García Vásquez, Carlos; Castellón Pavón, Camilo; Jiménez de Los Galanes, Santos; Gómez Patiño, Juan; Brea de Diego, Belén
Splenic abscesses are rare but may be associated with high mortality. Usually they occur in patients with systemic infection related to some immunocompromised state. The symptoms are nonspecific and the diagnosis is often late, but the development of better imaging techniques has enabled better diagnosis of splenic abscess and percutaneous drainage is a valid and safe complementary treatment option. We report a case of a patient with splenic abscess secondary to septic emboli after tooth extractions, managed conservatively with antibiotics and percutaneous drainage.
Çelebi, N; Kütük, M S; Taş, M; Soylu, E; Etöz, O A; Alkan, A
Oral infections have been implicated in adverse pregnancy outcomes such as pre-eclampsia, premature delivery and growth retardation. A 28-year-old and 9 months pregnant otherwise healthy woman with a complaint of facial swelling and dental pain was referred to the Department of Oral and Maxillofacial Surgery. Oral examination revealed perimandibular and masticator space infection related to the left mandibular third molar tooth. Eight hours after surgical intervention, fetal distress developed. The patient was immediately taken into surgery and a male baby delivered by Caesarean section. The baby was then admitted to the intensive care unit. On the twelfth day of his admission, the baby was discharged in good health. Severe maxillofacial infection in pregnancy is a medically complicated situation which should be treated by an oral and maxillofacial surgeon in consultation with an obstetric and gynaecology service.
Strojnik, Tadej; Roskar, Zdravko
Brain abscesses are rare, especially in children, but they can be life-threatening infections. To date, dental pathology has been linked to only a small number of brain abscesses. To our best knowledge this is the first reported case of a brain abscess following self-extraction of a milk tooth. We are reporting on a 12-year-old previously healthy boy who developed a brain abscess in the vicinity of the left precentral gyrus. Clinical examination prior to surgery showed a severe right hemiparesis, more pronounced in his leg. We performed an ultrasonographically guided puncture and aspiration of the abscess through a small craniotomy. Immediately after the procedure he became hemiplegic. Bacteriological examination of the aspirated pus revealed Streptococcus intermedius, Streptococcus beta-haemolyticus group F, Fusobacterium species and gram-negative rods. The same species of microorganisms were identified in a smear from the vicinity of the extracted tooth. The patient was carefully screened for possible other sources of infection, but none was found. Following appropriate antimicrobial treatment he recovered completely and returned home without any neurological deficit.
... liver abscess Anorectal abscess Bartholin abscess Brain abscess Epidural abscess Peritonsillar abscess Pyogenic liver abscess Skin abscess Spinal ... Anorectal abscess Bartholin cyst or abscess Brain abscess Epidural abscess Peritonsillar abscess Pyogenic liver abscess Skin abscess Spinal ...
Tuncturk, F Ruya; Uzun, Lokman; Kalcioglu, M Tayyar; Egilmez, Oguz Kadir; Timurlenk, Emine; Erguven, Muferet
Deep neck infections are mortal diseases that need emergency treatment. It can occur at any age but usually in pediatric ages. In this report, a left cervical carotid space abscess of a pediatric patient was discussed. It was interesting that the only origin of the left carotid sheath abscess was right inferior first molar tooth decay. Right neck spaces were all clean. Patient had no immunosupression and also there were no congenital masses such as branchial cleft cysts, foreign bodies, or masses suspicious for malignancies in cervical ultrasound and MRI. We discussed this rare condition under the light of the literature.
Cho, S Y
This article reports a case of dental abscess in a mandibular premolar with intact dens evaginatus. Dentists are advised to critically evaluate those teeth with dens evaginatus, both clinically and radiographically, before attempting prophylactic treatments. This is particularly important medicolegally in case the tooth develops symptoms shortly after the prophylactic treatment. Dentists practising in Western countries should also be aware of this dental anomaly because of the increasing global migration of people from Asia.
Kroppenstedt, S N; Liebig, T; Mueller, W; Gräf, K J; Lanksch, W R; Unterberg, A W
The presence of an abscess in a pituitary tumor is a very rare finding. The authors report the case of a 69-year-old man with a pituitary adenoma confirmed by neuroimaging results, in whom a high fever, meningismus, and left-sided ophthalmoplegia developed 4 days after tooth extraction. The results of serial cranial magnetic resonance imaging were highly indicative of an abscess formation within the pituitary adenoma. During surgery the tumor was approached transsphenoidally and removed. Histological examination confirmed the presence of an abscess formation within the pituitary adenoma. It is most likely that the tooth extraction caused a bacteremia, which led to an inflammation with abscess formation within the pituitary adenoma. The authors conclude that invasive dental procedures should be avoided before planned resection of a pituitary adenoma.
Kojima, Yuki; Kojima, Mizuha; Sakaguchi, Kazuhiro; Sakaguchi, Yutaka
We report a case of buccal abscess caused by an impacted wisdom tooth in an extremely elderly person with malnutrition. The patient was a 94-year-old man, who complained that he had found it hard to open his mouth and that his cheek had been swollen for the previous 2 weeks. He had a shallow oral wound caused by an improperly fitting denture; however, the wound became infected. We performed incisional drainage of the abscess under local anesthesia. The swelling disappeared and he was able to open his mouth 55 mm. The elderly have a high risk of healing failure of injuries and it has been reported that infection in a host in a compromised state is severely intractable. This elderly patient was in a compromised state because of malnutrition. Cases such as this one will increase as the elderly population increases. Dentists need to consider the quality of life of patients with a longer life expectancy and should offer patients several treatment options before their general condition deteriorates.
Kojima, Mizuha; Sakaguchi, Kazuhiro; Sakaguchi, Yutaka
We report a case of buccal abscess caused by an impacted wisdom tooth in an extremely elderly person with malnutrition. The patient was a 94-year-old man, who complained that he had found it hard to open his mouth and that his cheek had been swollen for the previous 2 weeks. He had a shallow oral wound caused by an improperly fitting denture; however, the wound became infected. We performed incisional drainage of the abscess under local anesthesia. The swelling disappeared and he was able to open his mouth 55 mm. The elderly have a high risk of healing failure of injuries and it has been reported that infection in a host in a compromised state is severely intractable. This elderly patient was in a compromised state because of malnutrition. Cases such as this one will increase as the elderly population increases. Dentists need to consider the quality of life of patients with a longer life expectancy and should offer patients several treatment options before their general condition deteriorates. PMID:27957349
Maraki, Sofia; Papadakis, Ioannis S; Chronakis, Efkleidis; Panagopoulos, Dimitrios; Vakis, Antonis
We report on a rare case of Aggregatibacter aphrophilus brain abscess of odontogenic origin in a 6-year-old previously healthy boy, who had close contact with a pet dog. The poodle was the most likely source of the infecting organism, which subsequently colonized the patient's oral cavity. The abscess was surgically removed and he recovered completely after prolonged antibiotic treatment with meropenem. We also review the relevant medical literature on A. aphrophilus pediatric brain abscesses.
An abscess is a pocket of pus. You can get an abscess almost anywhere in your body. When an area ... parasites and swallowed objects can all lead to abscesses. Skin abscesses are easy to detect. They are ...
... Loss Surgery? A Week of Healthy Breakfasts Shyness Abscess KidsHealth > For Teens > Abscess A A A What's ... and suddenly it's Pus City. What Is an Abscess? An abscess is an area of infected tissue ...
Fry, D E; Garrison, R N; Heitsch, R C; Calhoun, K; Polk, H C
To better define determinants of death in patients with intraabdominal abscess, 143 patients from a 5-year hospital experience were reviewed. Abscesses were most commonly results of trauma, spontaneous gastrointestinal perforations, and technical errors. Clinical presentation of abscess was quite variable as were criteria to justify reoperation for drainage. Abscesses occurred most commonly in the subphrenic space, pelvis, or subhepatic space. Complete abdominal exploration was employed most frequently for drainage. Those factors that were associated with a fatal outcome were: organ failure (P < 0.001), lesser sac abscess (P < 0.001), positive blood culture (P < 0.01), recurrent and/or persistent abscess (P < 0.01), multiple abscesses (P pE 0.01), age > 50 years (P < 0.03), and subhepatic abscess (P < 0.03). These data suggest that deaths from abdominal abscess are consequences of ineffective surgical drainage and failure of host defense mechanisms.
Salam, Badar; Camilleri, Andrew
Nasal septal abscess is an uncommon condition. Most commonly it is secondary to nasal trauma, which leads to haematoma, and subsequent abscess formation. There are other less common causes like sinusitis, dental infections and furunculosis. Non-traumatic nasal septal abscess has also been reported in immunocompromised individuals. We report a case of non-traumatic, spontaneous nasal septal abscess, in a healthy immunocompetent patient with no evidence of sinusitis or other localized infections. Using Medline and Google.co.uk search applications, there has been one previous report of such a condition. We stress the importance of excluding nasal septal abscess in patients presenting with nasal obstruction especially with signs of toxaemia.
Arslan, Ferhat; Karagöz, Ergenekon; Arslan, Birsen Yigit; Mert, Ali
Dental infections may lead to severe local or systemic infections such as endocarditis, brain abscesses and mediastinitis. Fever may be the only symptom. We aim to highlight dental/odontogenic abscesses as the occult source of unexplained fever by reporting on three cases and reviewing the relevant literature. Early dental evaluation and referral of patients with persistent fever (even without any oral symptoms) to a dentist plays a critical role in preventing unnecessary, time-consuming and high-cost further diagnostic tests and invasive procedures. A simple panoramic dental radiography may suffice to establish the diagnosis.
... notice a bubble (or “pimple”) on your gums. Prevention Prompt treatment of dental decay reduces the risk ... Dental cavities Endocarditis Ludwig’s angina Osteomyelitis Pneumonia - adults (community acquired) Root canal Toothaches Review Date 2/22/ ...
Neufeld, David; Keidar, Andrei; Gutman, Mordechai; Zissin, Rivka
Abdominal wall abscess due to Crohn's Disease used to be one of the definitive indications for operative treatment. The advent of interventional radiology, the accessibility to percutaneous drainage, and the availability of new medications raised the possibility of nonoperative treatment of this condition. The clinical presentation, treatment, and follow-up of 13 patients with abdominal wall abscesses secondary to Crohn's Disease were retrospectively reviewed. During a 10-year period (1993-2003), 13 patients with abdominal wall abscess were treated. Five patients had an anterolateral abdominal wall abscess and eight had a posterior abscess (psoas). In 11 patients, 17 drainage procedures were performed: 12 percutaneous and 5 operative. Despite initial adequate drainage and resolution of the abscess, all 13 patients eventually needed resection of the offending bowel segment, which was undertaken in 12 patients. The mean time between abscess presentation and definitive operation was 2 months. Percutaneous drainage is an attractive option in most cases of abdominal abscesses. However, in Crohn's Disease patients with an abdominal wall abscess, we found a high failure rate despite initial adequate drainage. We suggest that surgical resection of the diseased bowel segment should be the definitive therapy.
... En Español Making a Change – Your Personal Plan Hot Topics Am I in a Healthy Relationship? Who ... compress by wetting a washcloth with warm — not hot — water and placing it over the abscess for ...
Kaptan, Figen; Gulduren, Hakki Mustafa; Sarsilmaz, Aysegul; Sucu, Hasan Kamil; Ural, Serap; Vardar, Ilknur; Coskun, Nejat Ali
Brucellosis is an important cause of spondylodiscitis in endemic areas. Brucellar spondylodiscitis is a serious complication because of its association with abscess formation. Prospective studies comparing patients with and without abscesses are lacking. The objective of this study was to determine the frequency and demographic, clinical, laboratory, and radiological features of brucellar spondylodiscitis and to compare patients with and without abscesses regarding treatment and outcome. Out of 135 consecutive patients with brucellosis, 31 patients with spondylodiscitis were recruited for the study. Patients were grouped according to magnetic resonance imaging findings. The frequency of spondylodiscitis was 23.0 %. Sites of involvement were lumbar (58.1 %), lumbosacral (22.6 %), cervical (9.7 %), thoracolumbar (6.5 %), and thoracic (3.2 %). Abscesses occurred in 19 (61.3 %) patients and were associated with low hemoglobin levels. Medical treatment included a combination of streptomycin (for the first 3 weeks), doxycycline, and rifampin. The total duration of treatment was 12-39 (mean 17.0 ± 8.5 SD) weeks. By 12 weeks of treatment, evidence of clinical improvement (67 vs. 28 %) and radiological regression (92 vs. 50 %) was significantly greater in patients without abscesses. The duration of treatment was longer if an abscess was present. Two female patients with abscesses required surgical intervention. Both patients presented with high fever, neurologic deficit, and high Brucella standard tube agglutination test titers. Each patient should be evaluated individually, based on clinical findings, laboratory data, and radiological results, when undergoing treatment for brucellar spondylodiscitis. If abscesses are found, a longer course of treatment and even surgical intervention may be needed.
Flores, María S.; Obregón-Cárdenas, Adriana; Tamez, Eva; Rodríguez, Elba; Arévalo, Katiushka; Quintero, Isela; Tijerina, Rolando; Bosques, Francisco; Galán, Luis
Background/Aims Many parasites induce changes in the lipid profiles of the host. Cholesterol increases the virulence of Entamoeba histolytica in animal models and in vitro culture. This study aimed to determine, in patients with an amebic liver abscess, the correlation between cholesterol and other features, such as the size and number of abscesses, standard hematological and serum chemistry profiles, liver tests, and duration of hospital stay. Methods A total of 108 patients with an amebic liver abscess and 140 clinically healthy volunteers were investigated. Cholesterol and triglycerides were measured in the sera. The data from medical observations and laboratory tests were obtained from the clinical records. Results A total of 93% of patients with an amebic liver abscess showed hypocholesterolemia not related to any of the studied parameters. Liver function tests correlated with the size of the abscess. The most severe cases of amebic liver disease or death were found in patients whose cholesterol levels continued to decrease despite receiving antiamebic treatment and hospital care. Conclusions Our results show that the hypocholesterolemia observed in patients with an amebic liver abscess is not related to any of the clinical and laboratory features analyzed. This is the first study relating hypocholesterolemia to severity of hepatic amebiasis. PMID:25071907
Stewart, Thomas A; Carter, Cody S; Seiberling, Kristin
A 74-year-old immunocompetent man admitted for severe retro-orbital headache was diagnosed with isolated sphenoiditis. At the time of scheduled surgery, the patient was mildly obtunded, and a head CT revealed a temporal lobe abscess. The patient underwent a left temporal craniectomy and a bilateral endoscopic sphenoid sinusotomy, which revealed gross fungal debris. The patient made a full recovery with resolution of abscess and sinus findings. Suspicion for intracranial infection should be raised in any sinus patient with neurological changes. Early diagnosis with imaging studies is extremely important for surgical drainage before permanent neurological sequelae.
Van Leer, C; Wensing, A M J; van Leeuwen, J P; Zandbergen, E G J; Swanink, C M A
We describe a case of brain abscesses with gas formation following otitis media, for which the patient treated himself by placing clay in his ear. Several microorganisms, including Clostridium glycolicum, were cultured from material obtained from the patient. This is the first report of an infection in an immunocompetent patient associated with this microorganism.
Oh, Gerald S.; Abou-Al-Shaar, Hussam; Arnone, Gregory D.; Barks, Ashley L.; Hage, Ziad A.; Neckrysh, Sergey
Background: Spinal epidural abscess resulting from piriformis pyomyositis is extremely rare. Such condition can result in serious morbidity and mortality if not addressed in a timely manner. Case Description: The authors describe the case of a 19-year-old male presenting with a 2-week history of fever, low back pain, and nuchal rigidity. When found to have radiographic evidence of a right piriformis pyomyositis, he was transferred to our institution for further evaluation. Because he demonstrated rapid deterioration, cervical, thoracic, and lumbar magnetic resonance imaging scans were emergently performed. They revealed an extensive posterior spinal epidural abscess causing symptomatic spinal cord compression extending from C2 to the sacrum. He underwent emergent decompression and abscess evacuation through a dorsal midline approach. Postoperatively, he markedly improved. Upon discharge, the patient regained 5/5 strength in both upper and lower extremities. Cultures from the epidural abscess grew methicillin-sensitive Staphylococcus aureus warranting a 6-week course of intravenous nafcillin. Conclusion: A 19-year-old male presented with a holospinal epidural abscess (C2 to sacrum) originating from piriformis pyomyositis. The multilevel cord abscess was emergently decompressed, leading to a marked restoration of neurological function. PMID:28028447
Ang, Mia Yang; Dymock, David; Tan, Joon Liang; Thong, Ming Hang; Tan, Qin Kai; Wong, Guat Jah; Paterson, Ian C; Choo, Siew Woh
Parvimonas micra is an important oral microbe that has the ability to grow and proliferate within oral biofilms and is involved in periodontal disease, leading to gingival bleeding, gingival recession, alveolar bone loss, and tooth mobility. However, occasionally these normally oral pathogens can cause infections at other sites in the body. We present the genome sequence of Parvimonas micra strain A293, a smooth Parvimonas micra strain isolated from an abdominal abscess from a patient at Barts Hospital, London, United Kingdom.
Al-Hourani, Khalid; Frost, Chelsea
To our knowledge, there are no reports in the literature of patients with Parkinson disease (PD) developing upper cervical spine infections. Our objective is to present a case of upper cervical epidural abscess in a patient with PD and to review upper cervical spine infection. We present the patient’s presentation, physical examination, imaging findings, and management as well a review of the literature. A 66-year-old male with PD presented to the emergency department (ED) following referral by a neurologist for a presumed C2 fracture. The preceding history was 1 week of severe neck pain requiring a magnetic resonance imaging (MRI), which was initially interpreted as a C2 fracture. On admission from the ED, further review of the MRI appeared to show anterior prevertebral abscess and an epidural abscess. The patient’s neurological examination was at baseline. In the span of 2 days, the patient developed significant motor weakness. A repeat MRI demonstrated expansion of the epidural collection and spinal cord compression. Surgical management consisting of C1 and C2 laminectomy, irrigation, and debridement from anterior and posterior approaches was performed. Postoperatively, the patient did not recover any motor strength and elected to withdraw care and died. Spinal epidural abscess requires a high index of suspicion and needs prompt recognition to prevent neurological impairment. Upper cervical spine infections are rare but can lead to lethal consequences. PMID:26623170
Thirumala, Raghu; Babady, N. Esther; Kamboj, Mini; Chawla, Mohit
Capnocytophaga species are known commensals of the oral cavity of humans and animals (mainly dogs and cats) and are a rare cause of respiratory tract infections. We report a case of cavitary lung abscess caused by a Capnocytophaga species in a patient with a metastatic neuroendocrine tumor. PMID:22075586
Demir, Ali Oğuz; Doğan, Ersoy; Ecevit, Mustafa Cenk
A two-year-old girl patient, who presented to another center with three months of sore throat and one month of neck swelling with pain, was initiated antibiotherapy but no healing was achieved. Afterwards, the patient was directed to our clinic and an abscess was detected in magnetic resonance imaging extending in both lateral spaces of the neck. The patient was performed surgical drainage urgently. The wound was dressed with rifampicin and the patient was started parenteral antibiotherapy. A dramatic recovery was observed and no complication occurred in the patient.
Cerqueira, M.D.; Jacobson, A.F.
Myocardial abscess formation in patients with bacterial endocarditis in most clinical settings, especially in patients with prosthetic valves, is a primary indicator for surgical valve replacement. We report the detection of myocardial abscesses using /sup 111/In leukocyte scintigraphy in three patients with prosthetic or native valve endocarditis and nondiagnostic echocardiograms. Leukocyte scintigraphy may allow identification of myocardial abscess formation earlier than other imaging modalities.
Ramesh, Manish; Resnick, Elena; Hui, Yiqun; Maglione, Paul J.; Mehta, Harshna; Kattan, Jacob; Bouvier, Nicole M.; LaBombardi, Vincent; Victor, Tanya R.; Chaturvedi, Sudha
Chronic Granulomatous Disease (CGD), caused by genetic defects in components of the phagocyte NADPH oxidase pathway, leads to recurrent life-threatening bacterial and invasive fungal infections. While a number of unique pathogens have been associated with this disease, the causative organisms may be difficult to identify. Here, we present a 24 year old male with known X-linked CGD who concurrently developed a cervical abscess and an abscess in the subcutaneous tissues of the right hip, both of which were surgically drained. Cultures failed to identify any organisms. He was treated empirically with ertapenem but the hip abscess recurred at the original site and in contiguous dependent areas in the posterior thigh and knee. A filamentous organism was observed microscopically, initially considered a contaminant, but on culture yielded a mold growth, identified as Phellinus tropicalis (synonym: Inonotus tropicalis) based on phenotypic and molecular methods. This is the third case report of human infection with P. tropicalis, all in subjects with CGD. The patient was treated with voriconazole with resolution of his symptoms. PMID:24310980
Abscess - skin; Cutaneous abscess; Subcutaneous abscess; MRSA - abscess; Staph infection - abscess ... Skin abscesses are common and affect people of all ages. They occur when an infection causes pus ...
Iwaya, Shin-ichi; Ikawa, Motohide; Kubota, Minoru
An immature permanent mandibular central incisor with periapical involvement in a 7-year-old boy was treated to promote revascularization. The tooth suffered from acute apical periodontitis after periodontal treatment by a general practitioner. An access cavity was prepared in the tooth and the cavity was left open until the next visit to achieve drainage through the canal. The root canal was not mechanically cleaned during the treatment period, but was irrigated with hydrogen peroxide and sodium hypochlorite. Calcium hydroxide compound was used for disinfection. At the fifth visit vital tissue appeared in the canal near the apical region, and calcium hydroxide compound was placed in contact with the soft tissue in the root canal. The access cavity was sealed with glass-ionomer cement followed by an adhesive composite resin filling. Radiographic examination 30 months after the initial treatment confirmed closure of the apex and thickening of the root wall. The case was observed for up to 13 years and root development was confirmed.
Ghosh, Soumik; Sharma, Sourabh; Gadpayle, A K; Gupta, H K; Mahajan, R K; Sahoo, R; Kumar, Naveen
Objective. To describe the clinical profile, microbiological aetiologies, and management outcomes in patients with liver abscess. Methods. A cross-sectional study was conducted from May, 2011, to April, 2013, on 200 consecutive liver abscess patients at PGIMER and Dr. RML Hospital, New Delhi. History, examination, and laboratory investigations were recorded. Ultrasound guided aspiration was done and samples were investigated. Chi-square test and multivariate regression analysis were performed to test association. Results. The mean age of patients was 41.13 years. Majority of them were from lower socioeconomic class (67.5%) and alcoholic (72%). The abscesses were predominantly in right lobe (71%) and solitary (65%). Etiology of abscess was 69% amoebic, 18% pyogenic, 7.5% tubercular, 4% mixed, and 1.5% fungal. Percutaneous needle aspiration was done in 79%, pigtail drainage in 17%, and surgical intervention for rupture in 4% patients. Mortality was 2.5%, all reported in surgical group. Solitary abscesses were amoebic and tubercular whereas multiple abscesses were pyogenic (P = 0.001). Right lobe was predominantly involved in amoebic and pyogenic abscesses while in tubercular abscesses left lobe involvement was predominant (P = 0.001). Conclusions. The commonest presentation was young male, alcoholic of low socioeconomic class having right lobe solitary amoebic liver abscess. Appropriate use of minimally invasive drainage techniques reduces mortality.
Corti, Marcelo; Solari, Rubén; De Carolis, Luis; Cangelos, Diana; Bianchi, Mario; Negroni, Ricardo
Psoas muscle abscess is an uncommon infection that have been diagnosed increasingly in the last years. We present a case of a patient with advanced human immunodeficiency virus infection who developed a disseminated infection due to Nocardia asteroides sensu stricto type VI with psoas abscess. To our knowledge no other cases of Nocardia psoas abscess in the setting of HIV infection have been reported in the literature.
Shi, E C; Yeo, B W; Ham, J M
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.
Vallalta Morales, M; Solaz Moreno, E; Lacruz Rodrigo, J; Salavert Lletí, M; Silla Burdalo, G; Pérez-Bellés, C
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.
Basyuni, Shadi; Sharma, Valmiki; Santhanam, Vijay; Ferro, Ashley
We present the case of poor neurological recovery and subsequent death secondary to a thalamic abscess in a 53-year-old man. This patient initially presented with sudden dysarthria and left hemiparesis while driving. Neuroimaging showed a multilobular abscess involving the right thalamus with oedema extending to the basal ganglionic region and brainstem. The source of the abscess was initially unknown and it required draining multiple times while the different causes were being explored. The patient's neurological state along with intubation made for a difficult and inconclusive oral examination. It was only after neuroimaging included tooth-bearing areas that it became evident that this patient had extensive periodontal disease with multiple areas of periapical radiolucencies. The patient underwent complete dental clearance alongside repeated drainage of the abscess. Despite initial postoperative improvement, the patient never recovered from the neurological damage and died 3 weeks later.
Cariati, Paolo; Cabello-Serrano, Almudena; Monsalve-Iglesias, Fernando; Roman-Ramos, Maria; Garcia-Medina, Blas
Complication of dental infections might be various and heterogeneous. The most common complications are represented by maxilar celulitis, canine space celulitis, infratemporal space celulitis, temporal celulitis and bacteremia. Among rarest complications we found: sepsis, bacterial endocarditis, mediastinitis, intracranial complications, osteomyelitis, etc. Although dental infections are often considered trivial entities, sometimes they can reach an impressive gravity. In this regard, the present study describes a case of dental infection complicated by meningitis, subdural empiema and cerebral vasculitis. Furthermore, we observed other neurological complications, like thalamic ischemic infarction, during the disease evolution. Noteworthy, these entities were not presented when the patient was admitted to hospital. Therefore, the main aim of this report is to highlight the serious consequences that an infection of dental origin could cause. Key words:Meningitis, subdural empyema, odontogenic infections.
Cabello-Serrano, Almudena; Monsalve-Iglesias, Fernando; Roman-Ramos, Maria; Garcia-Medina, Blas
Complication of dental infections might be various and heterogeneous. The most common complications are represented by maxilar celulitis, canine space celulitis, infratemporal space celulitis, temporal celulitis and bacteremia. Among rarest complications we found: sepsis, bacterial endocarditis, mediastinitis, intracranial complications, osteomyelitis, etc. Although dental infections are often considered trivial entities, sometimes they can reach an impressive gravity. In this regard, the present study describes a case of dental infection complicated by meningitis, subdural empiema and cerebral vasculitis. Furthermore, we observed other neurological complications, like thalamic ischemic infarction, during the disease evolution. Noteworthy, these entities were not presented when the patient was admitted to hospital. Therefore, the main aim of this report is to highlight the serious consequences that an infection of dental origin could cause. Key words:Meningitis, subdural empyema, odontogenic infections. PMID:27703619
Amaya-Tapia, Gerardo; Rodríguez-Toledo, Arturo; Aguilar-Benavides, Sergio; Aguirre-Avalos, Guadalupe
Patient: Male, 46 Final Diagnosis: Generalized tuberculous lymphadenitis with retropharyngeal abscesses and disseminated tuberculosis Symptoms: Lymphadenopathy • dysphagia • weight loss Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Unusual clinical course Background: The retropharyngeal abscess is a rare presentation of head and neck tuberculosis. The pathogenesis of the abscess formation in the retropharyngeal space in the adult is controversial. Case Report: We report a case of large retropharyngeal abscesses in a 46-year-old man with disseminated tuberculosis. The patient had severe progressive dysphagia, weight loss, and a slowly enlarging bilateral cervical mass during a period of three months. His posterior pharynx wall was bulging and red, and both tonsils were enlarged and congested. The neck had an abscess of 5 cm in diameter that was firm, tender, and warm along the left sternocleidomastoid muscle. Palpable bilateral lymphadenitis was detected in the submandibular, cervical, axillary, and inguinal regions. A computed tomographic (CT) scan of the neck revealed large bilobulated retropharyngeal abscesses. A liver ultrasound showed multiple hypoechoic lesions. A Ziehl-Neelsen smear for acid-fast bacilli was positive from different abscess samples, and mycobacterial cultures subsequently yielded Mycobacterium tuberculosis. Antituberculous therapy was begun and the retropharyngeal abscesses were aspirated by external incision with complete drainage and relief of symptoms. Conclusions: Large retropharyngeal abscess is a rare entity in which Mycobacterium tuberculosis etiology should be considered, especially in endemic countries, and the diagnosis may be difficult because symptoms and signs are influenced by abscess size and time of onset, or if the etiology is not suspected. PMID:27680292
... doctors use antibiotics to treat tonsillitis. Tooth and gum disease can increase the chances of a peritonsillar abscess ... Tonsillitis Strep Throat How Can I Quit Smoking? Gum Disease Stop Smoking: Your Personal Plan Mouth and Teeth ...
Maude, Rapeephan R; Vatcharapreechasakul, Teerapon; Ariyaprasert, Pitchayanant; Maude, Richard J; Hongsuwan, Maliwan; Yuentrakul, Prayoon; Limmathurotsakul, Direk; Koh, Gavin C K W; Chaowagul, Wipada; Day, Nicholas P J; Peacock, Sharon J
Retrospective case series from Thailand have reported the presence of intra-abdominal abscesses in around half of patients with melioidosis, a much higher rate than our clinical experience would suggest. We performed a prospective, observational study of 230 adult patients with culture-confirmed melioidosis in which all patients underwent abdominal ultrasound. One or more abscesses were detected in the liver and/or spleen in 77 (33%) cases. These were often multiple (70%, 31/44 in hepatic abscesses and 88%, 50/57 in splenic abscesses) and clinically silent (27% of cases with abscesses presenting with abdominal pain). The mortality rate at 4 weeks post-discharge was lower in patients who were abscess-positive vs abscess-negative (10%, 8/77 vs 20%, 31/153).
Gettler, J. F.; Garner, B. F.
Unlike other forms of tuberculosis, tuberculous cerebral abscess is a rare complication of human immunodeficiency virus (HIV) infection and usually presents at a late stage of the disease. This article describes a case of tuberculous cerebral abscess in an HIV-infected patient that was effectively treated with surgery and chemotherapy. The patient has survived more than 5 1/2 years since being diagnosed and remains in good health. PMID:8855653
Gettler, J F; Garner, B F
Unlike other forms of tuberculosis, tuberculous cerebral abscess is a rare complication of human immunodeficiency virus (HIV) infection and usually presents at a late stage of the disease. This article describes a case of tuberculous cerebral abscess in an HIV-infected patient that was effectively treated with surgery and chemotherapy. The patient has survived more than 5 1/2 years since being diagnosed and remains in good health.
Hsiao, Po-Jen; Tsai, Ming-Hsien; Leu, Jyh-Gang; Fang, Yu-Wei
Iliopsoas abscess is a rare complication in hemodialysis patients that is mainly due to adjacent catheterization, local acupuncture, discitis, and bacteremia. Herein, we report a 47-year-old woman undergoing regular hemodialysis via a catheter in the internal jugular vein who presented with low back pain and dyspnea. A heart murmur suggested the presence of catheter-related endocarditis, and this was confirmed by an echocardiogram and a blood culture of methicillin-resistant Staphylococcus aureus. A computed tomography indicated a pulmonary embolism and an incidental finding of iliopsoas abscess. Following surgical intervention and intravenous daptomycin, the patient experienced full recovery and a return to usual activities. This case indicates that an iliopsoas abscess can be related to a jugular vein catheter, which is apparently facilitated by infective endocarditis. The possibility of iliopsoas abscess should be considered when a hemodialysis patient presents with severe low back pain, even when there is no history of adjacent mechanical intervention.
Onofrio, Anthony R.; Martinez, Lauren C.; Opatowsky, Michael J.; Spak, Cedric W.; Layton, Kennith F.
We describe an 81-year-old man receiving azacitidine monotherapy for myelodysplastic syndrome who was improving from Listeria monocytogenes bacteremia after receiving antibiotic therapy during an earlier hospital admission. Shortly after discharge he developed new-onset seizure activity, with brain imaging on subsequent admissions demonstrating a posterior right frontal lobe mass. Specimen cultures after resection of the mass revealed this to be a cerebral abscess related to L. monocytogenes. Brain abscesses related to this organism are rare. PMID:26130881
Shimohata, Mitsuteru; Naruse, Satoshi; Kawasaki, Satoshi; Watanabe, Yumiko; Koyama, Miyako; Ito, Yasushi; Tanaka, Hajime
Here, we report brain abscess due to Fusobacterium necrophorum (F. necrophorum) in a 78-year-old healthy man. He developed convulsion and did not have any signs of meningitis. Although the brain magnetic resonance imaging findings of the left occipital lobe were typical of a brain abscess, his cerebrospinal fluid examination revealed only slight pleocytosis and mild increase in protein levels. Thus, it was difficult to rule out the possibility of metastatic brain tumor; the patient's condition was provisionally diagnosed as symptomatic epilepsy secondary to brain abscess. His convulsion disappeared soon after administration of antiepileptic, antibacterial, and steroid agents. A craniotomy was performed to evacuate the abscess, and F. necrophorum was identified by culturing the abscess contents. After the operation, he was treated with appropriate antibacterial agents, which resulted in resolution of the brain abscess. Although Fusobacterium species are gram-negative anaerobic bacilli commensal of the human oropharynx, we need to recognize that Fusobacterium species can be a primary pathogen causing brain abscesses and may leave residual neurological sequelae without early appropriate treatment.
Park, In Hyung; Jun, Chung Hwan; Wi, Jin Woo; Park, Seon Young; Lee, Wan Sik; Jung, Sook In; Park, Chang Hwan; Joo, Young Eun; Kim, Hyun Soo; Rew, Jong Sun
Background/Aims Although pyogenic liver abscesses (PLAs) can be successfully treated, the visual prognosis of patients with endogenous endophthalmitis (EE) associated with a PLA is poor. Early diagnosis and prompt intervention may salvage useful vision. Therefore, we investigated risk factors for EE in patients with PLA, to facilitate early diagnosis. Methods Data from 626 patients diagnosed with PLA between January 2004 and July 2013 were analyzed retrospectively. Patients were divided into two groups: those with liver abscess-associated endogenous endophthalmitis (LAEE) and non-LAEE. Results The prevalence of EE in PLA patients was 1.92%. The mean age for all patients (373 males, 59.6%) was 62.8 years. Upon multivariate logistic regression, a liver abscess or another systemic infection (odds ratio [OR], 5.52; p = 0.005), an abscess in the right superior segment (OR, 5.26; p = 0.035), and Klebsiella pneumoniae infection (OR, 3.68; p = 0.039), were risk factors for LAEE. The final visual outcomes of patients with LAEE included no light perception in seven, hand motion only in three, and decreased visual acuity in two. Vitrectomy and early intravitreal injections of antibiotics improved visual acuity and preserved useful vision. Conclusions PLA patients with other systemic infections, abscesses in the right superior segment, and K. pneumoniae infection require close monitoring and early intervention to treat LAEE. Intravitreal antibiotic injections or early vitrectomy may salvage useful vision. PMID:26161011
Piccoli, Luca; Besharat, Laith Konstantinos; Cassetta, Michele; Migliau, Guido; Di Carlo, Stefano; Pompa, Giorgio
Summary Aim Assess oral health, treatment needs and the correlation between tooth wear and medications in patients with psychiatric disease. Methodology 92 patients (40 male and 52 female) admitted in the Department of Neurology and Psychiatry of the Umberto I Hospital of Rome underwent an oral and dental clinical examination in accordance according to World Health Organization Basic Methods Criteria. One dentist performed all clinical examinations, training and calibration was carried out by an experienced clinical examiner. To measure the degree of inter-examiner agreement Kappa statistics was calculated. Level of tooth wear was assessed using the tooth wear classification of Johansson et al. Exact psychiatric pathology and medications of each patient were registrated. The Statistical Package for the Social Sciences (SPSS Inc., Chicago, Ill.) was used to analyze the data. A value of P < 0.05 was considered statistically significant. Results 34.78% of the sample regarding tooth wear demonstrated score 2. Men demonstrated 30% score 2, and 20% score 3 and 4 whereas female patients 38.46% score 2, 7.69% score 3 and none score 4. Conclusions Chronic exposure to neuroleptic drugs can cause phenomena of bruxism. There is a direct correlation between tooth wear, psychiatric disorders and administration of certain drugs. Poor oral hygiene and extensive unmet needs for dental treatment were widespread among psychiatric patients. PMID:25002918
Katonis, Pavlos; Souvatzis, Xenia; Tsavalas, Nikolaos; Alpantaki, Kalliopi
Pyogenic haematogenous cervical epidural abscess complicated by tetraplegia is an uncommon entity, but its clinical importance overshadows its rarity. Predisposing risk factors for spinal epidural abscess include diabetes, intravenous drug abuse, liver disease, renal failure, malignancy, HIV, infection elsewhere, rheumatoid conditions, trauma and a number of spinal interventions. Lack of recovery and death are much more frequent when complete paralysis exists since more than 24 to 48 hours. Most authors combine decompressive laminectomy and antibiotics. Anterior decompression and needle aspiration are rarely used, the former more specifically in case of anterior abscess formation. A high index of suspicion along with reliance on gadolinium-enhanced MRI is essential to diagnose the pathology and institute appropriate treatment on an individual basis. The authors report on a diabetic male patient who developed a cervical epidural abscess with tetraplegia after dental extraction. He was treated within six hours by one stage anterior/posterior decompression and fusion, with complete recovery.
Udoh, David O.; Ibadin, Emmanuel; Udoh, Mojisola O.
Background: Intracranial abscess collections, though uncommon, are dreaded complications of head trauma, neurosurgical operations, meningitis, and otogenic, mastoid, and paranasal air sinus infections. Combining surgical evacuation with the appropriate antibiotic therapy is the effective treatment for intracranial abscesses. However, literature on surgical treatment is replete with several procedures which, on their own, may not Objectives: To determine the epidemiology and outcomes (of various treatment modalities) of intracranial abscesses in our institution, a major referral center for neurosurgical conditions in the midwestern region of Nigeria. Materials and Methods: This is a retrospective analysis of demographic data as well as indications, treatment modalities, and outcomes of various surgical procedures for evacuation of intracranial abscesses between September 2006 and December 2011. Results: We carried out 40 procedures in 32 (23 male and 9 female) patients with various intracranial abscesses. These represented approximately 5.6% of all operative neurosurgical procedures in our unit since inception. Most abscesses [16, i.e. 50%] occurred in the second decade. In the first decade, there were 7 (22%), and after the age of 30 years, there were 4 (12.5%). The most susceptible single year of life was infancy with 4 (12.5%) cases of intracranial abscesses. None of the infants had features of congenital heart disease. The predisposing factors were mostly otolaryngologic (9) or posttraumatic (6). Most abscesses (41%) were located in the frontal region, and intraparenchymal (i.e. intracerebral or intracerebellar) (50%) lesions were commoner than extradural, subdural, or intraventricular lesions. The commonest procedure performed (50%) was burr hole evacuation. Four patients (12.5% of cases) died. Prognosis appears to worsen with meningitis as the predisposing infection, ventriculitis, multiple abscesses especially in infants, and immunosuppression. Conclusion
Kurasawa, Miwa; Nishikido, Takashi; Koike, Junko; Tominaga, Shin-ichi; Tamemoto, Hiroyuki
We experienced a case of liver abscess due to Clostridium perfringens (CP) complicated with massive hemolysis and rapid death in an adequately controlled type 2 diabetic patient. The patient died 6 h after his first visit to the hospital. CP was later detected in a blood culture. We searched for case reports of CP septicemia and found 124 cases. Fifty patients survived, and 74 died. Of the 30 patients with liver abscess, only 3 cases survived following treatment with emergency surgical drainage. For the early detection of CP infection, detection of Gram-positive rods in the blood or drainage fluid is important. Spherocytes and ghost cells indicate intravascular hemolysis. The prognosis is very poor once massive hemolysis occurs. The major causative organisms of gas-forming liver abscess in diabetic patients are Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli). Although CP is relatively rare, the survival rate is very poor compared with those of K. pneumoniae and E. coli. Therefore, for every case that presents with a gas-forming liver abscess, the possibility of CP should be considered, and immediate aspiration of the abscess and Gram staining are important. PMID:24748935
Cholapranee, Aurada; Houten, Diana van; Deitrick, Ginna; Dagli, Mandeep; Sudheendra, Deepak; Mondschein, Jeffrey I.; Soulen, Michael C.
PurposePatients without a competent sphincter of Oddi due to prior surgical or endoscopic therapy are at high risk for liver abscess following chemoembolization despite aggressive antimicrobial prophylaxis. We examined a cohort of such patients undergoing Y-90 resin radioembolization and compared them to a cohort of chemoembolized patients.MethodsReview of our quality-assurance database identified 24 radioembolizations performed in 16 patients with prior biliary intervention. An aggressive prophylactic regimen of oral levofloxacin and metronidazole 2 days pre-procedure continuing for 14 days after, oral neomycin/erythromycin bowel prep the day before, and IV levofloxacin/metronidazole the day of treatment was prescribed. Patients underwent resin microsphere radioembolization dosed according to the BSA method. Patients had clinical, imaging, and laboratory assessment 1 month after each treatment, and then every 3 months. The chemoembolization cohort consisted of 13 patients with prior biliary intervention who had undergone 24 chemoembolization procedures.ResultsNo radioembolization patient developed an abscess. In the cohort of chemoembolized patients who received the same prophylaxis, liver abscess occurred following 3 of 24 (12.5 %) procedures in 3 of 13 (23 %) patients, one fatal.ConclusionsThis preliminary experience suggests that the risk of liver abscess among patients with prior biliary intervention may be lower following radioembolization than chemoembolization, which could potentially expand treatment options in this high-risk population.
