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PubMed2006

Transvaginal oocyte retrieval for in vitro fertilization complicated by ovarian abscess during pregnancy.

OBJECTIVE: To describe an ovarian abscess presenting very late after oocyte retrieval for IVF with several unusual clinical features. DESIGN: Case report. SETTING: Academic medical center. PATIENT(S): A 35-year-old nulliparous woman underwent IVF with uncomplicated transvaginal oocyte retrieval (TVOR), resulting in a dizygotic twin pregnancy. At 13 weeks of pregnancy she presented with vaginal discharge, but was otherwise constitutionally well. At 30 weeks she developed a low-grade fever, and the diagnosis of ovarian abscess was made. She received broad-spectrum antibiotics, and the abscess was drained percutaneously after cesarean delivery of twins. INTERVENTION(S): Antimicrobial therapy; cesarean section; postpartum percutaneous drainage. MAIN OUTCOME MEASURE(S): Clinical and radiologic resolution of infection. RESULT(S): Complete resolution of the abscess; delivery of healthy twins. CONCLUSION(S): Infectious complications of TVOR and other surgical procedures usually occur within days of the intervention. Our case illustrates the possibility of infectious complications of TVOR presenting months after the procedure. Our patient did not become acutely ill due to the formation of a spontaneous vaginal fistula, which allowed the abscess to drain. The optimal management of this complication is unclear, but final resolution of any pelvic abscess generally requires drainage.

Abscess↗
PubMed2006

Posterior spinal epidural abscess: an unusual complication of vertebroplasty.

OBJECTIVE: Complications after vertebroplasty are rare. There are few reported infectious complications requiring surgical management such as corpectomy with anterior reconstruction and posterior stabilization, although we have not seen any reports about epidural abscess in the literature. We present a patient in whom posterior epidural abscess developed after vertebroplasty in which drainage and antibiotherapy were required for treatment. METHODS: A 70-year-old female with a painful T12 osteoporotic compression fracture underwent percutaneous vertebroplasty using polymethylmethacrylate without complication. One week after vertebroplasty, however, she had fever and increased back pain. On clinical examination, soft tissue abscess formation was determined at the vertebroplasty site. This was drained surgically and antibiotic treatment was started. At follow-up, she had progressive neurological deterioration (paraparetic) on the 18th day after abscess drainage. MRI of the thoracolombar spine revealed posterior spinal epidural abscess at the T11/12 level. Partial laminectomy and drainage were performed. She had complete neurological recovery in the follow-up period. CONCLUSION: An epidural abscess, which is an unusual complication of vertebroplasty, represents a medical and surgical emergency. Treatment is generally urgent surgical drainage combined with antibiotics. The patient should be evaluated in detail for systemic infectious disease and comorbid conditions before the vertebroplasty procedure.

Aged↗
PubMed2006

Management of splenic abscess in children by percutaneous drainage.

BACKGROUND/PURPOSE: Isolated splenic abscesses are rare in pediatric patients. The recommended treatment in the literature has been in favor of splenectomy, although conservative treatment with splenic preservation is being increasingly reported. We report successful management of 4 pediatric patients with splenic abscess by needle aspirations and antibiotics. MATERIALS AND METHODS: Four children (aged 7-11 years; male-female, 3:1) were admitted in our institution with history of high-grade fever with chills, anorexia, left hypochondrial pain, and splenomegaly. One child was a known case of thalassemia, and one had a history of typhoid fever. The others did not have any predisposing condition. Ultrasonography (USG) and computed tomographic scan of the abdomen showed a solitary abscess in the spleen in 2 patients and multiple abscesses in the other 2. Ultrasonography-guided needle aspiration in 3 cases revealed purulent fluid, which, on culture, grew Escherichia coli in 1 case, Salmonella paratyphi A in 1 case, but sterile in 1 case. Blood culture was sterile in all the cases, but Widal's test was positive in 2 patients. Treatment protocol included USG-guided needle aspiration of pus along with intravenous ceftriaxone, metronidazole, and amikacin for 3 to 12 weeks. RESULTS: All 4 patients showed a good response to conservative treatment. Serial USG showed gradual resolution of abscess, and none was subjected to splenectomy. CONCLUSION: Isolated splenic abscess in children can be successfully treated with needle aspirations and intravenous antibiotics, thereby avoiding splenectomy.

