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PubMed1996

Cellular mechanisms of abscess formation: macrophage procoagulant activity and major histocompatibility complex recognition.

BACKGROUND: Macrophage procoagulant activity (PCA) has been proposed as a key mediator of abscess formation. Experimentally, transient systemic bacterial infection lead to increased numbers of intraabdominal abscesses after a subsequent episode of peritonitis. We tested the hypothesis that these events were regulated by classic major histocompatibility complex (MHC)-restricted antigen processing and presentation to lymphocytes followed by lymphocyte-mediated up-regulation of macrophage PCA. METHODS: In vitro, macrophages and lymphocytes from BALB/c or C57BL/6 mice either untreated or preexposed to Escherichia coli were coincubated with bacteria or lipopolysaccharide. Cell lysates were tested for PCA in a one-step dotting assay. In vivo, mice were either preexposed to E. coli or received passive transfer of lymphocytes from MHC-compatible or MHC-incompatible and naive or preexposed donors; peritonitis and intraabdominal abscesses were afterwards induced with E. coli, Bacteroides fragilis, and a sterile fecal adjuvant. Mice were killed after 10 days and were studied for abscess number and bacterial composition. RESULTS: The presence of lymphocytes consistently increased macrophage PCA; lymphocytes from preexposed donors induced twice as much PCA as lymphocytes from naive donors regardless of MHC background. Both bacterial preexposure and passive transfer of lymphocytes from preexposed donors increased later intraabdominal abscess number in an MHC-restricted fashion. CONCLUSIONS: Transient infections enhance subsequent lymphocyte-mediated macrophage PCA, correlating with increases in abscess formation after peritonitis. The need for MHC identity to reproduce these results via passive transfer in vivo is consistent with classic T-cell receptor-mediated antigen presentation and lymphocyte activation before enhancement of PCA during peritonitis.

Abscess↗
PubMed1997

Abscess superimposed on brain tumor: two case reports and review of the literature.

BACKGROUND: An abscess involving an already present brain tumor is a rare occurrence. METHOD: Two cases of an abscess superimposed on a brain tumor are presented and discussed. The medical literature is reviewed, and all reported cases are compared to our own. RESULTS: Only 15 cases of an abscess associated with a brain tumor were found in the literature, to which we add 2 of our own. About 60% were intrasellar or parasellar tumors. The origin of such an abscess at this location is by direct extension of the germs from a contiguous infected sinus. Our 2 additional cases were away from the sinuses. One is an ependymoma of the posterior fossa, and the other, a falcotentorial occipital meningioma, each with a superimposed abscess. CONCLUSIONS: We propose an alternate route for the formation of an abscess in conjunction with a brain tumor.

Brain Abscess↗
PubMed1987

Bacterial scleral abscesses after retinal buckling operations. Pathogenesis, management, and laboratory investigations.

Between 1971 and 1985, 28 patients were treated for a scleral abscess after a scleral buckle procedure. Twenty-six of the patients had the original surgery performed between those years during which a total of 4480 buckling procedures were performed. Therefore, the incidence of scleral abscess after buckling procedures was 0.58% (26/4480). All 28 patients had excessive pain, conjunctival chemosis and proptosis, a creamy white area of retina on the buckle, and a variable amount of vitreous inflammation. Seventeen of these patients had an especially severe scleral abscess with inflammatory vitreous opacification, which precluded visualization of the retinal vessels or allowed at most a hazy view of the optic nervehead or the scleral buckle. A review of these 17 severely involved patients showed that, in most cases (13 of 17), the vitreous inflammation was sterile. Therefore, most patients can be managed simply with immediate removal of the buckle along with topical and systemic antibiotics. A laboratory investigation showed that a cell-free millipore filtrate of Staphylococcus aureus culture in trypticase soy broth caused prominent but self-limited inflammation when injected intravitreally. Therefore, bacterial toxins or secretions could be the cause of the prominent vitreous inflammation in most patients with scleral abscesses. In another experiment, sponge exoplants, which had been soaked in a highly concentrated culture of S. aureus, were sutured episclerally in rabbits. A scleral abscess developed in 19 of 23 rabbit eyes with these infective sponges. Progressive scleral abscesses, which closely resembled those seen in humans, developed in 14 of the 23 eyes.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed1984

An experimental model for pyogenic liver abscess.

