-
Translational Pediatrics Aug 2022Descending necrotizing mediastinitis (DNM) is a rare but serious complication of odontogenic or pharyngeal infection spreading into the mediastinum. Very few childhood...
BACKGROUND
Descending necrotizing mediastinitis (DNM) is a rare but serious complication of odontogenic or pharyngeal infection spreading into the mediastinum. Very few childhood cases of DNM have been described.
CASE DESCRIPTION
We report a case of DNM complicated with severe thoracic empyema in a previously healthy 6-year-old girl who was successfully treated using minimally invasive video-assisted thoracoscopic surgery (VATS). The patient presented with odynophagia and dental pain, followed by rapid clinical deterioration including high fever, tachypnea, and left chest pain. As chest computed tomography (CT) revealed features of DNM, she was transferred from the local hospital to our hospital for intensive care. Empirical treatment was started with meropenem and linezolid. However, her tachypnea and dyspnea progressed rapidly. An ultrasound-guided left-sided thoracentesis drained 80 mL of brown sticky pus and the pus culture yielded . A contrast-enhanced CT scan demonstrated large mediastinal abscess and severe thoracic empyema. We performed debridement and drainage of the mediastinum and pleura using VATS. She recovered and was discharged on hospital day 18.
CONCLUSIONS
Early diagnosis by cervicothoracic CT and multidisciplinary approaches including intensive care, broad-spectrum antibiotics, and aggressive surgical intervention are crucial to reducing morbidity and mortality. VATS is a minimally invasive and appropriate treatment strategy for children with DNM, especially complicated with thoracic empyema.
PubMed: 36072533
DOI: 10.21037/tp-22-60 -
American Journal of Otolaryngology 2022Intraorbital and intracranial complications of acute bacterial rhinosinusitis require timely medical and surgical treatment to prevent the development of long-term...
PURPOSE
Intraorbital and intracranial complications of acute bacterial rhinosinusitis require timely medical and surgical treatment to prevent the development of long-term neurologic sequelae. The era of Coronavirus Disease-2019 (COVID-19) has complicated the management of complicated acute rhinosinusitis, especially when patients have concurrent acute sinusitis and COVID-19 infection. This case series aims to highlight the clinical course of pediatric patients at a single tertiary pediatric hospital with concurrent complicated bacterial rhinosinusitis and COVID-19.
MATERIALS AND METHODS
A search of pediatric patients treated for COVID-19 and complications from acute sinusitis was performed using billing records for the year 2020-2021 at a single pediatric tertiary hospital. Data regarding presentation, management, microbiology, and hospital course was collected for review.
RESULTS
A total of 6 patients with complicated bacterial sinusitis in the setting of COVID-19 infection were included. All patients were initially managed with medical therapy, consisting of systemic antibiotics, but 3 of these patients ultimately required surgical intervention. Cultures from the cohort grew Staphylococcus aureus, streptococcus intermedius, streptococcus constellatus or Prevotella species. All patients experienced clinical improvements and were eventually discharged home with oral antibiotics.
CONCLUSION
COVID-19 continues to be an unusual disease especially for the pediatric population. Concurrent complicated acute rhinosinusitis and COVID-19 appear to have higher rates of surgical requirement in the pediatric population. COVID-19 safety precautions have influenced management practices for patients with severe bacterial rhinologic infections. While there may be an association between complicated bacterial rhinosinusitis and COVID-19 infection, further research is necessary to determine a true correlation.
Topics: Acute Disease; Anti-Bacterial Agents; COVID-19; Child; Humans; Retrospective Studies; Rhinitis; Sinusitis; Staphylococcal Infections
PubMed: 35985081
DOI: 10.1016/j.amjoto.2022.103603 -
Cureus Jul 2022The authors present the case of a 29-year-old female diagnosed with acute appendicitis who underwent an uneventful laparoscopic appendectomy. Three weeks later, she...
The authors present the case of a 29-year-old female diagnosed with acute appendicitis who underwent an uneventful laparoscopic appendectomy. Three weeks later, she returned to the emergency department with fevers, abdominal pain, chills, and nausea. Laboratory analysis revealed elevated liver enzymes and leukocytosis, and a computed tomography scan of the abdomen revealed a liver abscess. Interventional radiology placed an 8 French drainage catheter in the hepatic abscess and drained 40cc of purulent fluid. A culture of the abscess fluid revealed Streptococcus constellatus, Bacteroides fragilis, and Bacteroides ovatus. We believe appendicitis causes hematogenous spreading of bowel organisms along the portal vein, which is seeded to the liver.