Abscess↗
PubMed2004

High prevalence of phagocytic-resistant capsular serotypes of Klebsiella pneumoniae in liver abscess.

To better understand the role of capsular polysaccharide (CPS) K1 or K2 in Klebsiella pneumoniae liver abscess as well as the development of metastasis to eye, neutrophil phagocytosis of 70 CPS isolates including K1 (n = 23)/K2 (n = 10), non-K1/K2 (n = 37) was evaluated by flow cytometry, fluorescence imaging, and electron microscopy. K1/K2 isolates were significantly more resistant to phagocytosis (P < 0.0001) than non-K1/K2 isolates and displayed increased resistance to intracellular killing. Although mucoid phenotype (M-type) K1/K2 isolates were significantly more resistant to phagocytosis (P = 0.0029) than M-type non-K1/K2, no significant difference in the phagocytosis rate was observed between K1/K2 isolates with M-type and non-M-type (P = 0.0924). Mucoidy is an associated factor that was predominant in K1/K2 isolates, but which itself is not an independent influence on phagocytic resistance. The K1/K2 CPS proved significantly more resistant to phagocytosis than non-K1/K2 CPS in liver abscess isolates (P < 0.0001) and non-abscess isolates (P = 0.0001), suggesting that K1/K2 isolates were generally more virulent in both liver abscess and in non-liver abscess conditions. These findings indicate that resistance of CPS K1 or K2 K. pneumoniae to phagocytosis and intracellular killing presumably contributes to their high prevalence in liver abscess and uniquely in endophthalmitis.

Antigens, Bacterial↗
PubMed2004

The importance of etiology on the clinical course of neck abscesses.

OBJECTIVE: Formation of neck abscesses from injecting illicit drugs continues to be a common problem in the United States. We sought to determine whether neck abscesses resulting from direct inoculation differ in their clinical course and severity from those that arise from direct spread through inflamed tissue, as in pharyngitis or odontogenic infections. STUDY DESIGN AND SETTING: Patients were separated based on the cause of their neck abscess into either an injection drug use group or a noninjection drug use group. We retrospectively compared both groups of patients by examining multiple clinical endpoints, including the number of operations, length of hospital stay, and requirement for emergent airway intervention. RESULTS: Injection drug use was the most common cause of neck abscess. Only 1 of these patients needed more than 1 drainage procedure, and no patients required emergent airway intervention or an intensive care unit (ICU) stay. The majority of the patients in the noninjection drug group had a neck abscess as a result of unknown causes; nearly one half required an emergent operation for airway management and the mean ICU stay was 2.5 days. CONCLUSION: Neck abscesses formed by direct inoculation have a relatively more benign clinical course than those resulting from spread through inflamed tissue. The latter require a longer hospital stay, more days in the ICU, and more emergent intervention.

Abscess↗
PubMed2005

Spinal epidural abscess: clinical presentation, management, and outcome.

