Drainage Of Pus Research Articles

Extended sequential intravenous and oral antimicrobial therapy improves cure rate in postoperative intracranial neurosurgical infections: a Spanish multicenter retrospective study

BackgroundPostoperative intracranial neurosurgical infections (PINI) complicate < 5% neurosurgeries. Scarce attention was dedicated to the extension and characteristics of its antimicrobial management considering their high morbidity, not negligible mortality, delayed hospital stay and increased healthcare costs.MethodsWe analyzed retrospectively (2014–2023) 162 PINI from eight Spanish third-level academic hospitals.ResultsElective clean craniotomies after tumor or vascular causes were the leading procedures. Epidural abscess (24.7%), scalp infections (19.8%), postsurgical meningitis (16.7%) and cranioplasty infections (16.7%) were the most frequent PINI. Gram negative bacteria (38.6%) and Staphylococcus spp (28.6%) were the predominant isolates. Overall 85.2% patients underwent pus drainage, mostly by craniotomy (40.3%). Interestingly 34% were already receiving antibiotics for extracranial infections before developing PINI while 16.8% did not receive pre-operative antibiotic prophylaxis. In total 77.2% patients started a combined intravenous (IV) antimicrobial therapy, of which 85.2% switched after 5 days to a second-line IV antibiotic regimen, in 41.3% cases combined, after pus culture results, for a median of 21 days. Overall 61.1% patients continued on oral antimicrobials after hospital discharge, 30.3% as a combined regimen, for a median of 42 days. Complete cure was obtained in 81.5% cases, while 11.1% relapsed, 7.4% failed to cure and 6.8% died after PINI complications. In the multivariate analysis oral antimicrobial therapy after hospital discharge (p = 0.001) was significantly associated with PINI cure with no effect on survival.ConclusionsWe conclude that an extended 6 weeks sequential IV and oral antimicrobial therapy in addition to neurosurgical correction increases PINI cure rate with no effect on survival.Clinical trial numberNot applicable.

Brain Abscess Causes Brain Damage With Long-Lasting Focal Cerebral Hypoactivity that Correlates With Abscess Size: A Cross-Sectional 18F-Fluoro-Deoxyglucose Positron Emission Tomography Study.

Bacterial brain abscesses may have long-term clinical consequences, eg, mental fatigue or epilepsy, but long-term structural consequences to the brain remain underexplored. We asked if brain abscesses damage brain activity long term, if the extent of such damage depends on the size of the abscess, and if the abscess capsule, which is often left in place during neurosurgery, remains a site of inflammation, which could explain long-lasting symptoms in patients with brain abscess. 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT), electroencephalography, and MRI were performed 2 days to 9 years after neurosurgery for bacterial brain abscess. FDG-PET/CT revealed hypometabolism in the neocortex or cerebellum overlying the previous bacterial abscess in 38 of 40 patients. The larger the abscess, the greater was the extent of the subsequent hypometabolism (r = 0.63; p = 3 × 10-5). In 9 patients, the extent of subsequent hypometabolism seemed to coincide with the extent of peri-abscess edema in the acute phase. Follow-up MRI after ≥1 year in 9 patients showed focal tissue loss and gliosis. In 13 patients with abnormal electroencephalography recordings, abnormalities extended beyond the cerebral lobe affected by the abscess, indicating damage to wider brain networks. The abscess capsule had an FDG signal indicating inflammation only during the first week after neurosurgical pus drainage. The bigger a brain abscess is allowed to grow, the more extensive is the long-term focal reduction in brain activity. This finding emphasizes the need for rapid neurosurgical intervention. The abscess capsule does not display long-lasting inflammation and probably does not explain long-term symptoms after brain abscess.

