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PubMed2005

Microbiology of intracranial abscesses and their associated sinusitis.

OBJECTIVE: To evaluate the organisms recovered from infected sinuses and associated intracranial abscesses (IAs). DESIGN: Retrospective review of findings from aspirate of pus from 10 infected sinuses and their corresponding IAs. SETTING: Academic medical center. PATIENTS: Ten patients diagnosed as having sinusitis (age range, 7-58 years). MAIN OUTCOME MEASURE: Aerobic and anaerobic bacteria findings from infected sinuses and IAs. RESULTS: Polymicrobial flora was found in 9 sinuses and 8 IAs. Anaerobes were isolated from all sinuses and 9 IAs. A total of 26 isolates (2.6 isolates per specimen) were recovered from the sinuses: 19 anaerobic, 6 aerobic or facultative, and 1 microaerophilic; 17 isolates were found in the IAs (1.7 isolates per site): 13 anaerobic, 2 aerobic or facultative, and 2 microaerophilic. The predominant anaerobes were Fusobacterium species (in 5 corresponding sinuses and abscesses, 1 in a sinus only, and 1 in an IA only), Prevotella species (in 3 corresponding sinuses and abscesses), Peptostreptococcus species (in 2 corresponding sinuses and abscesses, and 4 in a sinus only), Staphylococcus aureus, Haemophilus influenzae type b, microaerophilic streptococci, and Bacteroides ureolyticus (in 1 corresponding sinus and abscess each). Streptococcus pneumoniae was recovered 2 times, only from a sinus. Alpha-hemolytic streptococci and beta-hemolytic streptococci group F were each isolated once from the sinus. Concordance in the microbiological findings between the sinus and the IA was found in all instances. However, certain organisms were present at only one or the other site. CONCLUSION: These data illustrate the concordance in the recovery of organisms from infected sinuses and their associated IA and confirm the importance of anaerobic bacteria in sinusitis and IA.

Abscess↗
PubMed1988

Peritonsillarlike lateral oropharyngeal abscess after tonsillectomy.

Peritonsillar abscess is a well-known sequela of acute tonsillitis. However, not so well known is the occurrence of a peritonsillarlike oropharyngeal abscess in patients with previous tonsillectomy. No case report or review exists in the American medical literature. We present four cases of abscess after tonsillectomy and a review of the world literature. A discussion of the evaluation and treatment of posttonsillectomy abscess based on these cases is included. An attempt is made to alert the practitioner to the fact that patients who have undergone tonsillectomy can develop peritonsillarlike oropharyngeal abscesses.

Abscess↗
PubMed1989

Intracranial abscesses secondary to nasal, sinus, and orbital infections in adults and children.

Nineteen cases of intracranial abscesses secondary to infection of the midface are reported. The most common underlying cause was bacterial sinusitis. Other etiologic factors included mucormycosis following steroid therapy, Wegener's granulomatosis, nasal dermoid cyst and sinus tract, tooth abscesses, aspergillosis following chemotherapy for leukemia, squamous cell carcinoma of the frontal sinus, infected methylmethacrylate plate for a prior skull fracture, and a case of gauze packing left in the sinus following surgery. Anaerobic organisms were the predominant cause of the abscesses. The most dangerous intracranial complication was subdural abscess, which occurred in seven patients in this series. Three of them died. Four cases of frontal and parietal lobe abscesses were treated with systemic antibiotics only. This approach has not been well emphasized in our literature. Steroid therapy should not be used for the treatment of sinus and orbital infections. It can result in dreadful complications. The overall mortality rate in this series was 21% (4 of 19), despite aggressive treatment and close cooperation between the neurosurgeon, otolaryngologist, and other specialists. Early diagnosis and adequate treatment are paramount.

Adolescent↗
PubMed1997

Minimal endoscopic approach to subperiosteal orbital abscess.

OBJECTIVE: To limit endoscopic abscess drainage to the opening of the ethmoid cells involved, adjacent to the subperiosteal orbital abscess. DESIGN: Prospective study. PATIENTS: Twenty children with subperiosteal orbital abscess complicating acute sinusitis. INTERVENTION: Endoscopic opening of the medial wall of the bulla ethmoidalis and of the lamina papyracea. RESULTS: The limited endoscopic approach allowed subperiosteal orbital abscess drainage in all patients with positive clinical outcomes. Extensive ethmoidectomy was not necessary to achieve drainage. CONCLUSIONS: Endoscopic subperiosteal orbital abscess drainage does not require complete ethmoidectomy as was previously performed and can be limited to the opening of the bulla ethmoidalis and the lamina papyracea through the bulla ethmoidalis.

Abscess↗
PubMed1981

Cerebral abscess in children.