BACKGROUND: We sought to describe the clinical characteristics of patients with spinal epidural abscess and to relate presentation and treatment to short-term clinical and neurologic outcome. METHODS: We retrospectively reviewed the records and radiographic images of all patients admitted to our institution with a diagnosis of spinal epidural abscess between January 1995 and March 2001. RESULTS: Thirty males and 18 females were admitted with spinal epidural abscess. Median age was 61 years (range, 31-84). Twenty-three of 48 patients were febrile at presentation and the mean white blood cell (WBC) count was 15.5 (range, 4.0-38.7). Twenty-seven patients presented with motor deficits, 17 with pain alone, 2 with sepsis, 1 with dysphagia, and 1 incidentally on spinal imaging. Intravenous drug abuse was the most common risk factor (13 patients) followed by the presence of nonspinal infection, including endocarditis (10 patients). Blood cultures were positive in 29 patients. Staphylococcus aureus was the most common organism cultured from abscesses. Collections were located in the cervical spine in 11 patients, cervicothoracic in 4, thoracic in 7, thoracolumbar in 4, and lumbosacral in 22. One patient harbored both cervical and lumbar epidural abscesses. Twenty-three patients initially received nonoperative therapy with antibiotics alone; 25 underwent urgent surgery. Eleven patients initially treated with antibiotics eventually deteriorated and required delayed surgery. Patients receiving antibiotics suffered a significantly greater number of unfavorable outcomes (clinical deterioration or death) than those in the early surgical group (P < 0.005). CONCLUSIONS: Patients with spinal epidural abscess may be normothermic and have normal WBC counts. Urgent surgery was more likely to be offered to patients presenting with neurologic deficits than with pain alone. Patients treated without early surgery were significantly more likely to deteriorate and suffer poor outcomes.

Adult↗
PubMed2006

Brain abscess in 142 patients: factors influencing outcome and mortality.

BACKGROUND: With the introduction of CT, stereotactic techniques, and broad-spectrum antibiotics, the outcome for brain abscess has dramatically improved. The purpose of this study was to identify prognostic factors by reviewing data on 142 patients with brain abscess. METHODS: Clinical data, including age, sex, medical history, duration of symptoms, initial neurological status, associated predisposing factors, laboratory data, treatment, and abscess characteristics, were considered as potential prognostic factors. A comparison was made between patients with favorable (GOS: moderate disability or good recovery) and those with unfavorable (GOS: death, persistent vegetative status, or severe disability) outcomes at discharge. Univariate (chi(2) analysis or Fisher's exact test) and multivariate logistic regression analyses were used to identify prognostic factors. Data were considered significant when the 2-tailed P value was lower than .05. RESULTS: There were 98 male and 44 female patients (male/female ratio, 2.2). Their average age at diagnosis was 41.5 years (range, 2-84 years). There were 105 patients with a favorable outcome and 37 with an unfavorable outcome. Both univariate and multivariate analyses indicated that patients who were male, had an initial GCS score >12, had no other septic complication, or had Gram-positive cocci grown in abscess cultures had better outcomes. No association was found between outcome and other factors, including age, focal neurological deficits, seizures, laboratory findings, characteristics of the abscesses, associated factors, and treatment modalities. CONCLUSIONS: With the advancement of imaging studies and broad-spectrum antibiotic therapies, the outcome of brain abscess depends on prompt awareness of the diagnosis and effective infection control.

Adolescent↗
PubMed2006

Spinal epidural abscess due to Brucella.

BACKGROUND: Brucellar spinal epidural abscess (SEA) is a rarely encountered clinical entity during the course of the systemic Brucella infection. METHODS: We reported 9 patients diagnosed with Brucellar SEA with a mean follow-up of 20 months. Spinal epidural abscess was detected by magnetic resonance imaging in all cases. Brucella diagnosis was established by specific blood tests. Patients were administered antibiotics for a duration of 6 to 12 weeks. RESULTS: Spinal epidural abscess was localized in lumbar region in 6 patients, dorsal in 2 patients, and cervical in 1 patient. Abscess mimicked disk herniation clinically in 3 patients. Although neurologic examination was normal in 6 patients, we detected motor deficit in 3 patients. Symptoms regressed in all patients but 1 after the institution of antibiotic regimens, and all recovered fully without any sequel. Surgical drainage of abscess was performed in 1 patient. CONCLUSIONS: Proper antibiotic regimens in required doses and duration should be the primary treatment in Brucellar SEA. The criteria for terminating antibiotic therapy are clinical recovery and dissolution of abscess images radiologically. Lastly, should any neurologic deterioration be detected during the course of medical treatment, surgical decompression is to be considered.

Aged↗
PubMed1998

Medically sound, cost-effective treatment for pelvic inflammatory disease and tuboovarian abscess.