Gossypiboma with enterocutaneous fistula after cesarean section: a case report and review of the literature

IntroductionAlthough precautions taken for surgical procedures are strict and effective in most operative theaters, the incidence of retained foreign bodies following surgery has a reported rate of 0.01–0.001%, of which gossypibomas make up 80% of cases.Case presentationA 42-year-old woman who was Oromo in ethnicity came to the hospital with symptoms of infection, including pus drainage from her lower abdominal incision, fever, chills, and weight loss. Tests indicated an intraabdominal mass consistent with a foreign body from a previous surgery. An exploratory laparotomy revealed a surgical pack causing intestinal perforations. The foreign body was removed, and the patient recovered well postoperatively.ConclusionRetained surgical items are serious problems of surgical operations that can result in morbidity and mortality. Therefore, it should be among the differential diagnoses of any abdominal pain in patients having a history of prior surgery.

Taurolidine Irrigation Reduces Relapse and Recurrence of Hemodialysis Access Infection

Infection of hemodialysis access is a clinically important concern and can lead to increased morbidity and mortality among patients on hemodialysis. In this study, we aimed to determine whether using taurolidine as an irrigating antiseptic after drainage of pus or removal of infected tissue and graft during surgery decreases the relapse and recurrence of infection. Between January 2016 and December 2023, 48 episodes in 38 patients hospitalized and treated for hemodialysis access infections were examined. Relapse, recurrence, and mortality of infection were analyzed in patients who received additional taurolidine irrigation versus those who did not. After drainage alone or after total or partial graft removal, all patients received massive irrigation with normal saline. The episodes of infection were examined consecutively during follow-up. The majority (97.9%) of hemodialysis access infections was arteriovenous grafts (AVGs) or interposed grafts from native veins. In AVGs, infections occurred primarily after a median of 523days from the first needling. All prosthetic materials that were the infection foci were removed in 58.3% of the cases, with partial resection and bypass or drainage performed in the remaining cases. The most common pathogen was Staphylococcus aureus (45.8%). After surgical intervention, relapse was observed in 12.5% of the cases and recurrence in 20.8% of the cases. The relapse occurrence was significantly reduced by taurolidine irrigation (odds ratio [OR]: 0.16, 95% confidence interval [CI]: 0.02-0.98, P=0.05) and the total resection of prosthetic material (OR: 0.07, 95% CI: 0.01-0.70, P=0.02). Recurrence was significantly decreased by taurolidine irrigation (OR: 0.10, 95% CI: 0.02-0.56, P=0.01) and increased dramatically in cases with relapse history (OR: 8.50, 95% CI: 1.69-42.76, P<0.01). Finally, male sex (hazard ratio: 7.01, 95% CI: 1.19-41.40, P=0.03) and AVG (hazard ratio: 4.49, 95% CI: 1.01-20.01, P=0.05) were significantly associated with increased overall mortality in infected hemodialysis access. Additional taurolidine irrigation after surgical resection significantly reduced the relapse and recurrence of infection in hemodialysis access. Taurolidine appears to be a safe and useful antiseptic for the control of hemodialysis access infection.

Healing of periapical lesion by non-surgical endodontic therapy: A case report

Periapical lesions often arise as a consequence of pulpal diseases, and most inflammatory periapical lesions are initially managed with conservative non-surgical methods. The success of root canal treatment hinges on the thorough cleaning, shaping, and obturation of the root canal system. Calcium hydroxide and triple antibiotic paste (TAP) are preferred intracanal medicaments due to their effective antibacterial properties. This case report details the non-surgical management of a periapical lesion associated with the mandibular central incisors in a 18-year-old female who presented with periodic swelling and pus drainage in the labial sulcus, due to traumatic accident in the that area. The case underscores the effectiveness of using calcium hydroxide and TAP as interappointment endodontic dressings, leading to favorable clinical and radiographic outcomes for managing a periapical radiolucency.

