Hematogenous Dissemination Research Articles

Retrospective assessment of the patients with disseminated tuberculosis

Background: Disseminated tuberculosis (TB) is defined as the presence of two or more noncontiguous sites resulting from hematogenous dissemination of Mycobacterium tuberculosis, occurring as a result of progressive primary infection, reactivation of a latent focus with subsequent spread, or rarely through iatrogenic origin. Hence; the present study was undertaken for assessing the patients with disseminated tuberculosis. Materials & methods: A total of 50 patients who reported to the department and were confirmed with diagnosis of disseminated tuberculosis in the past one year. Complete demographic and clinical data of all the subjects was enrolled. Clinical profile of all the patients was recorded. Assessment of all the results was done using SPSS software. Results: Fever, malaise, weight loss and poor appetite were seen in 66 percent, 30 percent, 24 percent and 20 percent of the patients respectively. Cough, dyspnea, myalgia and joint pain was seen in 20 percent, 12 percent, 14 percent and 18 percent of the patients respectively. On chest imaging, consolidation, fibrotic change, miliary lesion and nodular change was seen in 16 percent, 10 percent, 50 percent and 8 percent of the patients respectively. Conclusion: Majority of the patients demonstrate clinical findings suggestive of disseminated TB.

Beyond Genetics: Metastasis as an Adaptive Response in Breast Cancer

Metastatic disease represents the primary cause of breast cancer (BC) mortality, yet it is still one of the most enigmatic processes in the biology of this tumor. Metastatic progression includes distinct phases: invasion, intravasation, hematogenous dissemination, extravasation and seeding at distant sites, micro-metastasis formation and metastatic outgrowth. Whole-genome sequencing analyses of primary BC and metastases revealed that BC metastatization is a non-genetically selected trait, rather the result of transcriptional and metabolic adaptation to the unfavorable microenvironmental conditions which cancer cells are exposed to (e.g., hypoxia, low nutrients, endoplasmic reticulum stress and chemotherapy administration). In this regard, the latest multi-omics analyses unveiled intra-tumor phenotypic heterogeneity, which determines the polyclonal nature of breast tumors and constitutes a challenge for clinicians, correlating with patient poor prognosis. The present work reviews BC classification and epidemiology, focusing on the impact of metastatic disease on patient prognosis and survival, while describing general principles and current in vitro/in vivo models of the BC metastatic cascade. The authors address here both genetic and phenotypic intrinsic heterogeneity of breast tumors, reporting the latest studies that support the role of the latter in metastatic spreading. Finally, the review illustrates the mechanisms underlying adaptive stress responses during BC metastatic progression.

Surgical management of a giant malignant phyllodes tumour of the breast: a case report

: Phyllodes tumour (PT) is a rare fibroepithelial neoplasm, being divided into benign, borderline or malignant, and usually presents as large masses with rapid growth. Breast tumours above 4 cm with these characteristics are highly suspicious of PT, and those above 10 cm are considered giant PTs, representing only 20% of these tumours. Prognosis relies on histological type and a mostly on a complete surgical resection with margins above 1 cm. Surgical management of giant PTs can be a technical challenge, and may require advanced breast reconstructive techniques. We present the case of a giant PT, completely resected with a mastectomy and nodal dissection. The patient was discharged without any complications and is currently on follow-up without recurrence. Adequate resection margins should always be the principal aim when providing an optimal surgical treatment of a PT. A multidisciplinary team evaluation by an experienced breast surgeon or a plastic reconstructive surgeon is recommended when planning a proper resection with further reconstruction. Axillary node metastases are rare, and dissection is limited to patients with pathological preoperative findings. Hematogenous dissemination may be present in malignant PTs. Classical adjuvant therapies like chemotherapy, hormonotherapy or radiotherapy are no widely prescribed when treating PT. We strongly emphasize in providing a correct initial resection of the tumour.

VlsE, the nexus for antigenic variation of the Lyme disease spirochete, also mediates early bacterial attachment to the host microvasculature under shear force.