We reviewed 94 consecutive episodes of pyogenic brain abscess seen at Children's Hospital Medical Center, Boston, between 1945 and 1980. After 1970, the mortality as reduced from 36% to 14%. Predisposing factors included congenital heart disease, otitic and sinus infections, closed head injuries, and cystic fibrosis. There were seven patients younger than 5 months of age. In one patient with Fallot's tetralogy, an abscess recurred at the site of retained thorium dioxide (Thorotrast) after an 11-year interval. The continuing substantial mortality is attributed to the presence of coma at the time of treatment, hemorrhagic complications of tapping abscesses, and the location of abscesses in deep brain structures. The early detection and successful treatment of brain abscesses in children remains a clinical challenge.

Adolescent↗
PubMed1981

Abscesses complicating DTP vaccination.

Reports of abscesses after the use of diphtheria and tetanus toxoids and pertussis vaccine (DTP vaccine) from two different lots (No. 1 and 2) of a single manufacturer (manufacturer A) prompted an investigation into the rates of abscess formation following the use of DTP vaccine from several different manufacturers. A total of 74 abscesses for lot 1, 16 for lot 2, and three for other DTP products was uncovered. The overall rate after lots 1 and 2 was 1.1 per 1,000 doses administered compared with 0.01 per 1,000 doses for DTP vaccine from other manufacturers (P less than .0001). Faulty technique, site and route of inoculation, microbiologic contamination, and hypersensitivity were ruled out as likely explanations for the increase in abscesses among recipients of DTP vaccine from manufacturer A. Use of a single needle to withdraw vaccine from the vial and to inoculate the vaccinees, combined with high aluminum adjuvant content in the implicated vaccine, may have led to an increased rate of abscess formation.

Abscess↗
PubMed1980

Pancreatic abscess after alcoholic pancreatitis.

Primary pancreatic abscess should be suspected in patients with acute or subsiding pancreatitis who have a tender abdominal mass with evidence of local and systemic sepsis. These individuals have a prolonged course of illness compared with patients with uncomplicated pancreatitis. Another group of patients without overt signs of sepsis may have abdominal masses thought to be pseudocysts, with unexplained temperature elevation and leukocytosis. This latter group may also have pancreatic suppuration, termed secondary because of its natural history. The distinction between primary and secondary abscesses is difficult unless time of onset of the preceding pancreatitis is known. Both groups of patients require early, thorough operation. Signs of sepsis or progressive deterioration in patients with acute pancreatitis must be recognized early since untreated abscess is usually fatal. Extensive debridement and external drainage of all abscess cavities present, preferably via posterolateral flank drain sites, are essential to successful surgical treatment of pancreatic abscess.

Abscess↗
PubMed1981

Synchronous anterior celiotomy and posterior drainage of pancreatic abscess.

Pancreatic abscess has been characterized by a high rate of reoperation for persistent sepsis and by a high mortality. Nine patients with pancreatic abscess have undergone synchronous anterior celiotomy and posterior drainage following resection of the 12th rib. Pancreatic abscess was secondary to acute pancreatitis in seven of the cases. In two cases, the combined procedure was a secondary operation to treat abscess that developed following surgery for pancreatic trauma. All of these nine patients survived. One patient required reoperation for drainage of a left retrocolic abscess. A synchronous approach permits adequate exploration of the abdomen, provides the exposure necessary to remove necrotic tissue, and allows dependent drainage of the left subphrenic space without fear of splenic, pancreatic, or vascular injury.

Abdomen↗
PubMed1986

Antibiotics fail to prevent abscess formation secondary to bacteria trapped in fibrin clots.

We inoculated 120 rats with 2 X 10(9) Escherichia coli or 2 X 10(9) Bacteroides fragilis suspended in normal saline solution or incorporated into fibrin clots. In the control group, all animals died after inoculation with E coli, but none died after the inoculation with B fragilis; both were suspended in normal saline solution. Escherichia coli entrapped in fibrin did not cause mortality but did result in abscess formation in all animals. Bacteroides fragilis incorporated into fibrin clots resulted in abscess formation in the majority of animals. Treatment with gentamicin sulfate, ampicillin sulfate, and cefoxitin sodium completely abolished the mortality secondary to E coli suspended in normal saline solution but did not influence the rate of abscess formation secondary to E coli incorporated into fibrin clots. Similarly, cefoxitin and clindamycin phosphate did not significantly change abscess formation secondary to B fragilis incorporated into fibrin clots. We conclude that systemic antibiotics are ineffective in the prevention of abscesses secondary to bacteria trapped in fibrin, either because they do not reach bactericidal levels in the fibrin clot, as in the case of gentamicin, ampicillin, and clindamycin, or, as in the case of cefoxitin, because of the inoculum effect caused by the high number of bacteria. Fibrinogen or fibrin itself do not afford any protection of bacteria against the action of antibiotics.

