Abscesses In Organs Research Articles

Mobile Microbiome

The link between oral infections and adverse systemic conditions has attracted much attention in the research community. Several mechanisms have been proposed, including spread of the oral infection due to transient bacteremia resulting in bacterial colonization in extra-oral sites, systemic injury by free toxins of oral pathogens, and systemic inflammation caused by soluble antigens of oral pathogens. Mounting evidence supports a major role of the systemic spread of oral commensals and pathogens to distant body sites causing extra-oral infections and inflammation. We review here the most recent findings on systemic infections and inflammation complicated by oral bacteria, including cardiovascular disease, adverse pregnancy outcomes, rheumatoid arthritis, inflammatory bowel disease and colorectal cancer, respiratory tract infections, and organ inflammations and abscesses. The recently identified virulence mechanisms of oral species Fusobacterium nucleatum, Porphyromonas gingivalis, Streptococcus mutans, and Campylobacter rectus are also reviewed. A pattern emerges indicating that only select subtype(s) of a given species, e.g., F. nucleatum subspecies animalis and polymorphum and S. mutans non-c serotypes, are prone to extra-oral translocation. These findings advocate the importance of identification and quantification of potential pathogens at the subtype levels for accurate prediction of disease potential.

Melioidosis and the kidney

Melioidosis, caused by the saprophytic soil and freshwater Gram-negative aerobic bacillus Burkholderia pseudomallei, is classically characterized by pneumonia, sometimes with multiple organ abscesses, usually in patients with defined risk factors and with a mortality rate of up to 40%. It is a major cause of community-acquired sepsis in Southeast Asia and tropical northern Australia with an expanding global geographical distribution. It is increasingly recognized as an opportunistic infectious disease of importance to physicians, who may need to suspect it in at-risk patients that may come from or visit endemic areas, and could be fatal if treated late or inappropriately. Mortality could be prevented by early institution of specific antimicrobial therapy. Epidemiology, clinical features, overall management, and aspects of melioidosis particularly relevant to kidney disease and immunosuppression are discussed in this review.

Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis

BackgroundSevere acute pancreatitis (SAP) with severe complications such as multiple organ failure, necrosis, abscess, and formation of pancreatic pseudocysts often gives rise to a high mortality despite intensive treatment. Parenteral nutrition (PN), elemental enteral nutrition, and ecoimmunonutrition (EIN) hastened the recovery of SAP patients, stimulated gastrointestinal motility, and alleviated the degree of systemic inflammatory response syndrome. This study aimed to examine the effects of enteral nutrition (EN) and EIN on bacterial translocation and cytokine production in patients with SAP. MethodsOne hundred eighty-three SAP patients were randomly divided into three groups receiving PN, EN, or EN + EIN. Acute Physiology and Chronic Health Evaluation II scores, complications (systemic inflammatory response syndrome, multiorgan failure, and infections), intestinal bacterial strains of stool, and plasma concentrations of endotoxin, tumor necrosis factor α (TNF-α), and interleukin (IL) 6 and IL-10 were evaluated. ResultsThe percentage of pancreatic sepsis, multiple organ dysfunction syndrome, and mortality was significantly lower in the EN group and was further lower in the EN + EIN group than that in the PN group. The plasma concentrations of TNF-α and IL-6 and APACHE II scores were significantly decreased in the EN group and were further lowered in the EN + EIN group than those in the PN group. The plasma concentration of IL-10 was higher in the EN group and was further increased in the EN + EIN group than that in the PN group. ConclusionsEN plays effective roles in the treatment of SAP by decreasing the expression of endotoxin, TNF-α, and IL-6 and the bacterial translocation, enhancing the expression of IL-10, and the combination of EIN with EN results in more therapeutic benefits than EN alone.

Aseptic Abscess: A Report of Two Cases

An aseptic abscess (AA) is an auto-inflammatory disorder characterized by necrotic lymph nodes and internal organ abscesses, most frequently located in the spleen. Described herein are two cases of aseptic abscesses; one in a patient with Behçet's disease and the other in a patient with mesenteric panniculitis.

