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PubMed2004

Comparison of outcomes in patients with active infective endocarditis with versus without paravalvular abscess and with and without valve replacement.

In 82 patients with infective endocarditis, including 11 with a perivalvular abscess detected by transesophageal echocardiography, age was a significant predictor of in-hospital mortality (p <0.001). At 3.8-year follow-up, 5 of 7 patients with an abscess who had valve replacement and 2 of 4 patients with an abscess who did not have surgery survived (p = NS); 13 of 22 patients (59%) with no abscess who had valve replacement and 20 of 49 patients (41%) with no abscess who did not have surgery survived (p = NS).

Abscess↗
PubMedDate not supplied

Predicting deep neck space abscess using computed tomography.

PURPOSE: To investigate objective measures that could increase the positive predictive value of computed tomography (CT) in diagnosing deep neck space infections (DNSIs). METHODS: A retrospective analysis of patients surgically treated at a tertiary care hospital for DNSIs for more than 2 years were reviewed. Patients who had had CT with contrast scanning suggestive of deep neck space abscess within 24 hours before surgery were included. The average Hounsfield units for each abscess were calculated. Based on the intraoperative finding of pus, the patients were divided into groups. Student t tests compared the average Hounsfield units, white blood cell count, and maximum temperature between the groups. Outcomes were measured by comparing overall length of hospital stay, length of postoperative stay, and complications. RESULTS: Of the 32 patients surgically drained, 24 (75%) had discreet collections of pus, whereas 12 (25%) did not. Hounsfield unit measurement was not reliable in distinguishing abscess from phlegmon. None of the other clinical variables studied to distinguish abscess from phlegmon were statistically different either. A statistical difference between the 2 groups was not identified. CONCLUSION: Although CT with contrast plays an important role in the diagnosis and management of DNSIs, the decision for surgical drainage of an abscess should be made clinically. A negative exploration rate of nearly 25% despite careful selection criteria should be expected.

Abscess↗
PubMed2005

[Severity of aortic ring abscess complicated by cardiac conduction abnormalities].

OBJECTIVE: To determine clinical features, management and prognosis of cardiac conduction abnormalities (CCA) complicating abscessed endocarditis. METHODS: We have analysed clinical, microbiologic and echocardiographic datas, therapies and outcome of cardiac abscesses complicated by CCA in patient hospitalized between 1995 and 2001 in our centre. RESULTS: Above 35 cardiac abscesses, six men (mean age 62 years) had CCA complicating six aortic ring abscesses (4 on native valve and 2 on prosthetic valve) with four cases of interventricular septal involvement and fistulization. Severe heart failure is present four times, a septic cerebral embolization twice. Streptococcus and Staphylococcus prevail. Complete atrioventricular block (AVB) reveals endocarditis twice and complicates the evolution three times. Trifascicular block (first degree AVB, left anterior fascicular block and complete right bundle branch block) revealed recurrence of endocarditis. Two patients were treated medically: one died quickly (complete AVB pre-mortem), and the other one had favourable issue (paroxystic complete AVB). Four patients had surgery with temporary pacemaker in three cases (one died) then definitive pacemaker in two cases. At 26.5 month (7-50), the four survivors had no recurrence of endocarditis. CONCLUSION: Severe CCA are classical in aortic ring abscessed endocarditis and associated with increased mortality. Immediate transfert in a dentre with cardiac surgery is necessary. Definitive cardiac pacing can be performed early without leads infection.

Abscess↗
PubMed2005

[CT-Guided transgluteal approach for percutaneous drainage of pelvic abscesses: results in 21 patients].

