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PubMed1977

[Regional suppurative lymphadenitis after BCG vaccination (author's transl)].

In the first half of 1975 there occurred in the Federal Republic of Germany an unusual rise in the incidence of suppurative inguinal lymphadenitis after BCG vaccination of newborns, in immediate time relation with change of the vaccine by its manufacturers, Behringwerke. The attenuated daughter strain Göteborg had been replaced by the effective but also rather aggressive strain Copenhagen 1331. The complication rate was 1.5% in West Berlin. Clinical course, operative technique as well as microbiological and histomorphological features of these cases were analyzed in a joint study. Since it is likely that, after re-admission of the Copenhagen vaccine, such complications may again occur despite reduced micro-organism count, vaccination of newborns should in future be restricted to those at risk.

BCG Vaccine↗
PubMed2002

Granulomatous and suppurative dermatitis at interferon alfa injection sites: report of 2 cases.

It has previously been reported that interferon alfa injection sites may develop pyoderma gangrenosum, interface dermatitis, vasculitis, or, more commonly, ulcers characterized by intravascular thrombi and a mixed inflammatory cell infiltrate. We describe 2 patients in whom granulomatous and suppurative dermatitis developed at interferon alfa injection sites. These cases extend the spectrum of interferon alfa injection site reactions. The histologic and clinical similarities of these cases with pyoderma gangrenosum and cutaneous Crohn's disease are explored.

Granuloma↗
PubMed1997

Microscopic polyarteritis following a suppurative wound infection.

Bacterial and viral infections may be associated with the onset of a number of autoimmune diseases and relapses of these conditions. We describe a patient in whom there was a close temporal relationship between a suppurative wound infection and the onset of microscopic polyarteritis. The clinical features of this disease responded to treatment with high dose prednisolone and cyclophosphamide. The patient had several further infective episodes while being treated, but there were no disease exacerbations or relapses related to these. Anti-neutrophil cytoplasmic antibodies (ANCA) were never demonstrated in this patient. Thus while it is likely that the infection precipitated the onset of the systemic vasculitic illness, this occurred independently of ANCA.

Aged↗
PubMed1986

Acute suppurative thyroiditis in a 3-year-old boy.

A previously healthy 3-year-old boy was referred because of persistent fever and anterior neck swelling and pain. The diagnosis of a mixed bacterial abscess of the thyroid gland was made. Incision and drainage were performed, and fever abated immediately. Antibiotic therapy was given in the hospital and for ten days after discharge. Acute suppurative thyroiditis is a rarely encountered infection. The majority of cases reported in the recent literature are from Japan. The case presented here, from the United States, demonstrates the difficulty that can be encountered in diagnosing this type of thyroiditis.

Child, Preschool↗
PubMed2002

Acute suppurative thyroiditis as a rare complication of aggressive chemotherapy in children with acute myelogeneous leukemia.

Acute suppurative thyroiditis (AST) is quite rare, even in immunocompromised patients. The authors describe 2 cases of AST during aggressive chemotherapy for acute myelogeneous leukemia (AML). They were treated with aggressive combination chemotherapy and achieved complete remission. After several courses of chemotherapy, they developed fever and pain in the region of the thyroid gland. Laboratory tests showed hyperthyroidism and elevated levels of thyroglobulin and C-reactive protein. Ultrasonography revealed hypoechoic areas in the thyroid gland. A diagnosis of AST was made. Bacterial infections were suspected because they were sucessfully treated with antibiotics. After a month, the patients' thyroid function and thyroglobulin levels returned to normal without a period of transient hypothyroidism. A pyriform sinus fistula was not demonstrated. The results suggest that neutropenia and preceding cellulitis around the thyroid gland, which might be subsequent to oral mucosal damage induced by anticancer drugs, may play a role in the development of AST. AST should be considered a potential complication of aggressive chemotheragy for leukemia.

Acute Disease↗
PubMed2002

Acute suppurative thyroiditis caused by Salmonella typhimurium: a case report and review of the literature.

