, splenic infarction, diabetes, trauma & associated parasitic infection of spleen. It is having a high mortality rate reaching around 50% which is much reduced due to modern diagnosis with CT, USG & prompt treatment. CT, USG & sometimes MRI not only promptly diagnose but also help in guided Percutaneous aspiration. Our case a 9-year-old boy who presented with pain in left upper quadrant and epigastrium and fever, was diagnosed promptly by CT abdomen on 2nd day of admission to hospital. Ultrasonography of abdomen is also informative. Our case was having enteric fever with widal 1:160. Small wedge-shaped infraction of Right kidney also detected by CT.

Prosthetic valve infective endocarditis due to Burkholderia pseudomallei: A case report and review of the literature.

Endocarditis is a very rare complication of Burkholderia pseudomallei infection and prosthetic valve endocarditis rarer still. We present, to our knowledge, the first confirmed Australian case of prosthetic valve endocarditis in a patient with melioidosis. Blood cultures were persistently positive for B. pseudomallei, a transoesophageal echocardiogram demonstrated a mobile vegetation on his bioprosthetic aortic valve, and computed tomography and magnetic resonance imaging identified no other focus of infection. Infection of prosthetic material appears to be rare in cases of melioidosis, however, if present, its removal should be strongly considered to effect cure. Fortunately, in our case, clinical response to 8 weeks of intravenous therapy and 6 months of high-dose oral co-trimoxazole obviated the requirement for valve replacement surgery. However, sadly, the patient died from complications of a stroke 4 months after cessation of his antibiotic treatment. The stroke was not felt to be directly related to his infection; however, his clinical course highlights the importance of aggressively addressing the comorbidities that predispose an individual to melioidosis and which also increase their risk of premature death.

Anaemia in a child with chronical disease and a newly diagnosed hypoparathyreosis

Anemia of chronic patients is a secondary hematological syndrome, and most often accompanies infectious-inflammatory, immunopathological and tumor processes. The introduction discusses the importance of blood testing to assess the response of the immune and hematopoietic systems to various adverse effects. Various mechanisms are involved in the pathogenesis of anemia, among which the main place belongs to the action of proinflammatory cytokines. In many cases, sideropenia develops that is not associated with an absolute iron deficiency, but occurs as a result of the redistribution of iron reserves in the body. In some patients, diagnosis of various types of pathology begins with the detection of anemia. This requires a comprehensive examination of patients, the exclusion of primary hematological pathology and the detection of all concomitant diseases, including foci of infection. This article presents a clinical example of a multidisciplinary approach to the diagnosis of normochromic normocytic anemia, which resulted in the detection of endocrine pathology — hypoparathyroidism, and chronic foci of Epstein–Barr virus and streptococcal infection in a teenage girl. The peculiarity of the case was that the patient initially consulted a hematologist about mild anemia, but during the examination it became obvious that complaints of progressive weakness, fatigue, hand tremors, and dizziness could not be linked to the existing hematological pathology. Spastic disorders and tetany of the limb muscles that arose during the examination period became the reason for diagnosing metabolic disorders: determining creatine phosphokinase, serum myoglobin, blood electrolytes, including calcium and phosphorus, as well as hormones of the thyroid and parathyroid glands. The examination results showed that the severity of the girl’s condition and neurological symptoms were caused by severe metabolic changes, phosphorus-calcium metabolism disorders in the form of hypocalcemia, hyperphosphatemia, increasing levels of creatine phosphokinase, high levels of lactate dehydrogenase, and were due to endocrine pathology. The presence of neurological symptoms, changes in magnetic resonance imaging and electrocardiogram against the background of a significant decrease in parathyroid hormone, hypocalcemia, and increasing levels of creatine phosphokinase required the patient to be referred to the hospital with a diagnosis of “Hypoparathyroidism”. The presented clinical case confirms the need for an individual, multidisciplinary approach to the diagnosis of secondary anemic conditions, which will allow identifying pathology of various organs and systems.