Hematogenous dissemination is a critical step in the evolution of local infection to systemic disease. The Lyme disease (LD) spirochete, which efficiently disseminates to multiple tissues, has provided a model for this process, in particular for the key early event of pathogen adhesion to the host vasculature. This occurs under shear force mediated by interactions between bacterial adhesins and mammalian cell-surface proteins or extracellular matrix (ECM). Using real-time intravital imaging of the Lyme spirochete in living mice, we previously identified BBK32 as the first LD spirochetal adhesin demonstrated to mediate early vascular adhesion in a living mouse; however, deletion of bbk32 resulted in loss of only about half of the early interactions, suggesting the existence of at least one other adhesin (adhesin-X) that promotes early vascular interactions. VlsE, a surface lipoprotein, was identified long ago by its capacity to undergo rapid antigenic variation, is upregulated in the mammalian host and required for persistent infection in immunocompetent mice. In immunodeficient mice, VlsE shares functional overlap with OspC, a multi-functional protein that displays dermatan sulfate-binding activity and is required for joint invasion and colonization. In this research, using biochemical and genetic approaches as well as intravital imaging, we have identified VlsE as adhesin-X; it is a dermatan sulfate (DS) adhesin that efficiently promotes transient adhesion to the microvasculature under shear force via its DS binding pocket. Intravenous inoculation of mice with a low-passage infectious B. burgdorferi strain lacking both bbk32 and vlsE almost completely eliminated transient microvascular interactions. Comparative analysis of binding parameters of VlsE, BBK32 and OspC provides a possible explanation why these three DS adhesins display different functionality in terms of their ability to promote early microvascular interactions.

Fluid shear stress regulates the survival of circulating tumor cells via nuclear expansion.

Distant metastasis mainly occurs through hematogenous dissemination, where suspended circulating tumor cells (CTCs) experience a considerable level of fluid shear stress. We recently reported that shear flow induced substantial apoptosis of CTCs, although a small subpopulation could still persist. However, how suspended tumor cells survive in shear flow remains poorly understood. This study finds that fluid shear stress eliminates the majority of suspended CTCs and increases nuclear size, whereas it has no effect on the viability of adherent tumor cells and decreases their nuclear size. Shear flow promotes histone acetylation in suspended tumor cells, the inhibition of which using one drug suppresses shear-induced nuclear expansion, suggesting that shear stress might increase nuclear size through histone acetylation. Suppressing histone acetylation-mediated nuclear expansion enhances shear-induced apoptosis of CTCs. These findings suggest that suspended tumor cells respond to shear stress through histone acetylation-mediated nuclear expansion, which protects CTCs from shear-induced destruction. Our study elucidates a unique mechanism underlying the mechanotransduction of suspended CTCs to shear flow, which might hold therapeutic promise for CTC eradication.

Clinical and microbiological characteristics of hypervirulent Klebsiella pneumoniae lung abscess

