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The American Journal of Case Reports May 2024BACKGROUND Uterine dehiscence, an infrequent event often mistaken for uterine rupture, is rarely linked to post-cesarean section procedures and can result in severe...
BACKGROUND Uterine dehiscence, an infrequent event often mistaken for uterine rupture, is rarely linked to post-cesarean section procedures and can result in severe complications, notably puerperal sepsis. In this report, we present a case that exemplifies the onset of puerperal sepsis and the emergence of intra-abdominal abscesses attributed to uterine dehiscence following a lower segment cesarean section (LSCS). CASE REPORT Our patient, a 28-year-old woman in her third pregnancy, underwent LSCS 1 week earlier. Subsequently, she returned to the hospital with lower abdominal pains, fever, and malodorous vaginal discharge. Computed tomography (CT) scan of whole abdomen verified uterine dehiscence and pus collection at the subhepatic region and right paracolic gutter. After referral to a specialized hospital, laboratory findings indicated an elevated white blood cell count and alkaline phosphatase levels, and coagulation abnormalities. She underwent an exploratory laparotomy, which unveiled uterine dehiscence, abscesses, and adhesions, necessitating a total abdominal hysterectomy and abdominal toileting. Pus culture analysis identified the presence of E. coli, which was susceptible to ampicillin/sulbactam. Complications were encountered after surgery, including wound dehiscence and pus re-accumulation. Successful management involved vacuum dressings and percutaneous drainage. Eventually, her condition improved and she was discharged, without additional complications. CONCLUSIONS This report underscores the importance of considering cesarean scar dehiscence as a diagnosis in women with previous cesarean deliveries who present during subsequent pregnancies with symptoms such as abdominal pain or abdominal sepsis. Diagnostic tools, such as CT, play pivotal roles, and the timely performance of an exploratory laparotomy is paramount when suspicion arises.
Topics: Humans; Female; Adult; Cesarean Section; Surgical Wound Dehiscence; Pregnancy; Abdominal Abscess
PubMed: 38796696
DOI: 10.12659/AJCR.943027 -
The Journal of Antimicrobial... Jul 2024Invasive fungal infections (IFIs) are severe and difficult-to-treat infections affecting immunocompromised patients. Antifungal drug penetration at the site of infection... (Comparative Study)
Comparative Study
BACKGROUND
Invasive fungal infections (IFIs) are severe and difficult-to-treat infections affecting immunocompromised patients. Antifungal drug penetration at the site of infection is critical for outcome and may be difficult to achieve. Data about antifungal drug distribution in infected human tissues under real circumstances of IFI are scarce.
METHODS
Multiple samples were obtained from soft tissue abscesses of a lung transplant patient with Candida albicans invasive candidiasis who underwent recurrent procedures of drainage, while receiving different consecutive courses of antifungal therapy [itraconazole (ITC), fluconazole, caspofungin]. Antifungal drug concentrations were measured simultaneously at the site of infection (surrounding inflammatory tissue and fluid content of the abscess) and in plasma for calculation of the tissue/plasma ratio (R). The concentration within the infected tissue was interpreted as appropriate if it was equal or superior to the MIC of the causal pathogen.
RESULTS
A total of 30 tissue samples were collected for measurements of ITC (n = 12), fluconazole (n = 17) and caspofungin (n = 1). Variable concentrations were observed in the surrounding tissue of the lesions with median R of 2.79 (range 0.51-15.9) for ITC and 0.94 (0.21-1.37) for fluconazole. Concentrations ranges within the fluid content of the abscesses were 0.39-1.83 for ITC, 0.66-1.02 for fluconazole and 0.23 (single value) for caspofungin. The pharmacodynamic target (tissue concentration ≥ MIC) was achieved in all samples for all three antifungal drugs.
CONCLUSIONS
This unique dataset of antifungal drug penetration in infected human soft tissue abscesses suggests that ITC, fluconazole and caspofungin could achieve appropriate concentrations in soft tissue abscesses.
Topics: Humans; Antifungal Agents; Abscess; Caspofungin; Soft Tissue Infections; Fluconazole; Candida albicans; Candidiasis, Invasive; Microbial Sensitivity Tests; Male; Itraconazole; Middle Aged; Female; Adult
PubMed: 38785349
DOI: 10.1093/jac/dkae162 -
Scientific Reports May 2024Despite extensive characterisation of uropathogenic Escherichia coli (UPEC) causing urinary tract infections (UTIs), the genetic background of non-urinary...
