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Cureus Nov 2023Gonorrhea is a sexually transmitted disease caused by and has a wide clinical spectrum that can range from asymptomatic to disseminated disease. Most women with...
Gonorrhea is a sexually transmitted disease caused by and has a wide clinical spectrum that can range from asymptomatic to disseminated disease. Most women with gonorrhea are asymptomatic and if left untreated, it can lead to serious complications like pelvic inflammatory disease (PID) and infertility. Disseminated gonococcal infection (DGI) is usually characterized by dermatitis, tenosynovitis, and septic arthritis but rarely can also cause bacteremia, endovascular infections, osteomyelitis, and meningitis. Gonococcal bacteremia is regarded as a disseminated disease and is typically associated with infection of the mucosal surfaces such as the urethra, endocervix, and pharynx. This report, to the best of our knowledge, presents a case of DGI associated with a mediport catheter in a patient with breast cancer without any history of gonococcal symptoms. She was monogamous and denied any history of sexually transmitted infections. The patient presented with fever and chills associated with pain and purulent discharge from the mediport catheter site. The mediport catheter was removed, and antibiotics were initiated. Both blood and wound cultures grew . She completed a 10-day course of ceftriaxone and improved clinically with complete remission of her symptoms. A review of the literature on the reported cases of DGI associated with bacteremia and endovascular infections is also presented.
PubMed: 38046706
DOI: 10.7759/cureus.48180 -
The American Journal of Case Reports Sep 2023BACKGROUND Tuberculosis (TB) was the leading cause of infectious death worldwide until the COVID-19 pandemic, which reduced case reporting and disrupted TB diagnosis and...
BACKGROUND Tuberculosis (TB) was the leading cause of infectious death worldwide until the COVID-19 pandemic, which reduced case reporting and disrupted TB diagnosis and services. While Mycobacterium tuberculosis remains a leading cause of morbidity and mortality globally, the disease burden within developed nations remains relatively rare. Although the many complications of TB are well known, no current data exists on those infected with TB who subsequently developed recurrent TB empyema, as it is such a rare complication, especially in pediatric and adolescent populations. CASE REPORT A previously healthy 15-year-old male patient presented with 5-day duration of cough, congestion, intermittent fever, and post-tussive emesis. Although born in the United States, 3 months before presentation, he returned from Senegal, where he had lived for 4 years. Imaging demonstrated consolidation with loculated effusion. Patient underwent video-assisted thoracoscopy and chest tube placement, draining 750 mL of purulent fluid testing positive for rare acid-fast bacilli. Rifampin, isoniazid, pyrazinamide, and ethambutol were administered, with discharge medication compliance ensured by daily videos surveillance through the Department of Health. Although compliant with medications, patient presented to the Emergency Department 2 months later with a multi-loculated fluid recollection and fistula formation requiring chest tube placement. After this discharge, patient experienced resolution of disease following completion of therapy. CONCLUSIONS TB complication should be considered as a differential diagnosis for pleural effusion in the appropriate clinical setting. Providers should not only consider the diagnosis but pursue appropriate testing and management early, particularly in those with risk factors, including travel to an endemic location.
Topics: Male; Adolescent; Humans; Child; Pandemics; COVID-19; Mycobacterium tuberculosis; Cough; Empyema
PubMed: 37697641
DOI: 10.12659/AJCR.939419 -
Cureus Mar 2024Complications can arise secondary to anorectal suppurative diseases, with infections spreading along the extraperitoneal space, such as the peri-vesical, prevesical,...
Complications can arise secondary to anorectal suppurative diseases, with infections spreading along the extraperitoneal space, such as the peri-vesical, prevesical, pre-sacral, and pararectal spaces, resulting in abscesses at remote sites, which can make diagnosis more challenging. Due to the absence of peritonitis symptoms, there is a delay in presentation among such patients. Comprehending the intricacies of these areas and the way infection can spread within them is crucial for promptly identifying and effectively draining the extraperitoneal abscess. We present a case series of six patients with a mean age of 45, all males. A total of three patients had undergone incision and drainage after being diagnosed with anorectal suppurative disease and remained symptomatic after the initial surgical intervention of incision and drainage. Two patients initially diagnosed with anterior abdominal abscesses patients, after being treated with incision and drainage, continued to have purulent discharge from the drainage site. Finally, the last patient continued to present with perianal pain after an open hemorrhoidectomy. CT scans of all six patients showed collections in the extraperitoneal spaces correlated with the observed complications. To deepen our understanding of pelvic extraperitoneal spaces, cadaver dissections were conducted and compared with CT images. Through cadaver dissections and CT imaging, the study provides insights into the anatomy and interconnections of pelvic extraperitoneal spaces, emphasizing the importance of early CT scans for diagnosis. Understanding these intricate anatomical structures is essential for accurate diagnosis and efficient and effective treatment. Timely diagnosis is vital to prevent prolonged illness and reduce the risk of complications and mortality. The importance of early CT scans in suspected patients is underscored, which is highly important to expedite appropriate actions.
