Single Abscess Research Articles

The Factors Contributing to Efficiency in Surgical Management of Purulent Infections of Deep Neck Spaces.

Deep neck infections (DNIs) are still emergency conditions in otorhinolaryngology. Due to rapid disease progression and life-threatening complications, the accurate surgical and medical treatment must be promptly applied. In the present study, we analyzed treatment protocols of 46 adults to assess efficacy of the treatment and search for prognostic factors of the outcomes. We performed retrospective analysis of medical data of 46 patients, who underwent surgical treatment in our department due to purulent DNI in the period from 2009 to 2017. Data investigated included age, sex, hospitalization time, duration of symptoms before drainage, comorbidities, selected laboratory tests results, location and the number of abscesses, results of microbiological cultures, and antibiotic treatment options. The study group consisted of 33 (71.7%) men and 13 (28.3%) women. Patients age ranged from 18 to 82 years. The mean duration of hospital stay was 13.2 ± 8.4 days. The most common site involved was submandibular space (43.5%), followed by parapharyngeal space (28.3%). The majority of patients had single abscess (81.2%), the multiple abscesses were revealed in 8 (18.8%) cases. The mean size of the abscesses was 42 mm. C-reactive protein level was increased in 96.7% patients (mean level 155.5 ± 146.7 mg/L), but the white blood cell count exceeded the normal in 60.9% cases (mean level 16.89 ± 5.59 × 109/L). Staphylococcus aureus (20.7%) and Peptostreptococcus (20.7%) were the most common species cultured from swabs. The antibiotic treatment included most commonly a combined ceftriaxone and metronidazole (n = 23). Two patients died due to complications. The correlation between different variables and the duration of hospitalization revealed only the hemoglobin level below 12.5 g/dL, a significant predictor of longer hospitalization (16.23 days vs 12.09 days, P = .017). Patients with purulent DNIs and decreased hemoglobin level are predisposed to prolonged recovery following the surgical drainage.

Clinical study of liver abscess

Background: The aim of our study was to study general considerations, etiological and predisposing factors, symptoms and signs and various modalities of treatment of liver abscess. Methods: We have taken 60 cases having proven liver abscess. All data collected from these cases was compared statistically. A predesigned proforma was used to collect this information for individual case. All selected cases were studied upto discharge regarding the type of liver abscess and treatment modalities. Results: Amoebic liver abscesses were more common than pyogenic liver abscesses. Liver abscesses were more common in 5th decade followed by 6th decade. Liver abscesses were more common in males than females; Diabetes mellitus (35%) and Alcoholism (23.3%) were the most common predisposing factor in our study. Single abscess was a finding in 71.66% and multiple abscess in 28.33% of patients. Conclusion: The modern day ultrasound and other non-invasive imaging techniques had greatly revolutionized the diagnosis and management of the liver abscess.Conservative management with IV antibiotics and USG guided percutaneous aspiration of liver abscess are most frequent treatment modalities used now; with fewer complications.

Safety and efficacy of ultrasound guided percutaneous needle aspiration of liver abscess

Background: Liver abscesses, both amoebic and pyogenic, continue to be an important cause of morbidity and mortality in tropical country. Traditionally for many years they were treated with antimicrobial alone, blind percutaneous aspiration or surgical exploration. This conception gradually changes into guided percutaneous aspiration or drainage with development of advanced diagnostic imaging modality.
 Objectives: To evaluate the safety and efficacy of management of liver abscess by Ultrasound (US) guided percutaneous needle aspiration.
 Methods: From August 2009 to July 2018 a total 380 patients with liver abscess were referred to the department of radiology and imaging for US guided percutancous aspiration. All patients were evaluated clinically and by USG. Aspiration of the abscess was carried out under strict aseptic precaution.
 Results: A total of 380 patients with liver abscess were successfully treated, consisting of 338 males and 42 females, male female ratio 8:1. The age ranges from 11 to 80 years. Majority (78%) had single abscess and 22% had two or more. Most of the abscess are located in the right lobe of liver (79%). Single needle aspiration were needed in 30% of patient, second aspiration were needed in 38% of patients and third aspiration in 32% of patients. Average aspiration per patient was 2.02. The amount of aspirated pus ranged from 250 to 2450 ml.
 Conclusion: Ultrasound guided percutaneous needle aspiration of liver abscess is a safe and successful therapeutic approach in the treatment of liver abscess whether pyogenic or amoebic.
 Bang Med J (Khulna) 2018; 51 : 3-6

