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PubMed1994

Mycobacterium avium intracellulare suppurative thyroiditis in a patient with Hashimoto's thyroiditis.

A case of suppurative thyroiditis occurring in a 72-year-old woman is reported. The clinical history of this woman, treated by tianeptine for mild exogenous affective disorder and by conventional insulin therapy for long-standing insulin-dependent diabetes, was remarkable for the pseudotumoral signs which led to the simultaneous diagnosis of hypothyroidism due to Hashimoto's thyroiditis and of mycobacterium avium intracellulare suppurative thyroiditis. To our knowledge, this is the second reported case of mycobacterium avium intracellulare thyroiditis. This case is also exemplary, given its occurrence in the absence of severe immunodepression, setting apart the mild impact on the immune system of affective disorder and of long duration's insulin-dependent diabetes.

Aged↗

PubMed2005

A study of suppurative pathologies associated with chronic anal fissures.

BACKGROUND: Suppurative pathologies associated with chronic anal fissures are common but not well documented. Fissure abscess, post-fissure fistula, and post-fissure antibioma are but a few of them. These pathologies increase the complications and morbidity of the primary lesion and need a comprehensive approach. METHODS: From the hospital case record of 532 patients treated for chronic anal fissures, 88 patients (16.5%) were found to have one of these pathologies. This retrospective study describes such pathologies in terms of demographics, clinical presentation, pathological features, operative technique and outcome. RESULTS: Of the 88 patients who presented with pain and discharge per anus, 90% could resume their duties within a week of the surgical procedure. Wound healing took between 2 weeks and 2 months. At the last follow- up at 18 months, three patients had a recurrence (3.4%). CONCLUSIONS: Suppuration in chronic anal fissure seems to be more frequent than described. While dealing with the anal fissure, it is desirable to look for and attend to these associated pathologies, especially to avoid complications and morbidity of the primary disease.

Abscess↗

PubMed1976

The urgency of diagnosis and surgical treatment of acute suppurative cholangitis.

Twenty patients with suppurative cholangitis were seen at the Massachusetts General Hospital over a nine year period. Fifteen patients had acute obstructive suppurative cholangitis due to complete obstruction of the common duct, many with coma, hypotension, and positive blood cultures. Sixty per cent of patients were older than seventy years, and most had a history of biliary tract disease. Although most had jaundice, abdominal pain, and fever, clinical symptoms were variable. The diagnosis of cholangitis was made in only 30 per cent of patients before autopsy or surgery. Eighteen patients had calculi in the common duct, and two had primary fibrosis of the ampulla. Patients explored less than 24 hours after admission or deterioration died less often than those operated on after some delay. Most patients underwent common duct exploration and four had a concomitant sphincterotomy. In one instance, cholecystostomy only was performed and this patient died because of ongoing sepsis. The overall mortality was 40 per cent; of those subjected to operation, 25 per cent died in the hospital. Recovery was dramatic among most survivors, and calculous disease did not recur, except for two patients with retained stones. Prophylactic cholecystectomy is recommended to prevent the occurrence of this subtle and highly dangerous syndrome.

Acute Disease↗

PubMed1987

Acute suppurative parotitis in outpatients: microbiologic and posttreatment sialographic findings.

The presenting clinical features of twenty-seven cases of acute suppurative parotitis seen in the Oral Medicine Unit, Glasgow Dental Hospital, between 1975 and 1985 are reviewed. The microbiologic findings plus the management and subsequent findings on sialography after recovery are summarized. Of the microorganisms isolated, alpha-hemolytic streptococci predominated, with many other bacteria similar in range to those reported in previous studies. Microbiologically, the drug of choice was erythromycin, closely followed by ampicillin. Sialography in the posttreatment phase demonstrated a local salivary gland abnormality in 70% of patients, and 22% of patients had a generalized salivary gland disorder. On the basis of these findings, a management regime for patients with acute suppurative parotitis is suggested.