PubMed: 38618365
DOI: 10.7759/cureus.56149 -
Porcine Health Management Oct 2023A farm in North-West Germany experienced a high morbidity and mortality in their sow herd. Sows showed fever, lethargy, oedema, mucosal discharge and dyspnoea. Necropsy...
A farm in North-West Germany experienced a high morbidity and mortality in their sow herd. Sows showed fever, lethargy, oedema, mucosal discharge and dyspnoea. Necropsy revealed a severe fibrinous and purulent polyserositis. Haematological and histological examinations confirmed septicaemia. Streptococcus equi subspecies zooepidemicus was isolated in high yields from major organs. Sequence typing of this isolate (21/455) revealed a new sequence type showing a significantly higher proliferation rate in comparison to two other isolates. Other infectious agents (influenza A virus, Porcine Reproductive and Respiratory Syndrome Virus, Porcine Circovirus 2, african swine fever virus, classical swine fever virus, Actinobacillus pleuropneumoniae) were excluded by routine diagnostic examinations. A climate check revealed an insufficient air supply in the area for the gestating sows. This case describes the first disease outbreak in swine due to S. zooepidemicus in Germany.
PubMed: 37875963
DOI: 10.1186/s40813-023-00344-8 -
The American Journal of Case Reports Jan 2024BACKGROUND Traditionally, penile implant infections have been treated by removal followed by immediate or delayed replacement. The use of antibiotics in conservative...
BACKGROUND Traditionally, penile implant infections have been treated by removal followed by immediate or delayed replacement. The use of antibiotics in conservative therapy has recently attracted attention. CASE REPORT We report our experience with 4 cases of infected penile implants managed conservatively. Case 1 was a 41-year-old with sickle cell anemia who presented with low-grade fever and purulent discharge that started 1 month postoperatively and lasted for 3 weeks. He had left graft after fibrotic tissue excision with 14-mm collection in the left corpus cavernosum. He was managed with IV pipracillin/tazobactam and vancomycin for 13 days. Follow-up after 23 weeks showed complete wound healing. Case 2 was a 62-year-old with diabetes who had purulent discharge that started 41 days postoperatively and lasted for 1 week. He received 5 days of IV vancomycin and gentamycin. Follow-up after 4 weeks showed marked improvement of the wound. Case 3 was a 61-year-old with diabetes and ischemic heart disease. He presented 30 days postoperatively with fever, purulent discharge for 5 days. He received a total of 10 days of IV vancomycin and gentamycin. Follow-up 3 weeks after discharge showed complete wound healing. Case 4 was a 61-year-old with diabetes and ischemic heart disease. He presented 1 month postoperatively with fever and pus discharge for 1 week. He completed 10 days of IV vancomycin and gentamycin. Follow-up after 1 week showed marked wound healing. CONCLUSIONS Choosing patients with early superficial infected penile prosthesis for conservative management should be tailored to selected patients who does not have leukocytosis, signs of sepsis, high-grade fever, or an exposed device.
Topics: Male; Humans; Adult; Middle Aged; Vancomycin; Penile Prosthesis; Conservative Treatment; Prosthesis-Related Infections; Gentamicins; Diabetes Mellitus; Myocardial Ischemia
PubMed: 38167227
DOI: 10.12659/AJCR.941806 -
Case Reports in Otolaryngology 2023An ectopic pituitary adenoma (EPA) is an uncommon type of pituitary adenoma, accounting for only 2% of all pituitary adenomas. EPAs are benign tumors that can occur...