A 79-year-old woman with acute suppurative Salmonella thyroiditis is reported. She presented with fever and an enlarged, painful thyroid mass. Diagnosis was suspected by clinical symptoms and signs and confirmed by ultrasound, neck magnetic resonance imaging, aspiration cytology, and culture. The culture of fine-needle aspirate yielded Salmonella typhimurium. She was treated by parental antibiotics and surgical drainage. The source and route of infection remained unclear under a series of examinations. No piriform sinus fistula was evident on the imaging study. A hematogenous spread seems to be the most possible route.

Acute Disease↗
PubMed2002

Acute suppurative thyroiditis caused by an infected piriform sinus fistula with thyrotoxicosis.

We report herein an unusual case of thyrotoxicosis caused by acute suppurative thyroiditis (AST) infected through a piriform sinus fistula (PSF). A 28-year-old man presented with pain over the thyroid gland and elevated serum thyroid hormone levels, a picture similar to subacute thyroiditis. A fine-needle aspiration biopsy from the left lobe showed neutrophil infiltration, and culture from the aspirate grew anaerobic peptostreptococcus. A neck computed tomography (CT) scan showed an abscess in the thyroid gland, and barium swallow revealed the presence of PSF. Appropriate antibiotic treatment ameliorated his symptoms of infection, followed by normalization of thyroid function. Three months later, he underwent fistulectomy and partial left lobectomy. The end of the PSF track was found in the left thyroid lobe. Thus infection of the thyroid gland through the infected PSF was likely the cause of supprative thyroiditis. The unusual clinical features of AST in this patient include the presence of severe thyrotoxicosis, relatively late onset (28-years-old) of infection despite the presence of congenital PSF, and the lack of acute inflammatory signs on the overlying skin of the thyroid gland. It is important to recognize this type of AST, since fistulectomy is required to prevent recurrent AST.

Acute Disease↗
PubMed2005

Acute suppurative thyroiditis after fine-needle aspiration causing thyrotoxicosis.

A case of thyrotoxicosis caused by acute suppurative thyroiditis after repeated fine-needle aspiration (FNA) is described. A 39-year-old woman with atopic dermatitis showed rapid enlargement of a left thyroid cyst after a third FNA. She had a high fever, painful swelling of the left thyroid, and elevated thyroid hormone levels. Ultrasonography revealed abscess formation in the left thyroid cyst. The cytologic examination of an FNA specimen showed abundant neutrophils, and culture of the aspirate yielded Staphylococcus aureus. Because antibiotic treatment for 1 month failed to improve the inflammatory findings, the patient subsequently underwent left thyroid lobectomy, which resulted in the normalization of thyroid function and the resolution of inflammation. Thyroid infection had possibly been induced by needle-track seeding, because atopic skin favors colonization by S. aureus because of local immunologic deficiency. FNA is a useful and safe technique for aspirating fluid from thyroid cysts, but special care is required in patients with atopic dermatatis to avoid bacterial infection.

Adult↗
PubMed2006

Acute suppurative thyroiditis caused by Pasteurella multocida and associated with thyrotoxicosis.

Acute suppurative thyroiditis (AST) is an uncommon condition of the thyroid gland. Organisms of the staphylococcal and streptococcal species are the most commonly reported causative agents. Rarely, AST has been associated with transient hyperthyroidism. We report a unique case of AST that was caused by Pasteurella multocida and was associated with thyrotoxicosis in a previously healthy 51-year-old woman.

Female↗
PubMed1995

Suppurative mediastinitis after open-heart surgery: a case-control study covering a seven-year period in Santander, Spain.

Suppurative mediastinitis developed in 34 (0.9%) of 3,645 patients who underwent median sternotomy at the Hospital Marqués de Valdecilla in Santander, Spain, from 1985 through 1991. These cases were analyzed in a case-control study designed to identify risk factors for poststernotomy mediastinitis. The significant risk factors were (1) preoperative factors: heavy cigarette smoking and history of endocarditis; (2) intraoperative factors: emergency surgery, prolonged duration of surgery, prolonged bypass pump time, ventricular failure, and tearing of the aortic or femoral artery; and (3) postoperative factors: reoperation, prolonged mechanical ventilation, prolonged stay in the intensive-care unit, and tracheostomy. All patients had abnormal sternal wounds (i.e., signs of wound infection or serous discharge). Twelve patients were bacteremic. Thirty-eight organisms were recovered from 31 patients with mediastinitis; 23 of the isolates were gram-positive and 15 were gram-negative. The infections were treated with extensive debridement and appropriate antibiotics. Mortality was 35%. Chronic sternal osteomyelitis was documented in two cases.

