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Cureus Apr 2024Nocardiosis is a disease caused by gram-positive, catalase-positive, rod-shaped bacteria that stain weakly on a Gram stain. It usually affects the lungs and skin but can...
Nocardiosis is a disease caused by gram-positive, catalase-positive, rod-shaped bacteria that stain weakly on a Gram stain. It usually affects the lungs and skin but can cause disseminated infections. has 85 species, ranging from nonpathogenic to pathogenic. is an opportunistic organism that causes infections in the immunocompromised; however, 7% of the immunocompetent population has suffered from infection. This case report highlights an unusual occurrence of pulmonary nocardiosis in a 31-year-old woman with a normal immune system. She was initially treated as an outpatient for what appeared to be community-acquired pneumonia. However, her condition deteriorated, ultimately revealing a substantial right pleural effusion with loculation and adjacent compressive atelectasis affecting a significant portion of her right middle and lower lung lobes, as detected by a CT scan followed by pleural fluid analysis which confirmed the infection. By sharing this experience, we aim to contribute to the collective knowledge of medical professionals and improve the accuracy of diagnosis and treatment.
PubMed: 38770507
DOI: 10.7759/cureus.58686 -
Cureus Apr 2024Foreign body (FB) aspiration is an infrequent cause of respiratory distress in adults. Advancing age, central nervous system disorders or trauma, drug or alcohol...
Foreign body (FB) aspiration is an infrequent cause of respiratory distress in adults. Advancing age, central nervous system disorders or trauma, drug or alcohol addiction, neuromuscular diseases, and mental health issues and illnesses are the main risk factors. The authors present an atypical clinical presentation of a 3-week-lasting foreign body aspiration mimicking a tumour that led to severe acute respiratory insufficiency and required aggressive artificial lung ventilation. Diagnosis of FB was based on the results of the chest computed tomography (CT) scans and flexible bronchoscopy, which, however, initially assumed a neoplastic disease in the right main bronchus. During FB extraction via flexible fiberoptic bronchoscopy inserted through an 8.5 mm endotracheal tube high-frequency ventilation through a catheter placed between the vocal cords was used to ensure adequate alveolar ventilation and maintain sufficient oxygenation. After extraction of the FB, thoracosurgical intervention was performed to resolve empyema as a septic complication of the FB aspiration. After this therapy, a complete resolution of pleural empyema and lung atelectasis was observed.
PubMed: 38765362
DOI: 10.7759/cureus.58584 -
Pediatric Surgery International May 2024Pleural empyema (PE) is a collection of purulent material in the pleural space. PE's management in children is a challenge and an inappropriate diagnostic-therapeutic... (Observational Study)
Observational Study
PURPOSE
Pleural empyema (PE) is a collection of purulent material in the pleural space. PE's management in children is a challenge and an inappropriate diagnostic-therapeutic work up can lead to serious short and long-term complications. The aim of this study is to define the correct timing to approach a pediatric PE by video-assisted thoracoscopic surgery (VATS).
METHODS
A retrospective observational study was conducted including pediatric patients who underwent video-assisted thoracoscopy for pleural empyema between May 2005 and September 2022.
RESULTS
62 patients were subjected to VATS for PE (32 in Group Early VATS, 30 in Group Late VATS). It emerged that the elapsed period between the onset of symptoms and surgery correlates in a statistically significant way with the post-operative stay in intensive care (z score 4.3 and p value < 0.0001) and the analysis between early VATS, late VATS and postoperative hospitalization showed a statistically significant reduction of the post-operative hospitalization in the early VATS groups (p value < 0.02).
CONCLUSIONS
VATS resulted to be safe and effective for the treatment of PE in children, and an early minimally invasive thoracoscopic intervention (early VATS) correlates with better outcomes, specifically in terms of intensive care hospitalization and overall hospitalization.
Topics: Humans; Thoracic Surgery, Video-Assisted; Retrospective Studies; Empyema, Pleural; Female; Male; Child; Child, Preschool; Treatment Outcome; Adolescent; Infant; Length of Stay
PubMed: 38761186
DOI: 10.1007/s00383-024-05715-y -
Cureus Apr 2024Lemierre-like syndrome is a rare, systemic sequelae following a persistent oropharyngeal infection, leading to septic thrombophlebitis of the internal jugular vein...
