Treatment Of Abscess Research Articles

Letter to the Editor regarding: “The utility of vertebral Hounsfield units as a prognostic indicator of adverse events following treatment of spinal epidural abscess”

Letter to the Editor regarding: “The utility of vertebral Hounsfield units as a prognostic indicator of adverse events following treatment of spinal epidural abscess”

Surgical treatment of extraintestinal amoebiasis with development of right lobe liver abscess: case study

The treatment of extraintestinal amoebiasis is a major surgical concern given the low prevalence in the Republic of Belarus and consequently difficult diagnosis. In this article, we present our own experience with the surgical treatment of a patient with an amoebic liver abscess. The patient underwent laparoscopy guided drainage of the abscess of the right lobe of the liver according to the technique developed in the clinic. A puncture-drainage system consisting of a Foley catheter and a guide stylet was used. The patient was discharged in satisfactory condition for outpatient treatment and observation by a surgeon, a general practitioner, and an infectious disease specialist. There were no repeated visits or admissions. The presented case emphasizes the importance of combined treatment of amoebic liver abscesses using percutaneous drainage and conservative therapy with amoebicidal drugs such as metronidazole.

Drainage of middle cranial fossa epidural abscess through mastoidectomy: Our experience and review of the literature

Background: Otitis media (OM) can uncommonly lead to intracranial complications. Epidural abscesses represent a large proportion of cases; however, literature regarding the optimal surgical management of otogenic epidural abscesses is sparse. Favorably located epidural abscesses may be amenable to drainage through a transmastoid approach because the tegmen mastoideum lies immediately inferior to the middle cranial fossa (MCF). Case Description: We report 3 pediatric patients with OM complicated by epidural abscesses of the MCF. The ages ranged from 3 to 6 years old, with 2 females and 1 male. All 3 patients had acute mastoiditis with an abscess of the MCF ranging from 1.6 cm to 6.3 cm at the largest dimension. All patients underwent canal wall-up mastoidectomy with the evacuation of the MCF abscess through a small window, 0.7 × 0.7 cm or less, created in the tegmen mastoideum. All patients were successfully treated through this approach and had complete resolution of their infection on follow-up imaging. There were no postoperative temporal lobe encephaloceles. Conclusion: This is one of the few descriptions of the treatment of an otogenic epidural abscess of the MCF through a transmastoid approach. Collaboration with neurosurgery is vital because their familiarity with the intracranial space helped to guide the accurate direction of dissection. This highlights the importance of a multidisciplinary approach in the treatment of epidural intracranial abscess of the MCF through this approach. The risk of postoperative temporal lobe encephalocele was minimized due to the small tegmen defect size.

A Retrospective Study on Endoscopic Surgery for the Treatment of Paravertebral Abscess in Spinal Tuberculosis Patients

A Retrospective Study on Endoscopic Surgery for the Treatment of Paravertebral Abscess in Spinal Tuberculosis Patients

Successful Multidisciplinary Treatment of Severe Pyogenic Liver Abscess Caused by Fish Bone: A Case Report

Successful Multidisciplinary Treatment of Severe Pyogenic Liver Abscess Caused by Fish Bone: A Case Report

Clinical utility of combined contrast-enhanced ultrasound and intracavitary contrast-enhanced ultrasound in the percutaneous treatment of pyogenic liver abscess

Aim: This study aimed to evaluate the utility of the combined use of contrast-enhanced ultrasound (CEUS) and intracavitary CEUS (IC-CEUS) with diluted SonoVue in the management of percutaneous treatment for pyogenic liver abscess (PLA). Methods: 36 patients (23 males, 13 females; mean age 64 ± 13.9 years) with 39 PLAs (mean size 7.6 ± 3.4 cm) were selected for percutaneous catheter drainage (PCD) and/or percutaneous needle aspiration (PNA). CEUS and IC-CEUS were employed during the interventional maneuver and follow-up during hospital stay in all cases. Results: 33 patients with 24 PLAs underwent PCD, 8 patients with 10 PLAs were treated with single or multiple PNA, and the combination of PCD and PNA was used in the remaining 5 cases. During the treatment planning phase, the combined use of CEUS and IC-CEUS affected therapeutic choices (e.g., drainage technique, additional therapeutic measures) in comparison with pre-operative imaging in 66.7% of patients. Throughout the follow-up period, CEUS and IC-CEUS facilitated monitoring of PLA evolution, providing crucial information, especially with IC-CEUS, on the optimal timing of catheter removal. No adverse events occurred after CEUS and IC-CEUS. Conclusions: The combination of CEUS and IC-CEUS proved to be a powerful and safe tool for tailoring US-guided percutaneous treatments to patients with PLA.

