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PubMed1987

Percutaneous abscess drainage in Crohn's disease.

The effect of 18 percutaneous abscess drainage procedures on the clinical management of 10 patients with Crohn's disease was evaluated. Two abscesses occurred immediately after surgery (two patients), five were in the liver (three patients), and 11 were the result of direct spread of disease from adjacent transmural bowel involvement (seven patients). Both postoperative and all five hepatic abscesses were treated successfully with percutaneous drainage. In two of the seven patients with abscesses secondary to transmural bowel disease, percutaneous drainage resulted in resolution of the abscess without the need for any further surgical intervention. The remaining five patients had subsequent elective intestinal surgery in which a single-stage surgical resection and primary reanastomosis were performed successfully. Two of these patients had abscesses recur at the same location, prompting a repeat percutaneous drainage before surgery. No enterocutaneous fistulas secondary to percutaneous drainage developed in any of the 10 patients. These results indicate that percutaneous abscess drainage can be a valuable technique for treating abscesses that result as a complication of Crohn's disease.

Abscess↗
PubMed1987

Percutaneous drainage of periappendiceal abscesses: review of 20 patients.

Twenty patients with periappendiceal abscesses diagnosed by CT underwent percutaneous catheter drainage. Eighteen (90%) of the 20 patients were successfully treated by percutaneous drainage and antibiotic therapy alone. In two of these patients, however, small recurrent abscesses were diagnosed by CT 4 and 6 weeks after drainage, but these abscesses resolved with additional antibiotic therapy. Surgery was performed in two patients in whom percutaneous drainage failed. One was a diabetic patient who had a gas-forming abscess that extended into the posterior pararenal space. Surgery was necessary in a second patient because of a technical failure of catheter insertion, which resulted in perforation of the abscess cavity and peritonitis. Abscess sinograms in eight (44%) of 18 patients showed fistulas between the abscess cavity and the base of the cecum or appendix. However, the fistulas did not pose a problem in clinical management, and all closed within 14 days. Percutaneous drainage is an effective alternative to surgery in selected patients with periappendiceal abscesses.

Abscess↗
PubMed1994

Serum neutralizing antibodies against Fusobacterium necrophorum leukotoxin in cattle with experimentally induced or naturally developed hepatic abscesses.

The relationship between serum-neutralizing antibody against Fusobacterium necrophorum leukotoxin and hepatic abscesses was investigated in cattle fed diets supplemented with or without tylosin. Sixteen cattle (eight each in tylosin and in control groups) were inoculated intraportally with F. necrophorum. Ultrasonographic scanning showed that all control animals developed hepatic abscesses after inoculation. In the tylosin group, two animals were free of abscess by d 7 and one was free by d 14. Leukotoxin-neutralizing antibody titers were low on d 0, but increased (P < .05) markedly after intraportal inoculation in both groups. In a second study, blood was collected at the time of slaughter from 141 feedlot cattle (36 fed diets with tylosin and 105 fed diets without tylosin), and livers were examined for presence or severity of hepatic abscesses at slaughter. The incidences of hepatic abscesses were 32% in the control group and 6% in the tylosin group. Antibody was detected in all animals; however, antibody titers were greater (P < .05) in cattle with abscessed liver than those without, and greater (P < .01) in the nontylosin than in the tylosin group. Abscess score and antibody titer were correlated (r = .34; P < .0001). We conclude that F. necrophorum leukotoxin is highly antigenic and that anti-leukotoxin antibody titer is related to the severity of hepatic abscesses.

Animals↗
PubMed1996

Evaluation of interleukin-1 receptor antagonist (IL-1RA) and tumor necrosis factor binding protein (TNF-BP) in a rodent abscess model of host resistance.