Mortality predictors and definition proposal for complicated coagulase-negative Staphylococcus bacteraemia: a multicentre prospective cohort study.

The study aimed to explore a definition for complicated coagulase-negative staphylococci bloodstream infections (CoNS BSIs) and to identify predictors for mortality. A prospective cohort study was conducted from October 2016 to March 2017 in 26 Spanish hospitals. Complicated CoNS BSI criteria included lack of early catheter removal in catheter-related cases, foreign indwelling implant, persistent bacteraemia, fever ≥72hours on active therapy, metastatic infection or deep-seated focus, and infective endocarditis. Independent predictors for 30-day mortality were evaluated by Cox regression, and the impact of the definition of complicated bacteraemia was assessed. Overall, 445 CoNS BSI cases were included; catheter-related infections were predominant (336/445, 75.5%). Complicated bacteraemia was identified in 240 of 445 patients (53.9%); 30-day mortality in complicated and uncomplicated cases was 53 of 240 (22.1%) and 24/205 (11.7%), respectively (p 0.004). Predictors of 30-day mortality identified in the multivariate analysis included age (hazard ratio [HR]: 1.03, 95% CI: 1.01-1.05), cerebrovascular disease (HR: 2.58, 95% CI: 1.45-4.58), immunosuppressive therapy (HR: 2.16, 95% CI: 1.22-3.84), SOFA score (HR: 1.09, 95% CI: 1.03-1.16), and complicated bacteraemia (HR: 2.14, 95% CI: 1.29-3.53). A catheter-related source of bacteraemia was found to be protective (HR: 0.49, 95% CI: 0.30-0.80). When specific criteria to define complicated bacteraemia were included, fever ≥72hours was associated with an increased risk of death (HR: 2.52, 95% CI: 1.52-4.17) and early catheter removal was protective (HR: 0.47, 95% CI: 0.26-0.83). A high proportion of patients presented complicated bacteraemia according to the proposed criteria; these patients had higher hazards for mortality. Other mortality predictors were identified. Further studies would be needed to validate the proposed criteria.

Patients with severe odontogenic infections receive insufficient dental treatment before hospitalization - a retrospective cross-sectional study.

The aim was to provide an in-depth characterization of patients hospitalized with severe odontogenic infections (SOI), especially in relation to the origin of the infection. Furthermore, the aim was to generate an overview of which kind of treatment the patients had received before hospitalization and to analyze risk factors for prolonged length of hospital stay. The study was a retrospective cross-sectional study, which included patients hospitalized at the University Hospital of Copenhagen, Denmark, with SOI from November 2012 through 2019. Data were extracted from medical hospital records. Analysis was performed using the χ2 test, analysis of variance, multiple correspondence analysis (MCA), and logistic regression. A total of 384 eligible patients were included. The most frequent origin of infection was apical periodontitis (46.9%), infection after tooth extraction (25.8%), multiple infectious foci (8.6%), and pericoronitis (6.0%). Significant differences in concomitant diseases (p = 0.017) were found between the groups of origin of infection. The MCA model showed little to no ability to generate an in-depth characterization of the group of patients. Eleven patients (2.9%) were treated with incision and drainage before hospitalization, and 131 patients (34.3%) received no kind of antibiotic before hospitalization. The results indicate that clusters of variables could not be related to the origin of infection. In general, patients received insufficient treatment before hospitalization. Future studies should define risk factors for developing SOI and examine dental records of dental treatment before hospitalization. To improve prehospital treatment with patients with SOI, general dental practitioners should treat the origin of the infection, attempt drainage, and optimize the prescription of antibiotics.