Management Of Large Periapical Lesion With A Noninvasive Approach: A Case Report

Periapical lesions develop as a sequela to pulpal diseases. The majority of inflammatory periapical lesions are initially treated with conservative non-surgical procedures. The success of root canal treatment is based on thorough cleaning, shaping and obturation of the root canal system. Calcium hydroxide and triple antibiotic paste (TAP) are recommended as intracanal medicaments due to its antibacterial properties. This case report describes the non-surgical management of a large cyst-like periapical lesion in relation to the maxillary lateral incisor of a 19-year-old male with the chief complaint of periodic swelling and pus drainage from the palatine region with a history of a traumatic accident in the same area. The present case highlights the use of calcium hydroxide and TAP as an interappointment endodontic dressing for non-surgical management of large periapical radiolucency, which resulted in favourable clinical and radiographic outcomes

Large Spontaneous Subcutaneous Abscess Formation due to Finegoldia magna in a Diabetic Patient: A Case Report.

Finegoldia magna is a member of the Gram-positive anaerobic cocci group and constitutes the flora of the skin and other parts of the body. It sometimes colonizes diabetic foot and rarely infects skin or soft tissue of non-immunocompromised patients. Here, we report the case of a severe subcutaneous abscess on the back caused by F. magna involving an immunocompromised patient with poorly controlled diabetes. A 48-year-old woman with diabetes mellitus and anemia associated with uterine fibroids was referred to us with a 1-month history of a skin manifestation on her back, with a body temperature of 35.9°C and blood pressure of 115/73 mm Hg. The manifestation involved a subcutaneous mass of 36 × 45 cm with a foul odor, partly covered with necrotic tissue, which had the appearance of a tortoiseshell-like pattern. Blood examination revealed C-reactive protein of 21.4 mg/dL and hemoglobin A1c of 9.1%. Contrast-enhanced computed tomography showed a subcutaneous abscess with internal emphysema. Emergency debridement was performed, resulting in drainage of foul-smelling gray-green pus. F. magna was detected in the pus and skin tissue. Skin and soft tissue infectious disease caused by F. magna is extremely rare, but the disease tends to become severe once developing in an immunocompromised patient, such as a patient with poorly controlled diabetes. Therefore, physicians should consider F. magna as a causative agent when poorly controlled diabetic patients suffer from severe infectious cutaneous manifestations.

Clinical value of endoscopic lacrimal duct probing in neonates with acute dacryocystitis

ObjectiveTo observe the clinical of endoscopic-assisted lacrimal duct probing in neonates with acute dacryocystitis. MethodsThe prospective treatment of 148 eyes of 103 cases of neonatal acute dacryocystitis was studied. In the observation group, 58 cases (76 eyes) underwent endoscopic exploration of lacrimal passage under topical anesthesia. Make the child lie on the bed, after the surface anesthesia of hydroxybucaine hydrochloride, dot dilator is not easy to expose the dilatable lower point. With the assistance of nasal endoscope, the probe of the No. 6 lateral foramina lacrimal duct entered the lacrimal duct and dacryocyst successively. After entering the dacryocyst, the pus was sucked out with a syringe and rinsed repeatedly with normal saline until no obvious suppurative secretions were discharged. Postoperative topical anti-inflammatory eye drops and oral antibiotics were used. In the control group, 45 patients (72 eyes) were treated with hospitalized systemic antibiotics and conservative treatment with local antibiotic eye drops. ResultsIn the observation group, 58 cases (76 eyes) underwent superficial anesthesia and nasal endoscopy assisted lacrimal duct exploration and achieved satisfactory results. Stenosis of the lower nasal passage was found in one eye. In all cases, there were no serious complications during and after surgery, and no recurrence was observed for 3 months to 1 year after surgery. In the control group, 45 cases (72 eyes) of neonates with acute dacryocystitis, 10 cases with conjunctival sac secretion disappeared after conservative treatment. Redness and swelling in the dacryocystitis were improved in 31 cases, of which 2 cases had facial scars due to drainage of pus from the conjunctiva sac through a percutaneous laceration incision. Four patients were discharged automatically due to the aggravation of symptoms. After 6 months of follow-up, about 50% of the children received exploratory treatment of lacrimal passage and completely healed. ConclusionNasal endoscope-assisted dacryocystitis is a method for the treatment of neonatal acute dacryocystitis, which is worthy of clinical promotion.