Lemierre-like syndrome is a rare, systemic sequelae following a persistent oropharyngeal infection, leading to septic thrombophlebitis of the internal jugular vein (IJV). Lemierre syndrome is caused by the obligate anaerobic organism , innate to the oropharyngeal tract. Lemierre-like syndrome is due to infections caused by other organisms, including methicillin-resistant (MRSA). We are reporting a case of a five-month-old male who presented with one week of fever that was not alleviated by acetaminophen, bilateral otitis media, and left-sided cervical lymphadenopathy not alleviated with medical therapy. The patient's clinical course continued to deteriorate as he developed respiratory distress that progressed to acute respiratory failure requiring mechanical ventilation support. Extensive laboratory investigation ruled out the causes of primary and secondary immunodeficiencies. Blood cultures were positive for MRSA, and he was treated initially with vancomycin, then switched to linezolid per ENT recommendations, and ultimately needed daptomycin and ceftaroline therapy. A computed tomography (CT) scan of the neck and chest showed deep neck space infection, bilateral loculated pleural empyema, and mediastinitis. The patient required a decortication video-assisted thoracoscopic surgery (VATS), multiple drains, and a mediastinal washout to control the MRSA infection. This report emphasizes that the rapid progression and spread of septic thrombus can become detrimental to a patient's recovery and survival; therefore, it should be recognized early and treated promptly.
PubMed: 38741847
DOI: 10.7759/cureus.58192 -
Cureus Apr 2024Valley fever is a fungal infection, commonly of the lungs, caused by Coccidioides immitis or Coccidioides posadasii. This disease is endemic to the southwestern United...
Valley fever is a fungal infection, commonly of the lungs, caused by Coccidioides immitis or Coccidioides posadasii. This disease is endemic to the southwestern United States, Central America, and South America. Infected individuals are typically asymptomatic but may develop community-acquired pneumonia. On rare occasions, coccidioidomycosis can present with severe complications in addition to the pulmonary manifestation. In this study, a 58-year-old immunocompetent male presented to the Emergency Department with a cough, night sweats, and pleuritic chest pain. Despite the administration of broad-spectrum antimicrobials, he developed a large right pleural effusion that did not resolve following thoracentesis. Serology was positive for Coccidioides, and the patient was referred to a thoracic surgeon due to persistent effusion. It is rare for patients with coccidiomycosis to develop a large pleural effusion requiring surgical intervention, especially in immunocompetent individuals. This case highlights the importance of monitoring patients with unresolved acute pneumonia in endemic areas and considering Coccidioides as a possible etiology.
PubMed: 38738118
DOI: 10.7759/cureus.57983 -
The Pediatric Infectious Disease Journal Jul 2024This study investigated empiric antibiotic treatment (EAT), guideline adherence, antibiotic streamlining and clinical outcomes in 1402 hospitalized children with...
OBJECTIVE
This study investigated empiric antibiotic treatment (EAT), guideline adherence, antibiotic streamlining and clinical outcomes in 1402 hospitalized children with pediatric parapneumonic effusion/pleural empyema (PPE/PE).
METHODS
A nationwide surveillance study collected data on EAT, clinical course/outcome, pathogens, susceptibility testing and antibiotic streamlining of children with PPE/PE in Germany between 2010 and 2018. Subgroups were compared using χ2 test/Fisher exact test, Mann-Whitney U test and linear regression analysis adjusting for patient age where appropriate.
RESULTS
Complete data on EAT were available for 1402 children. In children with monotherapy (n = 567) and in children with combination therapy of 2 antibiotics (n = 589), the most commonly used antibiotics were aminopenicillin/beta-lactamase inhibitor [138/567 (24.3%) and 102/589 (17.3%)] and cefuroxime [291/567 (51.3%) and 294/589 (49.9%)]. The most common combinations with these beta-lactams were macrolides, aminoglycosides and clindamycin. We observed no difference in clinical severity/outcome between EAT with aminopenicillin/beta-lactamase inhibitor and cefuroxime, neither when used in monotherapy nor when used in combination therapy of 2 antibiotics. Species diagnosis of Streptococcus pneumoniae (n = 192), Streptococcus pyogenes (n = 111) or Staphylococcus aureus (n = 38) in polymerase chain reaction or culture from pleural fluid or blood resulted in a switch to an appropriate narrow-spectrum beta-lactam therapy in 9.4%, 18.9 % and 5.2% of children. In a subset of children with reported bacterial susceptibility testing, penicillin resistance was reported in 3/63 (4.8%) of S. pneumoniae and methicillin resistance in S. aureus was reported in 10/32 (31.3%) of children.
