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Acta Gastro-enterologica Belgica 2021Congenital hepatic cysts are a common disorder. Usually they are asymptomatic and do not have to be treated. However, some serious complications can occur. We report...
Congenital hepatic cysts are a common disorder. Usually they are asymptomatic and do not have to be treated. However, some serious complications can occur. We report here the case of an 86-year old patient who has been treated by a percutaneous drainage for an infected solitary hepatic cyst due to urinary sepsis. She was admitted to the Department of Internal Medicine for epigastric pain with fever and chills. The patient was treated for a urinary tract infection 3 weeks ago by her General Practitioner. On admission, blood tests showed 21 620 neutrophils per microliter with a C-reactive protein level at 443.7 mg/L, procalcitonin > 200 ng/mL, total bilirubin at 1.43 mg/dL, lactate dehydrogenase at 666 U/L and alanine aminotransferase at 227 U/L. Urinalysis and hemocultures highlighted the presence of Escherichia coli and Streptococcus constellatus. The abdominal tomodensitometry indicated the presence of a left hepatic biliary cyst with banal appearance. She was first treated with intravenous amoxicillin clavulanic acid. After a few days, another abdominal tomodensitometry with contrast pinpointed a large abscess of 11 centimeters in diameter extending to liver segments II and IV with a similar small lesion in segments IV and V. clindamycin per os was added to the treatment because of its good diffusion in tissues. Percutaneous drain was inserted under tomodensitometric control and stayed in place until the follow-up at three weeks. Bacteriologic culture on the fluid sample demonstrated the presence of Escherichia coli and Streptococcus constellatus. The abscess completely regressed after 6 weeks of treatment and the biologic abnormalities resolved at the same time.
Topics: Aged, 80 and over; Cysts; Drainage; Female; Humans; Liver Diseases; Sepsis
PubMed: 33639705
DOI: 10.51821/84.1.319 -
Yakugaku Zasshi : Journal of the... 2022We report a rare case of suppurative thrombophlebitis of the posterior neck caused by Streptococcus constellatus. A 69-year-old female patient was admitted to the... (Review)
Review
We report a rare case of suppurative thrombophlebitis of the posterior neck caused by Streptococcus constellatus. A 69-year-old female patient was admitted to the hospital with neck pain and fever, which had persisted for 16 days prior to hospitalization. On day 1 (day of admission), blood cultures (later identifying S. constellatus) were performed, and ceftriaxone (CTRX) IV (2 g SID) was started. On day 3, suppurative thrombophlebitis of the posterior neck was diagnosed by CT scan. The antimicrobials were changed from CTRX to ampicillin/sulbactam IV (12 g QID) to guard against the possibility of complicated infection with Fusobacterium spp. or Prevotella spp. On day 17, a CT scan revealed that the thrombus remained. Therefore, oral edoxaban (30 mg SID) was started. On day 27, the patient was discharged after her medication was changed to oral amoxicillin/clavulanate (1500 mg/375 mg TID). On day 33, the amoxicillin/clavulanate was changed to oral cefaclor (1500 mg TID) and edoxaban was discontinued due to itching. On day 45, the course of cefaclor was completed. The patient went on to follow an uneventful course with no relapses or complications for two years since the conclusion of treatment. These results suggest that when a patient presents with persistent neck pain accompanied by fever, suppurative thrombophlebitis of the posterior neck should be considered. In antimicrobial therapy, the treatment could be switched from intravenous to oral. In addition, direct-acting oral anticoagulants may be an alternative to other forms of anticoagulants.
Topics: Administration, Oral; Aged; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Cefaclor; Deoxyuridine; Drug Substitution; Female; Humans; Infusions, Intravenous; Neck; Streptococcal Infections; Streptococcus constellatus; Sulbactam; Suppuration; Thrombophlebitis; Treatment Outcome
PubMed: 35110455
DOI: 10.1248/yakushi.21-00179 -
Cureus Feb 2022Infective endocarditis (IE) is a severe infection of the endocardium and cardiac valves by multiple etiologic agents. Clinical presentation can be acute or subacute...