Pyopericardium progresses to cardiac tamponade in patient of hypothyroidism due to Staphylococcus aureus

Pyopericardium is a rare condition with a high mortality rate, in which, infection propagates into pericardial space, leading to pus-filled pericardial effusion and cardiac tamponade which can lead to cardiogenic shock and death, if there is any delay in diagnosis and treatment with antibiotics and pericardial drainage. We report the case of a 28-year-old female, a known case of hypothyroidism from the last 6 years who presented with 2 months of fever and recent onset shortness of breath diagnosed as pyopericardium due to Staphylococcus aureus, and having clinical features of cardiac tamponade. She was a known case of hypothyroidism non-compliant with treatment. Pyopericardium conformed with transthoracic 2D echocardiography-guided aspiration of pericardial fluid. After pericardial pus drainage, the patient symptomatically improved initially but remained in shock due to ongoing sepsis and died due to septic shock and multi-organ failure.

Diagnosis of Empyema as a Complication of Liver Abscess in Peripheral Area

Right pleural empyema is one of the rare complications in liver abscess. This condition is life-threatening as it causes breathing difficulties and requires immediate life-saving. This case report aims to diagnose and manage empyema in a male patient with a liver abscess in a limited diagnostic setting. Methods: According to medical records, a 44-year-old man came to the emergency room (ER) of Umbu Rara Meha General Hospital with complaints of shortness of breath that had been getting worse for two months, accompanied by a cough with phlegm for one week, fever, and weight loss. The patient also complained of pain in the right upper abdomen for the last four months. History of pulmonary tuberculosis, diabetes mellitus, or hypertension was denied. The patient is not a smoker. On physical examination, there was an increase in the frequency of breathing and a decrease in the vesicular sounds on the right side. Right thorax X-ray examination revealed massive right pleural effusion without pulmonary infiltrates. Abdominal ultrasound showed a liver abscess. Emergency pleural puncture was performed in the ER, and 1600 cc of purulent pleural fluid was removed, followed by Water Sealed Draignase (WSD) installation. The patient was given intravenous broad-spectrum antibiotics and treated for 12 days. Conclusion: Empyema can be a rare but life-threatening complication of liver abscess. Medical action must be taken immediately in the ER to save the patient. Delaying pus drainage can increase morbidity and mortality rates.

Management of Dubayla al-Kabid (Liver abscess) in Unani medicine: A review

Dubayla al-Kabid (Liver abscess) is a condition in which collection of pus occurs in the liver commonly involving the right lobe. Traditional Unani medicine offers a detailed description of liver disorders alongwith their management. Causative factors of Dubayla al-Kabid include- infection, chronic dysentery, liver injury, cholelithiasis, irregular diets etc. The symptoms are fever with chills, abdominal pain, loss of appetite and difficulty in breathing. The line of treatment under Usool-e-Ilaj of the disease is based on evacuation of pus, use of medicines with Dāfi‘-i-Ḥummā (Antipyretic) , Daf‘-i-Ta‘affun (Antiseptic), Muḥāfiẓ-i-Jigar (Hepatoprotective) and Muqawwī-i-Jigar(Liver tonic) properties. In contemporary medicine liver abscess is an encapsulated collection of suppurated material within the liver resulting from either fungal, bacterial, or parasitic infection. Although Klebsiella pneumoniae accounts for 50–70% of cases in the Asian subcontinent, Entamoeba histolytica is also frequently seen in routine clinical practice causing liver abscesses. Escherichia coli is the most common bacterium causing liver abscesses. Thus, infection that spreads throughout the biliary system is one of the most frequent causes of liver abscess requiring antibiotics. The drainage of pus is the treatment of choice in cases of large abscess while small liver abscess of 2-3 cm is conventionally treated with antibiotics. Antimicrobial resistance and persistence are associated with an elevated risk of treatment failure and relapsing infections. Hence there is a need to explore the ages old treatment strategies for the management of small liver abscess laid down in traditional Unani medicine. This paper will further pave the way of developing novel therapies for the effective management of liver abscess. Keywords: Dubayla al-Kabid, Unani management, Usool-e-Ilaj