Modulation of pro-inflammatory cytokine responses can alter the normal protective mechanisms against invading pathogens. The cytokines interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha) are crucial in the inflammatory cascade for upregulation of adhesion molecule expression, neutrophil recruitment, and additional cytokine induction. To determine if the cytokine antagonists interleukin-1 receptor antagonist (IL-1ra) and tumor necrosis factor-binding protein (TNF-bp) alter host resistance mechanisms they were evaluated in a rodent abscess model. It has previously been shown that subcutaneous Staphylococcus aureus injections induce abscess formation in rats. These abscesses can be examined over a pre-determined time course for evaluation of size, severity and time to resolution. Treatment with immunosuppressive drug therapy can modify the normal course of abscess formation and/or resolution. IL-1ra and TNF-bp were administered either alone or in combination. Also, the effects of these cytokine antagonists in combination with dexamethasone were tested. Results indicated TNF-bp at any dose examined did not adversely alter any parameter of abscess formation or resolution. In contrast, high doses of IL-1ra increased abscess severity, while more clinically relevant doses did not. Combination treatment with IL-1ra and TNF-bp did not alter abscess parameters above individual findings. Dexamethasone, given in combination with either cytokine antagonist, significantly increased severity grading scores above dexamethasone given alone. Overall the data indicated high dosing regimens of IL-1ra or TNF-bp only caused transient impacts on this host resistance model, while more clinically relevant doses did not impact any aspect of the abscess. These findings demonstrate that these anti-cytokine therapies do not alter general host resistance.

Abscess↗
PubMed1981

Bacteriology of intracranial abscess in children.

The bacteriological and clinical findings in 19 pediatric patients with intracranial abscess are presented. Ten children presented with subdural empyema and nine had brain abscess. Sinusitis was present in 14 children, and dental abscess in two. The abscess was located in the frontal and parietal area in seven instances each, and in the temporal area in five. Anaerobic organisms alone were recovered in 12 (63%) of the patients (including eight with subdural empyema and four with brain abscess), aerobic bacteria alone were present in two children (11%), and mixed aerobic and anaerobic bacteria were present in five (26%) patients. There were 43 anaerobic isolates (2.3 per specimen). The predominant anaerobes were anaerobic Gram-positive cocci (16 isolates); Bacteroides sp. (10, including two B. fragilis); Fusobacterium sp. (nine isolates); and Actinomyces sp. (five isolates). A total of eight aerobic isolates (0.4 per specimen), including five Gram-positive cocci and three Haemophilus sp., were recovered. Antimicrobial therapy was administered to all patients. Five patients, four with sinusitis and subdural empyema and one with sinusitis and brain abscess, did not respond to antimicrobial therapy and aspiration of the abscess, and required surgical drainage of their inflamed sinuses. These findings indicate the major role of anaerobic organisms in the polymicrobial etiology of intracranial abscess in children.

Actinomyces↗
PubMed1988

Stereotaxic surgery in the treatment of multiple brain abscesses.

Controversy exists regarding the optimal treatment for patients with multiple brain abscesses. These lesions are often small and located deep in the brain and close to vital structures, making surgery difficult. With this in mind the authors review their experience in treating multiple abscesses using computerized tomography (CT)-guided stereotaxic aspiration. From 1983 to 1985, 15 patients were treated for multiple brain abscesses, of whom eight underwent stereotaxic aspiration. There were a total of 28 abscesses in these eight patients: 11 abscesses were aspirated and two excised using CT-guided techniques. Most were cortical in location, although there were 12 in the deep white matter, one in the thalamus, and two in the caudate nucleus. All patients received a total of 6 weeks of antibiotic therapy. Follow-up CT showed resolution of the abscesses in all patients. Currently, four are neurologically normal, one has a mild hemiparesis, one has a well-controlled seizure disorder, and one requires supportive care. A single death occurred 5 weeks postoperatively of unrelated causes. Location, size, and age of an abscess all have bearing upon the response to management and outcome of the patient. Stereotaxic surgery is a procedure with minimal morbidity and mortality. Stereotaxic aspiration should be considered in patients with small, multiple, or deep-seated abscesses, in those who are poor operative candidates, and in those who have failed prior therapy.

Adult↗
PubMed2003

Fusobacterial brain abscess: a review of five cases and an analysis of possible pathogenesis.

