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PubMed1998

Nocardia abscess of the choroid plexus: clinical and pathological case report.

OBJECTIVE: Cerebral Nocardia abscesses are rare, accounting for approximately 1 to 2% of all cerebral abscesses. Prompt aggressive surgical treatment involving craniotomy and excision of these lesions has been advocated by many authors, because these lesions have significantly higher morbidity and mortality rates than do most other cerebral abscesses. We report an atypical presentation of cerebral nocardiosis localized to the choroid plexus of the lateral ventricle. CLINICAL PRESENTATION: A 56-year-old man presented with a 3-week history of fever, cough, and progressive headache and an ensuing 3-day history of progressive lethargy, confusion, and gait ataxia. Radiographic studies demonstrated a loculated contrast-enhancing left lateral ventricular lesion with significant perilesional parenchymal edema that was thought preoperatively to be a neoplasm. INTERVENTION: The patient underwent a craniotomy for resection of the lesion. Intraoperatively, a reddish gray lesion with purulent exudate was encountered within the left lateral ventricle intimately adherent to the choroid plexus as well as to the ependyma and subependymal veins. A frozen section demonstrated an organizing abscess wall. The lesion was resected in its entirety, and multiple cultures were sent for analysis. CONCLUSION: Microbiology cultures grew Nocardia asteroides. A course of intravenous antibiotics was started, which included trimethoprim-sulfamethoxazole, amikacin, and ceftriaxone. Two weeks after surgery, at the time of discharge, the patient's neurological status had improved considerably. Although Nocardia abscesses have been documented to occur throughout the central nervous system, the presentation of a lesion confined to the choroid plexus of the lateral ventricle with significant parenchymal edema is unusual and demonstrates that Nocardia abscesses must be considered in the differential diagnosis of a contrast-enhancing intraventricular mass lesion involving the choroid plexus.

Brain Abscess↗
PubMed1997

The value of 67Ga-citrate scanning in psoas abscess.

Psoas abscess is a serious health problem which presents with non-specific symptoms and signs. To reduce morbidity and mortality, it is important to diagnose the presence and extent of a psoas abscess accurately using imaging studies. Because the 67Ga scan may facilitate the early diagnosis of insidious infection and assist CT-guided percutaneous drainage of the abscess, we examined the value of 67Ga scans in 18 patients with psoas abscess. The imaging results of 67Ga scans (18 patients), computed tomography (CT) (16 patients) and bone scans (13 patients) were analyzed. In this series, concomitant infections were very common (94%) in patients with psoas abscess. For detecting psoas abscess, the sensitivity of 67Ga scanning (92%) and CT (91%) was similar. However, 67Ga scanning is superior to CT in demonstrating concomitant infectious foci at other sites. Bone scanning is a sensitive tool for depicting osteomyelitis, which was common in this series of patients. We also found that increased vascularity in the psoas area was demonstrated by three-phase bone scanning in 60% of patients.

Adult↗
PubMed1991

Renal abscess in childhood: diagnostic and therapeutic progress.

During the past decade new techniques such as computed tomography (CT) and ultrasonography have been reported to have changed the diagnostic investigation and treatment of renal abscess in adults. To evaluate whether similar changes have taken place in the pediatric age group, a retrospective study of all patients seen between 1979 and 1989 was performed. Seven patients, 0.8 to 14 (mean, 9) years old, with renal abscesses in eight kidneys were identified. Ultrasound and computed tomography proved to be the most valuable diagnostic tools, revealing the diagnosis by showing a hypoechoic or hypodense mass. All patients had an initial trial of intensive antibiotic treatment, which led to resolution of the abscesses in two of the eight kidneys. In all other cases the abscesses were additionally drained, which was done surgically in two and by ultrasonography- or CT-guided percutaneous drainage in four patients. Abscess cultures grew Staphylococcus aureus (three), Escherichia coli (one) and Salmonella Group B (one) and were sterile in one case. Drainage was unsuccessful in only one patient, who subsequently underwent nephrectomy for uncontrolled infection of a diffusely damaged kidney. We conclude that the diagnosis of renal abscesses is greatly facilitated by ultrasonography and CT and that most patients can be cured without operation by antibiotics and, if necessary, by additional percutaneous drainage.