A comparative study of liver abscess: therapeutic aspiration verses continuous catheter drainage

Background: Previously liver abscesses were treated primarily by surgery but with advances in imaging techniques the trend is changing towards use of potent antimicrobials and minimally invasive ultrasound guided interventional procedures and surgery is being done only in selected cases. We conducted this study to find out the feasibility, limitations, effectiveness, outcome and complications of therapeutic needle aspiration and continuous catheter drainage of liver abscess.Methods: This was a hospital based randomized control prospective study in which patients with liver abscess were included. 100 patients of liver abscess selected by simple randomization to 2 groups namely Group A (needle aspiration) or Group B (continuous catheter drainage) undergo the above two interventional procedures. For statistical purposes P value less that 0.05 was taken as statistically significant.Results: This study consisted of 100 patients out of whom there were 78 (78%) males and 22 (22%) females with a M:F ratio of 1:0.28. Single hepatic abscess (75%) was more common than multiple abscesses (25%) and pyogenic abscess (67%) was more common than amoebic abscess (33%). Right lobe of liver was most commonly involved (61%) followed by left lobe (22%). All patients in both the groups were treated successfully and there was no treatment failure in any of the groups.Conclusions: Therapeutic needle aspiration as well as continuous catheter drainage both are equally effective in management of liver abscess but needle aspiration had the advantage of being less expensive, easily available and requiring less hospital stay.

Diagnosis and Management of Brain Abscesses in Children

During 4 years, 20 patients with brain abscesses were hospitalized in the Departement of Child Health, Dr. Cipto Mangunkusumo General Hospital, jakarta. Of those 20 patients 11 were males and 9 were females. The youngest patient was 2 months old and the oldest was 12 years old. The important signs and symptoms in making diagnosis were the sign of injection, increased intracranial pressure, and focal neurological disorders. Laboratory examinations were of little value in establishing the diagnosls of brain abscess. By performing head CT Scan the diagnosis of brain abscess will be confirmed accurately. Of the 20 patients, 15 (75 %) suffered from single abscess and 5 (25 %) suffered from multiple abscesses. The results of treatment by surgical intervention were better than nonsurgical treatment. The high mortallty of the nonsurgical patients was caused by the severity of the disease due to the ignorancy of their parent.

Nocardia paucivorans cerebellar abscess: Surgical and pharmacotherapy

Background:Nocardia species are ubiquitous in nature and mainly cause pulmonary disease in humans; however, they can also infect the central nervous system and skin. The management of cerebellar nocardiosis is troublesome and requires multiple considerations of the severity of the underlying systemic disease, difficulties in identifying the bacterium, and frequent delay in initiating adequate therapy.Case Description:We report a 52-year-old diabetic female patient with Nocardia paucivorans cerebellar abscesses. Brain magnetic resonance imaging (MRI) revealed innumerable small ring-enhancing lesions of posterior fossa. In this report, we present a case of primary single cerebellar abscesses due to N. paucivorans. Early diagnosis and surgical interventions were significant for the patient. The diagnosis was confirmed by DNA sequencing and the organism was susceptible to trimethoprim–sulfamethoxazole (TMP/SMX). The patient was successfully treated with drugs and surgical excision.Conclusion:According to the literature, surgical excision or aspiration of cerebellar abscess seems to provide favorable outcomes. In our experience, a successful outcome was achieved with subtotal resection and prolonged adequate antibiotic therapy.

Treatment of liver abscesses

The analysis of treatment of 244 patients with single bacterial abscesses of liver in 1998–2018 was performed. The puncture-drainage and resection methods were used. Minimally invasive treatment methods are considered as highly effective. Resections in most cases were used as reserve methods, but quite often were accompanied by lower number of postoperative complications and hospital stay. During treatment, abdominal complications occurred in 39 (16.0 %) patients and 12 (4.9 %) patients died. The causes of failures in most cases were associated with inefficient starting method of treatment for each patient. A basis of successful treatment of single liver abscesses is the differentiated approach considering origin, sizes, localization and stage of abscess formation. According to this, surgical management should be escalating which consists in timely transition to resection methods in case of failure of minimally invasive interventions.