Objective: To study the clinical and microbiological characteristics of hypervirulent Klebsiella pneumoniae (hvKP) lung abscess, and to compare with the classic Klebsiella pneumoniae (cKP) lung abscess. Methods: A total of 18 patients with Klebsiella pneumoniae lung abscesses admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from January 2017 to September 2020 enrolled. The strains with positive result of string test were defined as hvKP, and the negative strains were defined as cKP. The patients' basic diseases, symptoms, laboratory data and other clinical characteristics were collected. The microbiological characteristics of the strains included as following: VITEK method to determine the in vitro susceptibility of the strains to antibiotics; PCR to detect the capsular serotypes and virulence genes. The differences in clinical characteristics and microbiological characteristics of strains between hvKP group and cKP group were compared. Results: Among the 18 patients with Klebsiella pneumoniae lung abscess, 12 were hvKP infection, mainly male (10 cases), with a median age of 59.0 years; 8 cases in the hvKP group had an onset time of ≤2 weeks, and the median onset time was 10.5 days. There were significantly more diabetes (12 cases) and extrapulmonary abscesses (11 cases) in hvKP group than those in cKP group (both P<0.001). The extrapulmonary abscesses in the hvKP group were mainly liver abscesses (10 cases), and 4 cases were multi-site (≥3) abscesses. The number of indwelling catheters and invasive procedures before infection were higher in cKP group than those in hvKP group (both P=0.025). The imaging of Klebsiella pneumoniae lung abscess was mainly subpleural with the size of less than 10 cm. There were more multiple abscesses cases in hvKP group (9 cases) than cKP group (P=0.009). The median interval time between the detection of a pulmonary abscess and an extrapulmonary abscess was 1.0 day. The resistance rate of common antibiotics was significantly lower in hvKP than cKP. Conclusions: hvKP lung abscesses are more common in patients with diabetes, and the clinical manifestations are nonspecific. The lung imaging manifestations are multiple subpleural abscesses, indicating hematogenous dissemination. Liver abscesses were present in most cases, suggesting the source of infection. The main virulent gene of hypervirulent Klebsiella pneumoniae is aero. For patients with hvKP lung abscess, attention should be paid to finding hidden lesions.

How Gut Bacterial Dysbiosis Can Promote Candida albicans Overgrowth during Colonic Inflammation.

Candida albicans is a commensal opportunistic yeast, which is capable of colonising many segments of the human digestive tract. Excessive C. albicans overgrowth in the gut is associated with multiple risk factors such as immunosuppression, antibiotic treatment associated with changes to the gut microbiota and digestive mucosa that support C. albicans translocation across the digestive intestinal barrier and haematogenous dissemination, leading to invasive fungal infections. The C. albicans cell wall contains mannoproteins, β-glucans, and chitin, which are known to trigger a wide range of host cell activities and to circulate in the blood during fungal infection. This review describes the role of C. albicans in colonic inflammation and how various receptors are involved in the immune defence against C. albicans with a special focus on the role of mannose-binding lectin (MBL) and TLRs in intestinal homeostasis and C. albicans sensing. This review highlights gut microbiota dysbiosis during colonic inflammation in a dextran sulphate sodium (DSS)-induced colitis murine model and the effect of fungal glycan fractions, in particular β-glucans and chitin, on the modification of the gut microbiota, as well as how these glycans modulate the immuno-inflammatory response of the host.

Immuno-morphological characteristics of bone marrow in patients with ovarian cancer

Background. Nowadays, one of the promising areas is the study of bone marrow in malignant tumors. It is known that hematogenous metastasis to the bone marrow in cancer is a common event. Identification of bone marrow lesions in ovarian cancer, as well as the study of hematopoiesis, can provide additional information about the features of metastasis of this tumor and will make it possible to assess the prospects for targeted therapy.&#x0D; Aim. To assess the possibility of detecting disseminated tumor cells in the bone marrow in patients with ovarian cancer, to establish the frequency of bone marrow damage and to analyze the relationship with the clinical and morphological parameters of the tumor.&#x0D; Materials and methods. This work includes 42 patients with ovarian cancer who received treatment at the Blokhin National Medical Research Center of Oncology. The study was carried out by morphological and immunological methods. Morphological examination of the bone marrow (counting myelograms, calculating myelogram indices, detection of tumor cells) was performed by two morphologists. Disseminated tumor cells were detected using flow cytometry (FACS Canto II, USA, Kaluza Analysis v2.1 software). Monoclonal antibodies were used: CD45, EPCAM.&#x0D; Results. Disseminated tumor cells in the bone marrow of patients with ovarian cancer were determined based on the expression of the EPCAM antigen and lack of expression of CD45 antigen. Disseminated tumor cells were found in 65.2% (n=15)of bone marrow aspirates. Disseminated tumor cells did not correlate with tumor size, lymph nodes status and stage. The frequency of bone marrow damage was higher at stage III and reached 78.6% (11 out of 14 patients), while it was 33.3% (1 of 3 patients) in stage I. 40.0% of positive cases (2 out of 5 patients) were detected at stage IV. Disseminated tumor cells were found in 78.6% (n=11) of bone marrow aspirates in primary ovarian cancer, while in recurrent ovarian cancer they were found only in 44.4% (n=4).&#x0D; Conclusion. The hematogenous dissemination of ovarian cancer in the bone marrow was established. Bone marrow lesions was noted even in the early stages of the tumor process. The frequency of detection of disseminated tumor cells in the bone marrow of patients with ovarian cancer was 65.2%. More frequent bone marrow damage was noted in primary ovarian cancer. The number of myelocytes was significantly lower in primary ovarian cancer without bone marrow damage. The number of lymphocyte was lower in cases of bone marrow lesions.