Infective endocarditis (IE) is a severe infection of the endocardium and cardiac valves by multiple etiologic agents. Clinical presentation can be acute or subacute based on the host immunity and the causative agent's virulence. Although are responsible for most community-acquired native valve bacterial IE, is an infrequent cause. can rarely infect prosthetic cardiac valves. A middle-aged white male with poorly controlled type 2 diabetes mellitus was transferred to our facility for suspected stroke with an initial presentation of acute encephalopathy of uncertain duration. Transthoracic echocardiogram revealed a left ventricular apical mural vegetation, and brain imaging displayed multiple white matter hypodensities indicative of numerous small strokes. Blood cultures were positive for . Clinical presentation was unusual with an acute encephalopathy due to multiple septic emboli and primary mural IE with high-grade bacteremia due to . PubMed medical literature review reveals this to be a rare clinical presentation by an uncommon etiological agent with an infrequent echocardiogram finding.
PubMed: 35340460
DOI: 10.7759/cureus.22238 -
Archive of Clinical Cases 2022are gram-positive cocci belonging to the group that have a propensity to cause bacteremia and abscesses, especially in immunocompromised patients. Here, we report the...
are gram-positive cocci belonging to the group that have a propensity to cause bacteremia and abscesses, especially in immunocompromised patients. Here, we report the case of a 39-year-old male who was initially admitted to the hospital for diabetic ketoacidosis. During the hospitalization, he developed sepsis and blood cultures grew . CT imaging revealed multiple hepatic abscesses. A periapical abscess of the left mandibular central incisor found on CT Scan of face was identified as the likely source of infection. IR-guided drainage was performed however the patient went on to develop septic shock despite attempted source control and IV antibiotic therapy. Repeat imaging showed persistent hepatic abscesses in addition to new intraperitoneal abscesses necessitating exploratory laparotomy, drainage and abdominal washout. Fluid cultures grew and common enteric flora. Our report highlights the need for high clinical suspicion in cases of bacteremia to obtain diagnostic imaging for any abscess formation. Prolonged antibiotic therapy is a must and imaging guided or surgical drainage may be needed.
PubMed: 36176498
DOI: 10.22551/2022.36.0903.10215 -
Case Reports in Infectious Diseases 2020is an oropharyngeal commensal Gram-positive coccus, frequently associated with the respiratory tract. is part of the or group, which has traditionally been...
is an oropharyngeal commensal Gram-positive coccus, frequently associated with the respiratory tract. is part of the or group, which has traditionally been considered to have propensity to cause empyema and purulent abscesses, a property that is sometimes overlooked as the severity of infections it causes may have a varying degree. In this case, we present the case of a 54-year-old male with known liver cirrhosis who developed a severe empyema during an acute liver failure episode, requiring extensive decortication and prolonged hospital admission.
PubMed: 32733717
DOI: 10.1155/2020/4630809 -
Diagnostics (Basel, Switzerland) Nov 2022(SC) is a species of belonging to the group, along with and . Despite its commensal nature, underlying risk factors and medical conditions might lead to various...
(SC) is a species of belonging to the group, along with and . Despite its commensal nature, underlying risk factors and medical conditions might lead to various anatomic site infections caused by this opportunistic pathogen. Although SC infections have mostly been associated with bacteremia, some case reports of abscess and empyema formation have been documented. Herein, we report a case of a middle-aged female patient who initially presented with radiculopathy symptoms. Subsequent neurologic imaging revealed a pyogenic abscess along paravertebral muscles, which was found to be caused by SC. The patient was successfully treated with abscess drainage from the lumbar zone and antibiotics, and the symptoms of radiculopathy have completely resolved.
PubMed: 36359529
DOI: 10.3390/diagnostics12112686 -
Autopsy & Case Reports 2023is usually a benign, commensal bacteria but has increased incidence in blood cultures and abscesses. This pathogenic involvement is most prevalent in individuals with...
is usually a benign, commensal bacteria but has increased incidence in blood cultures and abscesses. This pathogenic involvement is most prevalent in individuals with underlying medical conditions, such as solid tumors and type 2 diabetes mellitus, as well as in cases of community-acquired infections. We report a 43-year-old male with a right medial thigh ulcer and necrotic scrotal skin. The wound culture from surgical debridement grew and histology was consistent with stage III necrotizing fasciitis. Regardless of etiology, the mortality rate of patients with necrotizing fasciitis is greatly decreased with early intervention and thorough surgical debridement.