Amoebic Liver Abscess: An Appraisal

Amoebic Liver Abscess: An Appraisal

The Epidemiology and Clinical Spectrum of Melioidosis: 540 Cases from the 20 Year Darwin Prospective Study

BackgroundOver 20 years, from October 1989, the Darwin prospective melioidosis study has documented 540 cases from tropical Australia, providing new insights into epidemiology and the clinical spectrum.Principal FindingsThe principal presentation was pneumonia in 278 (51%), genitourinary infection in 76 (14%), skin infection in 68 (13%), bacteremia without evident focus in 59 (11%), septic arthritis/osteomyelitis in 20 (4%) and neurological melioidosis in 14 (3%). 298 (55%) were bacteremic and 116 (21%) developed septic shock (58 fatal). Internal organ abscesses and secondary foci in lungs and/or joints were common. Prostatic abscesses occurred in 76 (20% of 372 males). 96 (18%) had occupational exposure to Burkholderia pseudomallei. 118 (22%) had a specific recreational or occupational incident considered the likely infecting event. 436 (81%) presented during the monsoonal wet season. The higher proportion with pneumonia in December to February supports the hypothesis of infection by inhalation during severe weather events. Recurrent melioidosis occurred in 29, mostly attributed to poor adherence to therapy. Mortality decreased from 30% in the first 5 years to 9% in the last five years (p<0.001). Risk factors for melioidosis included diabetes (39%), hazardous alcohol use (39%), chronic lung disease (26%) and chronic renal disease (12%). There was no identifiable risk factor in 20%. Of the 77 fatal cases (14%), 75 had at least one risk factor; the other 2 were elderly. On multivariate analysis of risk factors, age, location and season, the only independent predictors of mortality were the presence of at least one risk factor (OR 9.4; 95% CI 2.3–39) and age ≥50 years (OR 2.0; 95% CI 1.2–2.3).ConclusionsMelioidosis should be seen as an opportunistic infection that is unlikely to kill a healthy person, provided infection is diagnosed early and resources are available to provide appropriate antibiotics and critical care.

An Extensive Portal Venous Thrombosis in a Patient with a Pancreatic Abscess - A Lemierreʼs Syndrome Variant?

Purpose: Lemierre's Syndrome, otherwise referred to human necrobacillosis or post-anginal sepsis, is a disease usually associated with the occurrence of a pharyngitis followed by migration of anerobes (most frequently Fusobacterium) to the internal jugular vein, forming a septic thrombus. These spread and form abscesses in distal organs, such as the lungs or liver. There has recently been an advent of atypical cases of Lemierre's Disease, referred to as variant cases, characterized by thrombus formation or thrombophlebitis in concert with abscesses, but in the absence of a clinical pharyngitis or Fusobacterial etiology. Lemierre's Syndrome was once considered a forgotten disease; however with the advent of antibiotic resistance, there has been a resurgence of this disease entity. This case pertains to a patient with history of aortic endograft placement who presented to the hospital with abdominal pain. A CT scan showed a pancreatic head mass and questionable liver abscess, in addition to a portal vein thrombus. A CT guided fine needle aspiration of the pancreatic head mass yielded Fusobacterium; the diagnosis of variant Lemierre's Syndrome was rendered. Course: Patient is a 62 year old man with a medical history of alcoholism and abdominal aortic aneurysm and endograft repair in 1995 who presented to an outside hospital with epigastric pain, weight loss of 40 pounds in 6 months, and fever. The patient's total bilirubin on admission was 2.4 mg/dL and his white blood cell count was 31.3 k/μL. An abdominal CT scan showed a pancreatic head mass as well as questionable liver lesions and a portal vein thrombus. The patient was started on Metronidazole and Levofloxacin. A CT guided FNA produced fluid, positive for Fusobacterium. Patient was transferred, where his antibiotics were augmented to include Pipercillin/Tazobactam. An MRI was done which showed changes in the liver consistent with ischemia related to septic thrombophlebitis - additionally there was some concern for aortic graft infection. A CT angiogram of the abdomen corroborated these findings and showed a possible duodenal diverticulum versus diverticular perforation. Push enteroscopy was considered, but with the patient's poor respiratory status, this pursuit was abolished. In the absence of peritoneal signs on abdominal exam or blood in the patient's stool, conservative management was chosen. Currently, the patient is doing well on appropriate antibiotic therapy. Discussion: In those individuals with cystic pancreatic lesions and in the absence of other diseases such as cancer to explain the patient's presentation, Fusobacterium infections should be given consideration.