PubMed: 35978753
DOI: 10.7759/cureus.26867 -
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 -
Frontiers in Microbiology 2022Three distinct streptococcal species: , and , belonging to the group (SAG), also known as group, have been attracting clinicians and microbiologists, not only as oral... (Review)
Review
Three distinct streptococcal species: , and , belonging to the group (SAG), also known as group, have been attracting clinicians and microbiologists, not only as oral commensals but also as opportunistic pathogens. For years they have been simply classified as so called viridans streptococci, and distinct species were not associated with particular clinical manifestations. Therefore, description of SAG members are clearly underrepresented in the literature, compared to other medically relevant streptococci. However, the increasing number of reports of life-threatening infections caused by SAG indicates their emerging pathogenicity. The improved clinical data generated with the application of modern molecular diagnostic techniques allow for precise identification of individual species belonging to SAG. This review summarizes clinical reports on SAG infections and systematizes data on the occurrence of individual species at the site of infection. We also discuss the issue of proper microbiological diagnostics, which is crucial for further clinical treatment.
PubMed: 35898914
DOI: 10.3389/fmicb.2022.956677 -
International Journal of Environmental... Jul 2022The aim of this pilot study was to assess the time-related changes in viable nasal bacteria concentrations among waste-incineration plant (WIP) workers compared to a...
The aim of this pilot study was to assess the time-related changes in viable nasal bacteria concentrations among waste-incineration plant (WIP) workers compared to a group of office building (OB) workers outside the plant. In total, 20 volunteers participated in the study, including 14 WIP and 6 OB workers. WIP workers were divided into two sub-groups: supervisory staff (SVS) and maintenance and repair workers (MRW). Nasal swabs were collected before and after the morning work shift. Airborne bacteria were sampled with a six-stage impactor to assess the bioaerosol size distribution. The analysis showed that a significant, almost three-fold increase in nasal bacterial concentration was found only among WIP workers, and this referred mainly to anaerobic species. The load of anaerobic bacteria at the beginning of work was 12,988 CFU/mL, and after work shift 36,979 CFU/mL (p < 0.01). Significant increases in microbial concentrations was found only in the MRW subgroup, among non-smoking workers only. The results showed increased bacterial concentration in WIP nasal samples for as many as 12 bacterial species, including, e.g., Streptococcus constellatus, Peptostreptococcus spp., E. coli, and P. mirabilis. These preliminary data confirmed that the nasal swab method was helpful for assessment of the workers’ real-time exposure to airborne bacteria.
Topics: Aerosols; Air Microbiology; Bacteria; Environmental Monitoring; Escherichia coli; Humans; Incineration; Occupational Exposure; Pilot Projects
PubMed: 35897354
DOI: 10.3390/ijerph19158984 -
Frontiers in Cellular and Infection... 2022The combination of maxillofacial infections (MI) with descending necrotizing mediastinitis (DNM) is a complex disease characterized by rapid development and high...
The combination of maxillofacial infections (MI) with descending necrotizing mediastinitis (DNM) is a complex disease characterized by rapid development and high mortality. Here, we performed metagenomic next-generation sequencing (mNGS) using samples from 21 patients with MI and eight patients with DNM. In this study, we found that the species richness of the DNM group was higher than that of the MI group, and the species diversity of the DNM group was higher than that of the MI group, with no statistically significant differences between groups (P > 0.05). LefSE analysis revealed that the main species differing between groups were , , , and ( and ). In addition, the PLS-DA analysis revealed that the dominant groups in the DNM group at the species level were , , , , , and . Next, we correlated the clinical characteristics of the patients with the relative abundance of the pathogens identified in the LefSe and PLS-DA analyses. The relative abundance of was positively correlated with C-reactive protein (CRP) and calcitoninogen (PCT) but negatively correlated with the percentage of lymphocytes (Lymph%) (P < 0.05). On the other hand, was positively correlated with the percentage of neutrophils (Neut%) and glycated hemoglobin (GLU) (P < 0.05), and was positively correlated with CRP (P < 0.05).