PubMed: 38213877
DOI: 10.4322/acr.2023.467 -
Medicine Nov 2021Empyema caused by Streptococcus constellatus is rare in patients without underlying diseases. However, the importance of the Streptococcus anginosus group, which...
RATIONALE
Empyema caused by Streptococcus constellatus is rare in patients without underlying diseases. However, the importance of the Streptococcus anginosus group, which consists of S constellatus, S anginosus, and Streptococcus intermedius, as causative organisms of empyema has been increasing.
PATIENT CONCERNS
A 78-year-old man initially presented with dyspnea and chills for 4 days. He had no medical history.
DIAGNOSIS
Chest X-ray and chest computed tomography showed a large and multiloculated pleural effusion with an air bubble on the right side. Cultivation of the pleural effusion using clone library analysis of the 16S rRNA gene revealed S constellatus positivity.
INTERVENTIONS
The patient was treated by drainage of the pleural effusion and intravenous ceftriaxone and clindamycin for the possibility of anaerobes, followed by 10 weeks of oral antibiotics.
OUTCOMES
On the 11th day of admission, the thoracic drainage tube was removed. After 1 year of treatment, there were no sequelae of empyema.
LESSONS
Although S constellatus can cause serious infections in patients with underlying diseases and immunosuppression, physicians need to consider S constellatus infection in community-acquired empyema in elderly individuals. It should be treated with early pleural drainage and antibiotics to avoid surgical decortication and prolonged hospitalization.
Topics: Aged; Anti-Bacterial Agents; Empyema, Pleural; Humans; Male; Pleural Effusion; RNA, Ribosomal, 16S; Streptococcal Infections; Streptococcus constellatus
PubMed: 34766602
DOI: 10.1097/MD.0000000000027893 -
BMC Pulmonary Medicine Feb 2020Descending necrotizing mediastinitis is a severe infection of the mediastinum. This syndrome manifests as fever and chest pain following cough and sputum production. A... (Review)
Review
Descending necrotizing mediastinitis is a severe infection of the mediastinum. This syndrome manifests as fever and chest pain following cough and sputum production. A 49-year-old woman presented with fever and a 14-day history of pneumonia. CT showed mediastinal abscesses with a giant calcified mediastinal lymph node (21 × 18 mm) and pneumonia. Bronchoscopy by EBUS-TBNA under general anesthesia was performed. The pathogen found in the puncture culture was Streptococcus constellatus, and antibiotics (mezlocillin/sulbactam 3.375 IVGTT q8h) was administered. A proximal right main bronchial neoplasm, suspected lung cancer, was found and conformed to inflammatory granuloma. A total of 22 months post-discharge the patient was clinically stable. We also conducted a review of the literature for all Streptococcus constellatus descending necrotizing mediastinitis infections between 2011 and 2017.
Topics: Anti-Bacterial Agents; Bronchoscopy; Drainage; Female; Humans; Immunocompetence; Lymph Nodes; Mediastinitis; Middle Aged; Pneumonia; Streptococcal Infections; Streptococcus constellatus; Tomography, X-Ray Computed
PubMed: 32066414
DOI: 10.1186/s12890-020-1068-3 -
Infection and Drug Resistance 2022() is a well-known part of the normal flora in humans. Pyogenic spondylitis (PS) induced by is very rare. In this case, a 46-year-old male patient presented to our...
() is a well-known part of the normal flora in humans. Pyogenic spondylitis (PS) induced by is very rare. In this case, a 46-year-old male patient presented to our hospital with a 2-month history of low back pain and weakness in both legs. Based on his clinical manifestations, laboratory findings, blood culture results, imaging and histopathological findings, the patient was diagnosed with PS caused by . One unique aspect of this case is the acute and severe course of infection, which resulted in multiple organ dysfunction syndrome and septic shock in the first week and rapid vertebral destruction within 2 months of the patient's admission. His obese status may be relevant to his presentation. This case report suggests that infections should not be overlooked, especially in patients with known risk factors and predispositions to infectious diseases.
PubMed: 35971556
DOI: 10.2147/IDR.S371411