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Medicine Feb 2020The emphysematous prostatic abscess is a rare but potentially life-threatening clinical condition. The early diagnosis is difficult due to nonspecific symptoms. (Review)
Review
RATIONALE
The emphysematous prostatic abscess is a rare but potentially life-threatening clinical condition. The early diagnosis is difficult due to nonspecific symptoms.
PATIENT CONCERNS
A 72-year-old man with poorly controlled diabetes mellitus was admitted to hospital because of dysuria and acute urine retention. He had a refractory fever after admission.
DIAGNOSES
The diagnosis of emphysematous prostatic abscess was confirmed by culture of catheterized urine and pelvic CT.
INTERVENTIONS
We tried to give antimicrobial treatment and control of blood glucose at first, but the infection could not be controlled by antibiotic therapy and control of blood glucose. TRUS-guided aspiration was performed, but obviously not adequate for abscess drainage and the abscess progressed. TUR was then performed and the infection was gradually controlled.
OUTCOMES
Pelvic CT scan 1 month after discharge showed complete resolution of the EPA.
LESSONS
Given the poor conservative treatment effect of emphysematous prostatic abscesses, CT or TRUS should be performed in the patients with suspected diagnosis. Early and appropriate drainage with proper antibiotic therapy is important to achieve a favorable outcome.
Topics: Abscess; Aged; Anti-Bacterial Agents; Candida tropicalis; Candidiasis; Dysuria; Humans; Male; Prostate; Tomography, X-Ray Computed; Urinary Retention
PubMed: 32118790
DOI: 10.1097/MD.0000000000019391 -
Ideggyogyaszati Szemle Jan 2021Brain abscesses are potentially serious, life-threatening diseases that pose a complex diagnostic challenge not only to neurosurgeons but also to clinical... (Review)
Review
Brain abscesses are potentially serious, life-threatening diseases that pose a complex diagnostic challenge not only to neurosurgeons but also to clinical microbiologists, neurologists, psychiatrists, infectologists. The etiology of brain abscess is usually polymicrobial, most commonly involving a variety of aerobic and obligate anaerobic bacteria. Epidemiological studies on the anaerobic etiology of brain abscesses are common between the time period of 1960s and 1980s, but today there are very few new publications on the subject. The role of anaerobic bacteria in this disease was presumably underdiagnosed for a very long time, as many laboratories did not have the adequate laboratory capabilities for their cultivation and identification. The purpose of this review is to summarize the available literature on the etiology of obligate anaerobic bacteria in brain abscesses, including their prevalence and current therapeutic recommendations.
Topics: Bacteria, Anaerobic; Brain Abscess; Humans
PubMed: 33497059
DOI: 10.18071/isz.74.0017 -
The Journal of International Advanced... Dec 2018Luc's abscess is an extremely rare complication of otitis media, caused by the spread of the middle ear infection to the subperiosteal area and its accumulation beneath... (Review)
Review
Luc's abscess is an extremely rare complication of otitis media, caused by the spread of the middle ear infection to the subperiosteal area and its accumulation beneath the temporal muscle. Unlike other subperiosteal abscesses relating to otitis media, infection may not be associated with mastoid bone involvement. Therefore, it is defined as a benign complication of otitis media. However, its rare occurrence may lead to delayed diagnosis and treatment. Here we report a case of an 11-year-old boy diagnosed with Luc's abscess with mastoid involvement. We discuss its clinical presentation and treatment with a review of the literature.
Topics: Abscess; Child; Humans; Male; Otitis Media; Temporal Bone
PubMed: 30325335
DOI: 10.5152/iao.2018.4785 -
BMC Infectious Diseases Jun 2019We describe the clinical features of a cohort of patients with liver abscesses and investigate relationships between clinical, radiological and microbiological findings...
BACKGROUND
We describe the clinical features of a cohort of patients with liver abscesses and investigate relationships between clinical, radiological and microbiological findings and mortality.
METHODS
Retrospective review of pyogenic (PLA) or amoebic liver abscesses (ALA) diagnosed and treated at a major infectious diseases department in London over 9 years.