SP2.1 - Endoscopic retrograde appendicitis therapy for peri-appendiceal abscess

Abstract Aims ERAT is a novel technique primarily for uncomplicated appendicitis, but it is starting to be used also for peri-appendiceal abscesses. The aim of this study was to evaluate the efficacy and clinical outcomes of ERAT in treating patients with peri-appendiceal abscess. Methods Between January 2018 and April 2023, twenty-eight patients with peri-appendiceal abscess were treated with ERAT. We retrospectively analyzed the location and size of the peri-appendiceal abscess, success rate of ERAT, median operative time, postoperative hospital stay and complications. We defined success of ERAT as finding the appendiceal orifice and successful performance of ERAT without conversion to appendectomy or percutaneous drainage of the appendiceal abscess within one month. All patients were followed up at least 6 months, with a median follow-up of 31.5 months. Results The success rate of ERAT was 75.0% (95% CI, 54.8%-88.6%; n = 21/28). 35.7% (95% CI, 19.3%-55.9%; n = 10/28) of peri-appendiceal abscesses were located in the lower ileum, and the median size of appendiceal abscesses was 43.5 mm (95% CI: 33-53). 80.8% (95% CI, 60.0%-92.7%; n = 21/26) of patients had a visual analogue scale pain score of ≤3 at 24 hours after treatment. The median procedure time was 69.5 minutes (95% CI: 51-76), and the median hospital stay was 6.5 days (95% CI: 5-9). During the follow-up period, a total of four (17.1%; 95% CI, 0.9%-13.1%; 4/21) patients presented with abdominal pain associated with peri-appendiceal abscesses. Conclusions ERAT is a technically feasible treatment for peri-appendiceal abscesses.

National survey on peritonsillar abscess treatment and attitudes toward quinsy tonsillectomy

ABSTRACT Objectives Peritonsillar abscess (PTA) is a common deep neck infection traditionally managed with conservative measures. Quinsy Tonsillectomy (QT) is recognized as a definitive treatment but remains variably utilized. We aimed to investigate PTA management strategies and attitudes toward QT among otolaryngologists. Methods An anonymous questionnaire was distributed to members of the local national Society of Otolaryngology, evaluating treatment strategies based on patient characteristics and clinical scenario. Results A total of 108 otolaryngologists responded (response rate: 30.8%). Participants preferred to treat PTA patients as inpatients (89%) and predominantly offered incision and drainage (I&D) as the first (90.7%) and subsequent (98.1%) treatment plan. QT was favored as a primary treatment only in 1.9% of responders. QT adoption increased with multiple I&D failures, reaching 95.3% after four attempts. In patients with recurrent PTA or tonsillitis, 84.2% preferred I&D follows by interval elective tonsillectomy, while 15% considered QT. The most common reason (72.2%) to avoid QT was the perception of a high perioperative risk. Conclusion I&D was favored for initial PTA treatment. QT is considered after multiple failed I&D attempts, and its use is limited as a primary treatment, mainly due to concerns regarding perioperative risk.

Multifunctional Adaptable Injectable TiN-Based Hydrogels for Antitumor and Antidrug-Resistant Bacterial Therapy.