An ectopic pituitary adenoma (EPA) is an uncommon type of pituitary adenoma, accounting for only 2% of all pituitary adenomas. EPAs are benign tumors that can occur anywhere along the migratory embryonic path of the pituitary gland and have no relationship to intrasellar elements. They are usually hormonally active and have a minor female predominance. The clinical features of EPAs are highly dependent on its hormonal activity, anatomical location, and its local mass effect. Appropriate radiological imaging is essential for the evaluation of EPAs. Imaging investigations show a normal pituitary gland and sellar turcica, provide details on the size of the tumor, its margins, and extent, and help with surgical planning. The criteria for diagnosing an ectopic pituitary adenoma depend on detailed histopathological examination. EPA management should be individualized. We present a case of a 71-year-old male who presented with a 9-month history of left nasal obstruction, purulent nasal discharge, and intermittent anterior epistaxis. The patient was being managed by his general practitioner for chronic rhinosinusitis but failure of his symptoms to resolve prompted a visit to the otorhinolaryngologist. The patient was diagnosed with a null-cell ectopic pituitary adenoma through histological analysis of a biopsy specimen that showed adenohypophyseal cells without cell-type-specific differentiation. The patient subsequently underwent an endoscopic endonasal excision and had an uneventful hospital stay.
PubMed: 37868130
DOI: 10.1155/2023/5561092 -
Journal of Feline Medicine and Surgery Sep 2023The aim of the present study was to report clinical findings, surgical complications and outcomes for previously hoarded cats treated surgically for otitis media-interna...
OBJECTIVES
The aim of the present study was to report clinical findings, surgical complications and outcomes for previously hoarded cats treated surgically for otitis media-interna (OMI) and to investigate the risk factors for complications and poor outcomes.
METHODS
A retrospective study was conducted of 58 cats from an institutional hoarding environment that underwent ventral bulla osteotomy (VBO).
RESULTS
Inappetence was uncommon at presentation (9/58, 16%) compared with pruritus/alopecia (50%), nasopharyngeal signs (45%), otitis externa (OE) (79%) and otitis interna (OI) (ataxia ± head tilt/head excursions) in 40%. Purulent aural discharge occurred in 36% and polyps in 26%. The tympanic bulla wall was moderately or severely thickened radiographically in 38/108 (35%) ears. Cultures were positive for subspecies in 26/48 (54%) cats. Of the 58 cats, 40 (69%) had complications after the first VBO and 19/30 (63%) after the second. Of 101 complications, 56 (55%), from 27/88 (31%) surgeries, were considered serious, including life-threatening perioperative complications in seven, OI in eight, prolonged anorexia in six and worsening of pruritus/alopecia in nine cases. Three cats developed xerostomia (dry mouth) after the second VBO. Pruritus/alopecia, nasopharyngeal signs, OE and purulent aural discharge resolved in a statistically significant proportion of cats but persisted in some. Full resolution of OI was uncommon. OI preoperatively, and surgery performed by a generalist (vs specialist) surgeon, were risk factors for OE at recheck (OI: odds ratio [OR] 4.35; 95% confidence interval [CI] 1.21-15.70; = 0.02; surgery: OR 3.64; 95% CI 1.03-12.87; = 0.045). No other prognostic indicators were identified. No variables tested were significantly associated with risk of serious complications or euthanasia.
CONCLUSIONS AND RELEVANCE
Surgical management of chronic OMI was successful in most cases but was not benign and not always beneficial. The analysis was unable to identify clinically helpful outcome predictors. Optimal management of chronic feline OMI remains a challenge, particularly for animal shelters. Less invasive approaches and chronic medical management require further investigation.
Topics: Cats; Animals; Hoarding; Blister; Labyrinthitis; Retrospective Studies; Otitis Externa; Alopecia; Treatment Outcome; Otitis Media; Cat Diseases
PubMed: 37728478
DOI: 10.1177/1098612X231197089 -
European Review For Medical and... Jan 2024The aim of this prospective cross-sectional study was to investigate whether cleaning the episiotomy line with rifampicin solution before suturing will reduce infection...
OBJECTIVE
The aim of this prospective cross-sectional study was to investigate whether cleaning the episiotomy line with rifampicin solution before suturing will reduce infection and wound dehiscence in women who had vaginal delivery with episiotomy.
PATIENTS AND METHODS
A prospective cross-sectional study was conducted with a total of 400 primigravida patients. In the study group, irrigation with rifampicin of the subcutaneous tissue of the episiotomy incision was applied, and in the control group, there was no irrigation. Patients were evaluated for infection at the 1st, 3rd week, and 1-month controls. The groups were compared according to episiotomy infection and wound dehiscence rates.
