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The adult neck mass.

Family physicians frequently encounter neck masses in adult patients. A careful medical history should be obtained, and a thorough physical examination should be performed. The patient's age and the location, size, and duration of the mass are important pieces of information. Inflammatory and infectious causes of neck masses, such as cervical adenitis and cat-scratch disease, are common in young adults. Congenital masses, such as branchial anomalies and thyroglossal duct cysts, must be considered in the differential diagnosis. Neoplasms (benign and malignant) are more likely to be present in older adults. Fine-needle aspiration and biopsy and contrast-enhanced computed tomographic scanning are the best techniques for evaluating these masses. An otolaryngology consultation for endoscopy and possible excisional biopsy should be obtained when a neck mass persists beyond four to six weeks after a single course of a broad-spectrum antibiotic.

Adult↗

[Leber's idiopathic stellate neuroretinitis: about two cases].

BACKGROUND: Described by Theodore Leber in 1916, this syndrome is characterized by unilateral visual loss, optic disc swelling and a stellate pattern of exudative deposits in the macula. MATERIAL AND METHODS: Two young adults were examined for sudden unilateral visual loss preceded by a flu-like syndrome. Fundus examination revealed a swollen optic disc and a macular star, visualized on fluorescein angiography. Visual field, laboratory tests and cranial and orbital tomodensitometry were performed. RESULTS: Visual field examination showed a centrocecal scotoma. Laboratory tests showed inflammatory syndrome in one case. Serology testing (leptospirosis, cat scratch disease, toxoplasmosis and syphilis, etc.) were negative. Tomodensitometry of the brain and orbits gave normal results. One of the patients was treated with intravenous steroid boluses; the other received no treatment. A few weeks after the beginning of symptoms, the swelling of the optic disc seemed to have declined, leaving the macular star unchanged. CONCLUSION: These two cases typically describe Leber's idiopathic stellate neuroretinitis. The prognosis for visual recovery is usually reported to be excellent, but visual sequelae have been described.

Adolescent↗

The first fatal case of capnocytophaga canimorsus sepsis caused by a cat scratch.

A case is presented of fatal capnocytophaga canimorsus sepsis caused by a neglected cat scratch. Although fatalities are known to occur as a result of sepsis caused by this organism, death following cat scratch transmission has not previously been reported. The case is important as it demonstrates how a seemingly innocuous injury can have devastating consequences that may have been prevented by simple first aid measures.

Aged↗

[Epidermoid splenic cyst--state of the art].

In order to understand the features of splenic epidermoid cysts and their possible associated complications, four cases of splenic epidermoid cyst are presented in this report, two in children, one of them appeared in a child affected by a EBV and BH sepsis complicated with splenic abscesses due to scratch cat disease. The other two cases were adults. According to our histophatological findings, the pathogenesis may be related to a citodiferentation from mesothelium to squamous metaplasia. Our current knowledge about the role of spleen on immunological activity, mainly against capsulated germs, and the increase risk of overwhelming postesplenectomy septicemia have contributed to our conservative attitude about splenic surgery. We believe that management during the neonatal period should be conservative because cysts tend to disappear in most cases. In older children with a small cyst our recommendation is punction-aspiration and sclerotherapy, with ultrasound follow-up control.

Adolescent↗

Seroprevalence of Bartonella henselae and Bartonella quintana infections in children from Central and Northern Jordan.

OBJECTIVE: To investigate the prevalence of antibodies to Bartonella henselae (B.henselae) and Bartonella quintana (B.quintana) among children from central and northern Jordan. METHODS: Sera from 482 children were randomly collected from referenced governmental hospitals in the central and northern parts of Jordan during the period between January 2001 to March 2003. An indirect immunofluorescent assay was used to determine serum antibody titers to B.henselae and B.quintana. Sera that were reactive at a dilution >/-1:64 were considered positive. In addition, blood from 20 cats belonged to children with high B.henselae titers were tested using polymerase chain reaction. RESULTS: Out of the 482 serum samples examined, 53 (11%) and 20 (4.1%) had positive antibody titers for B. henselae and B.quintana. Bartonella henselae was isolated from 4 cats that belonged to 3 children with high antibody titers to B.henselae-IgG. The seroprevalence of IgG antibodies to B.henselae was significantly higher (P<0.05) in children aged 7-10-years than in younger or older ones. Having a cat in the household and having a history of cat scratches or bites were strongly associated (P<0.01) with seropositivity to B.henselae-specific IgG. Cats ownership and history of cat scratches or bites had no impact on the prevalence of B.quintana. Seropositivity to B.henselae-specific IgG was significantly higher (P<0.01) in children from northern Jordan than in children from central Jordan. CONCLUSION: This study substantiates the presence of B.henselae in Jordan, documents the seroreactivity to 2 Bartonella antigens, and suggests that cat ownership and history of cat scratches or bites are important epidemiological risk factors for B.henselae infection in Jordan.