Wernicke's encephalopathy is a fatal neurological disease caused by thiamine deficiency. Many reports indicate that Wernicke's encephalopathy is caused by malnutrition. We report the case of a 79-year-old female patient who had a left masticator space and parapharyngeal space abscess who was diagnosed with Wernicke's encephalopathy. She reported problems while eating due to the presence of the abscess, but the true quantities of food she was ingesting were never assessed. Clinicians have a responsibility to provide adequate nutritional support by ensuring that patients receive adequate nutrition. Clinicians should also keep in mind that Wernicke's encephalopathy may occur in patients who experienced prolonged periods of malnutrition. PMID:27162754
Khaja, Misbahuddin; Adler, Darryl; Lominadze, George
Background Brain abscess is an uncommon but life-threatening infection. It involves a focal, intracerebral infection that begins in a localized area of cerebritis and develops into a collection of pus, surrounded by a well-vascularized capsule. Brain abscess still poses a significant problem in developing countries but rarely in developed countries. Predisposing factors vary in different parts of the world. With the introduction of antibiotics and imaging studies, the mortality rate has decreased between 5% and 15%. If left untreated it may lead to serious neurologic sequelae. The temporal lobe abscess can be caused by conditions like sinusitis, otitis media, dental infections, and mastoiditis if left untreated or partially treated. Additionally, in neurosurgical procedures like craniotomy, the external ventricular drain can get infected, leading to abscess formation. Case presentation We present the case study of an elderly female patient who presented with expressive aphasia caused by brain abscess, secondary to Streptococcus intermedius infection. The 72-year-old female with a medical history of hypertension came to hospital for evaluation with word-finding difficulty, an expressive aphasia that began a few days prior to presentation. Computed tomography of the head showed a left temporal lobe mass-like lesion, with surrounding vasogenic edema. The patient was empirically started on courses of antibiotics. The next day, she was subjected to magnetic resonance imaging of the brain, which showed a left temporal lobe septated rim-enhancing mass lesion, with bright restricted diffusion and diffuse surrounding vasogenic edema consistent with abscess. The patient was also seen by the neurosurgery department and underwent stereotactic, left temporal craniotomy, with drainage, and resection of abscess. Tissue culture grew S. intermedius sensitive to ampicillin sulbactam. Subsequently her expressive aphasia improved. Conclusion Brain abscess has a high mortality, however
Paez Soria, Eugenia; Magnano, Paula; Schlaen, Ariel; Luvini, Paula; Arevalo Calderon, Gisela; Martinez Cartier, Mauricio; Chiaradía, Pablo; Couto, Cristóbal
This case report describes the features of a tuberculous subretinal abscess in a non-HIV patient. It includes the characterization of the lesion with spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence examination. SD-OCT and autofluorescence imaging showed external retinal involvement during development of the tuberculous subretinal abscess. Patients with tuberculous lesions need a multidisciplinary approach, since the disease may involve any part of the body. In this case in particular, incidental findings at computed tomography scan led to the detection of this rare ocular manifestation of tuberculous disease. PMID:28101049
Gezici, Ali Riza
Despite advances in neuroimaging and neurosurgical treatment modalities, spinal epidural abscess remains a challenging problem. Early diagnosis is often difficult and treatment is always delayed. Spinal epidural abscess usually develops in patients with predisposing factors such as IV drug abuse, senillity, diabetes mellitus, spinal attempts, alcoholism, immunosuppression, liver diseases and catheterizations. It is rarely seen in cervical region. A successful treatment is only possible with early diagnosis and accurate surgical and medical treatment. Optimal management is unclear and morbidity and mortality are significant. We present two adult haemodialysis patients with end-stage renal insufficiency who developed cervical epidural abscess following central venous catheter placement. Early surgical intervention is mandatory in cases those have progressive neurological deficit and spinal deformity, and this is also increases the success rate of medical therapy. PMID:20052368
Zhou, Bo; Han, Gang; Chen, Yu; A, Jiye; Gu, Guosheng; Chen, Jun; Wang, Gefei; Li, Jieshou
Abstract Background: Low serum albumin concentration is a predictor of failure of source control for intra-abdominal infection. However, data on dynamics of albumin synthesis in these patients and to what extent these changes contribute to hypoalbuminemia are relatively scarce. We investigated in a group of patients with gastrointestinal fistula the dynamic response of liver albumin synthesis to intra-abdominal abscess and how these related to hypoalbuminemia and circulating endocrine hormone profiles. Methods: Eight gastrointestinal fistula patients scheduled to undergo percutaneous abscess sump drainage were enrolled prospectively to measure albumin synthesis rates at different stages of the inflammatory response (immediately after diagnosis and 7 d following sump drainage when clinical signs of intra-abdominal sepsis had been eradicated). Eight age-, sex-, and body mass index–matched intestinal fistula patients were studied as control patients. Consecutive arterial blood samples were drawn during a primed-constant infusion (priming dose: 4 micromol·kg−1, infusion rate: 6 micromol·kg−1·min−1) to determine the incorporation rate of L-[ring-2H5]-phenylalanine directly into plasma albumin using gas chromatography/mass spectrometry analysis. Results: Patients suffering from intra-abdominal infection had reduced plasma albumin and total plasma protein concentrations, compared with control patients. Albumin fractional synthesis rates in patients with intra-abdominal abscess were decreased, compared with those in the control group. When the source of infection was removed, albumin synthesis rates returned to control values, whereas albumin concentrations did not differ significantly from the corresponding concentrations in control subjects and patients with intra-abdominal abscess. Conclusion: Despite nutritional intervention, albumin synthesis rate is decreased in intestinal fistula patients with intra-abdominal abscess; albumin synthesis returns to
Bumbasirević, Marko Z; Zagorac, Slavisa G; Lesić, Aleksandar R; Bumbasirevic, Vesna; Durasić, Ljubomir M
Drug abuse is related to many medical complications, which depend on the drug type, dose injected, the method of delivery and site of injection. We report a case of psoas abscess in young heroin addict, HIV negative, who was admitted in Emergency Center of Clinical Center in Belgrade because of fever, anaemia, prostration and right groin pain. Clinical and radiological examination were performed. CT showed large abscess of the right psoas muscle, 12 x 4 cm large. Treatment included percutaneous drainage and administration of iv antibiotics. There is regression of inflamation. At discharge patient was in good condition without signs of infection.
Background. Group B Streptococcus is an organism that commonly infects a wide range of hosts including infants in the first week of life, pregnant women, and older age adults as well as adults with underlying medical comorbidities. Case. Large pelvic abscess in a nonpregnant patient found to be caused by Group B Streptococcus was treated successfully with IR guided drainage and antibiotics. Conclusion. Though rare, GBS can still be a cause of invasive infection even in individuals who are nonpregnant and have no underlying comorbidities. Empiric antibiotic coverage for this organism should be kept in mind when treating an abscess. PMID:27529043
Sharma, Rekha; Kumar, Sushil; Singla, Anu
Objective: To determine the prevalence of tooth size discrepancy (TSD) in a representative orthodontics population, to explore how many millimeters of TSD is clinically significant and to determine the ability of simple visual inspection to detect such a discrepancy. Materials and Methods: The sample comprised 150 pretreatment study casts with fully erupted and complete permanent dentitions from first molar to first molar, which were selected randomly from records of the orthodontic patients. The mesiodistal diameters of the teeth were measured at contact points using digital calipers and the Bolton's analysis was carried out on them. Simple visual estimation of Bolton discrepancy was also performed. Results: In the sample group, 24% of the patients had anterior tooth width ratios and 8% had total arch ratios greater than ±2 standard deviation (SD) from Bolton's means. For the anterior analysis, correction greater than ±2 mm was required for 24% of patients in the upper arch or 14% in the lower arch. For the total arch analysis, correction greater than ±2 mm was required for 36% of patients in the upper arch or 32% in the lower arch. Conclusion: Bolton's analysis should be routinely performed in all orthodontic patients and the findings should be included in orthodontic treatment planning. 2 mm of the required tooth size correction is an appropriate threshold for clinical significance. Visual estimation of TSD has low sensitivity and specificity. Careful measurement is more frequently required in clinical practice than visual estimation would suggest. PMID:22090759
Lalitha, M K; Mathai, K V; Koshi, G
A high titer (1:256) of agglutinating antibodies against Bacteroides ureolyticus was demonstrated in a 35-year-old woman with brain abscess, using a microagglutination test. Tests done with B. ureolyticus and heterologous sera as well as with heterologous strains and the patient's serum were negative. Circulating antibody to B. ureolyticus has not been reported previously. PMID:6619293
... small abscess (less than 2 cm) An abscess deep in the brain An abscess and meningitis Several ... or MRI scan may be needed for a deep abscess. During this procedure, medicines may be injected ...
Kusumoto, Kiyonori; Hamada, Akihiko; Kusaka, Toshihiro; Yamaguchi, Daisuke; Yoshioka, Takuto; Nakai, Yoshitaka; Matsubara, Susumu; Azechi, Hidemasa; Fujii, Shigehiko; Kokuryu, Hiroyuki
A 64-year-old man presented with diarrhea, fever, and disturbance of consciousness; he was subsequently diagnosed with acute renal and hepatic disorder. Abdominal computed tomography identified a gas-forming liver abscess, and the patient underwent emergency drainage. However, his condition did not improve, and Clostridium perfringens was observed in his blood culture. Continuous perfusion drainage was performed by placing an additional drainage tube, which resulted in abscess shrinkage and improved the patient's general condition. Despite the low survival rate in patients with gas-forming liver abscesses caused by C. perfringens, therapy was successful in this patient.
Zafar, Saeed Zubair; Pervin, Najwa; Manthri, Sukesh; Bhattarai, Mukul
Multiple brain abscesses in an immunocompetent patient is a challenging clinical problem in the medical world despite advances in imaging techniques, laboratory diagnostics, surgical interventions, and antimicrobial treatment. It is a clinical entity that typically tends to occur in the presence of known predisposing factors. Clinicians seek to determine the potential risk factors responsible for the development of brain abscess because it is very crucial for management of this life-threatening condition. At times, like in our case, there are clinical situations where it is difficult to reveal any traditional risk factors. We report a case of multiple brain abscesses in a 51-year-old female with a past medical history significant only for factor V Leiden mutation, and deep vein thrombosis on chronic anticoagulation. She underwent thorough evaluation but no predisposing factors were found. Based on our extensive literature review, this is the index case of multiple brain abscesses in a patient with history of factor V Leiden mutation and the absence of any conventional risk factors. We also postulate a possible mechanism of infection in such patients. PMID:28203573
Cunha-Cruz, Joana; Pashova, Hristina; Packard, J.D.; Zhou, Lingmei; Hilton, Thomas J.
Objectives To estimate the prevalence of tooth wear and to investigate factors associated with tooth wear in patients from general practices in the Northwest United States. Methods Data on the diagnosis and treatment of oral diseases during the previous year were collected in a survey with a systematic random sample of patients (n = 1530) visiting general dentists from the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT) (n = 80). Prevalence ratios (PRs) of moderate to severe occlusal and incisal tooth wear by patient characteristics were estimated using cluster-adjusted multiple binomial regression for adults (18+ years) and children/adolescents (3–17 years). Results For adults, the mean number of teeth with wear facets was 5.4 [95% confidence interval (CI) = 4.6–6.2] and 51% of the adults had four or more teeth with wear. Participants 45–64 and 65+ years old were 1.3 (95% CI = 1.1–1.6) and 1.4 (95% CI = 1.1–1.8) times as likely to have 4+ teeth with moderate to severe wear facets as participants 18–44 years old. Adult males had a 20% (PR = 1.2; 95% CI = 1.1–1.4) higher prevalence of wear than adult females. Adults who were using, or had ever used occlusal splints had higher prevalence of tooth wear compared to those who never used such appliances (PR = 1.3; 95% CI = 1.0–1.5). Adults with any periodontal bone loss also had a 20% higher prevalence of wear than adults without periodontal disease (PR = 1.2; 95% CI = 1.0–1.4). For children/adolescents, the mean number of teeth with moderate to severe wear facets was 1.6 (95% CI = 0.9–2.6) and 31% of the children had one or more teeth with wear facets. The adjusted prevalence ratio of tooth wear (1+ teeth with wear facets) for boys was 1.6 times as high (95% CI = 1.1–2.4) as compared with girls. The prevalence of wear for children 12+ years old was 50% (PR = 0.5; 95% CI = 0.3–0.8) lower than that of children <12 years old. Angle’s class II was associated
Liu, Yu-Hsi; Su, Hsing-Hao; Tsai, Yi-Wen; Hou, Yu-Yi; Chang, Kuo-Ping; Chi, Chao-Chuan; Lin, Ming-Yee; Wu, Pi-Hsiung
Objectives To review cases of peritonsillar abscess and investigate the initial clinical factors that may influence the duration of hospitalization. To determine the predictive factors of prolonged hospital stay in adult patients with peritonsillar abscess. Methods Subjects were adults hospitalized with peritonsillar abscess. We retrospectively reviewed 377 medical records from 1990 to 2013 in a tertiary medical center in southern Taiwan. The association between clinical characteristics and the length of hospital stay was analyzed with independent t-test, univariate linear regression and multiple linear regression analysis. Results The mean duration of hospitalization was 6.2±6.0 days. With univariate linear regression, a prolonged hospital stay was associated with several variables, including female gender, older ages, nonsmoking status, diabetes mellitus, hypertension, band forms in white blood cell (WBC) counts, and lower hemoglobin levels. With multiple linear regression analysis, four independent predictors of hospital stay were noted: years of age (P<0.001), history of diabetes mellitus (P<0.001), ratio of band form WBC (P<0.001), and hemoglobin levels (P<0.001). Conclusion In adult patients with peritonsillar abscess, older ages, history of diabetes mellitus, band forms in WBC counts and lower hemoglobin levels were independent predictors of longer hospitalization. PMID:27334514
Karlı, Arzu; Belet, Nurşen; Danacı, Murat; Avcu, Gülhadiye; Paksu, Şule; Köken, Özlem; Şensoy, Gülnar
We aimed in this study to present the clinical findings in children with iliopsoas abscess (IPA) and to discuss the diagnosis and treatment. The files of five patients, hospitalized between August 2011 and June 2013 and monitored with a diagnosis of IPA, were reviewed retrospectively. Demographic characteristics, symptoms and signs, laboratory examinations, and diagnostic and treatment methods of the cases were evaluated. Two of the cases were females and three were males, and their ages ranged from 10 to 15 years. Before the diagnosis, the duration of symptoms in patients ranged from five days to one year. The primary symptoms included fever and difficulty in walking. One patient presented with septic shock and had a history of trauma as a predisposing factor. All patients except one had a higher erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) value. Psoas abscess was demonstrated by ultrasonography (USG), except in one patient. Four patients underwent percutaneous drainage of the abscess. The isolated microorganisms included Staphylococcus aureus, Mycobacterium tuberculosis, and Enterococcus faecalis. All the cases recovered without sequelae. Diagnosis of IPA in children is difficult, and many physicians are usually consulted before any diagnosis is made. IPA should be considered in the differential diagnosis in patients presenting with complaints of lower back, hip, groin and leg pain and difficulty in walking.
Bodman, Alexa; Riordan, Margaret; Chin, Lawrence S
Spinal epidural abscesses are an uncommon cause of spinal cord injury but, depending on the size and presence of neurological deficits, urgent neurosurgical intervention may be required. We present a unique case of a patient presenting with a spinal epidural collection several days after a fall. While a spinal epidural hematoma was suspected based on the patient's history and MRI findings, a spinal epidural abscess was found during surgery. The patient underwent laminectomy and instrumented fusion with successful treatment of her infection.
Mystakelli, Christina; Gourgiotis, Stavros; Aravosita, Paraskevi; Seretis, Charalampos; Kanna, Efthymia; Aloizos, Stavros
Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring in a patient after intubation with an endotracheal tube or tracheostomy tube lasting for 48 hours or more. We describe a case of 75-year-old male who initially presented with pneumonia of the right basis with accompanying plevritis. The patient was intubated and his condition was complicated with a VAP infection while he developed a lung abscess. The antibiotic therapy was based on susceptibility bronchial secretions isolated acinetobacter baumannii and klebsiella pneumoniae; these pathogens were also isolated from the drained abscess. The patient was discharged in good health. The interest of this case is recommended in the existence of two responsible pathogens, the paucity of the development of lung abscess in a patient with VAP, and the successful treatment of the patient with the combination of controlled drainage of the abscess and appropriate antibiotic therapy.
Ju, Min-Wook; Kwon, Hyon-Jo; Kim, Seon-Hwan; Koh, Hyeon-Song; Youm, Jin-Young; Song, Shi-Hun
Objective Spinal epidural abscess (SEA) can be fatal if untreated, so early diagnosis and treatment are essential. We conducted a retrospective study to define its clinical features and evaluate the risk factors of motor weakness. Methods We retrospectively analyzed the medical records and images of patients with SEA who had been hospitalized in our institute from January 2005 to June 2012. Pyogenic SEA patients were categorized as patients without motor weakness (Group A) and with motor weakness (Group B). Abscess volume was measured using the Gamma-Plan program. Intervertebral foramen height and posterior disc height were measured to evaluate degree of spinal stenosis. Results Of 48 patients with pyogenic SEA, 33 (68%) were treated surgically, and 15 (32%) were treated with antibiotics. Eleven patients had weakness and abscess volume was unrelated to motor weakness. Old age, 'spare room' (abscess volume subtracted from spinal volume) and intervertebral foramen height and posterior disc height were statistically significant. Among the 48 patients, 43 (85%) had good outcome and erythrocyte sedimentation rate (ESR) was the only meaningful prognostic factor (p=0.014). The cut-off value of ESR was 112mm/h with 80% sensitivity and 79% specificity and had borderline significance (p=0.062). Conclusion SEA needs emergent diagnosis and treatment. Motor weakness is the most important factor in treatment decision. By careful image reading, early surgical treatment can be an option for selected patients with severe spinal stenosis for prevent motor weakness. Inflammatory markers, especially ESR, are valuable to identify worsening of SEA. PMID:26512265
Vallianou, N; Gounari, P; Skourtis, A; Kougias, M; Sioula, E
Pyomyositis is a rarely encountered infection among diabetics, which usually affects lower extremities. Herein, we present a case of lower extremities and iliopsoas pyomyositis with concurrent septic arthritis and spinal epidural abscess in a patient with poorly controlled diabetes mellitus.
Heslop, Orville D.; Nyi Nyi, May-Phyo; Abbott, Sean P.; Rainford, Lois E.; Castle, Daphney M.; Coard, Kathleen C. M.
A 44-year-old diabetic female presented to a hospital in Jamaica with thermal burns. Trichosporon asahii was isolated from facial wounds, sputum, and a meningeal swab. Dissemination of the fungus was demonstrated in stained histological sections of the meninges and a brain abscess at autopsy. Pure growth of the fungus from patient samples submitted and an environmental isolate obtained from a wash basin in the hospital supported the diagnosis. PMID:22012010
... type of bacteria called group A beta-hemolytic streptococcus . Peritonsillar abscess most often occurs in older children, ... abscess can travel into the lungs and cause pneumonia. Symptoms of peritonsillar abscess include: Fever and chills ...
Objectives: To compare tooth size between subjects with mild, moderate and severe hypodontia and a control group. Material and Methods: The study comprised 120 patients with hypodontia divided into three groups of 40 mild (≤2 teeth congenitally missing), 40 moderate (3-5 teeth congenitally missing) and 40 severe (≥6 teeth congenitally missing) hypodontia; and 40 age and sex matched controls. Tooth size was recorded by measuring the mesiodistal and buccolingual dimensions of all fully erupted teeth on study models using digital callipers and compared between all hypodontia and control groups using Two-way ANOVA and Post Hoc Tests of subgroup comparison. Results: Two-way ANOVA revealed patients with hypodontia had significantly smaller mesiodistal and buccolingual tooth dimensions compared with controls (p<0.05). Furthermore patients with more severe hypodontia demonstrated significantly smaller tooth dimensions than those in the mild and moderate hypodontia subgroups (p<0.05). The most affected tooth in terms of tooth size reduction was the maxillary lateral incisor and the least affected tooth was the mandibular first molar. Conclusion: Patients with hypodontia have smaller tooth dimensions than control. Tooth size appears to be affected by the degree of hypodontia, with severe hypodontia having a greater effect on tooth size reduction. The findings of this study may contribute to understanding the aetiology of hypodontia and aid the multidisciplinary management of this complex condition. PMID:27583048
Viriyavejakul, Parnpen; Riganti, Mario
We report a case of amebic brain abscess due to Entamoeba histolytica. The patient was a 31-year-old man who presented with amebic liver abscess. His clinical course deteriorated in spite of proper drainage and treatment. He developed delirium, lethargy and then expired. With a history of heroin addiction, withdrawal syndrome from heroin was suspected. At autopsy, amebic abscesses were detected in the liver, large intestine, meninges and brain. A 19 cm amebic liver abscess was found in the right lobe of the liver. A 4 cm amebic brain abscess was found in the right occipital lobe. Microscopically, the tissue sections from the affected organs were confirmed to have degenerated E. histolytica trophozoites. Involvement of the brain in amebic liver abscess should be suspected in patients with neurological signs and symptoms.
Kuo, Chih-Lan; Lo, Sui-Foon; Liu, Chun-Lin; Chou, Chia-Hui; Chou, Li-Wei
There are few reports in the literature of tuberculous brain abscess. Tuberculous brain abscess usually occurs in an immunocompromised host. Almost all previously documented cases have involved acquired immune deficiency syndrome. We encountered a 53-year-old right-handed immunocompetent male who was initially suspected of having a cerebrovascular accident due to acute-onset right hemiparesis and paresthesia. A tentative diagnosis of brain tumor versus brain abscess was made on imaging studies. The patient was finally diagnosed with a tuberculous brain abscess based upon deterioration on imaging and a positive tuberculosis culture. The tuberculous brain abscess was located in the left parietal lobe, which resulted in Gerstmann's syndrome and right-sided apraxia. Stereotactic surgery was performed. He was also given antituberculosis chemotherapy and comprehensive rehabilitation. Considerable improvement was noted after rehabilitation. The patient even returned to a normal life and work. Our case demonstrates that an aggressive intensive inpatient rehabilitation program combined with stereotactic surgery and effective antituberculosis therapy play an important role in improving the outcome for patients with tuberculous brain abscess, Gerstmann's syndrome, and right-sided apraxia.
Kuo, Chih-Lan; Lo, Sui-Foon; Liu, Chun-Lin; Chou, Chia-Hui; Chou, Li-Wei
There are few reports in the literature of tuberculous brain abscess. Tuberculous brain abscess usually occurs in an immunocompromised host. Almost all previously documented cases have involved acquired immune deficiency syndrome. We encountered a 53-year-old right-handed immunocompetent male who was initially suspected of having a cerebrovascular accident due to acute-onset right hemiparesis and paresthesia. A tentative diagnosis of brain tumor versus brain abscess was made on imaging studies. The patient was finally diagnosed with a tuberculous brain abscess based upon deterioration on imaging and a positive tuberculosis culture. The tuberculous brain abscess was located in the left parietal lobe, which resulted in Gerstmann’s syndrome and right-sided apraxia. Stereotactic surgery was performed. He was also given antituberculosis chemotherapy and comprehensive rehabilitation. Considerable improvement was noted after rehabilitation. The patient even returned to a normal life and work. Our case demonstrates that an aggressive intensive inpatient rehabilitation program combined with stereotactic surgery and effective antituberculosis therapy play an important role in improving the outcome for patients with tuberculous brain abscess, Gerstmann’s syndrome, and right-sided apraxia. PMID:22665998
Legrand, L; Catherine, L; Brivet, F; Musset, D
Toxoplasmosis is a disease caused by an obligate intracellular protozoal parasite, Toxoplasma gondii. It is the most common cause of focal brain lesions in patients with AIDS. The imaging features and endocrine disorders of CNS toxoplasmosis in patients with AIDS are reviewed.
Othman, Nurulhasanah; Mohamed, Zeehaida; Yahya, Maya Mazuwin; Leow, Voon Meng; Lim, Boon Huat; Noordin, Rahmah
Entamoeba histolytica is a causative agent of amoebic liver abscess (ALA) and is endemic in many underdeveloped countries. We investigated antigenic E. histolytica proteins in liver abscess aspirates using proteomics approach. Pus samples were first tested by real-time PCR to confirm the presence of E. histolytica DNA and the corresponding serum samples tested for E. histolytica-specific IgG by a commercial ELISA. Proteins were extracted from three and one pool(s) of pus samples from ALA and PLA (pyogenic liver abscess) patients respectively, followed by analysis using isoelectric focussing, SDS-PAGE and Western blot. Unpurified pooled serum samples from infected hamsters and pooled human amoebic-specific IgG were used as primary antibodies. The antigenic protein band was excised from the gel, digested and analysed by MALDI-TOF/TOF and LC-MS/MS. The results using both primary antibodies showed an antigenic protein band of ∼14kDa. Based on the mass spectrum analysis, putative tyrosine kinase is the most probable identification of the antigenic band.
Roig Rico, P; Pérez Rodríguez, L; Navarro Ibáñez, V; López Pérezagua, M M; Portilla Sogorb, J; Cuadrado Pastor, J M
Two cases are reported of hepatic tuberculous abscesses (HTBA) in patients infected with the human immunodeficiency virus (HIV), stressing the rarity of this location. Likewise, a review is made of cases reported in the literature. Our two patients presented with a prolonged febrile condition, with constitutional symptoms and nonspecific abdominal discomfort. In one patient the hepatic location was accompanied by a pulmonar location too. The course of the patients was good and symptoms subsided with tuberculostatic therapy. To note the possibility of finding hepatic tuberculous abscesses in HIV patients with prolonged fever and nonspecific abdominal pain more frequently than considered until now.
Miftode, E; Luca, V; Mihalache, D; Leca, D; Stefanidis, E; Anuţa, C; Sabadis, L
In a retrospective study, 68 patients with Spinal Epidural Abscess (SEA) were reviewed. Of these, 66% had different predisposing factors such as staphylococcal skin infections, surgical procedures, rachicentesis, trauma, spondilodiscitis. Abscess had a lumbar region location in 53% of cases. Staphylococcus aureus was the most frequent etiological agent (81%). The overall rate of mortality in SEA patients was 13.2%.
Srikumar, Thejal; Pabbathi, Smitha; Fernandez, Jorge; Nanjappa, Sowmya
Patient: Male, 67 Final Diagnosis: Aspergillus terreus brain abscess complicated by tension pneumocephalus Symptoms: Blurred vision • hemiparesis Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Rare co-existance of disease or pathology Background: Aspergillus terreus is an evolving opportunistic pathogen, and patients with A. terreus often have poor outcomes due to its intrinsic resistance to several systemic antifungal agents. Here we present a unique case of intracranial abscesses of A. terreus in a patient with recurrent angiosarcoma, complicated by development of tension pneumocephalus. Case Report: A 67-year old gentleman with history of scalp angiosarcoma with wide excision two years prior presented to the hospital for left arm clumsiness, altered mental status, and low-grade fever. Staphylococcus aureus and Proteus mirabilis bacteremia was detected, and Computed Tomography (CT) of the head showed right frontal lobe abscesses. He was started on steroids, intravenous vancomycin and cefepime, and was eventually discharged. He presented to the hospital again due to persistent and worsening symptoms. MRI showed progression of the brain lesions, and surgical biopsy and culture of lesions revealed A. terreus and gram-positive cocci. He was started on trimethroprim/sulfamethoxazole and voriconazole and symptoms improved. On post-op day four, he acutely decompensated with total loss of left arm strength; MRI demonstrated tension pneumocephalus. Conservative management was undertaken with continuous supplemental oxygen. Serial x-ray imaging over the next week demonstrated resolution of the pneumocephalus, and the patient was able to regain all proximal lower and upper extremity strength. Conclusions: Never before has a case of A. terreus been associated with angiosarcoma or tension pneumocephalus in the literature. Proper identification and prompt diagnosis of species is crucial in the immunocompromised patient. Tension
Sakai, C; Iuchi, T; Ishii, A; Kumagai, K; Takagi, T
Multiple brain and liver abscesses developed immediately after Bacillus cereus bacteremia in a neutropenic patient with acute lymphoblastic leukemia. After even 8 weeks of antimicrobial chemotherapy together with administration of granulocyte colony-stimulating factor, every infectious process disappeared but the patient's headache has still persisted. Because the wall of one brain abscess became thin and was in danger of rupturing into the ventricle, surgical drainage was performed, resulting in disappearance of headache and resolution of brain abscess. The present case indicates that a combined medical and surgical approach is mandatory to treat patients with brain abscesses.
Lange, M; Tiecks, F; Schielke, E; Yousry, T; Haberl, R; Oeckler, R
Bacterial abscesses involving the spinal canal are associated with a high morbidity and mortality. Most frequently, these lesions are found in the epidural, rarely in the subdural space. In this report, our clinical material consists of a series of 16 patients treated during the last seven years. The clinical presentation included local neurological signs (back pain, para-/tetraparesis, bladder dysfunction), disturbances of consciousness (ranging from drowsiness to deep coma) and general inflammatory signs (meningism, fever). All patients presented with risk factors (septic foci, chronic diseases, and iatrogenic causes). Laboratory investigations revealed typically pathological blood sedimentation rate, leucocytosis and CSF-pleocytosis. Radiologically, the diagnosis was confirmed by myelography, CT and preferably MRI. The abscesses were located epidurally in 14 and subdurally in 2 cases. The surgical treatment included laminectomy, or multiple flavectomies in extensive lesions. Drainage systems (either simple silicon outflow drains or suction-/irrigation systems) were installed in all cases, as well as antibiotic treatment. Results of treatment: Following an observation period of 0.5-6 years, we found complete recovery in six (38%) cases, six (38%) others were mildly disabled and four (25%) patients died. Focussing on the results of the two different drainage systems, we found a statistically significant superiority of the inflow-/outflow system. Complications included mandatory re-exploration, post-inflammatory hydrocephalus, syringomyelia, spinal instability, surgical treatment of peripheral septic foci and therapy resistant septicaemia. In conclusion, we propose that spinal epi- or subdural abscesses require surgical evacuation, using a suction-/irrigation drainage system, as well as antibiotic and intensive care treatment.
Zhao, Hong-mei; Ran, Yu-ping; Jiang, Xian; Zeng, Wei; Xiong, Lin; Dai, Ya-lin; Du, Xiao-ping; Yang, Guo
We report here the discovery of Malassezia furfur from a groin abscess of a renal transplant patient. A 33-year-old male patient was admitted to our hospital because of a high fever and a persistent inflammatory nodule on his right groin for one week. He had received a renal transplant 3 years before and remained on immunosuppressive agents. He was treated with broad-spectrum antibiotics after hospitalization but the nodule formed a large abscess and then a deep ulcer instead of resolving. Examination of the culture by light microscopy revealed ovoid budding yeasts displaying collar-shaped structure. Subculture of the primary colonies onto Sabouraud's dextrose agar and medium containing rapeseed oil resulted in growth only on the medium containing rapeseed oil. All of the isolates was identified as Malassezia furfur. The pathogenicity of the isolates was tested in mice by intravenous injection of (3-5) x 10(8) cfu per mouse after immunosuppression with 500 mg/kg of prednisone intraporitoneally on day-2. In the mouse model, micro-abscess and inflammatory reaction and oval yeasts with budding were noted in histopathologic section of the viscera of the mice. A rib-like or serrate-like structure of the inner side of cell wall, characteristic for Malassezia spp., was observed by transmission electron microscopy. The patient received oral fluconazole and topical amphotericin B. The isolate before antifungal therapy was sensitive to both fluconazole and amphotericin B, while the isolate after antifungal treatment was only sensitive to amphotericin B. Proteinase activity of the isolates increased 1.43 times after antifungal treatment. This case indicated the invasive power of M. furfur in deep infection. Renal transplantation and reception of long-term immunosuppressive treatment are risk factors for the invasive infection of this fungus.
Thomson, C J; Berkowitz, R G
Nasal septal abscess (NSA) is an uncommon sequel to minor nasal trauma. Abscess extension beyond the nasal cavity is rarely documented. A case of a 10-year-old boy who presented with a NSA associated with a large extradural frontal abscess is presented and indications for CT scanning in the workup of pediatric patients with NSA is discussed.
Cavalie, Laurent; Daviller, Benjamin; Dubois, Damien; Mantion, Benoît; Delobel, Pierre; Debard, Alexa; Prere, Marie-Françoise; Marchou, Bruno; Martin-Blondel, Guillaume
Cutaneous infections due to Legionella species have rarely been reported (L. J. Padrnos, J. E. Blair, S. Kusne, D. J. DiCaudo, and J. R. Mikhael, Transpl Infect Dis 16:307–314, 2014; P. W. Lowry, R. J. Blankenship, W. Gridley, N. J. Troup, and L. S. Tompkins, N Engl J Med 324:109–113, 1991; M. K. Waldor, B. Wilson, and M. Swartz, Clin Infect Dis 16:51–53, 1993). Here we report the identification of Legionella pneumophila isolates, from subcutaneous abscesses in an immunocompromised patient, that grew in an unusual medium for Legionella bacteria. PMID:26292305
Barigou, Mohammed; Cavalie, Laurent; Daviller, Benjamin; Dubois, Damien; Mantion, Benoît; Delobel, Pierre; Debard, Alexa; Prere, Marie-Françoise; Marchou, Bruno; Martin-Blondel, Guillaume
Cutaneous infections due to Legionella species have rarely been reported (L. J. Padrnos, J. E. Blair, S. Kusne, D. J. DiCaudo, and J. R. Mikhael, Transpl Infect Dis 16:307-314, 2014; P. W. Lowry, R. J. Blankenship, W. Gridley, N. J. Troup, and L. S. Tompkins, N Engl J Med 324:109-113, 1991; M. K. Waldor, B. Wilson, and M. Swartz, Clin Infect Dis 16:51-53, 1993). Here we report the identification of Legionella pneumophila isolates, from subcutaneous abscesses in an immunocompromised patient, that grew in an unusual medium for Legionella bacteria.
Pascual-Gallego, María; Alonso-Lera, Pedro; Arribi, Ana; Barcia, Juan A.; Marco, Javier
Nocardial brain abscesses are uncommon and rarely occur in patients without predisposing factors. They may be mistaken for gliomas or necrotic metastases, and surgical intervention may be required to make the diagnosis. We report the first case of Nocardia farcinica cerebellar abscess in a patient without immunosuppression. He presented to us with headache and instability beginning a week before. Brain magnetic resonance imaging (MRI) revealed a cystic lesion located at the right cerebellar hemisphere, hypointense in T1 and hyperintense in T2, with a fine wall that enhanced after injection of gadolinium. Image tests also showed a cavitated lesion at the upper lobule of the right lung. The patient underwent craniotomy and drainage of the cerebellar abscess. Initial post-operative treatment with linezolid produced a limited response. He was re-operated and vancomycin, imipenem and ciprofloxacin were added with an excellent outcome of the cerebellar and lung lesions. PMID:27695569
Isasmendi, Adela M; Pinheiro, José L; Escudé, Natalia García; Efrón, Adriana M; Moscoloni, María A; Hernández, Claudia M
We report a case of a brain abscess caused by Haemophilus influenzae type e in a 12 year-old patient suffering from Apert syndrome. Apert syndrome is characterized by the premature closure of cranial sutures. In 2010 the patient suffered head trauma in the frontal area with cranial fracture and a cerebrospinal fluid fistula. In February 2013 he was admitted to hospital with fever, vomiting and generalized tonic-clonic seizure with deteriorating mental status/progressive sensory impairment. The computerized axial tomographic scan showed a right frontal lesion, perilesional edema, mild ventricular dilatation and pansinusitis. A brain abscess was diagnosed and drained. The clinical sample was then cultured. A gram negative coccobacillus was isolated and identified as Haemophilus influenzae serotype e. Empirical treatment was started with meropenem (120 mg/kg/day) and vancomycin (60 mg/kg/day), which was later switched to ceftriaxone (100 mg/kg/day) and metronidazole (500 mg/8 h) after culture results arrived. The patient was discharged in good clinical condition.
Johnson, Nicholas E; Heatwole, Chad R; Dilek, Nuran; Sowden, Janet; Kirk, Callyn A; Shereff, Denise; Shy, Michael E; Herrmann, David N
This study determines the impact of symptoms associated with Charcot-Marie-Tooth disease on quality-of-life. Charcot-Marie-Tooth patients in the Inherited Neuropathies Consortium Rare Diseases Clinical Research Network Contact Registry were surveyed. The survey inquired about 214 symptoms and 20 themes previously identified as important to Charcot-Marie-Tooth patients through patient interviews. Symptom population impact was calculated as the prevalence multiplied by the relative importance of each symptom identified. Prevalence and symptom impact were analyzed by age, symptom duration, gender, Charcot-Marie-Tooth type, and employment status. 407 participants returned the survey, identifying foot and ankle weakness (99.7%) and impaired balance (98.6%) as the most prevalent themes. Foot and ankle weakness and limitations with mobility were the themes with the highest impact. Both symptom prevalence and impact gradually increased with age and symptom duration. Several themes were more prevalent in women with Charcot-Marie-Tooth, including activity limitations, pain, fatigue, hip-thigh weakness, and gastrointestinal issues. All of the themes, except emotional or body image issues, were more prevalent among unemployed individuals. There were minimal differences in symptom prevalence between Charcot-Marie-Tooth types. There are multiple symptoms that impact Charcot-Marie-Tooth quality-of-life in adults. These symptoms have different levels of importance, are readily recognized by patients, and represent critical areas of Charcot-Marie-Tooth health.
Riordan, Margaret; Chin, Lawrence S.
Spinal epidural abscesses are an uncommon cause of spinal cord injury but, depending on the size and presence of neurological deficits, urgent neurosurgical intervention may be required. We present a unique case of a patient presenting with a spinal epidural collection several days after a fall. While a spinal epidural hematoma was suspected based on the patient’s history and MRI findings, a spinal epidural abscess was found during surgery. The patient underwent laminectomy and instrumented fusion with successful treatment of her infection. PMID:27382529
Li, Z; Wang, X; Bian, Z; Li, S; Zheng, H; Zhao, B; Chen, J
P. mirabilis and P. vulgaris are the two wellknown species in the genus Proteus. P. myxofaciens and P. penneri are recent additions to the genus. We isolated P. penneri from the pus of a patient with suppurative otitis media and an epidural abscess. The characteristics of the organism, including morphology, staining, physiology and biochemistry, were studied. Clinical microbiological laboratories should suspect P. penneri in the case of as Proteus strain that is negative for indole, salicin and esculin, but otherwise resembles P. vulgaris. Proteus penneri, formerly known as Proteus vulgaris indole-negative or as Proteus vulgaris biogroup 1, was named by Hickman et al in 1932. Little information about human infection by this organism is available. In 1982, Hickman and co-workers studied 20 strain of P. penneri which were isolated from clinical specimens (urine, stool, etc.) in the USA. However, its clinical significance, until recently, was unknown. We isolated a strain of P. penneri from the pus of a patient with suppurative otitis media and an epidural abscess on June 10 and 15, 1989. This paper concerns the problems encountered in identifying this organism and its clinical significance.
Bosma, Melissa S; Morden, Kasey L; Klein, Katherine A; Neal, Colleen H; Knoepp, Ursula S; Patterson, Stephanie K
In our study, we sought to report the management, clinical outcomes, and follow-up rates of patients who presented for evaluation of breast abscess in the Emergency Department (ED) after hours. A retrospective search of ultrasound reports at our institution identified all patients from January 1, 2009 to June 30, 2013 who were scanned in the ED after hours to evaluate for breast abscess. Patient demographics, clinical information, imaging findings, follow-up rates, and outcomes were reviewed. One hundred eighty-five patients were included in the study. Forty-four percent (86/185) of the patients were diagnosed with abscess based on ultrasound findings in the ED. Twenty-seven percent (23/86) were recently post-operative, and 12 % (10/86) were postpartum/breastfeeding. Mastitis was the diagnosis in the remaining 54 % (99/185). Only 1/86 cases were associated with breast cancer. Seventy-seven percent (66/86) of patients were treated with an invasive procedure; 39 % (26/66) had surgical evacuation, 30 % (20/66) image-guided drainage, 23 % (15/66) bedside or clinic incision and drainage, and 8 % (5/66) palpation-guided fine needle aspiration (FNA). Seventy-seven percent (143/185) of patients had clinical and/or imaging follow-up. Forty-four percent (63/143) had long-term follow-up (≥ 3 months). Almost 50 % of the patients who presented to the ED for evaluation of abscess were diagnosed with abscess while the remaining patients were diagnosed with mastitis. Appropriate clinical and/or imaging follow-up occurred in 77 %. Long-term follow-up (≥ 3 months) occurred more frequently in patients older than 30 years of age. Appropriate follow-up does not occur in approximately one fourth of cases, suggesting that additional clinician and patient education is warranted.
Tang, Hung-Jen; Liu, Wei-Lun; Chang, Tsung Chain; Li, Ming-Chi; Ko, Wen-Chien; Wu, Chi-Jung; Chuang, Yin-Ching; Lai, Chih-Cheng
Invasive cerebral aspergillosis always developed in immunocompromised host. Early diagnosis may save life in this critical condition; however, it is difficult to reach. Herein, we presented an unusual case of invasive cerebral aspergillosis in a cirrhotic patient. A 47-year-old man presented with progressive deterioration of consciousness for three days. The patient had a history of alcoholic liver cirrhosis, Child-Pugh class C. Magnetic resonance imaging (MRI) of brain showed multi-focal parenchymal lesions, which was consistent with multiple brain abscesses. The diagnosis of invasive cerebral aspergillosis was made by molecular based laboratory methods including Aspergillus galactomannan antigen assay and oligonucleotide array. Despite treatment with the antifungal agent, Amphotericin B, the patient died at the ninth day of hospitalization. Our findings suggest that liver cirrhosis can be one of risk factors of invasive cerebral aspergillosis, and support the diagnosing usefulness of MRI, Aspergillus galactomannan antigen assay, and oligonucleotide array.