The close relationship between bacteria and tumors has recently attracted increasing attention, and an increasing number of resources are being invested in the research and development of biomedical materials designed for the treatment of both. In this study, prefabricated TiN nanodots (NDs) and Fe(CO)5 nanoparticles are combined into sodium alginate (ALG) hydrogels to create a biomedical material for the topical treatment of breast cancer and subcutaneous abscesses, and a pseudocatalytic hydrogel with intrinsic photothermal and antibacterial activities is synthesized. TiN+Fe(CO)5+ALG hydrogels are used to determine the ability of Fe(CO)5 to promote CO production. Moreover, TiN NDs catalyze the production of reactive oxygen species (ROS) from hydrogen peroxide in tumor microenvironments and exhibit excellent photothermal conversion properties. After local injection of the TiN+Fe(CO)5+ALG hydrogel into subcutaneous tumors and subcutaneous abscesses, and two-zone near-infrared (NIR-II) irradiation, tumor cells and methicillin-resistant Staphylococcus aureus are effectively removed by the hydrogel, the mouse epidermis exhibiting complete recovery within 8 d, indicating that this hydrogel exhibits better antibacterial efficacy than the small-molecule antibiotic penicillin. This study demonstrates the potential of novel hydrogels for antitumor and antimicrobial combination therapy and aims to provide design ideas for the research and development of multifunctional antitumor and antimicrobial drug combinations.

Analysis of Risk Factors for Recurrence Following Conservative Treatment of Acute Appendicitis-Related Abscesses in Children

Background: Acute appendicitis accompanied by a periappendiceal abscess is a common pediatric surgical emergency, with a risk of recurrence. Objectives: To analyze the risk factors for the recurrence of acute appendicitis-related periappendiceal abscesses in children following the resolution of clinical symptoms. Methods: We retrospectively collected data from children admitted to the hospital with periappendiceal abscesses between 1 January 2015 and 31 December 2021. These children were categorized into recurrent and non-recurrent groups based on whether a periappendiceal abscess recurred. Gender, age, length of hospitalization, white blood cell (WBC) count, and C-reactive protein (CRP) levels at admission and discharge were compared between the two groups. Logistic regression was used to analyze the risk factors for the recurrence of periappendiceal abscesses in children following conservative treatment. Results: After 2 years of outpatient follow-up, 65 children were included in the study, nine of whom experienced recurrence. Significant differences were observed between the recurrent and non-recurrent groups in terms of abscess size at discharge (6.50 vs. 2.80 cm, P = 0.022), WBC count at discharge (13.25 × 10⁹/L vs. 6.98 × 10⁹/L, P = 0.016), and CRP level at discharge (32.80 vs. 8.60 mg/L, P = 0.002). A multifactorial logistic regression analysis indicated that both WBC count and CRP level at discharge were independently associated with the recurrence of periappendiceal abscesses. Conclusions: Increased attention should be given to the risk of recurrence in pediatric patients with elevated WBC counts and CRP levels at the time of discharge.

Utility of Contrast-Enhanced Ultrasound in Optimizing Hepatic Abscess Treatment and Monitoring.

Background/Objectives: Untreated hepatic abscesses (HAs) have an 80% mortality rate and can be caused by bacteria and fungi. Previously managed with surgery, current treatments now utilize interventional radiology and antibiotics, reducing complications to 2.5%. This study evaluates contrast-enhanced ultrasound (CEUS) for better drainage placement and monitoring, overcoming conventional ultrasound's limitations in detecting the HA liquefied portion. Methods: We conducted a retrospective study of 50 patients with HAs confirmed via computed tomography (CT) scans. Inclusion criteria comprised specific clinical symptoms and laboratory parameters. Both B-mode and CEUS were utilized for initial and follow-up imaging. Results: In the CEUS studies, the mean size of HAs was 6.26 cm, with pus displaying significantly lower echogenicity compared to the HA pouch and liver parenchyma in all phases. Classification by size (>6 cm, <6 cm) and volume (>113 mL, <113 mL) revealed differences in the assessment of fluid volume between CEUS and B-mode. Conclusions: CEUS is valuable for diagnosing, performing therapeutic procedures, and monitoring HA. It provides precise real-time assessment of HA morphology, including dimensions and volume. If the liquefied volume of an HA exceeds 113 mL, it may qualify for drainage placement. CEUS can replace CT as an effective, less harmful, and cheaper method, eliminating the need for multiple radiological departments. While CEUS is a safer, cost-effective alternative to CT for HA evaluation and monitoring, comprehensive clinical evaluation remains essential. Therefore, CEUS should be part of a broader diagnostic and monitoring strategy, not a stand-alone solution.