Despite extensive characterisation of uropathogenic Escherichia coli (UPEC) causing urinary tract infections (UTIs), the genetic background of non-urinary extraintestinal pathogenic E. coli (ExPEC) in companion animals remains inadequately understood. In this study, we characterised virulence traits of 104 E. coli isolated from canine pyometra (n = 61) and prostatic abscesses (PAs) (n = 38), and bloodstream infections (BSIs) in dogs (n = 2), and cats (n = 3). A stronger association with UPEC of pyometra strains in comparison to PA strains was revealed. Notably, 44 isolates exhibited resistance to third-generation cephalosporins and/or fluoroquinolones, 15 were extended-spectrum ß-lactamase-producers. Twelve multidrug-resistant (MDR) strains, isolated from pyometra (n = 4), PAs (n = 5), and BSIs (n = 3), along with 7 previously characterised UPEC strains from dogs and cats, were sequenced. Genomic characteristics revealed that MDR E. coli associated with UTIs, pyometra, and BSIs belonged to international high-risk E. coli clones, including sequence type (ST) 38, ST131, ST617, ST648, and ST1193. However, PA strains belonged to distinct lineages, including ST12, ST44, ST457, ST744, and ST13037. The coreSNPs, cgMLST, and pan-genome illustrated intra-clonal variations within the same ST from different sources. The high-risk ST131 and ST1193 (phylogroup B2) contained high numbers of ExPEC virulence genes on pathogenicity islands, predominating in pyometra and UTI. Hybrid MDR/virulence IncF multi-replicon plasmids, containing aerobactin genes, were commonly found in non-B2 phylogroups from all sources. These findings offer genomic insights into non-urinary ExPEC, highlighting its potential for invasive infections in pets beyond UTIs, particularly with regards to high-risk global clones.
Topics: Dogs; Animals; Urinary Tract Infections; Drug Resistance, Multiple, Bacterial; Male; Dog Diseases; Cats; Escherichia coli Infections; Pyometra; Abscess; Female; Cat Diseases; Uropathogenic Escherichia coli; Escherichia coli; Anti-Bacterial Agents; Prostatic Diseases; Virulence; Virulence Factors
PubMed: 38782931
DOI: 10.1038/s41598-024-62028-9 -
Emerging Infectious Diseases Jun 2024A 3-year-old patient in India experiencing headaches and seizures was diagnosed with a fungal infection, initially misidentified as Cladophialophora bantiana. Follow-up...
A 3-year-old patient in India experiencing headaches and seizures was diagnosed with a fungal infection, initially misidentified as Cladophialophora bantiana. Follow-up sequencing identified the isolate to be Fonsecaea monophora fungus. This case demonstrates the use of molecular methods for the correct identification of F. monophora, an agent of fungal brain abscess.
Topics: Brain Abscess; Humans; Ascomycota; Child, Preschool; Male; Mycoses; Antifungal Agents; Phylogeny; DNA, Fungal
PubMed: 38782016
DOI: 10.3201/eid3006.240077 -
Heliyon May 2024Pyoderma gangrenosum (PG) is an extremely rare case of sterile necrotic ulcerative disease associated with malnutrition as a predisposition factor. It is unclear,...
Pyoderma gangrenosum (PG) is an extremely rare case of sterile necrotic ulcerative disease associated with malnutrition as a predisposition factor. It is unclear, though, whether dilated cardiomyopathy, which affects blood flow and results in stenosis in the arteries, could play a role as an etiology. In this study, a case of pyoderma gangrenosum in a 10-year-old boy complicated by dilated cardiomyopathy, a previous history of cerebrovascular disease, and a malnourished condition were reported. The patient was reported to have exudative necrotic lesions in both legs. Lesions began as small, multiple, itchy lesions on both legs, which later became blisters and scuffed, and progressed into painful, peeled-off lesions with pus, bleeding, redness around lesions, and maggots within a month. A high fever was an accompanying symptom. The multidisciplinary team was involved to provide a comprehensive treatment for this patient. Antibiotics and necrotomy debridement were performed several times. Anticoagulant treatment was indicated as the coagulation markers were increased and echocardiography suggested thrombus in the left ventricle. The underlying condition that increases the risk of pyoderma gangrenosum should be corrected. The patient was discharged after a clinical improvement, although the continuation of outpatient monitoring was required. Our report suggests that a chronic condition of dilated cardiomyopathy that affects normal blood flow leads to malnutrition, the formation of thrombus, and stenosis of a peripheral artery, all of which contributed to pyoderma gangrenosum. Therefore, early surgical treatment, antibiotic administration, and anticoagulant treatment were recommended.
PubMed: 38778983
DOI: 10.1016/j.heliyon.2024.e30838 -
Revista Da Sociedade Brasileira de... 2024
Topics: Humans; COVID-19; Cellulitis; Neck; SARS-CoV-2; Acute Disease; Male; Female
PubMed: 38775569
DOI: 10.1590/0037-8682-0091-2024 -
BMC Infectious Diseases May 2024Chromobacterium violaceum is a rare but severe and often fatal cause of disease in humans. We present 2 clinical cases of sepsis and skin abscesses / cellulitis caused...
