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PubMed2005

Refractory ulcerative colitis accompanied with cytomegalovirus colitis and multiple liver abscesses: a case report.

Various hepato-biliary complications are an increased incidence in patients with inflammatory bowel disease, and portal bacteremia is well documented in patients with ulcerative colitis (UC). However, few reports mention UC in association with liver abscesses. Recently, there are several reports describing cytomegalovirus (CMV) infection in association with disease exacerbation and steroid refractoriness in patients with UC. Here we present a case of refractory UC accompanied with multiple liver abscesses and CMV colitis. The patient, a 72-year-old male, with a five-year history of repeated admissions to our hospital for UC, presented with an exacerbation of his UC. Sigmoidoscopy performed on admission suggested that his UC was exacerbated, then he was given prednisolone and mesalazine orally, and betamethasone enemas. However, he had exacerbated symptoms. Repeat sigmoidoscopy revealed multiple longitudinal ulcers and pseudopolyps in the rectosigmoid colon. Although immunohistochemical staining of biopsy specimens and the serum testing for antigenemia were negative on admission and after the repeat sigmoidoscopy, they became histologically positive for CMV. Nonetheless, the patient developed spiking fevers, soon after ganciclovir was administered. Laboratory studies revealed an increased white cell count with left shift, and Enterococcus fecalis grew in blood cultures. An abdominal computed tomography (CT) scan was obtained and the diagnosis of liver abscesses associated with UC was made, based on CT results. The hepatic abscesses were successfully treated with intravenous meropenem for 6 wk, without further percutaneous drainage. To our knowledge, this is the first reported case of multiple liver abscesses that develop during UC exacerbation complicated by CMV colitis.

Aged↗
PubMed2002

[Evaluation of safe surgical treatment of peritonsillar abscess using computed tomography].

With the development of new antimicrobial agents, the incidence of peritonsillar abscess (PTA) is on the decline. PTA is still often encountered in general practice, however, where it requires immediate diagnosis and treatment. Because the internal carotid artery runs medially to the medial parapharyngeal space, damage to nearby vascular or other structures is a surgical risk of PTA. We used contrast computed tomography (CT) from PTA patients to investigate the anatomical relationship between the abscess and parapharyngeal space, and to determine safe surgical sites. We observed 31 patients with PTA--19 men and 12 women--between February 1997 and April 1999, all examined by contrast CT and undergoing drainage or incision. The average age was 30.7 years (range: 12-54 years). The abscess was on the right side in 20 cases and on the left side in 11. We determined the sites of the abscess and carotid artery, internal jugular vein, and surrounding soft tissue density area including nerves in the parapharyngeal space based on the angle and distance from recognizable anatomical structures in CT scans. The anterior margin of the parapharyngeal space was 29 +/- 5 mm posterior from the upper posterior alveolar margin. The medial margin of that space was at 15 +/- 2 degrees laterally from the midline of the incisors, and 24 +/- 4 mm laterally from the midline sagittal plane. The internal carotid artery was located medially to the parapharyngeal space, running on the sagittal plane containing the upper posterior alveolar margin. The distance from the anterior margin of the parapharyngeal space to the posterior wall of the PTA was 9 +/- 4 mm, and the distance to the anterior wall of the abscess (including the pharyngeal mucosa) was 31 +/- 5 cm. The relationship between the upper posterior alveolar margin and midline sagittal plane was useful for determining the site of the parapharyngeal space. Because the internal carotid artery is located on the same sagittal plane as the upper posterior alveolar margin, when conducting drainage or incision of PTA, we should advance sagittaLly from the point of incision to a depth of no more than 20 mm. If the tip of the instrument is kept medial to the sagittal plane of the upper posterior alveolar margin, effective treatment should be achievable without the risk of vascular damage.

Adolescent↗
PubMed2003

[Report of 2 cases of tuberculous retoropharygeal abscess in adults].

We report 2 cases of tuberculous retoropharyngeal abscess. Case 1 was a 21-year-old man with tuberculous cervical spondylitis and pulmonary tuberculosis and Case 2 was a 32-year-old woman with tuberculous lymph adenitis and military tuberculosis. Both reported sore throat and dysphagea. In case 1, throat examination showed a bulging abscess at the posterior wall of the pharynx. X-ray examination of the neck showed a massive soft tissue swelling on the lateral view. As soon as the diagnosis was established, prompt focal aspiration was done since the increasing danger of grave respiratory distress was expected. And moreover, surgical incision and drainage of retropharyngeal abscess were indicated. In case 2, intraoral midline incision through the posterior wall of the pharynx was administered because the abscess was small and limited. Though various tuberculous statics and antibiotics are available, tuberculous retropharyngeal abscess still occurs and should be considered to ensure rapid adequate attention to diagnosis and treatment.

