Staphylococcal Abscess Research Articles

Potential Infections Related to Anabolic Steroid Injection in Young Adolescents

To the Editor. In their article “Anabolic Steroid Use by Male and Female Middle School Students,” Faigenbaum et al1 indicate that 2.7% of middle school students (grades 5 through 7) report anabolic steroid use. Anabolic-androgenic steroids (AS) can be administered orally or intramuscularly; the latter is the route of administration for 50% of AS users.2 It has been indicated previously that 25% of students who report AS use share needles for injection.3 Therefore, this young and relatively uneducated AS user group is potentially at risk for infections related to injection. We conducted a MEDLINE (1966–1998) and AIDSLINE (1980–1998) world literature review to examine references that attributed infections to AS injection.We found infections attributable to the multi-person use of needles and syringes and improper injection techniques in 11 individuals. None of these cases were among children or younger adolescents. The mean age of these individuals was 25 years (mean, 18–37 years). Three separate cases of human immunodeficiency virus (HIV) infection occurred in male, heterosexual bodybuilders who shared needles that were used for AS injection on multiple occasions.4–6 One of the individuals who was diagnosed with HIV infection also acquired hepatitis B through shared AS needles.4 Two cases of thigh abscesses were discovered in male and female professional weight lifters who injected a veterinary preparation of stanozolol contaminated with Mycobacterium smegmatis.7 Two case reports of staphylococcal gluteal abscesses developed in young bodybuilders 18 and 21 years of age.8 The steroids were injected by other weight lifters who were not trained in sterile injection technique. A staphylococcal abscess occurred in a 24-year-old bodybuilder who reported, for financial reasons, reusing needles on multiple occasions.9 Pectoral and deltoid abscesses were reported in a 20-year-old AS injector who had injected his AS preparation and then returned the needle to the vial to inject into another muscle group.10 The patient was thought to have contaminated his multi-dosage vial with skin flora and subsequently spread the infection.10 A counterfeit AS preparation contaminated with Pseudomonas spp was responsible for a deep gluteal abscess in one AS injector.11 Immune suppression secondary to long-term AS use may have contributed to Candida albicans endophthalmitis in a 24-year-old athlete who reported a 2-year history of injecting AS.12Serious infections attributable to AS injection have been reported in young adult professional and recreational athletes. Many of these young adult athletes appeared to have limited education about sterile injection technique and limited access to sterile needles and syringes. It is doubtful that adolescent middle school students have better education or easier access to needles and syringes. Although a harm reduction model may be appropriate for older athletes with a longer history of use, it is of paramount importance to encourage adolescents to abstain from AS use and injection. Intervention strategies to lower the intent to use AS among adolescents should include education regarding the potential infectious complications related to injection. Further studies that examine the prevalence and incidence of blood-borne pathogens and behavioral studies of the injection practices among AS users are needed.This work was supported in part by the National Institutes of Health, National Institute on Drug Abuse K20 Grant DA00268 to Dr Josiah D. Rich.

Prophylactic anti-infective activity of poly-[1-6]-beta-D-glucopyranosyl-[1-3]-beta-D-glucopryanose glucan in a guinea pig model of staphylococcal wound infection.

The judicious use of perioperative antibiotic prophylaxis reduces the infectious complications of surgery. However, increased bacterial resistance within hospitals may make antibiotic prophylaxis less effective in the future and alternative strategies are needed. New immunomodulatory agents might prevent wound infections by stimulation of the host immune system. To test this hypothesis, we administered poly-[1-6]-beta-D-glucopyranosyl- [1-3] -beta-D-glucopyranose glucan (PGG glucan), which enhances neutrophil microbicidal activity, intravenously to guinea pigs in doses ranging from 0.015 to 4 mg/kg of body weight on the day before, on the day of, and on the day after intermuscular inoculation with methicillin-resistant strains of Staphylococcus aureus and Staphylococcus epidermidis. Abscesses were identified at 72 h, and median infective doses (ID50) and statistical significance were determined by logistic regression. Guinea pigs receiving PGG glucan and inoculated with methicillin-resistant S. aureus and S. epidermidis exhibited ID50 of as much as 2.5- and 60-fold higher, respectively, than those of control guinea pigs not receiving PGG glucan. Maximal protection was observed with a dose of 1 mg of PGG glucan per kg, and efficacy was reduced at higher as well as at lower PGG glucan doses. Furthermore, a single dose of PGG glucan given 24 h following bacterial inoculation was found to be effective in preventing infection. We conclude that PGG glucan reduces the risk of staphylococcal abscess formation. Neutrophil-activating agents are a novel means of prophylaxis against surgical infection and may be less likely than antibiotics to be affected adversely by the increasing antibiotic resistance of nosocomial pathogens.