OBJECTIVE: Percutaneous drainage of pelvic abscesses may be challenging using a conventional anterior route because of overlying intestinal or vascular structures. Although, the posterior transgluteal route is not commonly performed, it may provide a safer approach when the conventional anterior route is not feasible. We retrospectively analyzed our experience in transgluteal percutaneous drainage of pelvic abscesses in 21 patients to determine the feasibility, safety, tolerance and efficacy of this technique. METHODS: The data of 21 patients with pelvic abscesses (15 postoperative and 6 secondary to diverticulitis) who were treated by CT-guided percutaneous transgluteal drainage between 1992 and 2002 were reviewed. Transgluteal drainage was considered as failure in case of persisting clinical sepsis, recurrence of abscess or when surgery was needed. RESULTS: The procedure was well tolerated in all patients. No major complication was observed. In one patient mild hematoma of the piriform muscle was noticed on postprocedure CT scan but did not require a specific treatment. Successful drainage as documented by follow-up CT examination was observed in 20 patients (20/21; 95%). One case of recurrence which was successfully treated by repeated percutaneous transgluteal drainage was observed in our series. CONCLUSION: Percutaneous imaging-guided transgluteal drainage is a feasible, safe, well-tolerated and effective method for the treatment of pelvic abscess when a conventional anterior route is not feasible.

Abscess↗
PubMed2006

Macrophage-activation inhibitor factor from L5178Y murine lymphoma and formation of hepatic abscesses in BALB/c mice.

BACKGROUND: Normal mice are naturally resistant to hepatic abscesses produced by Listeria monocytogenes. A macrophage-activation inhibitor factor (MAIF) isolated from the cell-free ascitic fluid of L5178Y lymphoma-bearing mice inhibited the lipopolysaccharide-induced production of nitric oxide (NO) by the macrophages. Because macrophages are also involved in the immune response towards L. monocytogenes, the present study had the objective of investigating whether MAIF was also capable of allowing L. monocytogenes to form hepatic abscesses. METHODS: BALC/c mice were inoculated intrahepatically with 5 x 10(5) bacteria. Experimental groups were treated daily with subcutaneous or intraperitoneal doses of 0, 1, 5 or 10 microg of MAIF/g of body weight. One dose was applied before inoculating bacteria and the remaining three doses 24, 48, and 72 h after inoculating bacteria. The development of hepatic abscess was analyzed 24 h after the last administration of MAIF. RESULTS: All treated mice (but not controls) developed hepatic abscess showing no differences regarding MAIF administration route. CONCLUSIONS: These results suggest a possible MAIF in vivo inhibition of NO macrophage production that allows L. monocytogenes hepatic abscess development in mice.

Animals↗
PubMed2005

Predictors of mortality in paravalvular abscess.

BACKGROUND: Paravalvular abscess formation is an ominous complication of infective endocarditis; however, prognostic variables in paravalvular abscess are poorly defined. METHODS: We examined our experience in patients with paravalvular abscess between 1987 and 2004. Clinical, echocardiographic, microbiologic, and surgical data were examined. RESULTS: There were 45 patients (17 females), age 57 +/- 17 years. Twenty-four patients had prosthetic valve endocarditis. Methicillin-sensitive Staphylococcus aureus and coagulase-negative S. aureus were the most common organisms accounting for 25 (56%) cases. Thirty-eight patients (84%) underwent surgery during initial admission. Surgical mortality was 7%, in-hospital mortality was 31%, and 1-year mortality was 38%. Between patients who died and patients who survived, there were no differences in age (61 +/- 20 years vs 55 +/- 15 years, P = .3), type of microorganism, presence of prosthetic heart valves (47% vs 57%), presence of moderate to severe or severe regurgitation of involved valve (47% vs 57%, P = .37), presence of associated valvular vegetation (93% vs 93%), area of abscess (5.6 +/- 2.9 cm2 vs 4.4 +/- 3.2 cm2, P = .39), left ventricular systolic function (56% +/- 13% vs 56% +/- 10%, P = .9), white cell count (13 +/- 4 vs 13 +/- 7, P = .9), or polymorphonuclear leukocytosis (86% +/- 6% vs 81% +/- 9%, P = .1). Patients who died were sicker on admission compared with those who survived (33% had stroke or altered mental status vs 7%, P = .03) and had worse renal function compared with those who survived (creatinine 4 +/- 4 mg/dL vs 1.6 +/- 1.9 mg/dL, P = .009). CONCLUSION: Neurologic impairment and renal impairment are significant determinants of 1-year survival in patients who present with paravalvular abscess.

