Psoas Abscess In Patient Research Articles

1363. Most Psoas Abscesses are Pyogenic; not Tuberculous: Experience from South India

Abstract Background It is a common belief that psoas abscess in patients from developing countries like India are mostly tubercular in origin. However, most of the diagnosis of a tubercular psoas abscess are based on radiological features and are not confirmed microbiologically. It is possible that many cases of pyogenic psoas abscesses are misdiagnosed as tubercular due to lack of good quality microbiology lab facilities in developing nations. We studied the microbiology of psoas abscess in patients admitted to KIMSHealth, a tertiary care hospital in Kerala, South India. Methods Clinical details of patients with a diagnosis of psoas abscess over a 6-year period (2015 – 2020) were retrieved from electronic medical records. Microbiological investigations done included bacterial culture of the pus, fungal culture, mycobacterial culture, cartridge based nucleic acid amplification test for Mycobacterium tuberculosis and blood cultures. Results 21 patients who had complete clinical details were included. 15 of them were males and the median age was 58 years. Diabetes mellitus was the most common comorbidity (52%). Fever (61.9%) and back pain (52.4%) were the most common symptoms. The abscess was left sided in 11 patients, right sided in 7 and bilateral in 3. Vertebral involvement was present in 9 patients while hip joint was involved in 3 patients. A microbiological diagnosis was made in 14 patients (66%). Most commonly isolated organism was Staphylococcus aureus (8 patients,MSSA:6, MRSA:2) followed by E.coli (3)and Klebsiella pneumoniae (2). Blood cultures were positive in 5 patients. Anti-tuberculous therapy was started in only one patient, which was based on characteristic histopathology and negative bacterial cultures. Rest of the culture negative cases were also treated as pyogenic abscesses with antibiotics. Surgical drainage was done for 7 patients and pig tail drainage for 3 patients, while percutaneous aspiration was done for 9 patients. All 19 patients who followed up had clinical resolution, while two were lost to follow-up. Conclusion Contrary to what is believed, we observed that most psoas abscesses are pyogenic in origin. Our observations reiterates diligent microbiological investigations in all cases of psoas abscess to avoid empiric anti-tuberculous therapy. Disclosures All Authors: No reported disclosures

Psoas abscess in an adolescent with diabetes mellitus

Psoas abscess is rare condition which occurs from a spread of nearby or distant infection. Although diabetes mellitus is the most important risk factor for psoas abscess, there are few cases reported psoas abscess in patients with diabetes mellitus. We reported a rare entity case of psoas abscess in a16 year's old adolescent patient who had poorly controlled diabetes mellitus type 1. He presented with diabetic ketoacidosis, right flank, and low back pain. Computed tomography showed an accumulation of fluid in right psoas muscle. After resuscitation with fluid and giving intravenous antibiotics, our patient underwent successful percutaneous drainage of the pus. Fluid culture revealed staphylococcus aureus. After 15 days, we discharged him with course of ciprofloxacin. Follow-up for five months showed no recurrence. To best of our knowledge, this is the fifth case of psoas abscess in an adolescent patient who had diabetes mellitus.

Characteristics of PSOAS Abscess in Patient with Tuberculosis spondylitis from 2016 to 2018 in Haji Adam Malik General Hospital Medan

Objective- Psoas abscess one of rare manifestation of tuberculosis spondylitis. 5% of cases will develop psoas abscess and can increase the number of morbidity and mortality if the diagnosis and treatment were late. Material and Method-This is a cross sectional study to determine characteristics of psoas abscess in patient with tuberculosis spondylitis. The data is taken from patient’s medical record in Haji Adam Malik General Hospital from January 2016 to Desember 2018. The Population of this study is all the patients with tuberculosis spondylitis who come to Emergency Department or Outpatient Clinic. The collected data is tabulated and presented in the form of a frequency distribution diagram or table and analysed descriptively using total sampling. Results-The Subject for this study are 13 patients, within the proportion 5 patients are male (38.5%) and 8 patients are female (61.5%). The data show 5 patients have the ages < 18 years old (38.5%) and 8 patients have the ages > 18 years old (61.5%). All the patients get antituberculosis drugs as non operative treatment and 11 patients (84.6%) get an additional operative treatment for drainage the abscess. The site of psoas abscess in this study, 3 patients developed in thoracolumbal region (21.7%), 7 patients developed in lumbal region (53.8%) and 3 patients developed in lumbosacral region (21.7%). Conclusion- from this study we conclude that the incidence are happened in female more common than male, it usually affects young adult >18 years old and the common site of psoas abscess is lumbar region.