Adult↗
PubMed2003

Microbiology of cerebral abscess at the neurosurgical unit of the National Hospital of Sri Lanka.

OBJECTIVES: To determine the microbial pathogens responsible for cerebral abscess, ascertain the most suitable antibiotic for treatment and to determine the predisposing causes of cerebral abscess. DESIGN: Prospective study with microbiological investigation of pus aspirated from cerebral abscesses. SETTING: Neurosurgical Unit, National Hospital of Sri Lanka, Colombo. STUDY GROUP: 41 patients with cerebral abscess. PERIOD OF STUDY: 18 months (May 1997 to December 1998) RESULTS: Of the 41 samples of pus 26 (63.1%) gave a positive microbial culture. The Gram stain of the direct smear was positive in 77% of the 26 positive cultures. The most frequently occurring species were Streptococcus milleri group (35%) followed by Staphylococcus aureus (10%). Anaerobes accounted for 23% of positive cultures. All Streptococcus milleri isolates were penicillin and cefotaxime, and all anaerobic isolates except one were susceptible to sensitive to metronidazole. 75% of Gram negative bacilli isolated were sensitive to cefotaxime. All Staphylococcus aureus isolates were methicillin resistant, but sensitive to vancomycin and chloramphenicol. Common predisposing conditions were congenital heart disease (30%), trauma (25%), middle ear disease (7%), and meningitis (7%). CONCLUSIONS: Organisms of the Streptococcus milleri group were most frequently found in cerebral abscesses. The present empirical therapeutic regime adopted in the unit which consisted of cefotaxime 1 g intravenously three times daily and metronidazole 500 mg intravenously three times daily was found to be satisfactory as a majority of the organisms isolated were sensitive to these antimicrobials. In the case of methicillin resistant Staphylococcus aureus (MRSA), it is recommended that chloramphenicol be added to the current regime in management until the antibiotic sensitivity pattern is available.

Anti-Bacterial Agents↗
PubMed2001

CXC chemokine receptor-2 ligands are required for neutrophil-mediated host defense in experimental brain abscesses.

We have developed a mouse brain abscess model by using Staphylococcus aureus, one of the main etiologic agents of brain abscesses in humans. Direct damage to the blood-brain barrier was observed from 24 h to 7 days after S. aureus exposure as demonstrated by the accumulation of serum IgG in the brain parenchyma. Evaluation of brain abscesses by immunohistochemistry and flow cytometry revealed a prominent neutrophil infiltrate. To address the importance of neutrophils in the early containment of S. aureus infection in the brain, mice were transiently depleted of neutrophils before implantation of bacteria-laden beads. Neutrophil-depleted animals consistently demonstrated more severe brain abscesses and higher CNS bacterial burdens compared with control animals. S. aureus led to the induction of numerous chemokines in the brain, including macrophage-inflammatory protein (MIP)-1alpha/CCL3, MIP-1beta/CCL4, MIP-2/CXCL1, monocyte chemoattractant protein-1/CCL2, and TCA-3/CCL1, within 6 h after bacterial exposure. These chemokines also were expressed by both primary cultures of neonatal mouse microglia and astrocytes exposed to heat-inactivated S. aureus in vitro. Because neutrophils constitute the majority of the cellular infiltrate in early brain abscess development, subsequent analysis focused on MIP-2 and KC/CXCL1, two neutrophil-attracting CXC chemokines. Both MIP-2 and KC protein levels were significantly elevated in the brain after S. aureus exposure. Neutrophil extravasation into the brain parenchyma was impaired in CXCR2 knockout mice and was associated with increased bacterial burdens. These studies demonstrate the importance of the CXCR2 ligands MIP-2 and KC and neutrophils in the acute host response to S. aureus in the brain.

Animals↗
PubMed2004

Epidural abscess and meningitis after epidural corticosteroid injection.

Epidural abscess with and without associated meningitis after epidural corticosteroid injections for radicular back pain is a rarely reported complication. We report the occurrence of an epidural abscess and meningitis in a 70-year-old man after 2 epidural corticosteroid injections for treatment of acute radicular lumbar back pain. At the time of diagnosis, cerebrospinal fluid cultures grew Staphylococcus aureus, and the patient was treated with intravenous antibiotics. Possible predisposing factors for the development of an epidural abscess and meningitis in this patient include a 2-year history of neutropenia and an accidental dural puncture that occurred during performance of the first epidural injection. A literature search identified 11 reported cases of epidural abscess, 2 of epidural abscess and meningitis, and 1 of meningitis attributed to epidural corticosteroid injections. Eight of the 14 reported patients were immunocompromised, and 8 (67%) of the 12 in whom cultures of blood, cerebrospinal fluid, or epidural pus were performed had results positive for S. aureus. Antibiotic prophylaxis for S. aureus should be considered for immunocompromised patients undergoing epidural corticosteroid injections.

