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Medicine Jun 2024Acute epiglottitis is not uncommon and it can cause high mortality due to airway obstruction. Acute epiglottitis complicated with cervical necrotizing fasciitis has...
INTRODUCTION
Acute epiglottitis is not uncommon and it can cause high mortality due to airway obstruction. Acute epiglottitis complicated with cervical necrotizing fasciitis has rarely been reported, and it is also a life-threatening disease with a fatality rate of 7% to 50%.
PATIENT CONCERNS
A 64-year-old woman presented to our hospital with chief complaints of sore throat and cervical swelling, long with foreign body sensation and hoarseness. Endoscopic laryngoscopy showed erythematous and swollen epiglottis with purulent secretions on the surface. Computed tomography (CT) scan showed swollen epiglottis and swelling of the neck with air- and fluid-containing necrotizing tissue.
DIAGNOSES
The diagnosis was acute epiglottitis and abscess complicated with cervical necrotizing fasciitis.
INTERVENTIONS
With the patient in awake condition, airway access was established by performing intubation with adjunctive use of gum elastic bougie, followed by surgical debridement under general anesthesia; a flap was used for skin coverage and intravenous piperacillin-tazobactam was administered.
OUTCOMES
The patient was discharged without complications.
CONCLUSION
Gum elastic bougie is a usable tool in difficult intubation. Adequate pre-anesthesia evaluation, patient sedation, and gentle manipulation assured the intubation success in this case.
Topics: Humans; Female; Fasciitis, Necrotizing; Middle Aged; Epiglottitis; Intubation, Intratracheal; Abscess; Acute Disease; Neck; Debridement; Laryngoscopy; Anti-Bacterial Agents; Tomography, X-Ray Computed
PubMed: 38905392
DOI: 10.1097/MD.0000000000038658 -
Clinical Medicine Insights. Case Reports 2024Intracranial empyema is a rare but serious and life-threatening infection. It is an accumulation of purulent material in the subdural or extradural space leading to...
INTRODUCTION
Intracranial empyema is a rare but serious and life-threatening infection. It is an accumulation of purulent material in the subdural or extradural space leading to development of subdural empyema or intracranial epidural abscess, respectively. The incidence of morbidity and mortality is high because the diagnosis is often unsuspected. Infections of dental origin could be responsible for such condition.
CASE REPORTS
A 22-year-old female and 30-year-old male patients, both with no significant medical history, presented with subdural empyema and intracranial epidural abscess, respectively, both complicating pan-sinusitis of dental origin. Successful outcomes were achieved with surgical drainage of the lesions, antibiotic therapy, and extraction of affected teeth. Female patient underwent further management for neurological sequelae, while male patient was discharged without neurological complications.
DISCUSSION
Intracranial suppuration of odontogenic origin is an uncommon but extremely serious complication. The most common dental origins are caries with periapical involvement and periodontitis. Wisdom tooth extraction is the most common preceding dental procedure for this infection. A multidisciplinary approach is essential for the identification and treatment of suspected oral sources. Antibiotic therapy with surgical approach is the gold standard treatment.
CONCLUSION
This sequel to odontogenic infection is quite rare, but it can be prevented by a good oral hygiene and removal of abscessed teeth.
PubMed: 38895741
DOI: 10.1177/11795476241261883 -
Cureus May 2024As implant dentistry expands, the number of implants being placed increases, and so does the prevalence of associated complications, resulting in implant failure if not...
As implant dentistry expands, the number of implants being placed increases, and so does the prevalence of associated complications, resulting in implant failure if not timely attended. The present case report aims to discuss the successful regenerative management of peri-implantitis by both hard and soft tissue augmentation with a five-year follow-up. A 60-year-old male reported a chief complaint of purulent discharge, 7 mm peri-implant probing depth, and radiographic bone loss with no pathologic mobility of the dental implant. The reflection of the full-thickness flap revealed a circumferential defect. Guided bone regeneration (GBR) was performed using a combination of autogenous and alloplastic bone grafts around the implant site. To maintain the peri-implant marginal bone level, soft tissue augmentation was done using the vestibular incision subperiosteal tunnel access (VISTA) approach, after six months. A five-year follow-up showed a significant bone fill and stable soft tissue around the implant clinically and radiographically.
PubMed: 38882948
DOI: 10.7759/cureus.60307 -
Frontiers in Veterinary Science 2024Omphalitis, commonly caused by opportunistic bacteria has been significantly associated with morbidity and mortality in neonatal calves. is a commensal and...