OBJECTIVE: Our purpose was to determine the clinical effectiveness and cost-effectiveness of three antibiotic regimens for the treatment of pelvic inflammatory disease and tuboovarian abscess. STUDY DESIGN: A review of all patients' hospitalized at Hutzel Hospital, Detroit, Michigan, for treatment of pelvic inflammatory disease and tuboovarian abscess between Jan. 1, 1993, and April 30, 1997, was performed. Demographic data, antibiotic choices, changes in therapy, operative interventions, and cost of therapy were assessed. RESULTS: Two hundred three patients were admitted for treatment of pelvic inflammatory disease during the study period. We were able to evaluate the clinical efficacy of antibiotic treatment in 179 patients, including 105 patients with pelvic inflammatory disease alone (uncomplicated pelvic inflammatory disease) and 74 women whose infection was complicated by tuboovarian abscess. The three antibiotic regimens evaluated were cefotetan plus doxycycline, clindamycin plus gentamicin, and ampicillin plus clindamycin plus gentamicin. All regimens demonstrated comparable efficacy in treating uncomplicated genital tract infections. Ampicillin plus clindamycin plus gentamicin was significantly better than clindamycin plus gentamicin and cefotetan plus doxycycline in treatment of tuboovarian abscess (p = 0.001). Fifteen women with tuboovarian abscess responded to a change to ampicillin plus gentamicin plus clindamycin antibiotic therapy alone. The hospital stay was prolonged by approximately 3 days in women failing to respond to initial antibiotic therapy, and operative interventions were common in this group of patients. CONCLUSIONS: Cefotetan plus oral doxycycline is the most cost-effective regimen for treating uncomplicated pelvic inflammatory disease, whereas triple-antibiotic therapy is the treatment of choice in women with tuboovarian abscess.

Abscess↗
PubMed2001

[Percutaneous drainage of perisigmoid abscesses of diverticular origin].

STUDY AIM: The aim of this multicentric retrospective study was to report the results on the percutaneous drainage of perisigmoid abscesses during acute sigmoid diverticulitis in 12 patients. PATIENTS AND METHOD: Between January 1993 and March 2000. 12 patients with a perisigmoid diverticular abscess were treated by antibiotic therapy and percutaneous drainage of the abscess. The patient population consisted of eight males and four females (mean age: 50.2 years). The diagnosis was established in two out of seven cases by enema, in four cases out of seven by abdominal ultrasonography, and in eight cases out of 11 by CT scan. Percutaneous drainage was carried out in all cases, and was guided by ultrasonography (n = 3) and CT scan (n = 9). The mean duration of drainage was 6.5 days. RESULTS: No drainage-associated complications were observed. Drainage combined with antibiotic treatment provided satisfactory results in ten out of 12 cases. Two cases of failure of the method occurred, and the patients involved were operated on day 4 and week 5 by colectomy with protective lateral ileostomy. There was an early recurrence of the abscess in three patients, who were treated by the Hartmann procedure in one case, and by one-stage colectomy in two cases. Five patients underwent a secondary one-stage colectomy. Two patients in whom no residual abscess was detected were not operated on at the time of the study. CONCLUSION: Percutaneous drainage of perisigmoid diverticular abscesses combined with antibiotic therapy provided efficient treatment in ten out of 12 cases. Secondary one-stage colectomy was performed in seven out of the eight patients requiring further surgery.

Abdominal Abscess↗
PubMed1998

Cold abscess of the chest wall: a surgical entity?