RESULTS
The episiotomy infection rate of the whole group was 8.5%, the wound dehiscence rate was 3.75%, and the average time of occurrence of the infection was 5.35±2.21 days. The most common infection findings were local pain and purulent discharge at 4.75%. In the control group, where the infection occurred earlier, the infection and wound dehiscence rates were significantly higher [11.5% vs. 5.5%; 6.0% vs. 1.5% (p<0.05)]. Purulent discharge was the most common finding in the control group, and local pain in the study group, but no significant difference was found between the two groups in terms of findings (p<0.05). When only the patients who developed episiotomy infection were evaluated among themselves, the only significant difference was found in wound dehiscence, which was higher in the control group (p<0.05).
CONCLUSIONS
Considering the high rates of episiotomy in our country, subcutaneous irrigation with rifampicin is a good option that can be kept in the foreground due to its low cost and ease of application.
Topics: Pregnancy; Humans; Female; Episiotomy; Rifampin; Subcutaneous Tissue; Prospective Studies; Cross-Sectional Studies; Surgical Wound Infection; Pain; Perineum
PubMed: 38235887
DOI: 10.26355/eurrev_202401_34924 -
JFMS Open Reports 2023An 11-month-old female domestic shorthair cat presented with a 24 h history of inspiratory dyspnoea, abnormal upper respiratory tract sounds, gagging, retching and...
CASE SUMMARY
An 11-month-old female domestic shorthair cat presented with a 24 h history of inspiratory dyspnoea, abnormal upper respiratory tract sounds, gagging, retching and making exaggerated swallowing motions. Retroflexed nasopharyngoscopy revealed a large, right-sided nasopharyngeal mass that was seen to exude purulent material and a possible small foreign body when pressure was applied with forceps. Thorough expression of the mass alleviated clinical signs. Cytology revealed septic neutrophilic inflammation, and a species with no noted antimicrobial resistance was cultured. The cat was discharged with oral antibiotics and analgesia and made a full recovery, with no recurrence of clinical signs at the 6-month follow-up.
RELEVANCE AND NOVEL INFORMATION
Abscess formation in the nasopharyngeal region has not been previously reported in cats, to the authors' knowledge. The cause of the abscess was suspected to be a foreign body, but other aetiologies could not be fully excluded. This case demonstrates that nasopharyngeal abscesses are a rare but potentially significant differential diagnosis for upper respiratory tract obstruction in cats.
PubMed: 37441537
DOI: 10.1177/20551169231178448 -
Frontiers in Pediatrics 2023To report and review infantile orbital abscess caused by methicillin-resistant (MRSA).
OBJECTIVE
To report and review infantile orbital abscess caused by methicillin-resistant (MRSA).
METHODS
We report a case of MRSA-induced infantile orbital abscess accompanied by sepsis, pneumonia, and purulent meningitis. We systematically review cases of MRSA-induced infantile orbital abscess published in PubMed, Web of Science and ScienceDirect until April 2023.
RESULTS
We reviewed 14 patients [our patient + 13 patients (10 papers) identified via literature searches]. There were nine boys and five girls; nine neonates and five older infants; and 8 full-term births and 1 preterm birth. The gestational age at birth was unknown for five infants. The right and left orbits were affected in 10 and 4 patients, respectively. The clinical presentation included periorbital soft-tissue edema or redness (11 patients), fever (7 patients), exophthalmos (10 patients), limited eye movement (4 patients), purulent eye secretions (2 patients), and skin abscess and convulsion (1 patient each). The source of infection was sinusitis (8 patients), vertical transmission, gingivitis, dacryocystitis, upper respiratory tract infection (1 patient each), and unknown (2 patients). MRSA was detected in blood (6 patients) or pus culture (8 patients). Vancomycin or linezolid were used for 11 patients; corticosteroids were administered to only 1 patient. Surgical drainage was performed for 13 infants (external drainage, 11 patients; endoscopic drainage, 2 patients). Two patients initially had pulmonary and intracranial infections. Except for one patient with neurological dysfunction at discharge, all other infants had no sequelae or complications.
CONCLUSION
Early aggressive anti-infective treatment and timely drainage are essential for managing MRSA-induced infantile orbital abscess.
PubMed: 38188913
DOI: 10.3389/fped.2023.1272852