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PubMed1977

The changing clinicopathological pattern of abscesses in or adjacent to the kidney.

We reviewed retrospectively 43 patients with various renal and perirenal abscesses. In contrast to previously published data a primary renal etiology was noted for nearly every abscess in or adjacent to the kidney, irrespective of the type of abscess. Currently, the concept that the renal carbuncle is a metastatic abscess whose origin lies at some distant site may be applicable no longer. Despite earlier recognition of symptoms, improved diagnostic techniques and better therapy the morbidity and mortality of abscesses in and adjacent to the kidney remain high, suggesting the important role of associated medical conditions and the need for early aggressive therapy.

Abscess↗
PubMed1991

Epidural abscess associated with intravenous drug abuse in a pregnant patient.

The association between intravenous drug abuse and epidural abscess is well known; however, this association has not previously been reported in a pregnant patient. The classic manifestation of epidural abscess is a febrile patient with back pain that progresses rapidly to radicular pain, spinal cord dysfunction, weakness, and then complete paralysis. Although this condition is rare during pregnancy, these serious complications necessitate prompt diagnosis and intervention. If spinal infection is suspected, magnetic resonance imaging should be performed immediately. After epidural abscess is diagnosed, emergent decompressive laminectomy and appropriate antibiotic coverage are necessary. Herein we describe a 27-year-old pregnant patient with epidural abscess probably related to use of contaminated needles for intravenous administration of drugs and subsequent hematologic spread of staphylococci to the epidural space. The differential diagnosis of epidural abscess can be difficult, and management options must consider the well-being of both the mother and the fetus.

Abscess↗
PubMed2002

Primary psoas abscess complicating a normal vaginal delivery.

BACKGROUND: Psoas abscess is a rare and potentially dangerous complication of normal delivery. CASE: We describe a case of primary psoas abscess after normal vaginal delivery. A young woman presented with fever, left back pain, left lower abdominal pain, and hip pain starting on postpartum day 2. Computed tomography demonstrated a large retroperitoneal collection. Aspiration drainage of the abscess under computed tomography guidance isolated Streptococcus viridans, which responded to antibiotic therapy and percutaneous drainage with complete resolution. CONCLUSION: A high index of suspicion is necessary for diagnosis of psoas abscess, which should be considered in postpartum patients with pyrexia, back and hip pain, and a normal neurologic examination. Computed tomography is effective for diagnosis and allows percutaneous drainage of the abscess.

Abdominal Pain↗
PubMed2002

Puerperal adrenal abscess complicating chorioamnionitis.

BACKGROUND: An abscess in the adrenal gland is a rare finding described only a few times in the literature. We present a case report of chorioamnionitis complicated by a puerperal adrenal abscess diagnosed and drained percutaneously using ultrasound and computed tomography. CASE: A 22-year-old woman delivered prematurely because of chorioamnionitis. Amoxicillin clavulanate was administered, and her fever defervesced. Six days later, the patient presented with a temperature of 40C and right flank pain. Workup revealed an abscess in the right adrenal gland, which was diagnosed by computed tomography scan, and then drained percutaneously. Follow-up revealed regression of the abscess to complete recovery. CONCLUSION: Adrenal abscess has not been described in the past as a possible complication of choriamnionitis. It is important to assess the entire abdominal cavity by ultrasound or computed tomography in febrile patients who do not respond to medical therapy.

Abscess↗
PubMed2000

Preterm delivery in mice with renal abscess.

OBJECTIVE: Our purpose was to develop a mouse model of renal abscess to study the effect of extrauterine infection on preterm delivery. METHODS: Escherichia coli or sterile medium was injected into the left kidney of 70 pregnant mice that had completed approximately 75% of gestation. Preterm delivery rates were recorded for various inocula. Kidney specimens were obtained and examined grossly and histologically for abscess formation. RESULTS: Thirty-one of 51 animals (60.8%) infected with 1 x 10(5)-9 x 10(6) bacteria and none of 19 uninfected animals delivered prematurely (P < .001). Renal abscess was induced in 100% of mice receiving bacterial inoculation but in none receiving sterile medium. CONCLUSION: Kidney injection provides a reliable method for inducing renal abscess in pregnant mice. Renal abscess induces preterm delivery at a stable rate across a wide range of bacterial inocula. This model of extrauterine infection may be particularly useful in investigations of infection-induced preterm delivery.

