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PubMed1989

Transbronchial catheter drainage via fiberoptic bronchoscope in intractable lung abscess.

The use of the fiberoptic bronchoscope as a drainage procedure for lung abscess has become more and more widespread. We have recently adopted the technique of inserting a simple polyethylene catheter through the flexible fiberoptic bronchoscope into the abscess cavity of 11 patients with lung abscess. All cases had not responded to aggressive postural drainage and adequate antibiotic therapy for at least a week. The results were as follows: 1) Among 11 patients, the therapeutic response was dramatic in 6 patients. 2) In the successful group, the abscess sizes were greater than 8cm in diameter and the airfluid levels were higher than two-thirds of the cavity. 3) Additional diagnoses, other than bacterial lung abscess, could be made in 2 cases when otherwise the diagnosis would have remained in doubt. The authors suggest that catheter drainage via fiberoptic bronchoscope is an effective treatment modality in the large lung abscess with a high air-fluid level which is intractable to other medical approaches, and it is also a safe procedure.

Adult↗
PubMed2001

[Clinical significance of the Streptococcus milleri group in peritonsillar abscesses].

Few researchers have microbiologically studied peritonsillar abscesses in detail, and their results have been conflicting. Although Streptococcus pyogenes (Group A beta-streptococcus) is commonly considered an important pathogen in this infection, recent studies have demonstrated the recovery of many other streptococci mainly consisting of alpha-streptococci. Few studies have identified these streptococci at the species level, however. We studied details of bacteriology in 31 cases of peritonsillar abscess treated between 1991 and 2000. The Streptococcus milleri group was most frequently isolated (25.8%), followed by Eikenella corrodens (9.7%), Staphylococcus aureus (6.5%), and S. pyogenes (3.2%). The S. milleri group, consisting of 3 species of Streptococcus constellatus, S. intermedius, and S. anginosus, forms part of the normal flora most commonly found in the mouth, throat, gastrointestinal tract, and genital tract. These species have become known as an important pathogen in abscess disease but little attention has been paid to their role in peritonsillar abscesses. To adequately culture the S. milleri group, incubation in air containing carbon dioxide or in an anaerobic condition is required, and then the differentiation of the 3 species requires the biochemical reactivity tests. Since hemolytic patterns of the S. milleri group vary, we studied the population of alpha-, beta-, and gamma-hemolytic strains among 36 strains of this group. We found 32 (88.8%) to be alpha-hemolytic. Although not all alpha-hemolytic strains belong to the S. milleri group, a considerable number of this group could be missed among alpha-streptococci isolated from the peritonsillar abscess. As antibiotics began being used widely, normal flora such as the S. milleri group may have become an important pathogen in peritonsillar abscesses due to an imbalance between organisms and host defense.

Adolescent↗
PubMed2004

Zwitterionic polysaccharides stimulate T cells with no preferential V beta usage and promote anergy, resulting in protection against experimental abscess formation.

Zwitterionic polysaccharides (Zps) from pathogenic bacteria, such as Bacteroides fragilis, are virulence factors responsible for abscess formation associated with intra-abdominal sepsis. The underlying cellular mechanism for abscess formation requires T cell activation. Conversely, abscess formation can be prevented by prophylactic s.c. injection of purified Zps alone, a process also dependent on T cells. Hence, the modulatory role of T cells in abscess formation was investigated. We show that Zps interact directly with T cells with fast association/dissociation kinetics. Vbeta repertoire analysis using RT-PCR demonstrates that Zps have broad Vbeta usage. Zps-specific hybridomas responded to a variety of other Zps, but not to a nonzwitterionic polysaccharide, indicating cross-reactivity between different Zps. Furthermore, Zps-reactive T cell hybridomas could effectively transfer protection against abscess formation. Analysis of the proliferative capacity of T cells recovered from Zps-treated animals revealed that these T cells are anergic to subsequent stimulation by the different Zps or to alloantigens in an MLR. This anergic response was relieved by addition of IL-2. Taken together, the data show that this class of polysaccharides interacts directly with T cells in a nonbiased manner to elicit an IL-2-dependent anergic response that confers protection against abscess formation.