... high. Possible Complications Complications may include: Multiple abscesses Sepsis When to Contact a Medical Professional Call your ... 2016:chap 144. Read More Abscess Pancreatic pseudocyst Sepsis Review Date 10/27/2015 Updated by: Subodh ...
Wong, San S; Daka, Smitha; Pastewski, Andrew; Kyaw, Win; Chapnick, Edward; Sepkowitz, Douglas
Spinal epidural abscess (SEA) is a rare but potentially devastating condition. We noticed an increase in the number of cases of SEA, with the majority in hemodialysis (HD) patients. This prompted a retrospective chart review of all cases of SEA admitted from 2000 to 2005 and a literature search of similar cases. We identified 19 SEA cases treated at Long Island College Hospital during this 6-year period, of which six were on HD: four were dialyzed via catheter, one via arteriovenous fistula, and in one the method of dialysis was not documented. Four patients had bacteremia with Staphylococcus aureus. Four patients presented with paresis or paralysis; only one improved. The mortality rate was 33% (2/6). We found 30 other cases of SEA in patients on HD from the literature. These 36 HD cases were compared with 85 SEA cases that were not on HD (13 from our study and 72 described in two large case series). The mortality rate was noted to be much higher in HD patients (23% [6/26] versus 7% [6/85]). Neurologic deficit at presentation was noted in 47% (17/36) of HD patients versus 69% (59/85) of non-HD patients, but neurologic improvement was higher in non-HD patients (71% [42/59] versus 29% [5/17]). This is the largest literature review of SEA in patients on HD. When compared with non-HD patients, HD patients had a higher mortality rate and were less likely to improve neurologically.
Navanukroh, O; Jitmuang, A; Chayakulkeeree, M; Ngamskulrungroj, P
Cunninghamella bertholletiae is a rare cause of invasive mucormycosis. We report the case of a 42-year-old Thai woman who suffered from disseminated C. bertholletiae infection. The patient developed dry cough, sharp shooting pain in the left buttock referred to the left leg, and fever 1 month after undergoing deceased-donor kidney transplantation. Radiographic studies exhibited multiple pulmonary cavities, osteomyelitis of the sacral spine, epidural abscess along the lumbrosacral spine, and paravertebral soft tissue involvement. Surgical debridement of the epidural abscess concurrent with prolonged intravenous administration of amphotericin B resulted in a good outcome.
Bulgurcu, Suphi; Arslan, Ilker Burak; Demirhan, Erhan; Kozcu, Sureyya Hikmet; Cukurova, Ibrahim
OBJECTIVE: Neck abscess is a disease that might cause mortality and severe morbidity, if it is not treated urgently. In our study, patients with diagnosis of neck abscess in our clinic were analyzed retrospectively and presented in the light of the literature. METHODS: In our clinic, age distribution, source of infection, systemic disease, imaging methods that were used in diagnosis, preferred anaesthesia during drainage, abscess sites, culture results of abscess material, complications during treatment procedure, any antibiotherapy before admission and duration of hospitalization of 79 cases with neck abscess who were treated in the hospital between January 2008 and January 2015 were assessed. RESULTS: Cases in our study were aged between 1–79 (mean 28.3) years and 43 of them were female and 36 were male patients. Systemic diseases were determined in 19 of the cases. The most common systemic disease was diabetes mellitus. Abscesses were localized mostly at peritonsillar region and 13 of the cases were operated when abscess were in multipl localizations. In 74 of the cases, drainage was performed under local anaesthesia and in 5 cases under general anaesthesia. Four of these 5 cases, abscesses were localized within retropharyngeal region and 1 of them had multiple abscesses at various regions. Staphylococcus aereus was the most detected microorganism based on culture results. Three adult cases were followed up in the intensive care unit because of development of mediastinitis. One of these 3 cases exited because of sepsis. Hospitalization periods of 79 cases ranged between 2–21 days (mean 7.64 days). Hospitalization period of 19 cases with systemic diseases were 9.47 days (p<0.05) and statistically which were statistically significantly longer when compared with those without any systemic disease. CONCLUSION: Neck abscess must be diagnosed early and treated with surgical drainage and parenteral therapy because it might cause severe complications. PMID:28058371
Ogawa, T; Shimizu, S; Morisaki, T; Sugitani, A; Nakatsuka, A; Mizumoto, K; Yamaguchi, K; Chijiiwa, K; Tanaka, M
To evaluate the efficacy of percutaneous transhepatic abscess drainage (PTAD) as an initial choice of treatment for liver abscess, the medical records of 28 patients with liver abscess were retrospectively analyzed. The patients were predominantly men (23 of 28) with a mean age of 59 years (range, 19-86 years). Their chief complaints were fever (86%), right hypochondralgia (32%), and jaundice (11%). Fifteen of the 28 patients (54%) had hepatobiliary and pancreatic carcinoma, and 31% had postoperative liver abscess. PTAD was performed in 23 patients and surgical drainage in 5. The overall success rate for PTAD was 83%. The success rate for PTAD for patients with multiple abscesses was 83% (5 of 6), compared with a success rate of 82% (14 of 17) for patients with solitary abscess. The prognostic factors for survival were cancer and sepsis and the mortality rate for patients with cancer was 40% (6 of 15) while the mortality rate for patients with sepsis was 56% (5 of 9). As a complication of drainage, 1 patient (4%) in the PTAD group had pleural abscess due to the transpleural puncture. Our findings support the use of PTAD as the primary treatment for liver abscess, as it is safe and effective irrespective of the number of abscesses and the patient's condition.
Durán-Cantolla, Joaquín; Alkhraisat, Mohammad Hamdan; Martínez-Null, Cristina; Aguirre, Jose Javier; Guinea, Elena Rubio; Anitua, Eduardo
Study Objectives: To estimate the frequency of obstructive sleep apnea syndrome (OSAS) in dental patients with tooth wear, and to assess the role of dentists in the identification of patients at risk of OSAS. Methods: Dental patients with tooth wear and treated with occlusal splint were prospectively recruited to perform sleep study. The severity of tooth wear was established by the treating dentist before patient referral to sleep disorders unit. Sleep questionnaires, anthropometric measurements, and validated respiratory polygraphy were performed. Results: All patients with dental wear were offered a sleepiness analysis. Of 31 recruited patients, 30 (77% males) participated in this study. Patients' mean age was 58.5 ± 10.7 years (range: 35–90 years) and the body mass index was 27.9 ± 3.4 kg/m2. Tooth wear was mild in 13 patients, moderate in 8 and severe in 9. The mean apnea-hypopnea index (AHI) was 32.4 ± 24.9. AHI < 5 was reported in 2 patients, AHI of 5–29 in 17, and AHI ≥ 30 in 11. A statistically significant association was found between AHI severity and tooth wear severity (Spearman R = 0.505; p = 0.004). Conclusions: Tooth wear could be a tool to identify those patients at risk of having OSAS. This highlights the importance of dental professionals to identify and refer patients with OSAS. Citation: Durán-Cantolla J, Alkhraisat MH, Martínez-Null C, Aguirre JJ, Guinea ER, Anitua E. Frequency of obstructive sleep apnea syndrome in dental patients with tooth wear. J Clin Sleep Med 2015;11(4):445–450. PMID:25665693
Mandai, Koichiro; Shirakawa, Atsushi; Uno, Koji; Yasuda, Kenjiro
Gastrointestinal perforation is a serious adverse event that occurs in approximately 1% of patients receiving ramucirumab and paclitaxel. A 67-year-old man with unresectable advanced gastric cancer was admitted to our hospital and treated with ramucirumab and paclitaxel. Gastric perforation occurred during the second cycle of chemotherapy. Although the patient's condition improved without surgery, an abscess developed in the intra-abdominal fluid collection resulting from the perforation. We performed endoscopic ultrasound-guided abscess drainage. The patient improved and was discharged in satisfactory condition. Endoscopic ultrasound-guided drainage is a treatment option for patients with intra-abdominal abscess following gastric perforation due to ramucirumab.
Mandai, Koichiro; Shirakawa, Atsushi; Uno, Koji; Yasuda, Kenjiro
Gastrointestinal perforation is a serious adverse event that occurs in approximately 1% of patients receiving ramucirumab and paclitaxel. A 67-year-old man with unresectable advanced gastric cancer was admitted to our hospital and treated with ramucirumab and paclitaxel. Gastric perforation occurred during the second cycle of chemotherapy. Although the patient's condition improved without surgery, an abscess developed in the intra-abdominal fluid collection resulting from the perforation. We performed endoscopic ultrasound-guided abscess drainage. The patient improved and was discharged in satisfactory condition. Endoscopic ultrasound-guided drainage is a treatment option for patients with intra-abdominal abscess following gastric perforation due to ramucirumab. PMID:28203161
Sayle, B.A.; Balachandran, S.; Rogers, C.A.
Two hundred and fifty-eight patients with clinically suspected inflammatory processes were studied. Seventy-two images were categorized as true positive; 211 as true negative. There were nine false-positive studies, four of which were due to activity in beds of excised organs. There were six false-negative studies, four of which were due to walled-off abscesses found either at surgery or biopsy. The sensitivity was 92%, the specificity 95%, and the accuracy 94%. This study shows that indium-111 chloride imaging provides a reliable way to locate inflammatory processes and overcomes the disadvantages of other imaging agents, for example gastrointestinal activity or the demonstration of healing surgical wounds with gallium-67, and the false-positive images due to cystic fibrosis and other respiratory diseases, or accessory spleens as seen with In-111-labeled white cells.
May, L.; McCann, C.; Brooks, G.; Rothman, R.; Miller, L.; Jordan, J.
Extranasal sites are common reservoirs of Staphylococcus aureus colonization, and may be relevant for methicillin-resistant S. aureus (MRSA) screening and infection control strategies. The objective here was to determine whether inguinal specimens could also be screened using Xpert SA Nasal Complete assay for MRSA. Results were compared to broth enrichment culture. Among 162 consented adults seeking care in the Emergency Department for cutaneous abscesses, inguinal specimens were found positive for MRSA more often than nares specimens; 24% and 26% by PCR or culture, respectively compared to 19% each by PCR or culture. Overall, 6% of adults colonized with MRSA would have been missed by nares screening alone. Compared to culture, Xpert SA Nasal Complete assay demonstrated sensitivity and specificity of 89% and 97%, respectively for detecting nares and/or inguinal MRSA colonization. In conclusion, inguinal specimens were a more common reservoir for MRSA than nares specimens in this population of patients. PMID:24958641
Hartog, Laurens; Meijer, Henny J A; Santing, Hendrick J; Vissink, Arjan; Raghoebar, Gerry M
This prospective study assessed patient satisfaction before and after single-tooth implant therapy in the esthetic zone. Before implant therapy, patients wore an acrylic resin tissue-supported removable partial denture (RPD). A total of 153 patients were included. Self-administered questionnaires regarding function, comfort, and esthetics were used to measure patient satisfaction with the RPD and with the implant at 6 and 18 months post-implant placement. Overall satisfaction was explored with a visual analog scale. It was suggested that patient satisfaction with a single-tooth implant in the esthetic zone is high and it improved when compared with an RPD that patients wore before implant treatment.
Alif Adlan, M T; Wan Mohd Rasis, W A K; Mohd Ramadhan, M D
Staphylococcus Aureus is a Gram-positive cocci bacteria which had been found to be the causative organism in over 88% of patients with primary iliopsoas abscess. We report the case of a 53-year-old diabetic woman with end-stage renal failure diagnosed with left iliopsoas abscess with a catheter-related infection. Computed tomogram (CT) of abdomen and pelvis revealed hypodense lesions of left psoas, iliacus and quadratus lumborum suggestive of psoas abscesses. In addition, osteomyelitis changes at left sacroiliac and hip joint were seen. At surgery, she was found to have abscess at the posterior psoas muscle where she underwent open surgery drainage and percutaneous drain was inserted. A high index of suspicion of iliopsoas abscess should be maintained among haemodialysis patients presenting with intradialytic pelvic and hip pain and treated with optimal antibiotics therapy with appropriate surgical intervention.
Elamin, Habab Osman; Abubakr, Neamat Hassan; Ibrahim, Yahia Eltayib
Objective: The aim of the present investigation is to identify tooth shade among a group of Sudanese patients. Materials and Methods: Total number of patients was 227. Participant's age ranged from 15 to 72 years, which, was divided into four groups. The tooth included in the study was either right or left sounds maxillary central incisor. Vita Easyshade was used to select the tooth shade. Investigation of the differences of Commission International de l’Eclairage (CIELab) coordinates among gender and state of origin was conducted together with an examination of the relationship between CIELab coordinates and age. One-way analysis of variance was used to test the differences in L*, a* and b* according to state of origin. Results: Results showed that A3 was the most common classical tooth shade respectively. There was highly significant difference in L* between males and females (P = 0.002). There was a significant relation between tooth shade and age (P = 0.026). There was a high significant association between classical tooth shade and Sudan regions (P = 0.00). Conclusion: In conclusion, most common classical shade was A3, women's teeth were lighter than men's. There was a relation between ethnic background and tooth shade. PMID:26038652
de OLIVEIRA, Anna Paula Romero; PAPPALARDO, Mara Cristina; DANTAS, Daniel; LINS, Diogo; VIDAL, José Ernesto
The spectrum of neurological complications associated with human immunodeficiency virus type 1 (HIV-1) infection is broad. The most frequent etiologies include primary diseases (caused by HIV itself) or secondary diseases (opportunistic infections or neoplasms). Despite these conditions, HIV-infected patients are susceptible to other infections observed in patients without HIV infection. Here we report a rare case of a brain abscess caused by Staphylococcus aureus in an HIV-infected patient. After drainage of the abscess and treatment with oxacilin, the patient had a favorable outcome. This case reinforces the importance of a timely neurosurgical procedure that supported adequate management of an unusual cause of expansive brain lesions in HIV-1 infected patients. PMID:27074328
Waldman, Alexander B
Adolescent patients often seek orthodontic treatment to correct spacing of the maxillary anterior teeth. If the spacing is caused by a tooth size discrepancy that affects one or more anterior teeth, an interdisciplinary treatment plan involving orthodontic, restorative, and periodontal treatment is recommended to achieve a harmonious esthetic result. This article describes a clinical approach for treatment of these complex cases, focusing on the importance of tooth form, gingival esthetics, and treatment sequencing.
Rothen, Marilynn; Scott, JoAnna; Cunha-Cruz, Joana
Objectives The goal of this study was to investigate the association between tooth wear and salivary measures in a random sample of patients from practices of dentist members of a practice-based research network. Materials and methods Patients completed a questionnaire on oral self-care, health, dietary habits, medications, and socio-demographic variables. Six salivary characteristics (consistency, resting salivary flow, resting salivary pH, stimulated salivary flow, stimulated salivary pH, and buffering capacity) were measured, and a dental examination included categorizing patients according to the dentist’s judgment of the degree of tooth wear (i.e., none/minimal, some, or severe/extreme). Bivariate and multinomial logistic regression models were used to relate salivary characteristics and other factors to the outcome of tooth wear. Results Data are reported from 1,323 patients (age range 16–97 years) from 61 practices. Patient age, gender, number of teeth, and perception of dry mouth were associated with tooth wear, but salivary and dietary factors were either weakly or not related. Conclusions The findings of this cross-sectional assessment suggest that using these salivary tests and dietary assessments in real-life clinical settings is unlikely to be useful in assessing tooth wear risk. Suggestions are offered about risk assessment for tooth wear. Clinical relevance Assessing a dental patient’s risk of tooth wear using salivary measures and dietary assessments as described is not recommended for general dental practice until stronger evidence exists indicating its utility. PMID:24647789
Keshani, Forouz; Jahanshahi, Gholamreza; Attar, Bijan Movahedian; Kalantari, Mahsa; Razavi, Seyed Mohammad; Hashemzade, Zahra; Tavakoli, Payam
Ewing's sarcoma is a rare malignant neoplasm that comprises approximately 4-6% of primary bone tumors. In most cases, femur and pelvis are affected, and less commonly the head and neck areas (in the jaws, usually the mandible). These tumors have been reported more frequently in males, mostly aged 5-20 years old. Systemic symptoms and signs such as fever, weight loss, anemia, leukocytosis, and elevated erythrocyte sedimentation rate (ESR) may be the first signs in oral Ewing's sarcoma. Such signs and symptoms are also seen in odontogenic infections and abscess. In one case, the patient went to a dentist with pain, swelling, and abscess similar to odontogenic infection and patient's tooth was pulled due to misdiagnosis. This tumor has an aggressive clinical behavior and is identified with rapid growth and high probability of metastasis at diagnosis. Thus, it is necessary to differentiate it from a dental abscess. As for the treatment of Ewing's sarcoma, first the tumor must undergo chemotherapy to reduce its size and, eventually, it undergoes extensive surgery. This case report deals with a 16-year-old patient wrongly diagnosed with odontogenic infection and abscess, and hospitalized. As the symptoms did not remit, biopsy was carried out and the patient was operated on with Ewing's sarcoma diagnosis.
Kuwabara, Hideyuki; Kawano, Tomoko; Tanaka, Masatugu; Kobayashi, Shoichi; Okabe, Gaichi; Maruta, Atsuo; Nagao, Takeshi; Ishigatsubo, Yoshiaki; Mori, Hiraku
Central nervous system infection caused by Bacillus cereus is a rare condition, which often progresses rapidly and is fatal in immunocompromised patients. A 54-year-old woman with acute myelogenous leukemia fell into a coma with high fever during severe neutropenia while undergoing chemotherapy. A blood culture demonstrated the presence of B. cereus and magnetic resonance imaging showed multiple abnormal lesions in her brain. The patient was treated with meropenem and vancomycin, and recovered from the coma in a week. Antibiotic therapy was administered for seven weeks, and then she underwent cord blood transplantation for refractory acute myelogenous leukemia with successful engraftment without exacerbation of the brain abscess. This case demonstrates that brain abscess caused by B. cereus can be treated without surgical treatment.
Agani, Zana Bajrami; Benedetti, Alberto; Krasniqi, Vjosa Hamiti; Ahmedi, Jehona; Sejfija, Zana; Loxha, Mergime Prekazi; Murtezani, Arben; Rexhepi, Aida Namani; Ibraimi, Zana
Background: The patients that are subjects to oral-surgical interventions produce large amounts of steroids in comparison with healthy patients which are not a subject to any dental intervention. The aim of research was to determine the level of stress hormone cortisol in serum, arterial blood pressure and arterial pulse, and to compare the effectiveness of the usage of lidocaine with adrenalin in comparison with lidocaine without adrenalin during the tooth extraction. Patients and methods: This clinical research includes patients with indication of tooth extraction divided in hypertensive and normotensive patients. Results: There is no important statistical distinction between groups, for the cortisol levels before, during and after tooth extraction regardless of the type of anesthetic used, while we registered higher values of systolic and diastolic values at hypertensive patients, regardless of the type of anesthetic Conclusion: There is significant systolic and diastolic blood pressure rise in both groups of patients hypertensive and normotensive patients, (regardless of anesthetic used with or without vasoconstrictor), who underwent tooth extraction. The special emphasize is attributed to hypertensive patients where these changes are more significant. As per cortisol level and pulse rate, our results indicate no significant statistical difference in between groups. PMID:26005263
For patients with systemic diseases who face difficulties visiting dental clinics, wearing fixed partial denture in the anterior region on the same day of tooth extraction can reduce the total period of treatment and the number of visits, as well as post-treatment psychological effect on the patient. PMID:28018570
Slauf, P; Antoš, F; Marx, J
Periproctal inflammations related to the anus are characterized by the rapid spread of the infection to the surrounding tissue, which is determined by the anatomical characteristics and infectious agents. Inflammation, which starts as a phlegmon, quickly forms boundaries and an abscess develops in most cases. Up to 80-90% of anorectal abscesses develop according to the crypto-glandular theory on the basis of infection of the anal glands, spilling into the Morgagni crypts in the anal canal. Up to two-thirds of such abscesses are associated with the emergence of anorectal fistulas. Anorectal abscesses can be divided into marginal and subcutaneous perianal abscesses, submucosal, intersphincteric, ischiorectal and supralevator abscesses. Their diagnosis is based on thorough physical examination, sometimes also with the help of imaging methods such as computed tomography, magnetic resonance imaging and endoanal ultrasound. What is decisive for the successful treatment of anorectal abscessess is their early and adequate surgical drainage. Adjuvant antibiotic therapy is necessary only when the overall signs of sepsis are present and for patients with a comorbidity such as diabetes, valvular heart disease, or immunodeficiency.
Ke, Shan; Ding, Xue-Mei; Gao, Jun; Wang, Shao-Hong; Kong, Jian; Xu, Li; Sun, Wen-Bing
Abstract This retrospective cohort study investigated the feasibility of radiofrequency (RF) ablation as an alternative to surgical intervention in patients with huge multiloculated pyogenic liver abscesses (PLAs). From August 2010 to April 2016, 83 patients with PLA were admitted to Beijing Chao-Yang Hospital, China. Four of these patients had huge multiloculated PLAs and underwent RF ablation plus antibiotics. The inclusion criteria for RF ablation were as follows: multiloculated PLA confirmed by computed tomography (CT) or magnetic resonance imaging (MRI), widest diameter of the PLA ≥5 cm, failure to respond to or not suitable to treatment with percutaneous drainage (PD), and patient refusal of surgery. The safety and effectiveness of RF ablation were initially assessed. All patients were commenced on antibiotics on admission to our hospital. CT-guided percutaneous catheter drainage was attempted in one patient but was unsuccessful. The main organism isolated from cultures of these patients’ blood or abscess samples was Klebsiella pneumoniae (3/4). RF ablation was performed as soon as eligibility according to the above criteria was established. RF ablation was technically successful in all 4 study patients, all PLAs being completely eradicated. The median duration of fever after RF ablation was 4.5 days. No abscesses recurred; thus, this strategy for managing PLA was 100% successful (4/4). No procedure-related deaths or major complications occurred. One patient had an asymptomatic right pleural effusion that resolved with conservative treatment including albumin infusion and diuretics. Our preliminary data indicate that RF ablation is a safe, feasible, and effective treatment for huge multiloculated PLAs. It should be considered as an alternative treatment for patients who fail to respond to or not suitable for PD plus antibiotics and refuse surgical intervention. PMID:27930527
Agochukwu, Nnenaya Q.; Rastinehad, Ardeshir R.; Richter, Lee A.; Barak, Stephanie; Zerbe, Christa S.; Holland, Steven M.; Pinto, Peter A.
Chronic granulomatous disease (CGD) is a rare hereditary disease in which phagocytes have difficulty forming the superoxide radical required to kill certain pathogens. Individuals with CGD are susceptible to a specific set of infections and granulomatous lesions. We present the case of a 15 year old male with X-linked CGD who presented with unremitting cough and fevers. He had a left sided pneumonia which persisted despite home IV antibiotics. He was admitted to an outside facility for bronchoalveolar lavage to obtain cultures and polymerase chain reaction (PCR). Computed Tomography (CT) of chest, abdomen and pelvis was done for baseline evaluation of extent of disease. CT revealed a fluid collection in the prostatic fossa, later determined to be a prostatic abscess. To our knowledge, this is the first reported case of a prostatic abscess in a pediatric patient with CGD. PMID:22325401
Stewart, Zachary E; Shaker, Mohammed; Baxter, J David
Urological problems are common in spina bifida and are often treated with urinary diversions. Spina bifida and ileal conduits put patients at increased risk for ascending urinary tract infections. Here we present a novel case of a Citrobacter koseri urinary tract infection complicated by a perinephric abscess with pleural extension. To our knowledge, no case of an ascending C. koseri UTI progressing to peri-nephric abscess and empyema by direct extension exists in the literature.
Kumaraguru, Janani; Flanagan, Sarah E.; Greeley, Siri Atma W.; Nuboer, Roos; Støy, Julie; Philipson, Louis H.; Hattersley, Andrew T.; Rubio-Cabezas, Oscar
OBJECTIVE To assess if tooth discoloration is a novel side effect of sulfonylurea therapy in patients with permanent neonatal diabetes due to mutations in KCNJ11. RESEARCH DESIGN AND METHODS A total of 67 patients with a known KCNJ11 mutation who had been successfully transferred from insulin injections onto oral sulfonylureas were contacted and asked about the development of tooth discoloration after transfer. RESULTS Altered tooth appearance was identified in 5 of the 67 patients. This was variable in severity, ranging from mild discoloration/staining (n = 4) to loss of enamel (n = 1) and was only seen in patients taking glibenclamide (glyburide). CONCLUSIONS These previously unreported side effects may relate to the developing tooth and/or to the high local concentrations in the children who frequently chewed glibenclamide tablets or took it as a concentrated solution. Given the multiple benefits of sulfonylurea treatment for patients with activating KCNJ11 mutations, this association warrants further investigation but should not preclude such treatment. PMID:19435956
Funato, M; Ono, Y; Baba, K; Kudo, Y
The aims of this study were to introduce a novel electronic system for reliable evaluation of the non-functional tooth contact in patients with temporomandibular disorders (TMDs) and investigate the possible associations between the non-functional tooth contact and some characteristics of the patients with TMD. We designed and installed a software program to send emails regarding the non-functional tooth contact to the subjects' preregistered cellular phones at intervals of 20 ± 9 min daily for 10 consecutive days. Twelve patients with TMD and 12 gender- and age-matched healthy subjects responded via emails to one of 3 choices: no tooth contact, tooth contact during oral functions or tooth contact not associated with oral functions. The influence of subjective stress, anxiety, depression, personality and daily activities on tooth contact was then assessed. The frequency of the non-functional tooth contact was significantly higher in the patients with TMD than in the healthy subjects (35·0% vs. 9·6%, P < 0·001), while no significant group difference was found for the frequency of functional tooth contact, the stress, anxiety, depression and personality.
Introduction A liver abscess in Crohn’s disease is a rare but important entity that is associated with a poor prognosis and high mortality when treatment is delayed. We report a case of successful liver segmentectomy for a methicillin-resistant Staphylococcus aureus liver abscess in a patient with Crohn’s disease under infliximab treatment. Case presentation A 31-year-old Japanese man, who had been treated with infliximab infusions for Crohn’s disease, was referred to our hospital presenting with an abrupt onset of high fever and an elevated white blood cell count and serum C-reactive protein level. Computed tomography revealed a liver abscess occupying segment 8. The limited effect of percutaneous transhepatic abscess drainage and antibiotics led us to perform radical resection of the abscess. The patient recovered quickly after surgery and the postoperative course was uneventful. Conclusion The present case suggests that surgical removal of an abscess should be considered for patients under immunosuppression or refractory to conventional treatment. PMID:23374532
... an anal fissure Sexually transmitted infection (STD) Trauma Deep rectal abscesses may be caused by intestinal disorders ... drains the pus. If the pus collection is deep, you may need to stay in the hospital ...
Al-Hajjar, Nadim; Graur, Florin; Hassan, Aboul B; Molnár, Geza
Splenic abscesses are rare entities (autopsy incidence between 0.14-0.7%). The most frequent etiology is the septic emboli seeding from bacterial endocarditis (about 20% of cases) or other septic foci (typhoid fever, malaria, urinary tract infections, osteomielitis, otitis). The treatment of splenic abscesses was until recently splenectomy with antibiotherapy. The actual trends are more conservative (mini invasive or non-invasive) because the immunologic role of the spleen has been better understood over the last year
Morimoto, Yoshinari; Niwa, Hitoshi; Nakatani, Takeshi
In patients on high-level anticoagulant therapy (prothrombin time-international normalized ratio [PT-INR] ≥ 4.5), surgical procedures can be carried out with bridging therapy using heparin. However, surgical treatment options are severely limited in patients on high-level anticoagulant therapy and who have heparin-induced thrombocytopenia (HIT), as heparin use is contraindicated. We performed tooth extraction using prothrombin complex concentrate (PCC) in 2 HIT patients on high-level anticoagulation therapy (PT-INR ≥ 4.5). Five hundred units of PCC were administered intravenously, and after 15 minutes, it was confirmed that PT-INR was less than 2.0. Tooth extraction was then performed and sufficient local hemostasis was achieved. At 3 hours after tooth extraction, PT-INR was 2.0 or higher and later increased to 4.0 or higher, but postoperative bleeding was mostly absent. When performing tooth extraction in HIT patients on high-level anticoagulant therapy, favorable hemostatic management was achieved through sufficient local hemostasis and transient warfarin reversal using PCC.
Fassl, Jens; Tobler, Daniel; Zumofen, Daniel; Steiner, Luzius A.; Goettel, Nicolai
We report the case of a 39-year-old male with complex cyanotic congenital heart disease undergoing emergency craniotomy for a cerebral abscess. Maintenance of intraoperative hemodynamic stability and adequate tissue oxygenation during anesthesia may be challenging in patients with cyanotic congenital heart disease. In this case, we decided to perform the surgery as an awake craniotomy after interdisciplinary consensus. We discuss general aspects of anesthetic management during awake craniotomy and specific concerns in the perioperative care of patients with congenital heart disease. PMID:27928498
Haddow, Lewis J; Sahid, Faieza; Moosa, Mahomed-Yunus S
Atypical manifestations of Cryptococcus neoformans disease have been reported in patients with HIV-1 infection as part of the spectrum of the immune reconstitution inflammatory syndrome (IRIS). We describe a cryptococcal breast abscess in a patient presenting after 11 months of highly active antiretroviral therapy (HAART). The arguments for and against the case being a novel manifestation of IRIS are discussed. The potential hazards of using CD4 count as a surrogate marker of IRIS and the danger of misdiagnosing IRIS as failure of HAART are highlighted.
Jeon, Jae Woong; Kim, Joo Seok; Ryu, Il Hwan; Choi, Ji Wook; Kim, Min Gyu; Na, Young Min; Yun, Hyeon Jeong
Patients with acquired immunodeficiency syndrome (AIDS) are at higher risks of bacterial pneumonia than the general population, and the pathogen is the most commonly involved Streptococcus pneumoniae. We hereby report a case of pneumococcal pneumonia associated with leptomeningitis, osteomyelitis and epidural abscess in a patient with AIDS. He is being successfully treated with ampicillin/sulbactam and clindamycin. And because the pneumococcal infection is usually associated with morbidity and mortality rates in the setting of AIDS, we should consider for pneumococcal vaccinations among the AIDS populations. PMID:24624217
... abscess usually occurs as a complication of an epidural abscess . Pus forms as a collection of: Destroyed tissue ... bone ( osteomyelitis ). The bone infection may cause an epidural abscess to form. This abscess gets larger and presses ...
Ogurel, Tevfik; Onaran, Zafer; Ogurel, Reyhan; Örnek, Kemal
The aim of this stuty is to describe a case of endophthalmitis after tooth extraction in a patient with previous perforating eye injury. 50 years old male patient attempted to our clinic with complaints of sudden severe pain, reduced vision, light sensitivity and redness in the right eye. The patient stated that severe pain in his eye began approximately 12 hours following tooth extraction. The patient's ocular examination revealed a visual acuity of hand motion in the right eye. Anterior segment examination of the right eye showed intense conjunctival hyperemia, chemosis, a fine keraticprespitat and corneal edema. Dental procedures of the patients who had recently underwent ocular surgery or trauma should be done in a more controlled manner under anti -infective therapy or should be postponed in elective procedures.
Terzi, Huseyin Agah; Demiray, Tayfur; Koroglu, Mehmet; Cakmak, Guner; Hakki Ciftci, Ihsan; Ozbek, Ahmet; Altindis, Mustafa
Introduction The Streptococcus anginosus group of bacteria are low-virulence bacteria existing as commensals in the oral flora and gastrointestinal tracts of humans. S. anginosus may spread to the blood in individuals with poor oral hygiene in cases of oral infections, such as gingivitis and tooth abscesses, that develop following the loss of mucosal unity. This may lead to infections in the whole body, primarily as brain and liver abscesses. Case Presentation A 32-year-old male patient presented with complaints of nausea, vomiting, and diffuse abdominal pain. Diffuse abdominal tenderness and rebound tenderness were detected particularly in the epigastrium and right upper quadrant. Laboratory assessment revealed a leukocyte count of 20,500/mm3. Free fluid around the liver and heterogeneous areas of abscess formation in the right lateral gallbladder were revealed on abdominal computed tomography. Diffuse adhesions between the bowel and seropurulent free liquid in the abdomen were detected on surgical exploration, and a sample was taken for cultures. The patient was discharged without complications on the sixth postoperative day and his antibiotic course was completed with 4 weeks of oral treatment. We reviewed the literature for similar cases of disseminated pyogenic infections caused by the S. anginosus group. Conclusions It should be kept in mind that the oral flora bacterium S. anginosus may cause transient bacteremia and deep-seated organ abscesses in immunodeficient patients with poor oral hygiene. Such patients with intra-abdominal abscesses should be treated with antibiotics and surgery. PMID:27630763
Heller, Joshua A; Marn, Richard Y
A pediatric patient with type 1 Charcot-Marie-Tooth disease-a disorder associated with a demyelinating polyneuropathy-presented for laparoscopic appendectomy in the setting of acute appendicitis. Induction and maintenance of anesthesia were successfully managed without the use of any depolarizing or nondepolarizing neuromuscular blocking agents. The patient was successfully extubated at the completion of the procedure without any respiratory or neuromuscular sequelae, with excellent pain control and no postoperative nausea or vomiting.
Johnson, Katherine G
Spinal epidural abscess is a rare bacterial infection located within the spinal canal. Early diagnosis and rapid treatment are important because of its potential to cause rapidly progressive spinal cord compression and irreversible paralysis. A staphylococcus bacterial infection is the cause in most cases. Treatment includes antibiotics and possible surgical drainage of the abscess. A favorable neurologic outcome correlates with the severity and duration of neurologic deficits before surgery and the timeliness of the chosen intervention. It is important for the critical care nurse to monitor the patient's neurologic status and provide appropriate interventions.
Sudhaharan, Sukanya; Chavali, Padmasri
Background and Objectives: Brain abscess remains a potentially fatal central nervous system (CNS) disease, especially in developing countries. Anaerobic abscess is difficult to diagnose because of cumbersome procedures associated with the isolation of anaerobes. Materials and Methods: This is a hospital-based retrospective microbiological analysis of 430 brain abscess materials (purulent aspirates and/or tissue), for anaerobic organisms, that were received between 1987–2014, by the Microbiology Laboratory in our Institute. Results: Culture showed growth of bacteria 116/430 (27%) of the cases of which anaerobes were isolated in 48/116 (41.1%) of the cases. Peptostreptococcus (51.4 %), was the predominant organism isolated in four cases followed by Bacteroides and Peptococcus species. Conclusion: Early diagnosis and detection of these organisms would help in the appropriate management of these patients. PMID:27307977
Erenel, Hakan; Yilmaz, Nevin; Oncul, Mahmut; Acikgoz, Abdullah Serdar; Karatas, Suat; Ayhan, Isil; Aslan, Berna; Tuten, Abdullah
We aimed to investigate the clinical importance of serum procalcitonin (PCT) levels in the diagnosis of tubo-ovarian abscess (TOA). Patients diagnosed with pelvic inflammatory disease (PID; n = 36) and patients diagnosed with TOA (n = 42) were included in the study. Sociodemographic characteristics, laboratory and clinical parameters were compared between the 2 groups. Mean PCT level was higher in the TOA group (p = 0.004). Mean length of stay in hospital was longer in patients with TOA (p < 0.001). White blood cell count, neutrophil count, percentage of neutrophils and C-reactive protein levels were higher than normal limits in all patients; however, no differences in these parameters were observed between the groups. A cutoff level of 0.330 ng/ml for PCT revealed 62% sensitivity and 75% specificity in predicting TOA. Serum PCT is a promising inexpensive marker for the diagnosis of TOA in PID patients.
Lussi, A; von Salis-Marincek, M; Ganss, C; Hellwig, E; Cheaib, Z; Jaeggi, T
The aim of this study was to compare tooth surface pH after drinking orange juice or water in 39 patients with dental erosion and in 17 controls. The following investigations were carried out: measurement of pH values on selected tooth surfaces after ingestion of orange juice followed by ingestion of water (acid clearance), measurement of salivary flow rate and buffering capacity. Compared with the controls, patients with erosion showed significantly greater decreases in pH after drinking orange juice, and the pH stayed lower for a longer period of time (p < 0.05). Saliva parameters showed no significant differences between the two patient groups except for a lower buffering capacity at pH 5.5 in the erosion group.
Guo, Hongmei; Lu, Wei; Han, Qianqian; Li, Shubo; Yang, Pishan
Aim. To report a case with an unusual drainage route of periapical inflammation exiting through the gingival sulcus of an adjacent vital tooth and review probable factors determining the diversity of the discharge routes of periapical inflammation. Summary. An 18-year-old male patient presented with periodontal abscess of tooth 46, which was found to be caused by a periapical cyst with an acute abscess of tooth 45. During endodontic surgery, a rarely reported drainage route for periapical inflammation via the gingival sulcus of an adjacent vital tooth was observed for the first time. Complete periodontal healing of the deep pocket of tooth 46 and hiding of the periapical cyst of tooth 45 followed after root canal treatment and periapical surgery with Bio-Oss Collagen implantation on tooth 45. The drainage routes of periapical inflammation are multivariate and the diversity of drainage pathways of periapical inflammation is mainly related to factors such as gravity, barriers against inflammation, and the causative tooth itself.
Guedj, Mickaël; Bertrand, Viviane; Foucquier, Julie; Jouve, Elisabeth; Commenges, Daniel; Proust-Lima, Cécile; Murphy, Niall P.; Blin, Olivier; Magy, Laurent; Cohen, Daniel; Attarian, Shahram
The Charcot-Marie-Tooth Neuropathy Score (CMTNS) was developed as a main efficacy endpoint for application in clinical trials of Charcot-Marie-Tooth disease type 1A (CMT1A). However, the sensitivity of the CMTNS for measuring disease severity and progression in CMT1A patients has been questioned. Here, we applied a Rasch analysis in a French cohort of patients to evaluate the psychometrical properties of the CMTNS. Overall, our analysis supports the validity of the CMTNS for application to CMT1A patients though with some limitations such as certain items of the CMTNS being more suitable for moderate to severe forms of the disease, and some items being disordered. We suggest that additional items and/or categories be considered to better assess mild-to-moderate patients. PMID:28095456
Jaffer, Faraz; Beatty, Norman; Ahmad, Kareem
A 56-year-old Hispanic male with solo risk factor of uncontrolled diabetes mellitus presented with recurrent haemoptysis. Initial concern was for malignancy with postobstructive pneumonia; however, invasive testing and biopsy confirmed infectious mass of fungal aetiology requiring surgical resection followed by a prolonged course of anti-fungal therapy. Discussion centred on approach to, progression of and course of action in the management of pulmonary abscess due to mucormycosis.
Banerjee, S; Farquharson, M; Cecil, T D; Gold, D; Moran, B J
Two cases are described of patients who presented with a buttock abscess 3 and 5 years after restorative proctocolectomy for ulcerative colitis. In both the abscess was secondary to a fistula, which was shown on further investigation to be a track traversing the greater sciatic notch. Both patients had had an ileo-anal J-pouch after a proctectomy which had included a mesorectal excision. The possibility that these unusual fistulae might be more common following removal of the mesorectum rather than a close rectal dissection is explored.
... gland. The areolar gland is located in the breast under or below the areola (colored area around the nipple). ... an ultrasound or other imaging test of the breast is recommended. A blood count and a culture of the abscess, if drained, may be ordered.
Siqueira, José F; Rôças, Isabela N
Acute apical abscess is the most common form of dental abscess and is caused by infection of the root canal of the tooth. It is usually localized intraorally, but in some cases the apical abscess may spread and result in severe complications or even mortality. The reasons why dental root canal infections can become symptomatic and evolve to severe spreading and sometimes life-threatening abscesses remain elusive. Studies using culture and advanced molecular microbiology methods for microbial identification in apical abscesses have demonstrated a multispecies community conspicuously dominated by anaerobic bacteria. Species/phylotypes commonly found in these infections belong to the genera Fusobacterium, Parvimonas, Prevotella, Porphyromonas, Dialister, Streptococcus, and Treponema. Advances in DNA sequencing technologies and computational biology have substantially enhanced the knowledge of the microbiota associated with acute apical abscesses and shed some light on the etiopathogeny of this disease. Species richness and abundance and the resulting network of interactions among community members may affect the collective pathogenicity and contribute to the development of acute infections. Disease modifiers, including transient or permanent host-related factors, may also influence the development and severity of acute abscesses. This review focuses on the current evidence about the etiology and treatment of acute apical abscesses and how the process is influenced by host-related factors and proposes future directions in research, diagnosis, and therapeutic approaches to deal with this disease.
Rôças, Isabela N.
SUMMARY Acute apical abscess is the most common form of dental abscess and is caused by infection of the root canal of the tooth. It is usually localized intraorally, but in some cases the apical abscess may spread and result in severe complications or even mortality. The reasons why dental root canal infections can become symptomatic and evolve to severe spreading and sometimes life-threatening abscesses remain elusive. Studies using culture and advanced molecular microbiology methods for microbial identification in apical abscesses have demonstrated a multispecies community conspicuously dominated by anaerobic bacteria. Species/phylotypes commonly found in these infections belong to the genera Fusobacterium, Parvimonas, Prevotella, Porphyromonas, Dialister, Streptococcus, and Treponema. Advances in DNA sequencing technologies and computational biology have substantially enhanced the knowledge of the microbiota associated with acute apical abscesses and shed some light on the etiopathogeny of this disease. Species richness and abundance and the resulting network of interactions among community members may affect the collective pathogenicity and contribute to the development of acute infections. Disease modifiers, including transient or permanent host-related factors, may also influence the development and severity of acute abscesses. This review focuses on the current evidence about the etiology and treatment of acute apical abscesses and how the process is influenced by host-related factors and proposes future directions in research, diagnosis, and therapeutic approaches to deal with this disease. PMID:23554416
Splenic abscess is a rare complication of systemic infection, sometimes associated with infective endocarditis. Due to its rarity and nonspecific symptoms, diagnosis is difficult. Antibiotic therapy alone is usually unsuccessful, and definitive treatment requires splenectomy, although percutaneous ultrasound-guided drainage has been successful in some patients. Abdominal computed tomography scans and ultrasound evaluation are usually diagnostic. We present two patients with treatment-resistant sepsis who were found at autopsy to have splenic abscess.