Septic pyomyositis, multiple pelvic osteomyelitis and thrombosis in a Thoroughbred foal

SummaryMultiple septic osteomyelitis, septic thrombi and septic arthritis are recognised as possible complications of sepsis; however, there are few reports of localised pyomyositis in association with septic arterial thrombosis in foals. A 1‐month Thoroughbred colt was presented for investigation of acute and progressive left hindlimb lameness. Physical and laboratory examinations were performed. Ultrasonographic, radiographic and computed tomographic examinations revealed the presence of multiple abscesses and areas of osteomyelitis localised to the gluteal muscles, coxal bone and lumbar spine respectively. Considering the poor prognosis, the foal was subjected to euthanasia. Necropsy confirmed the diagnostic imaging findings and revealed the presence of an extensive septic thrombus, affecting the internal iliac artery, and a single pulmonary abscess. Streptococcus equi subsp. zooepidemicus was isolated from all lesions.

A comparison of pyogenic liver abscess in patients with or without diabetes: a retrospective study of 246 cases

BackgroundPyogenic liver abscess(PLA) has become common in patients with diabetes mellitus (DM), but it is unclear whether differences exist between patients with and without DM. A retrospective study was performed to identify these differences, summarize the clinical experience, and improve the diagnosis and treatment of PLA.MethodsThe patients were enrolled in a teaching hospital from January 2012 to December 2016. The patients were separated into two groups based on comorbidity with diabetes mellitus (DM). The DM group was further separated into two subgroups according to the HbA1C concentration to investigate whether glycaemic control affected the clinical characteristics of PLA patients with DM. Chi-square, Fisher’s exact test, and t-tests were used to analyse and evaluate differences between the two groups.ResultsTwo hundred and forty-six PLA patients were identified and 90 (36.6%) had comorbid DM. Patients with DM were older, had higher levels of alkaline phosphatase and γ-glutamyl transferase, hypertension, a loss of body weight, a single abscess, and combined antibiotic therapy with the use of carbapenems and Klebsiella pneumoniae in their blood cultures but a less frequent history of abdominal surgery and Escherichia coli in their pus cultures. When DM patients were compared to non-DM patients, each of these differences was significant (P < 0.05). Diabetic PLA patients with poor glycaemic control had a significantly higher proportion of fever and both lobes abscess(P < 0.05).ConclusionPLA patients with diabetes are older, have more serious complications, a higher prevalence of cardiovascular disease, an increased use of combined antibiotic therapy with carbapenem, and K. pneumoniae as the predominant pathogen, but these patients had fewer abdominal surgeries and fewer E. coli infections. In addition, poorly controlled glycaemia in diabetic PLA patients is associated with high incidence of fever and both lobes abscess.

Etiology and clinical manifestations of bacterial liver abscess: A study of 102 cases.

This study aimed to analyze the clinical manifestations of patients with pyogenic liver abscess and characteristics of pathogenic that caused their infections, in order to provide guidance for the identification of the pathogens that cause liver abscess and selection of antibiotics for treatment of this disease.In the present study, the clinical characteristics, laboratory results, as well as the species and drug resistance of pathogens in patients with bacterial liver abscesses admitted to our hospital from January 2013 to December 2015 were retrospectively analyzed. The patients were treated by ultrasound or CT-guided percutaneous portal vein catheterization and drainage combined with intravenous infusion of antibiotics (the third-generation cephalosporins, the coformulation of carbapenem and dehydropeptidase-I inhibitors, or the coformulation of tazobactam and piperacillin).A total of 178 patients were diagnosed with liver abscess by B ultrasound or CT. The abscesses mostly occurred in elderly male patients and patients with diabetes mellitus. The major clinical and hematological features were fever (163/178, 91.2%), single focal abscess (146/178, 82.0%), elevated white blood cell count, and percentage of neutrophils (136/178, 76.4%). A total of 102 nonrepetitive strains of bacteria were isolated, including Klebsiella pneumoniae (82 strains, 80.3%), Escherichia coli (8 strains), Pseudomonas aeruginosa (2 strains), Acinetobacter baumannii (1 strain), and Gram-positive cocci (9 strains). Susceptibility to antimicrobial drugs was determined by analyzing the minimum inhibitory concentration, and among the 8 cultured E coli strains, 5 strains that could produce extended-spectrum β-lactamase (ESBLs) were among the most commonly seen nosocomial infections. In the present study, bacterial liver abscesses were mostly community-acquired, and K pneumoniae was highly susceptive to the commonly used antibiotics. Five patients had poor outcomes due to infectious shock or the accompanying liver cancer. In other patients, after treatment, the body temperature and the inflammatory indices, such as the total white blood cell count and C-reactive protein, returned to normal levels, and the area of abscess decreased.Most of the bacterial liver abscesses were caused by K pneumoniae, in which only a few strains exhibited resistance to the commonly used antibiotics. The use of ultrasound- or CT-guided percutaneous drainage combined with antibiotics was an appropriate way to treat the liver abscesses of these patients.

