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Cureus Jan 2023Breast tuberculosis (BTB) is a rare manifestation of tuberculosis (TB), and it is more common in countries with a high incidence of TB. We describe a case of a...
Breast tuberculosis (BTB) is a rare manifestation of tuberculosis (TB), and it is more common in countries with a high incidence of TB. We describe a case of a 36-year-old Angolan woman, who had a history of breast reduction surgery, presenting with right breast enlargement, pain, purulent discharge through multiple skin openings, fever, and abdominal pain, progressively worsening in the past year. She had already undergone several surgical drainages and six months of treatment with ciprofloxacin, with no improvement. Breast ultrasound and MRI were performed, which revealed a large fluid collection, with several small abscesses and surrounding adenopathies, complicated by multiple fistulae. The fluid was drained through needle aspiration, which was found to be sterile for bacteria, mycobacteria, and fungi. A lymph node biopsy showed necrosis without granulomas, and the biopsy culture was positive for (Mt). This case shows how a rare manifestation can simulate bacterial breast abscesses or cancer, and hence a high index of suspicion is necessary to reach the correct diagnosis and ensure appropriate treatment delivery in these patients.
PubMed: 36843718
DOI: 10.7759/cureus.34175 -
Journal of Medical Case Reports Nov 2022Acute dacryocystitis is an atypical and rare manifestation of pediatric mononucleosis still widely underdiagnosed in clinical practice. We report this rare condition and...
BACKGROUND AND OBJECTIVE
Acute dacryocystitis is an atypical and rare manifestation of pediatric mononucleosis still widely underdiagnosed in clinical practice. We report this rare condition and describe challenges in its diagnosis and treatment on the basis of a presented case.
CASE PRESENTATION
A 6-year-old Caucasian girl without any ophthalmic history was admitted for right preseptal cellulitis requiring intravenous antibiotic therapy. During hospitalization, she developed a fluctuating lump in the nasolacrimal region which resembled an abscess, both clinically and radiologically. There was no spontaneous purulent discharge. Serology was positive for acute mononucleosis and Epstein-Barr virus-related dacryocystitis was diagnosed. Following multidisciplinary discussion, she was treated conservatively with digital lacrimal sac massages and intravenous antibiotic therapy with an excellent outcome.
DISCUSSION
This rare form of Epstein-Barr virus is poorly documented in the literature, and thus barely known. As initial symptoms are nonspecific (rhinitis, fever, eyelid edema and erythema lack of purulent discharge, and moderate bilateral cervical lymphadenopathy), diagnosis is often difficult. Nevertheless, differentiating between dacryocystitis and abscess is crucial to select the appropriate treatment and avoid unnecessary, potentially harmful surgery. Conservative management of dacryocystitis appears to be the gold standard of treatment.
CONCLUSION
Acute dacryocystitis in children free of ophthalmic history should raise suspicion of primary Epstein-Barr virus infection. With conservative treatment, prognosis appears to be excellent; therefore, surgery should be avoided as much as possible.
Topics: Female; Humans; Child; Herpesvirus 4, Human; Epstein-Barr Virus Infections; Abscess; Dacryocystitis; Anti-Bacterial Agents
PubMed: 36401292
DOI: 10.1186/s13256-022-03646-7 -
JDS Communications May 2023Failure of a robust but well-regulated immune response may result in reproductive tract inflammatory disease, such as metritis, purulent vaginal discharge, or... (Review)
Review
Failure of a robust but well-regulated immune response may result in reproductive tract inflammatory disease, such as metritis, purulent vaginal discharge, or endometritis. Metritis is consistently associated with reduced diversity of the uterine microbiome. Similarly, purulent vaginal discharge at 4 to 6 wk postpartum is strongly associated with bacterial infection of the uterus. Conversely, the microbiome of healthy cows and those with subclinical endometritis is generally similar, so endometritis is thought to be a consequence of dysregulation of inflammation rather than changes in uterine microbiota. There is an emerging concept that inflammation is not only a reaction to injury or disease but that it can be a consequence of or precursor to metabolic disturbances. The degree of systemic inflammation is associated with the level of trauma and bacterial contamination of the uterus or mammary gland, the degree of fat mobilization and release of nonesterified fatty acids, and perhaps leaky gut, all of which result in the release of proinflammatory cytokines. Therefore, uterine inflammation may be exacerbated by systemic inflammation, but may also contribute to heightened systemic inflammation in transition cows. However, clarity and progress are limited by a lack of validated criteria to quantify systemic inflammation and to identify its sources.