Cardiac Surgical Procedures↗
PubMed1995

Prevalence of penicillin resistant bacteria in acute suppurative oral infection.

Pus aspirated from acute suppurative oral infections in 78 patients (age range 13-76 years) yielded a total of 331 bacterial strains consisting of 143 facultative anaerobes (predominantly Streptococcus spp.) and 188 strict anaerobes (predominantly Prevotella spp.). Seventy-five isolates (23%) were resistant to penicillin (MIC > 1 mg/L), 37 (11%) were resistant to ampicillin (MIC > 2 mg/L) and 16 (5%) isolates were resistant to amoxycillin/clavulanic acid (MIC > 2 mg/L). Samples from 43 (55%) of the patients yielded at least one penicillin resistant isolate and within this group 30 samples (73%) contained at least one strain which produced beta-lactamase. A history of antibiotic therapy during the 6 months before enrollment in the study did not influence the isolation of penicillin resistant bacteria. It is concluded that penicillin resistant bacteria are often present in the microflora of acute dental infection.

Acute Disease↗
PubMed2003

Acute bacterial suppurative parotitis: microbiology and management.

The parotid gland is the salivary gland most commonly affected by inflammation. The most common pathogens associated with acute bacterial parotitis are Staphylococcus aureus and anaerobic bacteria. The predominant anaerobes include gram-negative bacilli (including pigmented Prevotella and Porphyromonas spp.), Fusobacterium spp., and Peptostreptococcus spp. Streptococcus spp. (including S. pneumoniae) and gram-negative bacilli (including Escherichia coli) have also been reported. Gram-negative organisms are often seen in hospitalized patients. Organisms less frequently found are Arachnia, Haemophilus influenzae, Klebsiella pneumoniae, Salmonella spp., Pseudomonas aeruginosa, Treponema pallidum, cat-scratch bacillus, and Eikenella corrodens. Mycobacterium tuberculosis and atypical mycobacteria are rare causes of parotitis. Therapy includes maintenance of hydration and administration of parenteral antimicrobial therapy. Once an abscess has formed surgical drainage is required. The choice of antimicrobial depends on the etiologic agent. Maintenance of good oral hygiene, adequate hydration, and early and proper therapy of bacterial infection of the oropharynx may reduce the occurrence of suppurative parotitis.

Abscess↗
PubMed1994

Management of chronic suppurative otitis media: superiority of therapy effective against anaerobic bacteria.

The aerobic and anaerobic microbiology and management of 69 children who had chronic suppurative otitis media were studied retrospectively. A total of 188 isolates (103 anaerobic and 85 aerobic) were recovered. Anaerobic organisms alone were isolated from 11 (16%), aerobic bacteria only in 21 (30%) and mixed aerobic and anaerobic flora was present in 37 (54%). Forty-five beta-lactamase-producing bacteria were recovered from 60 (58%) patients. The most rapid time for resolution was noticed with clindamycin (8.3 +/- 0.6 days) (P < 0.001), as compared with ampicillin (12.0 +/- 0.8 days), erythromycin (16.5 +/- 1.6 days) and cefaclor (14.6 +/- 2.3 days). Resolution of the infection was achieved in 16 of 20 (80%) of those treated with clindamycin, 12 of 24 (50%) treated with ampicillin, 6 of 13 (46%) treated with erythromycin, and 4 of 12 (33%) treated with cefaclor. Organisms resistant to the antimicrobial used were recovered in 26 of 31 of patients who failed to respond to therapy. These findings indicate the role of resistant aerobic and anaerobic organisms in the polymicrobial etiology of chronic otitis media in children and illustrate the superiority of therapy effective against anaerobic bacteria.