Butyricimonas faecihominis: an atypically resistant bacterium implicated in abscess formation - a case report

BackgroundThis case report presents a unique instance of abscesses with an uncommon pathogen isolated from blood cultures.Case presentationWe present the case of a perianal abscess in a 50-year-old man with a history of cocaine abuse and bilateral hip replacements. The rapid progression led to septic shock and multi-organ failure, requiring intensive care unit admission, surgery including protective transversostomy. Blood cultures showed growth of Butyricimonas spp. with resistance to penicillin and piperacillin-tazobactam. The immediate switch to meropenem led to a significant improvement in the patient’s condition. The patient was discharged after 40 days of hospitalization in good general condition and the reversal of the transversostomy was performed six months later.ConclusionThe identification of Butyricimonas faecihominis, a rarely reported pathogen, emphasizes the challenges of diagnosing and treating unusual infections. This case emphasizes the importance of rapid microbiological diagnosis, interdisciplinary collaboration, and targeted antibiotic therapy in the treatment of abscesses and sepsis.

Therapeutic management of peritonsillar abscess during COVID-19.

The purpose of this study is to examine the effects of the Covid-19 pandemic and lockdown policies in Germany on frequency and treatment of peritonsillar abscess at a tertiary referral center in Germany. This retrospective case-control study analyzed all cases of peritonsillar abscess treated from 03/01/2018 until 08/30/2022 at Augsburg ENT University Hospital, Germany, through abscess tonsillectomy and/ or incisional drainage. Data was collected and correlated to Covid-19 Stringency Index using codes based on the Institute for Hospital Remuneration System in Germany. After excluding 303 cases, 975 abscess tonsillectomy and incisional drainage cases were studied, with the first German lockdown serving as cutoff date. Treatment algorithm was maintained regardless of co-infection with Covid-19. A total of 174 patients received abscess tonsillectomy as therapy, while 801 patients underwent incisional drainage. Before the first German lockdown, 452 patients received incisional drainage. Since the pandemic, 349 cases of incisional drainage were registered (OR = 0.54, 95%-CI [0.27-0.86], p = 0.04), despite no significant change in the percentage of peritonsillar abscess of all ENT emergencies. The mean age at presentation with PTA was 39.8 years, and the rate of relapse was 4.0%. The study found no association between the scale of policy measures and treatment (OR = 1.00, 95%-CI [0.99-1.01], p = 0.52). The results indicate that, despite the reduction in capacities due to Covid-19, the proportion of patients with peritonsillar abscess treated through abscess tonsillectomy increased at Augsburg ENT University Hospital since the first German lockdown. Hospitalization times could still be reduced with comparable relapse rates.

An Investigation of Moxibustion Treatment for Abscesses in the Song Dynasty: Focusing on the “Jiu Ai Tu”

Abstract Jiu Ai Tu (The Moxa Treatment) from the Song dynasty is the earliest surviving painting that focuses on the subject of acupuncture and moxibustion. This paper takes the medical activities depicted in the artwork as its research object and systematically analyzes the external treatment methods for abscesses during the Song dynasty reflected in Jiu Ai Tu. By examining the understanding of abscesses during that period, the paper explores the level of development in external medicine techniques. By analyzing the medical awareness and behaviors of patients when facing such severe illnesses, it aims to explore the societal cognition and experiences regarding health and disease. The paper attempts to present the folk medical ecology of the Song dynasty represented by Jiu Ai Tu.

Plasma and interstitial fluid antibiotic levels of subcutaneously implanted compounded florfenicol calcium sulfate beads in New Zealand White rabbits (Oryctolagus cuniculus).

