Septic Focus Research Articles

Acute kidney injury and severe septicemia: toll of over-the-counter availability of drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) act mainly on peripheral pain mechanisms and on the central nervous system to raise the pain threshold. Their usage is widespread and many of these drugs are available over-the-counter (OTC) and hence self-medicated and abused. Drugs and Cosmetics Act is quiescent on this issue. Literature review has shown that, nimesulide, a preferential COX-2 inhibitor group of NSAID is notorious to produce hepatic and renal damage besides gastric mucosal injury which surpass its benefits. Here a case has been reported on life-threatening condition faced on cumulative over-consumption of this OTC drug. A young female was admitted with sudden onset of abdominal pain, fever and vomiting. On examination, findings were almost within normal limit whether laboratory investigation over 2 successive days of admission revealed hyponatraemia, hypokalaemia, severe anaemia, deranged renal and liver function tests, nephrolithiasis in USG and sepsis without detection of any septic foci. The patient was managed conservatively with broad spectrum antibiotics besides supportive management. Nephrological and surgical consultation was taken alongwith. Upon being ambulatory and parameters on reaching to normal value, the patient was discharged following fortnight of hospitalization. Easy accessibility of OTC drugs even at online pharmacy is increasing the burden of iatrogenic ill-health to a great extent. If necessary steps are implemented for appropriate self-medication by Central Drugs Standard Control Organization (CDSCO) that might save Disability Adjusted Life Years (DALYs), health resources and thousands of lives.

Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study.

Anastomotic leak can adversely affect the outcome of surgery especially if detected late. The present study was carried out to detect the anastomotic leak early in the postoperative period using serial estimation of procalcitonin (PCT) and C-reactive protein (CRP). A single centre prospective cohort study was done on patients undergoing elective gastrointestinal surgery with anastomosis. Serial estimation of serum procalcitonin and C reactive protein was done on the first five postoperative days. Other parameters such as hemoglobin, total protein, albumin and WBC counts were noted perioperatively. Patients were followed up to 60th postoperative day to assess for anastomotic leak, wound infection and other septic foci. Eighty-four patients were included in the study. Anastomotic leak rate was 26.19% (22/84) and 3/22 patients died in the anastomotic leak group. Wound infection rate was 23.81%. The cut off value of CRP on third postoperative day in detecting anastomotic leak was 44.322 mg/dl with sensitivity of 72.73%, specificity of 66.13% and accuracy of 59.52%. The cut off value for WBC count measured perioperatively in detecting anastomotic leak was 9470 cell/mm3 with sensitivity of 72.73%, specificity of 56.45% and accuracy of 59.74%. Serum procalcitonin, haemoglobin, total protein and albumin measured were not sensitive enough to detect the anastomotic leak early. Measuring CRP on the third postoperative day can predict anastomotic leak with a cut off value of 44.32 mg/dl. Patients with raised CRP need careful evaluation to rule out anastomotic leak before deciding on early discharge.

Minimal Incision Venectomy for Peripheral Septic Thrombophlebitis

Peripheral septic thrombophlebitis is an uncommon but potentially lethal condition fraught with systemic complications. Optimal treatment calls for surgical excision of the inflamed venous segment, followed by antimicrobial therapy. However, the extended skin incision and meticulous flap elevation of conventional venectomy leaves substantial residual scarring. Herein, we detail a minimal incision venectomy performed for peripheral septic thrombophlebitis in a 55-year-old man. The patient was initially admitted for conservative management of intracranial hemorrhage but subsequently developed high fever and hypotension. An abscessed intravenous catheter site of the left forearm was the apparent source. Following emergency drainage and serial irrigation, surgical venectomy was undertaken to radically remove the septic focus, excising a 10-cm segment of infected vein through a separate proximal incision. After the procedure, the patient’s recovery was complete and free of complications at postoperative 6-month visit. Under appropriate indications, minimal incision venectomy can be an effective therapeutic alternative with minimal scarring.