Adult↗
PubMed2006

[Splenic abscess: presentation of nine cases].

Relatively rare, splenic abscess is difficult to diagnose and often fatal if left untreated. The disease is thought to be growing in frequency because of the increasing number of inmunocompromised patients. Several mechanisms for the development of splenic abscess may exist. Some studies demonstrate that prior splenic injury in addition to bacteraemia is required for a splenic abscess to occur. In our series, 9 non immunocompromised patients were identified to have this disease during a 6 years period. Pathogens isolated included Salmonella sp, Staphylococcus sp and Enterococcus sp. Splenectomy was performed in three patients; in another a percutaneous drainage was done. One patient died. In summary, though rare, splenic abscess presents with high morbidity and mortality. In our experience, risk factors as immunocompromise seem not to be so prevalent in patients with splenic abscess and therefore this diagnosis should be considered in all patients with fever of unknown origin.

Abdominal Abscess↗
PubMed2005

A case of thalamic abscess treated by endoscopic surgery.

We report about a 7-year-old female child with cyanotic heart disease whose thalamic abscess was successfully treated by endoscope-assisted abscess drainage. Endoscopic aspiration of thalamic abscess appears to be a safe and effective method of treatment for deep-seated abscesses, as direct visualization of the abscess cavity is possible and the completeness of evacuation can be assessed.

Brain Abscess↗
PubMed1986

Nonresolution of an amebic liver abscess after parasitologic cure.

A 43-year-old Filipino male was admitted to a Manila hospital with a 1 month history of epigastric pain and fever, and was found to have a palpable epigastric mass. Computerized tomography revealed a large hepatic abscess which serologically was shown to be amebic. Chemotherapy resulted in clinical cure and an initial reduction in size of the liver abscess. However, resolution of the abscess cavity did not occur, and on closed needle aspiration, 80 cc of characteristic amebic pus was recovered. Parasitological cure without complete repair of the abscess cavity itself raises questions concerning the potential danger of clinically silent residua and the role of therapeutic aspiration in the management of amebic liver abscesses.

Adult↗
PubMed2000

Brain abscess at the Kenyatta Nationai, Hospital, Nairobi.

OBJECTIVE: To study the aetiology, mode of presentation and outcome following treatment of brain abscesses at the Kenyatta National Hospital, Nairobi. DESIGN: A retrospective study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: Sixty five patients with brain abscesses who were seen at Kenyatta National Hospital between January 1989 and December 1993. RESULTS: Twenty patients died following surgery (30.7% mortality). Eight per cent of the patients who underwent surgery were serologically positive for the human immune deficiency virus (HIV). When these patients were excluded mortality was 25%. There were more male patients than females (ratio 2.4:1). Thirty eight per cent of the patients were children below the age of ten years. Trauma was the commonest cause of brain abscess. The aetiology was unknown in 24% of the cases. Twenty six patients who were HIV positive and had suspected brain abscesses were not included in this study because they did not undergo surgery. The commonest organisms isolated were Staphylococci, Streptococci, Klebsiella and Haemophylus influenzae. Sixty eight per cent of the patients had seizures. All the patients were diagnosed by computerised tomography (CT) scanning of the brain. Surgical treatment was by multiple burr hole aspirations and excision through craniotomy. CONCLUSION: Brain abscess is still a major cause of morbidity at the Kenyatta National Hospital with a high overall mortality of 30.7% during the period under study.

Adolescent↗
PubMed2005

[Meningitis and brain abscess caused by Streptococcus intermedius in a patient infected with HIV-1].

Streptococcus milleri group have been recognized as an important pathogens for abscess formation in various organs. Streptococci other than Streptococcus pneumoniae are a rare cause of bacterial meningitis in adults and can be associated with the presence of an undiagnosed brain abscess. Brain abscess is a focal collection within the brain parenchyma which can arise as a complication of a variety of infections. The most common etiologic organisms in clinical series have been microaerophilic streptococci and anaerobic bacteria. Although intracranial mass lesions that occur as a result of infection have commonly been reported in patients infected with the human immunodeficiency virus, brain abscess due to the common bacterial pathogens are rarely described in HIV infected patients and Toxoplasma gondii is the organism most frequently isolated from stereotactic brain biopsy in these patients. We report a patient with both HIV-1 infection and streptococcal meningitis secondary to brain abscess caused by S. intermedius.