Coagulase-negative staphylococci as a significant fact of generalization of infection in persons with a burdened comorbid background

Since the era of the widespread introduction of antibiotics into the human sphere of activity, the problem of antimicrobial resistance has become an urgent and very important topic around the world. Recently, coagulasonegative staphylococci (CoNS), which are representatives of opportunistic microorganisms of the microbiome of the skin and mucous membranes of healthy people, have made a certain contribution to its progression. For a long time, they did not pose a threat to patients, but in recent decades among microorganisms they have been seeded in more than two-thirds of patients with postoperative mediastinitis, catheter-associated infections, as well as from wounds of the neck vessels and the inguinal region separated by pacemaker beds. This paper discloses, using clinical examples, the significance of CoNS in the formation of systemic inflammatory response syndrome in patients with a burdened comorbid background (type II diabetes mellitus, grade 3 arterial hypertension). During the examination of patients, it was shown that skin defects are foci of persistent bacteremia of representatives of the CoNS group, which can cause the development of a systemic inflammatory infectious response with the formation of resistant strains of the opportunistic flora of the microbiome of the skin and mucous membranes. It has been shown that to determine the tactics of antibacterial therapy, a bacteriological study of all detected foci of infection in patients, screening of pathogens and their sensitivity to antibiotics, and especially in persons at risk, is necessary. This will increase the effectiveness of antibacterial therapy and reduce the possibility of forming resistant strains of pathogens.

Analysis of changes in the genome of the Omsk hemorrhagic fever virus (Flaviviridae: <i>Orthoflavivirus</i>) during laboratory practices for virus preservation

Introduction. Omsk hemorrhagic fever (OHF) is a severe disease identified in the 1940s in Western Siberia, Russia. Disease is caused by the OHF virus, which belongs to the genus Orthoflavivirus. The purpose of the work. Analysis of changes in the genome associated with the isolation of OHF virus strains in laboratory animals (Mus musculus). Materials and methods. Whole-genome nucleotide sequences of OHF virus strains from the working collection of the laboratory of arboviral infections of the department of natural focal viral infections of the Omsk Research Institute of Natural Focal Infections of Rospotrebnadzor were used in the study, as well as sequences from GenBank. Assessment of adaptive changes in the genome of the OHF virus was carried out using discriminant analysis methods, analyzing the composition and localization of emerging substitutions in viral RNA sequences obtained during the adaptation of viruses to the mouse organism as a result of passaging. Linked nucleotide substitutions were identified by calculating the mutual information for each pair of columns in the array of aligned nucleotide sequences. In the phylogenetic analysis, the relaxed clock algorithm of the BEAST program was used. Results. It has been shown that point substitutions during adaptation of OHF viruses to the mouse organism occur in all parts of the genome. Many of these substitutions are included in the pattern of linked substitutions identified in the genome of the OHF virus. Discriminant analysis of differences in nucleotide substitutions for groups combining sequences by the number of passages does not allow reliable discrimination between original sequences obtained from muskrat and sequences from first passages, but it recognizes well sequences from 7 or more passages, which suggests the possibility of adaptive selection of nucleotide substitutions when interacting with the body of a white mouse. Calculation of the average rate of substitutions per site per year without taking into account the occurrence of adaptive and related substitutions gives a value of 10−5, which is almost an order of magnitude different from the result when their presence is taken into account ‒ 10−4. Conclusion. Changes in the nucleotide sequences of OHF that occur during laboratory virus preservation practices may influence the evolutionary rate values determined when analyzing these sequences and require further study.

Quantitative assessment of the inflammatory reaction in the anterior chamber of the eye according to optical coherent tomograrhy data in standard cases of routine cataract surgery and in patients with concomitant ophthalmological and systemic pathology