CONCLUSION
This study points to antibiotic overtreatment in children with PPE/PE, particularly the frequent use of combinations of antibiotics. Children receiving combinations of antibiotics did not show differences in clinical outcomes. The low rate of children with streamlined antibiotic therapy even upon pathogen detection indicates a necessity for antibiotic stewardship measures in PPE/PE and the need of investigating other potential therapeutic strategies as anti-inflammatory therapy.
Topics: Humans; Anti-Bacterial Agents; Germany; Child, Preschool; Male; Female; Child; Empyema, Pleural; Infant; Pleural Effusion; Adolescent; Microbial Sensitivity Tests
PubMed: 38713819
DOI: 10.1097/INF.0000000000004359 -
Cureus Apr 2024Nephropleural fistula, a rare complication of percutaneous nephrolithotomy (PCNL), occurred in a 45-year-old male with adult autosomal dominant polycystic kidney disease...
Nephropleural fistula, a rare complication of percutaneous nephrolithotomy (PCNL), occurred in a 45-year-old male with adult autosomal dominant polycystic kidney disease (ADPKD). The patient had undergone right PCNL in 2021 and 2023 and presented to the emergency department with symptoms of fever, breathlessness, and cough lasting one week. Imaging studies, including chest radiograph and contrast-enhanced computed tomography (CECT) of the abdomen and pelvis, revealed gross right pleural effusion, right perinephric abscess, multiple renal cysts, right renal calculi and right ureteric calculi causing severe right hydronephrosis and proximal hydroureter. The imaging also confirmed a nephropleural fistula, with the right kidney's perinephric abscess communicating with the right pleura via the right subhepatic space. Subsequent thoracic ultrasound showed a large effusion of 1500ml with underlying lung collapse. Diagnostic thoracocentesis confirmed empyema, necessitating immediate tube thoracostomy. CT intravenous urography confirmed a non-functioning right kidney. The perinephric abscess was drained with a PCNL tube and meanwhile, pleural fluid and perinephric abscess isolated Klebsiella pneumonia on cultures. The patient received parenteral antibiotics and intravenous fluids and had an intercostal drain and PCNL tube in place for drainage. A right nephrectomy was recommended due to the non-functioning right kidney and the patient is awaiting the procedure.
PubMed: 38707149
DOI: 10.7759/cureus.57671 -
BMC Research Notes May 2024Thoracoscopy under local anaesthesia is widely performed to diagnose malignancies and infectious diseases. However, few reports have described the use of this procedure... (Observational Study)
Observational Study
OBJECTIVES
Thoracoscopy under local anaesthesia is widely performed to diagnose malignancies and infectious diseases. However, few reports have described the use of this procedure for diagnosing and treating intrathoracic infections. This study aimed to evaluate the safety and efficacy of thoracoscopy under local anaesthesia for the management of intrathoracic infections.
RESULTS
Data from patients who underwent thoracoscopy procedures performed by chest physicians under local anaesthesia at our hospital between January 2018 and December 2023 were retrospectively reviewed. We analysed their demographic factors, reasons for the examinations, diseases targeted, examination lengths, anaesthetic methods used, diagnostic and treatment success rates, as well as any adverse events. Thirty patients were included. Of these, 12 (40%) had thoracoscopies to diagnose infections, and 18 (60%) had them to treat pyothorax. In terms of diagnosing pleurisy, the causative microorganism of origin was identified via thoracoscopy in only three of 12 (25.0%) patients. For diagnosing pyothorax, the causative microorganism was identified in 7 of 18 (38.9%) patients. Methicillin-resistant Staphylococcus aureus was the most common causative microorganism identified. The treatment success rates were very high, ranging between 94.4 and 100%, whereas the identification rate of the causative microorganisms behind infections was low, ranging between 25.0 and 38.9%. The most frequent adverse events included perioperative hypoxaemia and pain. There were two (6.7%) serious adverse events of grade ≥ 3, but none resulted in death.