A Murine Model of Waning Scrub Typhus Cross-Protection between Heterologous Strains of Orientia tsutsugamushi.

Orientia tsutsugamushi, the etiologic agent of the life-threatening febrile disease scrub typhus, is an obligately intracellular small coccobacillary bacterium belonging to the family Rickettsiaceae and is transmitted by the parasitic larval stage of trombiculid mites. Progress towards a vaccine for protection against scrub typhus has been impeded by characteristics of the pathogen and the infection. There are numerous strains of O. tsutsugamushi in the Asia-Pacific region with geographical overlap. In human cases immunity has been described as poor against heterologous strains of the pathogen, as well as short-lived against the homologous strain, with a mean antibody reversion rate of less than one year. Animal models of cross-protection as well as of deterioration of this cross-protection are needed to enhance understanding of transient immunity to scrub typhus. To build upon current understanding of this ineffective protection we sought to utilize our recently developed models, sublethal intradermal infection followed by challenge via ordinarily lethal hematogenous dissemination. Mice that were initially infected sublethally with O. tsutsugamushi Gilliam strain and were challenged with an ordinarily lethal dose of heterologous Karp strain were protected from death by a robust immune response at one month after the primary infection as evidenced by an abundance of mononuclear cellular infiltrates in target organs such as lung, liver, and kidney; maintenance of body weight; and low bacterial loads in the organs. Waning protection from lethal Karp strain challenge indicated by weight loss mirroring that observed in naïve mice was observed as early as 9 months after primary Gilliam strain infection, and higher bacterial loads, severe disease, and eventual death in some mice was observed after challenge with Karp strain at 14 months post-initial heterologous infection.

Hand Swelling in an Adolescent.

Hand Swelling in an Adolescent.

A malignant disseminated tuberculosis: concurrent intracranial tuberculosis with skipped multilevel spondylitis in a young immunocompetent patient

Background/aim. Mycobacterium tuberculosis (M. tuberculosis) infection can cause pulmonary and extrapulmonary tuberculosis (TB), resulted from hematogenous or lymphatic dissemination of the bacteria. Disseminated TB is characterized by the presence of two or more non-contiguous sites from the spread. Dissemination to the central nervous system (CNS TB) has several manifestations that can cause devastating neurological complications. Several predisposing factors include older age, human immunodeficiency virus (HIV) coinfection, and pharmacological immunosuppression. As the manifestation of CNS TB itself is rare, diagnosing it remains a challenge. Prompt antituberculosis treatment is needed to improve patient’s outcome. This paper aims to present a rare case of malignant disseminated TB in a young immunocompetent patient. Case. This case presents an immunocompetent 17-year-old male with weakness in the four extremities. Through comprehensive history taking and examination, the patient was diagnosed with malignant disseminated TB, presenting as cerebellar tuberculoma, tuberculous meningitis, and multiple skipped level spondylitis TB; and concurrent pulmonary TB. Then, the patient underwent a surgery for the cervical lesion and was started on antituberculosis treatment in combination with corticosteroid. After the treatment, the patient’s motoric and sensoric functions improved and he was able to urinate and defecate normally. Conclusion. This case demonstrates the importance of considering disseminated TB in the differential diagnosis of a patient with neurological deficits, regardless of the fact that the patient is young and immunocompetent. Prompt diagnosis and rapid initiation of treatment can improve the patient’s outcome.