Abscess↗
PubMed2005

Role of diffusion weighted imaging in differentiation of intracranial tuberculoma and tuberculous abscess from cysticercus granulomas-a report of more than 100 lesions.

Restricted diffusion is noted in a large number of non-stroke conditions including tuberculoma. The purpose of this study was to demonstrate spectrum of diffusion weighted imaging (DWI) abnormalities in tuberculomas and tuberculous abscess and to distinguish these from degenerating neurocysticercosis. Seventy tuberculomas and tuberculous abscesses in 30 patients were categorized in three groups depending on the intensity in the core of the lesion on T2 weighted images. Mean apparent diffusion coefficient (ADC) was calculated from the core as well as from the wall of the lesions. Forty-five lesions of neurocysticercosis in different stage of evolution in 12 patients were also included for comparison. The mean ADC value from the core of the T2 hypointense lesions was significantly higher compared to the wall ((1.24+/-0.32)x10(-3) and (1.06+/-0.15)x10(-3)mm(2)/s, respectively), while mean ADC value from the core of mildly T2 hyperintense lesions was significantly lower compared to the wall ((0.80+/-0.08)x10(-3) and (1.08+/-0.13)x10(-3)mm(2)/s, respectively). Truly T2 hyperintense lesions were divided into two subgroups, tuberculomas and tuberculous abscesses; ADC values from the core and the wall of these lesions were (0.74+/-0.13)x10(-3), (0.61+/-0.08)x10(-3) and (1.03+/-0.14)x10(-3), (1.08+/-0.14)x10(-3)mm(2)/s, respectively, and was significantly lower in core as compared to the wall. However, there was no significant difference between ADC values of the tuberculous abscess and the hyperintense tuberculomas. Vesicular and degenerating stages of cysticercus cysts from the core showed ADC values of (1.66+/-0.29)x10(-3) and (1.51+/-0.23)x10(-3)mm(2)/s, respectively, and were significantly higher than the core of all groups of tuberculomas and tuberculous abscess. We conclude that addition of DWI to routine imaging protocol may help in differentiation of tuberculous lesions from degenerating cysticercus granuloma.

Adult↗
PubMed2005

Endoscopic debridement of paraesophageal, mediastinal abscesses: a prospective case series.

BACKGROUND: Mediastinal abscesses after esophageal perforation or postoperative leakage nearly always require surgical intervention. METHODS: Patients with paraesophageal abscesses were treated with EUS-guided or endoscopic mediastinal puncture if the abscess was >2 cm and sepsis was present. Abscess cavities were entered with a 9.5-mm endoscope after balloon dilation to allow irrigation and drainage. Debris was removed with a Dormia basket. Concomitant pleural effusions were treated with transthoracic drains. Patients received intravenous antibiotics and enteral/parenteral nutrition. RESULTS: Twenty patients fulfilled the entry criteria. Simple drainage was sufficient in 4 cases, and puncture was impossible in one case. Of the 15 treated patients (age 39-76 years, 5 women) the etiology of perforation was Boerhaave's syndrome (n = 8), anastomotic leak (n = 3), and iatrogenic perforation (n = 4). Debridement was successful in all cases and required a median of 5 daily sessions (range 3-10). All patients became apyrexial, with a C-reactive protein < 5 mg/L within a median of 4 days (range 2-8 days). Esophageal defects were closed with endoclips (n = 7), fibrin glue (n = 4), metal stents (n = 1), or spontaneously healed (n = 3). One patient died from a massive pulmonary embolism one day after successful debridement (mortality 7%). No other complications were seen. Median follow-up was 12 months (range 3-40 months). CONCLUSIONS: Nonoperative endoscopic transesophageal debridement of mediastinal abscesses appears safe and effective.

Abscess↗
PubMed2005

Methicillin-resistant Staphylococcus aureus as a pathogen in deep neck abscesses: a pediatric case series.