PubMed: 37360118
DOI: 10.3168/jdsc.2022-0328 -
Clinical Practice and Cases in... May 2021Acute suppurative parotitis is a rare finding in the neonate. It is commonly caused by Staphylococcus aureus, but other bacterial isolates may be emerging. It is a novel...
INTRODUCTION
Acute suppurative parotitis is a rare finding in the neonate. It is commonly caused by Staphylococcus aureus, but other bacterial isolates may be emerging. It is a novel disease for this age group and requires unique management. Only 32 cases of neonatal suppurative parotitis have been described in the English-language literature over the last 35 years.
CASE REPORT
We describe a case of a 14-day-old male who presented to the pediatric emergency department with a 24-hour history of swelling and redness of the right cheek. On examining him, purulent material was seen inside his oral cavity. He was subsequently hospitalized with a diagnosis of neonatal suppurative parotitis and received five days of parenteral antibiotics with improvement in swelling and redness. He was discharged home with oral antibiotics.
CONCLUSION
Although neonatal suppurative parotitis is rare, it should be suspected in newborns presenting with an erythematous pre-auricular mass with or without any predisposing factors. We describe a rare case of acute suppurative parotitis in a neonate and review the published literature.
PubMed: 34437009
DOI: 10.5811/cpcem.2021.3.51501 -
Journal of Leukocyte Biology Oct 2019Otitis media (OM) is one of the most common ear diseases affecting humans. Children are at greater risk and suffer most frequently from OM, which can cause serious... (Review)
Review
Otitis media (OM) is one of the most common ear diseases affecting humans. Children are at greater risk and suffer most frequently from OM, which can cause serious deterioration in the quality of life. OM is generally classified into two main types: acute and chronic OM (AOM and COM). AOM is characterized by tympanic membrane swelling or otorrhea and is accompanied by signs or symptoms of ear infection. In COM, there is a tympanic membrane perforation and purulent discharge. The most common pathogens that cause AOM are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis whereas Pseudomonas aeruginosa and Staphylococcus aureus are commonly associated with COM. Innate and adaptive immune responses provide protection against OM. However, pathogens employ a wide arsenal of weapons to evade potent immune responses and these mechanisms likely contribute to AOM and COM. Immunologic evasion is multifactorial, and involves damage to host mucociliary tract, genetic polymorphisms within otopathogens, the number and variety of different otopathogens in the nasopharynx as well as the interaction between the host's innate and adaptive immune responses. Otopathogens utilize host mucin production, phase variation, biofilm production, glycans, as well as neutrophil and eosinophilic extracellular traps to induce OM. The objective of this review article is to discuss our current understanding about the mechanisms through which otopathogens escape host immunity to induce OM. A better knowledge about the molecular mechanisms leading to subversion of host immune responses will provide novel clues to develop effective treatment modalities for OM.
Topics: Animals; Ear, Middle; Genetic Variation; Host-Pathogen Interactions; Humans; Immune Evasion; Immunity; Otitis Media
PubMed: 31075181
DOI: 10.1002/JLB.4RU0119-003R -
DEN Open Apr 2023Phlegmonous duodenitis is an extremely rare condition, and only a few cases have been previously reported. Here, we report a case of phlegmonous duodenitis caused by...
Phlegmonous duodenitis is an extremely rare condition, and only a few cases have been previously reported. Here, we report a case of phlegmonous duodenitis caused by and in a 78-year-old immunocompromised patient with diabetes mellitus and immunosuppressive drugs. Abdominal computed tomography showed diffuse thickening of the duodenum and gastric antrum, and esophagogastroduodenoscopy revealed some erosions with purulent discharge and reddish and edematous mucosa in the duodenal bulb. A bacteriological culture test detected the two abovementioned bacteria and established the diagnosis of phlegmonous duodenitis. Following the initiation of antibiotic treatment, his condition rapidly improved. Endoscopists should be aware of this rare entity and pay attention to the endoscopic duodenal findings similar to those of phlegmonous gastritis, particularly in immunocompromised patients who develop abdominal symptoms with severe inflammation.
