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PubMed1977

Treatment of acute suppurative otitis media.

The effect of myringotomy versus Penicillin therapy in the treatment of patients with acute suppurative otitis media was compared. A third group of patients treated with both myringotomy and Penicillin was included in the investigation. Ten days after institution of the treatment there were significantly more days with secretion/bulging drum in the myringotomy group than in the two other groups. At this time Penicillin therapy was started also in those patients belonging to the myringotomy group. With this reservation the occurrence of such late complications as secretory otitis media and relapses was the same, independent of treatment. No cases of mastoiditis were observed.

Acute Disease↗
PubMed1979

Non-suppurative otitis media in children. (A retrospective study of 100 cases).

This is a retrospective study of 100 cases of non-suppurative otitis media among children who presented to the E.N.T. Department at Poole General Hospital between 1975 and 1978. Their histories, investigations and management are reported, with special emphasis on the significance of surgical treatment, and its value in the prognosis of such cases.

Child↗
PubMed2001

Spontaneous occurrence of chronic non-suppurative destructive cholangitis and antimitochondrial autoantibodies in MRL/lpr mice: possible animal model for primary biliary cirrhosis.

MRL/MP mice bearing the lymphoproliferative gene lpr (known as MRL/MP-lpr/lpr or MRL/Ipr mice) are known to spontaneously develop severe autoimmune diseases such as glomerulonephritis, arteritis and arthritis at an early stage of their life. They have also been reported to develop severe sialadenitis, suggesting that this mouse could be a model for Sjögren's syndrome. Primary biliary cirrhosis, an autoimmune disease characterized by chronic non-suppurative destructive cholangitis and the occurrence of antimitochondrial antibodies, is frequently associated with Sjögren's syndrome. In this study, we examined whether cholangitis and/or antimitochondrial antibodies occur in this mouse model, using more than 100 young and old MRL/Ipr mice. We frequently found portal inflammation associated with cholangitis of small intrahepatic bile ducts, especially in older mice. There was also infiltration of inflammatory cells (monocytes) as well as CD4-positive T cells. Epithelioid granuloma and bile-duct loss were also occasionally found. These histological features resemble primary biliary cirrhosis. In addition, antimitochondrial antibodies were shown by immunocytochemistry to be present in the sera of MRL/Ipr mice. There is currently no established animal model for primary biliary cirrhosis. Therefore, further studies on MRL/Ipr mice, with respect to pathogenesis of primary biliary cirrhosis, are warranted.

Animals↗
PubMed2002

Autoimmune hepatitis associated with bile duct injury resembling chronic non-suppurative destructive cholangitis.

Autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) are representative autoimmune liver diseases in which hepatocytes and intrahepatic bile ducts, respectively, are selectively damaged by autoimmune mechanisms. Bile duct injury and loss is characteristic of PBC and chronic non-suppurative destructive cholangitis (CNSDC), in particular, is a histological hallmark of PBC. In this report, we present an unusual case of AIH accompanied by CNSDC-like bile duct injury in a 46-year-old woman. The patient's serum aminotransferase level was abnormally high. The serum levels of alkaline phosphatase, gamma-GTP and IgG were also elevated, but the IgM level was within normal limits. The titer of antismooth muscle antibody (SMA) was 1:80, while antinuclear autoantibody (ANA) and the M2 fraction of antimitochondrial antibody (AMA) were both negative. Liver biopsy disclosed CNSDC-like bile duct injuries and severe interface hepatitis and lobular hepatitis with perivenular zonal necrosis were observed. The aggregate score of the International Autoimmune Hepatitis Group corresponded to the category of probable AIH. Immunohistochemically, histocompatibility leukocyte antigen-DR, which is aberrantly expressed in the damaged bile ducts of PBC, was not found in the injured bile ducts of this case. Laboratory data were much improved by treatment with prednisone, but ursodeoxycholic acid was not effective. Although the possibility of an overlapping syndrome of AIH- and AMA-negative PBC could not be excluded, this case was diagnosed as AIH with CNSDC-like bile duct lesions.

Anti-Inflammatory Agents↗
PubMed1976

[Frequency of chronic non-suppurative destructive cholangitis and primary biliary cirrhosis in comparison with other chronic inflammatory liver diseases].

Primary biliary liver disease was diagnosed and verified by histology and demonstration of antibodies against mitochondrial proteins in 73 patients between 1970 and 1974. Comparing cases between 1950 and 1961 and between 1970 and 1974 with the frequency of other chronic inflammatory liver diseases it was found that figures for advanced primary biliary cirrhosis remained unchanged during both periods whereas early stages of primary biliary disease were detected far more frequently in the latter period. One case with chronic non-suppurative destructive cholangitis or complete primary biliary cirrhosis was outnumbered by 8 cases of chronic aggressive hepatitis and 15 of liver cirrhosis of various aetiologies in Kassel. The relations in Göttingen were 1 : 5 and 1 : 6, respectively. Primary biliary diseases are no longer rare.