Abscess↗
PubMed1998

Psoas abscesses complicating colonic disease: imaging and therapy.

Most surgeons think of psoas abscesses as a very rare condition related to tuberculosis of the spine, but in contemporary surgical practice they are more usually a complication of gastrointestinal disease. A case note study was undertaken on all patients treated for psoas abscess at two large hospitals in the mid-Trent region over a 2-year period. All seven patients presented with pyrexia, psoas spasm, a tender mass and leucocytosis. The diagnosis was made on abdominal radiographs in one patient, CT scan in three, MRI in two, and ultrasound in one. Aetiological factors included Crohn's disease in three, appendicitis in two, and sigmoid diverticulitis and metastatic colorectal carcinoma in one each. Six patients underwent transabdominal resection of the diseased bowel, retroperitoneal debridement and external drainage of the abscess cavity. Percutaneous drainage was performed in one. Two patients had more than one surgical exploration for complications. There were no deaths and the hospital stay ranged from 8-152 days. Psoas abscess can be a difficult and protracted problem. Bowel resection, thorough debridement, external drainage and concomitant antibiotics are essential for psoas abscesses complicating gastrointestinal disease. Defunctioning stomas may be necessary. However, in some cases a multidisciplinary approach may be required, as psoas abscesses can involve bone and joints.

Adult↗
PubMed1999

IL-2 mediates protection against abscess formation in an experimental model of sepsis.

Little is known regarding the mechanism by which T cells control intraabdominal abscess formation. Treating animals with polysaccharide A (PS A) from Bacteroides fragilis shortly before or after challenge protects against abscess formation subsequent to challenge with different abscess-inducing bacteria. Although bacterial polysaccharides are considered to be T cell-independent Ags, T cells from PS A-treated animals mediate this protective activity. In the present study, we demonstrate that CD4+ T cells transfer PS A-mediated protection against abscess formation, and that a soluble mediator produced by these cells confers this activity. Cytokine mRNA analysis showed that T cells from PS A-treated animals produced transcript for IL-2, IFN-gamma, and IL-10, but not for IL-4. The addition of IL-2-specific Ab to T cell lysates taken from PS A-treated animals abrogated the ability to transfer protection, whereas the addition of Abs specific for IFN-gamma and IL-10 did not affect protection. Finally, administration of rIL-2 to animals at the time of bacterial challenge prevented abscess formation in a dose-dependent manner. These data demonstrate that PS A-mediated protection against abscess formation is dependent upon a CD4+ T cell-dependent response, and that IL-2 is essential to this immune mechanism.

Abdominal Abscess↗
PubMed1999

Retropharyngeal abscesses: a clinical and radiologic correlation.

OBJECTIVE: This study evaluates the efficacy at our centre of the lateral neck x-ray and the computed tomography (CT) scan in differentiating retropharyngeal cellulitis from abscess in retropharyngeal space inflammatory process. METHOD: We reviewed the medical records of 37 patients with the diagnosis of retropharyngeal abscess or cellulitis hospitalized at the Centre Universitaire de Santé de l'Estrie in Sherbrooke between 1986 and 1997. Patients with a positive drainage at surgery were considered as retropharyngeal abscess and the rest as cellulitis. We measured the sensitivity, specificity, and positive and negative predictive values for the lateral neck x-ray and CT scan. Demographic and clinical data were also extracted for each patient. RESULTS: Twenty-five patients were classified as retropharyngeal cellulitis and only six patients as retropharyngeal abscess, although 13 patients went to the operating room for drainage. Results for the sensitivity and specificity were 80% and 100% for the lateral neck x-ray and 100% and 45% for the CT scan. Positive and negative predictive values for lateral neck x-ray were 100% and 94%, respectively. Forty percent and 100% were the values calculated for the CT scan. Clinical data were consistent with what has been reported in the literature. CONCLUSION: CT scan is helpful in the management of retropharyngeal abscess but has limits in differentiating cellulitis and abscess. Lateral neck x-ray was found to be very specific when the air sign was present.