Overview of Cutaneous Mycobacterial Infections.

Mycobacterial infections may affect any human organ and produce disseminated disease in immunocompromised individuals. Their most common clinical presentations include pulmonary, cutaneous (skin and soft tissues), and disseminated forms. The skin and soft tissues are frequent targets of affection by mycobacterial pathogens manifesting as localized or diffuse disease. Overall, infections due to Mycobacterium leprae, Mycobacterium ulcerans, and Mycobacterium tuberculosis are the most frequently recognized mycobacterial pathogens involving the skin and soft tissues. Additionally, all mycobacterial species of the nontuberculous group may also produce cutaneous disease. Of these, the most commonly identified organisms causing localized infections of the skin and subcutaneous tissues are the rapidly growing species (Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus complex), Mycobacterium marinum, and M. ulcerans. Since the skin and soft tissues are important protective barriers for environmental pathogens, their disruption often represents the portal of entry of nontuberculous environmental mycobacteria (soil, natural water systems, engineered water networks, etc.). Additionally, some mycobacterial diseases affecting cutaneous structures occur after exposure to infected animals or their products (i.e., Mycobacterium bovis). Mycobacterial infections of the skin and soft tissues may manifest with a broad range of clinical phenotypes such as cellulitis, single or multiple abscesses, subacute or chronic nodular lesions, macules, superficial lymphadenitis, plaques, nonhealing ulcers, necrotic plaques, verrucous lesions, and many other dermatologic manifestations. Geography and environmental exposure play an important role in the epidemiology of cutaneous mycobacterial infections. Mycobacterial infection of the skin and subcutaneous tissue is an important cause of human suffering in terms of morbidity, deformity, dysfunction, and stigma. The diagnosis of cutaneous mycobacterial infections is challenging requiring a low threshold of clinical suspicion for obtaining skin biopsies of cutaneous lesions for acid-fast staining and cultures, and molecular probe assays to detect the presence of mycobacterial pathogens. The choice of antibacterial therapy combinations and length of therapy for cutaneous mycobacterial infections is species-specific.

A study of clinical presentation, diagnostic difficulties and various treatment modalities of liver abscess

Background: Liver abscess is an uncommon entity and over past 100 years dramatic changes in demographics, etiology, diagnosis and treatment occurred. The purpose of this study was to determine the clinico-etiological demographic profile of liver abscess by using radiological studies and to evaluate the outcome associated with different treatment strategies.Methods: A prospective study was conducted over a cohort of 50 patients presenting with liver abscess. Patients diagnosed with malaria, enteric fever, pyrexia of unknown origin, acute viral hepatitis, chronic liver diseases, or hepatomegaly due to any cause, were excluded from study. Results: The amebic liver abscess was found in 32 patients and pyogenic abscess in 18 patients. The age group ranges from 16 to 78 years with mean age of 38 years and the peak incidence is found in the 31-40 years age group for both types. The M: F ratio is 7:2 in pyogenic liver abscess and 13:3 in amebic. In the present study, the most common symptoms in both types of liver abscess were pain abdomen, loss of weight, anorexia, chills and rigor, vomiting and cough. The most common signs seen in both type liver abscess were tenderness, hepatomegaly and jaundice. In both types liver abscess, right lobe was affected more commonly, and single abscess was more common. Hb &lt;10 gm % is present in more than 50 % cases in both liver abscesses. The right dome of diaphragm elevation present in 75%-89% in both types of liver abscess. In pyogenic liver abscess group, patient had associated intra-abdominal infections. In amebic liver abscess group associated illness was not seen. Antibiotics alone used for small multiple abscesses and antibiotics with needle aspiration done for large abscess, are the main line of treatment in this series. Mortality was nil in present series.Conclusions: Liver abscesses are more common in males, alcoholics and immune-compromised patients. Percutaneous drainage with antibiotics treat majority of cases. The mortality from liver abscess has decreased but incidence appears to be increasing.