Charcot Marie Tooth Disease (CMT); Hereditary Sensory and Motor Neuropathy; Nerve Compression Syndromes; Tooth Diseases; Congenital Abnormalities; Genetic Diseases, Inborn; Heredodegenerative Disorders, Nervous System
Clifton, T C; Kalamchi, S
Odontogenic infections can spread to any organ of the body and in some cases cause life threatening infections. We report a case of multiple odontogenic brain abscesses resulting from undetected tooth decay. Whereas most odontogenic brain abscesses occur following dental treatment, this report documents brain abscesses prior to dental treatment, signifying the dangers of covert dental infections. This case report updates the literature on the topic of odontogenic brain abscesses.
Jeong, Ho-Gul; Hwang, Jae Joon; Lee, Jeong-Hee; Kim, Young Hyun; Na, Ji Yeon
Purpose The aim of this study was to investigate the incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) after tooth extraction in patients with osteoporosis on oral bisphosphonates in Korea and to evaluate local factors affecting the development of BRONJ. Materials and Methods The clinical records of 320 patients who underwent dental extraction while receiving oral bisphosphonates were reviewed. All patients had a healing period of more than 6 months following the extractions. Each patient's clinical record was used to assess the incidence of BRONJ; if BRONJ occurred, a further radiographic investigation was carried out to obtain a more definitive diagnosis. Various local factors including age, gender, extraction site, drug type, duration of administration, and C-terminal telopeptide (CTx) level were retrieved from the patients' clinical records for evaluating their effect on the incidence of BRONJ. Results Among the 320 osteoporotic patients who underwent tooth extraction, 11 developed BRONJ, reflecting an incidence rate of 3.44%. Out of the local factors that may affect the incidence of BRONJ, gender, drug type, and CTx level showed no statistically significant effects, while statistically significant associations were found for age, extraction site, and duration of administration. The incidence of BRONJ increased with age, was greater in the mandible than the maxilla, and was associated with a duration of administration of more than 3 years. Conclusion Tooth extraction in patients on oral bisphosphonates requires careful consideration of their age, the extraction site, and the duration of administration, and close postoperative follow-up should be carried out to facilitate effective early management. PMID:28361029
Lupski, James R.; Reid, Jeffrey G.; Gonzaga-Jauregui, Claudia; Deiros, David Rio; Chen, David C.Y.; Nazareth, Lynne; Bainbridge, Matthew; Dinh, Huyen; Jing, Chyn; Wheeler, David A.; McGuire, Amy L.; Zhang, Feng; Stankiewicz, Pawel; Halperin, John J.; Yang, Chengyong; Gehman, Curtis; Guo, Danwei; Irikat, Rola K.; Tom, Warren; Fantin, Nick J.; Muzny, Donna M.; Gibbs, Richard A.
BACKGROUND Whole-genome sequencing may revolutionize medical diagnostics through rapid identification of alleles that cause disease. However, even in cases with simple patterns of inheritance and unambiguous diagnoses, the relationship between disease phenotypes and their corresponding genetic changes can be complicated. Comprehensive diagnostic assays must therefore identify all possible DNA changes in each haplotype and determine which are responsible for the underlying disorder. The high number of rare, heterogeneous mutations present in all humans and the paucity of known functional variants in more than 90% of annotated genes make this challenge particularly difficult. Thus, the identification of the molecular basis of a genetic disease by means of whole-genome sequencing has remained elusive. We therefore aimed to assess the usefulness of human whole-genome sequencing for genetic diagnosis in a patient with Charcot–Marie–Tooth disease. METHODS We identified a family with a recessive form of Charcot–Marie–Tooth disease for which the genetic basis had not been identified. We sequenced the whole genome of the proband, identified all potential functional variants in genes likely to be related to the disease, and genotyped these variants in the affected family members. RESULTS We identified and validated compound, heterozygous, causative alleles in SH3TC2 (the SH3 domain and tetratricopeptide repeats 2 gene), involving two mutations, in the proband and in family members affected by Charcot–Marie–Tooth disease. Separate subclinical phenotypes segregated independently with each of the two mutations; heterozygous mutations confer susceptibility to neuropathy, including the carpal tunnel syndrome. CONCLUSIONS As shown in this study of a family with Charcot–Marie–Tooth disease, whole-genome sequencing can identify clinically relevant variants and provide diagnostic information to inform the care of patients. PMID:20220177
sclerotic border with benign-appearing periosteal reaction and mild soft tissue swelling medially. There are no fracture lucencies and the ankle...2007 Brodie Abscess inflammatory process extends posteromedially through the cortex of the tibial epiphysis to involve the adjacent soft tissues. On...soft tissue inflammatory thickening medially also extends anteriorly to the margin of the anterior- tibial tendon and posteriorly to the lateral aspect
Liver abscess; Bacterial liver abscess ... There are many possible causes of liver abscesses, including: Abdominal infection, such as appendicitis , diverticulitis , or a perforated bowel Infection in the blood Infection of the bile draining tubes ...
Johnson, Ryan C.; Crawford, Katrina; Lanier, Jeffrey B.; Merrell, D. Scott
We describe a cutaneous abscess caused by catalase-negative methicillin-susceptible Staphylococcus aureus subsp. aureus in a patient who was concomitantly colonized with virulent USA300 methicillin-resistant S. aureus (MRSA). Sequencing of the katA gene demonstrated a thymine insertion leading to a frameshift mutation and premature truncation of catalase to 21 amino acids. PMID:24131694
Astramskaitė, I; Poškevičius, L; Juodžbalys, G
The aim of this study was to review previous studies and to identify reliable factors determining anxiety in adult patients undergoing tooth extraction procedures. An electronic literature search was conducted of the MEDLINE, ScienceDirect, SpringerLink, and Wiley Online Library databases covering the period January 2005 to May 2015. Sequential screening was performed at the title/abstract and full-text level. The review included all human prospective and retrospective follow-up studies and clinical trials, cohort studies, case-control studies, and case series that demonstrated at least one factor determining tooth extraction anxiety and/or fear and used specific scales for measurement. The search identified 16 articles meeting the inclusion criteria. Factors related to tooth extraction in patients were assessed: propensity to anxiety (P<0.05), pain experience or expectations (P<0.05), level of disturbance during the procedure (P<0.001), difficulty of the procedure (P=0.034), marital status (P=0.003), social class (P=0.012), and type of local anaesthesia (P=0.008). Using a video as the method of providing information (P<0.05) and having had a previous negative dental experience (P<0.05) led to an increase in patient anxiety level. Due to disagreements between studies, further investigations into the other factors are required to clarify the results. However, the absence of a single and appropriate scale that includes both the patient's evaluation and that of the doctor, hinders the rating of patient anxiety.
Sierpinska, Teresa; Kuc, Joanna; Golebiewska, Maria
Advanced tooth wear often results in lost vertical dimension and impacts facial aesthetics. Complex restorative treatment can replace the lost tooth structure and improve functional occlusal and facial skeleton parameters. Purpose: The aim of the study is to assess changes in the morphological and functional occlusal parameters of the facial skeleton after prosthetic rehabilitation that increased lost occlusal vertical dimension. Material and Methodology: 50 patients with advanced tooth wear were clinically examined, to assess the degree of wear. Each subject underwent cephalometric analysis, digital occlusal analysis, and electromyographic analysis, of the anterior temporalis, superficial masetter, anterior digastric, and the sternocleidomastoid muscles. Prosthodontic treatment was performed to restore the occlusal vertical dimension of each subject’s occlusion, which was followed by repeating the pretreatment analyses. Pre and post treatment parameters were statistically compared. Results: Pre-treatment cephalometric analysis showed that lost vertical dimension reduced anterior facial height and resulted in small angular skeletal parameters. Post treatment anterior facial height increased from the increased occlusal vertical dimension. The mean value of functional electrical activity during clenching post treatment, increased compared to pretreatment. Conclusion: Increasing the vertical dimension of occlusion improved facial aesthetics by positively affecting facial skeletal angles. The restored occlusal surface morphology changed the pre treatment flat broad occlusal contacts into more point contacts. The increased vertical dimension of occlusion after treatment also increased muscle activity levels over the pretreatment levels after three months period of adaptation. PMID:23802024
Hepatic amebiasis; Extraintestinal amebiasis; Abscess - amebic liver ... Amebic liver abscess is caused by Entamoeba histolytica. This parasite causes amebiasis , an intestinal infection that is also called ...
Ledin, A. O.; Dobkin, V. G.; Sadov, A. Y.; Galichev, K. V.; Rzeutsky, V. S.
We counted expedient to include different methods of the soft-laser use in the preoperative medicinal program and in the postoperative period. During the preoperative preparation the basic group patients together with standard treatment received the combined soft-laser therapy, which included intravenous laser blood irradiation (ILBI) by He-Ve laser and external transcutaneous irradiation of the abscess projection by semi-conductorial arrenite-gallium laser. During postoperative treatment with ILBI remarkable changes were observed in the functional activity of the T- and B- cell. The soft-laser use allowed to achieve improvement of quality and shortening of terms of the preoperative preparation of 1,4 times, to level the immunosuppressive influence of surgery to reduce amount of the postoperative complications in 1,8 times and duration of the postoperative period in 1,5 times.
Tran, C.; Even, M.; Carbonnel, M.; Preaux, F.; Isnard, F.; Rault, A.; Rouanne, M.; Ayoubi, J. M.
We report the case of a patient who developed a vesicoovarian fistula on an endometriosis abscessed cyst. The patient presented with an advanced endometriosis stage IV complicated with a right ovarian abscessed cyst of 10 cm. A first coelioscopy with cystectomy was realized. After surgery, a voiding cystography highlighted a fistula between the ovarian abscess and the bladder. A second surgery by median laparotomy was realized with the resection of the right ovarian abscess and the resection of vesical fistula. PMID:25152819
Mannino, Courtney M; Salhab, Mohammed; Schmidhofer, Sarah; Pop-Vicas, Aurora
We present a case of iliopsoas abscess in an immunocompetent patient. She experienced three weeks of worsening right hip pain, which was initially misdiagnosed as degenerative joint disease. This led to admission to the Intensive Care Unit for severe sepsis. The patient improved with intravenous antibiotics and percutaneous abscess drainage.
Tartaglia, Gianluca Martino; Maiorana, Carlo; Sforza, Chiarella
A 78-year-old woman reported pain in her right hemiface (middle and upper portions) together with nuchal headache, some days after upper right wisdom tooth extraction. She was treated with nonsteroidal anti-inflammatory drugs by her dentist. Three weeks later, a localized headache over her right superficial temporal artery was reported, and progressive bilateral blindness appeared. A biopsy showed a late stage of temporal arteritis. All the symptoms disappeared following corticosteroid treatment, except blindness. The possible complications linking oral bacteria and extraoral infections and diseases should always be attentively considered during the clinical management of fragile patients.
López-Jornet, Pia; Camacho-Alonso, Fabio; Sanchez-Siles, Mariano
Our aim was to analyse the amount of anxiety and fear felt before, immediately after, and one week after, dental extraction. We studied 70 patients (35 men and 35 women (mean (SD) age 43 (±10) years), who were listed for dental extraction under local anaesthesia in a private clinic that specialised in oral surgery. Patients were evaluated on 3 consecutive occasions: immediately preoperatively, immediately postoperatively, and 7 days later. Each patient's anxiety was measured using Spielberger's State-Trait Anxiety Inventory (Spanish version), the Modified Corah Dental Anxiety Scale (MDAS) and the Dental Fear Survey. There were significant differences in the STAI-Trait scale between before and 7 days after extraction (p=0.04), and in the MDAS between before and immediately after extraction (p=0.02), and between immediately after and 7 days after extraction (p=<0.001). The DFS also differed between before and immediately after extraction (p=0.002), and between immediately and 7 days after extraction (p<0.001). Dental anxiety immediately after tooth extraction may be influenced by operative techniques (type of anaesthesia, duration of operation, or position of tooth extracted), but anxiety at 7 days after extraction is not.
Oweis, Yaseen; Gemmete, Joseph J. Chaudhary, Neeraj; Pandey, Aditya; Ansari, Sameer
We describe the delayed development of intracranial abscesses following emergent treatment with a covered stent-graft for carotid blowout syndrome (CBS) in a patient with head and neck cancer. The patient presented with hemoptysis and frank arterial bleeding through the tracheostomy site. A self-expandable stent-graft was deployed across a small pseudoaneurysm arising from the right common carotid artery (RCCA) and resulted in immediate hemostasis. Three months later, the patient suffered a recurrent hemorrhage. CT of the neck demonstrated periluminal fluid around the caudal aspect of the stent-graft with intraluminal thrombus and a small pseudoaneurysm. Subsequently, the patient underwent a balloon test occlusion study and endovascular sacrifice of the RCCA and right internal carotid artery. MRI of the brain demonstrated at least four ring-enhancing lesions within the right cerebral hemisphere consistent with intracranial abscesses that resolved with broad-spectrum antibiotic coverage.
Coulthard, M; Isaacs, D
Of 31 children with retropharyngeal abscess treated at this hospital between 1954 and 1990, 17 (55%) were 12 months old or less and 10 (32%) less than 6 months. Three of these 10 children were neonates, only one of whom had a predisposing congenital lesion. Fourteen children (45%) had a preceding upper respiratory illness and four (13%) had a prior history of pharyngeal trauma or ingestion of a foreign body. In children less than 1 year old the clinical presentation was usually classical with fever, neck swelling, stridor, and pharyngeal swelling. Significantly fewer children over 1 year had neck swelling and no child over 3 years old had stridor. A lateral radiograph of the neck, when performed, had a sensitivity of 88% in diagnosis. Bacteria isolated included pure growths of Staphylococcus aureus (25%), klebsiella species (13%), group A streptococcus (8%), and a mixture of Gram negative and anaerobic organisms (38%). There were two deaths. In six cases (24%) the abscess recurred necessitating further surgical drainage. Images Figure 2 PMID:1953008
Enoch, D A; Phillimore, N; Karas, J A; Horswill, L; Mlangeni, D A
Daptomycin is a novel lipopeptide with activity against Gram-positive organisms including enterococci. It is licensed for the treatment of Staphylococcus aureus bacteraemia and right-sided endocarditis, but not endocarditis due to Enterococcus spp. We report a case of enterococcal prosthetic valve endocarditis with an aortic root abscess in an elderly patient who was not fit for surgery. The patient's endocarditis relapsed 9 weeks after a 6 week course of daptomycin.
Goel, Khushboo; Ateeli, Huthayfa; Ampel, Neil M.; L’heureux, Dena
Patient: Male, 61 Final Diagnosis: Streptococcus pneumoniae pericarditis Symptoms: — Medication: — Clinical Procedure: Pericardiocentesis Specialty: Critical Care Medicine Objective: Rare disease Background: Cardiac tamponade caused by pericardial effusion has a high mortality rate; thus, it is important to diagnose and treat this condition immediately. Specifically, bacterial pericarditis, although now very rare, is often fatal because of its fulminant process. Case Report: We present a case of a 61-year-old man with metastatic small cell lung cancer undergoing chemotherapy who presented with fatigue, poor appetite, and altered mental status. He was found to have a large-volume pericardial effusion with tamponade physiology. He underwent emergent pericardiocentesis. The pericardial effusion was nonmalignant, with cultures growing Streptococcus pneumoniae. It was only after his emergent pericardiocentesis that previous imaging from one month prior was able to be reviewed, which showed possible right upper lobe abscess. Conclusions: Most pericardial effusions in cancer patients are related to their malignancy, either due to direct metastasis or secondary physiologic effects. This case is a unique example of a lung cancer patient presenting with a pneumococcal pericardial effusion, which in itself is a rare phenomenon. This case report demonstrates the importance of considering early antibiotic therapy in patients presenting with pericardial effusion, especially given the high mortality rates of infectious pericardial effusions. PMID:27443973
Ohshita, Naohiro; Oka, Saeko; Tsuji, Kaname; Yoshida, Hiroaki; Morita, Shosuke; Momota, Yoshihiro; Tsutsumi, Yasuo M
Charcot-Marie-Tooth disease (CMTD) is a hereditary peripheral neuropathy and is characterized by progressive muscle atrophy and motor-sensory disorders in all 4 limbs. Most reports have indicated that major challenges with general anesthetic administration in CMTD patients are the appropriate use of nondepolarizing muscle relaxants and preparation for malignant hyperthermia in neuromuscular disease. Moderate sedation may be associated with the same complications as those of general anesthesia, as well as dysfunction of the autonomic nervous system, reduced perioperative respiratory function, difficulty in positioning, and sensitivity to intravenous anesthetic agents. We decided to use intravenous sedation in a CMTD patient and administered midazolam initially and propofol continuously, with total doses of 1.5 mg and 300 mg, respectively. Anesthesia was completed in 3 hours and 30 minutes without adverse events. We suggest that dental anesthetic treatment with propofol and midazolam may be effective for patients with CMTD.
Ohshita, Naohiro; Oka, Saeko; Tsuji, Kaname; Yoshida, Hiroaki; Morita, Shosuke; Momota, Yoshihiro; Tsutsumi, Yasuo M.
Charcot-Marie-Tooth disease (CMTD) is a hereditary peripheral neuropathy and is characterized by progressive muscle atrophy and motor-sensory disorders in all 4 limbs. Most reports have indicated that major challenges with general anesthetic administration in CMTD patients are the appropriate use of nondepolarizing muscle relaxants and preparation for malignant hyperthermia in neuromuscular disease. Moderate sedation may be associated with the same complications as those of general anesthesia, as well as dysfunction of the autonomic nervous system, reduced perioperative respiratory function, difficulty in positioning, and sensitivity to intravenous anesthetic agents. We decided to use intravenous sedation in a CMTD patient and administered midazolam initially and propofol continuously, with total doses of 1.5 mg and 300 mg, respectively. Anesthesia was completed in 3 hours and 30 minutes without adverse events. We suggest that dental anesthetic treatment with propofol and midazolam may be effective for patients with CMTD. PMID:27269665
Leff, R S; Martino, R L; Pollock, W J; Knight, W A
The first case of pituitary abscess arising in a patient during recovery from autologous bone marrow transplantation is reported. A 31-year-old man with a 9 month history of T-cell lymphoma died suddenly more than 60 days after successful treatment with high-dose cyclophosphamide, total body irradiation, and autologous bone marrow infusion. Autopsy revealed a pituitary abscess associated with clinically silent sphenoid sinusitis. Unique aspects of this case are presented and clinical and pathologic features of pituitary abscess are reviewed. Although rare, pituitary abscess may complicate recovery from bone marrow transplantation.
Salmerón-Valdés, Elías Nahúm; Lara-Carrillo, Edith; Medina-Solís, Carlo Eduardo; Robles-Bermeo, Norma Leticia; Scougall-Vilchis, Rogelio José; Casanova-Rosado, Juan Fernando; Pontigo-Loyola, América Patricia; Fernández Barrera, Miguel Ángel
Dental demineralization was determined in patients at three time points during fixed orthodontic treatment. A multiple cross-sectional study included 108 patients divided into three different groups: (1) beginning of orthodontic treatment; (2) one year into treatment; and (3) two years into treatment. Demineralization was estimated using a DIAGNOdent pen. We obtained data from multiple tooth-by-tooth demineralization readings combined with salivary pH and patients’ oral hygienic and dietary behaviors. A t-test for independent samples and Spearman´s correlation were performed. No demineralizations differences were found between the initial stage and one year into treatment. Between one and two years small differences were observed, but demineralization increased between the initial stage and second treatment year, predominating in upper right central incisors (p = 0.056), upper left lateral incisors (p = 0.040), both upper canines (p = 0.055 and p = 0.040, respectively) and first left premolars (p = 0.034 and p = 0.053, respectively). We did not find associations between oral hygiene and dietary behaviours or salivary pH. In conclusion, demineralization occurred in first year of treatment and increased during second year, predominating in the upper arch and the left side mainly in upper right central incisors, upper left lateral incisors, both upper canines, and first left premolars. PMID:27805027
Fong, T.C.; Johns, R.D.; Long, M.; Myles, S.T.
Pituitary abscess is a rare condition, with only 50 cases reported in the literature. Of those, 29 cases were well documented for analysis. Preoperative diagnosis of pituitary abscess is difficult. The computed tomographic (CT) appearance of pituitary abscess was first described in 1983; the abscess was depicted by axial images with coronal reconstruction. The authors recently encountered a case of pituitary abscess documented by direct coronal CT of the sella turcica.
Villa, Paula A; Oberti, Giovanni; Moncada, Cesar A; Vasseur, Olga; Jaramillo, Alejandro; Tobón, Diego; Agudelo, Jaime A
Pulpitis, external root resorption, and pain may be experienced during orthodontic movement. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been suggested to control these changes. The purpose of this study was to observe pulp-dentinal reactions, root resorption, tooth pain, and tooth movement after the application of a 4-ounce intrusive orthodontic force to human maxillary first premolars in patients given the NSAID nabumetone. Thirty-four maxillary first premolars were evaluated. A placebo was prescribed to 17 patients after an intrusive force was activated and reactivated for an 8-week period on the right side. The same procedure was repeated on the left side after patients were given nabumetone. Pulp-dentinal reactions and external root resorption were evaluated by histology. Pain and movement were also evaluated. Nabumetone was found to be useful in reducing pulpitis, external root resorption, and pain caused by intrusive orthodontic movement, without altering tooth movement in response to the application of orthodontic force.
Onçag, Ozant; Candan, Umit; Arikan, Fatih
The term fusion is used to define a developmental anomaly characterised by the union of two adjacent teeth. In the case reported here, clinical and radiographic examinations suggested a unilateral fusion between the mandibular left permanent incisor and a super-numerary tooth. Radiographs showed that the fused teeth had two distinct pulp chambers and canals. A diagnosis of chronic periapical abscess of the supernumerary tooth was made. Before root canal therapy, a periodontal surgical procedure was performed to section the central incisor and its fused supernumerary. Also, odontoplasty was performed on the roots, to establish an anatomy consistent with a normal central incisor. Later, the chronic apical abscess on the supernumerary tooth was instrumented chemo-mechanically, root canal filling was performed and an anterior composite resin restoration was placed. The patient was evaluated for one year after root canal therapy. The tooth was asymptomatic, not exhibiting any pathological root resorption or alveolar resorption, and the anterior composite restoration was intact. Instead of extracting the supernumerary tooth, the application of endodontic, periodontal, and restorative procedures proved to be an alternative treatment.
Yoneda, Masahiro; Uchida, Hatsumi; Suzuki, Nao; Mine, Mariko; Iwamoto, Tomoyuki; Masuo, Yosuke; Naito, Toru; Hatano, Yuko; Hirofuji, Takao
Here, we report a case of severe tooth wear associated with a patient's inappropriate efforts to reduce oral malodor. A 72-year-old male patient visited our breath clinic complaining of strong breath odor. Former dentists had performed periodontal treatments including scaling and root planing, but his oral malodor did not decrease. His own subsequent breath odor-reducing efforts included daily use of lemons and vinegar to reduce or mask the odor, eating and chewing hard foods to clean his teeth, and extensive tooth brushing with a hard-bristled toothbrush. Oral malodor was detected in our breath clinic by several tests, including an organoleptic test, portable sulphide monitor, and gas chromatography. Although patient's oral hygiene and periodontal condition were not poor on presentation, his teeth showed heavy wear and hypersensitiving with an unfitted restoration on tooth 16. Radiographic examination of the tooth did not reveal endodontic lesion, but when the metal crown was removed, severe pus discharge and strong malodor were observed. When this was treated, his breath odor was improved. After dental treatment and oral hygiene instruction, no further tooth wear was observed; he was not concerned about breath odor thereafter. PMID:20339568
Patiño Marín, Nuria; Loyola Rodríguez, Juan P; Medina Solis, Carlo E; Pontigo Loyola, América P; Reyes Macías, Juan F; Ortega Rosado, Jenny C; Aradillas García, Celia
The aim of this work was to determine the frequency of caries, periodontal disease and tooth loss in patients affected by diabetes mellitus types 1 and 2. It was a cross-sectional study involving 175 subjects distributed in the following groups: (1) 35 patients with diabetes type 1 (glycosylated hemoglobin values from 6.5%-7%), (2) 35 patients with diabetes type 1 (values of glycosylated hemoglobin higher than 7%), (3) 35 subjects without diabetes mellitus type 1, (4) 35 patients with diabetes type 2 and (5) 35 subjects without diabetes mellitus type 2. The following clinical parameters were evaluated for all the subjects who participated in the study: frequency of caries, filled teeth, missing teeth, prosthetic restoration, bacterial dental plaque, calculus index, probing depth and attachment level. On comparing the groups of patients with diabetes type 1 to the control group, there were no statistically significant differences among any of the study variables. On comparing the group of patients with diabetes type 2 to the control group, there were statistically significant differences in the variables missing teeth (p=0.0134), calculus (p=0.0001), probing depth (p=0.0009) and attachment level (p=0.0093). The variable periodontal disease showed statistically significant dIfferences in the group of patients with diabetes type 2. Prevention, supervision and review of the oral health of patients with diabetes (types 1 and 2) are needed in order to prevent oral alterations.
Lang, B R; Razzoog, M E
The interface of bone and soft tissue to dental implants has been extensively documented, while the influence of biomechanics and the occlusal interface continues to be overlooked. Yet that same occlusal interface may ultimately be the prime factor in the lifetime survival rate of dental implants. What is lacking, for the practitioner, is a clear concept of the occlusal rehabilitation which is required and appropriate for the totally edentulous implant patient. Lingualized integration represents an occlusal scheme using specific tooth molds designed to improve the likelihood of maximum intercuspation and an absence of deflective occlusal contacts, provide cusp height for selective occlusal reshaping, and achieve a natural and pleasing appearance. Factors in the articulation and arrangement of the posterior teeth to assure the attainment of the fundamental goals of comfort, function, and appearance in occlusal rehabilitation for edentulous implant patients are included.
This clinical report presents the clinical appearance and treatment approach in a case of excessive anterior teeth erosion resulted from swimming in a poorly-chlorinated swimming pool. Clinical findings revealed tooth sensitivity, severe enamel erosion resembling veneer preparations, and the presence of anterior open bite. A novel hybrid ceramic (Vita Enamic) was chosen for fabricating full-coverage crowns for this patient. After 6-months follow-up, the tooth sensitivity disappeared and the patient was satisfied with esthetic outcome. The hybrid ceramic restorations can be recommended with no complications. PMID:25352965
Caliste, Xzabia; Nazir, Shazia; Goode, Terral; Street, James H; Hockstein, Michael; McArthur, Karina; Trankiem, Christine T; Sava, Jack A
Most patients with anorectal abscess are diagnosed clinically based on pain, erythema, warmth, and fluctuance. Some patients, however, present with subtle or atypical signs. CT is easily accessible and is commonly used for diagnosis and delineation of anorectal abscess. The purpose of this study is to determine the sensitivity of CT scan in detecting perirectal abscesses and to see if immune status impacts the accuracy of CT. A retrospective study was conducted to identify patients from 2000 to 2009 with International Classification of Diseases, 9th Revision code 566 (anal or rectal abscess). Patients included had a CT scan less than 48 hours before drainage. Patients with CT-positive abscess were compared with patients with CT-negative abscess. Patients were categorized as either immunocompetent or immunosuppressed based on documentation of diabetes mellitus, cancer, human immunodeficiency virus, or end-stage renal disease. One hundred thirteen patients were included in this study. Seventy-four (65.5%) were male and the average age was 47 years. Eighty-seven of 113 (77%) patients were positive on CT for anorectal abscess. Sixty of 113 (53%) patients included in this study were immunocompromised. CT missed 26 of 113 (23%) patients with confirmed perirectal abscess. Eighteen (69%) of these patients were immunocompromised compared with CT-positive patients (42 [48%], P = 0.05). The overall sensitivity of CT in identifying abscess was 77 per cent. CT lacks sensitivity in detecting perirectal abscess, particularly in the immunocompromised patient.
Harrington, Amanda T; Hsia, Jennifer C; Mendez, Eduardo; Clarridge, Jill E
Lingual abscesses are rare. We describe a case in a healthy female with no recent history of trauma. The organism recovered by culture of drainage material collected prior to antibiotic treatment was Streptococcus intermedius, an organism recognized as flora of the oropharynx and associated with abscess formation. The isolate was resistant to clindamycin, which was the antibiotic therapy that the patient received.
Burton, Kirsteen R; Wang, Xi; Dhanoa, Deljit
Spinal epidural abscess (SEA) is a rare clinical entity. It is less common when the entire epidural space is involved, known as a holocord or panspinal SEA, and it is even less common in a pregnant patient. We report a case of methicillin-resistant Staphylococcus aureus holocord SEA in a 30-year-old female at approximately 22 weeks' gestational age who presented with lumbar pain and pelvic pressure and the urge to bear down. Magnetic resonance imaging of the spine demonstrated extensive SEA and meningitis from the foramen magnum to the lumbar spine that was treated both medically and surgically. The incidence of, clinical presentation of, and risk factors for developing SEA are discussed. If untreated, expanding SEAs produce sensory symptoms and signs, motor dysfunction, and, eventually, paralysis and death. The medical and surgical management of SEA is also discussed. SEA can have an insidious and atypical presentation despite extensive involvement of the epidural space. Therefore, the diagnosis of SEA should always be considered in patients who present to the emergency department with back pain.
Gupta, R; Singal, R P; Gupta, A; Singal, S; Shahi, S R; Singal, R
Primary breast tuberculosis manifested as abscess is a rare entity. We are reporting a case of primary breast tuberculosis, which presented as breast abscess. Abscess was drained and tissue sent for histopathology. To our surprise, diagnosis came as breast tuberculosis. Aspiration cytology was not done, as it is not a routine test for abscess cases. Patient was put on anti- tubercular drugs. In the follow-up of 6 months, she was asymptomatic and advised to continue medicine.
Cuddihy, P J; Srinivasan, V
Nasal septal abscess is a rare complication of septal haematoma. Nasal obstruction and, less frequently, pain are the usual presenting features. We report a case of a nasal septal abscess in a 21-year-old female patient who developed a naso-oral fistula. To our knowledge this is the first report of such an unusual presentation of a septal abscess. The aetiology, pathogenesis and management of septal abscesses are discussed.
Vaeth, Signe; Jensen, Uffe Birk; Christensen, Rikke; Andersen, Henning
Purpose To validate the diagnostic codes for Charcot–Marie–Tooth disease (CMT) in the Danish National Patient Registry (DNPR) using positive predictive value (PPV) as a measure of validity. Patients and methods We used the DNPR to identify all patients diagnosed with at least one primary CMT diagnosis at a specialized department in the Central Denmark Region during the period 1977–2012. From this population, we randomly selected 123 patients for the validation study. Medical files were reviewed and used as reference standard. We estimated the PPV of the CMT diagnoses and stratified the analysis according to age at diagnosis, gender, and calendar time. Results In the DNPR, 275 patients were identified. We were able to retrieve 96 medical files from the random sample of 123 patients, and 85 CMT diagnoses were confirmed. The average age at diagnosis was 42.5 years, and 34% were female. The PPV was 88.5% (95% confidence interval: 80.4–94.1). Conclusion The CMT diagnoses in the DNPR have high validity. The DNPR can be used as a data source for epidemiologic research on CMT. PMID:27920579
Boyaci, Ahmet; Boyaci, Nurefsan; Tutoglu, Ahmet; Dokumaci, Dilek Sen
Involvement of the skeletal system is a common complication of brucellosis. However, muscle involvement or paraspinal abscess formation are rare complications. Paraspinal abscess usually develops secondary to spondylitis. A case is reported here of a 33-year-old woman with symptoms of night sweats, fever and low back pain. Rose-Bengal test for brucellosis was positive and Brucella standard tube agglutination test was positive at a titre of 1/160. The diagnosis was made on MRI. The patient was treated with doxycycline and rifampin daily for 16 weeks. On day 14 of treatment, decline was observed in the patient's symptoms. In the presence of inflammatory lower back pain and fever, brucellosis should be considered particularly in the endemic areas. Furthermore, tuberculosis should be remembered in the differential diagnosis when a spinal epidural abscess is determined.
Re, D; Ceci, C; Cerutti, F; Fabbro, M Del; Corbella, S; Taschieri, S
Objectives The aim of this study was to evaluate the patients' willingness to pay (WTP) values and preference for the treatment of a tooth with very poor prognosis, among two options: root canal therapy and crown positioning or tooth extraction, implant insertion and crown positioning.Methods A total of 103 patients were recruited from a private dental clinic and interviewed. A questionnaire measured individuals' preferences among the two alternative treatments for a tooth with poor prognosis and the maximum amount of money they would be willing to pay for their choice with a starting bid of [euro]2,000 in [euro]100 increment/decrement. Demographic data, patient choice, median values and WTP association with socio-demographic factors (Student ttest and one-way ANOVA) and correlation between variables (Pearson chi-square test) were revealed.Results Seventy-six percent of patients expressed a preference for root canal therapy, while the remaining 24% chose the dental surgery. A fair agreement between previous experience and current therapeutic choice was found (P = 0.0001). The WTP median value was [euro]2,000 and 46% of participants would pay an additional sum of money for the therapy (median: [euro]300). The preferred treatment was influenced by previous experience, but no association was found between WTP values and socio-demographic factors.Conclusion Patients tend to prefer a conservative approach for the treatment of a tooth with poor prognosis and are willing to pay an additional fee to receive their treatment choice.
Niang, H E; Ka, M M; Badiane, M; Ba, A; Konde, L; Lamouche, P
Amoebic liver abscess is the most frequent location of the extra-intestine amibiasis with an epidemio-endemic repartition in our areas. We are reporting in this study the main echographic patterns that can be found. 117 documents were collected and studied between 1982 and 1988 in the main hospitals of Dakar (SENEGAL). Most of the patients were young, the range of age being between 25 and 55 years old and 83% of them, were male. The diagnosis of the amoebic liver abscess was evocated on the basis of the following clinical and biological symptoms: 54.38% of painful haetomegaly, 42.10% of pleuro-pulmonary and digestive signs, 3.50% of long lasting isolated fever, non specific biological sign of inflammation, 74.57% of positive hemaglutination test. An echographic test was performed before the anti-parasitic treatment with an echotomograph PHILIPS SDR 1500 in real time using a probe of 3 MHZ. The amoebic abscess of liver was detected by the echography in all cases. The unique abscess (83.10%) was the most frequent form. It was localized in the right liver (64%) and had an heterogeneous echostructure (55.70%). The hypo-echogeneous form (36.50%) was the earlier stage of the collecting abscess. The liquid form (07.80%) was observed in the latter stages of the disease. Some difficulties to determine the amoebic abscess may appear when primitive liver cancer or pyogensus abscess are present. In these cases it is necessary to analyse the liquid of ponction to be affirmative.
Clancy, U; Ronayne, A; Prentice, M B; Jackson, A
We describe the rare occurrence of an Actinomyces meyeri cerebral abscess in a 55-year-old woman following a dental extraction. This patient presented with a 2-day history of hemisensory loss, hyper-reflexia and retro-orbital headache, 7 days following a dental extraction for apical peridonitis. Neuroimaging showed a large left parietal abscess with surrounding empyema. The patient underwent craniotomy and drainage of the abscess. A. meyeri was cultured. Actinomycosis is a rare cause of cerebral abscess. The A. meyeri subtype is particularly rare, accounting for less than 1% of specimens. This case describes an unusually brief course of the disease, which is usually insidious. Parietal lobe involvement is unusual as cerebral abscesses usually have a predilection for the frontal and temporal regions of the brain. Although there are no randomised trials to guide therapy, current consensus is to use a prolonged course of intravenous antibiotics, followed by 6-12 months of oral therapy.
Sánchez-Aguilar, Martín; Morán-Mendoza, Onofre; Herrera-Hernández, Miguel F; Hernández-Sierra, Juan Francisco; Mandeville, Peter B; Tapia-Pérez, J Humberto; Sánchez-Reyna, Martín; Sánchez-Rodríguez, José Juan; Gordillo-Moscoso, Antonio
Objectives To identify the variables that predict the failure to treat amoebic liver abscesses. Methods We prospectively carried out a case–control study on a cohort of patients who had been diagnosed with amoebic liver abscesses using clinical, ultrasonic, and serologic methods. Patients with pyogenic abscesses, negative ELISA tests for amoebiasis, immunosuppression status, or previous abdominal surgery were excluded. All patients received metronidazole, and those who demonstrated 4 days of unfavorable clinical responses received percutaneous or surgical draining of the abscess. Demographic, laboratory, and ultrasonographic characteristics were assessed as prognostic indications of failure. Results Of 40 patients with amoebic liver abscess, 24 (mean age: 36.7±11.2 years) responded to medical treatment and 16 (41.8±11.6 years) required drainage, including 14 patients who underwent percutaneous drainage and two patients who required surgery. The albumin level, abscess volume, abscess diameter, and alkaline phosphatase level were all statistically significant (P<0.05) on the bivariate analysis. The highest (>99%) sensitivity and negative predictive value were observed for an abscess volume >500 ml and diameter >10 cm, while the best specificity and positive predictive value were achieved with the combination of low serum albumin level, high alkaline phosphatase level, and large abscess volume or diameter. Conclusions The prognostic indications of the failure to treat amoebic liver abscesses include low albumin, high alkaline phosphatase, and large abscess volume or diameter. The combination of these variables is a useful and easy tool for determining appropriate therapy. PMID:23265424
Wang, Su-Hsin; Chung, Ming-Pang; Su, Wen-Song; Cheng, Jen-Chan; Shieh, Yi-Shing
This case report describes the continued root formation following replantation and conventional root canal therapy of a traumatically avulsed open-apex tooth with suppurative apical periodontitis. A 7-year-old male patient had an avulsed upper left central incisor (tooth 21) replanted approximately 50 min after traumatic avulsion. A root canal procedure was initiated due to pulp necrosis and periapical abscess detected in the follow-up period. After endodontic treatment with calcium hydroxide (Ca(OH)(2)) dressing, a normal root length developed including an apical segment beyond the hard tissue barrier. Regeneration of the root occurred without pathology or ankylosis at 1-year of follow up.
Taniguchi, Juliana B; Elui, Valéria M C; Osório, Flávia L; Hallak, Jaime E C; Crippa, José A S; Machado-de-Sousa, João P; Kebbe, Leonardo M; Lourenço, Charles M; Scarel-Caminaga, Raquel M; Marques, Wilson
We assessed the functional impairment in Charcot-Marie-Tooth resulting from 17p11.2-p12 duplication (CMT1A) patients using the Short-Form Health Survey (SF-36), which is a quality of life questionnaire. Twenty-five patients of both genders aged ≥10 years with a positive molecular diagnosis of CMT1A were selected. Age- and gender-matched Control Group (without family history of neuropathy), and the sociodemographic and professional conditions similar to the patients' group were selected to compare the SF-36 results between them. The results showed that the majority quality of life impairments in CMT1A patients occurred in the social and emotional domains. Functional capacity also tended to be significantly affected; other indicators of physical impairment were preserved. In conclusion, social and emotional aspects are mostly neglected in the assistance provided to CMT1A Brazilian patients, and they should be better understood in order to offer global health assistance with adequate quality of life as a result.
You call it a cavity. Your dentist calls it tooth decay or dental caries. They're all names for a hole in your tooth. The cause of tooth decay is plaque, a sticky substance in your mouth made up mostly of germs. Tooth decay starts in the outer layer, called the enamel. Without ...
Hiroishi, K; Shigenobu, Y; Asai, M; Tsuzuki, Y; Hayashi, N; Tominaga, K; Matsui, K; Hada, T; Higashino, K
The management of disseminated intravascular coagulation (DIC) in a 22-year-old female patient with antiphospholipid syndrome is reported. Gabexate mesilate was given by continuous drip infusion at 1.5 g/day. No effect was seen, therefore Dalteparin sodium (DS) was administered by continuous drip infusion at 70 U/kg/day. The DIC score improved gradually during the first 4 days to normalization by 10 days. However, convulsive seizure was developed. Computed tomographic scan of brain demonstrated brain abscess at lt-basal ganglia. Continuous drainage was performed while administered continuous drip infusion of DS. Follow-up CT after operation showed reduction of low density area which means brain abscess. Finding in this case suggest that DS may play a role in the management of DIC accompanying intracranial infection.
... infected fluid and pus located inside the belly (abdominal cavity). This type of abscess can be located near ... abdominal abscesses: Abdominal x-ray Ultrasound of the abdomen and pelvis CT scan of the abdomen and ...
Patterson, J.E.; Andriole, V.T.
Our knowledge of the spectrum of renal abscesses has increased as a result of more sensitive radiologic techniques. The classification of intrarenal abscess now includes acute focal bacterial nephritis and acute multifocal bacterial nephritis, as well as the previously recognized renal cortical abscess, renal corticomedullary abscess, and xanthogranulomatous pyelonephritis. In general, the clinical presentation of these entities does not differentiate them; various radiographic studies can distinguish them, however. The intrarenal abscess is usually treated successfully with antibiotic therapy alone. Antistaphylococcal therapy is indicated for the renal cortical abscess, whereas therapy directed against the common gram-negative uropathogens is indicated for most of the other entities. The perinephric abscess is often an elusive diagnosis, has a more serious prognosis, and is more difficult to treat. Drainage of the abscess and sometimes partial or complete nephrectomy are required for resolution. 73 references.
Hayashi, Anri; Takano, Tomoyuki; Suzuki, Atsushi; Narumiya, Seiro
Brain abscesses caused by group A Streptococcus (GAS) are rare infectious diseases. In this report we present a case of brain abscess due to GAS infection occurring after milk tooth extraction in a healthy child. A literature review of previously reported cases is presented.