Cellulitis↗
PubMed1999

Abdominal tuberculous abscesses in AIDS patients: percutaneous treatment.

OBJECTIVE: to analyze certain epidemiological and ultrasonographic features, and the response to percutaneous treatment, of abdominal tuberculous abscesses in patients with human acquired immunodeficiency syndrome. METHODS: we reviewed the clinical records and ultrasonographic findings in 7 patients with abdominal tuberculous abscesses who were treated in our service by ultrasonography-guided percutaneous drainage. RESULTS: in 5 patients there was a previous diagnosis of AIDS. The abscesses (two in one patient) were located mainly in the retroperitoneum and appeared mottled at ultrasonography. Seven of the abscesses were drained via catheter, whereas in the remaining case aspiration puncture was used. Mycobacterium tuberculosis was found in the drained material in 6 patients, and 1 case presented superinfection by Enterococcus faecalis. Percutaneous drainage was effective in 6 patients, and in the remaining case it was only palliative. CONCLUSIONS: the incidence of abdominal tuberculous abscesses is increasing in patients with AIDS, and in some patients it is the first symptom. Abscesses are located primarily in the retroperitoneum. They can be dealt with satisfactorily by percutaneous drainage guided by ultrasonography.

AIDS-Related Opportunistic Infections↗
PubMed1999

Descending suppurative mediastinitis: nonsurgical approach to this unusual complication of retropharyngeal abscesses in childhood.

OBJECTIVE: To alert the pediatric emergency physician about suppurative mediastinitis as an unusual, life-threatening complication of retropharyngeal abscesses in children and to report an alternative therapeutic option for these cases. METHODS: We describe a case of suppurative mediastinitis secondary to a retropharyngeal abscess in a 19-month-old girl and discuss the pathophysiology, diagnosis, and treatment of this disease. RESULTS: Prompt diagnosis, based on clinical, radiographic, and CT findings, followed by immediate retropharyngeal drainage and appropriate antibiotic therapy, allowed conservative management of the mediastinal abscess, without the need for surgery. The child presented a good outcome and was discharged on hospital day 14. CONCLUSIONS: When evaluating a retropharyngeal abscess, the pediatric emergency physician should be aware of its complications. A chest radiograph should be prescribed for each patient presenting with an indolent course. Widening of the mediastinum should be considered as strong evidence of a mediastinal abscess for which the best therapeutic option is aggressive surgical drainage. In the rare cases in which marked improvement is achieved after retropharyngeal drainage, a nonsurgical approach to the mediastinal abscess could be attempted. CT scan and a simple chest radiograph have proved to be useful for diagnosis and follow-up.

Ceftriaxone↗
PubMed1999

Microbiology of subphrenic abscesses: a 14-year experience.

The objective of the review was to study the aerobic and anaerobic microbiology of subphrenic abscesses in relation with predisposing conditions. A retrospective review of clinical and laboratory data of 52 patients treated between 1974 and 1988 was conducted. Forty-three (83%) patients developed the abscesses after an operative procedure. These included 11 patients after colonic, 9 patients after gastric or duodenal, 7 patients after abdominal trauma, 7 patients after biliary, and 6 patients after appendix surgery. A total of 194 organisms (3.7 isolates/specimen), 83 aerobic (1.6/specimen), and 111 anaerobes (2.1/specimen) were recovered. Aerobic bacteria only were recovered in 7 (13%) abscesses, anaerobic bacteria only in 11 (21%), and mixed aerobic and anaerobic bacteria in 34 (65%). Polymicrobial infection was present in 47 (90%). The predominant aerobic isolates were Escherichia coli (28 isolates), Enterococcus group D(9), and Staphylococcus aureus (9). The predominant anaerobes were Peptostreptococcus species (33 isolates), Bacteroides fragilis group (25), Clostridium species (13), and Prevotella species (6). The number of isolates/site varied. The number of anaerobic bacteria/site outnumbered or was equal to the number of aerobic or facultatives in all instances, except in abscesses after biliary surgery. Their number/site was especially high in abscesses after appendectomy, and the number of aerobic and anaerobic bacteria was the lowest after gastric or duodenal surgery. S. aureus predominated after gastric, duodenal and posttrauma surgery; B. fragilis predominated after colonic, appendix, and postabdominal trauma surgery; Enterococcus group D predominated after biliary surgery; Fusobacterium and Prevotella species predominated after gastric or duodenal surgery; and Clostridium species predominated after colonic or appendix surgery. These data highlight the polymicrobial aerobic-anaerobic nature of subphrenic abscesses and their correlation with predisposing surgery.