A critical role of ultrasonography in management of liver abscesses

Aims and objectives: to see the efficacy of ultrasonography in the management of amoebic liver abscess. We assessed whether patient required surgery or can be managed with drainage procedure on ultrasonography basis.Materials and Methods: This is a prospective study done from July 2014 to May 2015, in a medical college in remote area. A total of 88 patients diagnosed with liver abscess were included in the study for ultrasound-guided percutaneous aspiration or pigtail drainage management. All patients had been treated with antibiotics or antimicrobials for at least 2 weeks if treated conservatively and were still being continued for another 6 weeks.Results: A total of 88 patients with liver abscess were successfully treated, consisting 79 males and 9 female. The age ranged from 18 to 82 years with a mean of 43.6 years. A total number of 76 (86.36%) cases undergone percutaneous catheter drainage and 12 (13.6%) underwent needle aspiration. A total of 73 (82.95%) patients had single large abscess, while 8 (9%) had two and 7 (7.9%) had multiple abscesses. The abscesses were commonly located on the right lobe of liver. The Pigtail catheters of sizes 10 F to 18 F was introduced either directly under the guidance of the guide wire with safety precautions. The volume of pus aspirated averaged from 70 - 1200 ml, while the period of catheter drainage ranged from 7 to 24 days with the follow up on ultrasonography.Conclusion: This study shows a success rate of ultrasonography almost 98 % by avoiding unnecessary surgical intervention. It was confirmed that needle aspiration in small abscesses and catheter drainage in large abscesses offers the safest and best modality.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.258-262

Mycobacterium Kansasii: A Case of Blood Stream Infection with Multiple Metastatic Abscesses

We describe a patient, who presented to our hospital with a prolonged febrile illness and was diagnosed with Acquired Immunodeficiency Syndrome (AIDS) with CD4 count of 12 cells/mm� and viral load of 738000 copies/mL. The CT scan of the chest did not show any abnormalities. Routine cultures were negative. The CT scan of the abdomen showed a single liver abscess, the routine cultures of liver abscess were negative.

Hidradenitis suppurativa: A comparison of guidelines

Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the folliculopilosebaceous unit (FPSU) in the intertriginous skin areas, especially axilla, groin, perineum, and peri- or sub-mammary fold in women, with secondary inflammation of eccrine and apocrine glands. HS disease activity and severity can be divided into three different stages according to the Hurley staging system. Stage I disease consists of single or multiple abscesses, while in Stage II, additional sinus tract formation or scarring can be seen, and in Stage III, interconnected tracts and abscesses have developed over a complete anatomic area. Due to its high disease burden, the extent to which HS negatively impacts patients' quality of life is higher than that of most other chronic dermatological conditions. Pain is considered one of the worst aspects of HS. In this article, we compare different guidelines for the management of HS between hospitals in Europe and the U.S. for Hurley Stage I, II, and III. Existing treatment guidelines were identified through systematic review of medical databases, including PubMed, using the search terms “hidradenitis suppurativa treatment guidelines” as well as “acne inversa treatment guidelines” for the European and German treatment guidelines, as well as American hospital-specific treatment algorithms, including Henry Ford Hospital, Detroit, Michigan, and Mayo Clinic, Rochester, Minnesota. In the German S1 guidelines, the goal is an improvement of one Hurley stage and/or a 25% improvement of the Sartorius score or the dermatology life quality index within 12 weeks. Radical surgical or laser excision, oral combination therapy of clindamycin and rifampin, or alternatively tetracycline, topical clindamycin, and hormonal therapy are recommended, while topical resorcinol, dapsone, finasteride, zinc gluconate, and acitretin are the treatment options that can be taken into consideration. Unlike the European or German S1 guidelines or the algorithm proposed by the Henry Ford Hospital, more systemic antibiotic therapy options are suggested in the Mayo Clinic algorithm before the addition of immunosuppressive therapy. Evaluation for efficacy happens every 3 months, and in case of treatment failure, the antibiotic regimen is changed and reevaluated 3 months later. Options include Trimethoprim-sulfamethoxazole, amoxicillin-clavulanate, fluoroquinolones, clindamycin, and rifampin, as well as rifampin plus moxifloxacin plus metronidazole. If none of the proposed antibiotic therapies help, acitretin, dapsone, or cyclosporine may be used instead. In refractory HS, infliximab or adalimumab is added to the regimen. For Stage III disease or in case of treatment failure so far, wide local excision as an addition to medical therapies can be considered. With the literature of the existing treatment options mostly being low evidence, scarce new randomized controlled trials, and the existing guidelines leaving room to interpretation, a gold standard for the treatment of HS does not yet exist. Further large-scale, randomized studies are necessary to continue treatment exploration and improve treatment regimens.