OBJECT: The cases of five patients with fusobacterial brain abscess are presented. The authors discuss their attempt to determine the pathogenesis. METHODS: The clinical and microbiological features of five cases of fusobacterial brain abscess are reviewed. Isolates of 2031 Fusobacterium spp. and other anaerobes collected (1989-2002) at our institution were analyzed and compared for incidences and isolation sources. The findings were correlated with extensive literature on the subject. The five patients were men between 45 and 74 years of age. All experienced an insidious onset of the disease and probable hematogenous seeding of the organism(s). One patient had a monomicrobic Fusobacterium necrophorum abscess, whereas the others had polymicrobic F. nucleatum abscesses. Despite surgery and a regimen of antibiotic medications and dexamethasone, three patients experienced a paradoxical deterioration 3 days postoperatively that necessitated reevacuation of the lesion. The evacuants observed at that time contained numerous leukocytes but no microorganisms, suggesting intensified inflammation as the likely cause of deterioration. This explanation is supported by literature that fusobacteria strongly activate neutrophils. An analysis of the 2031 anaerobes from blood, wounds, and abscesses showed the considerable virulence of Fusobacterium spp., which were able to enter and/or sustain themselves in the blood circulation. This pattern was similar to that of Clostridium spp., but different from those of Peptostreptococcus spp., Bacteroides spp., and Prevotella spp., which were less invasive but more abundant. CONCLUSIONS: Some fusobacterial brain abscesses may be associated with a paradoxical postoperative deterioration, which is probably due to intensified inflammation following treatment. The blood-borne dissemination and invasive behavior of fusobacteria likely initiate such a brain abscess, and further seeding of other synergic bacteria leads to a polymicrobic abscess.

Aged↗
PubMed2003

Emphysematous prostatic abscess due to Klebsiella pneumoniae: report of a case and review of the literature.

Emphysematous prostatic abscess is a very rare form of prostatitis. Emphysematous prostatic abscess due to Klebsiella pneumoniae may have a poor prognosis according to a few previous reports. We report a rare case of successfully treated emphysematous prostatic abscess with cystitis due to Klebsiella pneumoniae in a 50-yr-old man with 15-yr history of diabetes mellitus. The patient was referred to the emergency room of our hospital. The KUB film revealed gas shadows in the lower pelvic area suggestive of emphysematous cystitis or emphysematous prostatic abscess. The gas was mainly occupying the prostate and was also seen in the bladder on pelvic CT. The patient was successfully treated with long-term antibiotic use and additional percutaneous drainage of the abscess. Emphysematous prostatic abscess may be misdiagnosed as emphysematous cystitis due to the similar location of gas shadows on radiography. Computerized tomography and transrectal ultrasonography are helpful in making the diagnosis of emphysematous prostatic abscess. Appropriate use of effective antibiotics with drainage of pus is the best treatment. This case emphasizes the importance of timely and accurate diagnosis followed by appropriate treatment in emphysematous prostatic abscess in diabetic patients.

Abscess↗
PubMed1989

Ultrasonographic resolution time for amebic liver abscess.

Hepatic ultrasonography not only can be used to detect amebic liver abscess, but can follow its resolution. Twenty-five patients with 32 abscesses had hepatic sonography performed repeatedly. Sonography clearly demonstrated abscesses of 1-22 cm; 19 patients (76%) had abscesses only in the right lobe of the liver, and 22 (88%) had solitary abscesses. Resolution time ranged from 2 months for the smallest abscess to 20 months for the largest. Four abscesses initially had a heterogenous partially solidified pattern. All abscesses healed completely, leaving normal hepatic sonographic patterns.

Adolescent↗
PubMedDate not supplied

Pathogenic aspects of pyogenic liver abscess associated with experimental schistosomiasis.