To determine antibiotic levels in plasma and interstitial fluid (ISF) after SC placement of compounded florfenicol (FF) calcium sulfate beads (CSBs) in New Zealand White rabbits (Oryctolagus cuniculus). 6 juvenile female rabbits (n = 5 treatment and 1 control). An ultrafiltration probe and CSBs were placed SC in 6 rabbits (n = 5 for FF CSBs and 1 for control CSBs). Plasma (3, 6, 12, 24, and 48 hours and 7, 14, and 21 days) and ISF (daily for 21 days) samples were collected, and FF was measured by HPLC for pharmacokinetic analysis. Hematology, biochemistry, and histopathology were assessed. Means ± SD for the area under the curve, maximum concentration, time of maximum concentration, terminal half-life, and mean residence time to the last data point for plasma and ISF were 16.63 ± 8.16 and 17,902 ± 7,564 h·µg/mL, 0.79 ± 0.38 and 245 ± 223 µg/mL, 2.90 ± 0.3 and 59 ± 40 hours, 30.81 ± 16.9 and 27.3 ± 9.39 hours, 23.4 ± 10 and 73.7 ± 13 hours, respectively. Plasma FF was < 2 µg/mL at all time points. The ISF FF remained > 8 μg/mL for 109.98 to 231.58 hours. One rabbit death occurred during treatment, but the cause of death was undetermined. Local tissue inflammation was present, but no clinically significant systemic adverse effects were found on hematology, biochemistry, or histopathology in the remaining rabbits. Florfenicol CSBs maintained antibiotic concentrations in ISF at levels likely to be effective against bacteria sensitive to > 8 µg/mL for 5 to 10 days while maintaining low (< 2 µg/mL) plasma levels. Florfenicol CSBs may be effective for local antibiotic treatment in rabbit abscesses.

Conservative treatment of thyroid abscess in a child with thyroglossal duct cyst

Conservative treatment of thyroid abscess in a child with thyroglossal duct cyst

Early ultrasound-guided drainage of tubo-ovarian abscesses versus conservative treatment: a retrospective cross-sectional study.

To compare the short and long-term benefits (the length of hospital stay, surgical complications, and early clinical improvement) of adding early ultrasound-guided drainage to broad-spectrum antibiotic treatment. Patients undergoing tubo-ovarian abscess treatment between January 2017 and June 2022 in a tertiary hospital were retrospectively evaluated. Of the patients studied, 50 subjects were treated with antibiotics alone and 63 underwent guided drainage. Twenty-one individuals underwent early drainage within 72 hours of admission, and 42 underwent guided drainage after this period. There was no statistical difference in the length of hospital stay between the groups simultaneously, averaging 6.4 days for the controls, 5.1 days for the early drainage group, and 9.6 days for the late drainage group (p = 0.290). In the multiple linear regression with the length of hospital stay outcome and adjusting for potential confounding factors, there was an average reduction of 2.9 days in the hospital stay (p = 0.04) for the early drainage group (< 72 hours) compared to the controls. Early clinical improvement and an expected drop in CRP were more frequent in patients who underwent drainage. Length of hospital stay increases with abscess diameter: 0.4 [(95% CI 0.1 - 0.7) (p = 0.05)] days per centimeter, regardless of other variables. Ultrasound-guided drainage of tubo-ovarian abscesses associated with antibiotic therapy is an effective treatment, with few complications, and may lead to clinical improvement especially when performed early.

Splenic abscess and infective endocarditis.

To determine the background, bacteriological, clinical and radiological findings, associated lesions, treatment and outcome of splenic abscesses (SAs) in infective endocarditis (IE). Retrospective study (2005-2021) of 474 patients with definite IE. The diagnosis of SA was made in 36 (7.6%) patients (31, 86.1%, males, mean age = 51.3) on abdominal CT. The main implicated organisms were Streptococcus spp (36.1%), Enterococcus faecalis (27.7%), Staphyloccus spp (19.4%). Rare agents were present in 10 patients (27.8%). Pre-existing conditions included a prosthetic valve (19.4%), previous IE (13.9%), intravenous drug use (8.4%), diabetes (25%) alcohol abuse (13.9%), liver disease (5.5%). Vegetations ≥ 15mm were present in 36.1%. Common presentations were abdominal pain (19.4%) and left-sided pleural effusion (16.5%). SA were more often small (50%; 7 multiple) than large (36.1%; 1 multiple) or microabscesses (13.9%, 3 multiple). Associated complications were extrasplenic abscesses (brain, 11.1%; lung, 5.5%; liver, 2.8%), infectious aneurysms (16.7%: 3 intracranial, 1 splenic, 1 hepatic, 1 popliteal), emboli (brain, 52.8%; spleen, 44.4%, 5 evolving to SA; kidney, 22.2%; aorta, 2.8%), osteoarticular infections (25%). Twenty-eight (77.8%) patients only received antimicrobials, 7 (19.4%) underwent splenectomy, after cardiac surgery in 5. One had percutaneous drainage. The outcome was uneventful (follow-up 3months-14years; mean: 17.2months). In SA-IE patients, the prevalence of vegetation size, Enterococcus faecalis, rare germs, diabetes, osteo-arthritic involvement and cancer was higher than in non-SA patients. Some SAs developed from splenic infarcts. IE-patients with evidence of splenic emboli should be evaluated for a possible abcedation. Cardiac surgery before splenectomy was safe.