Medical management of a subretinal Klebsiella pneumoniae abscess with excellent visual outcome without performing vitrectomy

To report the case of a Klebsiella pneumoniae endogenous endophthalmitis (KPEE) of hepatic and urinary origin that was successfully treated with systemic antibiotherapy and 13 intravitreal antibiotics injections without performing a vitrectomy. Case report of a 60-year-old man with a subretinal abscess in the left eye that developed 3 days after initial presentation for K.pneumoniae bacteremia, liver abscess and urinary tract infection. Ophthalmic examination of the left eye showed anterior uveitis and a single subretinal abscess located in mid-peripheral temporal retina. BCVA dropped to 20/50. Follow-up was made with clinical examination and multimodal imaging (SD-OCT, FA, ICGA) with high field photographs. A total of 13 intravitreal injections (IVI) of ceftazidime were performed, and no vitrectomy was required. Ocular signs regressed and prognosis was excellent with 20/20 of final BCVA. KPEE is a rare but severe condition with a typically poor ocular prognosis. When diagnosis is made early, subretinal abscess with partially conserved BCVA could be treated successfully with medical management that includes systemic antibiotics and repeated intravitreal injections without requiring vitrectomy.

The clinical features of 93 bacterial liver abscess cases

Objective To investigate the clinical features of patients with bacterial liver abscess. Methods The clinical data of patients with liver abscess during January 2014 to December 2016 were retrospectively analyzed. Results There were 93 cases enrolled, 26.88% were accompanied by diabetes mellitus (DM), 60.22% were accompanied liver, gall bladder, pancreas diseases or had history of liver, bile duct or gastrointestinal surgery. The most common symptoms were fever (94.62%) and gastrointestinal symptoms (50.54%), while 15.05% for shock; 91.40% were single abscess, and 73.12% were in the right lobe. The white blood cell count (WBC), neutrophil (N), hypersensitive C-reactive protein (hsCRP), procalcitonin (PCT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were elevated in 60.22%, 65.59%, 97.85%, 82.93% (34/41), 47.31%, and 46.24% of patients, respectively. 12/62 (19.35%) were positive by blood culture and 32/54 (59.26%) were positive by pyogenic fluids or bile culture, the top two pathogenic bacteria were Klebsiella pneumonia (52.27%) and Escherichia coli (27.27%). Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores were between 0-25 points, 72.04% cases were (0-10) points, 26.88% case were (11-20) points and one patient was more than 20 points. Among the 93 cases, 82.79% were underwent antibacterial by carbapenem, penicillin enzyme compound preparation or combined with levofloxacin, and 45.16% were underwent liver puncture of drainage treatment. A percentage (96.77%) of patients was cured or recovered. Conclusions Biliary retrograde infection is the main cause of hepatic abscess. In the early experiential antibacterial therapy, the first-line choices of antibiotics are those effective to extended spectrum β-lactamase (ESBL) positive enterobacteriaceae bacteria. Liver puncture of drainage treatment may be effective and safety. APACHE Ⅱ score may be useful to assess the prognosis of live abscess. Key words: Liver abscess, pyogenic/DI/TH