Schistosomiasis mansoni infection that occurs concurrently with Staphylococcus aureus bacteremia favors the formation of pyogenic liver abscess. The present experimental study in mice evaluated the following aspects of the relationship between infection with Schistosoma mansoni and liver abscess caused by S. aureus: a) the role of the eggs of S. mansoni in the genesis of the abscesses; b) the influence of different phases of schistosomiasis in the development of liver abscesses; and c) the effect of the treatment of schistosomiasis on the development of the abscesses. Macroscopic and histopathological study showed multiple liver abscesses around granulomas of S. mansoni in the acute and chronic phases of schistosomiasis. Treatment of acute schistosomiasis before experimentally-induced bacteremia did not prevent the formation of liver abscess. The study findings indicate that granulomas around S. mansoni eggs and worms lodged in the liver provide a focus and substrate for pyogenic abscesses caused by S. aureus.

Acute Disease↗
PubMed2006

Risk factors for developing metastatic infection from pyogenic liver abscesses.

OBJECTIVES: The aim of this study was to identify the risk factors for developing extra-hepatic metastases from pyogenic liver abscesses. METHODS: We conducted a retrospective study and reviewed 225 patients (age, 19-93 years) with a discharge diagnosis of pyogenic liver abscess from a large medical centre in Taiwan, between January 1995 and June 2000. Clinical data were collected from medical records. Of the 225 patients with a pyogenic liver abscess, 24 had extrahepatic metastases and were classified into the metastatic infection group; the remaining 201 were classified into the non-metastatic infection group and served as the control group. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by exact logistic regression. RESULTS: After adjustment for age, sex, and the duration of symptoms before admission, diabetes mellitus (adjusted OR, 12; 95% CI, 3.3-67), alcoholism (adjusted OR, 5.2; 95% CI, 1.4-20), the time interval >7 days from the onset of symptoms to the time appropriate antibiotics were administered (adjusted OR, 3.9; 95% CI, 1.2-13), bacteraemia (adjusted OR, 5.4; 95% CI, 1.4-30), and infection (adjusted OR, 5.0; 95% CI, 1.1-47) were associated with the development of extra-hepatic metastases from pyogenic liver abscesses. On the other hand, fever (adjusted OR, 0.28; 95% CI, 0.089-0.92) and right upper quadrant pain/tenderness (adjusted OR, 0.091; 95% CI, 0.0020-0.50) were associated with the non-metastatic abscesses. We performed a multivariate analysis and found that diabetes mellitus (multivariate OR, 7.7; 95% CI, 2.1-29) and alcoholism (multivariate OR, 8.9; 95% CI, 2.6-30) were the independent risk factors for developing metastatic infections; yet right upper quadrant pain/tenderness (multivariate OR, 0.11; 95% CI, 0.014-0.87) was the predictor of no metastatic abscesses. CONCLUSIONS: Our data suggest that diabetes mellitus and alcoholism are significant risk factors for developing metastatic infections from pyogenic liver abscesses. These findings seem to imply that underlying conditions of the host influence the development of extra-hepatic metastases from pyogenic liver abscesses.

Adult↗
PubMed2004

Pathology of aural abscesses in free-living Eastern box turtles (Terrapene carolina carolina).

Aural abscess or abscess of the middle ear is common in free-living Eastern box turtles (Terrapene carolina carolina) of Virginia (USA) and elsewhere. Although its etiology remains unknown, hypovitaminosis A has been suggested on the basis of similar lesions occurring in captive chelonians fed diets that are deficient in vitamin A. This hypothesis was supported by significantly greater body burdens of organochlorine compounds (reported disruptors of vitamin A metabolism) and a nonsignificant trend toward lower serum and hepatic vitamin A levels in free-living box turtles with this lesion. The tympanic epithelium was evaluated in 27 box turtles (10 with aural abscesses and 17 without). Lesions of the tympanic epithelium of box turtles with aural abscesses included hyperplasia, squamous metaplasia, hyperemia, cellular sloughing, granulomatous inflammation, and bacterial infection. These changes were more severe in turtles with aural abscesses than in those without and were more severe in tympanic cavities that had an abscess compared to those without when the lesion was unilateral. Organs from 21 box turtles (10 with aural abscesses and 11 without) from the study population were examined for microscopic lesions, and minimal histopathologic changes were found, none of which were similar to those found in the tympanic epithelium. Histopathologic changes in box turtles with aural abscesses were consistent with a syndrome that may involve hypovitaminosis A.