BACKGROUND: Cold abscesses of the chest wall are rare tuberculous locations. Because of the resurgence of tuberculosis, this diagnosis must be considered more frequently. METHODS: During a 15-year period (1980 to 1995), 18 patients with one or more cold abscesses of the chest wall were managed in our department. Epidemiologic characteristics, indications, methods and results of operation, and pathogenesis of the abscesses were considered in this retrospective study. RESULTS: Most of the patients were immigrant men. A previous history of tuberculosis was noted in 15 cases (83%). Six patients had concomitant active pulmonary tuberculosis. There was mostly a solitary lesion in the chest wall, the most frequent location being the rib shaft (60%). Before operation the diagnosis was confirmed only in 4 patients (by needle aspiration of the abscess) and presumed in 4 others: an antituberculous chemotherapy was therefore given preoperatively to 8 patients. One patient did not undergo operation after a favorable response to medical treatment. In the other patients, an operation was indicated because of lack of response in 5 patients and the absence of diagnosis in 12 patients. Adequate debridement and a postoperative antituberculous regimen were performed with recurrence prevention in mind. A follow-up was obtained in 11 of the 17 patients undergoing operation. The only patient who required a second operation because of a recurrence at the same location had refused the antituberculous therapy after the first surgical procedure. Locations of the abscesses, computed tomographic scan results, and histologic examinations are in favor of a lymph-borne dissemination of tubercle bacilli. CONCLUSIONS: Because fine-needle aspiration remains an inaccurate diagnostic tool and antituberculous medical treatment is not always efficient, chest wall tuberculous cold abscesses remain in most cases a surgical entity.

Abscess↗
PubMed1981

Subphrenic abscess: the radiological approach.

Subphrenic abscess will continually plague the post-laparotomy patient. The high mortality associated with these abscesses can be reduced by diagnosing and draining them early. In 42 patients with 55 subphrenic abscesses, the most important diagnostic modality proved to be conventional radiographs of the abdomen allowing 65% of the subphrenic abscesses to be detected. Other procedures were largely confirmatory in suspicious cases. Thus ultrasound is useful in right subphrenic suprahepatic abscesses while modified upper and lower gastrointestinal studies allow rapid diagnosis of extra-intestinal abscess gas or mass effect.

Female↗
PubMed1985

Serial ultrasound in amoebic liver abscess.

Serial ultrasound examinations were conducted in 93 patients with amoebic liver abscess. The initial size of the abscesses ranged from 3 to 17 cm. The time taken for complete healing to occur varied from 10 to 300 days and correlated directly with the initial size of the abscess cavity. As healing progressed, the abscess cavity became increasingly hypoechoic and assumed a smoother margin. In uncomplicated cases, complete healing occurred and, on ultrasound, no residual lesions were seen in the liver. There were two cases each of delayed healing and recurrence of amoebic liver abscess and the value of ultrasound in these situations is discussed. Ultrasound examination of the liver appears to be very suitable for assessing satisfactory progress of healing in amoebic liver abscess.

Humans↗
PubMed2001

[Pyogenic liver abscesses in cancer patients].

OBJECTIVE: To analyse the clinical behaviour of pyogenic liver abscesses among cancer patients, and to determine whether there is any difference between clinical behaviour among patients without malignancies. PATIENTS AND METHODS: Retrospective, multicentric study with 133 patients with pyogenic liver abscesses diagnosed during 13 years. Patients were divided into two groups: 29 patients with malignant tumors identified during the five years prior to abscess development (group 1) and 104 patients without malignant tumors (group 2). Clinical, biological and bacteriological findings, morphology and lesional topography, treatment and particularly, clinical course were analysed. RESULTS: Abscesses with portal pathogenesis were more common in group 1 (24% versus 10%; p = 0.03). Clinical and biological data were similar in both group but jaundice (31% versus 18%; p = 0.09), liver enlargement (38% versus 21%; p = 0.06) and pleural effusion (48% versus 28%; p = 0.03), which were more common in group 1. In the same group, the mean AST level was also higher (112 149 versus 60 88; p = 0.07 ). Morphology and lesional topography, as well as bacteriology in both groups did not differ significantly. In group 1, surgical drainage was performed less frequently (21% versus 38%; p = 0.09) and mortality rate was higher (24% versus 11%; p = 0.08). Nevertheless, no significant differences were observed between hospital stay and morbidity. Among patients treated with antibiotics only, the mortality rate was higher in group 1 (50% versus 10%; p = 0.06). CONCLUSIONS: In pyogenic liver abscess in patients with malignant tumor disease a predominance of portal pathogenesis was observed. The presence of cancer among patients with pyogenic liver abscesses did not imply a significantly different clinical presentation; however, the clinical course was worse than that observed in cases without cancer.