Abscess↗
PubMed1993

Evaluation of oral erythromycin and local isoniazid instillation therapy in infants with Bacillus Calmette-Guérin lymphadenitis and abscesses.

A randomized placebo-controlled prospective trial was conducted to evaluate the efficacy of erythromycin therapy in 69 patients affected with Bacillus Calmette-Guérin lymphadenitis. When patients who developed subsequent regional abscesses were excluded, erythromycin caused significantly earlier resolution of lymphadenitis (5.1 months vs. 5.7 months for placebo; P < 0.01) compared with placebo. There was no significant difference in the proportion of patients who developed subsequent regional abscesses between the 2 groups (47% for erythromycin, 60% for placebo, P = 0.14). When the entire group of 69 patients was evaluated for "duration to heal" (regardless of subsequent abscess formation), erythromycin therapy (4.1 +/- 1.5 SD months) did not differ significantly from the placebo group (3.5 +/- 1.3 months, P = not significant). Patients who developed subsequent abscess (n = 36) along with those with B. Calmette-Guérin regional abscesses at presentation (n = 27) were further studied to compare oral erythromycin therapy with that of single dose 50-mg intranodal isoniazid instillation. Local isoniazid therapy caused significantly earlier resolution of the abscesses (3.9 months) compared with erythromycin therapy (5.2 months; P < 0.001).

Abscess↗
PubMed1982

Postmenopausal breast abscess.

Eighteen postmenopausal women with breast abscess were treated at Grady Hospital between 1975 and 1978. Breast abscess was remarkable for its characteristic lack of inflammation, as well as its rarity, in this age group (median, 59 years). Only 17% of patients reported fever and/or breast pain. On initial examination, 33% had erythema, warmth, and/or fluctuance. The white blood cell count was greater than 10,000/cu mm in only 14% of patients. (Abscess was not even suspected in 22%, as a breast "mass" was excised for diagnostic frozen section.) The preoperative diagnosis was cancer in 55%. Location was peripheral in 27% and subareolar in 72%, similar to what has been noted in premenopausal women. The rare occurrence of breast abscess in postmenopausal women can be confused with cancer because of the abscess' indolent characteristics. History, physical examination, mammograms, and white blood cell count are equally unhelpful in the diagnosis. Although ideal treatment of abscess is usually incision and drainage, in this age group excision of the total "mass" is sometimes beneficial for diagnosis and prevention of recurrence.

Abscess↗
PubMed1987

Clinical differentiation of abscess from neoplasm in newly diagnosed space-occupying lesions of the liver.

The clinical presentations of liver abscess, hepatoma, and metastatic tumor to the liver may be quite similar, and procedures such as computerized tomography, radionuclide scanning, and ultrasonography of the liver cannot make a specific diagnosis. Therefore, we compared the clinical presentations of 38 patients seen during the last five years with liver abscess (13 patients), hepatoma (eight patients), and undifferentiated carcinoma metastatic to the liver (17 patients). Patients with liver abscess were distinguished from the other two groups by a significantly shorter prodrome, a history of known risk factors for liver abscess, fever, leukocytosis, and a normal-sized liver (P values all less than .1). A finding of three or more of these criteria correctly identified all cases of liver abscess. Only one of the 25 patients with neoplasms had three of the criteria. The presence of multiple or single lesions, abdominal pain, weight loss, or liver function abnormalities did not differ significantly among the three groups. Thus patients with liver abscess can be reliably differentiated from patients with hepatic neoplasms by clinical criteria alone, and appropriate empiric antibiotic therapy can be started while the diagnosis is being confirmed.

Carcinoma, Hepatocellular↗
PubMed1988

Catheter drainage of ischiorectal abscesses.