Brain abscess caused by Streptococcus anginosus group: Three case reports

BACKGROUND This case series investigated the clinical manifestations, diagnoses, and treatment of cerebral abscesses caused by Streptococcus anginosus . We retrospectively analyzed the clinical characteristics and outcomes of three cases of cerebral abscesses caused by Streptococcus anginosus and conducted a comprehensive review of relevant literature. CASE SUMMARY Case 1 presented with a history of left otitis media and exhibited high fever, confusion, and vomiting as primary symptoms. Postoperative pus culture indicated a brain abscess caused by Streptococcus constellatus infection. Case 2 experienced dizziness for two days as the primary symptom. Postoperative pus culture suggested an intermediate streptococcal brain abscess. Case 3: Enhanced head magnetic resonance imaging (MRI) and diffusion-weighted imaging revealed occupancy of the left temporal lobe, initially suspected to be a metastatic tumor. However, a postoperative pus culture confirmed the presence of a brain abscess caused by Streptococcus anginosus infection. The three cases presented in this case series were all patients with community-acquired brain abscesses resulting from angina caused by Streptococcus group infection. All three patients demonstrated sensitivity to penicillin, ceftriaxone, vancomycin, linezolid, chloramphenicol, and levofloxacin. Successful treatment was achieved through stereotaxic puncture, drainage, and ceftriaxone administration with a six -week course of antibiotics. CONCLUSION Preoperative enhanced head MRI plays a critical role in distinguishing brain tumors from abscesses. Selecting the correct early diagnostic methods for brain abscesses and providing timely intervention are very important. This case series was in accordance with the CARE guidelines.

Efficient In Vitro Propagation of Turpinia arguta and Quantitative Analysis of Its Ligustroflavone and Rhoifolin Content

Turpinia arguta is an excellent medicinal plant mainly used for the treatment of pharyngitis, tonsillitis, and tonsillar abscesses. However, an efficient regeneration protocol using tissue cultures for T. arguta does not exist. Its main medicinal constituents are flavonoids, particularly ligustroflavone and rhoifolin. Here, we aimed to establish a tissue culture system for T. arguta for the first time using annual stem segments with axillary buds harvested from the field of the Jiangxi Academy of Forestry as explants by dynamically determining the accumulation of effective functional components in the tissue culture plantlets. Orthogonal tests were conducted to compare the effects of different explant disinfection times, media, and exogenous hormone ratios on the induction of the axillary bud growth, successional proliferation, and rooting of T. arguta stem segments. The best explant disinfection effect was achieved by disinfecting the T. arguta explant with 75% ethanol for 50 s, followed by 0.1% mercuric chloride (HgCl2) for 6 min, and the optimal media for successional proliferation and rooting were Murashige and Skoog (MS) + 0.2 mg/L of 6-benzyladenine (6-BA), + 0.03 mg/L of naphthaleneacetic acid (NAA), and ½ MS + 2.5 mg/L of indole-3-butyric acid + 0.5 mg/L of NAA, respectively. The detection of ligustroflavone and rhoifolin in tissue culture plantlets 0, 3, and 5 months after transplanting showed a significant increasing trend and eventually exceeded the content requirements of the 2020 Edition ofChinese Pharmacopoeia for T. arguta. Our findings provide, for the first time, an effective tissue culture system for T. arguta, thereby providing important information to support the germplasm preservation, innovation, and application of T. arguta in the future.