Abscess↗
PubMed1988

Status of percutaneous catheter drainage of abscesses.

The definitive role of catheter drainage in the therapy of abscesses has not yet been totally elucidated. The resolution rate of intra-abdominal infection with catheter drainage is highly variable, depending on the inclusion criteria employed. Certain infections are very effectively treated (i.e., abscesses that are single, not communicating with abdominal viscera, noncancerous, and bacterial) with simple catheter drainage, whereas others (i.e., infected pancreatic tumor phlegmon) prove to be much more resistant to simple catheter drainage. When all intra-abdominal "abscesses" are collected, the success of catheter drainage ranges from 47 per cent to 73 per cent. The wide variation should be seen not so much as a reflection of differences in technical ability of the radiologist to introduce a catheter, but rather as emblematic of the highly variable nature of the cause of intra-abdominal infection and the definition of an abscess. Hospitals with a large number of complex problems such as malignancy, transplant and other immunosuppressed patients, and referrals of patients with complex long-standing intra-abdominal infections are likely to have a much lower rate of success with percutaneously placed catheters than are those institutions that derive their series from post-traumatic or primary diseases such as appendiceal or diverticular disease. In the former series, a higher morbidity and mortality rate would be expected from any form of treatment when compared to a series from a practice based on more primary care problems. Intra-abdominal infections are a heterogeneous set of processes, and the role of interventional radiology in the diagnostic and therapeutic approach cannot be underestimated. In planning for the care of a patient with a presumed intra-abdominal infectious process, percutaneous aspiration of a fluid mass is an effective tool for establishing the diagnosis of an abscess. The brief introduction of a catheter has rarely led to contamination of an otherwise sterile collection. However, it often effects dramatic symptomatic relief if the fluid collection is infected. It has therefore been an evolving recommendation to employ the techniques of interventional radiology aggressively in a diagnostic capacity. Subsequently, therapeutic interventions can be undertaken in joint agreement among the physician, surgeon, and radiologist. The diagnosis and treatment of intra-abdominal infections can often times be carried out in a relatively easy and non-morbid manner that effects cure in a significant percentage of patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Abdomen↗
PubMedDate not supplied

Cerebellar abscesses secondary to occipital dermoid cyst with dermal sinus: case report.

BACKGROUND: Hydrocephalus and cerebellar abscesses as the principal manifestations of posterior fossa dermoid cyst are rare. In addition, extradural dermoid cyst of the posterior fossa has been described in only 9 cases in the literature. We present an unusual case of obstructive hydrocephalus due to cerebellar abscesses induced by an adjacent extradural dermoid cyst with complete occipital dermal sinus. CASE DESCRIPTION: A 14-month-old child presented with acute raised intracranially pressure, seizures, and meningitis. Neuroradiological studies revealed cerebellar cysts with ring enhancement associated with a contiguous occipital cyst, with compression of the adjacent cisterns and the fourth ventricle causing hydrocephalus. The diagnosis of cerebellar abscesses with congenital occipital defect was briefly entertained. The patient was treated by radical excision of the occipital cyst with hair contents, the dermal sinus, and the abscesses through a suboccipital approach, followed by systemic antibiotic therapy with a good outcome. Pathologic examination revealed a dermoid cyst. CONCLUSION: Posterior fossa dermoid cyst should be considered in all children with occipital skin lesions, especially dermal sinus. CT scan and MRI are the methods of choice for further investigation of suspect congenital dermal lesions. Neurosurgical treatment of these malformations should be planned early to prevent the high incidence of infections such as bacterial meningitis and cerebellar abscess. Clinical presentation, diagnostic evaluation, and treatment of these rare lesions are reviewed.

Brain Abscess↗
PubMed2003

MR demonstration of brain abscess rupture into the subarachnoid space and its possible implication in management.