Topics: Eubacterium; Humans; Mediastinitis; Streptococcus
PubMed: 35755831
DOI: 10.3389/fcimb.2022.873161 -
BMC Infectious Diseases May 2022The bacterial genus Aggregatibacter was categorized in 2006 to accommodate the former Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus, and H. segnis...
BACKGROUND
The bacterial genus Aggregatibacter was categorized in 2006 to accommodate the former Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus, and H. segnis species. Aggregatibacter kilianii is a normal resident of the human upper respiratory tract but can also cause serious infections. A. kilianii is relatively newly identified and has been isolated from conjunctivitis, wounds, abdominal abscesses, and blood.
CASE PRESENTATION
An 80-year-old female patient with distal common bile duct cancer was admitted to our hospital with sudden loss of consciousness and general weakness, fever, and abdominal pain for 3 days. Two colonial morphologies were isolated from both the blood and bile cultures; one was identified as Streptococcus constellatus subsp. pharyngis, but the other was not recognized by Vitek2 and MALDI-TOF. The 16 S rRNA sequences showed 99.73% similarity with the sequence of A. kilianii strains.
CONCLUSION AND DISCUSSION
This article presents the first case of a clinical isolate of A. kilianii outside Europe. This case is also the first of the antimicrobial profile of this strain. This report highlights the importance of proper molecular identification for timely diagnosis and treatment of disease.
Topics: Aged, 80 and over; Aggregatibacter; Aggregatibacter aphrophilus; Female; Humans; Streptococcus
PubMed: 35619055
DOI: 10.1186/s12879-022-07471-7 -
BMC Pulmonary Medicine Mar 2022This study aims to evaluate the diagnostic application and performance of the metagenomic next-generation sequencing (mNGS) in patients suspected of local pulmonary...
PURPOSE
This study aims to evaluate the diagnostic application and performance of the metagenomic next-generation sequencing (mNGS) in patients suspected of local pulmonary infection by comparing it to the traditional pathogen detection methods in lung tissue specimens obtained by a computerized tomography-guided biopsy (CT-guided biopsy).
METHODS
We retrospectively reviewed patients, admitted to the First Affiliated Hospital of Wenzhou Medical University, China from May 2018 to December 2020, who were suspected of local pulmonary infection. All cases received a CT-guided lung biopsy, tissue samples were sent both for conventional examinations (CE) and mNGS tests. The sensitivity and specificity of the two diagnostic approaches were compared.
RESULTS
106 patients enrolled, 76 patients were diagnosed with a pulmonary infection. Among 49 patients with identified pathogens, CE confirmed pathogenic infections in 32 cases. Mycobacterium spp. and fungi accounted for 37.5% (12/32) and 28.1% (9/32), respectively, with bacteria 34.4% (11/32). The mNGS examination detected extra pathogenic microorganisms in 22 patients that were consistent with the patients' clinical and radiographic pictures. The sensitivity of mNGS was 53.9% vs. 42.1% for the CE, while the specificity was 56.7% versus 96.7%. For detection rate, mNGS was significantly superior to CE in bacterial (96.3% vs. 40.7%, p < 0.05), and mixed infections (100% vs. 50%, p < 0.05), but inferior to CE in fungal (60% vs. 90%, p > 0.05) and Mycobacterium spp. infections (66.7% vs. 100%, p > 0.05) with no significant difference. Among 31 cases diagnosed with lung abscess, the diagnostic performance of the detection rate was 67.7% (21/31) in favour of mNGS compared to 29.0% (9/31) for CE (p < 0.05). Most polymicrobial infections were induced by anaerobic species that coexisted with Streptococcus constellatus. And Klebsiella pneumoniae was the most common isolated monomicrobial infection.
CONCLUSIONS
The most commonly detected causative pathogens for local pulmonary infections were bacteria, Mycobacterium spp. and fungi. Compared with the CE, the advantages of mNGS in the pathogens detection lie in the discovery of bacterial and mixed infections, as well as in the detection of lung abscess. Conversely, mNGS is not good enough to be recommendable for the detection of Mycobacterium spp. and fungi.
Topics: Biopsy; High-Throughput Nucleotide Sequencing; Humans; Lung; Metagenomics; Retrospective Studies
PubMed: 35351079
DOI: 10.1186/s12890-022-01912-4 -
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