PubMed: 36751396
DOI: 10.1002/deo2.212 -
Surgical Case Reports Nov 2021Mycoplasma hominis is a human commensal bacterium of the urogenital tract, and extragenital infection caused by M. hominis has rarely been reported. The identification...
BACKGROUND
Mycoplasma hominis is a human commensal bacterium of the urogenital tract, and extragenital infection caused by M. hominis has rarely been reported. The identification of M. hominis is challenging, and surgeons are generally not aware that this bacteria can cause postoperative infection. Here, we report a rare case of postoperative mediastinitis caused by M. hominis after cardiac surgery in an immunocompetent patient.
CASE PRESENTATION
A 54-year-old man presented with pain and purulent discharge from the wound after aortic valve replacement and patent foramen ovale closure. However, Gram staining and culture of bacteria from the purulent discharge was negative, and empiric sulbactam/ampicillin therapy was not effective. This patient developed mediastinitis and rupture of a pseudoaneurysm of the ascending aorta caused by mediastinitis, and re-operation was performed. Then, postoperative mediastinitis caused by M. hominis or Ureaplasma species was suspected and bacterial cultures targeting these pathogens were performed. M. hominis was identified from abscess and tissue obtained from the surgical site and urine. A final diagnosis of postoperative mediastinitis caused by M. hominis was determined. The patient was initially treated with levofloxacin and then with minocycline for 3 weeks. The patient's clinical condition improved; the patient was transferred to another hospital.
CONCLUSION
The role of M. hominis as a cause of postoperative infection might be underestimated in cardiac surgery. M. hominis should be considered when culture-negative purulent discharge is observed or there is no response to standard empiric treatment of postoperative infections.
PubMed: 34812956
DOI: 10.1186/s40792-021-01326-0 -
New Zealand Veterinary Journal May 2022To design a monitoring strategy that could be applied to regular veterinary visits to dairy farms to assess the prevalence and association between health conditions...
AIMS
To design a monitoring strategy that could be applied to regular veterinary visits to dairy farms to assess the prevalence and association between health conditions (uterine disease, hyperketonaemia and suboptimal body condition score) when diagnosed and treated at 1-7 days post-calving (DPC) and then re-examined at 28-35 DPC.
METHODS
This study evaluated data from 187 high-yielding dairy cows (21 primiparous, 166 multiparous) on one South Australian dairy farm on two occasions; Visit A which was 1-7 DPC and Visit B which was 28-35 DPC. On each visit, the nature of vaginal discharge, concentration of beta-hydroxybutyrate (BOH) in blood and BCS were recorded and assigned a clinical score. This was converted to a categorical outcome denoting the presence or absence of an abnormal health event, namely metritis or endometritis, hyperketonaemia (BOH concentration ≥1.2 mm/L) and suboptimal body condition score (>0.5 from optimum score). Cows with uterine disease or hyperketonaemia at either visit were treated. The prevalence of abnormal health events at each visit was determined and the association between the prevalence of disease at Visit A and Visit B (following appropriate treatment at Visit A) was measured using regression analysis.
RESULTS
The prevalence of abnormal vaginal discharge, hyperketonaemia and suboptimal BCS at Visits A and B were 26%, 7%, 35% and 25%,16%, 33% respectively. A higher proportion of primiparous cows (Visit A: 0.86 (95% CI = 0.70-1.00); Visit B: 0.95 (95% CI = 0.86-1.00)) were found to have suboptimal BCS at both visits compared to multiparous cows (Visit A: 0.28 (95% CI = 0.20-0.35); Visit B: 0.24 (95% CI = 0.17-0.32)). A higher prevalence of hyperketonaemia at Visit B for multiparous compared to primiparous cows (19 (95% CI = 12-25)% . 0 (95% CI = 0-17) respectively) was identified. An increase in clinical discharge score at Visit A increased the odds of purulent vaginal discharge at Visit B (OR = 1.77 (95% CI = 1.31-2.40)). Failing to calve at target BCS was strongly associated with cows missing target BCS at Visit B (OR = 5.77 (95% CI = 2.35-13.11)) and for every unit increase in BCS at Visit A, BCS at Visit B increased by 0.40 (95% CI = 0.26-0.53).