Adult↗
PubMed2005

Comparison of pyogenic liver abscesses of biliary and cryptogenic origin. An eight-year analysis in a University Hospital.

OBJECTIVES: The aim of this study is to delineate the clinical features of pyogenic liver abscesses of biliary and cryptogenic origin, and to compare the differences in outcome of patients between the two groups. METHODS: We studied 86 patients, aged 19 years or older, with pyogenic liver abscess admitted to Chung Shan Medical University Hospital, Taichung, Taiwan, between January 1996 and December 2003. The demographic data and medical information of the patients were reviewed and recorded. Of the 86 patients, 34 were classified into the biliary group and 52 were classified into the cryptogenic group. RESULTS: Patients with pyogenic liver abscesses of biliary origin had a higher frequency of underlying malignancy and Murphy's sign compared to those with pyogenic liver abscesses of cryptogenic origin. With respect to specific pathogens, Escherichia coli were more prevalent in the biliary group while Klebsiella pneumoniae were more prevalent in the cryptogenic group. Anaerobic isolates were less frequently cultured in the cryptogenic group than in the biliary group. After adjustment for age, sex, and the duration of symptoms before admission, there was no difference in mortality between both groups (biliary vs cryptogenic: 15% vs 8%; adjusted OR, 1.43; 95% CI, 0.24-8.25; p = 0.899). After adjustment for confounders, patients in the biliary group had higher frequencies of time to defervesce >1 week after admission (68% vs 40%; adjusted OR, 3.05; 95% CI, 1.09-9.04, p = 0.030) and hospital stay >3 weeks (47% vs 15%; adjusted OR, 4.34; 95% CI, 1.45-13.91; p = 0.007) than those in the cryptogenic group. CONCLUSIONS: This report highlights that pyogenic liver abscesses of cryptogenic origin had a benign clinical response, which was associated with shorter duration of hospitalisation and time to defervesce after admission, compared to those of biliary origin.

Adult↗
PubMed1977

Cutaneous abscesses. Anaerobic and aerobic bacteriology and outpatient management.

Specimens from 135 cutaneous abscesses in outpatients were cultured anaerobically and aerobically. Of these, 4% were sterile and 29% yielded pure cultures, predominantly of Staphylococcus aureus. Aerobic species were isolated from all anatomic areas. Anaerobes were found with a frequency comparable to aerobes in all nonperineal areas except the hand. In contrast, abscesses in the perineal region contained a greater variety and frequency of anaerobes. Only two patients were febrile. All abscesses were treated with incision and drainage, and all healed without complication, including those 74% that were treated without adjunctive antibiotics. Primary management of cutaneous abscesses should be incision and drainage. In general, routine culture and antibiotic therapy are not indicated for localized abscesses in patients with presumably normal host defenses.

Abscess↗
PubMed1999

[A case of multiloculated retroperitoneal abscess successfully treated by percutaneous drainage with a Malecot catheter].

Percutaneous catheter drainage offers an attractive alternative to open surgical drainage as the first choice in the treatment of retroperitoneal abscess. However, multiloculated abscess is difficult to drain percutaneously. We report a case of multiloculated retroperitoneal abscess successfully treated by percutaneous drainage with a Malecot catheter. A 47-year-old woman complained of fever and left flank pain. The peripheral while blood cell count was 16,800/mm3 and the blood sugar was 369 mg/dl. The computer tomographic (CT) scan showed a large multiloculated mass in the left retroperitoneum. An aspiration needle was inserted into the perinephric mass under ultrasonographic guidance. The definitive diagnosis of abscess was made by aspiration of purulent fluid. A 20 Fr. Malecot catheter was passed over the guide wire under fluoroscopic guidance. Two hundred ml of pus was smoothly aspirated. Streptococcus agalactiae was isolated from the aspirate. Antibiotics and insulin were started. The catheter was retained for 49 days until ultrasonography revealed disappearance of the abscess. One year later, she had no symptoms of recurrence.

Abdominal Abscess↗
PubMed1999

Cluster of postinjection abscesses related to corticosteroid injections and use of benzalkonium chloride.