Extrapulmonary Tuberculosis: Tomographic manifestations and associated complications

Tuberculosis (TB) is a re-emerging disease and an important cause of mortality. It manifests in two forms: pulmonary, which affects only the lungs, and extrapulmonary, which is defined as bacteriologically confirmed or clinically diagnosed infection by Mycobacterium tuberculosis that involves organs other than the lungs, being the pleural one of the most common. Extrapulmonary tuberculosis is usually the result of hematogenous dissemination of pulmonary infection and, therefore, indicates long-standing disease. The diagnosis of these forms of presentation represents a challenge due to the varied clinical manifestations, which requires a high index of suspicion, and early identification is essential to establish adequate treatment in these patients, since this presentation represents greater morbidity than the pulmonary form.

Hematogenous dissemination of pulmonary mucormycosis manifested as multiple subcutaneous nodules: a case report and review of the literature

BackgroundDisseminated mucormycosis presenting with multiple subcutaneous nodules is a rare condition with a poor prognosis, and delayed diagnosis and treatment is common.Case presentationWe report a case of 64-year-old Thai woman with colorectal cancer who initially presented with Acinetobacter baumannii pneumonia and respiratory failure. Following 10 days after her admission to the intensive care unit, she developed hospital-acquired pneumonia. Five days later, multiple subcutaneous nodules appeared on both arms and both legs. Bronchoalveolar lavage and skin biopsy cultures both grew Mucor spp. She was diagnosed with disseminated mucormycosis and was treated with liposomal amphotericin B at a dose of 5 mg/kg/day. Despite treatment, our patient succumbed to septic shock and multiorgan failure on the third day after definitive diagnosis.ConclusionsThis case demonstrates that the subcutaneous nodules caused by hematogenously disseminated mucormycosis are unusual in a patient with a solid tumor. Clinicians should be aware of this atypical presentation of mucormycosis in patients with solid tumors.

Infecciones por neumococo

Streptococcus pneumoniae are a gram-positive cocci arranged in pairs or short chains. Their natural reservoir is located in the posterior nasopharynx. S. pneumoniae are the etiological agent of non-invasive infections such as sinusitis, otitis media, or pneumonia. Community-acquired pneumonia is the most frequent clinical manifestation of pneumococcal disease. The hematogenous dissemination of pneumococci leads to invasive forms of infection such as sepsis, meningitis, endocarditis, septic arthritis, and peritonitis, among others. The diagnosis of non-invasive infections in outpatients is mainly based on the patient's signs and symptoms along with diagnostic imaging tests. In patients who meet the criteria for hospitalization, it is necessary to perform cultures of blood and sputum samples with the aim of identifying the microorganism early and establish targeted antibiotic therapy. Penicillin has been the most used antibiotic for treating pneumococcal infection. However, resistance to this antibiotic has increased, though in our setting it continues to be less than 5%. Third-generation cephalosporins are currently the most-used antibiotic for treating invasive pneumococcal infection.

Gene signatures of circulating breast cancer cell models are a source of novel molecular determinants of metastasis and improve circulating tumor cell detection in patients