Walsh, T R; Reilly, J R; Hanley, E; Webster, M; Peitzman, A; Steed, D L
Over a 5-year period, iliopsoas abscesses were found in 11 patients. Although the most common underlying condition was Crohn's disease (3 of 11 patients), 5 abscesses resulted from hematogenous spread from a distant site. Each of these five patients was elderly, severely malnourished, or had an underlying chronic disease. Fever was a presenting sign in 8 of 11 patients, whereas all 4 patients who presented with back pain had nontuberculous lumbar osteomyelitis or disk space infections. No patient presented with the classic triad of fever, back pain, and anterior thigh or groin pain. Computed tomographic (CT) scans accurately established the clinical diagnosis in 10 of 11 patients. Two of the patients died. One patient was an intravenous drug abuser, whereas the other patient was being treated with steroids for systemic lupus erythematosus. Elderly patients, diabetics, and patients with chronic disease are susceptible to this kind of occult infection and may present with minimal clinical findings. Aggressive diagnosis using CT scanning and treatment with resection of involved bowel, complete drainage of the abscess, and prolonged antibiotics are required to salvage these patients.
Numoto, Yoko; Mori, Takayuki; Maeda, Shigeru; Tomoyasu, Yumiko; Higuchi, Hitoshi; Egusa, Masahiko; Miyawaki, Takuya
Teeth are fundamental to maintaining good quality of life, but are often lost prematurely in individuals with intellectual disability. Furthermore, since bone mass decreases in menopausal women, women with intellectual disability have an augmented risk of losing their teeth. However, the relationship between periodontal disease-related tooth loss and bone mass has never been studied specifically in patients with intellectual disability. This study evaluated this relationship in a retrospective cohort study. Participants were female dental patients aged between 20 and 50 years and with an intellectual disability, who were treated in the Special Needs Dentistry unit of the Okayama University Hospital from January 2009 to March 2010. Logistic regression analysis was used to analyze which factors affect periodontal disease-related tooth loss. Information relating to 12 predictor variables, including age and bone mass level, was derived from medical records. The 27 subjects had a total of 704 teeth at the time of initial examination, but 20 teeth (2.8%) had been lost owing to periodontal disease by the time bone mass measurements were recorded. Results of the multinomial logistic regression analysis indicated a significant odds ratio for three items: number of missing teeth at the time of initial examination, bone mass, and living environment. This result suggests that low bone mass is an independent risk factor in tooth loss secondary to periodontal disease in patients with intellectual disability. Dentists should thus take account of this heightened risk of tooth loss when caring for post-menopausal women with intellectual disability. PMID:24358063
Gürbüz, Mehmet Sabri; Erdoğan, Barıs; Yüksel, Mehmet Onur; Somay, Hakan
Lumbar spinal arachnoiditis occurring after diagnostic lumbar puncture is a very rare condition. Arachnoiditis may also present with fever and elevated infection markers and may mimic epidural abscess, which is one of the well known infectious complications of lumbar puncture. We report the case of a 56-year-old man with lumbar spinal arachnoiditis occurring after diagnostic lumbar puncture who was operated on under a misdiagnosis of epidural abscess. In the intraoperative and postoperative microbiological and histopathological examination, no epidural abscess was detected. To our knowledge, this is the first case of a patient with postlumbar puncture arachnoiditis operated on under a misdiagnosis of epidural abscess reported in the literature. The authors suggest that arachnoiditis may mimic epidural abscess due to its clinical and radiological features and should be considered in the differential diagnosis of complications of lumbar puncture. PMID:24197809
Nouira, Ramzi; Bedoui, Riadh; Miaadi, Naoufel; Guesmi, Fethi; Ben Achour, Jamel; Hani, Mohamed; Daghfous, Mounir; Ben Osman, Samia; Zoghlami, Ayoub; Najah, Nabil
The objective of this work is to study factors of prognostic of mortality of abscesses of the liver. We have treated between 1990 and 2000 in our service, 38 patient for abscess of the liver. The symptoms are dominated by the pain of the right hypochondria (37 cases) and the fever (34 cases). An unique abscess has been recovered in 25 cases. Some multiple localizations have been observed in 12 cases. 21 patients have been operated. The bacteriological study at all patients revealed the presence of germ in 27 cases. In 6 cases, there were two germs. It was a bacillus negative gram in 26 cases and a cocci positive gram in 7 cases. Six complications have been observed at the operated patients. In 5 cases, it was a septic shock having leads to the death. After survey univariate and multivariate the only factor of bad prognostic recovered is the septic shock. The aetiology was identified in only 9 cases; it was abscess cholangiotis.
Causey, Marlin Wayne; Nelson, Daniel; Johnson, Eric K.; Maykel, Justin; Davis, Brad; Rivadeneira, David E.; Champagne, Brad; Steele, Scott R.
Background: Patients with Crohn’s disease (CD) are believed to have more aggressive anorectal abscess and fistula disease. We assessed the types of procedures performed and perioperative complications associated with the surgical management of anorectal abscess and fistula disease in patients with and without CD. Methods: The American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP, 2005-2010) was used to calculate 30-day outcomes using regression modeling, accounting for demographics, comorbidities and surgical procedures. ICD-9 codes for anorectal abscess or fistula were used for initial selection. Patients were then stratified, based on the presence or absence of underlying CD. Local procedures included incision and drainage of abscesses, fistulotomy and seton placement. Cutaneous fistulas were considered simple, while all others were classified as complex (-vaginal, -urethral and -vesical). Results: A total of 7,218 patients (mean age 45 years; 64% male) met inclusion criteria, with underlying CD in 345 (4.8%). CD patients were more likely to have a seton placed (9.9 vs 8.2%, P < 0.001) and be on steroids (15.4 vs 4.3%, P < 0.001). Thirty-seven percent of CD patients underwent local procedures, while 46% had a proctectomy and 8% underwent diversion. Fistulotomy was more common in those without underlying CD (16 vs 11%, P < 0.001). The overall complication rate after local treatment was 4.9%, with no difference between patients with and without CD (7.7 vs 4.9%, P = 0.144). This was not affected by fistula type—simple (7.9 vs 3.9%, P = 0.194) vs complex (33 vs 7.1%, P = 0.21)—or when stratified by wound (3.8 vs 2.4%; P = 0.26) or systemic complications (3.8 vs 2.5%; P = 0.53). Yet, complications following emergency procedures were higher in patients with CD (21.4 vs 5.9%, P = 0.047). Factors significantly associated with increased complications were Crohn’s disease (OR = 8.2), lack of functional independence (OR = 2
Introduction: Iliopsoas abscess is an uncommon condition in the paediatric population. The clinical presentation is variable and may be confused with other conditions such as septic arthritis, osteomyelitis and appendicular abscess. A suspicion of iliopsoas abscess requires a prompt diagnosis so that rapid management and treatment can be undertaken. Discussion: This case describes the presence of an iliopsoas abscess in a paediatric patient presenting to the emergency department within a rural community. Due to the variability in clinical presentation imaging studies are necessary to distinguish an iliopsoas abscess from other inflammatory processes. Ultrasound is often the modality of choice. Imaging guided percutaneous drainage and/or aspiration and the administration of intravenous antibiotics are minimally invasive modern techniques providing a safe treatment options in the presence of an iliopsoas abscess. Conclusion: Iliopsoas abscess is an uncommon condition in the paediatric population. Due to the variability in clinical presentation, imaging, and in particular, ultrasound play a vital role in the diagnosis of cases with a high suspicion of abscess formation. Accurate diagnosis leads to a rapid treatment plan, avoiding further insult.
Yamazaki, T; Yamori, M; Ishizaki, T; Asai, K; Goto, K; Takahashi, K; Nakayama, T; Bessho, K
This study estimated the cumulative incidence and risk ratio for osteonecrosis of the jaw (ONJ) after tooth extraction in patients with and without administration of bisphosphonates (BP) and identified potential risk factors for bisphosphonate-induced osteonecrosis of the jaw (BIONJ). A cohort study was conducted in all patients undergoing tooth extraction at a university hospital in Japan from April 2006 to June 2009. Of 3216 patients, 126 had BP administration, of whom 5 (3.9%, 95% confidence interval (CI): 1.2-9.2) developed ONJ, versus 1 (0.032%, 95% CI: 0.00081-0.18) among 3090 patients without BP administration. BP administration was associated with the development of ONJ after tooth extraction, with an unadjusted risk ratio of 122.6 (95% CI: 14.4-1041.8). When stratified by age and route of BP administration, the risk ratio for ONJ patients aged 65 years or older with intravenous BP administration compared to those without was 200.2 (95% CI: 23.8-1679.4, P<0.001). Patients receiving BP showed a significant association between the incidence of BIONJ and alveolar bone loss score. The risk of ONJ is higher in patients with than without BP administration, particularly intravenous administration. Severe periodontitis might be a risk factor for BIONJ.
Bloch, Jennifer; Lemaire, Xavier; Legout, Laurence; Ferriby, Didier; Yazdanpanah, Yazdan; Senneville, Eric
Proteus vulgaris is only rarely the cause of multiple septic metastases. We describe multiple brain abscesses due to P. vulgaris in an immunocompetent patient successfully treated by antibiotic therapy and colonectomy.
Grønkjær, Lea Ladegaard; Holmstrup, Palle; Schou, Søren; Schwartz, Kristoffer; Kongstad, Johanne; Jepsen, Peter; Vilstrup, Hendrik
Background Periapical radiolucency is the radiographic sign of inflammatory bone lesions around the apex of the tooth. We determined the prevalence and predictors of periapical radiolucency in patients with cirrhosis and the association with systemic inflammation status and cirrhosis-related complications. Methods A total of 110 cirrhosis patients were consecutively enrolled. Periapical radiolucency was defined as the presence of radiolucency or widening of the periapical periodontal ligament space to more than twice the normal width. Predictors of periapical radiolucency and the association with systemic inflammation markers and cirrhosis-related complications were explored by univariable and multivariable logistic regression analyses. Results Periapical radiolucency was present in one or more teeth in 46% of the patients. Strong predictors were gross caries (odds ratio [OR] 3.12, 95% confidence interval [CI] 1.43–6.79) and severe periodontitis (OR 3.98, 95% CI 1.04–15.20). Also old age (OR 1.10, 95% CI 1.01–1.19) and smoking (OR 3.24, 95% CI 1.02–17.62) were predictors. However, cirrhosis etiology (alcoholic vs nonalcoholic) or severity (Model of End-Stage Liver Disease score) were not predictors. The patients with periapical radiolucency had higher C-reactive protein (15.8 mg/L vs 8.1 mg/L, P=0.02) and lower albumin contents (25 g/L vs 28 g/L, P=0.04) than those without. Furthermore, the patients with periapical radiolucency had a higher prevalence of cirrhosis-related complications such as ascites, hepatic encephalopathy, and/or variceal bleeding (46% vs 27%, P=0.05). Conclusion Periapical radiolucency is often present as an element of poor oral health status and likely has an adverse clinical significance, which should motivate diagnostic and clinical attention to the findings. PMID:27695370
Steele, J G; Lamey, P J; Sharkey, S W; Smith, G M
Seventy-two migraine sufferers, whose attacks normally begin during or soon after waking from sleep, were compared with 37 age- and sex-matched controls to establish whether signs of mandibular dysfunction, occlusal discrepancies and known clenching or grinding habits were any more frequent among the former group. Temporomandibular joint tenderness or pain history, masticatory muscle tenderness and known clenching or grinding habits were found to occur at significantly increased levels in the migraine sufferers, with two-thirds of these patients reporting a parafunctional habit. Occlusal abnormalities, including non-working side or protrusive interferences and slides of greater than 1 mm to the intercuspal position, were found to occur at similar frequencies in the two groups. Assessment of wear of the occlusal surfaces also showed no difference, suggesting that any nocturnal habit with a role in migraine is more likely to be clenching in nature. In conclusion, evidence was found to support an aetiological role for nocturnal tooth clenching or grinding in migraine characterized by attacks that start predominantly during sleep or soon after waking, but no evidence of a link with occlusal factors was found in these patients.
... page: //medlineplus.gov/ency/article/002214.htm Tooth anatomy To use the sharing features on this page, ... upper jawbone is called the maxilla. Images Tooth anatomy References Lingen MW. Head and neck. In: Kumar ...
Mizuno, Ju; Tsujikawa, Tetsuya; Wakuta, Akiko; Matsuki, Michiko; Morita, Tsubasa; Gouda, Yoshinori
We report a case of septic shock associated with pyogenic liver abscess rescued with percutaneous transhepatic abscess drainage (PTAD). A 70-year-old male patient was admitted to our outpatient department of internal medicine with general fatigue, dullness of bilateral shoulders and extremities, appetite loss, weight loss, headache, and vertigo. Laboratory tests showed severe inflammatory indications, anemia, and high values of hepatobiliary enzymes and blood sugar. Abdominal ultrasonography and enhanced CT showed a pyogenic liver abscess of 10 cm in diameter at S 6-7 in the right hepatic lobe. The patient's condition deteriorated suddenly that night. From the results of abdominal ultrasonography and enhanced CT, we made diagnosis of septic shock associated with pyogenic liver abscess. Emergency abdominal ultrasound-guided PTAD was performed under local anesthetic. Postoperatively, the antibiotic was infused daily through a PTAD tube into the liver abscess space. He recovered and his laboratory tests improved gradually. On abdominal ultrasonography and enhanced CT, the liver abscess disappeared by 19th postoperative day, and PTAD tube was removed. There was no complication during PTAD treatment. We conclude that patients in septic shock should undergo further examinations immediately and treatment of the infected tissue should be started as soon as possible. PTAD may be an additional effective procedure for pyogenic liver abscess in septic shock. Furthermore, local antibiotic lavage through a PTAD tube into the liver abscess space may be an important supplementary method in the management of the illness.
Matijević, Marko; Uzarević, Zvonimir; Gvozdić, Vlatka; Mikelić, Valentina Matijević; Leović, Dinko; Macan, Darko
The aim of this study was to determine the extent to which the intensity of postoperative pain in the first seven days after lower wisdom tooth extraction is affected by operator experience, patient level of information and patient sex. Postoperative pain intensity after lower wisdom tooth extraction was assessed in 108 patients. Depending on the type of information given to each patient individually, the patients were divided into two groups: test group in which patients were provided with detailed standard written and verbal instructions and control group where patients only received detailed standard written instructions about treatment after surgery. Each of these two groups was divided into three subgroups depending on operator experience. Results of this study showed that the type of information irrespective of being given verbally or not had no effects on postoperative pain intensity, whereas operator experience and patient sex influenced postoperative pain intensity.
Ashwath, Mahi Lakshmi; Katner, Harold P
We report a patient with pancreatic abscesses and necrosis secondary to Alcaligenes faecalis infection. He initially presented with alcohol-induced acute pancreatitis. Twenty days after the initial presentation, he re-presented with increasing pain and was found to have pancreatic necrosis and abscesses. Treatment was initiated with meropenem. Because of persistent fevers, computed tomography-guided drainage was performed. The fluid grew A faecalis resistant to meropenem and the patient continued to be febrile. He recovered only after adequate surgical intervention and appropriate antibiotic coverage. Although this is the first case of A faecalis reported to cause pancreatic abscess, we believe selection of this organism occurred because surgical drainage was delayed while the patient was on the recommended treatment with meropenem. This case emphasizes the need for early surgical drainage of pancreatic abscesses to avoid the selection of such resistant pathogens.
Astramskaitė, I; Juodžbalys, G
The aim of this study was to review scales used to assess anxiety, stress, and pain in dental patients undergoing a tooth extraction procedure and to propose a novel psycho-emotional rating scale based on the relevant literature and our own experience. An electronic literature search was conducted of the National Library of Medicine database MEDLINE (Ovid) and EMBASE databases between January 2005 and April 2016. Sequential screening at the title/abstract and full-text levels was performed. The review included all human prospective or retrospective follow-up studies and clinical trials, cohort studies, case-control studies, and case series that demonstrated at least one scale used to measure tooth extraction anxiety, stress, or pain. The search resulted in 32 articles meeting the inclusion criteria. None of the studies were found to be suitable in evaluating patient's stress, pain, and fear at once. Also, no scales were found that included both the doctor's and the patient's rating. In a few studies, vital signs as psycho-emotional status indicators were rated. Guidelines for a suitable questionnaire that could be used for rating the psycho-emotional status of patients undergoing tooth extraction are listed in the present research. Further studies are required for verification and validation of offered scale.
Fukushige, Tetsushi; Sano, Tomomi; Yamada, Sinichi; Ueda, Sawako; Kano, Tatsuhiko
A 55-year-old man was admitted to a hospital with pain of the low back as well as the left leg, and fever. He was suspected of suffering from the lumbar disc herniation because of the presence of Lasegue's sign on the first physical examination. Abdominal computed tomography, however, revealed the swelling of the left iliopsoas muscle. Iliopsoas abscess accompanied epidural abscess was confirmed by subsequent magnetic resonance imaging (MRI). Antibiotic therapy was started for the successive 8 days. The fever resolved, but the pain persisted. The abscess extending from the iliopsoas muscle to the epidural space was still seen on the MRI 20 days after the completion of the antibiotic therapy, and he still complained of the pain of his low back and left leg. Therefore, we conducted epidural puncture under fluoroscopic guidance. Approximately 3 ml of pus was aspirated from the epidural space. Then, his complains decreased remarkably. Iliopsoas abscess should be taken into account in case of a patient with pain on the low back and leg and also inflammatory signs such as fever and leucocytosis.
Menotti, Federica; Laudani, Luca; Damiani, Antonello; Macaluso, Andrea
Background Charcot–Marie–Tooth 1A (CMT1A) patients show a reduction of spontaneous activities of daily living measured by means of questionnaires or pedometers, which are quite inaccurate compared to recent measurement techniques. Aim The study aimed at quantifying daily living activities in CMT1A patients by means of inertial sensors, which give information not only on the amount but also on the intensity of these activities. Materials and methods Time and count (amount), and velocity and power (intensity) of 24 h daily living activities were measured in eight patients (20–48 years; Barthel >90; Tinetti >20) and eight healthy individuals, matched for age and gender, by means of a wearable inertial sensor device. Results There were no differences between patients and controls in the 24-h distance covered and count of steps. However, count of step climbing and sit to stand were lower in patients than in controls (139.93 ± 141.66 vs. 341.06 ± 164.07 n and 58.23 ± 7.82 vs. 65.81 ± 4.75 n, respectively; P < 0.05) as well as mean daily step-climbing and walking velocities (1.07 ± 0.17 vs. 1.21 ± 0.10 m/sec and 1.16 ± 0.31 vs. 1.87 ± 0.50 m/sec, respectively; P < 0.05). In CMT1A patients there was a positive correlation between strength of the knee extensor muscles and both count of steps climbed (R = 0.80) and sit to stand (R = 0.79). Discussion and conclusion The reduced ability of CMT1A patients to carry out activities at high intensity, which was correlated with strength, suggests that strength training might be a rehabilitation tool for improving the 1 ability to carry out these activities. PMID:24653950
Teleb, Mohamed; Soto-Ruiz, Enrique; Domínguez, Delfina C; Antony, Suresh
Multi drug resistant (MDR) Pseudomonas aeruginosa and Extended-Spectrum-lactamase (ESBL) Enterobacteriaceae are becoming an increasing difficult clinical problem. Immediate resistance to some of the new antimicrobials such as ceftolozane/tazobactam is unusual and is due to a variety of mechanisms such as hy-per-production of inactivating enzymes and gene mutation. In addition, previous antimicrobial administration is a well-recognized risk factor to develop resistance. We present a patient with a liver abscess where the organism was resistant to ceftolozane/tazobactam resulting in a poor clinical outcome.
Gabrielli, Giovanni B; Stanzial, Anna Maria; Cassini, Marco; Corrocher, Roberto
Both pyogenic sacroiliitis and iliopsoas muscle abscess are uncommon infectious entities, and their coexinstence has been reported in very few patients. We present here the case of a woman who developed a large iliopsoas abscess as a consequence of a pyogenic sacroiliitis, initially misdiagnosed as a common sciatica and treated with corticosteroids. The patient was cured by the surgical drainage of the abscess and a long-lasting antibiotic treatment. We discuss diagnostic difficulties linked to the two infectious entities, their possible pathogenic connections, the role of imaging procedures, and therapeutic options. We conclude that pyogenic sacroiliitis and the potential evolution to an iliopsoas abscess must be taken into consideration in the differential diagnosis of lower back pain, especially if fever is a concomitant sign.
Zuckerman, G R
Fractured molars and premolars are very common. Fractures usually result from cracks that develop and slowly extend until the tooth separates into buccal and lingual fragments. Sometimes, as these cracks expand, the patient exhibits symptoms of what is commonly referred to as "cracked tooth syndrome" (CTS). When CTS occurs, an opportunity exists to diagnose and treat these patients, to relieve their discomfort and prevent sequelae that would require more extensive treatment.
Postelmans, J T F; Stokroos, R J
Charcot-Marie-Tooth disease (CMT), also named hereditary motor and sensory neuropathies (HMSN), comprises a clinically and genetically heterogeneous group of disorders affecting the peripheral nervous system. Deafness induced by CMT is clinically distinct among the genetically heterogeneous group of CMT disorders. Deafness in CMT patients is associated with point mutations or deletions in the transmembrane domain in the peripheral myelin gene (PMP) 22, which are in close proximity to the extracellular component of this gene. We present a patient with deafness induced by CMT type 1A, undergoing cochlear implantation. Prior investigations showed good results due to replacing a synchronous impulse by means of cochlear implantation in patients with auditory neuropathy.
Shields, D W; Robinson, Patrick G
A 35-year-old woman of Indian origin presented with a 5-month history of lower back pain, radiating down the back of her right leg in distribution of the sciatic nerve. Referral was made to the spinal clinic querying sciatica, but a deterioration in her symptoms developed, and the patient presented to the Accident and Emergency department. She was significantly tender at right sacroiliac joint and had positive psoas sign. The MRI scan showed a large iliopsoas abscess causing bony destruction, and extended culture was positive for mycobacterium tuberculosis. The patient was initially diagnosed with sciatica yet had a positive psoas sign and a painful sacrum. It is important that primary physicians are aware of the relations the iliopsoas muscle and the potential effect an abscess can have here. A sinister underlying cause of a patient's sciatic distribution of pain should be excluded before accepting a diagnosis of mechanical back pain.
Lepelletier, D; Pinaud, V; Le Conte, P; Bourigault, C; Asseray, N; Ballereau, F; Caillon, J; Ferron, C; Righini, C; Batard, E; Potel, G
The aim of this study was to describe the epidemiology of hospitalized patients with peritonsillar abscess (PTA). We conducted a multicenter survey in 13 French university hospitals in 2009-2012 describing 412 patients. Median age was 29 year (range, 2-84) and current smoking habit was reported by 177 (43 %) patients. Most of the patients (92 %) had consulted a physician for sore throat within 10 days before admission for PTA diagnosis. Additional symptoms such as visible tonsil abnormalities (83 %), tender cervical adenopathy (57 %) and fever ≥ 38.5 °C (53 %) were also reported. A total of 65 % patients (269/412) reported recent systemic anti-inflammatory agents (AIAs) exposure by medical prescription (70 %), self-medication (22 %), or both (8 %); 61 % and 27 % reported recent exposure to antibiotic and topical treatments for sore throat, respectively. Non-steroidal AIAs were used most often (45 %), particularly arylpropionic derivatives. A rapid diagnosis antigen test (RDT) for Streptococcus pyogenes was performed in 70 (17 %) patients and was positive in 17 (24 %), of whom 9 (53 %) were exposed to AIAs and 14 (82 %) to antibiotics. To treat PTA, antibiotic therapy was given to 392 (95 %) patients. Of 333 antibiotic prescriptions, amoxicillin-clavulanic acid and metronidazole were the most prescribed antibiotics (42 and 17 %, respectively). Surgical drainage of the abscess was performed in 119 (29 %) cases and tonsillectomy in 75 (18 %) cases. The clinical outcome was favorable during the hospital stay in 404 (98 %) patients. In conclusion, patients with sore throat are often exposed to AIAs before PTA diagnosis, and antibiotic prescription was not often based on the RDT positivity.
Jackson, R.; Stephens, L.; Kelly, A. P.
Cold abscesses are defined as having no associated erythema, heat, or tenderness. They may be present in immunodeficiency disorders, deep mycoses, and other infectious diseases. As there is a dearth information on this subject in the dermatology, surgery, and infectious disease literature, we present a case of cold abscesses secondary to coccidioidomycosis and discuss the possible role of humoral immunity, cell-mediated immunity, prostaglandins, T cells, and other mediators in cold abscess pathogenesis. In addition, therapeutic guidelines for abscesses are reviewed. Images Figure 1 Figure 2 PMID:2280425
Tamargo Delpón, María; Demelo-Rodríguez, Pablo; Cano Ballesteros, Juan Carlos; Vela de la Cruz, Laura
Staphylococcus lugdunensis is a coagulase-negative staphylococcus of growing importance and atypical behavior. The infections caused by this microorganism are becoming more frequent, having a broader spectrum. Psoas abscesses caused by this germ are rare, with few cases reported in the literature. In this work, we present a case of a psoas abscess caused by S. lugdunensis in a patient suffering from diabetes mellitus and rheumatoid arthritis, which was treated with intravenous cloxacillin with a good outcome.
Halberstam, M; Isenberg, H D; Hilton, E
Legionella micdadei is the second most common species implicated in the occurrence of Legionella pneumonia (D. J. Bremer, Semin. Respir. Infect. 4:190-205, 1987). Although there has been a reported lung abscess caused by dual infection (L. micdadei and L. pneumophila), there are no known cases of L. micdadei as the only causative organism. We report a case of a patient with a lung abscess from which L. micdadei was the sole organism isolated. PMID:1537927
Pereira, Claudio Maranhão; Gasparetto, Patrícia Freire; Carneiro, Danilo Santos; Corrêa, Maria Elvira P.; Souza, Cármino Antônio
Introduction. Dental treatment performed in patients receiving continuous oral anticoagulant drug therapy is becoming increasingly common in dental offices. For these patients it is imperative to carry out careful anamnesis, as well as a multiprofessional clinical evaluation with regard to the risk and control of hemorrhagic or thromboembolic episodes. Objectives and Material and Methods. The aim is to evaluate postextraction hemorrhagic or thromboembolic episodes in patients who have been on anticoagulant medications for an uninterrupted period of 48 months. Results. Among the 108 patients evaluated, 215 extractions were performed in which there was only one case of postoperative bleeding. Warfarin was used by 98 patients; Warfarin associated with salicylic acetic acid by 9 patients and salicylic acetic acid in only 1 patient. As regards the serologic tests performed, International Normalized Ratio (INR) ranged from 0.8 to 4.9, with a mean of 3.15. Conclusion. Extractions in patients on oral anticoagulants must be performed in the least traumatic manner possible. It is not necessary to stop anticoagulant therapy to perform extractions. Local hemostasis techniques, such as obliterative sutures alone are sufficient to prevent hemorrhagic complications. PMID:21991458
Krishnamohan, Prashanth; Berger, Joseph R
Spinal epidural abscess (SEA) remains a relatively infrequent diagnosis. Staphylococcus aureus is the most common organism identified, and the infectious source in SEA emanates from skin and soft tissue infections in about 20 % of instances. The thoracic spine is most often involved followed by the lumbar spine. The classic triad of fever, spinal pain, and neurological deficit is present in but a minority of patients. The appearance of neurological deficits with SEA has a significant impact on the prognosis; therefore, early diagnosis is imperative. Magnetic resonance imaging has permitted earlier diagnosis, although significant delays in diagnosis are common due to the nonspecific symptoms that frequently attend the disorder. Due to the rarity of this condition, there have been few randomized controlled trials to evaluate new treatment strategies, and most recommendations regarding treatment are based on case series studies often derived from the experiences at a single center.
Albrecht, Valerie S; Limbago, Brandi M; Moran, Gregory J; Krishnadasan, Anusha; Gorwitz, Rachel J; McDougal, Linda K; Talan, David A
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a prevalent cause of skin and soft tissue infections (SSTI), but the association between CA-MRSA colonization and infection remains uncertain. We studied the carriage frequency at several body sites and the diversity of S. aureus strains from patients with and without SSTI. Specimens from the nares, throat, rectum, and groin of case subjects with a closed skin abscess (i.e., without drainage) and matched control subjects without a skin infection (n = 147 each) presenting to 10 U.S. emergency departments were cultured using broth enrichment; wound specimens were cultured from abscess cases. Methicillin resistance testing and spa typing were performed for all S. aureus isolates. S. aureus was found in 85/147 (57.8%) of abscesses; 49 isolates were MRSA, and 36 were methicillin-susceptible S. aureus (MSSA). MRSA colonization was more common among cases (59/147; 40.1%) than among controls (27/147; 18.4%) overall (P < 0.001) and at each body site; no differences were observed for MSSA. S. aureus-infected subjects were usually (75/85) colonized with the infecting strain; among MRSA-infected subjects, this was most common in the groin. The CC8 lineage accounted for most of both infecting and colonizing isolates, although more than 16 distinct strains were identified. Nearly all MRSA infections were inferred to be USA300. There was more diversity among colonizing than infecting isolates and among those isolated from controls versus cases. CC8 S. aureus is a common colonizer of persons with and without skin infections. Detection of S. aureus colonization, and especially MRSA, may be enhanced by extranasal site culture.
Hsieh, Chi-Hsun; Wang, Yu-Chun; Yang, Horng-Ren; Chung, Ping-Kuei; Jeng, Long-Bin; Chen, Ray-Jade
As a disease commonly encountered in daily practice, acute appendicitis is usually diagnosed and managed easily with a low mortality and morbidity rate. However, acute appendicitis may occasionally become extraordinarily complicated and life threatening. A 56-year-old man, healthy prior to this admission, was brought to the hospital due to spiking high fever, poor appetite, dysuria, progressive right flank and painful swelling of the thigh for 3 d. Significant inflammatory change of soft tissue was noted, involving the entire right trunk from the subcostal margin to the knee joint. Painful disability of the right lower extremity and apparent signs of peritonitis at the right lower abdomen were disclosed. Laboratory results revealed leukocytosis and an elevated C-reactive protein level. Abdominal CT revealed several communicated gas-containing abscesses at the right retroperitoneal region with mass effect, pushing the duodenum and the pancreatic head upward, compressing and encasing inferior vena cava, destroying psoas muscle and dissecting downward into the right thigh. Laparotomy and right thigh exploration were performed immediately and about 500 mL of frank pus was drained. A ruptured retrocecal appendix was the cause of the abscess. The patient fully recovered at the end of the third post-operation week. This case reminds us that acute appendicitis should be treated carefully on an emergency basis to avoid serious complications. CT scan is the diagnostic tool of choice, with rapid evaluation followed by adequate drainage as the key to the survival of the patient.
Kihn, Patricia W
Vital tooth whitening, when administered correctly, is by all accounts one of the safest, most conservative, least expensive, and most effective aesthetic procedures currently available to patients. This article traces the evolution of the technology, describes what is known about the mechanism of action and explores such issues as toxicology and side effects associated with tooth whitening. The article also describes the various tooth-whitening systems, which include dentist-supervised night-guard bleaching, in-office or power bleaching, and bleaching with over-the-counter bleaching products. Combination treatments and light-activated treatments are also discussed. Finally, the article summarizes the areas of research needed in this field.
Xiao, Bo-Ren; Wang, Chih-Wei; Lin, Jung-Chung; Chang, Feng-Yee
Spinal epidural abscess is a rare but potentially fatal disease. A 67-year-old female suffered fever and painful swelling of the right knee and lower leg for one week. Both synovial fluid and blood cultures yielded methicillin-sensitive Staphylococcus aureus. Low back pain developed and fever was sustained despite the administration of intravenous oxacillin. Magnetic resonance imaging (MRI) of the thoracolumbar spine revealed spinal epidural abscess from T12 to S1. Because of severe hypoalbuminemia and general anasarca and followed by exploratory laparotomy for massive duodenal bleeding, she did not receive surgical intervention for the spinal epidural abscess. After intravenous administration of oxacillin 2 g 4-hourly for 12 weeks, she recovered and follow-up MRI confirmed the efficacy of the medical treatment. She remained well at 1-year follow-up. In a patient with minimal neurological deficit or surgical contraindication, spinal epidural abscess can be successfully treated with a medical regimen.
Dimitrova, Erieta Nikolikj; Božinovikj, Ivana; Ristovska, Simona; Pejcikj, Aleksandra Hadzieva; Kolevska, Aleksandra; Hasani, Mirjeta
BACKGROUND: Charcot-Marie-Tooth (CMT) disease is a hereditary disease with signs of chronic non-progressive motor-sensory neuropathy which is characterised by symmetric muscle atrophy and weakness of the distal portion of lower extremities. AIM: The aim is to present two cases with peroneal muscular atrophy, applied rehabilitation procedures and rehabilitation outcome. MATERIAL AND METHODS: Patient DR, aged 51, and patient KH, aged 78. Both patients had weakness and pronounced atrophy of the distal portion of lower extremities, numbness down the legs, contractures in the ankles and walking difficulties. Evaluation of patients included a clinical examination, Barthel Index, Time Up and Go test, measurement of the ankle range of motion, and a manual muscle test. On admission, the Barthel Index score was 60 in the first case, and 80 in the second. The rehabilitation program included exercise therapy with for lower extremity, occupational therapy, stationary bicycle riding, galvanic current, water exercises, and ankle-foot orthoses for both legs. RESULTS: The therapy applied had no significant changes in the clinical neurological status of the patients, but yet it provided some improvement in ankle contractures, better mobility, and a more stable gait. CONCLUSION: The application of rehabilitation procedures in patients with Charcot-Marie-Tooth disease can improve their functional status and walking stability. PMID:27703571
Kaur, Paramjot; Bahl, Rashi; Kaura, Sameer; Bansal, Sumit
Introduction: Lignocaine with epinephrine as local anesthetic (LA) provides hemostasis and decreases the risk of systemic toxicity. The purpose of the present study was to investigate and compare the response of lignocaine with and without epinephrine to evaluate hemodynamic and metabolic response in normotensive and type II controlled diabetic patients. Material and Methods: A total of 50 patients (25 healthy and 25 controlled type II diabetics) undergoing multiple tooth extractions (age group of 20–80 years) were included in this prospective, randomised, clinical study. On their first visit, the patients were given 2% lignocaine HCl with 1:200,000 epinephrine, and 2% lignocaine HCl was given on the second visit, to carry out tooth extractions. Blood pressure (BP), pulse rate, oxygen saturation, and blood glucose estimations were done at definite intervals (before, immediately after, and 20 min after the administration of LA) on both the visits. Results: The increase in blood glucose concentration following the administration of 2% lignocaine HCl with 1:200,000 epinephrine was statistically significant (P < 0.05) in controlled diabetic patients. Statistically significant variability in diastolic BP (DBP) was also noted in controlled diabetic patients. Both systolic BP and DBPs were statistically significantly elevated after the administration of 2% lignocaine HCl. Conclusion: 2% lignocaine HCl with 1:200,000 epinephrine in type II diabetics and 2% lignocaine HCl should be used with caution in normotensive as well as type II controlled diabetic patients. PMID:28356688
Sneider, Erica B; Maykel, Justin A
Benign anorectal diseases, such as anal abscesses and fistula, are commonly seen by primary care physicians, gastroenterologists, emergency physicians, general surgeons, and colorectal surgeons. It is important to have a thorough understanding of the complexity of these 2 disease processes so as to provide appropriate and timely treatment. We review the pathophysiology, presentation, diagnosis, and treatment options for both anal abscesses and fistulas.
Morgan, Robert David; Hannon, Edward; Lakhoo, Kokila
A 5-year-old female with Papillon-Lefèvre syndrome presented with renal mass. A radiological diagnosis of malignancy was made; however, partial nephrectomy revealed granulomatous disease indicative of chronic infection. Although liver abscess is an emerging complication in patient with Papillon-Lefèvre syndrome, this case represents the first renal abscess described in such patients.
Lin, Yi-Tsung; Lin, Jung-Chung; Chen, Te-Li; Yeh, Kuo-Ming; Chang, Feng-Yee; Chuang, Han-Chuan; Wu, Hau-Shin; Tseng, Chih-Peng; Siu, L. Kristopher
To determine the role of gastrointestinal carriage in Klebsiella pneumoniae liver abscess, we studied 43 patients. Bacterial isolates from liver and fecal samples from 10 patients with this condition and 7 healthy carriers showed identical serotypes and genotypes with the same virulence. This finding indicated that gastrointestinal carriage is a predisposing factor for liver abscess. PMID:22840473
Pehlivanov, B; Matev, M
We report a case of a 34 years old primigravida with Charcot-Marie-Tooth disease (CMTD). The course of pregnancy was uneventful with no deterioration of symptoms due to the disease. Performed amniocentesis showed healthy fetus. Planned cesarean section with spinal anesthesia was performed because of the restricted pelvis. The possible issues of combination pregnancy and CMTD are discussed.
Snead, Malcolm L.
A team of senior scientists was formed in 2006 to create a blueprint for the regeneration of whole human teeth along with all of the supporting structure of the dentition. The team included experts from diverse fields, each with a reputation for stellar accomplishment. Participants attacked the scientific issues of tooth regeneration but, more importantly, each agreed to work collaboratively with experts from other disciplines to form a learning organization. A commitment to learn from one another produced a unique interdisciplinary and multidisciplinary team. Inspired by the Kennedy space program to send a man to the moon, with its myriad of problems and solutions that no one discipline could solve, this tooth regeneration team devised an ambitious plan that sought to use stem cell biology, engineering, and computational biology to replicate the developmental program for odontogenesis. In this manner, team members envisioned a solution that consisted of known or knowable fundamentals. They proposed a laboratory-grown tooth rudiment that would be capable of executing the complete program for odontogenesis when transplanted to a suitable host, recreating all of the dental tissues, periodontal ligament, cementum, and alveolar bone associated with the canonical tooth. This plan was designed to bring regenerative medicine fully into the dental surgery suite, although a lack of funding has so far prevented the plan from being carried out. PMID:18676799
Lin, Shih-Yi; Ho, Mao-Wang; Yang, Ya-Fei; Liu, Jiung-Hsiun; Wang, I-Kuan; Lin, Shin-Huang; Huang, Chiu-Ching
In this report, we present 3 cases of abscess caused by Citrobacter koseri. All infected patients recovered after initial empirical antibiotic treatment and percutaneous drainage of the abscess. We reviewed the literature and found 9 adult cases of C. koseri abscess. Most of these patients recovered after timely antibiotic treatment and drainage.
Yang, Chengxian; Bao, Xinjie; Liu, Xiaohai; Deng, Kan; Feng, Ming; Yao, Yong; Wang, Renzhi
Abstract Background: Rathke cleft cyst (RCC) is a rare cystic sellar entity, which is usually small in size and asymptomatic in most patients. RCC presenting panhypopituitarism and a cystic lesion with rim enhancement on magnetic resonance imaging is extremely rare. Therefore, it is easy to be misdiagnosed as pituitary abscess because of the similar clinical manifestations and neuroimaging changes. Case summary: We report a rare case of RCC masquerading as pituitary abscess clinically and radiologically with no evidence of central nervous system infection. The patient was initially suspected to be diagnosed with pituitary abscess, which was denied by the histopathological findings of RCC with no intraoperative drainage of abscess. We present an uncommon case of RCC masquerading as pituitary abscess in a 62-year-old Chinese male patient. The patient was admitted to Peking Union Medical College Hospital complaining of severe frontal pulsatile headache, visual acuity deficit, polyuria, polydipsia, and slight disturbance of consciousness. The biochemical and endocrinological examinations revealed severe hyponatremia and panhypopituitarism. Magnetic resonance imaging showed a sellar lesion with the apparent cystic change and rim enhancement. Accordingly, pituitary abscess was misdiagnosed at the beginning. The patient received hormone replacement therapy and underwent a trans-sphenoidal surgery. The surgical findings were uneventful. The histopathological examinations showed no infiltration of inflammatory cells or pus, and proved the lesion to be RCC. Conclusion: Through this rare case, we aim to emphasize that the differential diagnosis of sellar lesions requires constant vigilance and that RCC may lead to clinical and radiological changes similar with pituitary abscess. PMID:28272259
Sarangi, Susmita; Taneja, Dipali; Saxena, Bhavna
A young female having complaints of quadriparesis along with bladder and bowel involvement, diagnosed to have osseous destruction of C4, C6, C7, T2 vertebral bodies with pre- and para-vertebral abscess, was taken up for anterolateral decompression and fusion of cervical spine. She presented with anxiety, agitation, sweating and headache and was in hypertensive crisis which was refractory to antihypertensives, anxiolytics and analgesics but showed a reasonable response to intravenous dexmedetomidine and finally responded dramatically to rectal evacuation. Autonomic dysreflexia was suspected with stimulus arising from distended rectum as all other causes of hypertension were ruled out. PMID:28003699
... saved.Start OverDiagnosisYour pain may be from a FRACTURED, CRACKED or LOOSE TOOTH.Self CareSave any pieces of the tooth, wrap ... OverDiagnosisYour pain may be from TEMPOROMANDIBULAR JOINT (TMJ) syndrome, a condition that affects the jaw.Self CareTry ...
Vishwanath, A E; Sharmada, B K; Pai, Sandesh S; Nandini, Nelvigi; Roopa, Tubaki
A displaced orthodontic elastic separator was proposed as being the source of a gingival abscess that progresses to severe bone loss and exfoliation in a healthy adolescent patient with sound periodontal status prior to commencement of orthodontic treatment. After one year of undergoing orthodontic treatment, the patient presented with dull pain and mobility in the left upper permanent molar for which there was no apparent etiology. On clinical examination the patient had gingival inflammation, associated with a deep pocket and severe mobility (Grade III) in relation to the same teeth. Radiographic examination ofan Orthopantomogram (OPG) and IntraOral Periapical Radiograph (IOPAR) revealed a chronic periodontal abscess with severe necrosis of the periodontal ligament and severe alveolar bone loss. On curettage it was found that there was orthodontic elastic separator which was displaced sub gingivally. Active orthodontic forces were temporarily removed and splinting was done. 6 month follow up showed no mobility and significant improvement of alveolar bone height.