Prevalence and Antibiotic Resistance Pattern of Staphylococcus aureus isolates from Clinical samples at a Tertiary Care Hospital, North India

Background: Staphylococcus aureus (S. aureus) is a well recognized nosocomial and community acquired pathogen which is implicated in causing a wide spectrum of superficial, deep pyogenic infections and toxin mediated illnesses. Localized infections sometimes progress to systemic infections, while ‘spontaneous’ bacteraemia also occur without an evident septic focus, particularly in chronic debilitated immunocompromised patients. Emergence of drug resistance to penicillins and penicillinase-resistant penicillins (i.e., oxacillin and methicillin) is a globally recognized problem. Methicillin Resistant Staphylococcus aureus isolates are also important with respect to the range of nosocomial infections it causes, leading to an increase in the hospital expenditure and mortality or morbidity rate. The increased prevalence of such resistant strains has narrowed down the list of available therapeutic options. Therefore, information regarding the prevalence of S. aureus infections in a health care setting and determining its current antibiotic resistance profile becomes crucial in selecting appropriate treatment regime. Therefore, the current study was done in the department of Microbiology to determine the prevalence of S. aureus infections and the antibiotic resistance pattern of S. aureus isolates from various clinical specimens at our tertiary care hospital in North India. Materials and Methods: A one year prospective study was carried out in the Department of Microbiology, at a tertiary care hospital in North India where non-duplicate strains of S. aureus isolated from various clinical specimens received in the Microbiology laboratory were studied. All S. aureus isolates were subjected to Antibiotic Susceptibility Testing using Kirby Bauer’s disk diffusion method on Mueller Hinton Agar plates in accordance to CLSI guidelines. The antibiotics tested included Penicillin (10U), Amoxicillin-clavulanic acid (20/10μg), Sulphamethoxazole-trimethoprim (1.25/23.75μg), Ciprofloxacin (5μg), Erythromycin (15μg), Clindamycin (2μg), Vancomycin (30μg), Teicoplanin (30μg) and Linezolid (30μg). Results: A total of 23,699 clinical specimens were processed in the laboratory while conducting this study, from which 1233 clinical isolates of S. aureus were identified and processed further. Among all clinical specimens, pyogenic samples (63.1%) yielded maximum number of S. aureus strains followed by blood samples (29.9%) and urine samples (4.8%). S. aureus infection was more evident in hospitalized 71.2% patients than in OPD patients 28.8%. Seasonal variation was also seen in isolation of S. aureus, with a higher percentage of isolates obtained during summer season than during winter season. On antibiotic susceptibility testing, 49.6% strains were Methicillin Resistant. Majority of the isolates were found resistant to Penicillin (92.1%), followed by Erythromycin (59%). Almost half of the total isolates were resistant to Sulphamethoxazole-Trimethoprim (49.3%) followed by Amoxicillin- Clavulanic acid (47.8%), Ciprofloxacin (43.4%) and Clindamycin (18.4%). Antibiotics to which all isolates showed 100% susceptibility included Vancomycin, Teicoplanin, Linezolid. Conclusion: Given the high prevalence of resistance to antibiotics seen in this study, effective treatment of infections caused by multidrug resistant Staphylococcal strains may become challenging. Drugs like Vancomycin, Teicoplanin and Linezolid promise to work as miracle drugs against the multidrug resistant MRSA strains but we need to warrant judicious use of these wonder drugs to conserve them for future use.

Multiple Cholecystoenteric Fistulas and Choledochal Cyst Identified during Laparoscopic Cholecystectomy: An Interesting Case

Introduction: Cholecystoenteric fistula is a rare complication of gallbladder disease and cholelithiasis, and are typically discovered incidentally during cholecystectomy. Identification and proper management with division and closure of the fistula is of paramount importance. Type I choledochal cysts are the most common type of choledochal cysts and carry a risk of malignancy. Here, we report a rare case of a patient with cholelithiasis who during laparoscopy was found to have both cholecystoduodenal and cholecystocolonic fistulas, as well as a Type I choledochal cyst. We describe an algorithmic approach to definitive management. Case description: A 55-year-old female presented with cholelithasis. During laparoscopy, a cholecystocolonic fistula, a cholecystoduodenal fistula, and a Type I choledochal cyst were found. Take-down of fistulae and cholecystectomy were performed followed by definitive biliary resection and reconstruction in a staged approach. To our knowledge, this is the first case of a patient with two incidentally discovered cholecystoenteric fistulae and concurrent choledochal cyst. Furthermore, as avoiding definitive biliary bypass in the presence of a septic focus, we describe a step-wise approach to management. Discussion: In patients with acute cholecystitis or choledocholithiasis, imaging frequently does not show evidence of gallbladder fistulas. Most commonly, these processes are only identified intra-operatively. We present a rare case of a patient with multiple cholecystoenteric fistulae and a Type I choledochal cyst discovered intra-operatively. This case report highlights an algorithmic approach to the management of not only dual or multiple cholecystoenteric fistulas, but also a concurrent Type 1 choledochal cyst.

