Metastatic Abscesses Research Articles

Infective endocarditis with metastatic infections in a renal transplant recipient: a case report

BackgroundInfective endocarditis is an uncommon but well-known post-transplant complication with significant morbidity and mortality. It has been observed to be about 171 times more common in solid organ transplant patients than in the general population. With the increasing rate of end-stage kidney disease, the higher demand for kidney transplantation with better graft survival, and life expectancy rates, more transplant recipients may develop infective endocarditis as a late post-transplant complication. Prompt diagnosis of infective endocarditis is therefore necessary to avert graft loss and other life-threatening outcomes.Case presentationWe present a case of a 52-year-old African patient who had a live donor kidney transplant 18 months prior to presentation and had been on oral tacrolimus 5 mg every morning/4.5 mg every evening, mycophenolic acid (MPA) 720 mg twice daily, and oral prednisolone 10 mg daily as maintenance immunosuppressive medications. Regarding the above immunosuppressive medications, he had been in good health and had a functioning transplant graft. He presented with a resolving right thigh swelling, recurrence of fever, new onset left hemiplegia, and seizures. Enterococcus faecalis infective endocarditis was diagnosed with metastatic brain abscesses, which was treated with intravenous vancomycin and gentamycin for 5 weeks. There are very few reported cases of infective endocarditis due to Enterococcus faecalis, and this case is unique because the initial presentation was pyomyositis.ConclusionInfective endocarditis with septic embolization to the brain should be considered in kidney transplant recipients with pyomyositis and multiple rim-enhancing lesions, especially in the late post-transplant period with Enterococcal spp. as an emerging cause of infective endocarditis in kidney transplant recipients. Clinicians will need to have a high index of suspicion to aid early diagnosis with appropriate treatment to prevent adverse outcomes.

Uncommon threads: pneumopericardium complexity following liver catheter removal in pancreatic cancer

Pneumopericardium, the presence of air within the pericardial sac, is a rare but critical condition that can lead to severe complications such as tension pneumopericardium and cardiac tamponade, causing hemodynamic instability and necessitating immediate intervention. Various etiologies include congenital defects, post-surgical complications, infections, and trauma. Malignancies, such as advanced esophageal cancer or lung carcinoma, can also cause pneumopericardium via fistula formation. Multimodal imaging, including chest X-ray, echocardiography, and computed tomography (CT), is essential for diagnosis. This case report discusses a 65-year-old male with advanced pancreatic adenocarcinoma who developed pneumopericardium following the removal of a left lobe liver drainage catheter. Initial CT imaging revealed liver lesions suspicious for metastatic disease or abscess, leading to drainage procedures. Following the removal of the drainage tube, the patient experienced respiratory distress and hypotension, and computed tomography pulmonary angiogram (CTPA) revealed pneumopericardium, likely due to a fistula formed between the abscess and pericardium. Despite no echocardiographic signs of tamponade, the patient’s persistent hypotension warranted CT-guided pericardiocentesis, resulting in gradual blood pressure improvement. This case highlights the intricate interplay between malignancy, infection, and procedural complications in developing pneumopericardium. It emphasizes the need for a multidisciplinary approach and the importance of considering both the quantity and rate of air accumulation when assessing the risk of hemodynamic compromise. The patient’s hemodynamic instability and subsequent improvement following pericardiocentesis underscore the critical role of timely intervention in managing this condition.

Intracranial dissemination of Klebsiella pneumoniae originating from pulmonary infection: a case report