Herlyn-Werner-Wunderlich: A Rare Disease

Herlyn-Werner-Wunderlich (HWW) is a rare Mullerian disorder characterized by uterine didelphys, hemivaginal obstruction, and ipsilateral renal agenesis. This paper aimed to describe a rare case of HWW in order to give better understanding of the disease, as well as diagnosis and treatment. Then urgent action is taken in the form of incision and drainage of pus. Methods: We searched medical record of a 17-year-old girl complaining of vaginal pain since menarche. Ultrasound examination found hematocolpos and vaginal septum, pelvic MRI found uterus didelphys and left renal agenesis, then the septal incision was performed to facilitate pus drainage. Conclusion: Herlyn-Werner-Wunderlich is a rare condition with varying age of onset. Anamnesis, physical examination, ultrasonography, and MRI are needed to confirm diagnosis. As an urgent measure, a septal incision and pus drainage are performed to reduce symptoms and complications that could occur in the future. In addition, the patient needs to undergo septal resection as a follow-up treatment which can only be done in a hospital where urogenital and reconstruction divisions are available.

Bacterial Brain Abscesses Expand Despite Effective Antibiotic Treatment: A Process Powered by Osmosis Due to Neutrophil Cell Death.

A bacterial brain abscess is an emergency and should be drained of pus within 24 hours of diagnosis, as recently recommended. In this cross-sectional study, we investigated whether delaying pus drainage entails brain abscess expansion and what the underlying mechanism might be. Repeated brain MRI of 47 patients who did not undergo immediate pus drainage, pus osmolarity measurements, immunocytochemistry, proteomics, and 18F-fluorodeoxyglucose positron emission tomography. Time from first to last MRI before neurosurgery was 1 to 14 days. Abscesses expanded in all but 2 patients: The median average increase was 23% per day (range 0%-176%). Abscesses expanded during antibiotic therapy and even if the pus did not contain viable bacteria. In a separate patient cohort, we found that brain abscess pus tended to be hyperosmolar (median value 360 mOsm; range 266-497; n = 14; normal cerebrospinal fluid osmolarity is ∼290 mOsm). Hyperosmolarity would draw water into the abscess cavity, causing abscess expansion in a ballooning manner through increased pressure in the abscess cavity. A mechanism likely underlying pus hyperosmolarity was the recruitment of neutrophils to the abscess cavity with ensuing neutrophil cell death and decomposition of neutrophil proteins and other macromolecules to osmolytes: Pus analysis showed the presence of neutrophil proteins (protein-arginine deiminases, citrullinated histone, myeloperoxidase, elastase, cathelicidin). Previous studies have shown very high levels of osmolytes (ammonia, amino acids) in brain abscess pus. 18F-fluorodeoxyglucose positron emission tomography showed focal neocortical hypometabolism 1 to 8 years after brain abscess, indicating long-lasting damage to brain tissue. Brain abscesses expand despite effective antibiotic treatment. Furthermore, brain abscesses cause lasting damage to surrounding brain tissue. These findings support drainage of brain abscesses within 24 hours of diagnosis.

Radiographic Evaluation of a Single Visit Non-Surgical Root Canal Treatment of Infected Anterior Teeth: Report of two Cases

This case report describes the non-surgical root canal treatment (RCT) of two cases with a periapical lesion associated with maxillary and mandibular anterior teeth of male patients who complained of swelling associated with pus drainage and pain. The obturation of both maxillary and mandibular central incisors was done by using lateral condensation and epoxy resin-based sealer, followed by composite resin filling as a permanent restoration. Clinical and radiographic re-evaluations at 4 months and 7 months for maxillary and mandibular teeth respectively revealed progressing bone healing, particularly in a maxillary region. This case report shows that an appropriate diagnosis in combination with RCT as a conservative non-surgical approach can lead to the complete healing of a large lesion without invasive treatments.