BackgroundProgression to stage IV disease remains the main cause of breast cancer-related deaths. Increasing knowledge on the hematogenous phase of metastasis is key for exploiting the entire window of opportunity to interfere with early dissemination and to achieve a more effective disease control. Recent evidence suggests that circulating tumor cells (CTCs) possess diverse adaptive mechanisms to survive in blood and eventually metastasize, encouraging research into CTC-directed therapies.MethodsOn the hypothesis that the distinguishing molecular features of CTCs reveal useful information on metastasis biology and disease outcome, we compared the transcriptome of CTCs, primary tumors, lymph-node and lung metastases of the MDA-MB-231 xenograft model, and assessed the biological role of a panel of selected genes, by in vitro and in vivo functional assays, and their clinical significance in M0 and M+ breast cancer patients.ResultsWe found that hematogenous dissemination is governed by a transcriptional program and identified a CTC signature that includes 192 up-regulated genes, mainly related to cell plasticity and adaptation, and 282 down-regulated genes, involved in chromatin remodeling and transcription. Among genes up-regulated in CTCs, FADS3 was found to increases cell membrane fluidity and promote hematogenous diffusion and lung metastasis formation. TFF3 was observed to be associated with a subset of CTCs with epithelial-like features in the experimental model and in a cohort of 44 breast cancer patients, and to play a role in cell migration, invasion and blood-borne dissemination. The analysis of clinical samples with a panel of CTC-specific genes (ADPRHL1, ELF3, FCF1, TFF1 and TFF3) considerably improved CTC detection as compared with epithelial and tumor-associated markers both in M0 and stage IV patients, and CTC kinetics informed disease relapse in the neoadjuvant setting.ConclusionsOur findings provide evidence on the potential of a CTC-specific molecular profile as source of metastasis-relevant genes in breast cancer experimental models and in patients. Thanks to transcriptome analysis we generated a novel CTC signature in the MDA-MB-231 xenograft model, adding a new piece to the current knowledge on the key players that orchestrate tumor cell hematogenous dissemination and breast cancer metastasis, and expanding the list of CTC-related biomarkers for future validation studies.

Miliary Tuberculosis: Moroccan Series of 101 Cases

Introduction: Miliary tuberculosis is an increasingly rare form (2% to 8%), defined by the hematogenous or lymphatic dissemination of the tubercle bacillus from a pulmonary or extra-pulmonary focus but which remains serious and can lead to acute respiratory failure due lesional pulmonary edema. Patients and Methods: This is a retrospective study of 101 cases of miliary tuberculosis hospitalized between January 1989 and July 2019 in the pneumology department of “20 Aout” in Casablanca. Results: The average age is 43 years with a predominance of men (64%), the history of tuberculosis is found in 8 cases and tuberculosis contagion in 10 cases. The common symptom in all cases (100%) is an alteration of the general condition, fever is present in 76% of cases, dry cough is found in 75.5% of cases and dyspnea is found in 38.3% of cases. Among the causes of immunosuppression, we noted: 3 cases of neoplasia, 5 cases of diabetes, 5 cases of pregnancy and 4 cases of system diseases. The chest X-ray (frontal view) found an aspect of pulmonary miliaria in all cases associated with pleurisy in 18 cases, an excavated opacity in 3 cases and pneumothorax in 1 case. Tuberculin intradermal reaction (tIDR) was positive in 35 cases. Antibacillary treatment was started urgently in all cases. The outcome was good in the majority of cases with 10 deaths. Further work-up allowed confirmation of the diagnosis either by direct isolation of the koch bacillus or by biopsy in 47.52% of cases.

Mouse Model of a Human STAT4 Point Mutation That Predisposes to Disseminated Coccidiomycosis.

STAT4 plays a critical role in the generation of both innate and adaptive immune responses. In the absence of STAT4, Th1 responses, critical for resistance to fungal disease, do not occur. Infection with the dimorphic fungus, Coccidioides, is a major cause of community-acquired pneumonia in the endemic regions of Arizona and California. In some people and often for unknown reasons, coccidioidal infection results in hematogenous dissemination and progressive disease rather than the typical self-limited pneumonia. Members of three generations in a family developed disseminated coccidioidomycosis, prompting genetic investigation. All affected family members had a single heterozygous base change in STAT4, c.1877A>G, causing substitution of glycine for glutamate at AA626 (STAT4E626G/+ ). A knockin mouse, heterozygous for the substitution, developed more severe experimental coccidioidomycosis than did wild-type mice. Stat4E626G/+ T cells were deficient in production of IFN-γ after anti-CD3/CD28 stimulation. Spleen cells from Stat4E626G mice showed defective responses to IL-12/IL-18 stimulation in vitro. In vivo, early postinfection, mutant Stat4E626G/+ mice failed to produce IFN-γ and related cytokines in the lung and to accumulate activated adaptive immune cells in mediastinal lymph nodes. Therefore, defective early induction of IFN-γ and adaptive responses by STAT4 prevents normal control of coccidioidomycosis in both mice and humans.