We have developed a reproducible small-animal model for pyogenic liver abscess, suitable for investigating diagnostic and therapeutic modalities. Male New Zealand white rabbits weighing 2-3 kg were anaesthetized and the liver exposed. Gentle pressure was applied with forceps to the right hepatic lobe. A suspension of 10(5) colony forming units (cfu) Escherichia coli plus Fusobacterium necrophorum (10(6) cfu) plus Bacteroides fragilis (10(6) cfu) was immediately injected into a mesenteric vein. Two weeks later a palpable mass (mean diameter 4 cm) had developed. Thick pus could be aspirated percutaneously. Necropsy revealed a single, but often multiloculated, abscess at the site of the previous trauma. Injection of E. coli alone did not produce any abscesses and B. fragilis alone only small abscesses, with low and variable frequency. Inoculation with F. necrophorum alone produced large abscesses, and a dose-response relationship was established. This is a simple and reliable small-animal model useful in studies of imaging techniques, antibiotic regimens and invasive treatments for pyogenic liver abscess.

Animals↗
PubMed1985

Legionella lung abscess after renal transplantation.

Although Legionella infections have been widely reported, the clinical importance of Legionella lung abscess has not been sufficiently emphasised. A renal transplant recipient with a pulmonary abscess due to Legionella pneumophila is presented and 21 other cases from the literature are reviewed. Seven abscesses arose in renal transplant patients. Even though an abscess may develop during treatment, superimposed infection with other micro-organisms appears to be uncommon, and an abscess may be expected to resolve with prolonged appropriate antimicrobial therapy alone. Recognition of lung abscess as a complication of legionella infection will therefore prevent unnecessary operations.

Adult↗
PubMed1997

Failure of intravenous antibiotic therapy of multiple temporal brain abscesses due to Propionibacterium acnes requiring temporal lobectomy.

Propionibacterium acnes is a common skin colonizer. Its involvement in brain abscesses is generally described as a complication of neurosurgical intervention. Propionibacterium acnes is susceptible to antibiotics used as treatment of anaerobic infections, except for the 5-nitroimidazoles. Surgical excision or drainage of a simple abscess combined with a long course of antibiotics is considered the treatment of choice. A case of a patient with multiple brain abscesses located in the right temporal lobe that occurred after the manipulation of an abscess of the right upper maxillary is reported. The patient did not improve despite a prolonged course of high-dose intravenous penicillin plus thiamphenicol and cure was finally obtained after the excision of the right temporal lobe. Culture of the purulent material and the shell of the abscesses yielded P. acnes which was sensitive to all the antibiotics administered to the patient up to the intervention. The temporal lobectomy was followed by a 6-month course of ofloxacin. One year after the intervention, the patient remained apyretic without any other abscess on cranial computed tomography scan.

Adult↗
PubMed1999

Selection of antibiotics after incision and drainage of peritonsillar abscesses.

Despite the fact that peritonsillar abscess is the most common complication of acute tonsillitis, the treatment of peritonsillar abscess remains controversial. One element of controversy is the choice of antibiotics after drainage of the abscess. In an attempt to assess the effect of antibiotic choice on the treatment of peritonsillar abscess, we conducted a retrospective review of records from patients with peritonsillar abscess treated with incision and drainage. Our review identified 103 patients, comprising two groups: 58 patients treated with broad-spectrum intravenous antibiotics and 45 patients treated with intravenous penicillin alone. These patients were hospitalized after incision and drainage, and therefore their clinical courses and responses to therapy could be rigorously assessed. Characterization of illness based on patient age, temperature, and white blood cell count revealed similar severity of illness between the two groups. Comparison of clinical outcomes with respect to hours hospitalized (mean 44.3 +/- 6.6 and 38.3 +/- 7.1 hours, 95% confidence interval, for broad-spectrum and penicillin groups, respectively) and mean hours febrile (16.9 +/- 5.0 and 13.3 +/- 4.2 hours, 95% confidence interval) were not statistically significantly different (p = 0.222 and 0.269, respectively) between groups, indicating that broad-spectrum antibiotics failed to show greater efficacy than penicillin in the treatment of these patients. The microbiologic characteristics of these infections, failures of therapy, and complication rates were similar to those reported in the literature. These results suggest that intravenous penicillin remains an excellent choice for therapy in cases of peritonsillar abscess requiring parenteral antibiotics after drainage.

Adolescent↗
PubMed1995

Brain abscess: with special reference to otolaryngologic sources of infection.