Adolescent↗
PubMed1999

[Prostatic abscesses: what treatment to propose?].

Microscopic abscesses of the prostate (< 1 cm) are usually treated by antibiotics with good prostatic diffusion, such as fluoroquinolones, for a minimum of 4 to 6 weeks. Complementary surgical drainage is generally required for larger abscesses or in case of an unfavourable course. The main points of discussion in the literature are the type of drainage and the incision that should be performed. Prostatic abscesses used to be drained via perineal incisions, but with a high mortality. The use of effective antibiotics has significantly improved the morbidity of prostatic abscesses. CT-guided percutaneous drainage (perineal or transrectal), or more frequently transrectal ultrasound-guided drainage, now allows rapid and effective evacuation of the abscess, without the need for general anaesthesia. The perineal route allows a simple J stent to be left in place for several days to ensure complete drainage, but it is not universally accepted. Transurethral exposure is indicated for periurethral prostatic abscesses.

Abscess↗
PubMed1999

[Diagnostic imaging and interventional radiology of amebic liver abscesses. Personal experience].

PURPOSE: The diagnostic imaging findings in hepatic amebiasis and the capabilities of percutaneous drainage have already been described but some debate is open on both diagnosis and treatment. We report our experience with ultrasound (US) and Computed Tomography (CT) studies of the hepatic amebic abscess and its management. MATERIAL AND METHODS: During the last 4 years we examined 14 patients with liver abscess: 11 men and 2 women; 13 were Italian and 1 African (25-61 years old, mean 36). All subjects underwent US and contrast-enhanced CT (with a conventional scanner in 12 and a helical unit in 2). The first 4 cases were also submitted to US-guided diagnostic aspiration. Six patients were treated with percutaneous drainage under US guidance using an 8-10 F pig-tail catheter which was removed 4-18 days later (mean 6). RESULTS: The abscesses were always single and uniloculated, in most cases located peripherally in the right lobe. They were large (2-11 cm, mean 7) and had round, oval, or irregular shape in 9, 3, and 2 cases respectively. US generally showed the abscess as an inhomogeneously hypoechoic mass with ill-defined walls. CT demonstrated a homogeneously hypodense collection with a thick peripheral hypodense halo; after contrast agent administration wall attenuation was increased between the edematous halo and the cavity, and an incomplete idosense ring appeared. Biphasic helical acquisitions allowed demonstration of some difference between the two vascular phases and yielded other interesting findings. Drug treatment provided complete abscess resolution in 8 patients, though in 2 it was badly tolerated. In one case no improvement was found and the patient was submitted to percutaneous drainage, which was the treatment of choice in the remaining 5 patients. The treatment was successful in all cases, but 1 patient who discontinued the combined medical therapy developed a heterotopic lesion. CONCLUSION: US and CT findings, though variable and partially different from those previously reported, may be considered sufficient for diagnostic assessment, especially if in the proper clinical and biohumoral setting. Both drug treatment and percutaneous drainage (to be considered for selected cases) are effective in the treatment of this type of abscess.

Adult↗
PubMed1999

[Giant psoas abscess with aggressive extension: report of a case].