Evaluation of Erythrocyte Sedimentation Rate, C Reactive Protein and Ante-Streptolysin O Titer Regarding Tonsillectomy Indication and their Postoperative Changes

Objective: To evaluate the serum erythrocyte sedimentation rate, C reactive protein and antistreptolysin O titer as indicators for tonsillectomy with assessment of their postoperative changes.Patients and Methods: Our prospective comparative study was carried out on 150 patients divided into two groups. Group I included 75 patients clinically diagnosed as chronic tonsillitis by symptoms and signs and group II included 75 patients with previous tonsillectomy as a control group. Both groups were compared regarding the levels of the three laboratory markers. Also, the preoperative values of these markers were compared with postoperative values at 1, 3 and 6 months.Results: The values of the three markers in group I were higher than values in group II but statistically insignificant (p = 0.13, 0.11 and 0.78 respectively). There was a highly significant decrease in postoperative results of erythrocyte sedimentation rate, C reactive protein in group I at 1, 3 and 6 months after tonsillectomy (p value < 0.0001 for all). There was a significant decrease in postoperative results of antistreptolysin O titer in group I at 1, 3 and 6 months after tonsillectomy (p= 0.008, 0.019, 0.001 respectively).Conclusion: Erythrocyte Sedimentation Rate, C Reactive Protein and antistreptolysin O Titer should not be considered as indicators for tonsillectomy in chronic tonsillitis patients by having a non-significant difference when compared with post tonsillectomy patients. Being inflammatory markers, the values of these markers showed a significant decrease after tonsillectomy due to removal of the septic focus of chronic tonsillitis

Neonatal sepsis-blood culture, antibiotic stewardship and clinico-bacteriological study

Background: Neonatal sepsis refers to an infection involving bloodstream in newborn infants less than 28 days old. It continues to remain a leading cause of morbidity and mortality among infants, especially in middle and lower-income countries. Neonatal sepsis is divided into 2 groups based on the time of presentation after birth: early-onset sepsis and late-onset sepsis.Methods: This study was done in the neonatal intensive care unit of tertiary hospital, Surendranagar. Study design being observational, data collected from clinical examination and records of the neonates admitted with positive septic screen, neonates admitted with suspected clinical sepsis (temperature &gt;990F or &lt;950F, respiratory rate more than 60 per minute, change in behavior, abnormal cry, not accepting feed, drowsy or unconscious, septic focus on skin or umbilicus, diarrhea and seizures) and neonates admitted with culture positive sepsis.Results: As per this research, neonatal sepsis has more male preponderance, with more commonly occurring in low birth weights and preterm. Klebsiella, Staphylococcus aureus and Pseudomonas being the most isolated organisms. Their resistance pattern, antibiotic profile and newer trends also came across.Conclusions: Neonatal sepsis comes as one of the major causes of mortality and morbidity of the newborns admitted. By this research, analyzing the sex, age, gestational weeks, organism isolated and the antibiotic profile, emerging new resistance and newer useful antibiotics can thus be studied and can be taken as a base for further study as well as evaluation of the same, along with also guiding to manage and treat neonatal sepsis better.