Abscess↗
PubMed1999

[Renal and perirenal abscess].

Renal and perirenal abscesses are rare infections of the urinary tract traditionally caused by Staphylococcus aureus. Today however there is a predominance of abscesses secondary to coliform bacteria such as E. coli. This paper presents a revision of our series over the last ten years (1987-1996). A total of 11 abscesses (3 renal and 8 perinephritic) were recorded. The most frequent symptom for visiting the clinic was back pain. All patients had predisposing associated conditions. The microbiological analysis revealed E. coli in most abscesses. An HIV+ patient had bilateral renal abscess secondary to Aspergillus fumigatus. CAT appears to be the most specific method for imaging diagnosis, and ultranosography is useful not only to guide percutaneous puncture but also in the follow-up of abscesses after antibiotic treatment. Two renal abscesses resolved with parenteral antibiotic therapy and subsequent observation. Three cases required ultrasound guided percutaneous puncture and intravenous antibiotic therapy. Surgical drainage was required in four. A revision of our experience and the recent literature verified the changes that have taken place in the last few years both in the etiopathogenesis as well as the diagnostic and therapeutical methodology of renal and perinephritic abscesses.

Abscess↗
PubMedDate not supplied

[A quiet clinical course in an otogenic brain abscess].

INTRODUCTION: The occurrence of otogenic intracranial complications has been significantly diminished by introduction of antibiotic therapy, improved diagnostic methods and surgical treatment of chronic otitis. Meningitis is still the most frequent otogenic intracranial complication, otogenic brain abscesses are following, while other complications occur rarely (1,2,3). Otogenic meningitis and brain abscesses are often associated, which makes the on time diagnosis of each complication harder. Mortality from otogenic brain abscesses is still relatively high, despite diagnostic and therapeutic achievements (4.5). CASE DESCRIPTION: The aim of this study is to present a patient with brain abscess, which arose quietly, as a consequence of chronic suppurative otitis and to point at possibilities of diagnostics and treatment of this complication. The diagnosis of brain abscess by clinical methods of examination is not always reliable. It is often accompanied by most severe form of meningitis, so that neurological examination, in most cases, reveals only signs of meningitis. In our patient, the abscess has been detected by computerized tomography, in its late stage, when it already had completely formed a capsule and had shown clinically manifesting focal signs. This case is interesting because of quiet and unperceived evolution of brain abscess. In the active phase of chronic suppurative otitis, the patient was receiving antibiotic therapy, which has most likely hidden the early symptoms of evolution of intracranial infections. The appearance of signs of focal intracranial infection (photophobia) required applying computerized tomography revealing brain abscess, which was clearly bounded, with a developed capsule, pointing at its late stage (about two months). These findings lead to a conclusion that an otologist should always keep in mind and check whether there is an intracranial infection in cases of active phase chronic otitis.

Adult↗
PubMed2000

[Puncture-drainage sanation of abdominal abscesses: is it sufficient treatment?].

Some anatomical grounds of postoperative extravisceral abscess formation, methods and results of their treatment, therapeutic policy in abscesses of parenchymatous organs are presented. 681 patients with abdominal abscess of various location were examined. Detailed analysis of ultrasonic and computed tomographic semiotics of postoperative extravisceral suppurative focus was carried out in 164 patients. The risk zones of extravisceral abscess formation in the conditions of changed visceral syntopy and destroyed ligamentic structures were determined. The efficiency of puncture-drainage treatment in different variants of subdiaphragmatic abscess was 89.4%, in abscess of omental bursa--83.3%. Intracavital prolonged proteolysis by immobilized proteinases (imosimase) was applied. The injection of imosimase in abscess cavity led to its content lysis, including the thick products of inflammation, improving their secretion through the drainage. In the majority of the patients, the puncture-drainage treatment of abscesses of various etiology and pathogenesis is an adequate method of sanation.