BackgroundMetastatic brain abscesses caused by Klebsiella pneumoniae are extremely rare but life-threatening conditions. To depict a unique case of the middle-aged hypertensive man with an unusual presentation of metastatic brain abscesses originating from a pleural abscess caused by Klebsiella pneumoniae and subsequently leading to loss of consciousness (LOC).Case reportA 52-year-old Iranian man with a history of hypertension presented to the emergency department with a five-day history of worsening cough, high-grade fever, shortness of breath, chest pain, fatigue, and a productive cough. Laboratory tests revealed leukocytosis, elevated C-reactive protein, and respiratory alkalosis. A chest computed tomography scan confirmed pneumonia, and a brain scan revealed multiple hypodense lesions. Despite antibiotic therapy, the patient's condition worsened, leading to confusion, disorientation, and loss of consciousness. Magnetic resonance imaging revealed multiple ring-enhancing lesions, suggesting an abscess formation. Bronchial washings and BAL samples confirmed a lower respiratory tract infection. Cultures from the bronchial washings grew Klebsiella pneumoniae.ConclusionsMetastatic brain abscesses caused by Klebsiella pneumoniae are exceedingly rare but life-threatening conditions. Timely diagnosis and effective antimicrobial treatment are critical for patient outcomes. This case underscores the significance of recognizing atypical presentations of bacterial infections, as early detection and appropriate management can significantly impact patient outcomes.

Metastatic Cutaneous Tubercular Abscesses in a Neglected 8-year-old Boy

Metastatic Cutaneous Tubercular Abscesses in a Neglected 8-year-old Boy

Multiple Cold Abscesses of a Chest Wall with Ribs Destruction in a Hemodialysis Patient

Cold abscess of the chest wall is an uncommon disease that is mainly caused by tuberculous infection. Staphylococcal cold abscesses of the chest wall are extremely rare and usually clinically occult, frequently leading to a delay in diagnosis and consequently severe infectious complications. We report an 88-year-old woman with end-stage renal disease, who presented with an exit site infection of a cuffed tunneled dialysis catheter caused by methicillin-resistant Staphylococcus aureus (MRSA). Despite the removal of the catheter and administration of antibiotics, she developed refractory MRSA bacteremia. Computed tomography (CT) of the chest revealed septic thrombophlebitis with metastatic cold abscesses of the chest wall and ribs destruction. Although CT-guided drainage and vancomycin therapy eliminated MRSA bacteremia, the chest wall abscesses did not resolve. Patients fitted with a central venous dialysis catheter are at risk of septic thrombophlebitis with metastatic cold abscesses of the chest wall that are resistant to antibiotic therapy. Early identification is based on serial blood cultures and prompt CT scans. Surgical management coupled with antibiotic therapy can eradicate the source of infection and improve patients’ outcomes.

A rare pathogen causing fatal metastatic deep-seated abscesses in a paediatric patient

NA

An incidental diagnosis of an unusually located echinococcus alveolaris.

Hydatid cyst disease is a zoonotic infection caused by the genus Echinococcus. Hydatid cysts are usually located in the liver or lungs whereas the brain is an unusual location. A 45-year-old male patient was diagnosed with an intracranial mass suggesting a metastasis in the frontal region shown in the cranial computed tomography (CT) scan following a cranial trauma. The histological evaluation revealed an acellular laminated lesion surrounded with reactive changes, compatible with a cuticle. These findings were evaluated in favour of a hydatid cyst caused by Echinococcus multilocularis. Alveolar echinococcosis is a zoonotic disease caused by the genus Echinococcus multilocularis. Hydatid cyst is a common public health issue in the countries where livestock farming is common. Primary or metastatic tumours and abscesses should be considered in the differential diagnosis of hydatid cysts regardless of their location.

Metastatic Tuberculous Abscess and Papulonecrotic Tuberculid Developing During Chemotherapy in a Post-Surgical Case of Carcinoma of Breast.

Metastatic Tuberculous Abscess and Papulonecrotic Tuberculid Developing During Chemotherapy in a Post-Surgical Case of Carcinoma of Breast.

A Previously Healthy Infant with Lemierre Syndrome in the Emergency Department: Case Report.