Association of High Sensitivity C-Reactive Protein with In-Hospital Mortality in Patients with Acute St-Segment Elevation Myocardial Infarction

Background and Aims: Among the various biomarkers, high sensitivity C-Reactive Protein (hs-CRP) has been widely studied and is easy to use in the prognostication of patients with acute ST elevation myocardial infarction (STEMI). This study aimed to associate serum level of hs-CRP with in-hospital mortality in patients presented with acute STEMI.&#x0D; Methods: This was a hospital-based prospective observational study conducted in Shahid Gangalal National Heart Centre among patients presented to the emergency department with chest pain of less than 24 hours duration, who were diagnosed subsequently to have STEMI. Patients who had known chronic inflammatory diseases, septic foci and chest pain of over 24 hours were excluded from the study. Blood sample for Hs-CRP was sent from the emergency department and was measured with Finecare TM FIA system; Model number: FS-112. The study was conducted from April 2019 to March 2020. Patient outcomes were stratified as per the four groups of serum level of hs-CRP and among them the relationship between mortality and hs-CRP level was tested with chi-square test. The p-value across the groups was again tested for inter-group significance using the Bonferroni adjusted significance level.&#x0D; Results: 140 patients (112 males and 28 females) with mean age of 58.1±14.86 years were enrolled in the study. There was no increased in-hospital mortality in acute STEMI patients who had serum level of hs-CRP below 3 mg/l. In-hospital mortality showed an increasing trend above this level but it reached statistical significance beyond 10 mg/l only. Thirty five percent of our patients of acute STEMI were found to have serum level of hs-CRP above this threshold. The total in-hospital mortality was 13 (9.28%).&#x0D; Conclusion: The increased serum level of hs-CRP was associated with increased in-hospital mortality in patients with acute STEMI.

Dental management in Oncology patient: osteonecrosis related osteonecrosis of the Jaw (MRONJ)

It is essential that oncological patients treated with antiresorptives or antiangiogenic drugs diagnosed Medication Related Osteonecrosis of the Jaw (MRONJ) must be treated in an interdisciplinary fashion. The patient’s stomatognathic system should be examined preventatively prior to the initiation of antiresorptive drugs in order to avoid pathological buccal manifestations, following the same healthcare clinical protocols used for patients receiving head and neck radiotherapy. Additionally, patients should be informed of the precautions to be taken, including regular dental appointments for oral health assessment. The risk of developing MRONJ should be evaluated according to the type of antiresorptives or antiangiogenic drugs administered and treatment duration. In the case of MRONJ, its fundamental characteristic is positioned in the biochemical particularity of the pharmacokinetic expression of antiresorptive drugs, reversibly (DS) or irreversibly (BPs) inhibiting the functionality of the osteoclast. Therefore, the consideration of invading bone tissue as little as possible and performing resective therapies in cases of systemic infectious spread follows, since its long-term resolution would not be effective because the drug (BPs) has frank accumulation at a distance, a characteristic used by treating doctors and it would not have clinical relevance to suggest its suspension. According to the recommendations of AAOMS; Task Force and AOCMF coincide with the sharing of consensus on minimally invasive manipulations once the necrotic foci have been installed and the preventive attitude prevails of eliminating all septic foci prophylactically before starting therapy with antiresorptive drugs. There are positions with a trend more committed to frank bone manipulation with the aim of evacuating the infectious problem and other more conservative positions in order not to expand drug necrosis volumetrically due to bone accumulation of BPs or DS.

Endogenous endophthalmitis during pregnancy: Case report

Abstract Endogenous endophthalmitis is a disease that potentially threatens vision. It is produced by the haematogenous spread of microorganisms from a septic focus. It is a rare condition that is related to debilitating diseases, immunosuppression states, and invasive procedures. Endogenous endophthalmitis during pregnancy is even rarer, and has become a challenge due to the safety and side effects of the local and systemic treatments. The case is presented of a pregnant woman with a history of complicated appendicitis, septic shock, and thrombocytopenia that presented endogenous endophthalmitis due to Candida albicans in the immediate post-operative period. This required the use of intravitreal and systemic antimycotics and vitrectomy. She made a significant anatomical and functional recovery, and without any maternal or foetal side effects.