We report a case of giant psoas abscess with aggressive extension outside the muscles of the iliopsoas component. A 57-year-old man was admitted to our hospital, presenting with right flank pain and severe general malaise. He had been diabetic, but no treatment had been performed for diabetes. Leukocytosis, positive CRP and hyperglycemia were noted, but he was nearly afebrile on admission. Computerized tomography revealed a large multilocular mass in the right retroperitoneal space involving the ipsilateral psoas muscle. The diagnosis was not apparent until the 12th hospital day, when moderate grade fever was noted and brownish purulent fluid was obtained by percutaneous puncture of the mass. Staphylococcus aureus was isolated on culture. Antibiotic chemotherapy was started, and ultrasound-guided percutaneous drainage was then performed under the diagnosis of psoas abscess. At that time, the abscess was aggressively extending from the iliopsoas component into the pelvic floor, involving the rectus muscle, the gluteal muscles and formation of subucutaneous lesions. At 46 days after drainage, surgical resection of the abscess with removal of the adjucent tissue was performed because of persistent discharge of pus and multiple residual lesions. The postoperative course was uneventful, and there has been no recurrence. Many cases of psoas abscess have been reported in the Japanese literature. Prompt drainage, either percutaneously or surgically are required. Surgical resection of the abscess, with not only opening the cavity but also removal of the adjacent tissue, may be recommended in some cases, especially those diffuse or multilocular lesions.

Anti-Bacterial Agents↗
PubMed2000

Ultrasound guided percutaneous drainage of abdominal abscesses.

OBJECTIVE: To see yield of ultrasound guided percutaneous drainage of abdominal abscesses. SETTING: Department of General Surgery Unit I, Lahore General Hospital and North Surgical Unit, Mayo Hospital, Lahore. DESIGN: A prospective case-controlled study. SUBJECTS: Patients with spontaneous or post operative abdominal abscesses. RESULTS: Overall success rate was 96.2%, major complications 11.5%, minor complications 26.9% and mortality 3.8%. In simple abscesses (20 patients), the success rate was 100% and in complex abscesses (six patients) 83.4%, with respective mortality 0.0% and 16.6%. Mean hospital stay was 10.7 days (range 3-25). CONCLUSION: Ultrasound guided percutaneous drainage of abdominal abscesses is an effective and safe method, suited particularly for simple abscesses.

Abdominal Abscess↗
PubMedDate not supplied

Isolation of Eikenella corrodens from polymicrobial hepatic abscess: report of one case.

Eikenella corrodens is a rare cause of hepatic abscess. We report a case of a hepatic abscess caused by (1) Bacteroides fragilis, (2) Streptococcus constellatus and (3) E. corrodens, which illustrates potential problems of antibiotic coverage due to the presence of Eikenella species. The infection followed an episode of acute gastroenteritis and the clinical course appeared indolent evolving over one week. Besides empirical antibiotics, initial percutaneous aspiration was performed and yielded pus which grew E. corrodens concomitantly with Streptococcus species. E. corrodens was sensitive to penicillin but resistant to clindamycin and metronidazole. But B. fragilis was resistant to penicillin. So the antibiotics were switched to amoxicillin/clavulanate. Unfortunately fever persisted and the abscess increased in size. Therefore echo-guided percutaneous drainage with pigtail catheter was installed. Fever subsided 5 days later. After 21 days treatment of antibiotics, the patient was discharged in good condition despite having some sterile fluid in the residual abscess cavity. Two months after discharge the follow-up echogram confirmed complete resolution of the residual abscess. This patient shows us the existence of E. corrodens in pediatric patients, especially when the hepatic abscess is very likely from the spread of an oral or abdominal infection.

Anti-Bacterial Agents↗
PubMed2000

Klebsiella pneumoniae renal abscess.