OBJECTIVES: Pediatric deep neck space abscesses are frequently treated by the otolaryngologist. We report four children with deep neck abscesses caused by methicillin-resistant Staphylococcus aureus (MRSA), including the first described case of descending mediastinitis caused by MRSA in a child. METHODS: Records from March 2001 to April 2002 were reviewed. RESULTS: Four patients presented with neck swelling, and three of these also had leukocytosis. All abscess cultures were positive for MRSA. Abscess drainage with antibiotic therapy successfully treated three cases without complication. The fourth case developed descending mediastinitis but survived after additional surgical treatment and prolonged antibiotic therapy. CONCLUSIONS: MRSA should be considered as a potential pathogen in deep neck space abscesses. A high index of suspicion is needed as well as aggressive treatment including incision and drainage along with culture-directed medical therapy. Surgical drainage may be the most important aspect of therapy.

Abscess↗
PubMed2005

Bilateral peritonsillar abscesses: not your usual sore throat.

We describe a rare case of a previously healthy 30-year-old man who presented to the Emergency Department (ED) with bilateral peritonsillar abscesses. The clinical presentation of fever, trismus and odynophagia was consistent with pertonsillar abscess (PTA), but the presence of symmetric tonsillar swelling and midline uvula confounded the diagnosis. The true incidence of bilateral peritonsillar abscesses is unknown, but the incidence of unsuspected contralateral peritonsillar abscess identified at tonsillectomy has been reported to be between 1.9% and 24%. The diagnosis of bilateral peritonsillar abscesses should be considered when the clinical presentation suggests the diagnosis of PTA, but the physical examination reveals bilateral swollen tonsils with a midline uvula.

Adult↗
PubMed2005

The epidemiology of peritonsillar abscess disease in Northern Ireland.

OBJECTIVES: 1. To describe the epidemiology of peritonsillar abscess disease in Northern Ireland. 2. To describe the impact of the nature of microbiological sampling on culture results. METHOD: Retrospective review of cases of peritonsillar abscess identified by diagnostic coding in three centres in Northern Ireland between August 2001 and July 2002. RESULTS: One hundred and twenty eight cases of confirmed peritonsillar abscess were treated as inpatients accounting for 1 in 10,000/year of the population in the hospitals' catchment area. The mean age was 26.4 (range 9-78) years. Sixty-nine patients were male; the mean length of hospital stay was 3 days. Culture yield was greatest from needle aspirates; throat swabs and blood cultures were typically unhelpful. Beta haemolytic streptococci were the most common isolates. Resistance among Group A haemolytic streptococci to macrolide antibiotics was present in 26% of isolates. Heterophile antibody testing was routine and revealed that Epstein-Barr virus infectious mononucleosis had a prevalence of 1.8% in this group of patients. CONCLUSION: In this population, although there were many similarities with the clinical features reported by other investigators, there were also several differences. Notably, we found a comparatively low proportion of anaerobic infections. Although cultures results did not influence individual patient treatment, reviewing data derived from populations is valuable for guiding empirical antibiotic therapy. SUMMARY: The epidemiology of peritonsillar abscess disease is not well described. Other investigators describing the bacteriology give differing results, presumably reflecting different countries and techniques. The need for routine microbiological testing has been questioned in several reports, but the benefit of routine culture and sensitivity data for planning empirical antibiotic treatment has not been explored. We present a retrospective review of 128 cases of confirmed peritonsillar abscess in Northern Ireland from August 2001 to July 2002. The annual population incidence in this region is 1 in 10,000/year. In this group concurrent Epstein-Barr virus infection was found to have a prevalence of 1.8%. The yield of positive cultures from routine microbiological sampling was low in comparison to that reported in detailed prospective studies, from various countries. Needle aspiration was the best technique for obtaining pus for culture; throat swabs and blood cultures were unhelpful. Culture results did not affect individual patient treatment, but may have a potentially useful role for selecting empirical therapy.

Adolescent↗
PubMed2005

Bacterial brain abscesses: an evaluation of 96 cases.