CONCLUSIONS AND CLINICAL RELEVANCE
This study describes a pilot monitoring strategy for clinical parameters indicative of post-partum disease at 1-7 and 28-35 DPC. Determining the herd prevalence of these conditions will enable tracking of herd disease status over time. BCS: Body condition score; BOH: Beta-hydroxybutyrate; DPC: Days post-calving; NEFA: Non-esterified fatty acids; SCHK: Subclinical hyperketonaemia.
Topics: Animals; Australia; Cattle; Cattle Diseases; Endometritis; Female; Ketosis; Lactation; Postpartum Period
PubMed: 34694981
DOI: 10.1080/00480169.2021.1997667 -
Journal of Child Neurology May 2021Hydrocephalus is a potentially lethal complication of neonatal purulent meningitis. Early detection of hydrocephalus helps to determine optimal treatment, improve...
OBJECTIVE
Hydrocephalus is a potentially lethal complication of neonatal purulent meningitis. Early detection of hydrocephalus helps to determine optimal treatment, improve prognosis, and reduce financial burden. We aimed to analyze the risk factors for hydrocephalus in neonates with purulent meningitis and discuss the characteristics of the disease.
METHODS
The records of neonatal purulent meningitis admitted to the Children Hospital of Fudan University from January 2013 to September 2019 were retrospectively included in the study cohort. The data of clinical, laboratory, and cranial magnetic resonance images (MRIs) were collected and analyzed (except discharge data) by univariate analysis, and values <.05 were further analyzed by multivariate logistic regression.
RESULTS
A total of 197 children who met the inclusion criteria were enrolled in the study cohort. Overall, 39.6% (78/197) of the patients had positive pathogen cultures, and 60.4% (119/197) of patients had clinical diagnosis of meningitis with negative pathogen cultures. Among 197 children, 67 of them experienced hydrocephalus, and the factors that were significantly associated with hydrocephalus in multivariate analysis were female sex, cerebrospinal fluid glucose <2 mmol/L, periventricular leukomalacia, punctate white matter lesions, and pyogenic intraventricular empyema. Children with hydrocephalus had a lower cure rate of meningitis (31.3% vs 75.4%), and poor discharge outcomes. In addition, they had longer length of hospital stay and higher hospital cost.
CONCLUSIONS
Female sex, cerebrospinal fluid glucose <2 mmol/L, periventricular leukomalacia, punctate white matter lesions, and pyogenic intraventricular empyema were identified as risk factors for hydrocephalus in neonatal purulent meningitis. Children with hydrocephalus had poor discharge outcomes and increased financial burden on their families.
Topics: Brain; Cohort Studies; Female; Humans; Hydrocephalus; Infant, Newborn; Infant, Newborn, Diseases; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Retrospective Studies; Risk Assessment; Risk Factors; Sex Factors
PubMed: 33393419
DOI: 10.1177/0883073820978032 -
Journal of Equine Veterinary Science Jan 2023An 8-year-old mare mule was presented with a facial mass and history of anorexia, unilateral epistaxis and purulent nasal discharge. The facial mass was encountered from...
An 8-year-old mare mule was presented with a facial mass and history of anorexia, unilateral epistaxis and purulent nasal discharge. The facial mass was encountered from the ventral to the lateral right canthus of the eye up to the facial crest. Thoracic ultrasonography showed five rounded masses. A standing CT under sedation was performed revealing a huge extension and infiltration on surrounding tissues. Due to the extension, type of lesions, outcome and suspicion of metastasis, the owner chose to euthanize the patient. Necropsy confirmed the presence of tumoral lesions spread into the lungs, spleen, adrenal glands, ovary, oral cavity, and right frontal sinus. The microscopic examination was consistent with hemangiosarcoma. Hence, hemangiosarcoma is a differential diagnosis to rule out in future similar cases. This clinical description did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Topics: Horses; Animals; Female; Equidae; Hemangiosarcoma; Horse Diseases
PubMed: 36031031
DOI: 10.1016/j.jevs.2022.104112