Chromobacterium violaceum is a rare but severe and often fatal cause of disease in humans. We present 2 clinical cases of sepsis and skin abscesses / cellulitis caused by C. violaceum seen in a referral hospital for infectious diseases in Vietnam. Both patients survived, but appropriate antibiotic treatment was only installed after culture of the organism. We reviewed and summarised the characteristics of C. violaceum infection and treatment.
Topics: Female; Humans; Anti-Bacterial Agents; Cellulitis; Chromobacterium; Gram-Negative Bacterial Infections; Sepsis; Vietnam; Child; Adolescent
PubMed: 38773469
DOI: 10.1186/s12879-024-09390-1 -
International Journal of... Jan 2024The most common organ affected due to tuberculosis (TB) is the lungs. Extrapulmonary TB is less common. Musculoskeletal organs are affected in around 8% of all...
BACKGROUND
The most common organ affected due to tuberculosis (TB) is the lungs. Extrapulmonary TB is less common. Musculoskeletal organs are affected in around 8% of all tubercular patients, of which the spine is affected in almost half of the patients. The criteria for diagnosing spinal TB are quite difficult and we use an array of investigations for the same.
METHODS
A retrospective study was carried out in the Neurosurgery and Microbiology Department at IMS and SUM Hospital between January 2021 and November 2023, and data were collected and tabulated in an Excel sheet. One hundred patients with spinal TB were evaluated, and their age, sex, samples sent, diagnostic investigation, duration of diagnosis from hospital admission, histopathology results, and surgical intervention (done or not) were recorded.
RESULTS
The best investigation done to diagnose spinal TB was imaging and surgical/computed tomography (CT)-guided biopsy. The earliest result to diagnose spinal TB was histopathology. The yield of positivity in pus culture, smear microscopy, and true nucleic acid amplification test (NAAT) was found to be low even though sensitivity was on the higher side.
CONCLUSION
Even though we have an array of investigations for diagnosing spinal TB, the best and the earliest diagnosing test was imaging plus CT-guided biopsy. The confirmation is made in the biopsy. Finding acid-fast bacteria (AFB) and NAAT tests are additional beneficial tests to supplement the diagnosis. Hence, we can conclude that sending for tests like AFB in pus, NAAT, and GeneXpert is a wastage of biological samples and delays in diagnosis.
Topics: Humans; Tuberculosis, Spinal; Retrospective Studies; Male; Female; Adult; Middle Aged; Mycobacterium tuberculosis; Young Adult; Aged; Tomography, X-Ray Computed; Adolescent; Biopsy; Nucleic Acid Amplification Techniques; Sensitivity and Specificity
PubMed: 38771286
DOI: 10.4103/ijmy.ijmy_14_24 -
Scientific Reports May 2024Liver abscess is a potentially life-threatening medical emergency. Prompt empirical antimicrobial with or without percutaneous aspiration or drainage is therapeutic. The... (Randomized Controlled Trial)
Randomized Controlled Trial
Liver abscess is a potentially life-threatening medical emergency. Prompt empirical antimicrobial with or without percutaneous aspiration or drainage is therapeutic. The rational for using empirical intravenous broad-spectrum antimicrobials upfront instead of oral Fluoroquinolone or Cephalosporin is contentious. In this double blind randomized control clinical trial 69 participants received Ciprofloxacin (500 mg q 12 hourly) and 71 participants received Cefixime (200 mg q 12 hourly) orally for 2 weeks. Both the group received oral Metronidazole (800 mg q 8 hourly) for 2 weeks and percutaneous drainage or aspiration of the abscess was done as per indication and followed-up for 8 weeks. Out of 140 participants, 89.3% (N = 125) achieved clinical cure, 59 (85.5%) in Ciprofloxacin group and 66 (93%) in Cefixime group (p = 0.154). Mean duration of antimicrobial therapy was 16.2 ± 4.3 days, 15.1 ± 4.5 days in Ciprofloxacin group and 16.0 ± 4.2 days in Cefixime group (p = 0.223). Total 15 (10.7%) participants had treatment failure, 10 (14.5%) in Ciprofloxacin group and 5 (7.0%) in Cefixime group (p = 0.154). The most common reason for treatment failure was need of prolong (> 4 weeks) antimicrobial therapy due to persistent hepatic collection requiring drainage, which was significantly (p = 0.036) higher in Ciprofloxacin (14.5%, N = 10) group, compared to the Cefixime (4.2%, N = 3) group. In conclusion, both, the Ciprofloxacin or Cefixime plus Metronidazole for duration of 2-3 weeks were efficacious as empirical oral antimicrobial regimen along with prompt percutaneous drainage or aspiration for the treatment of uncomplicated liver abscess with similar efficacy. Oral Cefixime was better than Ciprofloxacin in term of lesser chance of treatment failure due to persistent collection which is required to be investigated further in larger clinical trial.Trial registration: clinicaltrials.gov PRS ID: NCT03969758, 31/05/2019.