Acute Disease↗

PubMed1988

Suppurative inflammation of vas deferens: an unusual groin mass.

We report a case of suppurative vasitis that presented as an inguinal mass in a young man. Inflammation of the vas deferens may occur as a manifestation of genital tuberculosis or other genitourinary tract infection. A granulomatous vasitis, vasitis nodosa, is usually associated with previous trauma or surgery. Suppuration is rare. We report a case that represents a rare cause of an inguinal mass.

Abscess↗

PubMedDate not supplied

Acute suppurative thyroiditis and the branchial apparatus.

Acute suppurative thyroiditis and thyroid abscess are rare. The finding of a sinus tract arising from the pyriform sinus in some cases highlights the possibility of a branchial apparatus origin. We present three case histories that include a left-sided lesion and radiologic or surgical-anatomic evidence of an internal sinus tract. Our discussion focuses on two considerations: first, the exact branchial pouch from which this lesion arises, and second, a proposed protocol for the work-up and management of patients with the onset or recurrence of acute suppurative thyroiditis or thyroid abscess.

Abscess↗

PubMed1988

Suppurative thrombophlebitis due to Aeromonas.

A patient developed lethal suppurative thrombophlebitis and adjacent soft-tissue infection caused by Aeromonas. Potential risk factors included corticosteroid therapy and the use of warm tap water compresses at the site of intravenous catheter-related phlebitis. This case demonstrates the rapidly invasive characteristics of Aeromonas and the need for early surgical intervention in suppurative thrombophlebitis.

Aeromonas↗

PubMed1993

Acute suppurative salpingitis with concomitant intrauterine pregnancy.

A 20-year-old woman presented to the emergency department with a history of lower abdominal pain and recent loss of consciousness. She was admitted with a primary diagnosis of abdominal pain; ectopic pregnancy was ruled out. The culture of the endocervix was positive for Neisseria gonorrhoeae. Surgical exploration of the pelvis was performed, and histological analysis of the specimen showed an acute suppurative salpingitis and an intrauterine pregnancy. The patient was placed on intravenous antibiotics. Postoperative course was unremarkable, and the patient was discharged on oral antibiotics. Although a rare entity acute suppurative salpingitis with concomitant intrauterine pregnancy are not mutually exclusive. Ectopic pregnancy should be the presumptive diagnosis when clinical presentation is consistent with pelvic inflammatory disease and pregnancy especially in the first trimester. Patients who are pregnant and exhibit clinical signs and symptoms that are consistent with salpingitis should be admitted for aggressive management of their high-risk pregnancy. Fetal wastage seems to be significant in spite of aggressive management. Endocervical culture for N gonorrhoeae should be obtained from all pregnant patients with follow-up treatment pending culture results. The following is a case presentation along with a review of the existing cases in the English literature and discussion of the possible pathogenesis and clinical outcome of this entity.

Acute Disease↗

PubMed2004

[Suppurative cervical lymphadenitis in children. Review of 45 patients].

OBJECTIVE: To review the bacteriological features and treatment of suppurative cervical lymphadenitis in children in order to achieve optimal treatment. PATIENTS AND METHODS: Forty-five children were hospitalized. Time of hospitalization was evenly distributed over Year and between Years. Age ranged from 2.5 Months to 13.5 Years (median 1 Year 10 Months). Twenty-nine patients had received prior antibiotic treatment. Bacteriological samples were sterile in 15 out of 45 children and were positive for Staphylococcus (all meti-S) in 20. Cefotoxim and fosfomycin were prescribed and was sufficient in 14 children (with needle aspiration). Surgical drainage was performed in the other cases. CONCLUSION: Staphylococcus aureus is the predominant causal agent for acute suppurative lymphadenitis in children. Antibiotic therapy in the outpatient setting does not always prevent abscess formation and surgical drainage may be required.

Acute Disease↗

PubMed2001

Reactive nitrogen species contribute to blood-labyrinth barrier disruption in suppurative labyrinthitis complicating experimental pneumococcal meningitis in the rat.