Ampicillin↗
PubMed2000

Comparative safety and efficacy of cefdinir vs amoxicillin/clavulanate for treatment of suppurative acute otitis media in children.

OBJECTIVE: Two dosage regimens of cefdinir were compared with amoxicillin/clavulanate for the treatment of suppurative acute otitis media (AOM) in children. METHODS: This was an investigator-blinded, randomized, comparative, multicenter trial, in which tympanocentesis was performed in 384 patients, ages 6 months to 12 years, who had nonrefractory AOM. Patients were randomized to receive one of three 10-day treatment regimens: cefdinir 14 mg/kg daily (QD; n = 128); cefdinir 7 mg/kg twice a day (BID; n = 128); or amoxicillin/clavulanate 40/10 mg/kg/day divided for use three times a day (TID; n = 128). RESULTS: Of the 384 enrolled patients 303 were evaluable for clinical efficacy. Clinical success rates were statistically equivalent for the 3 treatment groups at the end of therapy: 85 of 102 (83.3%) for cefdinir QD; 81 of 101 (80.2%) for cefdinir BID; 86 of 100 (86%) for amoxicillin/clavulanate. Of the 197 evaluable patients from whom a susceptible pathogen was recovered, presumptive eradication rates at end of therapy were equivalent: 55 of 65 (84.6%), 54 of 66 (81.8%) and 55 of 66 (83.3%) for cefdinir QD-, cefdinir BID- and amoxicillin/clavulanate-treated patients, respectively. However, presumptive eradication rates for Streptococcus pneumoniae were significantly lower for cefdinir BID (55.2%) than for amoxicillin/clavulanate (89.5%; P = 0.0019) and marginally lower than for cefdinir QD (80%; P = 0.054). Diarrhea was the most common treatment-associated adverse reaction in all groups but was significantly more common in amoxicillin/clavulanate-treated patients (35%) than in patients who had been treated with cefdinir QD (10%, P<0.001) or cefdinir BID (13%, P<0.001). CONCLUSIONS: A 10-day regimen of cefdinir 14 mg/kg QD or 7 mg/kg BID was as clinically effective overall as a 10-day regimen of amoxicillin/ clavulanate 40/10 mg/kg/day divided TID in the treatment of tympanocentesis-confirmed, nonrefractory AOM in children. These data suggest that cefdinir QD may be a better alternative than cefdinir BID for refractory AOM. Both dosing regimens of cefdinir were associated with significantly fewer gastrointestinal adverse reactions than was amoxicillin/clavulanate.

Acute Disease↗
PubMed1984

Suppurative pylephlebitis due to pseudodiverticulosis coli.

Patients manifesting suppurative pylephlebitis and intrahepatic abscess formation secondary to pseudodiverticulosis coli and acute diverticulitis are uncommon, but have very high morbidity and mortality. As illustrated by this case report, the symptoms and signs such a patient manifests are nonspecific and the diagnostic modalities available may be insufficiently sensitive. The therapeutic options available at present are excision and drainage of any detected extrahepatic or intrahepatic septic focus and prolonged antibiotic administration.

Adult↗
PubMed1988

Suppurative thrombophlebitis: a new look at a continuing problem.

Despite knowledge of its existence and despite precautionary measures, suppurative thrombophlebitis remains a significant problem in critical care, with a reported incidence of approximately 4% and associated mortality as high as 83%. In a retrospective study, we identified additional risk factors such as emergency department or field placement of catheters and administration of potassium boluses. New guidelines for surveillance and prevention have proved successful.

Catheters, Indwelling↗
PubMed1991

Suppurative pylephlebitis.

Suppurative pylephlebitis is an unusual disease with an associated high mortality. Most cases are a complication of an intra-abdominal septic focus, but some may occur de novo. In the case we have presented, the diagnosis was made by modern imaging techniques that showed thrombus predominantly within the upper portal venous system. We hypothesize that the portal system was seeded through a gastric ulcer. The patient recovered completely with prolonged antibiotic therapy.

Adult↗