BACKGROUND: Rupture of brain abscess into the subarachnoid space as a cause of meningitis is rare. Early diagnosis improves the outcome. There is no previous report of MR demonstration of rupture of brain abscess into the subarachnoid space. CASE DESCRIPTION: Two young adults with chronic suppurative otitis media presenting with signs of increased intracranial pressure and meningeal irritation underwent magnetic resonance imaging, which showed brain abscess with evidence of rupture into the subarachnoid space and meningitis. This helped in early diagnosis and aggressive management. CONCLUSION: In cases of brain abscess where meningitis is suspected clinically, documentation of rupture of the abscess into the subarachnoid space will help in avoiding cerebrospinal fluid (CSF) examination that may be disastrous in these patients who already have increased intracranial pressure.

Adolescent↗
PubMed1996

Intrasellar abscess following transsphenoidal surgery.

BACKGROUND: Intrasellar abscess following transsphenoidal surgery has been described only twice in the English language medical literature. Overall mortality associated with intrasellar abscesses is 51%, while mortality in reported cases not treated surgically is 100%. METHODS: Two cases of intrasellar abscess following uncomplicated transsphenoidal surgery for pituitary pathology are reported. The incidence, radiographic features, clinical presentations, and treatment of intrasellar abscesses are discussed. RESULTS: Both patients described underwent uncomplicated transsphenoidal procedures for treatment of a primary pituitary lesion. Neither developed postoperative CSF rhinorrhea, and initial recovery was uneventful. The first patient presented with new symptoms several weeks after transsphenoidal surgery; the second patient almost two years postoperatively. The first displayed signs of an expanding sellar mass, requiring transsphenoidal drainage and postoperative antibiotics. The second presented with recurrent meningitis without discernible CSF leak, and was treated with transnasal endoscopic drainage in conjunction with antibiotic therapy. CONCLUSIONS: The high mortality associated with intrasellar abscess mandates its inclusion in the differential diagnosis of patients presenting with symptoms of meningitis or an expanding sellar mass after transsphenoidal intervention. Although antibiotic therapy is an important adjunct, surgical drainage is required for definitive treatment.

Brain Abscess↗
PubMed1998

Nasopharyngeal carcinoma presenting as an intracranial abscess.

BACKGROUND: There are many conditions related to brain abscess. Brain abscesses resulting from nasopharyngeal carcinoma is rare. It is unusual for an intracranial abscess to appear as the initial clinical presentation of nasopharyngeal carcinoma. CASE REPORT: A 43-year-old male patient suffering from nasopharyngeal carcinoma with the initial manifestation of an intracranial abscess without symptoms and signs suggestive of the primary nasopharyngeal carcinoma is reported. The diagnosis was particularly elusive and was not made until the third admission. CONCLUSION: Although it is rare, intracranial abscess should be considered as one of the possible manifestations of nasopharyngeal carcinoma.

Adult↗
PubMed1999

Brain abscess caused by Streptococcus intermedius: two case reports.

BACKGROUND: Although Streptococcus intermedius has been recognized as an important pathogen for abscess formation outside the central nervous System, the Streptococcus milleri group, of which it is a member, has not been recognized as a specific pathogen for brain abscess, often thought to be caused by Streptococcus viridans, which includes other streptococcal species. CASE DESCRIPTION: Two cases of brain abscess in the left frontal lobe caused by S. intermedius, which responded well to antimicrobial treatment combined with needle aspiration, are presented. In the first patient, the predisposing disease was paranasal sinusitis of the frontal and ethmoid sinuses. In the second patient, the source of the pathogen was not detected despite extensive examination. The patients underwent aspiration of pus under ultrasound guidance in the first patient, and via a computed tomography-guided stereotactic procedure in the second patient. They subsequently received appropriate antimicrobial therapy against S. intermedius isolated from the pus culture. Both patients were discharged without any neurological deficits. CONCLUSION: It is important to recognize S. intermedius as a pathogen of brain abscess, and to be aware of its predisposing factors, i.e., mucosal disturbance and liver abscess.

Adolescent↗
PubMed1979

Anaerobic subareolar breast abscess.