Sensorineural hearing damage is a frequent complication of bacterial meningitis, affecting as many as 30% of survivors of pneumococcal meningitis. There is a substantial body of evidence that oxidants, such as reactive nitrogen species (RNS), are central mediators of brain damage in experimental bacterial meningitis. In the present study, we investigated whether RNS also contribute to the pathophysiology of suppurative labyrinthitis in our well-established rat model of pneumococcal meningitis. In all infected rats, but not in uninfected controls, we observed suppurative labyrinthitis. Cochlear inflammation was accompanied by severe blood-labyrinth barrier (BLB) disruption as evidenced by increased Evans Blue extravasation. Furthermore, increased cochlear expression of endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) was detected by immunohistochemistry. Colocalization of iNOS and tyrosine nitration (a marker of RNS attack) indicated that nitric oxide (NO) produced by iNOS contributes to oxidative cochlear damage through the action of RNS. To determine the pathophysiological role of RNS in BLB disruption, rats were treated with peroxynitrite scavengers (MnTBAP and uric acid, UA). Six h after adjunctive treatment with 300 mg/kg i.p. UA or 15 mg/kg i.p. MnTBAP+100 mg/kg i.p. ceftriaxone, BLB disruption was significantly reduced compared with that in infected animals treated only with ceftriaxone. Therefore, we conclude that RNS are involved in the breaching of the BLB during meningogenic pneumococcal labyrinthitis.

Animals↗

PubMed1993

Inguinal-scrotal suppuration following treatment of perforated appendicitis.

Suppuration of a congenital hernia or communicating hydrocele following generalized peritonitis is rare. The lack of reported cases in the recent literature may indicate a decreasing incidence of this unusual complication. We report a case of suppuration of a communicating hydrocele with testicular loss 2 days after treatment of perforated appendicitis in a 10-year-old boy.

Appendicitis↗

PubMed1990

Medical management of chronic suppurative otitis media without cholesteatoma in children.

To determine whether systemic administration of antibiotics may eliminate or reduce the need for tympanomastoid surgery in chronic suppurative otitis media without cholesteatoma, we undertook a randomized, prospective study comparing three regimens: (1) daily suction and débridement, with intravenous administration of mezlocillin until 3 days after the discharge stopped, (2) daily suction and débridement, with intravenous use of ceftazidime until 3 days after the discharge stopped, and (3) daily suction and débridement without antibiotics. No topical antimicrobial agents were used during the study. Fifty-one patients were included, and 48 children completed the study. The duration of discharge from the ear before treatment was 2 to 123 months (median 20 months). In 26 patients (51%), the disease was bilateral. Aerobic cultures, obtained with the Alden-Senturia middle ear aspirator, yielded Pseudomonas aeruginosa in 98%, enteric gram-negative bacilli in 33%, staphylococci in 25%, and Haemophilus influenzae in 12%. The first 33 patients were randomly assigned to one of the three regimens. In the 21 patients treated with suction and antibiotics (either mezlocillin or ceftazidime), the discharge stopped completely, versus in only 1 (8%) of 12 patients in the suction-only regimen (p less than 0.01). Therefore the following 18 patients were randomly assigned to one of only two groups, which included the two suction-and-antibiotic regimens. In all patients treated initially with antibiotics, discharge stopped after 4 to 18 days (mean 12.0 days), but 25% needed treatment for greater than 14 days. Amoxicillin prophylaxis was administered to 27 (56%) of the patients after completion of therapy. All patients were followed for 6 months. Drainage recurred in 12 (25%) patients during the first 3 months after the study. The recurrence rate was not affected by the antibiotic regimen, the patient's age, the duration of drainage before initiation of antibiotic therapy, or prophylaxis. We conclude that intravenous wide-spectrum antibiotic therapy in conjunction with daily suction and débridement is efficacious for the treatment of chronic suppurative otitis media without cholesteatoma.