Abscess↗
PubMed1989

Liver abscess. The need for complete gastrointestinal evaluation.

The cause of liver abscess is frequently obscure at initial presentation. We reviewed the medical records of 20 patients with pyogenic liver abscess over a 6-year period from 1981 to 1987. Liver abscess was suspected in only 3 patients on admission; the most common initial diagnosis was fever of unknown origin. Subsequently, the origin of the abscess was found to be intestinal in 7 patients, pancreatobiliary in 11 patients, and cryptogenic in 2 patients. Eleven patients underwent percutaneous transhepatic drainage of the abscess as the initial treatment, while open operation was the initial treatment in 9 patients. Percutaneous transhepatic drainage was ultimately successful in only 4 patients (36%). In the absence of an obvious pathologic condition of the biliary tract, all patients should undergo full gastrointestinal evaluation.

Adult↗
PubMed1989

Management of severe incisional abscesses following laparotomy. Early reclosure under cover of metronidazole and ampicillin.

Patients developing severe incisional abscesses following laparotomy were treated with incision and drainage followed by early reclosure under antibiotic cover with metronidazole and ampicillin anhydricum. Patients with subcutaneous abscesses were randomized into two groups that were treated with antibiotics for one day (n = 23) or four days (n = 27). These patients all underwent reclosure four days later. In a third group of patients (n = 14) abscesses had developed down to, but not through, the peritoneum. These patients received antibiotic treatment for four days and underwent reclosure a mean of 5 1/2 days later (range, four to eight days). No abscesses reappeared in any group and all wounds healed by first intention. Five patients healed totally, with minor defects, but there was no need for surgical intervention. We conclude that the early reclosure technique is a safe procedure under antibiotic cover with metronidazole and ampicillin. One day and four days of antibiotic treatment are equally safe in patients with subcutaneous abscesses.

Abscess↗
PubMed1990

Aerobic and anaerobic bacteriology of wounds and cutaneous abscesses.

The aerobic and anaerobic microbiologic characteristics of 584 wounds and 676 skin or soft-tissue abscesses were studied and correlated with the infection site. In wounds, aerobic or facultative bacteria only were present in 223 specimens (38%), anaerobes only in 177 specimens (30%), and mixed flora in 184 specimens (32%). In total there were 1470 isolates, 558 aerobic and 912 anaerobic, an average of 2.5 isolates per wound (1.6 anaerobic and 0.9 aerobic isolates). In abscesses, aerobic or facultative bacteria were recovered in 177 specimens (26%), anaerobes only in 243 specimens (36%), and mixed flora in 256 specimens (38%). In total there were 1702 isolates, 602 aerobic and 1100 anaerobic, an average of 2.5 isolates per abscess. The highest rates of anaerobes in wounds were in the inguinal, buttocks, and trunk areas and in abscesses in the perirectal, external genitalia, neck, and inguinal areas. The predominant aerobic organisms were Staphylococcus aureus (363 isolates), group A streptococci (98 isolates), and Escherichia coli (97 isolates). The predominant anaerobic organisms were Bacteroides species (986 isolates), Peptostreptococcus species (559 isolates), Clostridium species (153 isolates), and Fusobacterium species (109 isolates). The predominance of certain isolates in certain anatomical sites was correlated with their distribution in the normal flora adjacent to the infected site. These data highlight the polymicrobial nature of wounds and cutaneous abscesses.

Abscess↗
PubMed1998

Splenic abscess and sickle cell disease.

This is a report of our experience with 10 cases of splenic abscess in patients with sickle cell disease (SCD). All presented with fever and abdominal pain and were found to have a tender enlarged spleen. Two were found to have a ruptured spleen and five of them were septicemic on presentation. Although both ultrasound and CT-scan of the abdomen were of diagnostic value, we found CT-scan more accurate and reliable in the diagnosis of splenic abscess. Ultrasound and/or CT-scan should be used routinely in the evaluation of SCD patients who present with fever and abdominal pain, especially if they have a tender enlarged spleen. Diagnostic aspiration under CT-scan or ultrasound guidance should be used in doubtful cases to differentiate between splenic abscess and a large splenic infarct. All our patients were managed by peri operative antibiotics and splenectomy with no mortality. Salmonella was the commonest causative organism. Although CT-guided aspiration of splenic abscess is being advocated recently, we feel splenectomy should be the treatment of choice in patients with SCD as there is no point in preserving a non-functioning spleen that is present in the majority of patients. CT-guided aspiration may be employed as a temporary measure for those patients who are at high surgical risk with unilocular abscess.