An Unusual Appearance of Discitis due to Gas-Forming Escherichia coli With Associated Pneumocephalus

Case report. To report on an unusual case of isolated septic discitis, meningitis, pneumocephalus, and solid organ abscesses associated with urosepsis from gas-producing Escherichia coli. Isolated septic discitis, or disc infection without involvement of adjacent vertebrae, following E. coli urosepsis is an unusual finding in the adult population and to our knowledge has not been reported previously. The clinical manifestations and imaging findings of a patient with a history of back pain are described. The significance of the reported case is discussed. Laboratory finding and imaging studies revealed a Gram-negative sepsis associated with meningitis, discitis, pneumocephalus, and solid organ abscesses. Due to widespread involvement of multiple organs, the infection remained refractory to treatment, and the patient died. Our report adds to the literature by describing an unusual appearance of spine infection in an adult. Furthermore, it emphasizes the importance of a systematic approach to the diagnosis and treatment of low back pain.

Pathological Changes in Captive Monkeys with Spontaneous Yersiniosis due to Infection by Yersinia enterocolitica serovar O8

An outbreak of fatal yersiniosis due to infection with Yersinia enterocolitica serovar O8 is documented in two species of captive monkey. Five of 50 squirrel monkeys (Saimiri sciureus) and one of two agile gibbons (Hylobates agilis) died following several days of diarrhoea. Necropsy examination revealed necrotizing enterocolitis and multifocal necrosis or abscesses in various organs. Microscopically, these lesions comprised multifocal necrosis with bacterial colonies, neutrophils and accumulation of nuclear debris. Occasional lesions included macrophages and abscess formation. Immunohistochemically, the bacteria were identified as Y. enterocolitica O8. In addition, Y. enterocolitica serotype O8 was isolated from animal organs in pure culture. This is the first report of fatal cases of infection with Y. enterocolitica serovar O8 in animals.

Staphylococcus aureus synthesizes adenosine to escape host immune responses

Staphylococcus aureus infects hospitalized or healthy individuals and represents the most frequent cause of bacteremia, treatment of which is complicated by the emergence of methicillin-resistant S. aureus. We examined the ability of S. aureus to escape phagocytic clearance in blood and identified adenosine synthase A (AdsA), a cell wall–anchored enzyme that converts adenosine monophosphate to adenosine, as a critical virulence factor. Staphylococcal synthesis of adenosine in blood, escape from phagocytic clearance, and subsequent formation of organ abscesses were all dependent on adsA and could be rescued by an exogenous supply of adenosine. An AdsA homologue was identified in the anthrax pathogen, and adenosine synthesis also enabled escape of Bacillus anthracis from phagocytic clearance. Collectively, these results suggest that staphylococci and other bacterial pathogens exploit the immunomodulatory attributes of adenosine to escape host immune responses.

Melioidosis and tuberculosis: dual pathogens in a neck abscess

Melioidosis is an infectious disease caused by a saprophytic bacterium, Burkholderia pseudomallei. It is endemic to Southeast Asia and Northern Australia. It may manifest as a pulmonary lesion, osteomyelitis, abscesses in soft tissue and various organs, or as septicaemia. We report a case of a 40-year-old, diabetic man who presented with a neck lump resulting from super-infection of a tuberculosis cavity with B pseudomallei. The patient was successfully managed by drainage along with meticulous excision of the capsule and prolonged antibiotic and anti-tubercular treatment. Melioidosis may be confused diagnostically with tuberculosis, as both diseases are endemic in the same regions. Our patient was unfortunate to suffer from both endemic diseases simultaneously, perhaps representing the first such case in the world literature. Increased awareness of melioidosis is important as, although the organism is easy to culture, it may be dismissed as a contaminant.

Liver Abscess Due To Unusual Gram Negative Bacilli: &lt;italic&gt;Burkholderia Pseudomallei&lt;/italic&gt;?

Burkholderia pseudomallei, a natural saprophyte of soil, stagnant waters of rice paddies etc. causes infection ranging from short febrile illness, Pyogenic abscesses in various organs to fatal septicemia. We report here two patients, occupationally field workers presenting with liver abscesses along with fever, abdominal pain and tender hepatomegaly. Aspirated pus from liver abscess was cultured and found to grow a non-fermenter later suspected to be Burkholderia pseudomallei based on various evidences. This organism is being documented for the first time from this hospital and brings to the notice the possible prevalence of this organism in this area.