Metastatic staphylococcal lung abscess due to a cutaneous furuncle

A seemingly trivial infection of the skin can lead to fulminant staphylococcal pneumonia and death. This case history describes the evolution of a fatal Staphylococcus aureus sepsis complicated by the development of multiple lung abscesses in a 17-year-old patient. A pre-existing cutaneous furuncle was the only identifiable cause. Early bacteraemic symptoms are described. Multiple cavitory lesions could be seen on a CAT-scan. The authors would like to stress the importance of early and adequate antibiotic treatment.

CT of staphylococcal anterior mediastinal abscess in an infant

A 6-week-old girl presented with bronchiolitis secondary to respiratory syncytial virus. Eight days after admission she developed a Staphylococcus aureus infection at a previous intravenous cannula site. Despite antibiotic therapy this led to an anterior mediastinal staphylococcal abscess, which was drained surgically and the patient recovered. Mediastinal abscesses are rare in children: haematogenous spread of infection is an unusual aetiological factor and we believe this to be the first case reported due to an infected cannula site.

Discordance Between F-18 Fluorodeoxyglucose Uptake and Contrast Enhancement in a Brain Abscess

A 29-year-old human immunodeficiency virus-negative intravenous drug abuser with a right hemispheric staphylococcal brain abscess underwent PET imaging of 18F-fluorodeoxyglucose (FDG) brain uptake. Diffuse right cortical hypometabolism was noted, as well as crossed cerebellar diaschisis. Unlike previous PET findings on FDG uptake in a brain abscess, however, the most intense uptake of FDG was found within the abscess and not in the contrast-enhancing walls.

Primary Sternal Osteomyelitis Presenting as a Pleural-based Mass

Osteomyelitis in uncommon locations can present unusual diagnostic difficulties. A patient with primary sternal osteomyelitis who presented with pain over the right supraclavicular area and a radiologic picture of a pleural-based right upper lung mass is discussed. A triple-phase bone scan was consistent with the diagnosis, and a needle aspiration of the mass revealed a staphylococcal abscess. Percutaneous drainage of the contiguous abscess and a prolonged course of antibiotic therapy cured the infection.

Effect of capsulation on the resistance of Staphylococcus aureus to the bactericidal lipids produced in abscesses

Staphylococcus aureus strains differ in their sensitivity to some of the bactericidal lipids produced by the host in staphylococcal abscesses. To evaluate whether the presence of a capsule might account for these differences, capsulate and non-capsulate S. aureus strains were compared for their sensitivity to staphylococcal abscess homogenates and the neutral lipid fraction derived from such material. Although the presence of a capsule appeared to reduce sensitivity, two non-capsulate mutants were only about three-to-four times more sensitive than their capsulate parent strains. Another strain, known for its resistance to these bactericidal lipids, was not capsulate. This suggests that mechanisms other than capsule formation must also determine sensitivity to the lipids.

Does blood transfusion or hemorrhagic shock induce immunosuppression?

Blood transfusions have been implicated in predisposing patients to infection by inducing immunosuppression. This study evaluated the effects of syngeneic (ST) and allogeneic (AT) blood transfusion with and without hemorrhagic shock (HS) to determine whether transfusion or the accompanying hemorrhage affected certain components of the immune response. Lewis rats received ST or AT at 10%, 20%, or 30% of blood volume. Hemorrhagic shock was induced in other animals, which were resuscitated with either shed blood or substituted 10%, 20%, or 30% ST or AT. Intradermal staphylococcal abscess size, peritoneal leukocyte elicitation, and peritoneal macrophage Ia receptor expression were selected to measure the immune system response. Hemorrhagic shock increased abscess size significantly (p less than 0.05), but ST or AT alone or in combination with HS had no effect. Both shock and transfusion per se increased macrophage Ia receptor expression (p less than 0.05), but no additive or synergistic effect was observed. Peritoneal leukocyte elicitation was not affected by HS, ST, or AT. These results suggest that HS and not blood transfusion is a major determinant of the risk of infection.