OBJECTIVES: Although the decline of the morbidity and mortality in recent years, brain abscess is still one of the most important problems in Neurosurgery. METHODS: Ninety-six patients with brain abscess are analysed retrospectively, that treated between 1988 and 2001, according to age, the clinical symptoms, etiologic factors, infecting organisms, prognostic factors, localization, diagnostic and treatment methods and outcome. RESULTS: Seventy-two patients treated with aspiration (streotactic aspiration in 12 cases), 14 patients with excision. Ten patients treated medically alone. Seven patients in the aspiration group and one patient in the excision group were died. Cure without any morbidity obtained in 55 patients. A significant correlation determined with initial neurologic grade, meningismus, high fever (>38.50), leucocytosis (>20.000/mm3) and mortality. There were no significant correlation the age groups and outcome, treatment groups and location of abscess, period of treatment, number of abscess, outcome according to GOS and factor, treatment period and received antibiotic. CONCLUSIONS: In appropriate cases, medical treatment can be successful alone but surgery, aspiration, is gold standard for brain abscesses. In that way, definite diagnosis is obtained and pathogen is identified and cure is obtained in a short time.

Adolescent↗
PubMed2005

Management of patients with Streptococcus milleri brain abscesses.

OBJECTIVES: We evaluated the efficacy of cefotaxime in the management of brain abscesses caused by Streptococcus milleri. Twenty two patients with a S. milleri brain abscess were treated with metronidazole and cefotaxime, in accordance with recent recommendations by the British Society Of Antimicrobial Chemotherapy (BSAC). Seven patients who had Glasgow Coma Scales < or =11 also received rifampicin and high dose cefotaxime. The clinical response of the patients was determined. METHOD: A retrospective study at the Queen Elizabeth Hospital, Birmingham covering the period April 1996-March 2004 was carried out. Neurosurgical and anti-microbial therapeutic approaches were reviewed. Any evidence of improvement of clinical features and radiological disappearance of brain abscesses were determined. RESULTS: Outcome was assessed using the Glasgow Outcome Score (GOS) at 3 and 6 months from the time of surgical intervention. Eighteen patients (82%) had a good outcome by 6 months, with an outcome score of 4-5. Thirteen patients resumed normal life despite minor deficits (GOS 5), while a further five patients had moderate disability though remained independent (GOS 4). One patient had a GOS of 3 and there were three deaths (14). The minimum time to radiological resolution of the abscess was within 1 month in six cases (27) These all represented solitary lesions that required a single drainage procedure in conjunction with 4 weeks of intravenous cefotaxime and metronidazole. Ten cases (45%) had resolution within 4 months and a further three cases took at least 6 months from the time of surgery to show radiological clearance. CONCLUSIONS: This cohort of patients responded favourably to the guidelines recommended by the BSAC. This was confirmed by the Glasgow Outcome Score (GOS 4-5) at 6 months review. Cefotaxime at a higher dose with rifampicin was prescribed for patients presenting with a decreased conscious level (GCS 8-11), subsequent failure of anticipated clinical improvement or clinical deterioration. There was no clinically significant difference in GOS between the two treatment groups. An algorithm for management of brain abscess is presented, based on our clinical experience and review of the literature.

Adolescent↗
PubMed2006

Cervical epidural abscess in an afebrile patient: a case report.

OBJECTIVE: The aim of the study was to discuss a case of cervical epidural abscess and present the clinical features and diagnosis of this disorder. CLINICAL FEATURES: A 52-year-old man had severe neck pain for 1 week. He had a long history of chronic recurrent neck pain, including 2 previous neck surgeries. He was afebrile on each visit, but developed rapid onset of motor loss, which necessitated immediate magnetic resonance imaging referral. The patient died in the magnetic resonance imaging tube. INTERVENTION AND OUTCOME: Because of the aggressive nature of the infection, causing death only 1 week after the initial onset of symptoms, there was no opportunity to institute treatment of the abscess. CONCLUSION: Spinal epidural abscess is a relatively rare but potentially life-threatening disorder in which the most common initial symptom is spinal pain. Because of this, patients with early spinal epidural abscess will often consult a chiropractic physician or other primary contact spine specialist. It is important for clinicians to be alert to the diagnostic features of spinal epidural abscess so that early treatment can be instituted.

Body Temperature↗
PubMed2006

Brain abscess following intracerebral haemorrhage.