Computed tomography for detection of septic foci: Retrospective analysis of patients presenting to the emergency department

ObjectiveSepsis is defined as organ dysfunction due to severe infection. Septic patients face a significant mortality risk. Thus, timely recognition with prompt focus identification and control are essential. This study aims to determine the current role of computed tomography (CT) in the diagnostic workup of septic patients. MethodsWe retrospectively identified 357 patients in the emergency department (ED) of a large university center with suspected sepsis in a two-year period. A total of 132 patients underwent CT scanning within 72 h of admission. Patients were characterized by clinical and laboratory findings. CT reports were categorized and matched with clinical data. ResultsOf 357 ED patients with suspected sepsis, 37.0% (132/357) underwent CT imaging within 72 h. The most commonly identified septic foci in CT were chest 38.6% (49/127), abdomen 22.0% (28/127) and genitourinary tract 20.5% (26/127) in descending order. The focus detection rate was 76.5% per patient with a concurrent number-needed-to-scan of 1.31. Contrast medium administration in CT did not improve focus detection rate (p = 0.631) or diagnostic confidence in this patient population (p = 0.432). CT had a positive predictive value of 81.82% (CI 76.31 to 86.28%) in predicting the focus of the discharge diagnosis. Follow-up imaging in patients with unclear focus reveals a new focus in 39.5% of patients. ConclusionsOur investigation of the role of CT in ED patients with suspected sepsis indicated a high positive predictive value for CT with regard to the discharge diagnosis. Repeat imaging may help identify further septic foci in a subgroup with persistently unclear focus. Use of contrast medium seems less relevant for focus detection than expected, as it did not increase diagnostic confidence.

Paediatric Type I Cartilage Tympanoplasty with or without Concomitant Adeno-tonsillectomy – An Institutional Experience

Introduction &#x0D; In the management of COM in paediatric age group, eradication of the septic foci in the tonsil and the adenoids while addressing the dysfunction of Eustachian tube play a key role This study aims to assess the success rate of type I tympanoplasty with cartilage graft in mucosal type of chronic otits media in paediatric age group and finally, whether concomitant adeno-tonsillectomy plays any role in outcome of surgery or curing the disease process. &#x0D; Materials and Methods &#x0D; A prospective clinical study was done over a period of one and half years amongst 59 patients, aged between 5 and 12 years, presenting with chronic otitis media with dry central perforation of ear-drum and pure conductive hearing loss. Patients were divided into two groups. Group 1 (n1= 22) underwent type I cartilage tympanoplasty with adenoidectomy/ tonsillectomy/ both in the same sitting and Group 2 (n2= 37) underwent type I cartilage tympanoplasty without any adeno-tonsillectomy. &#x0D; Results Graft uptake was 86.4% in Group 1 at 6 months post-operative follow up while that in Group 2 was found to be 86.5%. The mean hearing gain in two groups were found to be 15.91±6.54 dB and 17.02±8.96 dB respectively. No significant difference was found between graft uptakes and hearing gains in two groups at the end of the study. &#x0D; Conclusion &#x0D; Type I cartilage shield tympanoplasty, may be considered as an effective management strategy of paediatric chronic otitis media, mucosal disease. Type I tympanoplasty with concomitant adeno-tosillectomy did not prove to be better than type I tympanoplasty alone in terms of anatomic closure of tympanic perforation and hearing gain.

Metastatic endophthalmitis - Has the trend of causative organism changed in the modern antibiotic era - A Systematic Review

Endogenous endophthalmitis, EE, a less common form of endophthalmitis, occurs when the microorganisms spread to the eye through the bloodstream, from a septic focus elsewhere in the body, that breaches into the integrity of the eyeball itself. The etiopathogenesis of endogenous endophthalmitis has changed over the past two decades, the aim of this review being to study the changing trends in causative organism in the era of modern antibiotics.

Endoftalmitis endógena durante el embarazo: a propósito de un caso

Endogenous endophthalmitis is a disease that potentially threatens vision. It is produced by the haematogenous spread of microorganisms from a septic focus. It is a rare condition that is related to debilitating diseases, immunosuppression states, and invasive procedures. Endogenous endophthalmitis during pregnancy is even rarer, and has become a challenge due to the safety and side effects of the local and systemic treatments.The case is presented of a pregnant woman with a history of complicated appendicitis, septic shock, and thrombocytopenia that presented endogenous endophthalmitis due to Candida albicans in the immediate post-operative period. This required the use of intravitreal and systemic antimycotics and vitrectomy. She made a significant anatomical and functional recovery, and without any maternal or foetal side effects.