The Streptococcus milleri group—An unrecognized cause of disease in cystic fibrosis: A case series and literature review

The "Streptococcus milleri" group (SMG) is increasingly recognized for their role in pyogenic infections including empyema and solid organ abscesses. However, SMG disease has rarely been identified in cystic fibrosis (CF). Inherent difficulties in both growing the organisms and distinguishing SMG from less virulent oropharyngeal viridans streptococci may have led to a decreased recognition of this as a CF pathogen. We report on six cases of SMG-related infection over a 4-year time-frame occurring within an adult CF clinic in Canada, and a further four cases identified through a literature review. SMG manifested disease as bronchopulmonary exacerbations in 7 of 10 patients, and 4 of 10 patients had extra-pulmonary dissemination of SMG infection. Noticeably, pulmonary exacerbations were frequently associated with atypically malodorous sputum. Furthermore, patients clinically responded to anti-microbial therapies with no anti-Pseudomonal activity. There was a consistent correlation of SMG disease and co-colonization with P. aeruginosa leading to speculation of polymicrobial interactions resulting in enhanced virulence. SMG deserves considerable attention as a potential pathogen within the airways of patients with CF.

Cranial melioidosis presenting as a mass lesion or osteomyelitis

Melioidosis is caused by Burkholderia pseudomallei and causes multiple abscesses in different organs of the body. Cranial melioidosis, although uncommon, is sometimes confused with tuberculosis and is therefore under-recognized. The authors report on 6 cases of cranial infections caused by Burkholderia pseudomallei, presenting as mass lesions or cranial osteomyelitis, and review the literature. The authors performed a retrospective review of the records of patients with cranial melioidosis treated at their institution between 1998 and 2005 to determine the presentation, management, and outcome of patients with this infection. Of the 6 patients diagnosed with cranial melioidosis during this period, 4 had brain abscesses and 2 had cranial osteomyelitis. All patients were treated surgically, and a diagnosis was made on the basis of histopathological studies. All patients were started on antibiotic therapy following surgery and this was continued for 6 months. One patient died soon after stereotactic aspiration of a brain abscess, and the other 5 patients had good outcomes. Cranial melioidosis is probably more prevalent than has been previously reported. A high index of suspicion, early diagnosis, initiation of appropriate antibiotic therapy and treatment for an adequate period are essential for assuring good outcome in patients with cranial melioidosis. The authors recommend surgery followed by intravenous ceftazidime treatment for 6 weeks and oral cotrimoxazole for 6 months thereafter in patients with cranial melioidosis.

Case report: brain and liver abscesses caused by oral infection with Streptococcus intermedius

Organ abscesses are a rare and life-threatening complication mostly of hematogenously disseminated infections. We report a case of brain and liver abscesses. Identification of the lesions was made by contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI), respectively. An oral examination comprised an oral focus of infection. Streptococcus intermedius was isolated from oral smear, liver and ventricular drainage, and blood sample. After the commencement of antibiotic therapy, drainage of abscesses and oral rehabilitation, complete recovery was noted.

Melioidosis in an Italian Tourist Injured by the Tsunami in Thailand

Recently, many alerts regarding infectious diseases emerging in the wake of the disastrous tsunami in Southeast Asia have been reported 1. In particular, increased awareness of melioidosis has been suggested and several related strains have been isolated from people who were injured in the natural disaster 2-5. Melioidosis is an infection caused by Burkholderia psudomallei that lives in the soil in the tropical north of Australia and Southeast Asia. In particular the disease is endemic in Northern Thailand because of the high concentration of bacteria in rice paddy surface water. The disease is usually acquired by inhalation or inoculation through skin lesions of the microorganism which is present in contaminated soil or water 6. Symptoms may appear within 2 days or only after several years and can include skin abscesses or ulcers, abscesses in internal organs, septicemia and pneumonia. Moreover, severe pneumonia or septicemia can sometimes be fatal even with treatment 7. Diabetes, chronic renal or lung disease and other severe underlying conditions constitute predisposition factors to melioidosis. We report a case of human melioidosis in a 72year-old Italian woman traveller who returned to Italy after being injured by the tsunami in Thailand. To our knowledge, this is the first case of this type occurring in Italy in a person without any underlying severe predisposing condition, and directly related to wounds caused by a tsunami. The patient was admitted to the Campo di Marte Hospital, Department of Infectious Diseases, Lucca, Journal of Chemotherapy Vol. 18 n. 4 (443-444) 2006

Renal brucelloma: A rare infection of the kidney

We report a case of renal abscess caused by brucellosis (renal brucelloma) which was treated by surgery. Renal parenchymal involvement of systemic brucellosis is a very rare condition and relapses after medical treatment, such as solid organ abscess including kidney, should be especially considered. In chronic cases, laboratory findings including polymerase chain-reaction examination is needed for definitive diagnosis.