Omphalitis, commonly caused by opportunistic bacteria has been significantly associated with morbidity and mortality in neonatal calves. is a commensal and opportunistic pathogen that can cause suppurative infection in farm animals. Our case involved a 10-day-old female Korean indigenous calf that presented with umbilical enlargement accompanied by a greenish-yellow purulent discharge and right forelimb lameness. The calf was diagnosed with failure of passive transfer at 24 h of age. Physical examination found hypothermia (38.1°C), tachycardia (110 beats/min), tachypnea (47 cycles/min), and open mouth breathing. Ultrasonography revealed hyperechoic pus in the 9th and 10th right intercostals, for which a liver abscess due to omphalophlebitis was suspected. After 3 days, the calf died. was detected in the umbilical cord, lung, liver, kidney, intestine, mesenteric lymph node, urinary bladder, and bladder ligament. All genes related to the virulent factors (i.e., , and ) were also identified, with and being associated with pathogenicity. A final diagnosis of omphalitis was established based on the identification of virulent and umbilical cord dilatation on ultrasonography. Antimicrobial susceptibility tests showed that the isolated was susceptible to amoxicillin, ceftiofur, florfenicol, enrofloxacin, ofloxacin, and ciprofloxacin, suggesting the suitability of these antibiotics for treating -induced omphalitis. Hence, accurate and rapid diagnosis of the involved bacteria and antimicrobial susceptibility patterns can help guide therapeutic decisions. Our case provides useful information that could aid large animal clinicians in the diagnosis and treatment of -induced omphalitis.
PubMed: 38872804
DOI: 10.3389/fvets.2024.1362352 -
European Journal of Case Reports in... 2024Small cell lung cancer is an aggressive tumor with a poor prognosis that requires prompt treatment. While radiotherapy may enhance survival when superior vena cava...
BACKGROUND
Small cell lung cancer is an aggressive tumor with a poor prognosis that requires prompt treatment. While radiotherapy may enhance survival when superior vena cava syndrome is present, radiation therapy-induced pericardial disease can be a potential complication.
CASE REPORT
A 55-year-old man, who recently underwent radiotherapy for stage IV small-cell lung cancer complicated by superior vena cava syndrome, presented with chest pain and dyspnea. In the emergency room, he was dyspneic, hypotensive, and tachycardic. Pulmonary auscultation revealed the absence of lung sounds on the right. The initial electrocardiogram showed ST-segment elevation in lateral leads and in lead DII, with reciprocal changes in lead DIII. A bedside transthoracic echocardiogram revealed cardiac tamponade and emergent pericardiocentesis was performed, removing 500 ml of purulent fluid, resulting in an immediate clinical improvement. Thoracentesis was also performed, showing no empyema. Large spectrum empirical antibiotic therapy was started. Cultures from the pericardial fluid and peripheral blood grew multi-sensitive . Cytological analysis of the pericardial fluid was consistent with infection. The patient improved after 2 weeks of targeted antibiotic therapy and underwent the first cycle of chemotherapy. He was discharged with an early scheduled pulmonology appointment.
CONCLUSIONS
Although the most common causes of pericardial effusion in lung cancer are malignant, non-malignant etiologies should also be considered. This patient had an infectious pericardial effusion most probably due to a pericardial-mediastinal mass fistula caused by radiotherapy. This was a diagnostic challenge, both in the emergency room as well in the inpatient setting.
LEARNING POINTS
Small cell lung cancer is a fast-growing cancer that exhibits aggressive behavior.In patients with lung cancer, malignant pericardial effusions are more common than non-malignant ones.Purulent pericardial effusions, especially those due to lung cancer, are rare in developed countries with very few reports in the literature.
PubMed: 38846671
DOI: 10.12890/2024_004477 -
Antimicrobial Resistance and Infection... Jun 2024Although uncommon, infections associated with peripheral intravenous catheters (PIVCs) may be responsible for severe life-threatening complications and increase... (Randomized Controlled Trial)
Randomized Controlled Trial
Insertion site and risk of peripheral intravenous catheter colonization and/or local infection: a post hoc analysis of the CLEAN 3 study including more than 800 catheters.
AIM
Although uncommon, infections associated with peripheral intravenous catheters (PIVCs) may be responsible for severe life-threatening complications and increase healthcare costs. Few data are available on the relationship between PIVC insertion site and risk of infectious complications.
METHODS
We performed a post hoc analysis of the CLEAN 3 database, a randomized 2 × 2 factorial study comparing two skin disinfection procedures (2% chlorhexidine-alcohol or 5% povidone iodine-alcohol) and two types of medical devices (innovative or standard) in 989 adults patients requiring PIVC insertion before admission to a medical ward. Insertion sites were grouped into five areas: hand, wrist, forearm, cubital fossa and upper arm. We evaluated the risk of risk of PIVC colonization (i.e., tip culture eluate in broth showing at least one microorganism in a concentration of at least 1000 Colony Forming Units per mL) and/or local infection (i.e., organisms growing from purulent discharge at PIVC insertion site with no evidence of associated bloodstream infection), and the risk of positive PIVC tip culture (i.e., PIVC-tip culture eluate in broth showing at least one microorganism regardless of its amount) using multivariate Cox models.