Abscess↗
PubMed1981

Splenic abscess diagnosed with the aid of abdominal computerized tomography: report of 2 cases.

Two patients with splenic abscess successfully diagnosed and treated are described. The first case, a diabetic, developed a pyogenic abscess caused by klebsiella, while the other suffered a splenic infarct complicated by splenic abscess. although relatively easy to treat, solitary abscess of the spleen is a potentially lethal condition due to diagnostic difficulties. In both present instances the final diagnosis was easily achieved before surgery by the aid of computerized tomography (CT). This investigation seems to be more accurate than 99Tcm-sulphur colloid scan and ultrasound scan, which failed in both cases to diagnose splenic abscess clearly. The use of this investigation is suggested in every suspected case and will, no doubt, confirm the diagnosis at an early stage of the disease. Splenectomy with antibiotic cover will usually result in cure.

Abscess↗
PubMed1984

Pancreatic abscesses.

This paper presents the clinical features and problems in the management of 34 patients with pancreatic abscesses. In the majority of patients the abscesses developed following an attack of pancreatitis due to alcohol or gallstones. The abscesses were usually multilocular, and often had spread widely in the retroperitoneal space. Invasion into surrounding viscera or the peritoneal cavity occurred in 12 instances, and eight patients developed major bleeding into the abscess cavity. Obstructive complications (affecting bowel, common bile duct and large veins) occurred in eight patients. Twelve of the 34 patients (35 per cent) died, most deaths being due to failure to control sepsis (seven patients) or to massive bleeding from the abscess cavity (three patients). The mortality of this condition is likely to remain high, but may be reduced by better drainage techniques at the initial exploration. The importance of the infra-mesocolic approach for drainage is emphasized.

Abscess↗
PubMed1987

Review of a hospital experience of breast abscesses.

A retrospective review of breast abscesses during a 10-year period was performed. Only 8.5 per cent (6/72) of patients were in the puerperium. Peripherally sited abscesses were predominantly staphylococcal in origin, incision and drainage was effective treatment in all. By contrast, a subareolar abscess yielded a higher proportion of anaerobic bacteria and 46 per cent (13/28) of these patients had duct ectasia. We conclude that in present day practice a breast abscess is more likely to be related to duct ectasia than to the puerperium, and that patients with anaerobic infection or subareolar abscesses should be assumed to have duct ectasia and may require excision of the major duct system (Hadfield's procedure).

Abscess↗
PubMed1996

Conservative management of infective mastitis and breast abscesses after ultrasonographic assessment.

Current practice in this unit for a suspected breast abscess is preliminary ultrasonographic scan, aspiration of any pus, antibiotic therapy and repeat aspiration in the outpatient clinic if necessary. Inflammatory masses are treated with antibiotics alone. A retrospective review of this strategy has been made. Over a 2-year interval 53 patients were admitted to hospital with a suspected breast abscess. Twenty-two abscesses were aspirated, of which 19 resolved and three required subsequent incision and drainage. Eight patients underwent primary incision and drainage, one of whom required a second drainage procedure. In five patients the abscess discharged spontaneously before intervention. The remaining 18 patients were found on ultrasonography to have inflammation without evidence of focal pus which settled with antibiotic therapy in all but two patients. One of these was found to have an inflammatory cancer and the other developed an abscess, which was drained. Aspiration combined with ultrasonographic imaging is an effective alternative to incision and drainage.

Abscess↗
PubMed2003

Pathophysiology of intra-abdominal adhesion and abscess formation, and the effect of hyaluronan.

BACKGROUND: Intra-abdominal adhesions and abscesses cause significant morbidity and mortality. The formation of fibrin in the abdominal cavity is a common pathophysiological pathway for both. The aim of this review was to investigate the pathophysiology of intra-abdominal adhesions and abscesses, and to explore the possible sites of action of hyaluronan. METHODS: Data were reviewed from the literature using the Medline database. RESULTS: Both surgery and peritonitis disturb the equilibrium between coagulation and fibrinolysis in the abdominal cavity in favour of the coagulation system. Hyaluronan-based agents reduce adhesion formation after surgery. Moreover, hyaluronan solution reduces abscess formation in experimental peritonitis. Possible mechanisms of action include mechanical separation of wound surfaces, improvement of peritoneal healing, modulation of the inflammatory response and enhanced fibrinolysis. CONCLUSION: Diminished fibrin degradation is a common pathway for the formation of adhesions and abscesses. The potential of hyaluronan-based agents to reduce intra-abdominal adhesions and abscesses in abdominal surgery and sepsis is a promising new concept. Elucidating the mechanisms involved and the clinical application of hyaluronan in peritonitis are challenges for future research.

Abdominal Abscess↗