CONCLUSIONS
The efficacy of managing intrathoracic infections through thoracoscopy under local anaesthesia is commendable. Nonetheless, the diagnostic accuracy of the procedure, regarding the precise identification of the causative microorganisms responsible for intrathoracic infections, persists at a notably low level, presenting a substantial clinical hurdle.
Topics: Humans; Thoracoscopy; Male; Anesthesia, Local; Female; Middle Aged; Aged; Retrospective Studies; Adult; Treatment Outcome; Aged, 80 and over; Pleurisy; Empyema, Pleural
PubMed: 38705975
DOI: 10.1186/s13104-024-06794-9 -
Kardiochirurgia I Torakochirurgia... Mar 2024Postpneumonectomy empyema (PPE) is a severe and often fatal complication of pneumonectomy, but some benefits of PPE were reported in patients who underwent either lobe...
INTRODUCTION
Postpneumonectomy empyema (PPE) is a severe and often fatal complication of pneumonectomy, but some benefits of PPE were reported in patients who underwent either lobe or an entire lung resection due to lung cancer.
AIM
To compare the survival outcomes of patients with non-small-cell lung carcinoma (NSCLC), who developed PPE after pneumonectomy with uneventful recoveries available in our center's database.
MATERIAL AND METHODS
Outcomes of 928 pneumonectomies performed due to NSCLC between 1995 and 2009 were evaluated. The selection of the control group took into account the requirements for propensity score matching in terms of follow-up period, age, sex, tumor histopathology, TNM classification and the side of surgery.
RESULTS
Thirty-two patients with a PPE syndrome and 96 patients without complications after pneumonectomy were included. The estimated 5- and 10-year survival rates were 71% and 59%, respectively. The average and median survival was almost two- and three-fold longer compared to the group with uneventful recoveries. A 2-fold lower cancer-related mortality rate and a 1.5-fold higher cancer-unrelated mortality rate were noted in the PPE group as opposed to the group without complications. Having recovered from PPE, the patients had their risk of death reduced by 2.5-fold and 3.5-fold due to all causes and cancer, respectively.
CONCLUSIONS
Pleural empyema in NSCLC patients who underwent pneumonectomy seems to improve the survival outcomes compared to patients with uneventful recoveries.
PubMed: 38693979
DOI: 10.5114/kitp.2024.138376 -
Cureus Mar 2024Empyema is the collection of pus in the pleural cavity and most times, it occurs unilaterally. It is often associated with underlying pneumonia, but other causes have...
Bilateral Empyema With Beta Hemolytic Group C Streptococcus and Streptococcus constellatus Co-infection Resulting From an Esophageal Perforation and Associated With Septic Shock, Diffuse ST Elevation, and New-Onset Atrial Fibrillation.
Empyema is the collection of pus in the pleural cavity and most times, it occurs unilaterally. It is often associated with underlying pneumonia, but other causes have been identified as well. When it occurs after an esophageal perforation, which in itself is also rare, morbidity and mortality are even higher. Esophageal perforation can cause life-threatening complications due to its close proximity to the vital organs of the mediastinum, necessitating its timely diagnosis and aggressive management. Bacteria forming part of the normal esophageal and oral flora are the most common causative pathogens for empyema from an esophageal perforation. Streptococcus constellatus and group C Streptococci, though both rare and often not taken seriously, have been identified as individual causes of empyema. We present a case of a 58-year-old male who presented with a worsening cough, chest pain, and shortness of breath after choking on a fish bone. He was diagnosed with bilateral loculated empyema resulting from esophageal perforation with the pleural fluid culture isolating both group C streptococcus and Streptococcus constellatus. He also developed respiratory failure, mediastinitis, and septic shock. This case will enable physicians to take empyema caused by these bacteria seriously and also to include esophageal perforation as a differential diagnosis when a patient presents with bilateral empyema associated with chest pain and electrocardiographic changes.
PubMed: 38686265
DOI: 10.7759/cureus.57251