Bodem, Jens Philipp; Kargus, Steffen; Eckstein, Stefanie; Saure, Daniel; Engel, Michael; Hoffmann, Jürgen; Freudlsperger, Christian
As the most suitable approach for preventing bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients undergoing surgical tooth extraction is still under discussion, the present study evaluates the incidence of BRONJ after surgical tooth extraction using a standardized surgical protocol in combination with an adjuvant perioperative treatment setting in patients who are at high-risk for developing BRONJ. High-risk patients were defined as patients who received intravenous bisphosphonate (BP) due to a malignant disease. All teeth were removed using a standardized surgical protocol. The perioperative adjuvant treatment included intravenous antibiotic prophylaxis starting at least 24 h before surgery, a gastric feeding tube and mouth rinses with chlorhexidine (0.12%) three times a day. In the follow-up period patients were examined every 4 weeks for the development of BRONJ. Minimum follow-up was 12 weeks. In 61 patients a total number of 184 teeth were removed from 102 separate extraction sites. In eight patients (13.1%) BRONJ developed during the follow-up. A higher risk for developing BRONJ was found in patients where an additional osteotomy was necessary (21.4% vs. 8.0%; p = 0.0577), especially for an osteotomy of the mandible (33.3% vs. 7.3%; p = 0.0268). Parameters including duration of intravenous antibiotic prophylaxis, the use of a gastric feeding tube and the duration of intravenous BP therapy showed no statistical impact on the development of BRONJ. Furthermore, patients currently undergoing intravenous BP therapy showed no higher risk for BRONJ compared with patients who have paused or completed their intravenous BP therapy (p = 0.4232). This study presents a protocol for surgical tooth extraction in high-risk BP patients in combination with a perioperative adjuvant treatment setting, which reduced the risk for postoperative BRONJ to a minimum. However, the risk for BRONJ increases significantly if an additional osteotomy is necessary
Deme, Swaroopa; Mohan, KNKJ; Adiraju, Krishna Prasad; Modugu, Nageswar Rao; Chandra, Naval; Narendra, AMVR; Yadati, Sathyanarayana Raju
Introduction Splenic abscess is a rare entity with potentially life threatening complications. Sparse recent published data are available documenting the aetiological profile and management of patients with splenic abscess from India. Aim To study the clinical profile of splenic abscess. Materials and Methods We retrospectively collected data from case records of admitted patients with splenic abscesses, to Nizam’s Institute of Medical Sciences and Hospital which is a multispecialty, tertiary care referral hospital over a period of 15 months (from March 2014 to May 2015) and parameters studied were age, sex, symptoms, signs, risk factors, investigations like Ultrasound, CT scan, blood & microbiological culture, treatment and outcome. Results Most common presenting symptom was fever (90%). Mean age was 33.5 years. Five patients (55%) had risk factors like HIV, leukaemia and diabetes. From pus culture Escherichia coli was the most common organism (22%) grown. Staphylococcus saureus, Enterococcus faecium were seen in one each, blood culture grown Cryptococcus neoformans, Pseudomonas aeroginosa in one each, Plasmodium falciparum was seen on peripheral smear in one. Three were empirically treated as disseminated koch’s. Another was treated as possible infective endocarditis. All were given antimicrobials, five (55%) were treated with antimicrobials alone, three (33%) with PCD (Per Cutaneous Drainage) and one (11%) with sub-total splenectomy. All patients recovered. Conclusion With early diagnosis and increased use of ultrasound guided procedures like aspiration or drainage, spleenectomy can be avoided. Optimal treatment for splenic abscess is yet to be defined and customized to each patient. PMID:27891372
OYAMA, HIROFUMI; KITO, AKIRA; MAKI, HIDEKI; HATTORI, KENICHI; NODA, TOMOYUKI; WADA, KENTARO
ABSTRACT This study retrospectively analyzed 12 patients with brain abscesses. Half of the patients were diagnosed inaccurately in the initial stage, and 7.2 days were required to achieve the final diagnosis of brain abscess. The patients presented only with a moderately elevated leukocyte count, serum CRP levels, or body temperatures during the initial stage. These markers changed, first with an increase in the leukocyte count, followed by the CRP and body temperature. The degree of elevation tended to be less prominent, and the time for each inflammatory index to reach its maximum value tended to be longer in the patients without ventriculitis than in those with it. The causative organisms of a brain abscess were detected in 10 cases. The primary causative organisms from dental caries were Streptococcus viridians or milleri, and Fusobacterium nucleatum. Nocardia sp. or farcinica were common when the abscess was found in other regions. The primary causative organisms of unrecognized sources of infection were Streptococcus milleri and Prolionibacterium sp. Nocardia is resistant to many antibiotics. However, carbapenem, tetracycline and quinolone were effective for Nocardia as well as many other kinds of bacteria. In summary, the brain abscesses presented with only mildly elevated inflammatory markers of body temperature, leukocyte and CRP. These inflammatory markers were less obvious in the patients without ventriculitis and/or meningitis. The source of infection tended to suggest some specific primary causative organism. It was reasonable to initiate therapy with carbapenem. PMID:23092104
Rodrigues, Larycia Vicente; Moreira, Mayara dos Santos Camêlo; de Oliveira, Carla Ramos; de Medeiros, Julia Julliêta; Lima, Eufrásio de Andrade; Valença, Ana Maria Gondim
Background The most common and best known hereditary coagulopathies are hemophilia A and B followed by von Willebrand Disease. Objective This study aimed to estimate the prevalence of tooth loss and investigate its association with demographic and socioeconomic data, as well as to discuss self-reported oral morbidity and use of health services by patients with coagulopathies treated in blood centers in Paraíba, Brazil. Methods This was a quantitative cross-sectional epidemiological survey. Data was collected in the period from October 2011 to July 2012 by clinical examination and by assessing interviews using a semi-structured questionnaire. The findings were analyzed by descriptive and inferential statistics with the level of significance (α) being set at 10%. Results One hundred and six, predominantly male (88.8%), patients with coagulopathies were evaluated. The ages ranged from one to 59 years. Most patients were of mixed race (61.3%), most reported family incomes between R$ 501.00 and R$ 1500.00 (49.1%), and most had not completed elementary school (37.1%). Hemophilia A was found in 76.4% of the cases. The prevalence of dental caries among individuals was 50.0% predominantly in the 13- to 19-year-old age range (66.7%). As regards to tooth loss, teeth were missing in 35.1% of the study participants. Conclusion Tooth loss is high in this population. Males with severe hemophilia A, those who use fluoride and have a good or very good perception about their last dental appointment have a reduced chance of losing their teeth. PMID:24255614
Ramareddy, Raghu S.; Alladi, Anand
Aim: To report a series of scrotal abscess, a rare problem, their etiology, and management. Materials and Methods: A retrospective study of children who presented with scrotal abscess between January 2010 and March 2015, analyzed with respect to clinical features, pathophysiology of spread and management. Results: Eight infants and a 3-year-old phenotypically male child presented with scrotal abscess as a result of abdominal pathologies which included mixed gonadal dysgenesis (MGD) ; three anorectal malformations with ectopic ureter , urethral stricture , and neurogenic bladder ; meconium peritonitis with meconium periorchitis , ileal atresia , and intra-abdominal abscess ; posturethroplasty for Y urethral duplication with metal stenosis  and idiopathic pyocele . Transmission of the organism had varied routes include fallopian tube , urethra ejaculatory reflux , hematogenous , and the patent process of vaginalis . Two of the nine required extensive evaluation for further management. Treating the predisposing pathology resolved scrotal abscesses in eight of nine patients, one of whom, required vasectomy additionally. Idiopathic pyocele responded to needle aspiration and antibiotics. Conclusion: Scrotal abscess needs a high index of suspicion for predisposing pathology, especially in infants. Laparoscopy is safe and effective in the management of the MGD and ectopic ureter. PMID:27695207
Waldbaur, H; Thierauf, P
On the basis of 6 cases of late cerebral abscesses after lesions caused by shell-splinters treated by us, clinic, diagnostics and therapy of this complication are discussed in detail. In 3 patients there were no direct relations between the splinters and the abscesses so that further factors (age, vascular wall changes, and the like) must play a role in the formation of the abscesses; such vascular wall fibroses were found histologically in 3 of the examined abscess capsules. In 3 cases the bacteriological identification of the pathogens was possible. The treatment was carried out by employing puncture or extirpation or the combination of the two methods.
Dimofte, Gabriel; Dubei, Liviu; Lozneanu, Lili-Gabriela; Ursulescu, Corina; Grigora Scedil, Mihai
Acute appendicitis represents one of the most frequent abdominal emergencies encountered in everyday surgical practice. Local infectious complications are not unusual and retroperitoneal abscesses after acute retrocaecal appendicitis have been previously described. The authors present the case of a 22-years-young female patient, admitted for a right iliac fossa abscess, secondary to gangrenous appendicitis. A right adrenal mass 35/40 mm was revealed during preoperative ultrasound evaluation, which evolved in an adrenal abscess that spontaneously drained 10 days after appendectomy and retrocecal drainage. Adrenal abscesses are exceptionally rare, with only a few cases being reported in the literature, but none of these after acute appendicitis.
Significant advances in the diagnosis and management of bacterial brain abscess over the past several decades have improved the expected outcome of a disease once regarded as invariably fatal. Despite this, intraparenchymal abscess continues to present a serious and potentially life-threatening condition. Brain abscess may result from traumatic brain injury, prior neurosurgical procedure, contiguous spread from a local source, or hematogenous spread of a systemic infection. In a significant proportion of cases, an etiology cannot be identified. Clinical presentation is highly variable and routine laboratory testing lacks sensitivity. As such, a high degree of clinical suspicion is necessary for prompt diagnosis and intervention. Computed tomography and magnetic resonance imaging offer a timely and sensitive method of assessing for abscess. Appearance of abscess on routine imaging lacks specificity and will not spare biopsy in cases where the clinical context does not unequivocally indicate infectious etiology. Current work with advanced imaging modalities may yield more accurate methods of differentiation of mass lesions in the brain. Management of abscess demands a multimodal approach. Surgical intervention and medical therapy are necessary in most cases. Prognosis of brain abscess has improved significantly in the recent decades although close follow-up is required, given the potential for long-term sequelae and a risk of recurrence. PMID:25360205
Kollert, Sina; Rukoyatkina, Natalia; Sturm, Julia; Gambaryan, Stepan; Stellzig-Eisenhauer, Angelika; Meyer-Marcotty, Philipp; Eigenthaler, Martin; Wischmeyer, Erhard
Aim Primary failure of tooth eruption (PFE) is causally linked to heterozygous mutations of the parathyroid hormone receptor (PTH1R) gene. The mutants described so far lead to exchange of amino acids or truncation of the protein that may result in structural changes of the expressed PTH1R. However, functional effects of these mutations have not been investigated yet. Materials and Methods In HEK293 cells, PTH1R wild type was co-transfected with selected PTH1R mutants identified in patients with PFE. The effects on activation of PTH-regulated intracellular signaling pathways were analyzed by ELISA and Western immunoblotting. Differential effects of wild type and mutated PTH1R on TRESK ion channel regulation were analyzed by electrophysiological recordings in Xenopus laevis oocytes. Results In HEK293 cells, activation of PTH1R wild type increases cAMP and in response activates cAMP-stimulated protein kinase as detected by phosphorylation of the vasodilator stimulated phosphoprotein (VASP). In contrast, the PTH1R mutants are functionally inactive and mutant PTH1R/Gly452Glu has a dominant negative effect on the signaling of PTH1R wild type. Confocal imaging revealed that wild type PTH1R is expressed on the cell surface, whereas PTH1R/Gly452Glu mutant is mostly retained inside the cell. Furthermore, in contrast to wild type PTH1R which substantially augmented K+ currents of TRESK channels, coupling of mutated PTH1R to TRESK channels was completely abolished. Conclusions PTH1R mutations affect intracellular PTH-regulated signaling in vitro. In patients with primary failure of tooth eruption defective signaling of PTH1R mutations is suggested to occur in dento-alveolar cells and thus may lead to impaired tooth movement. PMID:27898723
... management of impacted teeth. In: Hupp JR, Ellis E, Tucker MR, eds. Contemporary Oral and Maxillofacial Surgery . 6th ed. St. Louis, MO: Elsevier Mosby; 2014:chap 9. Read More Abscess Review Date 2/22/2016 Updated by: Michael Kapner, DDS, general and aesthetic dentistry, Norwalk Medical ...
Jorge, Jannaina F.; Costa, Andressa B. V.; Rodrigues, Jorge L. N.; Girão, Evelyne S.; Luiz, Roberta S. S.; Sousa, Anastácio Q.; Moore, Sean R.; Menezes, Dalgimar B.; Leitão, Terezinha M. J. S.
Pyogenic liver abscesses caused by Salmonella enterica serotype Typhi, although rare, can occur especially in patients with pre-existing hepatobiliary disease, hepatocellular carcinoma, and metastatic liver tumors. We present a case of Salmonella liver abscesses complicating metastatic melanoma in a 24-year-old alcoholic male. PMID:24591434
Maines, Evelina; Franceschi, Roberto; Cauvin, Vittoria; d’Annunzio, Giuseppe; Pini Prato, Alessio; Castagnola, Elio; Di Palma, Annunziata
Key Clinical Message Iliopsoas abscesses have been reported in adult diabetic patients, but only one case has been so far reported in the pediatric diabetic literature. We report three cases of iliopsoas abscesses in three adolescents with type 1 diabetes mellitus, suggesting that an increased awareness of this condition is required for its early recognition and prompt treatment. PMID:26273460
Smith, Chez; Kavar, Bhadrakant
A spinal epidural abscess is a neurosurgical emergency. Successful treatment frequently requires decompression of the spinal canal in combination with intravenous antibiotics. We report a patient with Crohn's disease who developed an extensive spinal epidural abscess communicating with an intra-abdominal collection.
Koyama, Shinsuke; Hirota, Masaki; Kobayashi, Masaki; Tanaka, Yusuke; Kubota, Satoshi; Nakamura, Ryo; Isobe, Masanori; Shiki, Yasuhiko
Anorectal symptoms and complaints caused by hemorrhoids or anal fissures are common during pregnancy. It is known that one-third of pregnant women complain of anal pain in the third trimester. Anal pain may be caused by a wide spectrum of conditions, but if it begins gradually and becomes excruciating within a few days it may indicate anorectal abscess. We experienced a case of anorectal abscess during pregnancy which was diagnosed by magnetic resonance imaging and treated by incision and seton drainage at 36 weeks of gestation, followed by a normal spontaneous delivery at 38 weeks of gestation. To our knowledge, this is the first case report of anorectal abscess during pregnancy in the English-language published work. The clinical course of our case and clinical considerations of anorectal abscesses are discussed.
Berne, T V; Donovan, A J
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.
Şenol, Özgür; Süslü, Hikmet Turan; Tatarlı, Necati; Tiryaki, Mehmet; Güçlü, Bülent
Streptococcus constellatus is a microorganism that lives commensally in the oropharyngeal region, urogenital region, and intestinal tract. However, it can cause infection in patients with certain predisposing factors. Rarely, this microorganism can cause a brain abscess. Thalamic localization of brain abscesses is much rarer than abscesses in other locations of the brain. Brain abscess caused by streptococcus constellatus are very rarely been reported in the literature. We present a rare case of a left-sided thalamic abscess caused by streptococcus constellatus in a 25-year-old male patient who was injured by shrapnel pieces in the head and who was malnourished. The patient was successfully treated by stereotactic aspiration and antibiotherapy. PMID:27800109
Couloigner, Vincent; Sterkers, Olivier; Redondo, Aimée; Rey, Alain
This retrospective study analyzed 29 cerebral abscesses of ear, nose, and throat (ENT) origin. The mean follow-up of patients was 37 months. ENT etiologies included 45% otitis media (n = 13), 48% sinusitis (n = 14), and 7% ethmoidal sinus tumors (n = 2). Thirty-eight percent (n = 5) of otogenic abscesses occurred within 15 days after a mastoidectomy. Sinogenic abscesses were never due to surgery but were associated in 31% of cases (n = 5) with anterior skull base defects. The main locations of otogenic abscesses were the temporal lobe (54%; n = 7) and the cerebellum (23%; n = 3), whereas sinogenic abscesses were located in the frontal lobe in 75% of cases (n = 12). Because of this location, sinogenic abscesses were less symptomatic than otogenic ones and had greater size and encapsulation at the time of diagnosis. Thus, they required longer antibiotic treatment (p = 0.05) and more numerous surgical drainages (p = 0.02). Bacteriologic abscesses samples were positive in 90% of cases. Bacteria found in brain abscesses were different from the ones found in ENT samples in 62% of cases. Thus, the results of ENT bacteriologic samples were not helpful for choosing adequate antibiotic agents in case of negative brain abscess samples. Although mortality was not significantly higher in otogenic abscesses (31%; n = 4) than in sinogenic ones (6%; n = 1, p = 0.08), otogenic abscesses appeared more threatening. Indeed, they represented 80% (n = 4) of lethal cases and encompassed more clinical or radiological prognosis pejorative factors than sinogenic ones (p = 0.006). In conclusion, higher danger of otogenic abscesses mainly resulted both from their temporal or cerebellous locations and from the bacteria that were more frequently resistant to antibiotics. PMID:17171060
Byrd, B.F. III; Weiner, M.H.; McGee, Z.A.
A spinal epidural abscess developed in a renal transplant recipient; results of a serum radioimmunoassay for Aspergillus antigen were positive. Laminectomy disclosed an abscess of the L4-5 interspace and L-5 vertebral body that contained hyphal forms and from which Aspergillus species was cultured. Serum Aspergillus antigen radioimmunoassay may be a valuable, specific early diagnostic test when systemic aspergillosis is a consideration in an immunosuppressed host.
Ellanti, P; Morris, S
Spinal epidural abscess is an uncommon entity, the frequency of which is increasing. They occur spontaneously or as a complication of intervention. The classical triad of fever, back pain and neurological symptoms are not always present. High index of suspicion is key to diagnosis. Any delay in diagnosis and treatment can have significant neurological consequences. We present the case of a previously well man with a one month history of back pain resulting from an epidural abscess.
van Bijsterveld, O P
Central corneal abscess developed in the experimental animal after inoculation of biologically active staphylococcal strains in a paracentral epithelial lesion of the cornea. These abscesses did not ulcerate, developed only with high inocula, occurred more frequently in immunized rabbits. A serpiginous type of ulceration did not develop at the site of the initial epithelial lesion nor at any other place in the cornea. Histologically, the lesions consisted of densely packed polymorphonuclear leukocytes between the corneal lamellae.
Satoh, H; Matsuyama, S; Mashima, H; Imoto, A; Hidaka, K; Hisatsugu, T
We describe a rare case of gas-containing pyogenic liver abscess which penetrated the adjacent colon, forming a hepatocolic fistula, after percutaneous transhepatic abscess drainage (PTAD) had been performed. To the best of our knowledge, this is the first report of hepatocolic fistula associated with a gas-forming liver abscess in a diabetic patient, with radiological and surgical confirmation of the fistula.
Zhu, Min; Liu, Chao; Ren, Shuangshuang; Lin, Zintong; Miao, Leiying; Sun, Weibin
Gemination or fusion is a rare occurrence in the mandibular posterior teeth. The aim of this article is to describe the problems encountered and the strategy employed in treating such cases. A 34 years old patient came with the complaint of spontaneous and radiating pain in the right mandibular posterior region. The tooth in concern was an anomalous ‘double’ second mandibular molar diagnosed as having necrotic pulp with chronic apical abscess of endodontic origin. The present case emphasizes the importance of identifying anatomical anomalies during treatment of fused teeth with supernumerary tooth, and the need for the use of advanced imaging modalities like CBCT which is a critical aid in the diagnosis of such cases. Fused teeth can be managed quite efficiently by an overall combined treatment including both endodontic and periodontal therapy. PMID:26550101
Capello, V; Lennox, A
A two-year-old guinea pig presented for difficulty chewing. Examination and diagnostic imaging, including computed tomography and magnetic resonance, revealed an odontogenic retromasseteric abscess associated with a mandibular cheek tooth. Treatment included removal of the abscess and marsupialisation of the surgical site for repeated debridement and healing by second intention. Unique features of this case included the use of advanced diagnostic imaging and utilisation of marsupialisation for surgical correction.
Clancy, U; Ronayne, A; Prentice, M B; Jackson, A
We describe the rare occurrence of an Actinomyces meyeri cerebral abscess in a 55-year-old woman following a dental extraction. This patient presented with a 2-day history of hemisensory loss, hyper-reflexia and retro-orbital headache, 7 days following a dental extraction for apical peridonitis. Neuroimaging showed a large left parietal abscess with surrounding empyema. The patient underwent craniotomy and drainage of the abscess. A. meyeri was cultured. Actinomycosis is a rare cause of cerebral abscess. The A. meyeri subtype is particularly rare, accounting for less than 1% of specimens. This case describes an unusually brief course of the disease, which is usually insidious. Parietal lobe involvement is unusual as cerebral abscesses usually have a predilection for the frontal and temporal regions of the brain. Although there are no randomised trials to guide therapy, current consensus is to use a prolonged course of intravenous antibiotics, followed by 6–12 months of oral therapy. PMID:25870213
Kirmeier, R; Truschnegg, A; Payer, M; Malyk, J; Daghighi, S; Jakse, N
Teeth exceeding the normal dental complement that have erupted into the nasal cavity are a rare pathological entity. This case report describes a female patient with recurrent complaints and fetid discharge from the left nasal cavity. The suspected clinical diagnosis of a supernumerary nasal tooth was confirmed by computed tomography. After endoscopic removal, the tooth was examined using X-ray microtomography and thin-section preparations; these findings are presented for the first time. A literature search identified 25 supernumerary nasal teeth in 23 patients.
van der Linden, Marleen H; van der Linden, Saskia C; Hendricks, Henk T; van Engelen, Baziel G M; Geurts, Alexander C H
In order to determine the influence of somatosensory impairments, due to the loss of large myelinated fibres, on the postural stability of Charcot-Marie-Tooth 1A (CMT) patients, a cross-sectional balance assessment was done. Nine CMT patients were compared with eight patients with a distal type of Spinal Muscular Atrophy (SMA), and 11 healthy control subjects. The balance assessment consisted of four tasks: quiet barefoot standing on a stable versus compliant surface, with eyes opened or closed. Force plate signals were used to calculate the velocity of the centre of pressure of the ground reaction forces. The patients' distal muscle force (MRC scale), vibration detection threshold (Rydel-Seiffer tuning fork) and superficial tactile sensation (Semmes-Weinstein monofilaments) were clinically assessed. Compared to the healthy subjects, postural stability of both patient groups was seriously impaired, however, increased visual dependency was only found in the CMT patients. The postural instability of the CMT patients correlated significantly with decreased vibration sense only. The strength of the correlation increased with task complexity. It is concluded that somatosensory deficits substantially contribute to impaired postural stability and increased visual dependency in CMT patients.
Bissar-Tadmouri, N; Parman, Y; Boutrand, L; Deymeer, F; Serdaroglu, P; Vandenberghe, A; Battaloglu, E
The major Charcot- Marie-Tooth Type 1 (CMT1) locus, CMT1A, and Hereditary neuropathy with liability to pressure palsies (HNPP) cosegregate with a 1.5-Mb duplication and a 1.5-Mb deletion, respectively, in band 17p11.2. Point mutations in peripheral myelin gene 22 (PMP22), myelin protein zero (MPZ), and connexin 32 (Cx32) have been reported in CMT1, and in PMP22 in HNPP patients without deletion. We have screened 54 CMT1 patients, of variable clinical severity, and 25 HNPP patients from Turkey, with no duplication or deletion, for mutations in the PMP22 and Cx32 genes. A novel frameshift mutation affecting the second extracellular domain of PMP22 was found in an HNPP patient, while a point mutation in the second transmembrane domain of the protein was detected in a CMT1 patient. Two point mutations affecting different domains of Cx32 were identified in two CMTX patients. Another patient was found to carry a polymorphism in a non-conserved codon of the Cx32 gene. The clinical phenotypes of the patients correlate well with the effect of the mutation on the protein.
Matsubayashi, Tadashi; Matsubayashi, Rie; Saito, Isamu; Tobayama, Shigeo; Machida, Hiromichi
We report a 20-month-old girl with splenic abscess. The patient was admitted to our hospital because of persistent high fever and abdominal pain. Laboratory data showed leucocytosis and elevated C-reactive protein levels. Abdominal computed tomography showed multiple low-density lesions in the spleen. These findings were consistent with a diagnosis of splenic abscess. She was successfully treated with ultrasonographically guided percutaneous drainage for 11 days and intravenous antibiotic for 17 days. On culture, aspirated fluid from the abscess grew Streptococcus intermedius. This case illustrates that the differential diagnosis of unknown-focus infection in infants should include splenic abscess. We recommend conservative therapy (antibiotics and drainage) as first-line therapy for splenic abscess in pediatric patients, based on the importance of the immunological functions of the spleen.
Kawakami, Shigehisa; Kumazaki, Yohei; Manda, Yosuke; Oki, Kazuhiro; Minagi, Shogo
Aim The role of parafunctional masticatory muscle activity in tooth loss has not been fully clarified. This study aimed to reveal the characteristic activity of masseter muscles in bite collapse patients while awake and asleep. Materials and Methods Six progressive bite collapse patients (PBC group), six age- and gender-matched control subjects (MC group), and six young control subjects (YC group) were enrolled. Electromyograms (EMG) of the masseter muscles were continuously recorded with an ambulatory EMG recorder while patients were awake and asleep. Diurnal and nocturnal parafunctional EMG activity was classified as phasic, tonic, or mixed using an EMG threshold of 20% maximal voluntary clenching. Results Highly extended diurnal phasic activity was observed only in the PBC group. The three groups had significantly different mean diurnal phasic episodes per hour, with 13.29±7.18 per hour in the PBC group, 0.95±0.97 per hour in the MC group, and 0.87±0.98 per hour in the YC group (p<0.01). ROC curve analysis suggested that the number of diurnal phasic episodes might be used to predict bite collapsing tooth loss. Conclusion Extensive bite loss might be related to diurnal masticatory muscle parafunction but not to parafunction during sleep. Clinical Relevance: Scientific rationale for study Although mandibular parafunction has been implicated in stomatognathic system breakdown, a causal relationship has not been established because scientific modalities to evaluate parafunctional activity have been lacking. Principal findings This study used a newly developed EMG recording system that evaluates masseter muscle activity throughout the day. Our results challenge the stereotypical idea of nocturnal bruxism as a strong destructive force. We found that diurnal phasic masticatory muscle activity was most characteristic in patients with progressive bite collapse. Practical implications The incidence of diurnal phasic contractions could be used for the prognostic
Okano, Hiroshi; Shiraki, Katsuya; Inoue, Hidekazu; Kawakita, Tomoyuki; Yamamoto, Norihiko; Deguchi, Masatoshi; Sugimoto, Kazushi; Sakai, Takahisa; Ohmori, Shigeru; Murata, Kazumoto; Nakano, Takeshi
Currently, pyogenic liver abscess is not frequent, but it is a severe infectious disease. However a strategy for the effective treatment of liver abscess is not established. We analyzed 75 cases of liver abscess over an eight year period and evaluated their prognosis, any associated underlying disease, or the effect of percutaneous transhepatic abscess drainage (PTAD). For all 75 cases, laboratory data were analyzed and imaging studies were performed. Next, PTAD and antibiotic administration were started on these cases as first choice treatments. These treatments were continued until the laboratory data of the patient were restored to within the normal range. Those cases that were PTAD non-effective or required operation for underlying diseases, underwent operations. Of the total 75 cases, 63 survived after treatment and 12 cases died. Bacteria were detected in 50 cases and Klebsiella pneumoniae was detected in 31 of these 50 cases, but 25 out of 75 cases were negative. The biliary system was the main route of infection. PTAD was effective, especially in cases that were complicated with disseminated intravascular coagulation (DIC) or acute renal failure (ARF). PTAD is an effective treatment for liver abscess, it is especially useful in the restoration of severe general conditions as indicated by this study.
Viani, R M; Bromberg, K; Bradley, J S
Obturator internus muscle (OIM) abscess is an uncommon entity often mistaken for septic arthritis of the hip. We describe seven children with OIM abscess and review seven previously reported cases. The most common presenting symptoms were hip or thigh pain (14 patients), fever (13), and limp (13). The hip was flexed, abducted, and externally rotated in 11 patients. Magnetic resonance imaging and computed tomography (CT) were diagnostic for OIM abscess in the 14 patients. Associated abscesses were located in the obturator externus muscle (5 patients), psoas muscle (2), and iliac muscle (1). The etiologic agents were Staphylococcus aureus (8 patients), Streptococcus pyogenes (2), Neisseria gonorrhoeae (2), and Enterococcus faecalis (1). Three patients underwent CT-guided percutaneous drainage, and three had surgical drainage. Three patients had ischial osteomyelitis in addition to OIM abscess. The 11 children with uncomplicated OIM abscess were treated for a median of 28 days. All patients had an uneventful recovery.
Antunes, Héliton-Spíndola; Ferreira, Elza-Maria de Sá; de Faria, Lúcia-Maria-Dias; Schirmer, Marcelo; Rodrigues, Pedro-Carvalho; Small, Isabele-Avila; Colares, Marta; Bouzas, Luis-Fernando-da Silva; Ferreira, Carlos-Gil
A retrospective evaluation of 73 consecutive recipients of hematopoietic stem cell transplantation (HSCT) was conducted to investigated the role of oral care and incidence of streptococcal bacteremia in patients submitted to hematopoietic stem cell transplantation. Patients were retrospectively evaluated and divided into group A (GA=38) and group B (GB=35). During hospitalization patients from GA performed oral hygiene daily with extra soft toothbrush and toothpaste besides performing mouth cleaning with an ethanol-free 0.12% chlorhexidine solution tree times a day. In contrast GB patients performed mouth cleaning with extra soft toothbrush and toothpaste, but no chlorhexidine was used. Using the Chi square test it was observed that all patients from GA presented negative blood culture for alpha-hemolytic Streptococcus viridans and Candida albicans and only 1 patient without oral mucositis from GB presented positive blood cultures for Streptococcus intermedius (p=0.48). The results indicate that methodology used for oral care before the HSCT and the practice of tooth brushing during the period were effective in preventing streptococcal bacteremia. Moreover, our data suggest that the mouth cleaning with chlorhexidine during HSCT may be not mandatory.
Chen, Pai-L; Chiang, C-W; Shiao, C-C
The authors reported a 56-year-old man with progressive pain over left bottom of oral cavity involving tongue for 3 days. He had a puncture history of tongue by fishbone, which was immediately removed 3 weeks ago. The subsequent contrast-enhanced computed tomography scan of neck disclosed an abscess formation with a faint linear radiopaque material inside, consisting with remnant fishbone retention. The patient was treated conservatively with intravenous antibiotics, followed by an uneventful course during subsequent follow-up for more than 9 months until now. Tongue abscess is a rare but potentially life threatening clinical entity. Foreign body puncture-related tongue abscess should be listed as a differential diagnosis in cases with acute tongue swelling.
Chen, Pai-Lien; Chiang, Ching-Wen; Shiao, Chih-Chung
The authors reported a 56-year-old man with progressive pain over left bottom of oral cavity involving tongue for 3 days. He had a puncture history of tongue by fishbone, which was immediately removed 3 weeks ago. The subsequent contrast-enhanced computed tomography scan of neck disclosed an abscess formation with a faint linear radiopaque material inside, consisting with remnant fishbone retention. The patient was treated conservatively with intravenous antibiotics, followed by an uneventful course during subsequent follow-up for more than 9 months until now. Tongue abscess is a rare but potentially life threatening clinical entity. Foreign body puncture-related tongue abscess should be listed as a differential diagnosis in cases with acute tongue swelling.
Tomasetti, Patrick; Kuttenberger, Johannes; Bassetti, Renzo
Subcutaneous emphysema is a rare complication in oral surgery. In most cases, it resolves spontaneously. However, air might disperse into deeper facial spaces causing life-threatening complications such as compression of the tracheobronchial tree or the development of pneumomediastinum. Moreover, microorganisms might spread from the oral cavity into deeper spaces. Hence, rapid diagnosis of subcutaneous emphysema is important. Characteristic signs are both a shiftable swelling and crepitation. In this case report, a 30-year-old man, suffering from the Gilles de la Tourette Syndrome, with a distinct subcutaneous emphysema after bilateral surgical wisdom tooth extraction is presented. Induced by a specific motor tic, air accumulated from the periorbital through to the parapharyngeal region. Applying a 10-cm-long Redon drainage tube as air valve, 10 days after wisdom teeth extraction, the patient was asymptomatic with complete resolution of the emphysema. PMID:26077530
García Galera, A; Martínez León, M I; Pérez da Rosa, S; Ros López, B
A dermal sinus is a congenital defect arising from a closure failure of the neural tube that results in different degrees of communication between the skin and the central nervous system. A dermal sinus can occur anywhere from the root of the nose to the conus medullaris, and the occipital location is the second most common. Dermal sinuses are often found in association with dermoid or epidermoid cysts and less frequently with teratomas. Patients with an occipital dermoid cyst associated with a dermal sinus can develop meningitis and/or abscesses as the first clinical manifestation of the disease due to the dermoid cyst itself becoming abscessed or to the formation of secondary abscesses; few cases of the formation of secondary abscesses have been reported. We present a case of a dermoid cyst associated with an infected dermal sinus and posterior development of cerebellar abscesses and hydrocephalus.
Gupta, Monica; Sharma, Alka; Singh, Ram; Lehl, S S
Liver abscess is a common pathology in the Indian subcontinent and usually results from amoebic or bacterial infection. Pyogenic abscesses usually occur in those with underlying predisposing factors like intra-abdominal infections, biliary infections or comorbidities like malignancy, immunosuppression, diabetes mellitus and previous biliary surgery or interventional endoscopy. Citrobacter is an unusual cause of pyogenic liver abscess and may occur in the setting of underlying comorbidities. We report a 56-year-old man with diabetes (operated for periampullary carcinoma 20 years ago), who presented with a history of fever for 1 week and on evaluation was found to have Citrobacter koseri-related hepatic abscess. The patient was managed with parenteral antibiotics, repeated aspiration of liver abscess and pigtail drainage.
Monini, André da Costa; Guimarães, Murilo de Sousa; Gandini Júnior, Luiz Gonzaga; Santos-Pinto, Lourdes; Hebling, Josimeri
This article reports the case of a 12-year-old patient with tooth extrusion, pain, gingival bleeding, and localized periodontitis near the maxillary second premolar. Despite probing and radiographic examination, it was not possible to establish the etiology. Tooth extraction was indicated because of the severe tooth mobility and extrusion. Curettage of the tooth socket revealed a rubber separator. Preventive approaches are suggested to avoid iatrogenesis and legal problems.
Tonziello, Gilda; Valentinotti, Romina; Arbore, Enrico; Cassetti, Paolo; Luzzati, Roberto
Patient: Male, 73 Final Diagnosis: Salmonella typhimurium abscess of the chest wall Symptoms: — Medication: Ciprofloxacin Clinical Procedure:— Specialty: Infectious Diseases Objective: Unusual clinical course Background: Non-typhoid Salmonella extra-intestinal infections usually develop in infants and in adult patients with pre-existing predisposing conditions. Blood stream infections and urinary tract infections are the most common clinical presentations, but other sites of infection may be involved as well. Case Report: We describe a case of invasive salmonellosis caused by Salmonella typhimurium involving the chest wall in a 73-year-old man. The patient had suffered from gastroenteritis followed by left basal pneumonia with pleural effusion 7 weeks before. The CT scan of the chest wall showed a pericostal abscess with shirt-stud morphology near the left last cartilaginous arch. The abscess was surgically drained and patient was cured after a 40-day ciprofloxacin treatment. Conclusions: A review of the literature on extra-intestinal non-typhoid salmonellosis shows that pleuropulmonary and soft-tissue infections are uncommon. We argue that non-typhoid Salmonella might be considered as a possible cause of chest wall abscess in individuals with recent history of gastroenteritis complicated by pneumonia and pleural effusion. PMID:24298305
Grisold, Andrea J; Hoenigl, Martin; Leitner, Eva; Jakse, Klaus; Feierl, Gebhard; Raggam, Reinhard B; Marth, Egon
Mycoplasma salivarium preferentially resides in the human oral cavity. Unlike other Mycoplasma species, M. salivarium has not been regarded as a pathogen, although one case of M. salivarium-caused arthritis in a patient with hypogammaglobulinemia has been reported. We describe the first case of submasseteric abscess caused by M. salivarium.
Escobar, A; Del Brutto, O H
A report is presented of a patient with cerebral mucormycosis without rhinosinusal or systemic evidence of the disease. The predisposing condition was drug-induced immunosuppression. Computed tomography (CT) showed focal areas of abnormal enhancement which correlated with necropsy findings of localised parenchymal brain damage; this represented encapsulated brain abscesses, a rare form of presentation of cerebral mucormycosis. Images PMID:2351973
Surgically assisted rapid mandibular expansion is a contemporary treatment alternative to enable genuine skeletal mandibular widening. Mandibular widening via a tooth-borne distractor is a practical and noninvasive clinical approach. Recently, to expand and protract the maxilla, the alternate rapid maxillary expansion-and-constriction procedure was suggested. In this case report, we describe a female patient (12 years 7 months old) having severe maxillary and mandibular crowding who underwent repeated alternate rapid maxillary expansion and constriction in combination with tooth-borne symphyseal distraction osteogenesis.
Kodama, Koichi; Takase, Yasukazu; Motoi, Isamu; Mizuno, Hideki; Goshima, Kenichi; Sawaguchi, Takeshi
Despite improved diagnostic modalities for psoas abscesses, the optimum management strategy is not uniform. A 67-year-old man presented with bilateral psoas abscesses secondary to L1-L2 pyogenic discitis. On contrast-enhanced CT, the largest of these abscesses measured 13 × 14 × 33 mm on the right. The patient developed sepsis caused by Klebsiella pneumonia. There were no signs of improvement after 3 weeks of systematic antibiotic administration. We performed surgical drainage of bilateral psoas abscesses by retroperitoneoscopy. Intraoperative laparoscopic ultrasound was useful to determine abscess location in the muscles prior to drainage and confirm no residual abscesses after drainage. The patient was afebrile 3 days later, and his clinical symptoms resolved. Retroperitoneoscopic drainage may represent a feasible minimally invasive therapeutic option for psoas abscess, and intraoperative laparoscopic ultrasound has the potential to increase the safety and efficacy of this surgical procedure.
Levy, R.M.; Gutin, P.H.; Baskin, D.S.; Pons, V.G.
A 56-year-old man developed an abscess within a right parietal cystic anaplastic astrocytoma 3 days after removal of iodine-125 sources placed 9 days earlier for interstitial radiation therapy. After treatment with cephalosporin antibiotics proved unsuccessful, the patient was treated with intravenous vancomycin and intermittent percutaneous drainage of the abscess. Vancomycin levels obtained from the brain abscess fluid, both before and during later operative removal of the abscess, were 15 and 18 micrograms/ml, respectively; the serum vancomycin level was 21 micrograms/ml. This is the first report of the excellent penetration of vancomycin into brain abscess fluid.
Hibberd, Christine E; Nguyen, Trang D
A primary molar dental abscess was implicated as the cause of a brain abscess in an 11-year-old boy. This case report describes the neurological signs and symptoms, and acute management of a brain abscess in a child. A brain abscess is provisionally diagnosed from the patient's medical history, as well as the presence of signs and symptoms such as fever, headache, nausea, vomiting, focal neurological deficit, altered mentation, speech alterations, papillary edema, and neck stiffness or seizures. A definitive diagnosis of brain abscess is confirmed through imaging. The dental source of infection is identified by the exclusion of more probable foci such as the ears, heart, lungs, eyes or sinuses.
Memon, Kashif A; Cleveland, Kerry O; Gelfand, Michael S
Although brain abscesses are frequently cryptogenic in origin, bacteria must reach the brain either by direct or hematogenous spread. Right-to-left shunts, caused either by intrapulmonary vascular malformations or congenital heart defects, may allow microorganisms to evade the normal host defenses in the lungs and lead to development of brain abscesses. Two patients recently presented with brain abscesses and were found to have conditions associated with right-to-left shunts. The diagnosis of brain abscess should prompt the clinician to consider right-to-left shunts as a possible predisposing condition for brain abscess.
Brennan, Kathryn M.; Bai, Yunhong; Pisciotta, Chiara; Wang, Suola; Feely, Shawna M.E.; Hoegger, Mark; Gutmann, Laurie; Moore, Steven A.; Gonzalez, Michael; Sherman, Diane L.; Brophy, Peter J.; Züchner, Stephan; Shy, Michael E.