RESULTS
One hundred forty-one patient records were identified; 132 (93.6%) had PLA and 9 (6.4%) ALA. No organism was identified in 38.6% (51/132); a single bacterial species was isolated in 47.0% (62/132) of PLA, ≥ 2 in 14.4% (19/132). There was weak evidence of variation in abscess size by type of microorganism, with streptococcal PLA typically larger (p = 0.03 for Streptococcus milleri group, p = 0.05 for non-milleri streptococci). Patients with ALA were younger (median 41, IQR 37-51 years) than those with PLA (median 68, IQR 50.5-78 years) (p = 0.003) and all were male (9/9, 100%, (p = 0.03)), with a history of recent travel in the majority (6/9, 66.7% (p = 0.003)). C-reactive protein was higher in ALA than in PLA (p = 0.06). In the entire cohort, loculation (HR = 2.51 (95% CI 1.00-6.32), p = 0.04) and baseline ALP (HR = 4.78 (95% CI 1.19-19.2) per log increase, p = 0.03) were associated with mortality. 16S ribosomal RNA (rRNA) analysis was used in a subset of culture-negative cases and increased the diagnostic yield by 13%.
CONCLUSIONS
Clinical or radiological features cannot be used to distinguish between PLA and ALA, or help identify the bacterial cause of PLA. However, ALA is more common in young, male patients with a history of travel. 16S rRNA analysis of abscess fluid has a role in improving microbiological diagnosis in culture-negative cases.
Topics: Adult; Aged; Bacterial Typing Techniques; Cohort Studies; Female; Humans; Liver Abscess, Amebic; Liver Abscess, Pyogenic; London; Male; Middle Aged; RNA, Ribosomal, 16S; Retrospective Studies; Streptococcus; Streptococcus milleri Group; Treatment Outcome
PubMed: 31159769
DOI: 10.1186/s12879-019-4127-8 -
Techniques in Coloproctology Oct 2023Approximately 15-50% of patients with an anorectal abscess will develop an anal fistula, but the true incidence of this entity is currently unknown. The aim of the study... (Observational Study)
Observational Study
PURPOSE
Approximately 15-50% of patients with an anorectal abscess will develop an anal fistula, but the true incidence of this entity is currently unknown. The aim of the study was to determine the incidence of anorectal abscess and development of a fistula in a specific population area and to identify potential risk factors associated with demographic, socioeconomic and pre-existing disease (e.g. diabetes and inflammatory bowel disease).
METHODS
A longitudinal observational study was designed including a large cohort study in an area with 7,553,650 inhabitants in Spain 1st january 2014 to 31st december 2019. Adults who attended for the first time with an anorectal abscess and had a minimum of 1-year follow-up were included. The diagnosis was made using ICD-10 codes for anorectal abscess and anal fistula.
RESULTS
During the study period, we included 27,821 patients with anorectal abscess. There was a predominance of men (70%) and an overall incidence of 596 per million population. The overall incidence of anal fistula developing from abscesses was 20%, with predominance in men, and a lower incidence in the lowest income level. The cumulative incidence of fistula was higher in men and in younger patients (p < 0.0001). On multivariate analysis, patients aged 60-69 years (hazard ratio 2.0) and those with inflammatory bowel disease (hazard ratio 1.8-2.0) had a strong association with fistula development (hazard ratio 2.0).
CONCLUSIONS
One in five patients with an anorectal abscess will develop a fistula, with a higher likelihood in men. Fistula formation was strongly associated with inflammatory bowel disease.
Topics: Adult; Male; Humans; Female; Abscess; Cohort Studies; Follow-Up Studies; Anus Diseases; Rectal Fistula; Inflammatory Bowel Diseases
PubMed: 37548781
DOI: 10.1007/s10151-023-02840-z -
Wounds : a Compendium of Clinical... Sep 2021Necrotizing fasciitis results in progressive destruction of the fascia and overlying tissue. Mortality primarily depends upon the timing of medical care and the extent...
INTRODUCTION
Necrotizing fasciitis results in progressive destruction of the fascia and overlying tissue. Mortality primarily depends upon the timing of medical care and the extent of infection.
OBJECTIVE
This article presents a case series of thigh abscesses originating from intra-abdominal pathologic conditions and progressing to necrotizing fasciitis due to delayed diagnosis.
MATERIALS AND METHODS
The data concerning 3 patients with thigh abscess originating from an intra-abdominal pathologic condition and progressing to necrotizing fasciitis are presented.
RESULTS
All patients had undergone previous colorectal surgery for malignancy and were admitted to the hospital with pain concentrated in the lower back and spreading down to the buttock, sacrum and coccyx, and leg. Patients had received symptomatic therapy, including nonsteroidal anti-inflammatory drugs, and 1 patient had undergone diskectomy for a herniated disk in the lumbar region. All 3 patients subsequently developed thigh abscesses (initially treated by percutaneous and/or surgical drainage) and received antibiotic therapy. One patient underwent percutaneous drainage, and 2 patients underwent abdominal surgery to address the abdominal abscess. During the course of treatment, thigh abscesses progressed to necrotizing fasciitis, which was treated by surgical debridement with or without negative pressure wound therapy. All patients died of overwhelming sepsis.