ASSESSMENT OF THE PRESENT BACTERIOLOGICAL PROFILE AND ANTIBIOTIC SENSITIVITY PATTERN IN CHRONIC SUPPURATIVE OTITIS MEDIA IN SANA’A, YEMEN

Background and objectives: The drainage of pus from the ear through a ruptured tympanic membrane that lasts longer than 12 weeks is known as chronic suppurative otitis media (CSOM). The purpose of the study was to ascertain the microbiological profile of middle ear chronic inflammation (CSOM) and the isolates' susceptibility to locally accessible antibiotics. Subjects and methods: Total 111 ear swab samples from patients with clinically confirmed active CSOM were used in this cross-sectional investigation. Following a standard protocol, ear swabs were cultured to identify microbes. A modified Kirby-Bauer disk diffusion method was used to test antibiotic susceptibility, and the Clinical Laboratory Standards Institute's guidelines were followed to determine the diameter of the zone of inhibition. Results: During two years, 111 patients with chronic suppurative otitis media were collected from January 2020 to the end of December 2022. Most of the patients were males (63.96%) while females were 36.04%. 36.04% of the total patients were in the ≤10-year group, and 29.7% were in the ≥46-year group while the other age groups were less frequent. Microbial growth was seen in 91.9% of samples, but 7.2% of samples did not. Among the samples with growth, 71.2% were monomicrobial, 12.6% were polymicrobial, and 9% had mixed growth with more than three microorganisms. The most frequently isolated bacteria were Pseudomonas aeruginosa (34.95%) followed by Staphylococcus aureus (14.6%) and Klebsiella spp. (9.8%). The antibiotics most sensitive against P. aeruginosa were cefepime (97.7%), meropenem (95.3%), piperacillin-tazobactam (95.3%), and ciprofloxacin (93%). Staphylococcus aureus showed the highest sensitivity to rifampin (100%) and fusidic acid (88.9%). Conclusion: In the bacteriological profile of CSOM, P. aeruginosa, S aureus, Klebsiella spp., and Acinetobacter spp. are highly prevalent. The distribution of CSOM varies depending on the age group. The antibiotic susceptibility pattern of the bacterial isolates decreased. It is critical to review antibiotic prescriptions based on susceptibility and to be informed of the current trend in bacteriological profiles. Peer Review History: Received: 8 August 2023; Revised: 19 October; Accepted: 2 November, Available online: 15 November 2023 Academic Editor: Dr. Iman Muhammad Higazy, National Research Center, Egypt, imane.higazy@hotmail.com Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Tamer Elhabibi, Suez Canal University, Egypt, tamer_hassan@pharm.suez.edu.eg Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com Dr. Wadhah Hassan Ali Edrees, Hajja University, Yemen, edress2020@gmail.com

Case Study On Successful Management of Complicated Fistula in Ano with CKD and Septic Shock Through Integrated Surgical Approach

Swelling, discomfort, redness, soreness, and a localized increase in temperature are the clinical signs of an abscess. Fistula in ano,the complication most frequently with perianal abscess, is caused by poor pus drainage or incorrect dressing in the post-operative stage.Modern science describes treatment as a two-step process, including an incision and drainage. An abscess can be correlated to Vidradhi inAyurveda. The irritated Dosha affects the tweak, rakta, means, media, and asthi; majja becomes localized and causes a problematic swelling knownas Vidradhi that is deeply ingrained, painful, and expands steadily. When its Pakwa avastha is complete, the vidradhi opens up or bursts. At thisstage, we must perform bhedhana karma to drain the vitiated materials that cause a cavity. The case presented was a recurrent Perianalabscess associated with fistula in ano with Chronic Kidney Disease (CKD) in which the patient had severely deranged Kidney functions, poorsigns of oral nutrition, swollen feet and ankles, puffiness around eyes, oliguria leading to Septic Shock, was managed through Surgical andintegrated approach of Ayurveda. The method followed here is pre-operative medications which was the utmost emergency as the patientwas in Septic shock, and then the surgical management, i.e., Incision (Bhedana) leading to immediate drainage of peri-anal abscess followed byKsheerasutra application for complete drainage along with cutting &amp; healing of the cavity. The planned treatment of the Ksheerasutra applicationafter I &amp; D resulted in a complete cure for the condition. This case study provides the successful emergency management of Gudagata vidradhiwith Bhagandara and comorbidities via surgical &amp; Ayurvedic management.