RESULTS
Eight hundred twenty three PIVCs with known insertion site and sent to the laboratory for quantitative culture were included. After adjustment for confounding factors, PIVC insertion at the cubital fossa or wrist was associated with increased risk of PIVC colonization and/or local infection (HR [95% CI], 1.64 [0.92-2.93] and 2.11 [1.08-4.13]) and of positive PIVC tip culture (HR [95% CI], 1.49 [1.02-2.18] and 1.59 [0.98-2.59]).
CONCLUSION
PIVC insertion at the wrist or cubital fossa should be avoided whenever possible to reduce the risk of catheter colonization and/or local infection and of positive PIVC tip culture.
Topics: Humans; Female; Male; Catheterization, Peripheral; Catheter-Related Infections; Middle Aged; Aged; Chlorhexidine; Adult; Disinfection; Povidone-Iodine; Risk Factors; Anti-Infective Agents, Local; Equipment Contamination; Wrist
PubMed: 38840171
DOI: 10.1186/s13756-024-01414-4 -
Journal of Inflammation Research 2024The increasing popularity of tattoo art, including facial cosmetic tattoos, has led to a growing societal acceptance of tattoos. However, complications such as lip...
The increasing popularity of tattoo art, including facial cosmetic tattoos, has led to a growing societal acceptance of tattoos. However, complications such as lip inflammation following cosmetic lip tattoos remain a concern. This article presents the case of a 47-year-old Asian woman who experienced recurrent lip swelling, purulent discharge, and scarring after receiving lip tattoos. Despite previous treatment with corticosteroid injections yielding unsatisfactory results, the patient showed significant improvement with topical application of 2% Crisaborole, a phosphodiesterase-4 inhibitor. Crisaborole modulates intracellular cyclic adenosine monophosphate levels, thereby reducing tissue inflammation and swelling associated with chronic cheilitis. Additionally, pulse laser therapy was effective in addressing residual tattoo pigment and scar tissue. This case highlights the therapeutic challenges of managing chronic inflammatory diseases of the lips secondary to cosmetic tattoos and introduces Crisaborole as a promising treatment option, offering insights for managing similar conditions in the future.
PubMed: 38828051
DOI: 10.2147/JIR.S465630 -
Journal of Dairy Science May 2024Our objectives were to compare the efficacy of ketoprofen or ceftiofur for treatment of metritis in dairy cows considering subsequent health, production, and...
Our objectives were to compare the efficacy of ketoprofen or ceftiofur for treatment of metritis in dairy cows considering subsequent health, production, and reproduction. Cows from 2 commercial dairy farms in Ontario, Canada were examined with a Metricheck device 3 times per week from 2 to 14 d in milk (DIM). Cows with metritis (fetid vaginal discharge; n = 193) were blocked by parity and fever (rectal temperature ≥39.5°C or <39.5°C) and within each block per farm, randomly assigned to receive 3 mg/kg BW of ketoprofen (KET) or 2.2 mg/kg of ceftiofur hydrochloride (CEF), once a day for 3 d. Day of enrollment was considered study d 0. Rectal temperature and attitude were evaluated in cows with metritis on study d 0, 3, 4, 7, 10, and 13, and vaginal discharge was evaluated on study d 4, 7, 10, and 13. Body condition was scored at enrollment and 35 DIM, and serum concentration of haptoglobin was measured at d 0, 2, 4, and 7. Cows with rectal temperature ≥39.5°C or a depressed attitude on d 3 were classified as clinical failure and received treatment with ceftiofur for 3 d (KET), or 2 additional days (CEF), to a maximum of 5 d of treatment with ceftiofur. At 35 ± 3 DIM cows were examined for uterine involution by transrectal palpation, purulent vaginal discharge (PVD) by Metricheck, and endometritis by endometrial cytology. Time to onset of cyclicity was assessed by serum progesterone (P4) measurements at 28, 42, and 56 DIM. Contemporary cows from the same farms without metritis (NOMET; n = 1,043) were used for comparison. Data were analyzed with mixed linear or logistic regression or Cox's proportional hazard models, including herd as a random effect. The proportion of clinical resolution of metritis on d 3 (96% vs. 92%), of cows with fever (from d 3 to d 13 after enrollment) or fetid discharge (from d 4 to d 13 after enrollment), and the number of medical treatments (3.1 vs. 3.3) were not different between CEF and KET, respectively. Cows in KET received fewer antibiotic treatments than cows in CEF (0.3 vs. 3.1). Uterine involution, the prevalence of PVD (50% vs. 47%) and subclinical