CONCLUSIONS
Thigh abscess may spontaneously arise from surrounding soft tissues, or it may be a sign of intraperitoneal, retroperitoneal, or pelvic pathologic conditions. Deep, vague pain in the back or hip area that spreads downward to the buttock and leg may be an early symptom of these pathologic conditions. Clinical suspicion may be effective in reducing mortality by enabling early surgical intervention, especially in the patient with a previous history of abdominal surgery, radiotherapy, or inflammatory or malignant disease.
Topics: Abdominal Abscess; Abscess; Debridement; Drainage; Fasciitis, Necrotizing; Humans; Thigh
PubMed: 34734841
DOI: No ID Found -
Journal of the American Veterinary... Feb 2022To evaluate patterns of bacterial culture and antimicrobial susceptibility test results for dogs with retrobulbar abscesses and generate recommendations for empirical...
OBJECTIVE
To evaluate patterns of bacterial culture and antimicrobial susceptibility test results for dogs with retrobulbar abscesses and generate recommendations for empirical antimicrobial selection.
ANIMALS
133 dogs examined between 2002 and 2019.
PROCEDURES
Records were retrospectively reviewed to determine type of bacterial culture, number and type of bacterial isolates, antimicrobial susceptibility test results, concurrent and recent antimicrobial exposure, effect of culture results on antimicrobial regimen, and outcome.
RESULTS
Aerobic culture alone was performed in 37 dogs, and aerobic and anaerobic culture was performed in 96 dogs. Isolates were recovered from 96 dogs, with multiple isolates recovered from 54 (56%) of those dogs. Of the 69 dogs for which both aerobic and anaerobic culture was performed and at least 1 isolate was obtained, 34 (49%) had purely aerobic infections, 15 (22%) had mixed aerobic and anaerobic infections, and 20 (29%) had purely anaerobic infections. Pasteurella spp (n = 26), Streptococcus spp (20), and Escherichia coli (12) were the most common aerobic isolates. Bacteroides spp (n = 22), Actinomyces spp (10), and Fusobacterium (10) spp were the most common anaerobic isolates. Susceptibility test results led to changes in the antimicrobial regimen in 37 of 80 (46%) dogs. Of the 76 dogs for which outcome information was available, 78 (97%) recovered.
CLINICAL RELEVANCE
Multipathogen and anaerobic infections were common in dogs with retrobulbar abscesses. Susceptibility data supported the use of amoxicillin-clavulanate or a combination of clindamycin and enrofloxacin as first-line treatments. Additional study is needed to characterize anaerobic antimicrobial susceptibilities and to compare results of susceptibility testing with in vivo responses to antimicrobial administration.
Topics: Abscess; Animals; Anti-Bacterial Agents; Anti-Infective Agents; Bacteria, Anaerobic; Bacterial Infections; Dog Diseases; Dogs; Escherichia coli; Microbial Sensitivity Tests; Retrospective Studies
PubMed: 35175928
DOI: 10.2460/javma.21.04.0180 -
Therapeutic Advances in Respiratory... 2021Pyogenic lung abscesses are rare and poorly described infections. This study aimed to describe their prognostic factors.
BACKGROUND
Pyogenic lung abscesses are rare and poorly described infections. This study aimed to describe their prognostic factors.
METHODS
We retrospectively included all patients hospitalized between 1 January 1998 and 1 June 2018, with an International Classification of Diseases, version 10 (IDC-10) diagnosis of pyogenic lung abscess, from the Diamm based medical records (Micro6, Nancy, France). Parasitic, fungal, or mycobacterial lung abscesses were excluded.