More than Just a Hole in the Wall: Evolving Management and Treatment Paradigms of Suppurative Gastritis

Suppurative gastritis is an uncommon lesion and often an occult cause of upper abdominal pain without florid signs of a septic focus. There are two main phenotypic forms: (1) localized, also referred to as gastric abscess; and (2) diffuse, in which the differential diagnosis includes a more diverse range of benign and malignant lesions. Cross-section imaging such as CT allows for rapid diagnosis and demonstrates the location and extent, but not the specific etiology, of the lesion. High-frequency endoscopic ultrasound (EUS) and fine needle aspiration (FNA) have greatly improved the safety and diagnostic accuracy of suppurative gastritis. EUS/FNA provides an opportunity to arbitrate among infectious and malignant or benign tumors, to identify specific pathogens, and in cases of localized gastric abscesses, for resolution by decompression. More advanced endoscopic procedures are rapidly emerging to supplement EUS/FNA, which already demonstrate the promise of improved, minimally-invasive diagnosis and effective management for the diverse range of lesions causing suppurative gastritis.

A prospective observational study to explore the correlation of peripheral arterial pulse/resistance index, organ function, and inflammation in patients with septic shock.

Introduction:The evaluation of the functional status of blood vessels, especially the arterial system, plays a very important role in the judgment of the condition of septic shock patients and the guidance of resuscitation programs and the judgment of the therapeutic effect. We aimed to design an observational study protocol to explore the correlation of peripheral arterial pulse/resistance index, organ function and inflammation in patients with septic shock.Methods and analysis:A total of 60 patients with septic shock in the Affiliated Hospital of Southwest Medical University from June 2020 to September 2020 and 20 healthy volunteers will be enrolled. Total of 60 patients with septic shock will be randomly divided into 20 groups by lot method. Group 1: fluid resuscitation; Group 2: fluid resuscitation + norepinephrine; Group 3: fluid resuscitation + norepinephrine + ulinastatin; Group 4: healthy control group. Fluid resuscitation is an early goal-directed fluid resuscitation in which norepinephrine is adjusted by a senior intensive care unit specialist for clinical presentation and ulinastatin is pumped at 20,000 U/h. Index including vascular ultrasound, inflammatory factors, organ function will be collected and analyzed.Discussion:Existing studies on septic shock focus on hemodynamics of the heart, brain, and kidney, while the differences in blood flow between peripheral blood vessels and protective renal vessels may be consistent, and imaging analysis is still lacking. This study protocol aims to explore the correlation of peripheral arterial pulsation index/resistance index, organ function, and inflammation in patients with septic shock.Trial registration:Chinese Clinical trial registry: ChiCTR2000031565

Time to clearance of abdominal septic focus and mortality in patients with sepsis.

ObjectiveTo assess the relationship between time to focus clearance and hospital mortality in patients with sepsis and septic shock.MethodsThis was an observational, single-center study with a retrospective analysis of the time to clearance of abdominal septic focus. Patients were classified according to the time to focus clearance into an early (≤ 12 hours) or delayed (> 12 hours) group.ResultsA total of 135 patients were evaluated. There was no association between time to focus clearance and hospital mortality (≤ 12 hours versus > 12 hours): 52.3% versus 52.9%, with p = 0.137.ConclusionThere was no difference in hospital mortality among patients with sepsis or septic shock who had an infectious focus evacuated before or after 12 hours after the diagnosis of sepsis.