Adult↗
PubMed1980

Cryptogenic hepatic abscess in two uncompromised children.

A pre-mortem diagnosis of cryptogenic liver abscess in children is rare, but this diagnosis must be considered in the evaluation for pyrexia of unknown origin. Two previously healthy children were suspected of harboring liver abscesses. Radioisotopic, sonographic, and angiographic evidence supported the clinical diagnosis. Operative drainage was performed in each case. No source for either abscess was found and no cause established. Anaerobic bacteria, microaerophilic streptococcus and Fusobacterium necrophorum, each in pure culture, were retrieved on culture of the pus from each child's abscess. Experience gleaned from these two cases emphasizes the possibility of an hepatic abscess existing in the uncompromised child with fever of unknown origin. A cryptogenic hepatic abscess may occur in a child with only mild gastrointestinal complaints and in a child with sickle cell disease. Recovery is attributed to suspicion of diagnosis, prompt investigation, operative drainage, effective culture technique with isolation of organism and appropriate antibiotic coverage.

Adolescent↗
PubMed1994

Presentation, diagnosis and treatment of renal abscesses: 1972-1988.

We reviewed 61 consecutive patients with renal abscesses who were treated between 1972 and 1988 to determine whether the patient characteristics and mortality differed from those of patients treated during the preceding 2 decades. The results demonstrate that the predisposing conditions, symptomatology, abnormal physical findings, abnormal laboratory results, abnormal radiographic findings and infecting organisms of patients with renal abscesses have not changed during the last 40 years. Ultrasonography and computerized tomography, which became available in the 1970s, identified 35 of 38 (92%) and 23 of 24 (96%) abscesses, respectively. In 57 cases (97%) the abscess was drained and the patients survived. In 4 cases the abscess escaped clinical detection and contributed to patient death. The marked improvement of survival among patients with renal abscesses during the last 2 decades is attributable to improved diagnostic precision and, probably, improved antimicrobial therapy and supportive care.

Abscess↗
PubMed1992

Psoas abscess: case report and review of the literature.

Psoas muscle abscess is rare and presents a diagnostic challenge requiring a high index of suspicion. We report an unusual case of primary psoas abscess caused by Proteus mirabilis. Primary psoas abscess is most commonly present in children and is usually caused by Staphylococcus aureus. A total of 434 cases of psoas abscess has been reported. The subject is discussed noting the differences between primary and secondary cases, and emphasizing the importance of ultrasound and computerized tomography guided drainage of psoas abscess. A flow chart for the evaluation and management of primary and secondary abscess is presented, taking into consideration the success rate of the various methods of treatment described in the literature.

Aged↗
PubMedDate not supplied

Pyogenic liver abscesses and acute schistosomiasis mansoni: report on 3 cases and experimental study.

Three children with acute schistosomiasis mansoni developed pyogenic liver abscesses. The abscesses were diagnosed by ultrasonography and confirmed during laparotomy. Staphylococcus aureus were the sole bacteria isolated from the abscesses. An experimental study was carried out in mice to establish whether schistosomiasis is a predisposing cause for pyogenic liver abscesses. Seventeen mice (group 1) were infected with 40 Schistosoma mansoni cercariae (LE strain) and 60 d later inoculated intravenously with a strain of Staph. aureus, isolated from a patient with bacteraemia; 17 mice infected with Sch. mansoni (group 2), 19 infected with bacteria alone (group 3), and 18 uninfected mice (group 4), served as controls. Thirteen group 1 mice (77%) developed multiple liver abscesses while none was observed in the controls. These results indicate that acute schistosomiasis mansoni concurrent with Staph. aureus bacteraemia favours the colonization of the liver by bacteria and the development of pyogenic hepatic abscesses.

Acute Disease↗