Retroperitoneal abscess as a presentation of colon cancer: The largest case set analysis to date, which extracted from our unit and the literature.

Colon cancer with retroperitoneal abscess is a rare and easily misdiagnosed disease and has only been reported via case. There is an urgent need to conduct a dataset analysis for such patients, which is crucial to improving the survival rate and quality of life of these patients. Patients with colon cancer associated with retroperitoneal abscess were extracted from our hospital and the PubMed, EMBASE and Web of Science databases. Clinical information, including the patients' basic characteristics, clinical symptoms, laboratory tests, imaging examinations, treatment methods and prognosis was analyzed. Sixty-one patients were analyzed, with an average age of 65 years. The proportions of right and left colon cancers were 63.9% and 36.1%, respectively. A total of 98.0% of the patients had adenocarcinoma. Many patients have insidious symptoms such as fever and weight loss. At the first medical visit, pain was the most common symptom (71%), with pain in the thigh (21.8%), abdomen (21.8%), and waist and back (14.5%) ranking among the top three. The misdiagnosis rate of the patients referred to our department was 75%, while the overall misdiagnosis rate in the literature was 43.9%. Laboratory tests show that these patients often have elevated white blood cells and anemia. CT examination showed that 87.2% of patients had an iliopsoas muscle abscess, and tumors were not simultaneously detected in 37.2%. A total of 33.9% of patients had local abscesses of the iliopsoas muscle, 26.4% had drainage into the subcutaneous tissue of the waist and upper buttocks, and 22.6% had drainage around the adductor muscle group of the thigh. These patients have a variety of treatments, and many patients have undergone multiple and unnecessary treatments. Thirteen patients died after surgery, and 6 died in the hospital, of whom four were patients undergoing direct surgery, and the other 7 died after discharge due to cachexia. Colorectal cancer with retroperitoneal abscess is a relatively rare and easily misdiagnosed subtype of colon cancer. It is more likely to occur in right-sided colon adenocarcinoma. The main clinical symptom is pain caused by the drainage of pus to the corresponding areas of the waist, abdomen, and legs. CT is the preferred diagnostic method. Actively treating the abscess and then transitioning to standard colon cancer treatment can prevent patient death and improve treatment quality.