Mycobacterial skin infection.

Purpose of reviewThe aim of this article is to review the most recent evidences concerning mycobacterial skin infections, limiting the period of literature research to 2020--2021.Recent findingsMycobacterial skin infections include a heterogeneous group of cutaneous diseases.Cutaneous tuberculosis is usually the result of hematogenous dissemination or spread from underlying foci and it must be distinguished from tuberculids, resulting from the immunological reaction to Mycobacterium tuberculosis antigens. Leprosy prevalence was drastically reduced after introduction of multidrug therapy in the 1980 s, but cases are still reported due to underdiagnosis, and animal and environmental reservoirs. Recent advances concentrate in the diagnostic field. Specific guidelines for the treatment of nontuberculous mycobacteria skin infections are missing and surgical procedures may be required. Prognosis is better as compared to nontuberculous mycobacteria lung disease. Rapid laboratory-confirmed diagnosis of Buruli ulcer may be achieved by the IS2404 PCR. Among new drugs, telacebec is promising in terms of potency, shorter duration and tolerability in animal studies. A clinical trial in humans is planned.SummaryMycobacterial cutaneous lesions are nonpathognomonic and clinical suspicion must be confirmed by culture or molecular detection. Long-course multidrug treatment is required based on susceptibility tests. Surgical intervention may also be required. Rehabilitation and psychosocial support reduce long-term physical and mental consequences mostly in Buruli ulcer and leprosy.

Pneumonia with empyema: rare complication after sea urchin injury

Staphylococcal pneumonias are rare, especially in immunocompetent children. They can represent a complication of tissue infection with hematogeneous dissemination. Sea urchin injuries can result in local reactions, granulomas and, unfrequently, systemic disease. We describe the case of a 16-year-old boy with a four-day fever and left-sided chest pain, with referral to a sea urchin injury five days before admission. Physical examination revealed diminished pulmonary sounds and crackles in the left lower hemithorax. The chest radiograph showed a pleural effusion. Blood tests showed leukocytosis, neutrophilia, and an elevated C-reactive protein. Empyema was diagnosed after performing a thoracentesis. Subsequently he initiated inflammatory signs with fluctuation on his right heel, with purulent drainage. Suspecting on a staphylococcal etiology, he was treated with flucloxacillin, a suspicion that was confirmed by the isolation of Staphylococcus aureus in pleural liquid and abscess material. After antibiotic treatment was established, there was a favorable clinical and radiological evolution. With this case report, we would like to draw attention to the possibility of hematogenous dissemination of a microorganism after local skin infection, even in immunocompetent individuals.

ОСОБЕННОСТИ ТЕЧЕНИЯ И ДИАГНОСТИКИ РАЗЛИЧНЫХ ФОРМ ТУБЕРКУЛЕЗНОГО СИНОВИТА

Tuberculous synovitis occurs in various forms: multiorgan tuberculous inflammation, in combination with pulmonary tuberculosis (TB), with osteoarticular tuberculosis, and singularly. The pathogenesis of tuberculous synovitis includes hematogenous dissemination of the pathogen into the synovial membrane with the development of a specific inflammatory process [5, 8, 1, 11]. Later, with a delayed diagnosis and absence of pathogenetic therapy, the inflammatory process can affect the bone tissue with development of specific tuberculous osteomyelitis. This work demonstrates different courses of tuberculous synovitis and diagnostic criteria of specific inflammation.