The number of brain abscesses has been reduced since the preantibiotic era. This was accomplished by judicious use of antibiotics, by the advent of computed tomography, and by improvements in patient care and surgical techniques. Analysis from 122 patients with brain abscess demonstrated this trend of progress. Our series had a 3.2-to-1 male predominance. The underlying conditions included otolaryngologic infections (26 cases), cyanotic heart diseases (27 cases), implantation abscess (25 cases), lung infections (5 cases), meningitis (4 cases), osteomyelitis (2 cases), decreased immunity from chronic systemic diseases (12 cases), and unknown causes (21 cases). Otolaryngologic subgroups can be detailed as chronic otitis media with cholesteatoma (15 cases), chronic otitis media with mastoiditis (4 cases), sinusitis (2 cases), esophageal stenosis (3 cases), cheek cellulitis (1 case), and nasopharyngeal carcinoma (1 case). The initial symptoms and signs were headache (46 cases), fever (36 cases), altered consciousness (30 cases), neurologic deficits (33 cases), vomiting (11 cases), and seizure (17 cases). Of the brain abscesses treated, multiple brain abscess represented 16.4% of all cases. The overall percentage of patients with full recovery was 52.5%, whereas 84.8% of otolaryngologic subgroup recovered fully. The overall mortality was 19.7%. The mortality rate of brain abscess from otolaryngologic sources was 3.8%, whereas that from nonotolaryngologic sources was 24%.

Adolescent↗
PubMed2000

[Percutaneous treatment of retroperitoneal abscesses].

UNLABELLED: The retroperitoneal abscess is an uncommon disease, that must be treated by drainage. The progressive use of the percutaneous drainage, under ultrasound or computed tomography guidance (CT), has changed the therapeutical management and has demonstrated to be a valid alternative to surgical drainage. From 1986 to 1998, 16 patients with retroperitoneal abscesses were treated by percutaneous drainage (14 with CT and 2 with ultrasound guidance). This method eradicated the abscess in 13 cases, in 2 was necessary a new function to cure the abscess, and 1 patient, with a severe sepsis, died. Percutaneous drainage was the unique treatment used in 12 patients. In the remaining four, the patients' clinical status improved after percutaneous drainage, and they were able to undergo subsequent elective nephrectomy. CONCLUSIONS: Percutaneous drainage of retroperitoneal abscesses has been established as a viable alternative to surgical intervention. This method can resolve the abscess or improve the patient' clinical status to undergo elective surgery.

Abscess↗
PubMed1998

Ultrasound-guided interventional procedures in splenic abscesses.

The results of ultrasound (US)-guided interventional procedures over a period of 12 years in 21 consecutive patients with splenic abscess were reviewed. The interventional procedures were done with 21- or 18-gauge needles for aspiration of relatively small abscesses (< 3.5 cm) in eight patients and with an 8.3-9.0 French pigtail catheter for continuous drainage in 13 patients with larger abscesses (> or = 3.5 cm). In some patients, multiple abscesses were treated separately according to their various sizes. More than one catheterization were done in three patients because of detached catheter or recurrent abscesses. The interventional procedures were followed by at least eight weeks of appropriate antibiotic therapy. Only one patient had the complication of minimal subcapsular hematoma which needed no further treatment. All the patients had uneventful clinical courses. US-guided interventional procedure proved to be a treatment-of-choice for splenic abscess, and may avoid splenectomy by conserving the spleen.

Abscess↗
PubMed2002

Splenic abscess with Vibrio cholerae masking pancreatic cancer.

A 77-year-old man presented to our hospital with a clinical scenario suspicious for endocarditis with septic emboli to the lungs and splenic abscess. Vibrio cholerae was isolated from purulent material aspirated from the abscess. Medical therapy and percutaneous drainage of the abscess were unsuccessful. The patient underwent splenectomy and distal pancreatectomy revealing a pancreatic tail carcinoma involving the spleen and colon. The patient later expired secondary to metastatic disease. This case represents the first isolation of V. cholerae from a splenic abscess but also illustrates that although newer imaging technologies have made the diagnosis of splenic abscess easier, the true etiology of the abscess may remain elusive.

Abscess↗
PubMed1999

Renal abscess: early diagnosis and treatment.