Animals↗

Fever of unknown origin.

FUO is an uncommon problem in pediatric patients if one uses a strict definition of at least 2 weeks of fever. Perhaps the best definition, as suggested by Lorin and Feigin, is more than 1 week of fever and a negative initial evaluation, including examination and preliminary laboratory results. Most patients, especially younger ones, will spontaneously improve or have common disorders, usually respiratory-related infections. Most patients will have uncommon manifestations of more commonly recognized disorders. Mortality rates, even in those series that include a week in the hospital without a diagnosis, are 15% to 20% at maximum--half that seen in most series of adult patients. Common mistakes are failure to document fever, failure to perform a complete history or physical examination, a shotgun approach that uses the laboratory to make diagnoses, and overuse or inappropriate use of newer imaging techniques in an undirected fashion. Patience, persistence, repeated histories and physical examinations, and continued observation offer the best chance of making a diagnosis in difficult cases. In the current decade, we continue to learn about new manifestations of old disorders--cat-scratch disease, Kawasaki disease, neonatal syphilis, and Epstein-Barr virus infection are examples. The use of older and well-established methods (history and physical examination) and the addition of newer techniques (ultrasound, CT, MRI, etc.) to pursue suggested diagnoses offer the best current approaches to the patient with prolonged and unexplained fever.

Child↗

Bartonella infections: diagnostic and management issues.

Bartonella species are emerging pathogens. Renewed interest in this group of bacteria has been highlighted by the recent description of new species, which are pathogenic for humans (Bartonella elizabethae and Bartonella clarridgeae), and their association with an increasing number of clinical manifestations, the more prevalent being cat scratch disease, bacillary angiomatosis, and culture-negative endocarditis.

Journal Article↗

Bacillary angiomatosis: a systemic opportunistic infection with prominent cutaneous manifestations.

Bacillary angiomatosis is an opportunistic infection with systemic manifestations. Although most cases have occurred in human immunodeficiency virus-positive patients, other immunosuppressed patients, and even seemingly immunocompetent individuals, can become infected. In addition to the well-characterized cutaneous manifestations, visceral involvement can occur and may be the only locus of infection. Lymphadenopathy, bone or soft-tissue masses, fever, and hepatosplenomegaly can be presenting signs. The causative bacterium is still unidentified, but resemblances to the rickettsiae, Rochilamea quintana, the recently identified cat-scratch disease bacillus, and Bartonella bacilliformis have been noted by various investigators. Systemic disease is treatable and can be cured with antibiotic therapy.

Angiomatosis, Bacillary↗

[Corneal abscess caused by Pasteurella following cat scratch injury].

Authors report a Pasteurella Multocida corneal abscess after a scratch from a cat. The evolution was torpid and needed a transfixiant keratoplasty. They recall bacterial tanks, infestation ways, clinical manifestations and bacteriological identification. They note the low occurrence of ophthalmological manifestations and the sensibility of Pasteurella to various antibiotics, especially Beta lactams, phenicol and cyclins.

Abscess↗

[A case of primary psoas abscess with paravesical extension].

We report a case of primary psoas abscess with paravesical extension. A 16-year-old man who had suffered from remittent fever for two months was admitted to our clinic. He had no urological symptoms or walking disturbances, but ultrasonography showed a well-defined echoic mass at the right paravesical space. Computed tomography confirmed this finding, and right psoas muscle appeared to be enlarged with irregular low density areas. Percutaneous drainage for right paravesical abscess was performed, and 15 ml of pus was obtained. The bacterial and fungal culture of the specimen resulted in no growth of any organisms. Six days after percutaneous drainage, he received en bloc resection of right paravesical abscess with segmental resection of bladder wall and peritoneum adherent to it. Furthermore, the affected region of the right psoas muscle was salvaged as highly upward as possible. Surgical specimen disclosed, pathologically, a non-specific granuloma with stellate necrosis. This finding suggested a feature of cat-scratch disease, tularemia, lymphogranuloma venereum and Yersinia infection. We reviewed the related literature on diagnostic images such as CT, ultrasonography and 67Ga scintigraphy. Moreover, bacterial causes and therapy of primary psoas abscess are discussed.

Abscess↗

The cat menace.

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Animals↗