Simultaneous Anterior and Posterior Surgery in the Management of Tuberculous Spondylitis with Psoas Abscess in Patients with Neurological Deficits

Study DesignThis is a retrospective study.PurposeWe wanted to evaluate the treatment outcomes of performing simultaneous anterior and posterior surgery for patients with tuberculous spondylitis and psoas abscess.Overview of LiteratureAlthough various treatment options have been used for spinal tuberculosis, there are only a few reports on the treatment of tuberculous spondylitis with psoas abscess.MethodsBetween March 1997 and February 2006, we performed operations on 14 cases of tuberculous spondylitis with psoas abscess. All the cases underwent anterior debridement with an interbody bone graft and posterior fusion with using pedicle screws.ResultsUnder the Frankel classification, 1 case improved by two grades, 10 cases improved by 1 grade and 3 cases demonstrated no change. The Kirkaldy-Willis functional outcomes were classified as excellent in 10 cases and good in 4. One year after surgery, bony union was confirmed in all 14 cases. The mean kyphotic angle of the spinal lesion was 12.4° and the mean lordotic angle at the final follow-up was 6.4°. Postoperative complications (superficial wound infections) were encountered in 2 cases.ConclusionsOur results demonstrate that anterior debridement with interbody bone grafting and posterior instrumented fusion can provide satisfactory results for treating tuberculous spondylitis with psoas abscess in patients with neurological deficits.

Psoas abscess in patients with an infected aortic aneurysm

Psoas abscess is an uncommon disease, and its presenting features are usually nonspecific. Infected aortic aneurysms could be complicated by psoas abscess. A retrospective chart review was conducted to examine the incidence, clinical presentations, microbiology, and outcomes of psoas abscess in patients with an infected aortic aneurysm. Between 1996 and 2007, 40 patients (32 men) with an infected infrarenal aortic aneurysm were treated in our hospital. Their median age was 71 years (range, 38 to 88 years). In 38 patients a blood or tissue culture had a positive result. The most common responsible pathogen was Salmonella spp in 29 patients (76%), followed by Staphylococcus aureus in 3 (8%), Escherichia coli in 2 (5%), Klebsiella pneumoniae in 3 (8%), and Mycobacterium tuberculosis in 1 (3%). One patient underwent endovascular repair but died. In-situ graft replacement was done in 32 patients. Persistent or recurrent infection occurred in seven (22%) of 32 operated on patients. The mortality rate was 86%, and the overall aneurysm-related mortality rate of in situ graft replacement was 22% (7/32). In eight (20%) of the 40 patients, aortic infection was complicated by psoas abscess. Infection complicated by psoas abscess was present in seven of 32 operated patients. It was associated with higher incidence of emergency operation, hospital mortality, prosthetic graft infection, and aneurysm-related mortality than infection without abscess. Psoas abscess was common in patients with infected infrarenal aortic aneurysm. Salmonella spp was the most common pathogen. Psoas abscess was associated with a high mortality rate, emergency operation, and persistent infection.

Diagnosis and treatment of pyogenic psoas abscess in diabetic patients: usefulness of computed tomography and gallium-67 scanning

Objectives. To examine retrospectively the clinical presentations, microbiologic characteristics, and treatment outcomes of psoas abscess in patients with diabetes mellitus (DM) and to assess the usefulness of computed tomography and gallium-67 scanning in its early diagnosis. Methods. During a 9-year period, psoas abscesses in patients with DM were collected at a medical center. The clinical history and associated etiologic factors, microbiologic results, clinical outcomes, and hospitalization days were recorded. The use of imaging in the diagnosis of psoas abscess and other concomitant infectious lesions was also studied. Results. Fifteen patients with DM and psoas abscess (13 women and 2 men; mean age 58.7 ± 9.0 years) were found. The most frequent symptom was fever (12 of 15). Of the six different microorganisms that grew in the blood and/or abscess cultures, Staphylococcus aureus was the most frequent (7 of 15). The most commonly associated pathologic finding was vertebral osteomyelitis (5 of 15). Computed tomography and/or magnetic resonance imaging confirmed the diagnosis of psoas abscesses in all 15 patients. The gallium-67 scan especially aided in the diagnosis of the patients who had initially been diagnosed as having fever of unknown origin (4 of 5) and in the diagnosis of concomitant lesions (9 of 12). Debridement or surgical drainage of the abscess was done in 12 patients. All the patients received adequate antibiotic treatment. However, the mortality rate was 20%. The average hospitalization stay was 42.7 ± 20.7 days. Conclusions. Psoas abscess in patients with DM is a disease with both diagnostic and therapeutic challenges. We found the infecting microorganisms to be variable and the mortality rate high.