Exceptional source of liver abscess: 3 cases of oropharynx origin

Background: Pyogenic liver abscess is a rare entity, it is fatal when untreated. Its approach has been improved due to percutaneous drainage and better microbiological characterization. In our environment, the most common pathogens are Enterobacteriaceae. Our aim is to present 3 cases of liver abscess caused by unusual microorganisms, habitual commensals of the oropharynx. Material & Methods: Two men and a women was admitted to emergency service with a story of fever (>38.5ºC). Case 1: A 64-year-old man without other sintoms. US and CT scan was performed, showed focal subcapsular lesion in the VII-VI segment, hypoechoic with hyperechogenic areas suggestive of abscess. Abscess drainage was performed and positive culture was obtained for Haemophilus parainfluenzae. Case 2: A 57-year-old woman mujer de 57 with jaundice and coluria. CT scan reported multiple hepatic abscesses. Abscess drainage was performed with positive culture for Streptococcus intermedium. The orthopantomography study showed radicular remnants of 36 and 46, both with implants. Case 3: A 61-year-old man with abdominal pain. CT showed heterogeneous mass in liver segments VII and VIII with small cystic areas inside. Abscess drainage was performed with positive culture for Streptococcus intermedium. Orthopantomography showed septic foci associated with implants. Results: All three patients were admitted with antibiotic treatment and radiologic drainage. In two of them (cases 1 and 3) antibiotic treatment was not enough, therefore surgery was performed; while in case 2 the antibiotic treatment was adequate. In addition, cases 2 and 3 received surgical treatment by maxillofacial surgery to extract the dental pieces. Currently, patients are asymptomatic. Conclusions: Haemophilus parainfluenzae and Streptococcus intermedium are a uncommon cause of liver abscess. Without treatment, the mortality of the liver abscess is 100%. Early diagnosis and correctly isolate the pathogens are essential even more when we face something uncommon.

Surgical Management of Non-Malignant Esophageal Perforations: A Single-Center Analysis Over a 15-Year Period

Purpose: Esophageal perforations are associated with high morbidity and mortality. Different nonoperative and operative treatment options have been proposed. This study focuses on the impact of different surgical treatments in nonmalignant esophageal perforations and tries to identify predictors of mortality in a single tertiary center over a 15-year period. Methods: From 2002 to 2017, patients with surgically managed esophageal perforation were identified from our database. Patients with esophageal malignancies were excluded. Etiology, clinical data, treatment, and outcome were analyzed. A multivariate logistic regression analysis was performed to investigate the impact on mortality. Results: A total of 72 patients were identified. The majority of perforations were iatrogenic (54.2%) followed by Boerhaave’s syndrome (23.6%). Most ruptures were found in the distal third of the esophagus (59.7%) measuring <3 cm (61.1%). Patients were treated with exploration and drainage (8.3%), primary suture and patch reinforcement (36.1%), resection and restoration of continuity (25.0%), or resection without restoration of continuity (30.6%). Delayed therapy significantly correlated with sepsis (p < 0.0001) and mortality (p = 0.032). A correlation between an increasing perforation length with sepsis (p = 0.012) was observed. A higher Perforation Severity Score (PSS; OR 4.430; 95% CI 1.143–17.174; p = 0.031) and a higher American Society of Anesthesiologists (ASA) score (OR 2.923; 95% CI 1.011–8.448; p = 0.048) were associated with mortality in multivariate analysis. Conclusion: Esophageal perforations are associated with high mortality, and larger ruptures are associated with worse outcome. Rapid diagnosis and treatment are crucial for patient survival. Hence, PSS and ASA score help to identify high-risk patients. The advantage of surgical management lies in the rapid control of the septic focus in an already critically ill patient. Though, the kind of surgical technique needs to be adjusted to the individual situation.

Clinical cases of meningococcal infection caused by Neisseria meningitidis serogroup W

Meningococcal infection remains a socially significant disease due to a wide range of clinical manifestations, severe course with high mortality, reaching 40-80% for certain forms. In recent years we observe a change in the serogroup picture of meningococcal infection, in particular, an increase in the proportion of meningococcal serogroup W, characterized by polymorphism of clinical manifestations. The authors present two their own clinical observations of a generalized form of meningococcal infection with a severe course in adolescents caused by Neisseria meningitidis of W serogroup with fatal outcome. They describe the peculiarities of the cases, namely, inconsistency of the clinical picture at the beginning of the disease and post-mortem changes. The article describes heart damage in the form of focal purulent septic myocarditis and purulent foci of destruction in the brain stem, hemorrhagic infarction of the choroid plexus with hemotamponade of the lateral ventricles of the brain, the predominance of septicopia over septicemia. The revealed changes are likely to reflect clinical and morphological features of meningococcal infection caused by N. meningitidis of serogroup W.