The purpose of this study was to identify initial clinical characteristics that can lead to early diagnosis of renal abscess in the emergency department and predict poor prognosis. A retrospective review of 88 renal abscess patients, from April 1979 through January 1996, was conducted. Patients were categorized into two groups. In group 1, renal abscess was diagnosed by an emergency physician, whereas in group 2 renal abscess was not diagnosed by an emergency physician. Clinical characteristics included demographic data, predisposing medical problems, duration of illness before diagnosis, time spent in hospital diagnosis, initial signs and symptoms, laboratory tests, and radiology studies that may have been useful in the early diagnostic regimes. Clinical factors were also analyzed for their value in predicting poor prognosis. The mean age of 88 patients with renal abscess was 59.8 years. The most common predisposing disorder was diabetes mellitus, followed by renal calculi and ureteral obstruction. The duration of diagnosis by emergency physicians was shorter for group 1 patients (1.2 +/- .4 v group 2, 2.8 +/- 2.9 days; P < .01) and the blood urea nitrogen level was higher in group 1 (55.7 +/- 42.2 mg/dL, v group 2, 33.5 +/- 33.5 mg/dL; P = .02). In the early diagnosis of renal abscess, emergency physicians should focus on patients who have predisposing disorders, ie, diabetes mellitus, renal stones, immunosuppression, longer duration of symptoms of urinary tract infection, and renal failure, who should promptly be investigated with ultrasound in the emergency department. The cure rate after treatment with routine antibiotics plus percutaneous drainage was 64%. This therapy is recommended for initial treatment. Poor prognosis is associated with elderly patients with lethargy and with elevation of the serum blood urea nitrogen level.

Abscess↗
PubMed2001

Brain abscess in patients with hereditary hemorrhagic telangiectasia: case report and literature review.

Hereditary hemorrhagic telangiectasia (HHT), or Osler-Weber-Rendu disease, affects multiple organ systems. Brain abscess is a potential complication, and this disease carries a high mortality. In the setting of HHT the abscess most likely results from paradoxical septic emboli or bacterial seeding of an ischemic portion of the brain after paradoxical sterile emboli. Brain abscess is the diagnosis that must be ruled out in patients with HHT presenting with new onset neurologic symptoms. The clinician can be misled by seemingly benign and nonspecific symptoms, signs, and laboratory test results. Appropriate diagnostic imaging with computed tomography or magnetic resonance imaging of the head is mandatory. We present a case of brain abscess in a patient with HHT presenting to the Emergency Department. The review of the literature deals with the pathophysiology and manifestations of HHT with particular focus on the pathologic and clinical features, and management of cerebral abscess in this setting. Differences between patients with brain abscess with or without HHT are highlighted.

Brain Abscess↗
PubMed2003

Loss of hemolysin expression in Staphylococcus aureus agr mutants correlates with selective survival during mixed infections in murine abscesses and wounds.

During the screening of a Staphylococcus aureus signature-tagged mutagenesis library, it was noted that nonhemolytic bacteria became more abundant as time passed in murine abscess and wound models, but not within organ tissues associated with systemic infections. To examine this further, a mixed population of hyperhemolytic, hemolytic, and nonhemolytic S. aureus strain RN6390 cells were inoculated into mice using abscess, wound, and systemic models of infection. After 7 days in the abscess, the hyperhemolytic group markedly declined, whereas the nonhemolytic population increased significantly. A similar phenomenon occurred in murine wounds, but not during the systemic infection. Sequencing of several of the signature-tagged mutants indicated mutations in the agrC gene or within the agrA-agrC intergenic region. Both alpha-hemolysin and delta-hemolysin activity was curtailed in these mutants, but beta-hemolysin activity was unaffected. Single strain comparisons between wild-type strain 8325-4 and strain DU1090 (hla-) as well as between strain RN6911 (agr) and wild-type strain RN6390 were performed using the same three animal models of infection. The agr mutant strain and the hla mutant strain showed no difference in bacterial counts in murine wounds compared to their respective parent strains. The same held true in murine abscesses at day 4, but strain RN6911 counts then declined at day 7. Considerable clearing of the hla mutant strain and the agr mutant strain occurred in the systemic model of infection. Mixed infections with the DU1090 and 8325-4 strains in the abscess model showed a slight advantage given to the DU1090 population, but a distinct selection for the parental 8325-4 strain in the liver. These results suggest that agr mutations cause reductions in the expression of several secreted proteins, including alpha- and delta-hemolysin, which in turn contribute to a growth advantage of this agr mutant group within a mixed population of S. aureus cells residing in abscesses and wounds.

Abscess↗
PubMed1998

The role of power Doppler sonography in the evaluation of superficial soft tissue abscesses.