Aged↗
PubMed1995

[Suppurative parotitis as a sequela of infection with Salmonella enteritidis].

Extraintestinal manifestations of Salmonella infection are rare events and occur primarily in immunocompromised hosts. We report on a 69-year old male patient hospitalized for absceding suppurative parotitis. From the swab taken on incision of the abscess, Salmonella enteritidis was cultivated. There was no preceding gastrointestinal infection in our patient. Risk factors in our patient included a poorly controlled non-insulin-dependent diabetes mellitus, chronic alcohol abuse, and advanced age. Quinolones are the therapy of choice in extraintestinal salmonellosis. On ciprofloxacin perorally, the patient showed rapid recovery.

Abscess↗
PubMed1987

[A chronic destructive non-suppurative cholangitis-like disease picture with antinuclear antibodies (immunocholangitis)].

Three females had suffered, two for many years, from bouts of a liver disease of unknown origin, which clinically, histologically and biochemically fulfills the criteria of chronic destructive non-suppurative cholangitis. None of the patients had antimitochondrial antibodies, but all had antinuclear antibodies at high titres. Two of them are mother and daughter; the latter has two daughters (aged 10 and 12 years), both of whom have antinuclear antibodies at low titres but no abnormal liver function tests. The female family members of the third patient also had antinuclear antibodies in their serum with normal liver enzyme tests. None of the patients was taking any drugs. Contrary to true chronic destructive nonsuppurative cholangitis (primary biliary cirrhosis), in the three patients immunosuppressive treatment with azathioprine (Imurek) and prednisone (Decortin) was successful. It is suggested that the described disease be called immunocholangitis.

Adult↗
PubMed1988

Acute suppurative parotitis in a patient on total parenteral nutrition.

A report of a patient who developed acute suppurative parotitis while on total parenteral nutrition for small bowel fistula is presented. The importance of early detection of parotitis as a cause of fever is emphasized. Attention to oral hygiene and early resumption of oral intake, whenever possible, are to be encouraged.

Acute Disease↗
PubMed2001

Current understanding and management of chronic hepatosplenic suppurative brucellosis.

To outline the characteristics and define appropriate management of chronic hepatosplenic suppurative brucellosis (CHSB), 905 patients with brucellosis were analyzed. Sixteen episodes of CHSB (14 in the liver and 2 in the spleen) were found in 15 patients. Six patients had had previous remote brucellosis. Twelve patients presented with systemic symptoms, and 12 with local symptoms. Cultures of blood samples yielded negative results in all cases except 1, and the results of cultures of pus specimens were positive for Brucella melitensis in only 2 cases. All patients showed calcium deposits surrounded by a hypodense area on computed tomography. Patients often had low titers of agglutinating antibody. In patients who were receiving conservative management, early response was successful in 50% and late response was successful in 33.3%. In the patients who underwent surgery and concomitant antibiotic therapy, early and late response was successful in 100%. Thus, CHSB mainly represents a local reactivation of previous brucellosis. Its diagnosis may be difficult to establish and surgery may be required to cure many patients.

Adult↗
PubMed1981

Acute suppurative parotitis associated with anaerobic bacteremia.

Most episodes of acute suppurative parotitis are caused by Staphylococcus aureus. Reported here is a patient who had acute parotitis associated with anaerobic sepsis caused by Bacteroides melaninogenicus and Peptostreptococcus micros. Acute parotitis should be included in the ever-widening spectrum of clinical infections caused by anaerobic bacteria.

Acute Disease↗
PubMed1984

Necrotizing sarcoid granulomatosis with suppurative features.

Necrotizing sarcoid granulomatosis has become a well-defined entity within the spectrum of disorders classified as pulmonary granulomatosis with angiitis. It is characterized clinically by disease generally restricted to the chest, steroid sensitivity, and a good prognosis. Pathologically, confluent granulomas, vasculitis, and bland necrosis are seen. The authors report a patient initially presenting with the typical clinical and pathologic features of necrotizing sarcoid granulomatosis who, on subsequent recurrence, demonstrated a suppurative character to the necrosis. This feature has not been reported previously, and its recognition will allow more cases to be diagnosed correctly. Serum angiotensin converting enzyme (ACE) was not elevated, and ACE could not be demonstrated in tissue from the lung biopsy obtained during recurrence of disease. This further suggests significant differences between this entity and sarcoid.

Adult↗
PubMed1992

Evaluation of new anti-infective drugs for the treatment of acute suppurative arthritis in children. Infectious Diseases Society of America and the Food and Drug Administration.

Diagnostic criteria for bacterial suppurative arthritis include the demonstration of an inflammatory exudate by aspiration of synovial fluid and the isolation of bacteria from cultures of synovial fluid and/or blood. Clinical manifestations include joint effusion, swelling, tenderness, and pain, with or without redness of the overlying skin. Management consists of antimicrobial therapy, measures designed to relieve symptoms, surgical drainage of infected fluid, and physical therapy. Studies of new anti-infective therapy should be limited to cases of bacterial origin. Prospective, randomized, double-blind, or evaluator-blinded, active-control comparative clinical trials should be performed. Clinical response is characterized as success (cure), failure, or indeterminate outcome. The most common successful microbiological outcome is presumptive eradication. Follow-up should continue for 1 year before the final assessment.