Efficacies of various antimicrobial agents in treatment of Staphylococcus aureus abscesses and correlation with in vitro tests of antimicrobial activity and neutrophil killing

A rabbit perforated-capsule model was utilized to study antimicrobial efficacy in treating 2-week-old Staphylococcus aureus abscesses. Animals received either ciprofloxacin (30 mg/kg), cefazolin (100 mg/kg), or ciprofloxacin (30 mg/kg) plus rifampin (20 mg/kg) every 8 h for 8 days or no antibiotic. Antibiotic levels within the abscess exceeded the MIC for the test organism. At the end of treatment, ciprofloxacin was no more effective than the control, animals receiving cefazolin had a mean log10 fall of 2.41 CFU/ml, and animals receiving ciprofloxacin plus rifampin had a mean log10 reduction of 5.06 CFU/ml (P = less than 0.01). Six days after completion of therapy, all abscesses in animals receiving ciprofloxacin plus rifampin were culture negative. Surviving organisms in animals receiving ciprofloxacin or rifampin did not develop resistance to the treatment antibiotics. In vitro time-kill curves performed with logarithmic- and stationary-phase organisms in broth, serum, and abscess fluid supernatants did not correlate with the in vivo results. Neutrophil killing studies of S. aureus pretreated with antibiotics revealed greater killing of organisms pretreated with ciprofloxacin plus rifampin than of those pretreated with cefazolin or ciprofloxacin alone. In conclusion, ciprofloxacin plus rifampin was effective therapy in this staphylococcal abscess model, compared with the moderate efficacy of cefazolin and no effect observed with ciprofloxacin alone. Enhanced neutrophil killing of S. aureus pretreated with antibiotics may be an important mechanism by which bacteria are killed in suppurative infections.

Red eyes and red rash with fever: an uncommon initial presentation for staphylococcal obturator abscess with adjacent ischial osteomyelitis.

"Red eyes and red rash with fever" is a common pediatric complaint; however, it is an uncommon initial presentation for staphylococcal obturator abscess with adjacent ischial osteomyelitis. The case of a 13-year-old boy who was admitted to the hospital with conjunctivitis, erythematous maculopapular lesions, and fever and had this final diagnosis is reported. The differential diagnosis included various bacterial diseases, several viral illnesses, and rickettsial disease.

Activity of antibiotics againstStaphylococcus aureus within polymorphonuclear neutrophils

The intracellular location of certain strains of Staphylococcus aureus serves as a reservoir of bacteria which is thought to be important in therapy of recurrent infections in humans and in chronic staphylococcal mastitis in dairy cows. This overview summarizes data pertaining to the intracellular survival of Staphylococcus aureus within polymorphonuclear neutrophils (PMNs) both in vitro and in vivo in the face of antibiotic treatment. While compounds such as rifampin, clindamycin, erythromycin, and ciprofloxacin have been shown to be rapidly taken up by PMNs, the ability of antibiotics to concentrate within PMNs did not strictly correlate with their ability to kill intracellular Staphylococcus aureus. Rifampin and ciprofloxacin have been shown to be the most effective intraphagocytic killing agents, while clindamycin and erythromycin were inactive in these in vitro assays. In vivo, in therapy of Staphylococcus aureus arthritis and peritonitis in humans and in certain mouse models rifampin has generally been shown to be more effective than comparator antibiotics. In a staphylococcal subcutaneous abscess model, however, clindamycin was very effective in curing the Staphylococcus aureus abscesses in this system where PMNs were the primary inflammatory cells involved. The intracellular bacterial counts decreased as rapidly as the extracellular bacteria. Rifampin was also effective in the abscess model but ciprofloxacin was ineffective at the highest doses tested. The relevance of in vitro and in vivo models and the importance of PMNs as a reservoir of infection in staphylococcal diseases in humans and the dairy cow are discussed.

Mixed Staphylococcal and Cryptococcal Epidural Abscess in a Patient with AIDS

Mixed Staphylococcal and Cryptococcal Epidural Abscess in a Patient with AIDS

Osteomyelitis of the cervical spine presenting as a neurenteric cyst

A healthy 3-week-old baby girl developed a cyanotic spell that required intubation and ventilation. During part of her initial emergency examination and treatment, a neck mass was felt, and a positive blood culture grew staphylococcus aureus. She was transferred to the ICU, and was ventilated and treated with intravenous cloxacillin. Bronchoscopy showed a paralyzed left cord. Computerized tomography (CT) scan of her neck showed a midline mediastinal mass (behind the compressed trachea and esophagus), that extended from C7 to the carina. Because of the suspicion of an abnormal C7 vertebral body, diagnosis of a neurenteric cyst was made, and a myelogram showed a complete block at the T1 level and an absent C7 vertebral body. There were no neurologic signs. Her right knee then became red and swollen, and x-rays showed a lytic area in the distal femur. This knee was explored under general anesthesia, and an osteomyelitis found and drained. Several days later, a barium swallow showed the mediastinal mass pushing the esophagus to the left, but several more cervical vertebrae were "missing," and the diagnosis of osteomyelitis of the cervical spine was confirmed. The mediastinal staphylococcal abscess was then drained through the neck. Follow-up has been unremarkable over the last 4 years.