Case report of cerebral phaeohyphomycosis caused by Fonsecaea monophora

Cerebral phaeohyphomycosis (CP) is a rare cause of fungal central nervous system (CNS) infection. Among the many fungal genera associated with CP, Fonsecaea is rarely the culprit pathogen. As such, Fonsecaea-associated CP is poorly understood, with few cases reported in the literature. The authors report a case of a progressive brain abscess caused by F. monophora in a 63-year-old man with poorly controlled type 2 diabetes, liver cirrhosis, and recent travel to South Sudan. The patient presented with headache and constitutional symptoms 2 days after returning from South Sudan. Fungal culture of a biopsy from a single left frontal abscess isolated a dematiaceous mould that was identified as F. monophora based on colony morphology and DNA sequence analysis of the ribosomal internal transcribed spacer (ITS) region. Despite treatment with liposomal amphotericin B and voriconazole, the patient clinically deteriorated and died. Dematiaceous fungal brain abscesses are a rare cause of CNS infections. Early diagnosis with tissue biopsy is essential for timely access to appropriate antifungal therapy. Complete surgical resection is associated with improved outcomes.

Primary Pyomyositis as Unusual Cause of Limp: Three Cases in Immunocompetent Children and Literature Review

AbstractPyomyositis (PM) is an uncommon primary skeletal muscle infection caused mainly by Staphylococcus aureus that is characterized by single or multiple intramuscular abscess formation. In our ward, between 2013 and 2015, three children (two females and one male) aged from 2 to 12 years were diagnosed and treated for PM. Patients' medical records and imaging studies were examined retrospectively. All patients, otherwise healthy, complained of limp, fever, and severe lower limb pain. Skin scratch lesions were detected in two cases; one of them showed an edematous appearance of the affected area. Multifocal bilateral abscesses of gemini and gastrocnemius were detected in the youngest patient; right obturator and iliac muscles were affected in the second patient; and right gluteus and pyriform muscles were involved in the third patient. All patients showed elevated acute phase reactants and had normal serum creatinine kinase levels. Blood cultures and polymerase chain reaction (PCR) investigations were negative in all cases. Magnetic resonance imaging (MRI) findings included muscle enlargement, deep fascia, high signal in subcutaneous tissues, and postgadolinium abscess formation. No patient required surgical or percutaneous drainage. All three were treated conservatively with intravenous oxacillin, associated with ceftriaxone in the first patient and ceftazidime in the other two, followed by oral antibiotic therapy for a period ranging from 5 to 6 weeks. Pyomyositis must be considered as an unusual cause of limp in children of all ages. When promptly diagnosed and adequately treated, it has a favorable outcome without relapses or sequelae as occurred in all our patients.

Evaluation of Continuous Irrigation and Drainage with a Double-Cavity Sleeve Tube to Treat Brain Abscess.

Brain abscesses carries a high morbidity and mortality, and despite medical advances, it continues to pose diagnostic and therapeutic challenges worldwide. The traditional surgical approaches to treating brain abscess (burr hole aspiration and craniotomy) have both advantages and disadvantages and remain controversial. Here we report a single institution's experience with a new surgical approach for brain abscess. We retrospectively analyzed 46 patients with intracranial abscess who underwent continuous irrigation and drainage through a double-cavity sleeve tube placed surgically in conjunction with a 4-week course of intravenous cefotaxime and metronidazole at Renmin Hospital of Wuhan University between January 2008 and December 2016. The patients' medical records were analyzed for demographic data, clinical presentation, predisposing factors, imaging findings, microbiological test results, treatments, surgical techniques, and outcomes. The 46 patients included 29 males and 17 females, ranging in age from 22 to 74 years. A single abscess was detected in 34 patients, whereas 12 patients had multiple abscesses. The average duration of hospitalization was 12.6 days. After treatment, 38 of the 46 patients resumed a normal life despite minor deficits (Glasgow Outcome Score [GOS] 5), 6 patients exhibited slight neurologic deficits (GOS 4), and 2 patients died of severe systemic infection and multiorgan failure. In particular, a patient with a brain abscess broken into the ventricle recovered well (GOS 5). No patient required repeat aspiration or surgical excision. Continuous brain abscess cavity irrigation and drainage with a double-cavity sleeve tube is an effective treatment for brain abscess and produces excellent results, especially for an abscess broken into the ventricle. It combines the advantages of burr hole aspiration and open craniotomy excision. It is easy to perform and reduces costs and damage to the patient, and also shortens hospitalization time and antibiotic treatment time, greatly reducing the likelihood of reoperation. This approach may be the optimal choice to treat brain abscess.