Purpose: to determine the risk factors of the inflammatory reaction in the anterior chamber aqueous humor in routine cataract surgery of patients with concomitant ophthalmological and systemic pathology based on a quantitative assessment of the eye anterior segment optical coherent tomography (OCT) data.Material and methods. The study enrolled 60 patients aged 38 to 85 years, 45 % of them were men. Before planned phacoemulsification, a standard ophthalmological examination, the eyelids status assessment, parameters of the lacrimal meniscus, calculation of cell in the anterior chamber using OCT were performed, also general clinical data were analyzed. 2 groups were analyzed: group 1 — risk group — 30 patients with symptoms of inflammatory reaction according to a blood test, paraocular foci of chronic infection and diabetes mellitus, as well as those who had chronic blepharitis, group 2 control — 30 patients without these signs. Biomicroscopy and anterior segment OCT were performed before and 4 hours after the surgery, as well as on days 1, 7, and 14.Results. Group 1 patients had cytosis of 2.5 cells (0-20) in the anterior chamber humor at the preoperative stage. Cells were detected in 57.58 % of cases (p = 0.000), but in no case in group 2. In the first hours after surgery, the same frequency of humor opalescence fibrinoid reaction and ophthalmohypertension was observed in the groups, but the frequency of corneal tunnel edema in group 1 was significantly higher (p = 0.048). In the first hours after the intervention, the cell suspension in the aqueous humor was more intense in patients of the risk group; in all cases the number of cells progressively decreased and leveled out between the groups. Correlation analysis showed the relationship between the severity of cell suspension and opalescence of the anterior chamber humor with the presence of cytosis at the preoperative stage (R = 0.88, p = 0.002), the type of IOL chosen (R = 0.74, p = 0.021) and the presence of diabetes mellitus in history (R = 0.82, p = 0.007).Conclusions. Usage of precise imaging techniques to assess anterior chamber humor cytosis is a convenient, objective, and reliable method. The presence of cell suspension in the anterior chamber aqueous before surgery, especially in elderly patients with diabetes mellitus, is a prognostic factor for a more expressed inflammatory reaction of the anterior segment in uncomplicated phacoemulsification.

Evaluation of the association between periodontal disease and total cancer risk: A cross-sectional study.

The body is in a continuous state of inflammatory burden due to local and systemic inflammation, which is triggered in periodontal tissues in response to microorganisms. A number of studies have linked periodontitis to systemic diseases such as diabetes mellitus, cardiovascular disease and respiratory disease. Periodontal inflammation acts as a focus of infection, which can cause detrimental effects on distant target organs. In some cases, it may lead to tumor progression in various cancers. The aim of the study was to evaluate the correlation between periodontal disease (PD) and its potential role as a risk factor for the development of systemic cancer and its metastasis. A single-center, cross-sectional study was conducted, including 66 patients with different systemic malignancies (group 1, the test group) and 66 healthy individuals (group 2, the control group). Group 1 was further subdivided into 2 categories: M0, comprising patients without metastases (n = 34); and M1, comprising patients with distant metastases (n = 32). The number of missing teeth, Greene and Vermilion's simplified oral hygiene index (OHI-S), probing pocket depth (PPD), Löe and Silness' bleeding on probing (BoP), clinical attachment loss (CAL), and Ramfjord's periodontal disease index (PDI) were recorded. Appropriate statistical tests were performed to analyze the data. A p-value <0.05 was considered statistically significant. The differences between the PDI, CAL and PPD values in both group 1 and group 2 were found to be statistically significant (p = 0.000). In M0 and M1, no statistically significant differences were observed between any of the parameters. The odds ratios (ORs) between group 1 and group 2 for CAL and PDI were 3.986 and 4.286, respectively. The ORs for M0 and M1 with regard to CAL and the mean number of teeth lost were 0.373 and 0.188, respectively. The findings of the study indicate a significant association between the overall risk of cancer and PD. In cases of known systemic malignancies, no significant correlation has been identified between PD and the risk of metastasis.