Abdominal Abscess↗
PubMed2001

[Dermal sinus and dermoid cyst revealed by abscess formation in posterior fossa. Report of 2 pediatric cases and review of the litterature].

Cranial dermal sinus, usually associated with dermoid cyst, is the persistance of an abnormal embryonal communication between the skin and the central nervous system. It may be the source of intracranial infection, most often a meningitis and rarely an abscess formation. Two cases of little girls (18 months and 2 years) having dermal sinus with dermoid cyst revealed by cerebellar abscess formations are reported. In the first case there were multiple cerebellar abscesses with hydrocephalus leading to a raised intracranial pressure. In the second case there was an abscess formation adjacent to the dermoid cyst. CT scan showed cysts and abscesses but MRI, achieved in the second case, was useful in demonstrating the sinus tract as well as the associated cyst and abscess. The two patients underwent a posterior fossa surgery with antibiotic therapy. In the first case abscess drainage and ventricular external drainage were necessary before sinus and cyst excision. Two months after surgery the two patients were neurologically intact and developping well. Surgery with total excision of dermal sinus and dermoid cyst, even sometimes difficult, must be preferred to the simple abscess drainage and antibiotic therapy.

Abscess↗
PubMed2001

[Therapeutic aspects of renal abscess. Report of 50 cases].

INTRODUCTION: Renal abscess often raises therapeutic problems. Based on their experience and a review of the literature, the authors propose a treatment plant for renal abscess. MATERIAL AND METHODS: The authors report 50 cases of renal abscess treated between January 1988 and September 1999 in the Department of Urology of Charles Nicolle Hospital in Tunis. The diameter of the abscess was less than or equal to 4 cm in 19 cases, between 4 and 10 cm in 29 cases and greater than 10 cm in 2 cases. Renal ultrasound and intravenous urography are an integral part of the initial morphological assessment. All patients were treated by intravenous antibiotics for a mean duration of 28 days. Complementary percutaneous drainage of the abscess was indicated in 25 patients. Surgical treatment was indicated in 13 patients in the presence of a large perirenal collection or severe sepsis, or following failure of percutaneous drainage. RESULTS: Antibiotics alone were proposed in only 17 patients with an abscess less than 4 cm in diameter and 90% of these patients were cured. Percutaneous treatment was performed in 25 patients with an 80% success rate; the other patients underwent open surgery. One patient died after surgery in a context of septic shock despite salvage nephrectomy. The other patients has a favourable outcome. CONCLUSION: The treatment of renal abscess is based on antibiotics alone or combined with a percutaneous or surgical drainage procedure depending on the size of the abscess and the clinical course. The authors describe their decisional flow-chart.

Abdominal Abscess↗
PubMedDate not supplied

Obturator internus muscle abscess in children.

The authors describe four cases of obturator internus muscle (OIM) abscess in children, including their clinical presentations and treatment. This was a retrospective chart review. Children and adolescents younger than 18 years discharged between July 1, 1985, and September 30, 1998, from Brenner Children's Hospital with the diagnosis of muscle abscess or pelvic abscess were identified. A total of 56 patients were identified with the diagnosis of muscle abscess or pelvic abscess. OIM abscess was defined by radiologic findings of an inflammatory process with fluid collection in the OIM, along with the clinical findings suggestive of an OIM abscess. Four of the patients met the definition of OIM muscle abscess. The common presenting features were fever, limp, and hip pain. Computed tomography or magnetic resonance imaging was diagnostic in all four patients, and Staphylococcus aureus was the causative agent in each. All the patients recovered, one after surgical drainage and the other three after antimicrobial therapy alone or with needle aspiration. The presentation of OIM pyomyositis is similar to that of psoas muscle pyomyositis and other infectious processes of the pelvis and hip. The S. aureus is the most common etiologic agent but not the only one reported. Most patients can be managed without open surgical drainage, but needle aspirations may be helpful both therapeutically and diagnostically.

Abscess↗