RESULTS
A total of 64 patients were included. Abscesses were associated with immunosuppression in 28 patients, including HIV infection and immunosuppressive therapy for eight and 12 patients, respectively. Bacterial identification was obtained for 36 patients. Nine patients (14%) developed lung abscesses after hematogenous dissemination. They differed from bronchogenic abscesses by their younger age ( = 0.03), the absence of smoking or emphysema ( = 0.05), ( = 0.001) or spp. ( = 0.05) isolation, and the smaller size of their abscess ( = 0.02). Overall, evolution was marked by radiological sequelae (46.9%), relapse (12.5%), and death (4.8%). Radiological sequelae occurred more frequently during the course of bronchogenic abscesses ( = 0.02), particularly when they spontaneously discharged ( = 0.04). Relapses were more frequent in patients with emphysema ( = 0.04) and when was isolated ( = 0.04). In multivariate analysis, poor outcomes, including death, sequelae, and relapse occurred more frequently in patients who had bronchogenic abscess ( = 0.02), and in those who received antibiotics during less than 6 weeks ( = 0.05).
CONCLUSION
A duration of antibiotic treatment of less than 6 weeks and bronchogenic presentation were globally associated with poor outcome of pyogenic lung abscesses. These data should be considered when proposing guidelines for the care of pyogenic lung abscesses..
Topics: Hospital Units; Humans; Liver Abscess, Pyogenic; Retrospective Studies; Risk Factors
PubMed: 34098822
DOI: 10.1177/17534666211003012 -
Journal of the American Veterinary... Jul 2022Describe clinical features, treatment, and outcomes in dogs with deep neck infections.
OBJECTIVE
Describe clinical features, treatment, and outcomes in dogs with deep neck infections.
ANIMALS
19 dogs undergoing surgical treatment of deep neck infections from January 1, 2015, through December 31, 2020.
PROCEDURES
Retrospective record review was conducted, with data collected including clinical signs; neutrophil-to-lymphocyte ratio (NLR); diagnostic imaging, surgical, and histopathologic findings; and follow-up. Spearman correlation and Wilcoxon rank sum were used to compare variables to NLR.
RESULTS
All dogs had cervical swelling, and 9 were febrile. On CT, a distinct mass or abscess (7/13) or abscessed lymph node (4/13) was common, with contrast enhancement (10/13), fluid tracking (8/13), and displacement of the trachea, pharynx, or larynx (6/13) also frequently seen. Foreign material was suspected on CT for 4 dogs and was identified at surgery or histopathology for 4 dogs, only 1 of which was suspected on CT. Histopathology most commonly revealed pyogranulomatous inflammation (14/15). Increasing NLR was moderately correlated to a decreased duration of clinical signs before presentation (ρ = -0.548; P = .035) and an increased length of hospitalization (ρ = 0.645; P = .009). Bacterial culture was submitted for all dogs, and polymicrobial infections were common (8/19). Broad-spectrum empirical antimicrobials were commonly prescribed. Change in antimicrobial treatment based on culture was uncommon (3/19). All dogs survived to hospital discharge; 18 dogs with long-term follow-up had complete resolution of clinical signs.
CLINICAL RELEVANCE
CT was useful to plan for surgery, and surgical treatment resulted in resolution of clinical signs in all dogs with long-term follow-up available. Empirical antimicrobial treatment, such as amoxicillin-clavulanic acid or ampicillin-sulbactam, should be considered.
Topics: Dogs; Animals; Retrospective Studies; Dog Diseases; Anti-Bacterial Agents; Neck; Abscess; Anti-Infective Agents
PubMed: 35943934
DOI: 10.2460/javma.22.04.0169 -
Medicina 2024Brain abscess is a focal suppurative process produced in most cases by bacterial agents. Aggregatibacter aphrophilus is a gram-negative bacteria belonging to the HACEK...
Brain abscess is a focal suppurative process produced in most cases by bacterial agents. Aggregatibacter aphrophilus is a gram-negative bacteria belonging to the HACEK group, which causes infective endocarditis, liver abscesses, among others. Brain abscesses secondary to this germ are rare and, in most cases, it is associated with contact with pets, poor dental hygiene or dental procedures. Treatment consists of drainage of the abscess (greater than 2.5 cm) combined with antibiotic therapy, ideally beta-lactams. The case of a 64-year-old male patient with no relevant history is here presented. He was admitted to the emergency service due to headache, hemianopsia of a week's duration and later tonic-clonic seizures, in whom imaging studies and culture of a brain lesion subsequently revealed a brain abscess due to A. aphrophilus. This case aims to illustrate about the rarity of this infection, because A. aphrophilus is a normal part of the oropharyngeal flora and respiratory tract, in which it rarely causes invasive bacteremia.
Topics: Brain Abscess; Humans; Male; Aggregatibacter aphrophilus; Middle Aged; Pasteurellaceae Infections; Anti-Bacterial Agents; Drainage
PubMed: 38683524
DOI: No ID Found