We retrospectively reviewed the charts of 55 patients with ischiorectal abscesses treated from 1980 to 1983 at the Cleveland Clinic Foundation. The patients were treated by placement of a 10F to 16F soft latex mushroom catheter into the abscess cavity under local anesthesia as an office procedure. The end of the catheter was shortened to leave 2 to 3 cm exiting the skin, and a bandage was applied. No sutures or irrigations were used, and the drains were removed an average of 12 days after placement. Antibiotics were not given. The patients ranged in age from 17 to 76 years (mean, 40 years) and 36% were female. Four patients had diabetes, and eight had a history of inflammatory bowel disease. Nine patients had been treated previously for anorectal abscesses. There were no complications. Adequate follow-up was obtainable in 31 patients (ten to 63 months; mean, 30 months). Eight of them (26%) were subsequently treated for fistulas found after resolution of the abscess, and an additional eight (26%) had a second abscess form during the follow-up period. The average time to this recurrence was 20 months. Catheter drainage of ischiorectal abscess in selected cases resulted in healing with low morbidity and significant cost savings.

Abscess↗
PubMed1995

Intramedullary spinal cord abscess. A case report.

STUDY DESIGN: A case of an intramedullary spinal cord abscess is presented. The literature on this subject is carefully reviewed. OBJECTIVES: To give an overview of clinical presentation, radiographic examination, pathogenesis, treatment, and outcome of intramedullary spinal cord abscesses. Cases presented in the literature are arranged and the findings summarized. SUMMARY OF BACKGROUND DATA: Intramedullary spinal cord abscesses are rare. Most frequently, single cases were reported, followed by a short discussion. All previously reported cases were reviewed. METHODS: After an extensive literature search, all cases of an intramedullary spinal cord abscess (totaling 93 patients), including ours, were reviewed. Incidence, clinical presentation, neuroradiologic investigations, treatment, and pathogenesis are discussed. RESULTS: Intramedullary spinal cord abscesses are rare. The presentation can be very confusing, mimicking thoracic or abdominal diseases. Magnetic resonance imaging is the best diagnostic technique, although the findings are not pathognomonic. Appropriate antibiotic therapy after surgical drainage is warranted. If left untreated, the outcome is bleak. Whereas most cultures remain sterile (38.7%), Staphylococcus or Streptococcus species are involved frequently (23.7% and 17.2%). CONCLUSIONS: Although intramedullary spinal cord abscess is a rare disease, every spine surgeon should have knowledge of its existence because misjudgment and deferring adequate treatment may lead to an unfavorable outcome.

Abscess↗
PubMed1995

Latent solitary tuberculous psoas abscess 52 years after healed thoracolumbar tuberculous spondylitis.

STUDY DESIGN: This study reports on an extremely rare case of tuberculous psoas abscess and describes the mode of diagnosis and treatment. OBJECTIVE: This patient is presented to emphasize that cases of solitary psoas abscess resulting from tuberculosis exist today. SUMMARY OF BACKGROUND DATA: No recent cases of latent solitary tuberculous psoas abscess have been reported, to the authors' knowledge. METHODS: A tuberculous psoas abscess associated with fistula to the greater trochanter may remain dormant for years after tuberculous spondylitis has healed, as a distinct entity without concomitant active bone infection. In our 58-year-old female patient, the diagnosis of a psoas abscess was greatly aided by the "three pass" technetium bone scan and computed tomography, but the anamnesis also was important. RESULTS: Anti-tuberculosis medication (streptomycin, aminosalicylic, and isoniazid) combined with open drainage, curettage of the psoas, and simultaneous revision of the fistula eradicated the disease, making the course of the disease uneventful until the 5-year follow-up evaluation. CONCLUSIONS: Orthopedic surgeons must be aware of the rare, delayed appearance of a solitary psoas abscess after tuberculous spondylitis.

Female↗
PubMed2003

Drainage of liver abscess via laparoscopic trocar with local anesthesia.