Adolescent↗

PubMed1981

Anaerobic bacteria in suppurative infections of the male genitourinary system.

Cultures were done to determine the prevalence of anaerobic bacteria in 18 male patients with suppurative infections of the genitourinary tract. The types of infections studied were scrotal abscess, prostatic abscess, scrotal gangrene and perinephric abscess. Anaerobic bacteria were recovered in 16 of the 18 specimens examined. These 16 specimens yielded a total of 48 anaerobic strains and 19 aerobic or facultative strains. The dominant organism isolated was Bacteroides fragilis, which was found in 11 patients. It would appear that most suppurative infections of the male genitourinary tract involve anaerobic bacteria. These observations have important implications regarding recommendations for cultures and selection of antimicrobials.

Abscess↗

PubMed2002

Treatment of chronic suppurative otitis media with ofloxacin in hydroxypropyl methylcellulose ear drops: a clinical/bacteriological study in a rural area of Malawi.

Chronic suppurative otitis media in young children is a major problem in Africa, with socio-economic consequences at a later age. Common treatment regimens with antibiotics are expensive and often not practically feasible. Therefore, a project was started to develop a low-cost and effective treatment in a rural area of Malawi by studying the clinical efficacy of an inexpensive application regimen of ofloxacin (0.075%) in hydroxypropyl methylcellulose (1.5%) ear drops. In earlier studies with this treatment regimen, it was possible to cure approximately 70% of ears. The aim of this study was to find out whether the bacteriological spectrum cultured from wet ears before and after treatment, and patterns of resistance to antibiotics, played a role in the percentage of cures. Patients with long-standing chronic suppurative otitis media were clinically assessed and treated with suction cleaning and instillation of ear drops on days 1, 3, 7 and 10. Bacterial swabs were taken for culture and sensitivity tests for ofloxacin were on days 1 and 10 from the ears that were still discharging. After 21 weeks, the ears were assessed again clinically. Clinical cure was considered to be complete cessation of otorrhea. Ninety of 104 tested patients (124 ears) completed the study. About 73% of the ears had become dry by day 10. This dropped to 42% after 21 weeks. Before treatment, most ears (91%) harbored fecal bacteria, Proteus mirabilis (74%) and enterococci (60%) being the most frequently isolated microbes. The second group of frequently cultured bacteria were water bacteria e.g. Pseudomonas species and other non-fermenters (69%), whereas the classical otitis media pathogens were detected only in 15% of ears. Before treatment, 9.7% of strains were resistant to ofloxacin, most (30/35) of which were cultured from ears that were eventually cured. After treatment, fecal and water bacteria were still the most frequently found, with 36% new strains and an overall sensitivity to ofloxacin of 58%. Bacterial resistance did not appear to play an important role in the outcome of treatment. These data rather suggest a very high risk of infection due to poor hygiene conditions. Medical treatment can only have a longer-lasting effect if accompanied by community-based programs that focus on improvement of hygiene. A public health approach is necessary alongside a medical approach for the management of CSOM.

Adolescent↗

PubMed2003

Microbiology and management of acute suppurative thyroiditis in children.

This review describes the microbiology, diagnosis and management of suppurative thyroiditis (ST). Staphylococcus aureus, Streptococcus pyogenes, Streptococcus epidermidis, and Streptococcus pneumoniae, are the predominant aerobic isolates. The most common anaerobic bacteria are Gram-negative bacilli and Peptostreptococcus spp. Agents that are rarely recovered include Klebsiella spp., Haemophilus influenzae, Streptococcus viridans, Salmonella spp., Enterobacteriaceae, Mycobacterium tuberculosis, atypical mycobacteria, Aspergillus spp., Coccidioides immitis, Candida spp., Treponema pallidum, and Echinococcus spp. Viruses have been associated with subacute thyroiditis, and include measles, mumps, influenza, enterovirus Epstein-barr, adenovirus, echovirus, and St Louis encephalitis. Therapy includes administration of antibiotics effective against the causative pathogen(s). Proper selection of therapy can be guided by culture of the lesion. Surgical drainage may be necessary in case of suppuration.