Benzalkonium chloride (BC) is an unreliable disinfectant. A matched case-control study and environmental investigation were conducted to determine the cause of and risk factors for a cluster of postinjection abscesses at a private medical clinic where BC was used as a disinfectant. Twenty-eight case-patients who had an abscess at the injection site were matched with 126 control patients who had received an intramuscular injection at the clinic on the same day. Risk factors for abscess development in a multivariable logistic model were corticosteroid injection and being female. All case-patients had received a corticosteroid injection from a multidose vial. Cultures of abscesses from 20 of 23 case-patients grew Pseudomonas aeruginosa. Cultures of BC prepared at the clinic also grew P aeruginosa, suggesting that BC was the source of infection. Injection site cleaning with BC did not appear to be the route of infection since use of BC at the time of injection was not associated with abscess development. A more likely route of infection was injection of contaminated corticosteroid from multidose vials that could have been inoculated with pseudomonads via needle puncture after vial septa were wiped with contaminated BC. Benzalkonium chloride should not be used to clean injection vial septa or injection sites.

Abscess↗
PubMed1999

[An update in the treatment of intra-abdominal abscesses].

BACKGROUND AND AIMS: Intra-abdominal abscesses represent a relatively severe complication in gastroenterological surgery owing to their association with high levels of morbidity and mortality. METHODS: The authors report their experience between January 1990 and January 1996 in 11 patients with intra-abdominal abscesses secondary to emergency surgery for gastroenterology in 10 cases and gynecology in 1 case. After the lesion had been identified using ultrasonography and CT, it was emptied, washed with antibiotic and drained using Seldinger's ultrasonographic and CT-guided technique. Small abscesses (less than 5 mm) were completed removed. RESULTS: The following results were obtained: the immediate disappearance of pain and fever, accompanied by improved general conditions, restoration of canalisation and closure of the abscess cavity (on average between 10 and 15 days). CONCLUSIONS: In conclusion, ultrasonographic-CT guided drainage of postoperative intra-abdominal abscesses, which were previously managed using surgical methods, appears to be the best treatment, relying on the use of imaging techniques and thereby allowing both morbidity and mortality to be reduced.

Abdomen↗
PubMed1999

Ruptured tuboovarian abscess in late pregnancy. A case report.

BACKGROUND: Tuboovarian abscess is an unusual obstetric complication that causes maternal and fetal morbidity and mortality. CASE: A woman, G1, P0, with a 32-week pregnancy presented with abdominal pain. Physical examination on admission revealed fever and unremarkable abdominal signs. Eleven hours after admission, signs of peritonitis became prominent, necessitating emergency laparotomy. Surgical findings included an 8-cm, right, ruptured tuboovarian abscess with massive purulent contamination of the abdominal cavity. Cesarean hysterectomy with bilateral salpingo-oophorectomy was performed. Neither the newborn nor the mother had postoperative complications. CONCLUSION: Since there are discrepancies in the incidences of tuboovarian abscess in pregnant and nonpregnant groups, the pathogenesis of tuboovarian abscess may be different in the two populations. In pregnancy, diagnosis and management are also more difficult than in the nonpregnant state. Clinical data may not reveal the diagnosis until surgery is mandatory. Because most pregnant women with tuboovarian abscesses are young, conservative surgery should be attempted if the pathology is limited to only one side of the adnexa and further reproduction is desired.

Abdominal Pain↗
PubMedDate not supplied

[Percutaneous drainage of amebic hepatic abscess by guided ultraound. Preliminary results].

Amebic hepatic abscess (AHA) is the most frequent extraintestinal complication of amebiasis. Over time, its treatment has gone through some changes and at present is based on amebicides and in some cases, percutaneous drainage. The objective of this work is to present our experience with percutaneous drainage by means of guided ultrasound in patients with AHA. In this work, we include 170 patients admitted to the Gastroenterology Unit of the Hospital General de Zona No. 1, (IMSS) in Mexico City during a period of eight years (1990-1997). These cases included the following criteria: Failure to medical therapy, AHA of liquid matter greater than 5 cm determined by ultrasound; risk of rupture, prolonged incapacity with no data of toxico-infection, accessible drainage route; availability of operating room before risk of complication, and normal coagulation tests. A modified Seldinger's technique was utilized. A single punction was carried out in 131 patients, who had only one abscess. Thirty-nine patients required a second evacuation on presenting two abscesses, and in four cases, a third evacuation was required due to the presence of three or more abscesses. Only one case required an urgent surgical procedure due to abscess rupture to pleura. Five patients suffered complications, including the latter. The remaining four patients had a spontaneous resolution. All patients were released during the 24 hours following surgery, and no patient required hospitalization. For this reason, this can be considered a procedure that in the expert hands of interventionist radiologists, has less morbidity. This work will be carried out to 10 years.

Adolescent↗