BACKGROUND: The clinical characteristics of renal abscess caused by Klebsiella pneumoniae have not been previously reported in case-series studies. The purpose of this study is to demonstrate the clinical characteristics of K pneumoniae renal abscess for early diagnosis and to identify the clinical risk factors associating with poor prognosis. METHODS: We retrospectively reviewed the medical records of 24 patients with K pneumoniae renal abscess, from April, 1982 through February, 1998. The clinical presentations, including the demographic characteristics, predisposing disorders, initial signs and symptoms, laboratory test results, diagnostic radiology studies, therapeutic modalities and risk factors associated with mortality were studied. RESULTS: The mean age was 58.7 years and the male to female ratio was 10:14. The most common predisposing factors were diabetes mellitus (58%), urolithiasis (25%) and immunosuppression (17%). Fever, chills and flank pain were the most common symptoms and signs, whereas pyuria, elevation of leukocyte count, glucose, blood urea nitrogen and creatinine were the common laboratory features. The distinct complications of K pneumoniae renal abscess were bacteremia in 13 (54%), emphysematous pyelonephritis in five (21%), and metastatic septic infection in three (12.5%). The cure rate was 52% (11/21) in patients treated with a combination of antibiotics and percutaneous drainage; however, six (35%) patients who survived required another surgical procedure for complete recovery. The overall mortality rate was 25%. The clinical factors of elderly age (>65 years) at presentation, lethargy, elevation of serum blood urea nitrogen and pulmonary complications were associated with poor prognoses. CONCLUSIONS: Focusing on the early diagnosis of K pneumoniae renal abscess and recognition of the prognostic factors for a poor prognosis, we highlight the specific clinical characteristics that include elderly age, lethargy, impairment of renal function, metastatic septic lesions and pulmonary complications. All patients with K pneumoniae renal abscesses should receive empiric antibiotics and percutaneous drainage or aspiration, and surgical intervention as necessary for patients with intractable disease.

Abscess↗
PubMed2000

Laparoscopic drainage of postoperative complicated intra-abdominal abscesses.

Intra-abdominal abscess, which carries significant rates of death and complications, may complicate the postoperative course. Treatment options include percutaneous needle aspiration, placement of an external drain under ultrasonic guidance, or surgical drainage, depending on the size, site, and nature (simple or complicated) of the abscess. Laparoscopic drainage may be a treatment option. A retrospective review of patients who underwent laparoscopic drainage of postoperative complicated intra-abdominal abscesses at the authors' institution from January 1997 to July 1999 was performed. Seven patients had complicated intra-abdominal abscesses 7 to 17 (mean 11) days after their initial operation. All abscesses were successfully drained by laparoscopy. The mean operative time was 64 minutes. There were no intraoperative or postoperative complications. The postoperative analgesic requirement was minimal. The suction drain was removed on average 5 days after laparoscopy, and the mean hospital stay was 6 days. There was no recurrence of symptoms at a mean follow-up of 23 months. Laparoscopic drainage, in combination with systemic antibiotics, is a safe and effective treatment option in patients with postoperative complicated intra-abdominal abscesses.

Abdominal Abscess↗
PubMed2000

[Hepatic abscesses: is simple aspiration puncture with echography control an alternative to catheter drainage?].

UNLABELLED: Percutaneous drainage is currently the treatment of choice in liver abscess. The most commonly used technique is catheter placement but this procedure is not free of complications. OBJECTIVE: To analyze the safety and efficacy of needle aspiration in the treatment of liver abscesses. PATIENTS AND METHODS: Non-random, prospective study of nine patients with pyogenic liver abscess who underwent simple needle aspiration with sonographic guidance. RESULTS: In all patients, aspiration identified the etiologic agent. In eight patients (88.9%) the procedure was effective and in the remaining patients, the abscess was finally drained by sonographically guided catheter placement. In five patients, aspiration was successful at the first attempt and only one abscess required more than two attempts. No complications were observed. CONCLUSIONS: In our experience, needle aspiration with sonographic guidance is safe and effective in the treatment of pyogenic liver abscesses. Use of catheters is reserved for cases of rapid reaccumulation of exudate without general improvement in the patient.

Adult↗
PubMed1975

Cerebellar abscesses: a review of seventeen cases.

Seventeen cases of cerebellar abscesses are reviewed. The incidence was 18% of all brain abscesses. Thirteen were males, and four were females. Headache was the most common presenting symptom. These abscesses have a better prognosis for survival and neurological function than supratentorial abscesses. They are less likely to be encapsulated. Continued neurological decline in the face of adequate surgical treatment of a single abscess should alert the physcian to the possibility of a second abscess.

Adolescent↗