There are several methods for treatment of liver abscess. These include drainage by open surgery, laparoscopic surgery, or percutaneous catheterization. In this report a new therapeutic approach is presented. A 47-year-old man admitted to the hospital had an abscess 12 cm in diameter, originating from the left liver lobe. After the patient's permission was obtained, a laparoscopic trocar was inserted into the abscess with the patient under local anesthesia in the operating room. A 28-French chest tube catheter was introduced through the trocar cannula, and approximately 1,000 mL of pus was drained. There were no complications, and the patient was discharged on the same day. After computed tomography showed an obliterated abscess cavity, the drain was removed on postoperative day 7. The pus culture, performed on the day of surgery, was found to be positive for Escherichia coli, which was responsive to cefaclor. Oral antibiotic therapy was given for 1 month. At follow-up 2 months after surgery, the patient was asymptomatic. This report describes the first case of a liver abscess drained by a laparoscopic trocar with local anesthesia. This method can be the treatment of choice for some easily accessible liver abscesses.

Anesthesia, Local↗
PubMed2004

Management of splenic abscess in a critically ill patient.

Because of the increased number of immunocompromised patients within the general population, the incidence of splenic abscesses has increased over the last decade. This cohort of immune-deficient patients with splenic abscesses engenders a distinct evolution in the pathogenesis and microbiology of the disease process. Moreover, the morbidity and mortality rates for splenic abscesses are increased in this unique population. Clinically, these patients do not have a characteristic presentation. Diagnostically, computed tomography of the abdomen is the test of choice. Antibiotics and splenectomy remain the standard of care in most clinical settings. However, percutaneous drainage is reported with solitary and unilocular abscesses and in poor operative candidates. An unusual case of a patient with a splenic abscess awaiting heart transplantation is presented. This patient was successfully treated with percutaneous drainage and antibiotics. The literature regarding the presentation, diagnosis, pathogenesis, and treatment of splenic abscesses is reviewed as well.

Abscess↗
PubMed2004

Extended cervicolumbar spinal epidural abscess associated with paraparesis successfully decompressed using a minimally invasive technique.

STUDY DESIGN: A case of a multisegmental, cervicothoracolumbar epidural abscess, in an 80-year-old man, successfully decompressed by using a minimally invasive technique, is presented. OBJECTIVE: To review risk factors, diagnosis, treatment, decompression techniques, and morbidity and mortality regarding spinal epidural abscess. SUMMARY OF BACKGROUND DATA: Extended spinal epidural abscess is a rate entity. To our knowledge, this is the first report of a multilevel spinal epidural abscess, completely decompressed by limited laminectomies in combination with the use of a silicon catheter, epidurally. METHODS: The clinical and radiographic features associated with spinal epidural abscess, as well as decompression technique, are presented. The 80-year-old man, with a one week history of urinary tract infection, presented with fever and low back pain, mild weakness in his legs and jaundice. He underwent bilateral limited laminectomies at T2-T3 and a right hemilaminectomy at L1-L2 and the pus was drained, under mild continuous suction, using a 2.7 mm outer and 1.3 mm inner diameter silicon catheter, inserted caudally and cranially into the epidural space, at both the laminectomy sites. RESULTS: The patient experienced immediate relief of the low back pain, gradual fever subsidence and full neurological recovery during the next 3 weeks. CONCLUSION: In cases of suspected acute epidural abscess, especially in elderly debilitating patients: the whole spine should be scanned by MRI to exclude the possibility of multilevel involvement and adequate pus drainage, when indicated, could be performed with the above described minimally invasive technique.

Aged↗
PubMed2004

Epidural abscess and discitis complicating instrumented posterior lumbar interbody fusion: a case report.