Using exome sequencing in an individual with Charcot-Marie-Tooth disease (CMT) we have identified a mutation in the X-linked dystrophin-related protein 2 (DRP2) gene. A 60-year-old gentleman presented to our clinic and underwent clinical, electrophysiological and skin biopsy studies. The patient had clinical features of a length dependent sensorimotor neuropathy with an age of onset of 50 years. Neurophysiology revealed prolonged latencies with intermediate conduction velocities but no conduction block or temporal dispersion. A panel of 23 disease causing genes was sequenced and ultimately was uninformative. Whole exome sequencing revealed a stop mutation in DRP2, c.805C>T (Q269*). DRP2 interacts with periaxin and dystroglycan to form the periaxin-DRP2-dystroglycan complex which plays a role in the maintenance of the well-characterized Cajal bands of myelinating Schwann cells. Skin biopsies from our patient revealed a lack of DRP2 in myelinated dermal nerves by immunofluorescence. Furthermore electron microscopy failed to identify Cajal bands in the patient's dermal myelinated axons in keeping with ultrastructural pathology seen in the Drp2 knockout mouse. Both the electrophysiologic and dermal nerve twig pathology support the interpretation that this patient's DRP2 mutation causes characteristic morphological abnormalities recapitulating the Drp2 knockout model and potentially represents a novel genetic cause of CMT. PMID:26227883
Brennan, Kathryn M; Bai, Yunhong; Pisciotta, Chiara; Wang, Suola; Feely, Shawna M E; Hoegger, Mark; Gutmann, Laurie; Moore, Steven A; Gonzalez, Michael; Sherman, Diane L; Brophy, Peter J; Züchner, Stephan; Shy, Michael E
Using exome sequencing in an individual with Charcot-Marie-Tooth disease (CMT) we have identified a mutation in the X-linked dystrophin-related protein 2 (DRP2) gene. A 60-year-old gentleman presented to our clinic and underwent clinical, electrophysiological and skin biopsy studies. The patient had clinical features of a length dependent sensorimotor neuropathy with an age of onset of 50 years. Neurophysiology revealed prolonged latencies with intermediate conduction velocities but no conduction block or temporal dispersion. A panel of 23 disease causing genes was sequenced and ultimately was uninformative. Whole exome sequencing revealed a stop mutation in DRP2, c.805C>T (Q269*). DRP2 interacts with periaxin and dystroglycan to form the periaxin-DRP2-dystroglycan complex which plays a role in the maintenance of the well-characterized Cajal bands of myelinating Schwann cells. Skin biopsies from our patient revealed a lack of DRP2 in myelinated dermal nerves by immunofluorescence. Furthermore electron microscopy failed to identify Cajal bands in the patient's dermal myelinated axons in keeping with ultrastructural pathology seen in the Drp2 knockout mouse. Both the electrophysiologic and dermal nerve twig pathology support the interpretation that this patient's DRP2 mutation causes characteristic morphological abnormalities recapitulating the Drp2 knockout model and potentially represents a novel genetic cause of CMT.
Li, Li-Xi; Zhao, Shao-Yun; Liu, Zhi-Jun; Ni, Wang; Li, Hong-Fu; Xiao, Bao-Guo; Wu, Zhi-Ying
Charcot-Marie-Tooth (CMT) disease is the most common hereditary peripheral neuropathy. More than 50 causative genes have been identified. The lack of genotype-phenotype correlations in many CMT patients make it difficult to decide which genes are affected. Recently, targeted next-generation sequencing (NGS) has been introduced as an alternative approach for diagnosis of genetic disorders. Here, we applied targeted NGS in combination with PMP22 duplication/deletion analysis to screen causative genes in 22 Chinese CMT families. The novel variants detected by targeted NGS were then further studied in cultured cells. Of the 22 unrelated patients, 8 had PMP22 duplication. The targeted NGS revealed 10 possible pathogenic variants in 11 patients, including 7 previously reported variants and 3 novel heterozygous variants (GJB1: p.Y157H; MFN2: p.G127S; YARS: p.V293M). Further classification of the novel variants according to American College of Medical Genetics and Genomics (ACMG) standards and guidelines and functional analysis in cultured cells indicated that p.Y157H in GJB1 was pathogenic, p.G127S in MFN2 was likely pathogenic, while p.V293M in YARS was likely benign. Our results suggest the potential for targeted NGS to make a more rapid and precise diagnosis in CMT patients. Moreover, the functional analysis is required when the novel variants are indistinct.
Liu, Zhi-Jun; Ni, Wang; Li, Hong-Fu; Xiao, Bao-Guo; Wu, Zhi-Ying
Charcot-Marie-Tooth (CMT) disease is the most common hereditary peripheral neuropathy. More than 50 causative genes have been identified. The lack of genotype-phenotype correlations in many CMT patients make it difficult to decide which genes are affected. Recently, targeted next-generation sequencing (NGS) has been introduced as an alternative approach for diagnosis of genetic disorders. Here, we applied targeted NGS in combination with PMP22 duplication/deletion analysis to screen causative genes in 22 Chinese CMT families. The novel variants detected by targeted NGS were then further studied in cultured cells. Of the 22 unrelated patients, 8 had PMP22 duplication. The targeted NGS revealed 10 possible pathogenic variants in 11 patients, including 7 previously reported variants and 3 novel heterozygous variants (GJB1: p.Y157H; MFN2: p.G127S; YARS: p.V293M). Further classification of the novel variants according to American College of Medical Genetics and Genomics (ACMG) standards and guidelines and functional analysis in cultured cells indicated that p.Y157H in GJB1 was pathogenic, p.G127S in MFN2 was likely pathogenic, while p.V293M in YARS was likely benign. Our results suggest the potential for targeted NGS to make a more rapid and precise diagnosis in CMT patients. Moreover, the functional analysis is required when the novel variants are indistinct. PMID:27027447
Rezende, Rejane L. S.; Bonjardim, Leonardo R.; Neves, Eduardo L. A.; Santos, Lidiane C. L.; Nunes, Paula S.; Garcez, Catarina A.; Souza, Cynthia C.; Araújo, Adriano A. S.
Background. The aim of this study was to evaluate the oral health status of temporomandibular disorders (TMD) and bruxism, as well as to measure masticatory performance of subjects with Charcot-Marie-Tooth type 2 (CMT2). Methods and Results. The average number of decayed, missing, and filled teeth (DMFT) for both groups, control (CG) and CMT2, was considered low (CG = 2.46; CMT2 = 1.85, P = 0.227). The OHIP-14 score was considered low (CG = 2.86, CMT2 = 5.83, P = 0.899). The prevalence of self-reported TMD was 33.3% and 38.9% (P = 0.718) in CG and CMT2 respectively and for self-reported bruxism was 4.8% (CG) and 22.2% (CMT2), without significant difference between groups (P = 0.162). The most common clinical sign of TMD was masseter (CG = 38.1%; CMT2 = 66.7%) and temporalis (CG = 19.0%; GCMT2 = 33.3%) muscle pain. The geometric mean diameter (GMD) was not significantly different between groups (CG = 4369; CMT2 = 4627, P = 0.157). Conclusion. We conclude that the CMT2 disease did not negatively have influence either on oral health status in the presence and severity of TMD and bruxism or on masticatory performance. PMID:24391462
Perveen, Shazia; Mannan, Shazia; Hussain, Abrar; Kanwal, Sumaira
Charcot-Marie-Tooth (CMT) disease is a well-known neural or spinal type of muscular atrophy. It is the most familiar disease within a group of conditions called Hereditary Motor and Sensory Neuropathies (HMSN). The disease was discovered by three scientists several years ago. Several genes are involved as the causative agents for the disease. Hundreds of causative mutations have been found and research work for the identification of a novel locus and for the treatment of CMT1A is going on. This review article was planned to gather information on CMT disease and updates on its treatment.National Center for Biotechnology Information (NCBI) and PubMed were searched for data retrieval. Molgen database, which is the exclusive site for CMT mutation, was the other source of articles. Different aspects of the CMT disease were compared.Advancements in the finding of the causative gene, discovery of the novel Loci are the current issues in this regard.CMT disease is incurable, but researchers are trying to get some benefits from different natural compounds and several therapeutic agents.Various groups are working on the treatment projects of CMT1A. Major step forward in CMT research was taken in 2004 when ascorbic acid was used for transgenic mice treatment. Gene therapy for constant neurotrophin-3 (NT- 3) delivery by secretion by muscle cells for the CMT1A is also one of the possible treatments under trial.
... the local anesthetic is injected. Most of the sensation is at the skin incision site which is numbed using local anesthetic. ... open surgical drainage. Risks Any procedure where the skin is penetrated ... organ may be damaged by percutaneous abscess drainage. Occasionally ...
Kontaxopoulou, Isavella; Alam, Sonia
Tooth wear has an increasing prevalence in the UK population. The aetiology is commonly multifactorial, and the aetiopathology is through a combination of erosion, attrition, abrasion and abfraction. Erosion is associated with intrinsic or extrinsic acids, and therefore subjects with reflux disease and eating disorders are at increased risk. Fruit juice, fruits and carbonated drink consumption, frequency of consumption and specific habits are also risk factors. Attrition is more prevalent in bruxists. Other habits need to be considered when defining the risk of tooth wear. Abrasion is usually associated with toothbrushing and toothpastes, especially in an already acidic environment. Patients with extensive lesions that affect dentin may be at higher risk, as well as those presenting with unstained lesions. Monitoring of the progress of tooth wear is recommended to identify those with active tooth wear. Indices for tooth wear are a helpful aid.
Garcez, Catarina Andrade; Neves, Eduardo Luis Aquino; Melo, Saulo Maia D''avila; Nunes, Paula Santos; Barreto, Lidiane Carine Lima; Costa, Iandra Maria Pinheiro; Souza, Cynthia Coelho; Rezende, Rejane Lenier; Araújo, Adriano Antunes de Souza
The aim of this study was to evaluate the pulmonary condition in a large family with Charcot-Marie-Tooth disease type 2 (CMT2). Eighteen participants diagnosed with CMT2 and 20 healthy individuals were evaluated by spirometry and maximal expiratory and maximal inspiratory pressures (MEP and MIP, respectively). Clinical disability was measured with CMT neuropathy score (CMTNS; range 0-36). One control group (CG) comprising 20 individuals, matched for age, sex and body mass index, were used for comparison. Eight patients were female (44.5%) and 10 patients were male (55.5%); mean age was 31.8 years (range 11-79) and CMTNS range was 6-26. Differences between CMT2 and CG in the spirometry and respiratory muscle strength were statistically significant for all dimensions. There were significant correlations between CMTNS and MIP (Pearson = -0.581) and MEP (Pearson = -0.5090). The results of this study show that patients with CMT, in spite of not showing clinical signs of advanced respiratory impairment, may present subclinical respiratory changes. The respiratory comprise in the CMT disease can be silent and insidious without presenting characteristic clinical signals.
Kim, Young-Il; Kim, Myung-Jin; Choi, Jeom-Il; Park, Soo-Byung
The physiologic tooth position is determined by interactions between the periodontal tissue and occlusal, tongue, and lip forces. Bone destruction resulting from chronic periodontal disease disturbs the equilibrium of these interactive balances, leading to pathologic tooth migration, often requiring multidisciplinary treatment approaches. The present case demonstrates a systematic periodontal-orthodontic-prosthetic treatment for achieving the optimal structural, functional, and esthetic outcomes.
Miller, Michael B
Solving tooth sensitivity requires both you and the patients to be resilient and to understand that if one approach doesn't work, you can try another one that is non-invasive or, at worst, minimally invasive. Much like the clinician who posted the original question, I strongly believe that it is our responsibility to convince patients that jumping to a radical solution could be totally unnecessary--and expensive-- and still might not solve the problem.
Soto-Hernández, José Luis; Moreno-Andrade, Talía; Góngora-Rivera, Fernando; Ramírez-Crescencio, María Antonieta
We report the case of a 30-year-old man with known HIV-positive status who developed, 4 months prior to admission, recurrent left partial motor seizures followed by left hemiparesis. At another hospital, contrasted CT scan of the head revealed right frontal hypodense lesion with mass effect and focal contrast enhancement. A small left occipital lesion was also present. HIV-associated brain toxoplasmosis was considered and phenytoin, pyrimethamine, clindamycin and antiretrovirals were administered. Hemiparesis improved but, 3 weeks prior to admission, he developed progressive headache and bilateral visual defects. Upon admission to our center, he was found with left homonymous hemianopsia, right hemiparesis and a large hypodense left occipital lesion on a head CT scan. Proton MR spectroscopy showed lactate at 1.3ppm, amino acids at 0.9ppm, and diffusion-weighted imaging (DWI) revealed hyperintensity at the lesion, suggesting a pyogenic abscess. Aspiration yielded purulent material and Nocardia asteroides grew in culture. The patient was treated with trimethoprim-sulfametoxazole and recovered with a mild visual field residual defect.
Ogihara, M; Masaki, T; Watanabe, T; Hatano, K; Matsuda, K; Yahagi, N; Ichinose, M; Seichi, A; Muto, T
We describe herein the case of a psoas abscess complicating Crohn's disease, and present a review of the literature on this unusual disease entity. A 22-year-old Japanese man with a 5-year history of Crohn's ileocolitis presented with right lower abdominal and hip pain, and a diagnosis of right psoas abscess was subsequently made by abdominal computed tomography (CT). Following the administration of antibiotics and CT-guided percutaneous drainage of the abscess, the patient's symptoms temporarily improved; however, 2 weeks later, the abscess cavity was found to have extended around the periarticular tissue of the right hip joint. To prevent the development of septic arthritis of the hip joint, surgical drainage of the abscess cavity and ileocecal resection were immediately performed, after which the patient's condition greatly improved. The resected specimen showed Crohn's ileocolitis with an external fistula in the terminal ileum which was considered to have caused the psoas abscess. Since psoas abscess in Crohn's disease can result in serious complications such as septic arthritis of the hip joint if left untreated, aggressive treatment should be initiated without delay.
Staufer, Kirsten; Hamadeh, Sinan; Gesch, Dietmar
The aim of this paper was to analyze delayed tooth eruption in two children with cerebral palsy who had severe bruxism and to determine whether treatment could influence tooth eruption and alignment. Extraction of primary teeth was carried out and orthodontic treatment was considered due to severe tooth wear of primary teeth, lack of space, and development of a class III malocclusion. Analysis was based on clinical examination, photographs, radiographs, and dental casts. In both patients, early mixed dentition was delayed for more than 5 years. Calcification and root development of posterior permanent teeth corresponded with the chronological age. Root resorption of the severely abraded primary teeth and eruption of their successors were delayed or failed. Eruption of permanent teeth occurred slowly after primary teeth were extracted. Orthodontic treatment succeeded in one patient, achieving a normal overjet in combination with a successful orofacial therapy. The disturbed exfoliation of abraded primary teeth and failure of tooth eruption of the posterior teeth could be linked to the systemic pathology and to bruxism. At age 20, eruption of the canines and premolars remained questionable.
Adjamian, Norair; Kikam, Adeline; Wessell, Kathryn Ruda; Casselman, Jason; Toller-Artis, Erin; Olasokan, Olapeju; Hostoffer, Robert W.
Nocardia brain abscesses are a known occurrence in patients with immunocompromised conditions. Nocardial infection is commonly an unfortunate sequela to other complications which these patients are being followed up and treated for. The incidence of nocardial brain abscess in an otherwise healthy patient is extremely rare. We present a case of Nocardia brain abscess in a previously healthy individual, who, upon workup for vision and gait abnormalities, was shown to have multiple brain abscesses and a decreased absolute CD4+ lymphocyte count. Adding to the rarity of our case, the finding of lymphocytopenia in our patient was unrelated to any known predisposing condition or infectious state. PMID:26448886
Peng, K-T; Hsieh, M-C; Hsu, W-H; Li, Y-Y; Yeh, C-H
Most perianal abscesses originate from infected anal glands at the base of the anal crypts. Most abscesses below are usually drained through perianal incision and can be treated successfully. However, when perianal abscesses extend to the high intrapelvic cavity, it may be inadequate treatment through a single route incision through a perianal approach. The aim of this technical note is to show that combined anterior ilioinguinal and perianal incisions may provide optimal surgical field and multiple drainages. Here, we report a 56-year-old male patient with perianal-originating parapsoas abscesses. Residual abscess still remained after initial perianal incision and drainage after 1-month treatment. We presented combined anterior ilioinguinal and perianal incision technique methods for proper drainage in this complicated case. No recurrent or residual abscess remained after 2 weeks of operation. So, combined anterior ilioinguinal incision is feasible for high-located perianal abscess.
Marusza, Wojciech; Mlynarczyk, Grazyna; Olszanski, Romuald; Netsvyetayeva, Irina; Obrowski, Michael; Iannitti, Tommaso; Palmieri, Beniamino
Injectable filling agents offer the promise of a better appearance without surgery and, among them, hyaluronic acid is the most commonly used. Although complications are rare, it is necessary to know the possible side effects and complications in order to be prepared for their management. That is why many researchers have been focusing on the interactions between hyaluronic acid and pathogens, inflammatory mediators, the immune system, and markers of oxidative stress to achieve efficient drug delivery, given that hyaluronic acid has widening applications in the field of nanomedicine. Here we report the case of a 37-year-old female patient who returned to our clinic with an abscess in her left cheek 3 months after a deep injection of 1 mL of stabilized hyaluronic acid in both cheeks. Steroid and antibiotic therapy was initiated without success, and abscess drainage was performed. Extraction of tooth 16 was performed 11 days after insertion of drains into the abscess. Laboratory blood tests showed acute inflammation of presumed bacterial etiology. Microbiological examination of pus was negative. Bacterial cultures were found in the extracted tooth. After antibiotic therapy, a complete reversal of the pathological process was observed. The present report highlights the need to assess periodontal problems prior to any aesthetic facial treatment. Analyses of further case reports and clinical studies are necessary to understand the potential role of hyaluronic acid in the formation of biofilm, and how to avoid this complication, thereby increasing the safety of hyaluronic acid-based procedures.
Mallia, Alvin James; Ashwood, Neil; Arealis, George; Galanopoulos, Ilias
Retroperitoneal abscesses are unusual occurrences with occult and insidious presentations. There is often a lack of abdominal signs, leading to delays in drainage and high mortality rates. We report a case of thigh emphysema in an 88-year-old patient with diabetes. Prior to admission the patient reported a vague 4-week history of left thigh pain and an inability to fully weight bear. She presented to our emergency department with sepsis and acute kidney impairment. An X-ray of her left femur revealed widespread gas between muscular planes. A retroperitoneal abscess involving the left renal fossa, psoas, iliacus and upper thigh muscles was revealed on an urgent CT scan. The patient was transferred to intensive care unit (ICU) and underwent an emergency drainage. Despite ICU the patient died 2 days after admission. PMID:25576509
Mallia, Alvin James; Ashwood, Neil; Arealis, George; Galanopoulos, Ilias
Retroperitoneal abscesses are unusual occurrences with occult and insidious presentations. There is often a lack of abdominal signs, leading to delays in drainage and high mortality rates. We report a case of thigh emphysema in an 88-year-old patient with diabetes. Prior to admission the patient reported a vague 4-week history of left thigh pain and an inability to fully weight bear. She presented to our emergency department with sepsis and acute kidney impairment. An X-ray of her left femur revealed widespread gas between muscular planes. A retroperitoneal abscess involving the left renal fossa, psoas, iliacus and upper thigh muscles was revealed on an urgent CT scan. The patient was transferred to intensive care unit (ICU) and underwent an emergency drainage. Despite ICU the patient died 2 days after admission.
Bang, Jin Hyuk
Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus. PMID:26512268
Bang, Jin Hyuk; Cho, Keun-Tae
Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus.
Lobo, D N; Dunn, W K; Iftikhar, S Y; Scholefield, J H
Most surgeons think of psoas abscesses as a very rare condition related to tuberculosis of the spine, but in contemporary surgical practice they are more usually a complication of gastrointestinal disease. A case note study was undertaken on all patients treated for psoas abscess at two large hospitals in the mid-Trent region over a 2-year period. All seven patients presented with pyrexia, psoas spasm, a tender mass and leucocytosis. The diagnosis was made on abdominal radiographs in one patient, CT scan in three, MRI in two, and ultrasound in one. Aetiological factors included Crohn's disease in three, appendicitis in two, and sigmoid diverticulitis and metastatic colorectal carcinoma in one each. Six patients underwent transabdominal resection of the diseased bowel, retroperitoneal debridement and external drainage of the abscess cavity. Percutaneous drainage was performed in one. Two patients had more than one surgical exploration for complications. There were no deaths and the hospital stay ranged from 8-152 days. Psoas abscess can be a difficult and protracted problem. Bowel resection, thorough debridement, external drainage and concomitant antibiotics are essential for psoas abscesses complicating gastrointestinal disease. Defunctioning stomas may be necessary. However, in some cases a multidisciplinary approach may be required, as psoas abscesses can involve bone and joints.
Hu, Hsiao-Yun; Lee, Ya-Ling; Lin, Shu-Yi; Chou, Yi-Chang; Chung, Debbie; Huang, Nicole; Chou, Yiing-Jenq; Wu, Chen-Yi
Abstract To date, the effect of tooth loss on all-cause mortality among elderly patients with a different weight group has not been assessed. This retrospective cohort study evaluated the data obtained from a government-sponsored, annual physical examination program for elderly citizens residing in Taipei City during 2005 to 2007, and follow-up to December 31, 2010. We recruited 55,651 eligible citizens of Taipei City aged ≥65 years, including 29,572 men and 26,079 women, in our study. Their mortality data were ascertained based on the national death files. The number of missing teeth was used as a representative of oral health status. We used multivariate Cox proportional hazards regression analysis to determine the association between tooth loss and all-cause mortality. After adjustment for all confounders, the hazard ratios (HRs) of all-cause mortality in participants with no teeth, 1 to 9 teeth, and 10 to 19 teeth were 1.36 [95% confidence interval (CI): 1.15–1.61], 1.24 (95% CI: 1.08–1.42), and 1.19 (95% CI: 1.09–1.31), respectively, compared with participants with 20 or more teeth. A significant positive correlation of body mass index (BMI) with all-cause mortality was found in underweight and overweight elderly patients and was represented as a U-shaped curve. Subgroup analysis revealed a significant positive correlation in underweight (no teeth: HR = 1.49, 95% CI: 1.21–1.83; 1–9 teeth: HR = 1.23, 95% CI: 1.03–1.47; 10–19 teeth: HR = 1.20, 95% CI: 1.06–1.36) and overweight participants (no teeth: HR = 1.37, 95% CI: 1.05–1.79; 1–9 teeth: HR = 1.27, 95% CI: 1.07–1.52). The number of teeth lost is associated with an increased risk of all-cause mortality, particularly for participants with underweight and overweight. PMID:26426618
George, Noelle; Flamiatos, Erin; Kawasaki, Kellie; Kim, Namgu; Carriere, Charles; Phan, Brian; Joseph, Raphael; Strauss, Shay; Kohli, Richie; Choi, Dongseok; Craig Baumgartner, J.; Sedgley, Christine; Maier, Tom; Machida, Curtis A.
Background and objectives Acute apical abscesses are serious endodontic diseases resulting from pulpal infection with opportunistic oral microorganisms. The objective of this study was to identify and compare the oral microbiota in patients (N=18) exhibiting acute apical abscesses, originating from the demographic region in Portland, Oregon. The study hypothesis is that abscesses obtained from this demographic region may contain unique microorganisms not identified in specimens from other regions. Design Endodontic abscesses were sampled from patients at the Oregon Health & Science University (OHSU) School of Dentistry. DNA from abscess specimens was subjected to polymerase chain reaction amplification using 16S rRNA gene-specific primers and Cy3-dCTP labeling. Labeled DNA was then applied to microbial microarrays (280 species) generated by the Human Oral Microbial Identification Microarray Laboratory (Forsyth Institute, Cambridge, MA). Results The most prevalent microorganisms, found across multiple abscess specimens, include Fusobacterium nucleatum, Parvimonas micra, Megasphaera species clone CS025, Prevotella multisaccharivorax, Atopobium rimae, and Porphyromonas endodontalis. The most abundant microorganisms, found in highest numbers within individual abscesses, include F. nucleatum, P. micra, Streptococcus Cluster III, Solobacterium moorei, Streptococcus constellatus, and Porphyromonas endodontalis. Strong bacterial associations were identified between Prevotella multisaccharivorax, Acidaminococcaceae species clone DM071, Megasphaera species clone CS025, Actinomyces species clone EP053, and Streptococcus cristatus (all with Spearman coefficients >0.9). Conclusions Cultivable and uncultivable bacterial species have been identified in endodontic abscesses obtained from the Portland, Oregon demographic region, and taxa identifications correlated well with other published studies, with the exception of Treponema and Streptococcus cristae, which were not commonly
Lal, Hira; Thakral, Anuj; Sharma, Manohar Lal; Kumar, Tarun
Considering the high incidence of amoebic and pyogenic liver abscess in the developing world, occurrence of inferior vena cava thrombosis secondary to liver abscess is a rare but life threatening complication. We report 4 such complicated cases of liver abscess(s). The first case involved a large caudate lobe abscess extending across middle hepatic vein into suprahepatic inferior vena cava (IVC). Development of a left hepatic artery pseudoaneurysm following attempted percutaneous aspiration highlights the difficulties encountered in percutaneous interventional management of caudate lobe abscesses. The second case involved multiple liver abscesses with large thrombus in the right ventricular cavity & right ventricular outflow tract. The patient developed cardiorespiratory arrest limiting any aggressive management options for the complex nature of illness. The third case had a large caudate lobe abscess with direct extension into Intrahepatic IVC while the fourth showed a segment 4 abscess with thrombosis of adjacent left hepatic vein. These cases highlight the fact that diagnosis of such life threatening complications of liver abscesses as hepatic vein & IVC thrombosis requires high clinical suspicion followed by targeted imaging. Image guided interventional therapy is a useful tool for management in cases of liver abscess. But, abscesses in precarious locations like caudate lobe are associated with higher risk of complications including pseudoaneurysm formation asking for a cautious approach to interventional therapy in such circumstances.
Ranson, J H; Madayag, M A; Localio, S A; Spencer, F C
An unexplained increase in the frequency of pyogenic liver abscesses of unknown etiology has, fourtunately, been paralleled by significant advances in diagnostic and therapeutic methods. This report reviews experience with 14 patients operated upon at NYU Medical Center since 1971. Eight cases (57%) were cryptogenic. Other abscesses were associated with biliary disease (3); abdominal sepsis (2); and trauma (1). Abscesses were present on hospitalization in 12 patients. Clinical findings included fever (101-108 F); 100%; leucocytosis, 71%; anorexia and vomiting, 50%; localized tenderness and hepatomegaly, 50%; hypoalbuminemia, 86%; hypocholesterolemia, 78%; elevated SGOT, 71%; and elevated aikaline phosphatase, 43%. Technetium hepatic scintiscans showed focal defects in 10 of 12 patients (83%), but did not detect multiple abscesses in 2 of these. Hepatic arteriography performed in 10 patients was highly accurate, outlining single abscesses in 6 and multiple abscesses in 4. Furthermore, in one patient a false positive scintiscan was demonstrated by negative arteriography, confirmed by autopsy. In 4 patients, arteriography indicated an abscess in the posterior-superior area of the right hepatic lobe. With precise anatomical localization, a trans-thoracic approach permitted uncomplicated drainage in each case. This approach provides excellent exposure and direct drainage for abscesses in this area. An additional therapeutic adjunct in two patients, with 4 and 11 abscesses each, was postoperative intraportal infusion of antibiotics through the umbilical vein. Thirteen patients (83%) recovered, one dying from pulmonary embolism. Primary hepatic abscesses occur with increasing frequency. Primary hepatic abscesses occur with increasing frequency. Primary hepatic abscesses occur with increasing frequency. The methods described allow more precise preoperative diagnosis and direct surgical drainage. Images Fig. 1. Fig. 2. PMID:1130869
Scheepers, N J; van Bommel, P F; Bleker, O P
This case report presents a patient with a psoas abscess related to a dilatation and (aspiration) curettage for an incomplete abortion with an IUD. Psoas abscess is extremely rare in obstetrics and gynecology and a life threatening condition. It is important to recognize the clinical presentation. Psoas abscess should be suspected in patients presenting with fever, pain in the leg, thigh, or low back region. Whether antibiotic prophylaxis in abortion curettage may prevent this and other complications is discussed.
Carroll, B.; Silverman, P.M.; Goodwin, D.A.; McDougall, I.R.
Ultrasound and indium 111 white blood cell scanning were performed on 163 patients with suspected intraabdominal abscesses. In all but one case, intraabdominal abscesses were correctly identified by one or both tests; conversely, no patient was falsely diagnosed by both tests to have an abscess. Sonography was useful in those patients with focal symptoms, and frequently identified nonabscess causes for fever. White cell scanning was valuable when focal signs were absent, and frequently identified extraabdominal sources of sepsis. The two imaging modalities are complementary and provide a highly accurate and sensitive means of intraabdominal abscess detection.
Ohara, N; Tominaga, O; Uchiyama, M; Nakano, H; Muto, T
We report a case of primary iliopsoas abscess successfully treated by ultrasonographically guided percutaneous drainage. A 56-year-old man presented at our hospital with lumbago, right-sided back pain, fever (temperature 38.5 degrees C) and chills. On physical examination, we found dark red skin, swelling, and tenderness localized at the right side at the back of his waist. Laboratory examination showed leukocytosis (white blood cell count 9700/mm3) with a leftward shift and elevated C-reactive protein (5.2 mg/dl). Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging revealed a hypodense lesion in the right iliopsoas muscle extending to the subcutaneous tissue. About 50 ml of thick yellow pus was obtained by ultrasonographically guided aspiration drainage. A drain catheter was inserted in the abscess cavity. Laboratory findings improved and clinical symptoms abated rapidly after drainage. On the twenty-first day after drainage, US and CT showed that the abscess was no longer present. The patient was discharged after 32 days of hospitalization. As possible primary diseases causing iliopsoas abscess, such as digestive tract disease, tuberculosis, and osteomyelitis, were not found, we diagnosed the disease as primary iliopsoas abscess. Although surgical drainage has been performed in most reported cases of iliopsoas abscess, this case report shows that ultrasonographically guided percutaneous drainage is also effective for treating primary iliopsoas abscess if it is diagnosed early enough.
Mirhashemi, Seyyedhadi; Soori, Mohsen; Faghih, Gholamhossein; Peyvandi, Hassan; Shafagh, Omid
Acute pancreatitis is characterized by activation of digestive enzymes inside the pancreas. In severe pancreatitis, necrosis of pancreas and surrounding tissues may occur. Acute necrotizing pancreatitis commonly presents as pancreatic abscess occasionally with systemic complications. Rarely, necrotic tissue may be drained from scrotum due to retroperitoneal extension of necrotic process. Here, we report a case of acute necrotizing pancreatitis in a 29-year-old man who presented with severe abdominal pain, nausea and vomiting. A computerized tomography (CT) scan confirmed necrotizing pancreatitis with multiple abscesses spreading bilaterally in the pelvic cavity. Several surgical operations were performed, including necrosectomy and drainage. Subsequently, the patient developed a scrotal abscess, which was drained surgically. The patient's condition was complicated by pleural effusion, acute respiratory distress syndrome, colocutaneous and scrotal fistulas, and incisional hernia. It seems that the scrotal abscess is a very rare complication of necrotizing pancreatitis.
Cherian, Joel; Singh, Rahul; Varma, Muralidhar; Vidyasagar, Sudha; Mukhopadhyay, Chiranjay
Pyogenic liver abscesses are rare with an incidence of 0.5% to 0.8% and are mostly due to hepatobiliary causes (40% to 60%). Most are polymicrobial with less than 10% being caused by Staphylococcus aureus. Of these, few are caused by methicillin-resistant Staphylococcus aureus (MRSA) and fewer still by a community-acquired strain. Here we present a case study of a patient with a community-acquired MRSA liver abscess. The patient presented with fever since 1 month and tender hepatomegaly. Blood tests revealed elevated levels of alkaline phosphatase, C-reactive protein, erythrocyte sedimentation rate, and neutrophilic leukocytosis. Blood cultures were sterile. Ultrasound of the abdomen showed multiple abscesses, from which pus was drained and MRSA isolated. Computed tomography of the abdomen did not show any source of infection, and an amebic serology was negative. The patient was started on vancomycin for 2 weeks, following which he became afebrile and was discharged on oral linezolid for 4 more weeks. Normally a liver abscess is treated empirically with ceftriaxone for pyogenic liver abscess and metronidazole for amebic liver abscess. However, if the patient has risk factors for a Staphylococcal infection, it is imperative that antibiotics covering gram-positive organisms be added while waiting for culture reports. PMID:27540556
Li, Jennifer S.; Sheele, Johnathan Michael
We report the first case of a tuboovarian abscess complicated by a ruptured spleen. Our patient was a 27-year-old female with human immunodeficiency virus (HIV) who presented to the emergency department (ED) with complaints of urinary symptoms and diarrhea. After being diagnosed with a tuboovarian abscess (TOA), she received antibiotics and was admitted to the gynecology service. Shortly thereafter she developed hemorrhagic shock, necessitating a splenectomy and salpingooophorectomy from a ruptured spleen. PMID:26904315
Choi, B-O; Nakhro, K; Park, H J; Hyun, Y S; Lee, J H; Kanwal, S; Jung, S-C; Chung, K W
Charcot-Marie-Tooth disease 2A (CMT2A) is the most common axonal form of peripheral neuropathy caused by a defect in the mitofusin 2 (MFN2) gene, which encodes an outer mitochondrial membrane GTPase. MFN2 mutations result in a large range of phenotypes. This study analyzed the prevalence of MFN2 mutation in Korean families with their assorted phenotypes (607 CMT families and 160 CMT2 families). Direct sequencing of the MFN2 coding exons or whole-exome sequencing has been applied to identify causative mutations. A total of 21 mutations were found in 36 CMT2 families. Comparative genotype-phenotype correlations impacting severity, onset age, and specific symptoms were assessed. Most mutations were seen in the GTPase domain (∼86%). A deletion mutation found in the transmembrane helices is reported for the first time, as well as five novel mutations at other domains. MFN2 mutations made up 5.9% of total CMT families, whereas 22.9% in CMT2 families, of which 27.8% occurred de novo. Interestingly, patient phenotypes ranged from mild to severe even for the same mutation, suggesting other factors influenced phenotype and penetrance. This CMT2A cohort study will be useful for molecular diagnosis and treatment of axonal neuropathy.
Maeda, Yukihide; Kataoka, Yuko; Sugaya, Akiko; Kariya, Shin; Kobayashi, Katsuhiro; Nishizaki, Kazunori
Charcot-Marie-Tooth disease (CMT) is the most common form of hereditary sensorimotor neuropathy and sometimes involves disorders of the peripheral auditory system. We present a case of steroid-dependent auditory neuropathy associated with CMT, in which the patient experienced 3 episodes of acute exacerbation of hearing loss and successful rescue of hearing by prednisolone. An 8-year-old boy was referred to the otolaryngology department at the University Hospital. He had been diagnosed with CMT type 1 (demyelinating type) at the Child Neurology Department and was suffering from mild hearing loss due to auditory neuropathy. An audiological diagnosis of auditory neuropathy was confirmed by auditory brainstem response and distortion-product otoacoustic emissions. At 9 years and 0 months old, 9 years and 2 months old, and 10 years and 0 months old, he had experienced acute exacerbations of hearing loss, each of which was successfully rescued by intravenous or oral prednisolone within 2 weeks. Steroid-responsive cases of CMT have been reported, but this is the first case report of steroid-responsive sensorineural hearing loss in CMT. The present case may have implications for the mechanisms of action of glucocorticoids in the treatment of sensorineural hearing loss.
Vescovi, Paolo; Meleti, Marco; Manfredi, Maddalena; Fornaini, Carlo; Guidotti, Rebecca; Nammour, Samir
Objective: Trauma during dental surgery is a predisposing factor for bisphosphonates (BP)-related osteonecrosis of the jaws (BRONJ). However, about 40% of cases of BRONJ are not related to dental invasive procedures, being probably associated to endodontic or periodontal infections. Extraction of non-treatable teeth is considered a reliable choice, to improve symptoms and to reduce the risk of BRONJ. Here we report our experience of tooth extractions in patients under oral or intravenous BP therapy. Study Design: Two-hundred and seventeen patients (38 males, 179 females; mean age 68.72 ± 11.26 years, range 30 to 83 years) under BP therapy received 589 tooth extractions at the Unit of Oral Medicine, Pathology and Laser-assisted Surgery of the University of Parma, Italy, between June 2006 and December 2010. Ninety five patients were under BP therapy for oncological disease (multiple myeloma (MM): 23; bone metastases (BM): 72) and 122 patients for non oncological diseases: 119 osteoporosis (OP), 2 rheumatoid arthritis (RA) and 1 Paget’s disease (PD). The mean duration of BP was of 35 months. Antibiotic treatment was administered three days before and 2 weeks after tooth extractions. Patients were additionally treated with low level laser therapy (LLLT) through Nd:YAG laser (1064 nm – power 1.25 W; frequency 15 Hz; fibre diameter: 320 ?m), 5 application of 1 minute each. Patients were evaluated 3 days and once a week for 2 months after the extractions and every time they received LLLT. Mean follow-up was 15 months (ranging from 4 to 31 months). Results: In a total of 589 extractions (285 mandibular, 304 maxillary) performed, a minimal bone exposure was observed in 5 cases, treated with Er:YAG laser vaporization and than healed. Conclusions: Our experience supports the hypothesis that the association of antibiotic treatment and LLLT can be effective in preventing ONJ after tooth extractions in patients under BPT. Key words:Nd:YAG laser, low level laser therapy
Jeong, Woo Shin; Choi, Sung Youn; Jeong, Eun Haeng; Bang, Ki Bae; Park, Seung Sik; Lee, Dae Sung; Park, Dong Il; Jung, Yoon Suk
Klebsiella pneumoniae (K. pneumoniae) can at times cause invasive infections, especially in patients with diabetes mellitus and a history of alcohol abuse. A 61-year-old man with diabetes mellitus and a history of alcohol abuse presented with abdominal and anal pain for two weeks. After admission, he underwent sigmoidoscopy, which revealed multiple ulcerations with yellowish exudate in the rectum and sigmoid colon. The patient was treated with ciprofloxacin and metronidazole. After one week, follow up sigmoidoscopy was performed owing to sustained fever and diarrhea. The lesions were aggravated and seemed webbed in appearance because of damage to the rectal mucosa. Abdominal computed tomography and rectal magnetic resonance imaging were performed, and showed a perianal and perirectal abscess. The patient underwent laparoscopic sigmoid colostomy and perirectal abscess incision and drainage. Extended-spectrum beta-lactamase-producing K. pneumoniae was identified in pus culture. The antibiotics were switched to ertapenem. He improved after surgery and was discharged. K. pneumoniae can cause rapid invasive infection in patients with diabetes and a history of alcohol abuse. We report the first rare case of proctitis and perianal abscess caused by invasive K. pneumoniae infection.
In patients presenting to the emergency department with skin and soft tissue infections what is the diagnostic accuracy of point-of-care ultrasonography for the diagnosis of abscess compared to the current standard of care? A systematic review and meta-analysis
Chenkin, Jordan; Cho, Dennis D; Jelic, Tomislav; Scheuermeyer, Frank X
Objectives The primary objective of this systematic review was to determine the accuracy of point-of-care ultrasonography (POCUS) in diagnosing abscess in emergency department (ED) patients with skin and soft tissue infections (SSTI). The secondary objective was the accuracy of POCUS in the paediatric population subgroup. Setting Prospective studies set in emergency departments. Participants Emergency department patients (adult and paediatric) presenting with SSTI and suspected abscess. Primary and secondary outcome measures This systematic review was conducted according to Cochrane Handbook guidelines, and the following databases were searched: PubMed, MEDLINE, EMBASE and the Cochrane database of systematic reviews (1946–2015). We included prospective cohort and case–control studies investigating ED patients with SSTI and abscess or cellulitis, a defined POCUS protocol, a clearly defined gold standard for abscess and a contingency table describing sensitivity and specificity. Two reviewers independently ascertained all potentially relevant citations for methodologic quality according to QUADAS-2 criteria. The primary outcome measure was the sensitivity and specificity of POCUS for abscess. A preplanned subgroup (secondary) analysis examined the effects in paediatric populations, and changes in management were explored post hoc. Results Of 3028 articles, 8 were identified meeting inclusion criteria; all were rated as good to excellent according to QUADAS-2 criteria. Combined test characteristics of POCUS on the ED diagnosis of abscess for patients with SSTI were as follows: sensitivity 96.2% (95% CI 91.1% to 98.4%), specificity 82.9% (95% CI 60.4% to 93.9%), positive likelihood ratio 5.63 (95% CI 2.2 to 14.6) and negative likelihood ratio 0.05 (95% CI 0.01 to 0.11). Conclusions A total of 8 studies of good-to-excellent quality were included in this review. The use of POCUS helps differentiate abscess from cellulitis in ED patients with SSTI. Trial registration
Sasani, Mehdi; Aydin, Ozlem; Aydin, Ahmet Levent; Oktenoglu, Tunc; Ozer, Ali Fahir; Ercelen, Omur
Spinal epidural abscess is a collection of suppurative material that forms between the dura mater and the ligamentum flavum. If not recognized early and treated correctly, it can lead to life-threatening sepsis. Here we report the case of a female patient, 51 years of age, with difficulty walking and bilateral leg pain after having had degenerative discogenic pain for many years. The patient had occasionally received intramuscular non-steroidal anti-inflammatory drug injections. The current report is that of an unusual case of epidural abscess that formed following multiple dose of intramuscular non-steroidal anti-inflammatory drug over a 1-year period. Hematogenous or direct dissemination is the suspected cause. To prevent serious morbidity and mortality, early diagnosis is essential. Patients with localized back pain who are at risk for developing such epidural spinal abscesses should receive a magnetic resonance imaging scan with contrast enhancement without delay. The existence of predisposing factors such as intramuscular injections should be considered in the assessment of suspected spinal epidural abscess.