Lemierre syndrome (LS) is a rare condition with a high mortality risk. It is well described in older children and young adults involving bacteremia, thrombophlebitis, and metastatic abscess commonly due to Fusobacterium infections. Young, pre-verbal children are also susceptible to LS; thus, careful attention must be given to their pattern of symptoms and history to identify this condition in the emergency department (ED). A 12-month-old previously healthy boy with a recent diagnosis of acute otitis media and viral illness presented to the ED with a complaint of fever. Additional symptoms developed at the head and neck and were noted on subsequent ED visits. Advanced imaging revealed significant lymphadenopathy and deep space inflammation extending to the mediastinum. Subsequent imaging confirmed extensive sinus and deep vein thromboses, consistent with LS. Methicillin-resistant Staphylococcus aureus (MRSA) was the only organism identified. After surgical debridement, appropriate intravenous antibiotics, and heparin anticoagulation therapy, the patient experienced full recovery after prolonged hospitalization. A febrile infant with multiple acute care visits and development of lymphadenopathy, decreased oral intake, decreased cervical range of motion, and sepsis should raise suspicion for Lemierre syndrome. The medical evaluation of deep neck spaces and deep veins should be similar to that of older children and adults with LS, including advanced imaging of the head and neck. However, medical management should particularly target MRSA due to its emerging prevalence among infantile LS cases. Further research is necessary to determine the optimal management strategies of LS for this age group.

DEVELOPMENT OF A METHOD FOR MANUFACTURING AND OBTAINING HYPERIMMUNE SERUM AGAINST STREPTOCOCCOSIS IN FARM ANIMALS

In the livestock farms of our country, infectious diseases are becoming more and more common in their etiology, the dominant role belongs to the opportunistic microflora. Streptococcus also belongs to this group of microorganisms [1].
 Streptococcosis is an infectious disease of young farm animals, characterized by severe septic phenomena, inflammation of respiratory system, gastrointestinal tract, joints.
 All types of young animals are susceptible to streptococcosis, but calves, lambs and foals get sick more often, starting from the first days of life, up to 3-4 months. The disease begins with a respiratory rate, the appearance of breath sounds and wheezing, and cough with the development of pneumonia. The first signs of the disease appear in foals at the age of 1.5-4 weeks. Clinical manifestations differ depending on the location and extent of metastatic abscesses. Mortality from complications reaches 10%. Factors contributing and predisposing to the emergence and development of this disease are inadequate balanced nutrition, violation of the rules for the care and maintenance of calves.
 The basis for the prevention of streptococcosis should be a complex of veterinary and sanitary measures and good nutrition. On dysfunctional farms, it is impossible to keep sick and recovered cows with newborns, as well as drink their colostrum and milk. In this regard, it is very important for veterinary medicine to investigate infectious diseases of cattle, as well as to develop effective means for protecting animals, improving measures related to the prevention and elimination of this disease[7,8].This work presents data on the isolation of a field isolate of bovine streptococcosis, an indication and identification of a bacterial culture. Bacterial mass obtained and prepared antigen for development hyperimmune serum. The scheme of immunization and obtaining hyperimmune serum on laboratory and industrial animals has been worked out. Carried out laboratory and industrial tests of hyperimmune serum.

Comparison of diagnosis and treatment of MSSA and MRSA osteomyelitis in children: a case–control study of 64 patients

BackgroundWe aimed to compare the clinical characteristics of acute osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) in children.MethodsWe retrospectively analyzed the data of 64 children treated between September 2017 and June 2021. Based on the bacterial culture results, they were divided into MRSA and MSSA infection groups. Both groups were treated with debridement and vacuum-assisted closure for negative pressure drainage. Parameters including clinical manifestations, number of operations, length of hospital stay, inflammatory indicators, and concurrent arthritis were compared between the two groups.ResultsIn the MRSA infection group, there was one case each of residual joint stiffness and pathological fracture. Conversely, the MSSA group had two cases of residual joint stiffness. The MRSA infection group was more prone to high fever (t = 3.61, P = 0.001), white blood cell count elevation (t = 2.41, P = 0.022), arthritis (X2 = 7.48, P = 0.013), metastatic abscess (X2 = 4.78, P = 0.042), and a shorter length of progression from onset to admission (t = − 2.04, P = 0.046); however, it required more surgeries (t = 2.68, P = 0.009) and longer hospital stay (t = 2.04, P = 0.045).ConclusionsPediatric acute osteomyelitis caused by MRSA is more prone to cause high fever and markedly elevated of white blood cell count, and is often accompanied with suppurative infection of adjacent joints and metastatic abscesses, thus requiring more surgeries and longer hospital stay.

Brain abscesses in infective endocarditis: contemporary profile and neuroradiological findings.