Topics: Humans; Ciprofloxacin; Metronidazole; Cefixime; Male; Female; Middle Aged; Adult; Anti-Bacterial Agents; Liver Abscess; Treatment Outcome; Double-Blind Method; Drug Therapy, Combination; Drainage; Aged
PubMed: 38769330
DOI: 10.1038/s41598-024-59607-1 -
Ui Sahak Apr 2024During the Song period, abscesses were a disease that could affect anyone regardless of their class. This study examines how people at that time explained the cause of...
During the Song period, abscesses were a disease that could affect anyone regardless of their class. This study examines how people at that time explained the cause of abscesses and their efforts to treat them, focusing on the experiences of those who suffered from abscesses and their families. Previous research on disease history during the Song period primarily focused on ailments like colds and infectious diseases , or plagues prevalent in the southern regions of China. On the other hand, examining abscesses as a common everyday illness that could affect anyone and considering them from the perspective of patients' experiences has remained unexplored in previous studies. To reconstruct the experiences of Song period patients, this study analyzes over sixty anecdotes related to abscesses found in Yi Jian Zhi written by Hong Mai. These cases span across the mid to late 12th century, with a majority of the patients being from the literati () class or connected to the literati. These anecdotes exhibit two distinct trends. One focuses on narratives surrounding the onset of abscesses, attributing their cause primarily to the patients' lifestyle. When the cause of the abscesses was unknown, people metaphorically attributed its onset to perceived blasphemy against God, an act of killing, negligence in duties, or other wrongdoings. This trend is evident among the literati class in particular, where abscesses were often linked to factors such as excessive legal executions or exploitation, and even acts of killing people. Except for those cases, in explaining the cause of abscesses in commoners, there were instances caused by a pediculus infestation, while in case of literati, Dansha () poisoning was a common cause. It is interesting to note that the narrative tradition, prevalent in official history biographies, which attributes the onset of abscesses to worries and resentment, was not evident in written records such as Yi Jian Zhi. Furthermore, the detailed description of external similarities, portraying abscesses as traces of punishment from the underground realm, is a narrative characteristic that solidified such stereotypical perceptions. The literati's notion that they should alert people through these related anecdotes contributed to the spread of this perception. Another trend in these anecdotes was centered around narratives of abscess treatment, where the focus shifted primarily to seeking "doctors," unlike the metaphorical explanations of abscess onset causes and processes. When afflicted with abscesses, people generally sought out those renowned surgeons, known as Yang-yi , and those famous for treating abscesses. In local communities, individuals who had "received the divine secrets of abscesses," those possessing their own mysterious abscesses cures, and those famous for generations for treating abscesses by using stone acupuncture were active. Such information about them was shared within the local societies. Their treatment predominantly consisted of surgical procedures to lance abscesses and drain pus, which often led patients to endure significant pain during the treatment process. In many cases, such patients sought treatment from well-known local surgeons and abscess specialists who surgically treated them. The literati, who are said to have influenced the development of pulse-centered medical and academic medicine in China, also sought out surgeons for abscess treatment. Medical formularies compiled by the court as well as privately published ones rarely mentioned surgical methods utilizing tools. The fact that surgical techniques were utilized in local regions at that time indicates a disparity between the official medical practices documented in texts and the practical methods employed in local communities. An analysis of approximately sixty anecdotes related to abscesses shows that abscesses were characterized by unknown causes and excruciating pain. Their onset was often attributed to the patient's lifestyle and wrongdoings, and they were also perceived as punishment for one's wrongdoings. However, as it was a disease where treatment effects could be relatively easily observed through surgical procedures, there was a proactive utilization of the locally formed treatment environment, preferring surgical interventions over relying on religious powers. Contrary to the medical trends and methods outlined in medical literature, surgical treatments were prevalent as the chosen method of treatment among the population in local communities. It appears that the realities experienced, reasoned, and shared by people in the Song period regarding the perception and response to abscesses did not necessarily align with those of mainstream medical practices. Moreover, despite attributing the onset of abscesses to one's wrongdoing, there was a preference for seeking surgeons or Yang-yi over religious methods in their treatment, reflecting a characteristic of the local medical culture surrounding abscesses during the Song period.
Topics: Abscess; China; Humans; History, Medieval; Medicine, Chinese Traditional; Music
PubMed: 38768993
DOI: 10.13081/kjmh.2024.33.135