We report two cases of brain abscess, which developed at the site of an intracerebral haemorrhage (ICH) in a 75-year-old man and a 32-year-old-man. The patients recovered after surgical treatment and systemic antibiotic therapy. The route of infection could not be detected in either case. The literature contains only 13 reported cases of brain abscess as a complication of ICH. Although the interval from initial ICH to abscess formation ranged from 4 to 20 weeks, almost all patients had episodes of high fever, indicating the presence of systemic infection and bacterial seeding, 0-14 days after the onset of their ICH. Therefore, abscess formation appears to be caused by haematogenous seeding of infection in patients with ICH. Abscess formation should be considered when a patient deteriorates clinically with a febrile episode after an ICH.

Adult↗
PubMed2006

Nocardial brain abscess: review of clinical management.

Nocardiosis has become a significant opportunistic infection over the last two decades as the number of immunocompromised individuals has grown worldwide. We present two patients with nocardial brain abscess. The first patient was a 39-year-old woman with systemic lupus erythematosus. A left temporoparietal abscess was detected and aspirated through a burr-hole. Nocardia farcinica infection was diagnosed. The patient had an accompanying pulmonary infection and was thus treated with imipenem and amikacine for 3 weeks. She received oral minocycline for 1 year. The second patient was a 43-year-old man who was being treated with corticosteroids for glomerulonephritis. He was diagnosed with a ring-enhancing multiloculated abscess in the left cerebellar hemisphere, with an additional two small supratentorial lesions and triventricular hydrocephalus. Gross total excision of the cerebellar abscess was performed via a left suboccipital craniectomy. Culture revealed Nocardia asteroides, and the patient was successfully treated with intravenous ceftriaxone, then oral trimethoprime-sulfamethoxazole for 1 year. The clinical course, radiological findings, and management of nocardial brain abscess are discussed in light of the relevant literature, and current clinical management is reviewed through examination of the cases presented here.

Adult↗
PubMed2004

[Liver abscesses secondary to sigmoid diverticulitis: report of four cases].

INTRODUCTION: Pyogenic liver abscess often revealed by right sided abdominal pain and fever is a serious and life-threatening pathology. Biliary tract disease is the origin of the abscess in most cases but sometimes remains unidentified. A sigmoid septic source sometimes paucisymptomatic or hidden by an immunosuppressive treatment must be looked for. EXEGESIS: Here are four observations of liver abscesses, which are secondary to unknown sigmoiditis. The etiologic diagnosis was made either by abdomino-pelvic computed tomography or by enema with water-soluble products completed by a coloscopy. Each patient's liver abscesses were emptied by aspiration or catheter drainage in conjunction with antibiotics. Surgical treatment of sigmoiditis was performed either at the same time or later. CONCLUSION: Any liver abscess of unknown origin must lead to a search for unknown or disguised septic sigmoid pathology. Most of the time, injected abdomino-pelvic computed tomography makes the diagnosis possible, but enema associated with coloscopy is sometimes necessary.

Aged↗
PubMed2005

Utility of diffusion-weighted images using fast asymmetric spin-echo sequences for detection of abscess formation in the head and neck region.

OBJECTIVE: The objective of this study was to evaluate the utility of new diffusion-weighted magnetic resonance images (DWI) using fast asymmetric spin-echo (FASE) sequences for the detection of abscess formation in patients with phlegmon in the oral and maxillofacial regions. METHODS: We compared diffusion-weighted images using FASE sequences with those using the gradient-echo type of echo-planar images (EPI) in 10 control volunteers and 10 patients with phlegmon in the oral and maxillofacial regions. RESULTS: Many kinds of tissues in the oral and maxillofacial regions were relatively well visualized in all subjects on FASE-DWI, but not well on EPI-DWI. Apparent diffusion coefficients calculated from FASE sequences in abscess areas of patients with phlegmon were significantly lower than those in abscess-free areas; however, apparent diffusion coefficients calculated from EPI were not significantly different due to prominent distortion in small sample size study. CONCLUSIONS: We could accurately recognize the presence of abscess formation within inflammatory tissue in 5 patients with phlegmon using FASE-DWI. As an additional magnetic resonance examination, FASE-DWI might be useful in the detection of abscess formation in the oral and maxillofacial regions.

Abscess↗