STUDY DESIGN: A case of epidural abscess and discitis following instrumented PLIF using a single carbon fiber interbody cage is presented. OBJECTIVE: To describe a previously unreported complication of epidural abscess and discitis following posterior lumbar interbody fusion using a single carbon fiber cage. SUMMARY OF BACKGROUND DATA: Various complications have been reported with PLIF. These include graft migration, pseudarthrosis, implant subsidence, epidural hemorrhage, incidental durotomy, arachnoiditis, transient or permanent neurologic deficits, persistence of pain, and wound infections. There are no reported cases of epidural abscess or refractory discitis associated with PLIF. METHODS: A 35-year-old infantryman on active duty with chronic low back pain and single-level lumbar disc degeneration underwent instrumented PLIF after reporting no improvement with 3 years of extension-based physical therapy and nonsteroidal pain medications. His back pain was reported improved at 6 weeks after surgery. At 12 weeks after surgery, he presented to the emergency department with intense back pain and fevers. Laboratory data were remarkable for elevated erythrocyte sedimentation rate (118) and C-reactive protein (38). Initial imaging studies, including a lumbar MRI, did not demonstrate any abnormalities. The patient continued to spike fevers, and a repeat lumbar MRI 1 week later clearly demonstrated the presence of an epidural abscess at the level of the PLIF surgery. The patient was treated with surgical debridement and epidural abscess drainage. The interbody cage was left in place. Surgical cultures identified Staphylococcus aureus as the pathogen, and the patient was placed on intravenous vancomycin. During the ensuing 3 weeks, his clinical symptoms worsened and his radiographs demonstrated lucency in the region of his interbody cage. Repeat debridement was performed, and his interbody cage and pedicle screw instrumentation were removed 4 months after initial surgery. RESULTS: The disc space infection resolved following removal of the implants. Radiographs at 6 months after instrumentation removal demonstrated solid bilateral posterolateral arthrodesis. The patient returned to active duty 1 year after his initial surgery, reporting that his back pain was reduced compared with his preoperative level. CONCLUSIONS: There is a paucity of literature on epidural abscess and discitis as complications associated with PLIF. In this case, the infection persisted despite surgical debridement and intravenous antibiotics. The patient ultimately required removal of the interbody implant and posterior instrumentation. The patient developed solid posterolateral arthrodesis despite the presence of deep infection, which led to early implant removal 4 months after the initial surgery. This case underscores the potential importance of concomitant posterolateral fusion, particularly following wide laminectomy and facetectomy required for PLIF.

Adult↗
PubMed2006

Two cases of pott disease associated with bilateral psoas abscesses: case report.

STUDY DESIGN: Two case reports and a literature review of spinal osteomyelitis with bilateral psoas abscesses secondary to Mycobacterium tuberculosis. OBJECTIVE: Describe the presentation, diagnosis, treatment, and outcome of spinal tuberculosis (i.e., Pott disease). SUMMARY OF BACKGROUND DATA: Pott disease is a well-known condition in unindustrialized countries causing multiple spinal deformities in children. However, its association with bilateral psoas abscesses in adults with minimal risk factors is not commonly recognized in industrialized countries. METHODS: There are 2 adult cases of Pott disease with psoas abscesses presented, and the relevant literature is reviewed. Plain spine radiographs, spine magnetic resonance imaging (MRI), routine bacterial and acid-fast bacilli cultures of infected material, and other diagnostic testing for M. tuberculosis were performed. RESULTS: Plain radiographs and MRI of the spine showed vertebral osteomyelitis with compression fractures, and MRI also revealed bilateral psoas abscesses. Acid-fast bacilli culture and other M. tuberculosis diagnostic testing of psoas abscess specimens confirmed the diagnosis of M. tuberculosis. CONCLUSION: Although spinal osteomyelitis with psoas abscess is classically associated with Staphylococcus aureus infection, Pott disease should be considered in this clinical setting, and risk factor assessment and testing for tuberculosis should be performed.

Aged, 80 and over↗
PubMed2007

Infantile lumbosacral spinal subdural abscess with sacral dermal sinus tract.

STUDY DESIGN: Clinical case report of a spinal subdural abscess in an infant presenting with sacral dermal sinus tract (DST). OBJECTIVES: To suggest that sacral DST with caudal direction may require surgical resection as early as possible. SUMMARY OF BACKGROUND DATA: DST may induce the formation of a spinal abscess. However, it is sometimes difficult to decide on early surgical resection for DST, especially in cases that are located at a lower level than the lumbar spine and directed caudally that is not accompanied by cerebrospinal fluid leakage. METHODS: A 9-month-old girl was transferred due to intermittent fever and vomiting, with the midline sinus of the lower back at the second sacral spinal level. She showed mild tenderness of the lower back and slight weakness of both lower extremities with increased residual urine volume of the bladder. Magnetic resonance imaging (MRI) showed that the low-lying sacral DST traced into the subdural space with caudal orientation, and the presence of extensive subdural spinal abscess from the first lumbar spine to the fourth sacrum. RESULTS: Emergency resection of the sacral DST was performed after laminotomy from the first lumbar spine to the second sacrum, and the subdural spinal abscess was also surgically removed. After 8 weeks of intravenous antibiotic treatment, she showed no neurologic deficit and no evidence of residual abscess on MRI. CONCLUSION: We suggest that even low-lying sacral DST may require surgical resection as early as possible because it may result in indolent and extensive spinal abscesses.