Design of risk-based surveillance to demonstrate absence of Phytophthora agathidicida in New Zealand kauri forests

Kauri forests are threatened by kauri dieback disease, caused by the microscopic soil-borne pathogen Phytophthora agathidicida (PA). Despite it being more than 15 years since the pathogen was discovered on the New Zealand mainland, there is still a paucity of information on the distribution of symptomatic trees and/or of the pathogen itself, which makes it challenging to understand where the infection foci are and how fast the pathogen is spreading. The considerable cost of surveillance for PA, as well as the risks associated with people walking between infected and non-infected sites, necessitates careful prioritisation of sites to be selected for surveillance. This task requires an understanding of which part of the landscape and how much of it needs to be surveyed to effectively detect the pathogen if present. We use information on the distribution of kauri trees with visible stress symptoms in the canopy to develop a baseline relative risk map depicting areas where PA is most likely to be present for three kauri forests in Northland, New Zealand. The relative risk map provides a simple, yet effective management tool to target trees for surveillance, monitoring, and protection. Using this insight, we demonstrate the application of a proof of absence statistical model to determine the surveillance effort required to be confident that if no PA is found during surveillance in selected priority sites, the pathogen can confidently be considered absent from these areas. Results from these analyses showed that many samples are needed to achieve 95% confidence in pathogen absence, but this varied between forests and sectors of each forest. However, these analyses are valuable to guide field efforts as well as to ensure realistic expectations among practitioners. The methods described here are applicable to many other pathogens affecting plants of cultural and/or ecological importance worldwide.

A rare cause of multiple cavitary lung lesions

We report on a 32-year-old woman with multiple, progressive cavitary lung lesions. Lung cavities may occur in the context of various diseases and, thus, represent a huge diagnostic challenge. The spectrum of diseases comprises infections, systemic autoimmune rheumatic diseases, and malignancies. Several microorganisms may cause lung cavities such as common bacteria (e.g. Haemophilus influenzae, Klebsiella pneumoniae), Mycobacterium tuberculosis, non-tuberculous mycobacteria, uncommon bacteria such as Nocardia species, fungi (e.g. Aspergillus species), and parasites such as Echinococcus species. In respect of systemic autoimmune rheumatic diseases, granulomatosis with polyangiitis is frequently associated with cavitary lung lesions. Malignancies such as lung carcinomas and pulmonary metastasis may also manifest with cavern formation. In our case, we primarily assumed infection as the cause of the cavitary lung lesions - in fact, an infection with Actinomyces species. However, despite antibiotic therapy according to the resistance test results and the removal of the supposed focus of infection (tonsillectomy with proof of Actinomyces colonization of the tonsils), there was clear progression of lung cavities. Therefore, diagnostics were expanded and enhanced including FDG-PET-CT, bone marrow puncture, VATS pulmonary wedge resection, as well as EBUS- and CT-guided lymph node puncture. Finally, a rare clinical manifestation of Hodgkin lymphoma was diagnosed as the underlying cause of the multiple cavitary lung lesions.

"Pyogenic Spondylodiscitis from Oral Odontogenic Origins: A Frequently Overlooked Entity".