OBJECTIVE: To evaluate the efficacy of power doppler ultrasonography in depicting increased vasculature and hyperemia around the superficial soft tissue abscess. MATERIALS AND METHODS: 21 patients with soft tissue abscess were evaluated with gray scale imaging, color doppler sonography, power doppler sonography and computed tomography. In each case attempts were made using power doppler sonography to demonstrate any areas of increased vascularity around the lesion. The results were compared with computed tomographic findings. RESULTS: Peripheral hyperemia and increased vasculature were demonstrated with power doppler sonography in 19 of 21 patients with soft tissue abscess. The hyperemic area demonstrated around the wall of the abscess by power doppler sonography was similar to the enhanced area shown by computed tomography performed after contrast administration. CONCLUSION: Power doppler sonography shows increased vasculature and hyperemia in the wall of abscesses. Therefore, power doppler sonography can be used to assist with the diagnosis of superficial soft tissue abscess.

Abscess↗
PubMed1998

Predictive model for the diagnosis of intraabdominal abscess.

RATIONALE AND OBJECTIVES: The authors investigated the use of an artificial neural network (ANN) to aid in the diagnosis of intraabdominal abscess. MATERIALS AND METHODS: An ANN was constructed based on data from 140 patients who underwent abdominal and pelvic computed tomography (CT) between January and December 1995. Input nodes included data from clinical history, physical examination, laboratory investigation, and radiographic study. The ANN was trained and tested on data from all 140 cases by using a round-robin method and was compared with linear discriminate analysis. A receiver operating characteristic curve was generated to evaluate both predictive models. RESULTS: CT examinations in 50 cases were positive for abscess. This finding was confirmed by means of laboratory culture of aspirations from CT-guided percutaneous drainage in 38 patients, ultrasound-guided percutaneous drainage in five patients, surgery in five patients, and characteristic appearance on CT scans without aspiration in two patients. CT scans in 90 cases were negative for abscess. The sensitivity and specificity of the ANN in predicting the presence of intraabdominal abscess were 90% and 51%, respectively. Receiver operating characteristic analysis showed no statistically significant difference in performance between the two predictive models. CONCLUSION: The ANN is a useful tool for determining whether an intraabdominal abscess is present. It can be used to set priorities for CT examinations in order to expedite treatment in patients believed to be more likely to have an abscess.

Abdominal Abscess↗
PubMed2000

Prompt regression of paravertebral and epidural abscesses in patients with pyogenic discitis. Sixteen cases evaluated using magnetic resonance imaging.

OBJECTIVE: To determine whether spinal magnetic resonance imaging performed one month into anti-microbial therapy for pyogenic discitis demonstrated changes of value for predicting outcomes and making therapeutic decisions. METHODS: Prospective study of 16 patients with discitis. A physical evaluation, laboratory tests for inflammation, plain radiographs centered on the affected vertebral level, and magnetic resonance imaging with gadolinium injection were performed at baseline and on day 30. All 16 patients were reevaluated after three months and 15 after six months. RESULTS: The 12 men and four women had a mean age of 59 years. Fourteen patients had a paravertebral abscess (n=12) and/or an epidural abscess (n=6). On day 30, 14 of the 16 patients were clinically improved and ten were radiologically improved. The C-reactive protein level was still elevated in five cases. All reevaluated patients were improved after three months (16/16) and six months (15/15). Only two magnetic resonance imaging features improved during the first month: the size of paravertebral abscesses decreased in 11 of 12 patients, and the size of epidural abscesses decreased in four of six patients. CONCLUSION: Paravertebral and epidural abscesses improve promptly under antimicrobial therapy. However, the presence of these lesions have no prognostic significance. Magnetic resonance imaging does not add significantly to the follow-up of patients who respond clinically to antimicrobial therapy. However, in patients with an unsatisfactory clinical response, follow-up magnetic resonance imaging can provide useful therapeutic orientation by showing whether the paravertebral and/or epidural abscesses have decreased in size.

Adult↗
PubMed1991

Bezold's abscess.

Since the introduction of antibiotics for the treatment of suppurative otitis media the incidence of complications from this disease has been greatly diminished. Acute mastoiditis, resulting in the deep neck abscess known as Bezold's abscess, has become very rare. A case of Bezold's abscess is presented with special reference to the clinical presentation and pathogenesis of this now uncommon condition. The variations in the routes of spread of the abscess in the fascial planes of the neck are described in detail. The difference between what is known today as a Bezold's abscess and the abscess that Bezold described in the early part of this century are presented.

Abscess↗