15 non-puerperal women with breast abscess were seen during one year. In 8, anaerobes were cultured from pus obtained from the abscess, in 6, Staphylococcus aureus was grown, and in 1 the pus was sterile on culture. All 7 breast abscesses in puerperal women seen during the same period were staphylococcal. The anaerobic abscesses were all subareolar; they were recurrent in 4 patients and were associated with retracted nipples in 7. The anaerobes isolated were those found as normal commensals in the oropharynx and vagina but did not include the colonic commensal Bacteroides fragilis. Squamous metaplasia with keratin plugging of the breast ducts was identified histologically in the 2 non-puerperal patients in whom duct excision was performed. Surgical treatment of the underlying duct abnormality is important in the management of recurrent non-puerperal subareolar breast abscess.

Abscess↗
PubMed1994

Subperiosteal abscess of the orbit. Age as a factor in the bacteriology and response to treatment.

BACKGROUND: Earlier studies of subperiosteal abscess secondary to sinusitis showed considerable variation in the clinical course and bacteriology. At one extreme, patients recovered with intravenous antibiotics alone; at the other extreme, complex pathogens persisted despite early surgical drainage and appropriate antibiotics, and visual or intracranial complications occurred. To better direct management of individual patients, this study evaluates the role of patient age in the complexity and responsiveness of subperiosteal abscess. METHODS: The records of 37 patients with a computed tomography diagnosis of subperiosteal abscess were reviewed. Initial and follow-up culture results were evaluated in the context of prior treatment of individual patients. Responses to therapy and pathogens were compared among three age groups. RESULTS: Among patients younger than 9 years, 83% either cleared without drainage (25%) or had negative cultures at the time of drainage (58%). In the culture-positive cases, single aerobes were found, and anaerobes were not isolated. Patients 9 to 14 years old showed a transition toward more complex infections. Patients 15 years of age or older all had positive cultures after more than 3 days of antibiotics, which were frequently effective in vitro. Polymicrobial infections were the rule, including anaerobes in every case. CONCLUSION: Variations in the complexity and responsiveness of subperiosteal abscesses appear to be age-associated. Treatment protocols should consider visual compromise, pain, location of the abscess, which sinuses are involved, intracranial complications, and the age of the patient.

Abscess↗
PubMed1983

Pathogenicity of encapsulated Bacteroides melaninogenicus group, B. oralis and B. ruminicola subsp. brevis in abscesses in mice.

The pathogenicity of 27 clinical isolates of the Bacteroides melaninogenicus (BM) group and four clinical isolates of B. oralis and B. ruminicola subsp. brevis were investigated by inoculating them into mice and subsequently determining their ability to cause subcutaneous (SC) or intraperitoneal abscesses. Only 11 isolates of BM group and one B. ruminicola induced abscesses in mice, and all were found to be heavily encapsulated on recovery from the abscesses (more than 50 per cent of the organisms were encapsulated). When the other 23 isolates, however, were injected SC in combination with either Klebsiella pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus or Streptococcus pyogenes, abscesses were formed in 16 of the 23 combinations. The Bacteroides spp. recovered from the mixed infection were heavily encapsulated. Capsules also formed in Bacteroides if the organisms were injected together with capsular material or formalin killed cells of K. pneumoniae or encapsulated Bacteroides sp. Once non-encapsulated or only slightly encapsulated strains acquired a capsule, they could induce abscesses on reinoculation into mice.

Abscess↗
PubMed1998

Disseminated subcutaneous Nocardia farcinica abscesses in a nephrotic syndrome patient.

We describe an unusual case of disseminated subcutaneous abscesses caused by Nocardia farcinica in a 49-year-old man with nephrotic syndrome. He had received systemic corticosteroid therapy for 5 months. He developed a submandibular abscess associated with sialoadenitis on the right submaxillary gland. Magnetic resonance imaging revealed connection between the submandibular abscess and the right submaxillary gland. The subcutaneous abscess spread from the submandibular triangle to the left axillary region, the left upper arm, the left hypochondriac region, the left scapular region, the right epigastric region, and the bilateral legs. A chest radiograph and computed tomograms of the chest and the brain did not reveal any pathologic changes. The patient was successfully treated by surgical drainage of the abscesses and by oral administration of minocycline.

Abdomen↗
PubMed1999

Common presentations of amebic liver abscess.