Brain abscesses (BA) are severe lesions in the course of infective endocarditis (IE). We compare the bacteriological, clinical data, background, associated lesions, and outcome of IE patients with and without BAs, and assess the MRI characteristics of BAs. Retrospective study of 351 consecutive patients with definite IE (2005-2020) and at least one brain MRI. Patients with and without BAs were compared. Twenty patients (5.7%) had BA (80% men; median age: 44.9 ± 11.5). They were younger (p = 0.035) and had a higher rate of predisposing factors (previous IE 20% vs 2.2%, p = 0.03), intravenous drug use [25% vs 2.2%; p < 0.0001]), underlying conditions (HIV infection, 20% vs 2.2%, p < 0.0001; alcohol abuse, 20% vs 2.2% p < 0.0001]; liver disease p = 0.04; hemodialysis, p = 0.001; type 2 diabetes, p = 0.001), bacterial meningitis (p = 0.0029), rare species involvement (35% vs 7%, p < 0.0006) and extra-cerebral abscesses (p = 0.0001) compared to patients without BA. Valve vegetations were larger in Group 1 (p = 0.046). Clinical presentation could suggest the diagnosis of BA in only 7/20 (35%) patients. MR identified 58 BAs (mean/patient 2.9; range 2-12): often multiple (80%), bilateral (55%) and ≤ 10mm (72%). The presence of BA did not modify cardiac surgery indication and timing. Favorable outcome was observed in 85% of patients. Rates of predisposing, underlying conditions, rare IE agents, meningitis and metastatic abscesses are significantly higher in BA-IE patients. As BAs can develop in asymptomatic IE patients, the impact of brain MRI on their management needs thoroughly to be further investigated.

A Rare Case of Tropical Pyomyositis

Tropical myositis is a primary muscle abscess arising within the skeletal muscle which strictly excludes intermuscular abscesses, abscesses extending from adjoining bone/subcutaneous tissues, and those secondary to previous septicemia. The purpose of the case report is to bring awareness for tropical pyomyositis and the importance of early detection and culture-guided initiation of IV antibiotics for salvaging adjoining joints and prevention of other complications such as deep venous thrombosis and septic emboli, metastatic abscesses and dissemination, septicemia and septic shock and toxic shock syndrome. Keywords: Tropical pyomyositis, abscess, antibiotics

Uncommon manifestation of disseminated tuberculosis with metastatic skin abscesses in an immunocompromised adult patient: A case report

Background: Cutaneous lesions account for less than 2% of all extrapulmonary manifestations of tuberculosis (TB). Metastatic tuberculous abscesses (tuberculous gummas), uncommon forms of cutaneous TB, typically result from the bacillus spreading hematogenously from the main site of infection to the subcutaneous tissue when the body's cell mediated immunity is compromised and present with one or more non-tender and fluctuant subcutaneous nodules. Case Presentation: A 51-year-old male presented with dry cough of one month duration associated with loss of appetite, easy fatigability and vomiting of ingested matter. He had left armpit and lower back skin swellings of similar duration. Physical findings were remarkable for whitish coat over the dorsal part of the tongue, crepitation over the lower two-third of bilateral posterior chest, and non-tender fluctuant masses over the left axilla and lower back region. Chest X-ray revealed multiple bilateral air space nodules and abdominopelvic U/S showed numerous hypoechoic splenic lesions. Urine lipoarabinomannan and Xpert MTB/RIF (mycobacterium tuberculosis/rifampicin) assay from the axillary skin abscess were positive for MTB. He was started on anti-tuberculous therapy and showed marked improvement after a month of follow up. Conclusion: It is worth considering the uncommon manifestations of tuberculosis including metastatic skin abscesses in the appropriate clinical context, to avoid misdiagnosis and underreporting in high tuberculosis burden countries. We strongly advise the utilization of Xpert MTB/RIF assay and/or urine lipoarabinomannan for the diagnosis of different forms of tuberculosis including cutaneous TB in HIV positive patients, especially in the absence of sputum for microbiologic tests, like in our patient

Metastatic Thyroid Abscess: A Rare Presentation of Catheter-related Bloodstream Infection in an End-Stage Kidney Disease Patient on Hemodialysis.