Abscess↗
PubMed2005

Effect of corticosteroids in the acute management of pediatric orbital cellulitis with subperiosteal abscess.

PURPOSE: To determine the effect of intravenous corticosteroids in the acute management of pediatric orbital cellulitis with subperiosteal abscess. METHODS: The inpatient records of all patients treated for orbital cellulitis with subperiosteal orbital abscess between January 2001 and August 2003 were reviewed. The use of corticosteroids, length of hospital stay, need for surgical drainage, treatment course, and clinical outcomes were reviewed. A t test and Fisher exact test analysis were calculated to evaluate statistical significance. RESULTS: Twelve patients received intravenous corticosteroids and 11 patients did not receive corticosteroids. All patients had complete resolution of their abscess without complications. Length of hospitalization between the patients treated with and without intravenous corticosteroids was not significantly different (p = 0.26). Four of 12 patients treated with intravenous corticosteroids underwent orbitotomy for drainage of the abscess, and 6 of 11 patients treated without intravenous corticosteroids underwent surgical drainage (p = 0.20). Two of 12 patients treated with corticosteroids received intravenous antibiotics after discharge, whereas 7 of 11 in the group not treated with corticosteroids received intravenous antibiotics after discharge (p = 0.03). CONCLUSIONS: The use of intravenous corticosteroids does not appear to adversely affect clinical outcomes and may be beneficial in the treatment of pediatric orbital cellulitis with subperiosteal abscess. Review of our data suggests that a prospective, randomized trial is warranted to further clarify the role of corticosteroids in the acute management of pediatric orbital cellulitis with subperiosteal abscess.

Abscess↗
PubMed2005

The contemporary approach to diagnosis and management of peritonsillar abscess.

PURPOSE OF REVIEW: Peritonsillar abscess is a common problem, but some aspects of diagnosis and management remain controversial. We review the recent literature on peritonsillar abscess. RECENT FINDINGS: Intraoral ultrasound can be a helpful diagnostic tool for peritonsillar abscess. For management, needle aspiration, incision and drainage, and quinsy tonsillectomy all yield successful results. Recent reviews have still not established that one treatment is consistently preferred. A randomized, placebo-controlled trail found that the use of intravenous steroids seems to reduce many symptoms, when used along with abscess drainage. SUMMARY: The use of steroids may be beneficial in the treatment of peritonsillar abscess, and different techniques for abscess drainage are still used around the world, with consistently good results.

Anti-Inflammatory Agents↗
PubMed1981

Survival of Staphylococcus aureus in intraperitoneal abscesses.

An examination of 10 strains of Staphylococcus aureus for survival within abscesses developing in the peritoneal cavity of mice revealed three distinct patterns of survival. Although non-haemolytic mutants were destroyed more rapidly than were their parent strains, this difference could not be attributed to any particular haemolysin. In abscesses generated with mixtures of non-haemolytic variants and their parent strains, the former were preferentially eliminated; this suggests that the non-haemolytic variants were inherently more sensitive to the conditions within these lesions. Subsequent studies confirmed that abscess homogenates were cidal for staphylococci and that this activity resided in the insoluble fraction of the homogenates. Staphylococci added to abscess homogenates were killed, but only after a lag. This lag could be shortened or eliminated by incubating homogenates before adding the test organism. After development of a suitable assay, it was found that the cidal activity in abscess homogenates could be increased 3-20-fold by pre-incubation. Staphylococcal strains differed in their relative sensitivities to the cidal material; those strains rapidly destroyed within abscesses were the most sensitive and strains capable of better survival were more resistant. The results support the concept that the cidal material is responsible for destruction of staphylococci within such lesions.

Abscess↗