STUDY OBJECTIVE: The most common extraintestinal manifestation of Entamoeba histolytica, the agent of amebiasis, is a hepatic abscess. This infection is common throughout the world and can be associated with life-threatening consequences. Given the often nonspecific nature of the complaints related to an amebic abscess, a retrospective review of patients with confirmed disease was done to recognize the most common patterns of presentation. METHODS: A retrospective case series was conducted of all patients with confirmed amebic liver abscess over a 5-year period. All available emergency department and inpatient records were reviewed. Age, sex, country of origin, chief complaint (including duration), vital signs, and physical and laboratory findings were recorded. The use of ultrasonography, computed tomography scan, chest radiograph, and serum antibodies was noted, as well as the final ED diagnosis. RESULTS: Seventy-five patients were reviewed; mean patient age was 35.5 years, 80% were male, and Mexico was the country of origin for 64%. The most common complaint was fever (77%), followed by abdominal pain (72%), which was most often located in the right upper quadrant. Cough (16%), chest pain (19%), and chest radiographic abnormalities (57%) were also common. The majority of patients (69%) had symptoms for less than 13 days. The WBC count was the most consistent laboratory abnormality (83%), whereas the liver aminotransferase, alkaline phosphatase, and bilirubin levels were often normal. Most patients received their diagnoses on the basis of ultrasonography (85%), followed by a confirmatory serum antibody titer (88%). The diagnosis of amebic liver abscess was correctly made in the ED in 31.5% of the patients, with the most common misdiagnoses being cholecystitis (16.4%), hepatitis (12.3%), and pneumonia (9.6%). CONCLUSION: Patients with amebic liver abscess do present to EDs in the southwestern United States, especially in areas with a high immigrant population from endemic areas. Patients with complaints of fever and right upper quadrant abdominal pain, especially men of Hispanic origin, warrant a high degree of vigilance. Whereas most laboratory studies are unhelpful, the diagnosis can often be made in the ED by means of a bedside ultrasonographic test. Treatment should be initiated with metronidazole with disposition to an inpatient medical service.

Abdominal Pain↗
PubMedDate not supplied

[Abscess of the psoas muscle. Description of a series of 23 cases].

BACKGROUND: Abscess of the psoas muscle (PA) is an infrequent disease of difficult diagnosis. During the last decade, the number of cases has increased because of the raising use of radiology tecniques: ecography, computerized tomography and magnetic resonance nuclear. METHODS: The presentation and management of psoas abscess was studied retrospectively in 23 patients from 1992 2000. RESULTS: Sixteen of 23 abscesses were regarded as secundary: spondylodiscitis and pyelonefritis were most frequent pathologic processes. Homolateral pain in the flank area and hip were the usual manifestations. The duration of symptoms prior to the diagnosis was superior than 7 days. Staphylococcus aureus was the most common pathogen, followed by Escherichia coli and Mycobacterium tuberculosis. All abscesses were diagnosed by computerized tomography images. Seven patients underwent percutaneous drainage, while nine received surgical debridement. Four of the patients with psoas abscess died and only three relapsed. CONCLUSIONS: Not specific symptoms and signs and subacute presentation difficult diagnosis of AP. High range antibiotics and drainage (percutaneous or surgical) should be considered as the election treatment.

Adult↗
PubMed2002

[Tubercular abscess of the psoas without associated spinal involvement. A case report].

INTRODUCTION: Tuberculous psoas abscess outside of locoregional causes is uncommon and can cause a problem of differential diagnosis. EXEGESIS: We report a case of unilateral tuberculous abscess of the psoas which first clinical and radiological features presented like a retroperitoneal tumor. Exploration laparotomy discovered a bulky abscess of the left psoas muscle. Bacteriologic and histologic evaluation confirmed the tuberculous origin. Radiological study of the spine did not show any signs of spondylodiscitis. Under antituberculosis treatment a crural collection occurred and a surgical drainage was performed. Five years later, there was a recurrence of a crural collection which responded well to antituberculosis treatment. CONCLUSION: Tuberculous psoas abscess is usually secondary to spinal involvement, more uncommonly to digestive, urologic or genital tuberculosis. Primary abscess was rarely described and the pathogenesis remains unclear. Psoas contamination is supposed to be hematogenous or lymphatic in origin. Ultrasonography and computed tomography (CT) transformed the diagnosis and the therapeutic approach by percutaneous puncture and drainage.

Adult↗