Dear Editor, Over two-third of patients initiated on hemodialysis (HD) in India have temporary catheters as the initial venous access.[1] Bloodstream infections caused by infection of the catheters can lead to metastatic complications like infective endocarditis and septic arthritis.[2] We report a case of acute suppurative thyroiditis in an end-stage kidney disease (ESKD) patient with a history of prolonged use of non-tunneled catheter. A 35-year-old male had been undergoing HD through a right internal jugular non-tunneled catheter for three months. He presented to us with complaints of high fever, chills and rigors, swelling of the neck, and dysphagia for 10 days. Local examination revealed a large, tender, warm, and fluctuant anterior neck mass [Figure 1a].Figure 1: (a) A patient having diffuse painful neck swelling on admission. (b) Contrast-enhanced computed tomography of the neck showing multiple hypodense collections in both lobes of the thyroid and extending to the retropharyngeal space. (c) Resolution of swelling of the same patient after treatmentContrast-enhanced computed tomography of the neck revealed multiple loculated hypodense collections, approximating around 90 cc and showing enhancement of walls and septa in both lobes of the thyroid: these were suggestive of acute suppurative thyroiditis [Figure 1b]. Blood cultures sent from the catheter, peripheral blood, and pus culture from the thyroid abscess grew methicillin-resistant Staphylococcus aureus (MRSA). Henceforth, a diagnosis of metastatic thyroid abscess secondary to catheter-related bloodstream infection was considered. The catheter was removed followed by ultrasound-guided drainage of the abscess and antibiotics as per culture sensitivity. There was complete resolution of the abscess [Figure 1c]. Metastatic infections have been observed in approximately 5%–10% of patients undergoing HD through central venous catheters.[3] The tough capsule, high iodine content, and good lymphatic drainage make the thyroid gland resistant to infections.[4] We could find only one other case[5] that reported acute suppurative thyroiditis in an ESKD patient. CRBSI presenting as thyroid abscess is extremely rare and should always be suspected in any HD patient with painful neck swelling. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Successful rescue of disseminated Nocardia infection with multiple abscesses in a patient with membranous nephropathy after cardiopulmonary resuscitation: A three-year follow-up.

Nocardiosis manifests as an opportunistic infection, primarily affecting individuals who are immunocompromised and susceptible to the infection. We present a case study of one patient with nephrotic syndrome and membranous nephropathy, who underwent treatment with prednisone and cyclosporine in 2016. In early 2017, the patient was diagnosed with a "fungal infection" and discontinued the use of cyclosporine. After one month of anti-infection therapy, a cranial magnetic resonance imaging scan showed multiple abscesses in the right temporal region. The diagnosis of nocardiosis was confirmed based on the presence of metastatic abscess masses, multiple lung and brain lesions, and a positive culture of Nocardia in the drainage. We changed the anti-infection therapy to a combination of trimethoprim-sulfamethoxazole (TMP-SMX), minocycline, and voriconazole. However, the patient experienced a sudden cardiac arrest and subsequently recovered after cardiopulmonary resuscitation. During the five-month follow-up period following the discharge, the patient displayed an enhanced nutritional status and stable renal function. The focal infection ultimately resolved during the subsequent three years. Neuro-infection caused by Nocardia should be considered in immunocompromised patients, and TMP-SMX is the preferred initial therapy; however, because of the high mortality rate, a long-term combination therapy with imipenem, cefotaxime, amikacin, and TMP-SMX is suggested.

Spontaneous rupture of pyogenic splenic abscess in infective endocarditis

Infective endocarditis (IE) has various cardiac and extracardiac complications, which include metastatic abscesses of the solid organs such as the liver, kidney, brain, and spleen. Splenic abscess in IE is an uncommon entity, and spontaneous rupture of a large abscess in a newly diagnosed patient with IE is infrequently described in the literature. A 42-year-old male presented to us with a fever and worsening pain in his left upper quadrant. A detailed evaluation led to the diagnosis of IE and a large pyogenic splenic abscess. The blood culture had a growth of Escherichia coli. He was managed initially with intravenous antibiotics, but an urgent laparotomy and splenectomy were undertaken as he deteriorated and developed shock. Unfortunately, despite a prompt surgical intervention, he succumbed to the illness due to persistent postoperative shock. The case describes the catastrophic complications of IE and broadens the understanding of its complication spectrum.