Anti-Bacterial Agents↗

PubMed1997

Mastoidectomy in noncholesteatomatous chronic suppurative otitis media: is it necessary?

Chronic suppurative otitis media (CSOM) without cholesteatoma, the surgical treatment of which is still controversial, is a common diagnosis in otologic practice. A retrospective analysis of 323 patients who underwent surgery for noncholesteatomatous chronic otitis media in the Gruppo Otologica, Piacenza, Italy, between April 1983 and December 1993 is presented. Cases were separated into three groups according to different surgical treatment modalities and conditions of the ears at the time of operation. Group I (n = 53) consisted of cases of CSOM treated by tympanoplasty without mastoidectomy (TLWOM). Group II (n = 28) included cases of CSOM treated by tympanoplasty with mastoidectomy (TLWM). Intact canal wall technique was used in these cases. The ears in both these groups were discharging severely at the time of surgery. Group III (n = 242) included patients whose ears were dry at the time of surgery but who had had previous recurrent episodes of suppuration and who were treated by TLWOM. At the last follow-up, graft success rates for groups I, II, and III were 90.5%, 85.7%, and 89.2%, respectively, and mean residual gaps were 17.2 dB, 20.1 dB, and 19.4 dB, respectively. There was no statistically significant difference between the three groups either on graft success rates (p > 0.05) or on final functional hearing outcome (p > 0.05). TLWM is the preferable treatment modality for most surgeons in noncholesteatomatous CSOM. Nevertheless, in our experience TLWOM yields comparable results for this group of patients. In addition, we could not find any significant difference in results of graft success and final functional hearing rates between dry and discharging ears (p > 0.05).

Adolescent↗

PubMed1998

A new dosage regimen for topical application of ciprofloxacin in the management of chronic suppurative otitis media.

The clinical and bacteriologic efficacy of topically applied ciprofloxacin was studied in 60 patients with chronic suppurative otitis media. Two hundred fifty and 125 microg/ml concentrations of ciprofloxacin solutions were given to two groups of patients. The duration of therapy was determined according to the clinical cure at follow-up. More than 21 days of therapy was not needed in any patient. The clinical cure rate with 250 microg/ml ciprofloxacin was 78.1% at 14 days and with 125 microg/ml it was 83.3%. However, a 100% clinical cure rate and complete bacteriologic eradication was obtained in 21 days in both groups. In each group only one patient had otomycosis by the fourteenth day of therapy, although ear discharge had ceased. It was concluded that 125 microg/ml ciprofloxacin could be applied as successfully as 250 microg/ml, and the duration of therapy had to be at least 14 days. This new dosage regimen can be adopted as an optimal dosage for ototopical application of ciprofloxacin in chronic suppurative otitis media. It will also obviously decrease the expense of therapy.

Administration, Topical↗

PubMedDate not supplied

Oxygen consumption of middle ear and peripheral blood neutrophils in acute suppurative otitis media.

Using an oxygen electrode, oxygen consumption has been measured in peripheral blood neutrophils and the corresponding middle ear fluid neutrophils of 26 patients with acute suppurative otitis media. The data suggest that the middle ear fluid neutrophil is functional and is capable of producing an adequate oxygen burst in response to membrane stimulation by opsonized zymosan particles. Some middle ear neutrophils are actually capable of producing a greater respiratory burst than their counterparts in the peripheral blood. However, middle ear neutrophils do not show the increased metabolic activity at 40 degrees C, which blood neutrophils regularly displayed compared with tests performed at 37 degrees C. It is believed that this temperature (40 degrees C) is more physiological during infection and might explain why middle ear neutrophils may not always be capable of destroying bacteria, even though they are present in adequate numbers in the middle ear fluid in some cases of acute suppurative otitis media. Further studies are needed to determine the nature of the defect(s) present in middle ear neutrophil at 40 degrees C.

Adolescent↗