P23 Curing the nail

Abstract Introduction Ultraviolet light is a well known trigger for inducing cutaneous flares in people who are predisposed or have been diagnosed with cutaneous lupus, it may have far reaching implications, triggering organ threatening disease Ultraviolet light could be from various sources including the sun, light bulbs and drying lamps used in nail salons to “cure the nails”. Curing the nails is a term used in the manicure world where UVA type 2 light is used to facilitate complete and quick drying of the nail polish: these type of UV light have been implicated in the pathogenesis of lupus. Case description This is the case of a 41 year old lady of African descent diagnosed with discoid lupus at the age of 33. Symptoms include hair loss, hypopigmented lesions on her ear, urticarial rash, fatigue, joint stiffness. Prior history of pregnancy loss at 14 weeks noted, and her sister also suffers from lupus. On examination she was found to have scarring alopecia with hyperkeratotic erythematous lesions at the periungual area with acrylic nails. Blood work showed lymphopenia, positive ANA, positive dsDNA by ELISA, RO+, positive anti smith antibody, normal complements and no evidence of kidney involvement. She was treated with topical therapy and then escalated in turns to hydroxychloroquine, mycophenolate mofetil, azathioprine, rituximab and methotrexate. She had developed a rash on hydroxychloroquine leading to it's discontinuation. The periungual lesions were resistant to all of the above treatment including intralesional steroid. She had recurrent flares of the lesions which resulted in episodes of infection, pus drainage, and treatment with antibiotics. Nifedipine was introduced but did not ameliorate symptoms A causal link was eventually made between her exposure to UV light at the nail salon and the periungual lesion. She was advised to discontinue using the UV light and possibly resort to traditional nail polish and air drying. The periungual lesions significantly improved on cessation of using the UV lights. Discussion Gel/acrylic manicures are becoming increasingly popular as they are more aesthetically pleasing and long lasting compared to traditional nail polish which uses air drying method, however we should be aware of the risk of ultraviolet (UV) light exposure which is used to dry the nails. UV light stimulates keratinocytes to express more small nuclear ribonucleoproteins thereby secreting IL-1,1L-6, IL-3, GM-CSF which lead to tissue damage and increased autoantibody production, this can result in development of cutaneous lupus, worsening of cutaneous lupus or in some cases can precipitate organ threatening systemic lupus. As clinicians we should be aware of the risks and educate our patients on the implication to their disease, they should be encouraged not to use this method of manicure but rather resort to the traditional nail polish which uses air drying technique rather than UV light. Other options may include applying sun protection cream to the fingers before manicure or the use of UV protective gloves, these measures though may not provide adequate coverage to the periungual area. We should be aware and educate our patients on avoidance of other sources of UV light including avoidance of fluorescent light, tanning beds, surgical lamps and measures to reduce exposure. Key learning points Consider other sources of UV light exposure in patients with hard to treat skin disease. It is critical that we educate our patients on the possible side effects of UV exposure and counsel on strategies to minimise exposure

Non-healing wound suspicious of foreign body

A 55-year-old male, known case of type II diabetes mellitus, from Manthali – 1, Ramechhap presented with history of fall injury from tree one day back followed by pain and swelling over his right face. He presented with history of swelling over right cheek extending from right chin to right forehead. Despite of many counseling, patient refused to visit higher center for further management. He was under oral antibiotics, oral hypoglycemic agents. On subsequent follow up, we noticed pus drainage near from right medial canthus. After one month of incident, Incision and drainage was done and black chunk of wooden piece (5x2cm) were removed.

Clinical features of Streptococcus intermedius infection in children: a case series study.

Streptococcus intermedius is an opportunistic pathogen associated with prolonged hospital stays and high mortality rates in adults. However, little is currently known about the clinical features of Streptococcus intermedius infection in children. This retrospective case series study included 40 children diagnosed with Streptococcus intermedius, confirmed through bacterial cultures or high-throughput sequencing. Antibiotic resistance was assessed through susceptibility testing. The site and clinical manifestations were evaluated for all patients. The common infection sites were the abdominal cavity, skin and soft tissue, intracranial, and invasive pulmonary, with the abdominal cavity being the most frequently affected. The drug susceptibility test showed 100% sensitivity to ceftriaxone, levofloxacin, chloramphenicol, vancomycin, and linezolid, 92.6% sensitivity to penicillin, 73.3% resistance to erythromycin, and 76.7% resistance to clindamycin. Besides antibiotic therapy, surgical intervention or pus drainage was often necessary. Lung imaging of four patients revealed pulmonary abscesses, nodules, or encapsulated pleura. Two cases yielded positive culture results, while three were identified as positive through high-throughput nucleotide sequencing of pleural effusion. In children with Streptococcus intermedius infection, emphasis should be placed on the risk of pus or abscess formation. In cases of pulmonary abscess and pleural effusion, especially in male children, Streptococcus intermedius should be suspected even if the culture is negative. Improvements in high-throughput nucleotide sequencing are required to reduce misdiagnosis rates.