Primary spondylodiscitis occurs through the hematogenous spread of a pathogen entering the body via a point of entry. The infection's origin often remains unclear. During dental procedures or through minor traumas, oral bacteria can enter the bloodstream and disseminate throughout the body. This study's objective was to further investigate the role of odontogenic (i.e., teeth-related) causes of spondylodiscitis, especially in cases where another infective focus could not be identified initially. Retrospective analysis. In a cohort of 340 consecutive patients with primary spondylodiscitis treated at a Level I Spine Center from 01/01/2018 to 12/31/2022, those with oral bacteria in blood cultures or disc tissue samples and available orthopantomograms (OPG, i.e. panoramic X-ray of the teeth) (please define this-general readership will not know what this is) were retrospectively reevaluated for odontogenic origins. Patients with secondary spondylodiscitis from a previous operation (< 3 months) in the same segment were excluded. Radiological features indicating an infectious dental focus included apical (in the mandible/maxilla?) radiolucency of the tooth, impacted teeth, residual roots, and vertical or cup-shaped bone loss. Patients' medical records, imaging data, laboratory, microbiological and histopathological findings, and surgical reports were analyzed. The term oral bacteria refers to the whole microbiome of the oral cavity. Periodontal bacteria are bacterial species implicated in periodontal diseases. For further classification, periodontal bacteria were assigned to one of five complexes previously described. The most frequent infective source was (what joints?) an infection of the major joints of the extremeties (14.1%), followed by ulcers of the extremities (10.3%) and urosepsis (10.0%). An odontogenic origin was initially identified in 8.9%. In 33.1% of cases, the source of infection was not found. Oral bacteria were found in 38 cases (13.3%) of 286 (i.e. all cases with a positive pathogen detection) of the 33.1% of cases?. Six of these had an identified focus of the throat, and six had an initially clear dental focus. Of the remaining 26 cases, OPG was available for 14. Re-evaluation of OPG revealed an odontogenic focus in 9 out of 14 cases (64.3%). Two of these cases had a concomitant infective focus, while in 7 cases, initially, no infectious focus was found. An odontogenic origin for spondylodiscitis was more prevalent than initially presumed, particularly in patients where no source was identified at first sight. We therefore recommend a thorough diagnostic dental work-up as a standard procedure for patients with primary spondylodiscitis.

Pediatric Acute Lobar Nephronia: A Case Series and Literature Review.

Acute lobar nephronia (ALN) is a focal renal infection without liquefaction, historically regarded as rare in the pediatric population, yet recent literature suggests it may be under-diagnosed, which may result in the formation of renal abscess and future renal scarring. The clinical presentation, investigations, treatment and long-term outcomes of 5 patients diagnosed with ALN was described and literature review was conducted by reviewing publications in PubMed using the keywords "acute lobar nephronia" and "pediatric". Three patients were males, aged 1 to 11 years. The primary complaint in all cases was fever, accompanied by significantly elevated inflammatory markers. Upon presentation, none of the patients exhibited pyuria on urinalysis, and all had sterile blood and urine cultures. Diagnosis was based on CT scans for three patients and renal sonography for two. Main findings included hyperechogenic renal parenchyma, and hypodense localized parenchyma. Treatment consisted of broad-spectrum intravenous antibiotics, administered for 7 to 12 days and additional 1week course with amoxicillin-clavulanate, resulting in similar defervescence times across all patients. None of the patients demonstrated recurrence and none had renal pathology upon repeated renal sonography and upon DMSA scintigraphy. Clinical suspicion for ALN should arise in cases of abdominal pain and markedly increased inflammatory markers. It"s crucial to note that the absence of pyuria and negative culture results should not exclude ALN diagnosis, underscoring the need for a high index of suspicion in the pediatric population.

A Case of Orbital Cellulitis with an Underlying Intraconal Tumour: An Unlikely Co-existence

Orbital cellulitis is an acute onset, rapidly progressive and potentially sight-threatening disease of the eye. It is more prevalent in developing regions and low socio-economic strata and may be associated with a host of other systemic diseases, such as paranasal sinus or dental infections, diabetes mellitus, urinary tract infections and sepsis. Often, orbital cellulitis is associated with an orbital or periosteal abscess, which can be diagnosed with orbital imaging and may sometimes require drainage to relieve the pressure. A 63-year-old male patient presented with orbital cellulitis of the right eye. The patient did not reveal any focus of infection upon investigation. Orbital imaging revealed a well-defined intraconal tumour with contrast enhancement, abutting but not involving the optic nerve, likely a cavernous haemangioma. The patient was admitted and managed with parenteral antibiotics, showing an excellent response to treatment. Given that the clinical signs did not support a benign tumour, repeat imaging was performed and again favoured a cavernous haemangioma. Presently, the patient is asymptomatic with slight proptosis and is under observation. This is an uncommon and interesting presentation of proptosis with a hyperacute cause superimposed on a more chronic lesion.

Evaluating Risk Factors for Clinical Failure Among Tigecycline-Treated Patients.