Platelet-to-White Blood Cell Ratio: A Feasible Biomarker for Pyogenic Liver Abscess.

The platelet-to-white blood cell ratio (PWR) has been reported to predict the severity of patients with various diseases. However, no previous studies have assessed the use of the PWR as a prognostic marker for pyogenic liver abscesses (PLA). This observational retrospective study was performed between January 2008 and December 2017, including 833 patients with PLA from multiple centers. The enrolled patients, on average, had a PWR of 17.05, and 416 patients had a PWR lower than 17.05. A total of 260 patients (31.2%) with PLA showed complications of metastatic infection, pleural effusion and abscess rupture. A low PWR level was identified as a strong risk factor for metastatic infection and pleural effusion. The low PWR group also had a longer hospital stay. In the multivariate analysis, old age, anemia, albumin and CRP levels and unidentified pathogens were significant factors for low PWR levels. A low PWR, old age, male sex, abscess size, albumin, ALP and unidentified causative pathogens showed significant associations with a hospital stay longer than 28 days. As a result, PLA patients presenting with a low PWR were shown to have more complications and a poor prognosis. Considering its cost-effectiveness, PWR could be a novel biomarker used to predict a prognosis of PLA.

Lung abscess with metastatic brain abscess- A case report

Brain abscess can result from spread of infection from contiguous sites or from distant hematogenous spread. Hematogenous spread from a distant site as from the lungs is more common with cyanotic congenital heart disease and in patients with infective endocarditis. We report a case of hematogenous spread of brain abscess from lung in a patient who had no concurrent heart disease. Klebsiella pneumonia was isolated both from brain abscess and from lung abscess. A fifty years old lady with uncontrolled sugars presented with cough with expectoration and fever. Chest X ray showed cavity with fluid level on the right side and sputum culture showed Klebsiella pneumoniae. She was treated with sensitive antibiotics. During in hospital stay she developed headache and blurring of vision. CT brain showed a right parietal lobe abscess. She underwent decompression procedure and abscess from brain was drained which also revealed growth of Klebsiella pneumoniae. Her echo was normal. She was treated with sensitive antibiotics and had clinical improvement. While treating a case of lung abscess, clinicians should be aware of the possibility of metastatic spread and a high index of suspicion and a radiological imaging leads to early diagnosis and treatment.

Outer membrane vesicles-transmitted virulence genes mediate the emergence of new antimicrobial-resistant hypervirulent Klebsiella pneumoniae

ABSTRACT Hypervirulent Klebsiella pneumoniae (hvKp) is a notorious clinical pathogen that is more likely to cause severe primary and metastatic abscesses. The dissemination of antimicrobial-resistant hvKp isolates has been reported worldwide, posing a great challenge and severe clinical threat. However, the mechanisms of antimicrobial-resistant hvKp isolates prevalent worldwide are not well precise. Outer membrane vesicles (OMVs) secreted from gram-negative bacteria are an important vehicle for delivering effector molecules inter- and intra-species. To explore whether OMVs as the vector of virulence genes horizontal transfer among Klebsiella pneumoniae and to explain the potential mechanism for the development of antimicrobial-resistant hvKp isolates, we isolated OMVs from hvKp and classical Klebsiella pneumoniae (cKp) by sequential differential centrifugation, respectively. Then, the characteristics and contents of hvKp-OMVs and cKp-OMVs were analyzed. These hvKp-OMVs contain virulence genes, which could be transferred from hvKp horizontally to extended-spectrum beta lactamase (ESBL)-producing cKp, leading to the production of antimicrobial-resistant hypervirulent transformants. Further experiments confirmed the transformants exhibited antimicrobial resistance and hypervirulent phenotypes in vitro and in vivo. In short, this work demonstrated that hvKp-OMVs facilitated virulence genes transfer, allowing an increase in the virulence level of ESBL-producing cKp and providing a new mechanism for the emergence of antimicrobial-resistant hvKp isolates.