Recurrent infections and staphylococcal liver abscess in a child with C1r deficiency

Complete absence of the C1r portion of the first component of complement was found in a 2 1 2 -year-old boy of Puerto Rican origin who presented with a staphylococcal liver abscess. His medical history also included two episodes of pneumonia complicated by a pneumatocele and empyema, purulent staphylococcal lymphadenitis, recurrent otitis media, and pneumococcal bacteremia. The C1s component of complement was 50% of normal, and C4 was elevated. Other immunologic tests, including nitroblue tetrazolium test, and IgE were normal. This is the tenth patient reported with C1r deficiency. The patient differs from other reported patients with C1r deficiency in that he presented with a liver abscess, an infection that has not been reported in patients with complement deficiencies, and in that he has an apparent susceptibility to staphylococcal infection.

Psoas abscess: changing patterns of diagnosis and etiology.

From 1976 to 1984, 43 patients with psoas abscess were seen at the Mayo Clinic. Intestinal disease, including Crohn's disease, diverticulitis, and carcinoma, was the most frequent cause (14 patients). Eleven patients had osteomyelitis, five had postoperative complications, four had a foreign-body reaction, and three had a primary staphylococcal abscess. Two patients each had extension of a primary pancreatic and perinephric abscess. One patient had tuberculosis of the spine, and in the remaining patient, an exact cause was not determined. Definitive treatment of psoas abscess includes adequate debridement, drainage of the abscess cavity, and resection of involved bowel.

Intracranial hematoma with subsequent brain abscess after carotid endarterectomy

A 62-year-old man developed an infected left carotid endarterectomy with false aneurysm formation and subsequent bacteremia after staged carotid endarterectomies. He was found to have a right frontal lobe hemorrhage that developed into a staphylococcal brain abscess. We postulate there was bacterial seeding of the hematoma resulting in brain abscess formation.

Neonatal Staphylococcal Lung Abscess with Massive Pulmonary Hemorrhage

Neonatal Staphylococcal Lung Abscess with Massive Pulmonary Hemorrhage

CEFUROXIME VERSUS AMPICILLIN AND CHLORAMPHENICOL FOR THE TREATMENT OF BACTERIAL MENINGITIS: Report from a Swedish Study Group

In a prospective randomised multicentre study cefuroxime was compared with a combination of ampicillin and chloramphenicol in the treatment of 50 consecutive patients with acute bacterial meningitis, in 40 of whom the bacterial aetiology was proven by cerebrospinal-fluid (CSF) cultures. Excellent clinical results were obtained in 18 of 21 evaluable patients treated with cefuroxime and in 14 of 19 evaluable patients treated with ampicillin and chloramphenicol. The meningitis was caused by Haemophilus influenzae in 20 of the evaluable patients, by meningococci in 11, by pneumococci in 5, and by other bacterial species in 4. Two of the H. influenzae strains were β-lactamase producing, and the 2 patients infected with these strains, 1 in each treatment group, were cured. 4 of the patients died from their infections. 3 of these patients, 1 in the cefuroxime group and 2 in the ampicillin plus chloramphenicol group, were children who were admitted in extremely poor condition. The 4th patient had a staphylococcal abscess in the hip which was not recognised and drained. He recovered from his meningitis but died from brain abscesses. In 1 patient in the cefuroxime group and 2 patients in the ampicillin plus chloramphenicol group there was incomplete resolution of symptoms or complications had developed by the end of the treatment period. At follow-up 6 weeks after the end of the treatment period 1 patient in the cefuroxime group showed a hearing defect not noted on discharge from hospital. No serious adverse reactions were noted. Determination of CSF and serum concentrations of cefuxomime 6–12 h after a dose showed a high degree of penetration of cefuroxime through the blood-CSF barrier. Cefuroxime is an alternative for treatment of acute bacterial meningitis in children and adults.

Retroperitoneal iliac fossa abscess: A complication of suppurative iliac lymphadenitis

The clinicopathologic manifestations in four patients with staphylococcal abscess localized to the retroperitoneal iliac fossa are presented. This type of abscess may represent a distinct entity and is most likely a complication of suppurative iliac lymphadenitis. Retroperitoneal abscesses localized to the iliac fossa rarely have any osseous component. Extraperitoneal drainage is curative.

Staphylococcal meningitis and abscess associated with intracranial foreign body, as a late complication of cranial trauma.

Report of the case of a patient who presented a meningitis associated with a brain abscess as the result of a head injury which occurred several months beforehand and which, although it seemed trivial at the time, resulted in the penetration into the brain of an unsuspected foreign body. The possibilities of prevention and treatment of such complications are discussed and the necessity for a careful exploration of any penetreting wound of the face even after a trivial head injury is stressed.