Clinical trials have documented that tigecycline has a higher mortality risk than other treatments; it continues to be widely used for various infections in real-world settings, where its associated risk factors for clinical failure are understudied. This retrospective analysis included a prospective 2019-2021 cohort of tigecycline-treated patients, excluding those with multiple infection sites. We assessed the outcomes on day 28, with clinical failure defined by mortality, persistent initial infection symptoms, or the requirement for continued antimicrobial treatment. Multivariable logistic regression was used for the outcome analysis. Of 253 patients included in the study, 94 experienced clinical failure. The infection foci included pneumonia (46.3%), bloodstream infection (BSI) (25.3%), and skin/soft tissue infections (10.3%). There were no significant differences in high-dose tigecycline administration or monotherapy rates between patients with favorable outcomes and those with clinical failure. A higher Charlson comorbidity index (adjusted odds ratio [aOR] = 1.20, P = 0.001), Pitt bacteremia score (aOR = 1.25, P = 0.007), and BSI (aOR = 3.94, P < 0.001) were significant predictors of clinical failure. Concomitant use of Pseudomonas aeruginosa-active fluoroquinolone (aOR = 1.97, P = 0.03) and carbapenem (aOR = 2.20, P = 0.01) was linked to increased clinical failure. Multiple comorbidities, BSI, and higher Pitt bacteremia scores are associated with increased risk of clinical failure in tigecycline-treated patients. These results suggest clinicians should consider alternatives to tigecycline for patients with these risk factors. When administering tigecycline, vigilant monitoring is indicated to manage potential clinical failures.

Therapy Options in the Management of Brain Abscess. Literature Review

Abstract Introduction Despite the advancements in modern neurosurgical techniques, new antibiotics, neuroimaging technologies, anesthesia practices, and microbial isolation methods, cerebral abscess remains a potentially fatal infection of the central nervous system. Its treatment remains controversial to this day. The combination of clinical and surgical interventions has been widely accepted, yielding satisfactory outcomes. Methods The literature review process primarily relied on data obtained from the Pubmed database, Bireme (Lilacs, Medline, Scielo, Medicaribe, Cochrane). Key search terms included: central nervous system infection, cerebral abscess, and treatment. After a thorough selection analysis, 103 articles covering the period from 1980 to 2023 were included in this work. Results The ideal treatment is surgical; however, clinical treatment has been employed in selected cases. Simple aspiration, stereotactic-guided aspiration, and endoscopy have been performed with efficient results. The outcomes of clinical or surgical treatment depend on factors such as the patient's age, neurological status, microbial isolation, primary cause of the abscess, number of infectious foci, location, and stage of abscess development. Corticosteroids have been recommended for cases of vasogenic cerebral edema, while anticonvulsants are indicated for supratentorial abscesses. Conclusion The combination of aspiration or excision, tailored to the specific cause, number, location, and developmental stage, and intravenous antibiotics has consistently yielded satisfactory results.

TÉCNICA CIRÚRGICA EM 1 ESTÁGIO EM ARTROPLASTIA TOTAL DE JOELHO COM INFECÇÃO ADAPTADA À REALIDADE BRASILEIRA

Infection is one of the most frequent and serious complications of total knee arthroplasty, and its diagnosis is a challenge for the orthopedic surgeon. Accurate diagnosis and adequate treatment are essential to prevent functional loss and progression to systemic infection. The present study describes the surgical technique in a stage of total knee arthroplasty that presents bacterial infection and discusses the indications, contraindications, postoperative care, as well as the adaptability of this technique to the Brazilian reality. This surgical technique is like a tumor resection, as it requires the orthopedic surgeon to be rigorous in terms of visual and tactile aspects to eliminate the focus of infection in the wound. This ends up being a good treatment option as it presents a less painful postoperative period, quick recovery from the infection, as well as financial savings as it will avoid performing more surgical procedures.