Acute Disease↗
PubMed1995

Suppurative cutaneous granulomata caused by Microascus cinereus in a patient with chronic granulomatous disease.

We describe a patient with chronic granulomatous disease who presented with erythematous papular skin lesions on the chest, back, and arm. Examination of biopsy specimens from the lesions on the arm and back showed suppurative granulomata in association with acute and chronic inflammation. Histopathologic examination of a specimen from the lesion on the arm revealed fungal elements, and cultures yielded Microascus cinereus. The patient was treated with 2.5 g of intravenous amphotericin B, and the lesions resolved. We report what is, to our knowledge, the first case of invasive disease due solely to M. cinereus.

Amphotericin B↗
PubMed1982

Protection against chronic pyelonephritis in rats by suppression of acute suppuration: effect of colchicine and neutropenia.

Previous experiments in rats have suggested that renal scarring after acute, obstructive pyelonephritis due to Escherichia coli results from parenchymal damage due to acute inflammation and suppuration. To assess the role of acute infiltration by polymorphonuclear leukocytes (PMNLs) in the pathogenesis of chronic pyelonephritis (CPN), rats were either treated with colchicine to depress leukocyte motility or rendered neutropenic with a single dose of cyclophosphamide. Colchicine given during acute pyelonephritis reduced kidney inflammation and protected against CPN two months later. Similarly, neutropenia reduced acute inflammation and protected against chronic parenchymal destruction and scarring. Protection against renal scarring in both colchicine-treated and neutropenic rats occurred despite higher renal bacterial counts during acute pyelonephritis. These experiments provide further evidence that CPN (renal scarring) results from kidney damage that occurs during early acute obstructive pyelonephritis. This damage appears to result from infiltration of the kidney by PMNLs rather than direct damage from bacterial infection.

Abscess↗
PubMed1989

Acute suppurative parotitis caused by Pseudomonas pseudomallei in children.

During a prospective clinical study of melioidosis in northeast Thailand, suppurative parotitis was observed as a characteristic presentation in children. Parotitis constituted 6.3% of all culture-positive melioidosis and 38% of melioidosis in children. Nine cases are described. None had apparent predisposition to infection, although two patients developed rising mumps virus antibody titers, suggesting a possible relation between these conditions. Complications included abscess formation (nine), spontaneous rupture into the auditory canal (five), facial nerve palsy (two), and septicemia and osteomyelitis with septic arthritis (one each). All children initially responded to surgical drainage and appropriate antibiotic therapy. Pseudomonas pseudomallei parotitis should be considered in children from endemic areas with fever and facial swelling. It has a good prognosis with appropriate treatment. It may also prove to be a sensitive clinical indicator of the presence of melioidosis within a particular geographic area.

Abscess↗
PubMed1995

Intravenous ciprofloxacin as treatment for patients with acute suppurative cholangitis: a randomized, controlled clinical trial.

One hundred consecutive patients with acute suppurative cholangitis were randomized in a prospective, controlled clinical trial to receive either ciprofloxacin (200 mg bd iv) or triple therapy comprising ceftazidime (1 g bd iv), ampicillin (500 mg qds iv) and metronidazole (500 mg tds iv); 46 and 44 patients in the ciprofloxacin and triple therapy groups respectively were suitable for inclusion in the analysis of efficacy. In two-thirds of the patients biliary obstruction was caused by ductal calculi and in one-third by malignant or benign strictures of the biliary tract. Bacteraemia was documented in 38% of patients in the ciprofloxacin group and in 34% of patients in the triple therapy group, while bile cultures were positive in 87% and 92% of patients in the ciprofloxacin and triple therapy groups respectively. Escherichia coli, Klebsiella spp. and Enterococcus spp. were the most common biliary isolates. Eighty-five per cent of evaluable patients in the ciprofloxacin group and 77% of those in the triple therapy group responded to therapy. The mean durations of fever, septicaemic shock and hospitalization were also similar in the two treatment groups. Six (13%) patients in the ciprofloxacin group and seven (16%) in the triple therapy group required urgent endoscopy or surgery for uncontrolled infection. Recurrence of fever after an initial response was documented in one (2%) patient receiving ciprofloxacin and in three (7%) patients receiving triple therapy. The incidences of mortality were 4% in the ciprofloxacin group and 2% in the triple therapy group. The results of this study suggest that ciprofloxacin alone is adequate empirical therapy for patients with cholangitis.

Acute Disease↗
PubMed1980

Suppurative Candida phlebitis of a peripheral vein.

A patient receiving total parenteral alimentation through a central catheter developed fatal candida sepsis originating from suppurative phlebitis of a peripheral vein. This case underscores the importance of aggressively pursuing all potential endovascular sources of fungemia in susceptible patients: those on antibiotics, with chemical phlebitis, and hyperglycemia.

Adult↗