endometritis (6.6% vs. 4.3%), and the proportion of cyclic cows (82% vs. 86%) did not differ between CEF and KET. Cows in KET had greater serum haptoglobin concentration from d 2 to 7 after enrollment. The incidence of mastitis, lameness, or displaced abomasum to 60 DIM and subclinical ketosis to 21 DIM did not differ among CEF, KET, and NOMET. There were no differences in median days to first AI (CEF = 68 d; 95% CI: 65-70; KET = 69 d; 95% CI: 68-72; NOMET = 69 d; 95% CI: 68-70), and median days to pregnancy (CEF = 118 d; 95% CI: 92-145; KET = 113 d; 95% CI: 90-135; NOMET = 105 d; 95% CI: 101-109), pregnancy at first AI at 33 d after insemination (CEF = 42%; KET = 41%; NOMET = 41%), pregnancy loss after first AI (CEF = 8%; KET = 11%; NOMET = 8%), hazard of pregnancy or hazard of culling up to 300 DIM. Milk yield was not different between CEF and KET during the first 10 weeks, but lesser in KET at wk 2 and 4 and CEF at wk 2, 4, and 6 than in NOMET. In this pilot-scale study, given early detection, we did not detect differences in subsequent health, milk yield, or reproductive performance in cows with metritis initially treated for 3 d with CEF or KET. Additional, larger studies are warranted.
PubMed: 38825109
DOI: 10.3168/jds.2023-24585 -
Cureus Apr 2024Primary immunodeficiency (PID) Disorders include a variable group of diseases that are classified according to the functional defects encountered. Chronic granulomatous...
Primary immunodeficiency (PID) Disorders include a variable group of diseases that are classified according to the functional defects encountered. Chronic granulomatous disease (CGD) is inherited as an X-linked recessive disorder in many cases, and it is the clinical model of disorders of phagocytosis. Skin and solid organs abscesses are the most common presenting symptoms; we will report the case of a four-day-old boy admitted to our hospital for a neck mass with purulent discharges associated with umbilical stump and circumcision site infection; the diagnosis of CGD was later confirmed by the Dihydrorhodamine (DHR) test that turned out to be positive.
PubMed: 38817488
DOI: 10.7759/cureus.59374 -
Frontiers in Medicine 2024The administration of anesthesia for elderly individuals who are critically ill, suffering from severe craniocerebral injuries, and living in plateau regions presents a...
BACKGROUND
The administration of anesthesia for elderly individuals who are critically ill, suffering from severe craniocerebral injuries, and living in plateau regions presents a rare, intricate, and high-risk challenge. This case study outlines the specific anesthesia management protocols necessary for plateau-dwelling patients with significant craniocerebral damage undergoing prolonged invasive procedures.
CASE REPORT
A 76-year-old male patient had a 26-year history of foreign-body penetration of the skull and had experienced local purulent discharge and pain for the previous 20 days. The diagnoses included right hypoplasia, a foreign body in the skull with an infection, hypokalemia, hypoproteinemia, pulmonary fibrous foci, and bilateral pleural effusion. For almost 6 months, the patient suffered from recurring headaches, blurred vision, and sluggish bodily movement. The patient had a poor diet, poor sleep quality, normal urination, and no noticeable weight loss since the onset of the illness. The right anterior ear had a 2 cm skin abscess with yellow pus and a black metal foreign body tip. The left eyelid was red and swollen, and the left conjunctiva was hyperemic; the right eyelid showed no abnormalities, and both pupils were wide and round, with light and adjustment reflexes and no cyanosis on the lips. Skull development was normal. No dry or moist rales were audible in either lung. The heart rhythm was regular, and the heart rate was 50 bpm. Chest CT revealed left lung calcification foci, bilateral pleural effusion, and fiber foci in the lower lobes of both lungs.
CONCLUSION
Furthermore, the patient in question was of advanced age and had a complex medical history, including prolonged exposure to high altitudes and previous instances of severe craniocerebral trauma, among other uncommon pathophysiological characteristics. In particular, the patient also underwent surgical interventions at both high and low altitudes, adding to the complexity of their case. To ensure patient safety, close multidisciplinary collaboration, the development of a precise surgical plan, and the implementation of a suitable perioperative anesthetic management strategy are imperative.
PubMed: 38803347
DOI: 10.3389/fmed.2024.1385603