A 15-Year-Old with Sepsis and Cavitary Lung Lesions

We report the case of a critically ill patient with Lemierre syndrome. Lemierre syndrome is characterized by septic thrombophlebitis of the internal jugular vein and metastatic abscesses in different organs, most frequently in the lungs. The disease usually occurs in young, previously healthy individuals. Most cases are caused by Fusobacterium necrophorum, an anaerobic gram-negative rod. Oropharyngeal infection occurring 2–3 weeks prior to septicemia is a harbinger of the syndrome. Frequently oropharyngeal symptoms and local signs are absent at the time of presentation. Computed tomography (CT) scan of the neck with contrast is the most helpful diagnostic study to identify internal jugular vein thrombosis. Treatment involves a prolonged course of intravenous antibiotics with anaerobic coverage. It is important for an intensivist to keep this syndrome in mind, especially when dealing with a young, otherwise healthy patient with sepsis. Mortality is high if the disease is not diagnosed and treated promptly. The syndrome is rare in the antibiotic era, therefore a high index of suspicion is essential.

A 15-Year-Old with Sepsis and Cavitary Lung Lesions

We report the case of a critically ill patient with Lemierre syndrome. Lemierre syndrome is characterized by septic thrombophlebitis of the internal jugular vein and metastatic abscesses in different organs, most frequently in the lungs. The disease usually occurs in young, previously healthy individuals. Most cases are caused by Fusobacterium necrophorum, an anaerobic gram-negative rod. Oropharyngeal infection occurring 2–3 weeks prior to septicemia is a harbinger of the syndrome. Frequently oropharyngeal symptoms and local signs are absent at the time of presentation. Computed tomography (CT) scan of the neck with contrast is the most helpful diagnostic study to identify internal jugular vein thrombosis. Treatment involves a prolonged course of intravenous antibiotics with anaerobic coverage. It is important for an intensivist to keep this syndrome in mind, especially when dealing with a young, otherwise healthy patient with sepsis. Mortality is high if the disease is not diagnosed and treated promptly. The syndrome is rare in the antibiotic era, therefore a high index of suspicion is essential.

The effects of health classification and housing and management of feeder pigs on performance and meat inspection findings of all-in–all-out swine-finishing herds

The effects of health classification and of housing and management on performance and meat inspection findings were studied in 166 all-in–all-out finishing herds in Finland in 1995 and 1998. Producers could buy either health-classified (certified free of certain diseases) or standard-class pigs for their farms. Herds that had attained a certain level of housing and management were eligible to join the LSO 2000 management system for finishing herds. In 1995, none of the study herds were LSO 2000 units. In 1998, 76 of them had become LSO 2000 units, while 90 had remained as non-LSO 2000 units. Continuous outcome variables (daily gain and time in the finishing unit) were analysed with a mixed-model procedure with repeated measurements from the same farms. Discrete variables were analysed either with Poisson regression (mortality, whole- and partial-carcass condemnations, organ condemnations, arthritis, abscesses) or logistic regression (liver condemnations, pneumonia, pleuritis). The models were adjusted for the year, size of the herd and the average slaughter weight of the batch. The benefits obtained by the health classification of the feeder pigs included a substantial increase in daily gain (37 g, about 5%) and decrease in time in the finishing unit (4 days, about 4%), decrease in mortality (odds ratio, OR 0.68), a substantial decrease in pneumonia (OR 0.37) and pleuritis (OR 0.60), and a substantial decrease in liver (OR 0.45) and organ (OR 0.72) condemnations. Classification of the pigs did not have an effect on the prevalence of whole-carcass condemnations, arthritis or abscesses. The health-classified pigs had, unexpectedly, more partial-carcass condemnations (OR 1.15) than the standard-class pigs. The obtained benefits of the LSO 2000 units were an increase in daily gain (14 g, about 2%), decrease in time in the finishing unit (2 days, about 2%), a decrease in mortality (OR 0.69) and a decrease in whole-carcass (OR 0.69) and partial-carcass (OR 0.81) condemnations. The LSO 2000 units did not have any advantage over the non-LSO 2000 units in their prevalence of liver or organ condemnations, arthritis, abscesses, pneumonia or pleuritis.