Miri-Moghaddam, Ebrahim; Baghaee, Elnaz; Bazi, Ali; Garme, Yasaman
Background Apical Periodontitis (AP) is an inflammatory disease that affects the tissues surrounding the root end of a tooth. The disease which is caused by endodontic infections presents in different clinical ways including development of an acute abscess. Recent studies have provided information suggesting role of a multitude of factors in pathogenesis of acute apical abscess (AAA). In this case-control study, our goal was to evaluate the frequency and potential role of two common polymorphisms of toll like receptor-4 (TLR-4) gene; Thr399Ile (1196 C>T) and Asp299Gly (+896 A>G), in 50 patients with AAA as cases and 50 patients with asymptomatic apical periodontitis (AAP) as controls. Material and Methods Saliva sample containing mucosal epithelial cells was used for DNA extraction. Polymorphisms were detected by Tetra-ARMS (Amplification Refractory Mutation System) PCR method. Statistical analyses were carried out in SPSS 21 software. Results Homozygous wild type (CC) and heterozygous (CT) genotypes of Thr399Ile polymorphism were detected in 84% and 16% of AAA patients respectively. In controls, respective ratios were 94% (CC) and 6% (CT). Observed difference was not statistically significant (P>0.05) for distribution of these genotypes. The mutant homozygous (TT) genotype of this polymorphism was identified in neither of the participants. Overall, T allele frequency was obtained 8% in AAA and 3% in AAP (OR=2.6, 95% CI; 0. 6-10.6, p>0.05). For Asp299Gly polymorphism, no individual was detected with the mutant allele in case or control groups. Conclusions Our results indicated a possible role for Thr399Ile polymorphism in acute presentations of abscess in AAA. However, the impact of this polymorphism needs to be more assessed in future studies. Key words:Genetic polymorphism, periapical abscess, periapical periodontitis, toll-like receptor 4. PMID:28210435
Biller, J A; Grand, R J; Harris, B H
Little information is available about the development of abdominal abscesses in adolescents with Crohn's disease. We report the clinical presentation of five adolescents with Crohn's disease who developed this complication. The mean time from diagnosis until development of an abdominal abscess was 1.7 years. The admitting diagnosis was an acute abdomen in two patients and recurrent Crohn's disease in the other three. No features of the clinical presentation or laboratory data distinguished this group from other adolescents with Crohn's disease. The use of ultrasound and CT scanning was helpful in making this diagnosis preoperatively. Those patients with active Crohn's disease who do not respond promptly to medical therapy should be evaluated for the development of this complication.
Muzumdar, D; Bhatt, Y; Sheth, J
We describe a cervical intramedullary neurenteric cyst in a 12-year-old male patient who presented with gradual onset and progressively worsening neck pain, spastic quadriparesis and impaired sensation in the C(2) dermatome. MR imaging revealed a well-defined peripherally enhancing cystic intramedullary lesion with a posteroinferior enhancing nodule at the C(2)-C(3) level mimicking an abscess. There was no evidence of spinal dysraphism. The lesion was completely resected through a posterior approach and the patient showed radical improvement in his symptomatology. At follow-up after 3 years, he was asymptomatic and the MR imaging showed no evidence of any residual or recurrent cyst. The case presented here is unique, since a spinal neurenteric cyst showing intense peripheral contrast enhancement mimicking an abscess is unusual. The radiological features, pathogenesis and surgical considerations in cervical intramedullary neurenteric cysts are discussed and the relevant literature is briefly reviewed.
Deshpande, Aartee; Haleblian, George; Rapose, Alwyn
Prostate abscess is a rare complication of an ascending urinary tract infection (UTI). Its incidence has reduced secondary to routine and early use of antibiotics for treatment of UTIs. Prostate abscess has been reported in patients with uncontrolled diabetes, prolonged indwelling urinary catheters, prostate biopsy or other instrumentation of lower urinary tract. Prostate abscess is most commonly associated with Gram-negative bacteria. Staphylococcus aureus is rarely implicated and has been reported in patients with underlying risk factors like long-term or uncontrolled diabetes, intravenous drug abuse or bacteraemia. We present a rare case of prostate abscess due to methicillin resistant S aureus without obvious risk factors.
Ramani, A.; Ramani, R.; Kumar, M. S.; Lakhkar, B. N.; Kundaje, G. N.
This prospective study was carried out on 200 patients with clinically, ultrasonographically and serologically confirmed amoebic liver abscess. The role of ultrasound-guided needle aspiration in addition to medications was evaluated compared to drug treatment alone. Both the groups were monitored clinically and sonographically for up to 6 months after diagnosis. The initial response (after 15 days) was better in the aspirated group (P < 0.05) but resolution of abscess after 6 months were similar. There was a more rapid clinical response in the aspirated group, particularly in those with larger (> 6 cm) abscesses and there were no complications. Percutaneous ultrasound-guided needle aspiration is a safe diagnostic and therapeutic approach which enhances clinical recovery, accelerates resolution, especially in large abscesses, and prevents complications. PMID:8346134
Steward, Sarah C; Chauvenet, Allen R; O'Suoji, Chibuzo
Rhabdomyosarcoma (RMS) is the most common soft tissue malignancy seen in childhood and frequently occurs in the head and neck region. Pediatric head and neck RMS is often misdiagnosed as common benign conditions. Here we describe an embryonal RMS that presented as a peritonsillar abscess (PTA). Due to an incorrect initial diagnosis and lack of imaging, the patient received unnecessary medical therapy and diagnosis of RMS was delayed.
Ha, Kyung Ho; Song, Jung Eun; Kim, Byung Seok; Lee, Chang Hyeong
AIM: To evaluate the clinical characteristics and progression of liver abscess caused by toxocara. METHODS: We retrospectively reviewed the medical records of patients with serum IgG antibody to Toxocara canis and liver abscess diagnosed using abdominal computed tomography between February 2010 and February 2015. Among 84 patients exhibiting serum IgG antibody to Toxocara canis, 34 patients were diagnosed with liver asbscess and treated with albendazole. A follow-up period of 1 year was conducted. RESULTS: Mean patient age was 53 (34-79) years, with 26 (76.5%) patients being male. Twenty-one (61.7%) patients were moderate or heavy drinkers, 23 (67.6%) patients had a history of eating raw meat or liver and 6 (17.6%) patients owned pet dogs or cats. Main patient symptoms consisted of right upper quadrant pain, fever, and fatigue; 18 (52.9%) patients, however, presented with no symptoms. Lung involvement was detected in 444 (11.7%) patients. The eosinophil count increased in 29 (85.3%) patients at initial diagnosis, and decreased in most patients after albendazole treatment. The initial serum IgE level increased in 25 (73.5%) patients, but exhibited various response levels after albendazole treatment. Liver abscess formation improved in all patients. CONCLUSION: The liver abscess was improved with albendazole treatment. PMID:27366302
Catanzaro, D; Mirk, P; Carbone, A; Macis, G; Danza, F M
We report a rare case of amebic abscess of the urachus, mimicking an urachal neoplasm: no previous reports of amebic infection of the urachus were found in the literature. The challenges of the differential diagnosis between urachal abscess and carcinomas based both on clinical and radiological data are discussed.
Merola, Joseph; Tipper, Geoffrey Adrian; Hussain, Zakier; Balakrishnan, Venkataraman; Gan, Peter
We present a case of intracranial abscess in a young female with Ectopia Cordis, an exceptionally rare cardiac condition. The neurosurgical implication is the predisposition to intracranial abscess formation. A heightened awareness of this association will aid diagnosis in similar clinical scenarios.
Thiagarajan, Srinivasan; Krishnamurthy, Sriram; Raghavan, Renitha; Mahadevan, Subramanian; Madhugiri, Venkatesh S; Sistla, Sujatha
Although cerebral abscesses caused by animal bites have been reported, they are extremely rare in infants and have not been described following monkey bite. A 55-day-old male infant presented with a multi-loculated Streptococcus oralis cerebral abscess following a monkey bite on the scalp. There was a clinical response to antibiotic therapy and repeated surgical aspiration followed by a ventriculoperitoneal shunt. This is the first report of a patient with a brain abscess following a monkey bite.
Sty, J.R.; Starshak, R.J.
Three children, two with aplastic anemia and one with chronic granulomatous disease of childhood, were evaluated for hepatic abscess with hepatic scintigraphy (HS), gray-scale sonography (GSS), 67Ga imaging (GA), and computed tomography (CT). Each of the children was found to harbor two abscesses. All were detected with GSS and CT. In the two children imaged with GA, all four abscesses were seen. In two patients imaged twice with HS, 50% of the lesions were missed.
Şimşek, Gürcan; Gündeş, Ebubekir; Tekin, Şakir; Tavlı, Şakir
Breast abscess usually occurs during lactation and the responsible organism is often S. Aureus. Breast abscess in non-lactating women is extremely rare and limited data is available in the literature regarding this entity. In our study, a 36-year-old non-lactating female patient who developed bilateral breast abscess due to E. coli infection without any predisposing factors has been discussed in light of the literature.
Wolfsen, H C; Bolen, J W; Bowen, J L; Fenster, L F
Fulminant hepatitis due to herpes simplex virus (HSV) in adults is a rare and deadly disease. We describe a 23-year-old woman with a 20-year history of Crohn's disease (CD) who was hospitalized with an acute febrile illness and diarrhea. A computed tomography (CT) scan of the abdomen demonstrated an intramural sigmoid colon abscess and multiple abscesses in the liver. Despite high-dose parenteral corticosteroids and broad-spectrum antibiotics, the patient remained acutely ill, with high fever and markedly elevated serum transaminase levels, but no jaundice. Sigmoid resection and wedge liver biopsy were performed at laparotomy. Histologic examination documented HSV-type intranuclear inclusions and inflammation with necrosis in both the sigmoid colon and liver specimens. The patient subsequently died despite parenteral acyclovir treatment. Although rare, fulminant hepatitis due to HSV simplex virus should be considered in the differential diagnosis of all patients with severe hepatitis. Of special note, the necrotizing liver lesions may be mistaken for pyogenic abscesses on CT scan.
Teh, Catherine S. C.; Casupang, Ma. Amornetta J.
Case Presentation. This is a case of a 44-year-old male, farmer, known to be diabetic, presenting with two-week history of vague abdominal pain associated with high grade fever. Abdominal CT scan showed localized liver abscess at segment 8 measuring 7.5 × 6.8 × 6.1 cm. Patient subsequently underwent laparoscopic ultrasound guided pigtail insertion for drainage of abscess. Culture studies showed moderate growth of Burkholderia pseudomallei in which the patient completed seven days of IV Meropenem. On follow-up after 12 weeks of oral Sulfamethoxazole/Trimethoprim, taken twice a day, the patient remained asymptomatic with no residual findings based on the abdominal ultrasound. Discussion. Diagnosis of melioidosis, a known “great masquerader,” relies heavily on culture studies. Consensus with regard to the management of liver abscess caused by Burkholderia pseudomallei has not yet been established due to the rarity of cases. Surgical intervention through either a percutaneous or open drainage has shown good outcomes compared to IV antibiotics alone. In Philippines, the possibility of underreporting is highly plausible. This write-up serves not only to report a rare presentation of melioidosis but also to add to the number of cases reported in the country, possibly indicative of disease emergence. PMID:27529039
Shweta; Prakash, S Krishna
Dental abscess is a frequently occurring infectious process known to the health practice. The fate of the infection depends on the virulence of the bacteria, host resistance factors, and regional anatomy. Serious consequences arising from the spread of a dental abscess lead to significant morbidity and mortality. Acute dental abscess is polymicrobial, comprising of strict anaerobes, such as anaerobic cocci, Prevotella, Fusobacterium species, and facultative anaerobes, such as viridans group streptococci and the Streptococcus anginosus group. Numerous novel, uncultivable and fastidious organisms have been identified as potential pathogens with the use of non-culture techniques. The majority of localized dental abscesses respond to surgical treatment while the use of antimicrobials is limited to severe spreading infections. There is a need for good-quality clinical trials of sufficient size to identify the ideal treatment. The microbiology of the acute dentoalveolar abscess and its treatment in the light of improved culture and diagnostic methods are reviewed. PMID:24348613
Adigüzel, Özkan; Kaya, Sadullah; Akkuş, Zeki
Objectives: To evaluate whether age and gender differences are predictive factors for inferior alveolar nerve position with respect to mandibular first molar roots. Study Design: Cone-beam computed tomography scans [0.2-mm3 voxel size; n = 200 (100 males, 100 females)] of patients aged 15–65 years showing mandibular first and second molars were included in this study. Patients with pathoses that might affect inferior alveolar nerve position, including second molar and/or first premolar extraction, were excluded. Fourteen measurements (mm) were taken from the inferior alveolar nerve to the mesial and distal root apices. Subjects were grouped by age and gender. Data were analysed using two-way analyses of variance with post hoc Bonferroni corrections. Results: The distance from the inferior alveolar nerve to the root apices was smaller in females than males, regardless of age (p < 0.01). Distal roots were closer to the nerve than mesial roots in both genders (p < 0.05). Total buccolingual mandibular length (at 3-mm apical level) was shorter in females than males (p < 0.01) but mean buccolingual mandibular width at the level of the inferior alveolar canal did not differ. Nerve–root apex distances were significantly shorter in males and females aged 16–25 and 56–65 years than in other age groups (p < 0.01). Conclusions: The distance between inferior alveolar nerve and mandibular first molar roots depends upon the age and gender: it is shorter in females than in males and in subjects aged 16–25 years and >55 years than in other age groups. Key words:Age, cone-beam computed tomography, inferior alveolar nerve, root apex, gender. PMID:22926478
Flancbaum, L; Nosher, J L; Brolin, R E
Improvements in radiologic localization have made percutaneous catheter drainage (PCD) the initial procedure of choice for many intra-abdominal abscesses (IAA). During the past seven years 154 patients underwent PCD for treatment of abdominal abscesses. Fourteen of these patients had PCD as the initial treatment for IAA secondary to a perforated viscus and subsequently underwent an elective one-stage operation to treat the underlying disease. Etiologies of the abscesses included perforated appendicitis in six patients, sigmoid diverticulitis in three patients, Crohn's ileitis in two patients, and one case each of perforated gastric ulcer, perforated sigmoid carcinoma, and perforated gallbladder. Initial localization of the abscess was achieved by either CT or ultrasound. Seven abscesses were localized in the right lower quadrant, four were localized in the liver, and one was localized each in the left flank, right flank, subhepatic space, and pelvis. All patients subsequently underwent a definitive elective operation for their primary disease including six interval appendectomies, four sigmoid colectomies, two small-bowel resections, one subtotal gastrectomy and one cholecystectomy. There were no complications due to PCD and no deaths occurred. We conclude that PCD can be successfully performed as the initial treatment for IAA associated with a perforated viscus, obviating the first stage of the traditional two-stage surgical approach.
Reyna-Fabián, Miriam E.; Zermeño, Valeria; Ximénez, Cecilia; Flores, Janin; Romero, Miguel F.; Diaz, Daniel; Argueta, Jesús; Moran, Patricia; Valadez, Alicia; Cerritos, René
Several recent studies have demonstrated that virulence in Entamoeba histolytica is triggered in the presence of both pathogenic and nonpathogenic bacteria species using in vitro and in vivo experimental animal models. In this study, we examined samples aspirated from abscess material obtained from patients who were clinically diagnosed with amebic liver abscess (ALA) or pyogenic liver abscess (PLA). To determine the diversity of bacterial species in the abscesses, we performed partial 16S rRNA gene sequencing. In addition, the E. histolytica and Entamoeba dispar species were genotyped using tRNA-linked short tandem repeats as specific molecular markers. The association between clinical data and bacterial and parasite genotypes were examined through a correspondence analysis. The results showed the presence of numerous bacterial groups. These taxonomic groups constitute common members of the gut microbiota, although all of the detected bacterial species have a close phylogenetic relationship with bacterial pathogens. Furthermore, some patients clinically diagnosed with PLA and ALA were coinfected with E. dispar or E. histolytica, which suggests that the virulence of these parasites increased in the presence of bacteria. However, no specific bacterial groups were associated with this effect. Together, our results suggest a nonspecific mechanism of virulence modulation by bacteria in Entamoeba. PMID:26572872
Reyna-Fabián, Miriam E; Zermeño, Valeria; Ximénez, Cecilia; Flores, Janin; Romero, Miguel F; Diaz, Daniel; Argueta, Jesús; Moran, Patricia; Valadez, Alicia; Cerritos, René
Several recent studies have demonstrated that virulence in Entamoeba histolytica is triggered in the presence of both pathogenic and nonpathogenic bacteria species using in vitro and in vivo experimental animal models. In this study, we examined samples aspirated from abscess material obtained from patients who were clinically diagnosed with amebic liver abscess (ALA) or pyogenic liver abscess (PLA). To determine the diversity of bacterial species in the abscesses, we performed partial 16S rRNA gene sequencing. In addition, the E. histolytica and Entamoeba dispar species were genotyped using tRNA-linked short tandem repeats as specific molecular markers. The association between clinical data and bacterial and parasite genotypes were examined through a correspondence analysis. The results showed the presence of numerous bacterial groups. These taxonomic groups constitute common members of the gut microbiota, although all of the detected bacterial species have a close phylogenetic relationship with bacterial pathogens. Furthermore, some patients clinically diagnosed with PLA and ALA were coinfected with E. dispar or E. histolytica, which suggests that the virulence of these parasites increased in the presence of bacteria. However, no specific bacterial groups were associated with this effect. Together, our results suggest a nonspecific mechanism of virulence modulation by bacteria in Entamoeba.
Miller, S.W.; Dinsmore, R.E.
Abscesses in the aortic root are a serious complication of infective endocarditis and require accurate diagnosis for antibiotic and surgical management. Nineteen cases of endocarditis of a native valve or prosthetic valve and adjacent abscess cavities were identified with angiography. Of 6 patients with endocarditis of a native valve, 5 had bicuspid aortic valves and all had severe aortic regurgitation. Of 13 patients with endocarditis of a prosthetic aortic valve, all had paravalvular regurgitation. Fistulas were detected into the mitral anulus in 8 patients, and into the right ventricle in 3 patients. No complications from the catheterization were recorded during the 48-hour follow-up.
Al Amer, Nasser A.; Abd El Maksoud, Walid M.
We reported a rare case of abscess of the caudate lobe of the liver in a 60-year old man. We first tried computed tomography (CT) guided percutaneous drainage of the abscess but failed to eradicate the infection. Deterioration of the general condition of the patient necessitated open surgical drainage, which resulted in cure of the abscess. The peculiar anatomical location of caudate lobe abscess introduces a great challenge for the surgeon in planning the appropriate management and paucity of patients with caudate lobe abscess has led to lack of guidelines for management. The non-operative interventional radiology approach has become the therapeutic choice for pyogenic liver abscess, but is it applicable also for caudate lobe abscess? PMID:24086176
Earley, Edward T; Rawlinson, Jennifer E; Baratt, Robert M
Common indications for cheek tooth extraction in the horse include dental fracture, periodontal disease, severe decay/ caries, mandibular fracture with alveolar/tooth involvement, and periapical abscess. Complications secondary to extraction of cheek teeth are prevalent. Typical complications may include retained root tip(s), collateral damage of neighboring teeth and alveolar bone, mandibular fracture non-union or delayed union, cemental ankylosis, dilacerated root(s), oroantral/oronasal fistula, palatal deviation of cheek teeth, bone sequestration, sinus involvement, alveolar plug failure, and palatine artery laceration. This paper presents a series of cases that had complications following cheek tooth extraction. Anticipation of problematic extractions, recognition of complications, and appropriate treatment will aid the clinician in managing the inevitable cheek tooth extraction complication.
Karagiannis, Apostolos K A; Dimitropoulou, Fotini; Papatheodorou, Athanasios; Lyra, Stavroula; Seretis, Andreas
Summary Pituitary abscess is a rare life-threating entity that is usually misdiagnosed as a pituitary tumor with a definite diagnosis only made postoperatively. Over the last several decades, advances in healthcare have led to a significant decrease in morbidity and mortality due to pituitary abscess. We report a case of a 34-year-old woman who was admitted to our department for investigation of a pituitary mass and with symptoms of pituitary dysfunction, headaches and impaired vision. During her admission, she developed meningitis-like symptoms and was treated with antibiotics. She eventually underwent transsphenoidal surgery for excision of the pituitary mass. A significant amount of pus was evident intraoperatively; however, no pathogen was isolated. Six months later, the patient was well and had full recovery of the anterior pituitary function. Her menses returned, and she was only on treatment with desmopressin for diabetes insipidus that developed postoperatively. Learning points Pituitary abscess is a rare disease and the reported clinical features vary mimicking other pituitary lesions. The diagnosis of pituitary abscess is often very difficult to make and rarely included in the differential. The histological findings of acute inflammatory infiltration confirm the diagnosis of pituitary abscess. Medical and surgical treatment is usually recommended upon diagnosis of a pituitary abscess. PMID:27274845
Ichimi, K; Ishiguri, H; Kida, Y; Kinomoto, T
The authors report a case of brain abscess following cerebral infarction. A 73-year-old man was admitted to our clinic with symptoms of right hemiparesis and total aphasia. CT scan revealed abnormal low density area in the left fronto-temporo-parietal region. Cerebral angiography demonstrated occlusion of the left middle cerebral artery at the M1 portion. On the 16th hospital day, an episode of generalized seizure with high fever appeared, and intermittent high fever persisted thereafter. Two months after admission, CT scan revealed several cystic lesions with marked ring enhancement at the site of cerebral infarction, suggesting multiple abscesses. Aspirations of left frontal and parietal abscesses were accomplished and the cultures of the pus disclosed Proteus vulgaris. Due to progressive hydrocephalus, a ventriculoperitoneal shunt was constructed one month later. Repeated CT scans showed a gradual diminution of the abscesses. It is considered that the blood-brain barrier is broken and the local immunological system against bacteria may be weakened when the brain is damaged by ischemia. Brain abscess seems to be developed in such circumstances even under the influence of transient bacteremia which originates in other parts of the body. Therefore the possibility of cerebral abscess should be suspected if patients with cerebral infarction suffer from the symptoms such as fever, neck stiffness or disturbance of consciousness.
Donly, Kevin J; Donly, Adriana Segura; Baharloo, Laila; Rojas-Candelas, Edith; Garcia-Godoy, Franklin; Zhou, Xiaojie; Gerlach, Robert W
Although there are several case reports of vital tooth bleaching in children, there is limited clinical trial evidence of the safety or efficacy of this practice. Accordingly, a new clinical trial was conducted to evaluate the effects of 2 different bleaching systems, a 6.5% hydrogen peroxide strip system and a 10% carbamide peroxide tray system, in a population of preteens and teens. A total of 106 volunteers, aged 11 to 18 years, took part in this 8-week study. Patients were randomized by a ratio of 2:1 to the strip or tray groups, with each group treating the maxillary arch first and then the mandibular arch for 4 consecutive weeks each. Individuals assigned to the strip group used the system twice daily for 30 minutes (a total of 56 contact hours over the 8-week study). Those assigned to the tray group used that system overnight (approximately 448 contact hours). Digital images were obtained at baseline and after every 2-week treatment period. Average tooth color was determined in L*, a*, b* color space, where L* indicated lightness, a* indicated red-green, and b* indicated yellow-blue. Both systems significantly whitened teeth (P < 0.0001). While there were no significant differences between groups with respect to the primary whitening response (delta b*) on the maxillary teeth, 4 weeks of overnight treatment with the 10% carbamide peroxide tray (approximately 224 contact hours) yielded statistically significant whitening (P < 0.05) on the mandibular teeth compared with the 6.5% hydrogen peroxide strip used for 28 hours. Both tooth-whitening systems had similar sensitivity/irritation reported after instructed use. This research demonstrates that tooth whitening in teens may be safely accomplished using either the short-contact-time hydrogen peroxide bleaching strips or the overnight carbamide peroxide tray systems tested in this study.
Turner, Ryan C; Dodson, Sean C; Rosen, Charles L
A large abscess of the posterior fossa often warrants surgical intervention. We report a case of a 50-year-old male presenting with a cerebellar abscess measuring 2.8 cm x 1.6 cm located in the left cerebellar hemisphere at the level of the middle cerebellar peduncle that was treated conservatively and successfully with antibiotics. Therapeutic management options are discussed in regards to this case specifically as well as a review of the literature. This case illustrates the successful medical management of a cerebellar abscess of otogenic origin in an adult, a unique result in terms of abscess size and age of the patient.
Bosscha, K; van Vroonhoven, Th J M V
Two young women, aged 19 and 25 years, suffered from persistent perianal sepsis after local drainage of unusual gluteal abscesses. Preoperative CT scanning showed unrecognised and inadequately treated abscesses and signs of inflammatory bowel disease. Both patients underwent a reoperation: affected bowel segments were removed, stomas were created and abscesses were drained. In the case of unusual perianal abscesses the diagnosis 'Crohn's disease' must be considered. Preoperative examinations should include CT or MRI scans of the abdomen and pelvis. Intraoperative colonoscopy can often be helpful in assessing the extent of the affected bowel segment.
Jayasekera, Hasanga; Gorissen, Kym; Francis, Leo; Chow, Carina
A non-healing peri-anal abscess can be difficult to manage and is often attributed to chronic disease. This case documents a male in his seventh decade who presented with multiple peri-anal collections. The abscess cavity had caused necrosis of the internal sphincter muscles resulting in faecal incontinence. Biopsies were conclusive for diffuse large B-cell lymphoma. A de-functioning colostomy was performed and the patient was initiated on CHOP-R chemotherapy. Anal lymphoma masquerading as a peri-anal abscess is rare. A high degree of suspicion must be maintained for an anal abscess which does not resolve with conservative management.
Santos, Sofia A; Alberto, Sara CF; Cruz, Elsa; Pires, Eduardo; Figueira, Tomás; Coimbra, Élia; Estevez, José; Oliveira, Mário; Novais, Luís; Deus, João R
Hepatic abscess due to perforation of the gastrointestinal tract caused by ingested foreign bodies is uncommon. Pre-operative diagnosis is difficult as patients are often unaware of the foreign body ingestion and symptoms and imagiology are usually non-specific. The authors report a case of 62-year-old woman who was admitted with fever and abdominal pain. Further investigation revealed hepatic abscess, without resolution despite antibiotic therapy. A liver abscess resulting from perforation and intra-hepatic migration of a bone coming from the pilorum was diagnosed by surgery. The literature concerning foreign body-induced perforation of the gastrointestinal tract complicated by liver abscess is reviewed. PMID:17457985
Cho, Jinbeom; Park, Ilyoung; Lee, Dosang; Sung, Kiyoung; Baek, Jongmin
Surgeons occasionally encounter a patient with a gastric cancer invading an adjacent organ, such as the pancreas, liver, or transverse colon. Although there is no established guideline for treatment of invasive gastric cancer, combined resection with radical gastrectomy is conventionally performed for curative purposes. We recently treated a patient with a large gastric cancer invading the abdominal wall, which was initially diagnosed as a simple abdominal wall abscess. Computed tomography showed that an abscess had formed adjacent to the greater curvature of the stomach. During surgery, we made an incision on the abdominal wall to drain the abscess, and performed curative total gastrectomy with partial excision of the involved abdominal wall. The patient received intensive treatment and wound management postoperatively with no surgery-related adverse events. However, the patient could not receive adjuvant chemotherapy and expired on the 82nd postoperative day. PMID:26468420
Buttaro, M; González Della Valle, A; Piccaluga, F
A 65-year-old man with a left uncemented total hip arthroplasty performed 11 years previously was admitted with a history of progressive low back pain, left hip pain, and sepsis that had begun 6 months earlier. On physical examination, a gross, fluctuant mass was palpated in the left thigh. A computed tomography (CT) scan revealed a 6.5 x 3 cm left retrofascial psoas abscess communicating with the hip joint. The patient underwent irrigation and débridement of the hip with removal of the components. The psoas abscess was drained through the iliopsoas bursa. A residual psoas abscess was drained percutaneously under CT guidance. Cultures isolated Escherichia coli, and the patient responded to 6 months of ciprofloxacin therapy. After 1 year, the patient had no evidence of infection. Pathways of infection spread, diagnosis, and treatment of a patient with this rare association are discussed with a review of the literature.
Zenda, T; Kaizaki, C; Sato, H; Miyamoto, S; Okada, T; Mabuchi, H
We present here two suggestive cases in considering the advantages and disadvantages of irrigation of pyogenic liver abscess: one patient developed an intrahepatic hematoma as an unusual sequela, while the other was successfully treated by abscess irrigation, overcoming failure of percutaneous catheter drainage and the patient's seriously ill condition. Based on these cases, we propose a novel method of liver abscess irrigation via percutaneous drainage tubes with the following three characteristics: 1) use of a drip infusion apparatus for irrigant instillation and drainage in order to avoid elevation of pressure in the abscess, a source of potential life-threatening sequelae, 2) addition of contrast medium to irrigant, and 3) employment of computed tomography in dynamic equilibrium of irrigant in order to evaluate the efficacy of current irrigation. Of interest was the parenchymal enhancement around the irrigated liver abscess revealed by computed tomography with this method, which suggested that dissemination of abscess contents may be inevitable with irrigation. Although the indications for liver abscess irrigation must be considered carefully given the critical sequelae potentially associated with it, the method we present can be used as a second-line trial exclusively for liver abscesses refractory to first-line treatment with percutaneous catheter drainage or needle aspiration, since it can be used not only as a therapeutic procedure with mechanical washing or dilution of abscess contents but also as a diagnostic aid enabling more effective subsequent treatment by defining the areas in which drainage and irrigation is not effective.
Development of patient-based questionnaire about aesthetic and functional differences between overdentures implant-supported and overdentures tooth-supported. Study of 43 patients with a follow up of 1 year
GARGARI, M.; PRETE, V.; PUJIA, M.; CERUSO, F. M.
SUMMARY Development of patient-based questionnaire about aesthetic and functional differences between overdentures implant-supported and overdentures tooth-supported. Study of 43 patients with a follow up of 1 year. Objective The aim of this study is to compare functional efficiency and patients satisfaction between tooth-supported and implant-supported overdenture through a questionnaire that accurately reflects the real concerns of patients with dental prosthesis. Methods Forty-three patients were selected from the out patient clinic, Department of Dentistry “Fra G.B. Orsenigo Ospedale San Pietro F.B.F.”, Rome, Italy. Their age were ranging from 61 to 83 years. Eighteen patients were rehabilitated with overdentures supported by natural teeth and twenty-five with overdentures implant-supported. Discussion and Result The questionnaire proposed one year after the insertion of the prosthetis has showed that there isn’t difference statistically significant in terms of function, phonetics and aesthetics between overdenture implant-supported and tooth-supported. Conclusions The results of the questionnaire showed that the patients generally had a high level of satisfaction concern to the masticatory function, esthetics and phonetics. In addition, on average, they haven’t difficulty in removal and insertion of the denture and in oral hygiene. They haven’t in both groups problems related to fractures. PMID:23741602
Shah, S B; Murr, A H; Lee, K C
Proper management of a nasal septal abscess requires prompt diagnosis, adequate surgical drainage, and antibiotics to prevent the potentially dangerous spread of infection and the development of severe functional and cosmetic sequelae. Most septal abscesses are the result of trauma to the nose with septal hematoma and subsequent infection. We present our experience with nasal septal abscesses in five immunocompromised patients without history of nasal trauma. All patients were treated with surgical drainage and antibiotics. The infections in four patients resolved, whereas in the fifth, the infection led to death. We report these cases to depict alternate etiologies of nasal septal abscess, particularly in the immunocompromised patient. Our review illustrates the wide spectrum of disease presentation, provides treatment strategies, and emphasizes the potentially catastrophic sequelae of this disease when unrecognized. With the growing number of immunocompromised individuals, it is important to recognize the potential for immunocompromise to influence the development of septal abscess.
Güzel, Yunus; Çiftçi, Sadettin; Özdemir, Ali; Acar, Mehmet Ali
Psoas abscess, which is a rarely encountered infection, is defined as the accumulation of suppurative fluid within the fascia surrounding the psoas and iliac muscles. It is categorised as being primary or secondary. Although there are reports in the literature of secondary psoas abscess from foreign bodies, to the best of our knowledge, this is the first reported case of psoas abscess developing due to a bullet, following a firearms injury. The patient was first seen in the Emergency Department following a firearms injury in the posterolateral lumbar region and as the neurovascular examination was normal, the patient was discharged after 24 hours of observation. One month later, the patient presented again to the polyclinic with a high temperature and back pain. As a result of physical examination and tests, a diagnosis was made of psoas abscess and percutaneous drainage was applied under ultrasonography guidance. The complaints improved but, 10 days later with an increase in pain and indications of infection, open abscess drainage was applied and the bullet was removed. At the 6-month follow-up examination, the patient had no complaints. PMID:26075128
Güzel, Yunus; Çiftçi, Sadettin; Özdemir, Ali; Acar, Mehmet Ali
Psoas abscess, which is a rarely encountered infection, is defined as the accumulation of suppurative fluid within the fascia surrounding the psoas and iliac muscles. It is categorised as being primary or secondary. Although there are reports in the literature of secondary psoas abscess from foreign bodies, to the best of our knowledge, this is the first reported case of psoas abscess developing due to a bullet, following a firearms injury. The patient was first seen in the Emergency Department following a firearms injury in the posterolateral lumbar region and as the neurovascular examination was normal, the patient was discharged after 24 hours of observation. One month later, the patient presented again to the polyclinic with a high temperature and back pain. As a result of physical examination and tests, a diagnosis was made of psoas abscess and percutaneous drainage was applied under ultrasonography guidance. The complaints improved but, 10 days later with an increase in pain and indications of infection, open abscess drainage was applied and the bullet was removed. At the 6-month follow-up examination, the patient had no complaints.
Preciado, A; Matthews, B D; Scarborough, T K; Marti, J L; Reardon, P R; Weinstein, G S; Bennett, M
Spillage of gallstones into the peritoneal cavity is a frequent problem during laparoscopic cholecystectomy (as much as 30%) and is frequently dismissed as a benign occurrence. However, several complications associated with spillage of gallstones have been reported recently. Most of these complications presented late after the original procedure, many with clinical pictures not related to biliary etiology, confounding and delaying adequate management. For patients presenting with intraabdominal or thoracic abscesses of unknown etiology, if there is a history of laparoscopic cholecystectomy, regardless of the time interval, certain evaluations should be considered. A sonogram and a CT scan are advisable to detect retained extraluminal gallstones, as most patients will require, not only drainage of fluid collections, but also removal of the stones. A case is described of a patient who presented with a right empyema and transdiaphragmatic abscess 18 months after a laparoscopic cholecystectomy. Treatment included decortication, enbloc resection of the abscess, repair of the diaphragm, and drainage.
Huang, C J; Pitt, H A; Lipsett, P A; Osterman, F A; Lillemoe, K D; Cameron, J L; Zuidema, G D
OBJECTIVE: The authors document changes in the etiology, diagnosis, bacteriology, treatment, and outcome of patients with pyogenic hepatic abscesses over the past 4 decades. SUMMARY BACKGROUND DATA: Pyogenic hepatic abscess is a highly lethal problem. Over the past 2 decades, new roentgenographic methods, such as ultrasound, computed tomographic scanning, direct cholangiography, guided aspiration, and percutaneous drainage, have altered both the diagnosis and treatment of these patients. A more aggressive approach to the management of hepatobiliary and pancreatic neoplasms also has resulted in an increased incidence of this problem METHODS: The records of 233 patients with pyogenic liver abscesses managed over a 42-year period were reviewed. Patients treated from 1952 to 1972 (n = 80) were compared with those seen from 1973 to 1993 (n = 153). RESULTS: From 1973 to 1993, the incidence increased from 13 to 20 per 100,000 hospital admissions (p < 0.01. Patients managed from 1973 to 1993 were more likely (p < 0.01) to have an underlying malignancy (52% vs. 28%) with most of these (81%) being a hepatobiliary or pancreatic cancer. The 1973 to 1993 patients were more likely (p < 0.05) to be infected with streptococcal (53% vs. 30%) or Pseudomonas (30% vs. 9%) species or to have mixed bacterial and fungal 26% vs. 1%) infections. The recent patients also were more likely (p < 0.05) to be managed by percutaneous abscess drainage (45% vs. 0%). Despite having more underlying problems, overall mortality decreased significantly (p < 0.01) from 65% (in 1952 to 1972 period) to 31% (in 1973 to 1993 period). The reduction was greatest for patients with multiple abscesses (88% vs. 44%; p < 0.05) with either a malignant or a benign biliary etiology (90% vs. 38%; p < 0.05). Mortality was increased (p < 0.02) in patients with mixed bacterial and fungal abscesses (50%). From 1973 to 1993, mortality was lower (p = 0.19) with open surgical as opposed to percutaneous abscess drainage (14
Murata, Mai; Hiratsuka, Munehisa; Suzuki, Shigehiko
Summary: We herein report a 62-year-old man with an extensive sacral decubitus ulcer complicated by an epidural abscess. An epidural abscess is a rare disease, but it should be considered in the differential diagnosis of a deep infection with decubitus. Moreover, the diagnosis may be late in such instances and should be carefully considered when a patient has paralysis. PMID:27536469
Cyrkowicz, A; Cibor, Z; Słowińska-Zabówka, M; Kisiel, W; Oleksy, P; Orczyk, K; Bajorek, M; Kwiek, G
Delayed surgical intervention connected with misdiagnosis of preterm labour and urinary tract infection caused in gravida 3 in 34th gestational week appendiceal abscess, septic shock, stillbirth by cesarean section, necessity of hysterectomy, recidivism of multi peritoneal and pleural abscesses. Although the patient was rescued the retrospective pro memoria considerations of our procedure are regarded.
Franco, A; Menéndez, V; Luque, M P; Ribal, M J; Mallafre, J M; Alcover, J; Vilana, R; Carretero, P
Prostatic abscesses are an infrequent pathology, probably due to a better and early management of prostatic infections. Predisposing factors in this pathology are diabetes mellitus, urethral catheterism or manipulation, and immunodepressed states like AIDS. Nowadays, ultrasonography is an excellent diagnostic method of this pathology, and serves as a guidance of directed drainage. We present five cases in which the size of the abscess was determining in relation to the therapeutic attitude. Abscesses of less than 2 cm, measured by transrectal ultrasonography, can be evacuated by directed puncture, followed by antibiotic treatment. When the diameter of the abscess is greater than 2 cm, we realize a perineal drainage with a catheter placed with transrectal ultrasonography. Currently, TUR and other methods seems to be overcome.
Brown, Tamara; Beaufrère, Hugues; Brisson, Brigitte; Laniesse, Delphine; Zur Linden, Alex
A rabbit was presented for severe dyspnea and was diagnosed with an odontogenic abscess obstructing the rostral nasopharynx using CT scan and oral endoscopy. The offending tooth was extracted intraorally, but due to persistent dyspnea, an endoscopic-guided ventral rhinotomy was performed. The dyspnea subsequently resolved, but the rabbit died 5 weeks later from a seemingly unrelated cause.
Brown, Tamara; Beaufrère, Hugues; Brisson, Brigitte; Laniesse, Delphine; zur Linden, Alex
A rabbit was presented for severe dyspnea and was diagnosed with an odontogenic abscess obstructing the rostral nasopharynx using CT scan and oral endoscopy. The offending tooth was extracted intraorally, but due to persistent dyspnea, an endoscopic-guided ventral rhinotomy was performed. The dyspnea subsequently resolved, but the rabbit died 5 weeks later from a seemingly unrelated cause. PMID:27493289
Hyo, Yukiyoshi; Fujisaki, Tomoya; Hyo, Rui; Tanaka, Hiroki; Harada, Tamotsu
Iliopsoas abscess was once an uncommon condition but now occurs somewhat more frequently due to the increasing number of immunocompromised patients, such as those with diabetes. We encountered a case of iliopsoas abscess following chemoradiotherapy for hypopharyngeal cancer. A 60-year-old man was admitted for a sore throat and left neck swelling. Hypopharyngeal cancer was diagnosed, but the patient refused surgery. After two rounds of chemotherapy, febrile neutropenia developed and chest computed tomography (CT) revealed an iliopsoas abscess. The platelet count was low but recovered after administration of antibiotics and could not be explained by puncture of the abscess. CT-guided drainage eventually improved his symptoms. Even for disorders of the head and neck region, iliopsoas abscess should be suspected in immunocompromised patients who develop a fever. CT and magnetic resonance imaging should be performed at an early stage as it is important to determine whether surgical drainage is indicated. PMID:26989543
Kobayashi, Scott D; Malachowa, Natalia; DeLeo, Frank R
Staphylococcus aureus causes many types of human infections and syndromes-most notably skin and soft tissue infections. Abscesses are a frequent manifestation of S. aureus skin and soft tissue infections and are formed, in part, to contain the nidus of infection. Polymorphonuclear leukocytes (neutrophils) are the primary cellular host defense against S. aureus infections and a major component of S. aureus abscesses. These host cells contain and produce many antimicrobial agents that are effective at killing bacteria, but can also cause non-specific damage to host tissues and contribute to the formation of abscesses. By comparison, S. aureus produces several molecules that also contribute to the formation of abscesses. Such molecules include those that recruit neutrophils, cause host cell lysis, and are involved in the formation of the fibrin capsule surrounding the abscess. Herein, we review our current knowledge of the mechanisms and processes underlying the formation of S. aureus abscesses, including the involvement of polymorphonuclear leukocytes, and provide a brief overview of therapeutic approaches.
Kuciel, Natalia Maria; Konieczny, Grzegorz Krzysztof; Oleksy, Łukasz; Wrzosek, Zdzisława
There is very limited, evidenced data about movement possibilities in patients with high level of lower limb muscles atrophy and fatigue in patients suffering from Charcot-Marie-Tooth syndrome. Patient (age 46) suffering from Charcot-Marie-Tooth disease for 30 years with multiple movement restrictions and muscles atrophy above knees took part into the study. Tests were performed for 8 muscles of the lower limb and pelvis. Muscles electrical activity was tested in sitting and standing position (for knees extended and hyperextended). In the right leg rectus femoris, vastus lateralis obliquus, gluteus medius and semitendinosus muscles activated at first and were working the longest time. The highest activity was observed in standing position with knees extended. In the left leg rectus femoris and biceps femoris muscles activated at first and biceps femoris was working the longest time. Activity level in left lower limb is much lower than in the right one. Muscles weakness is asymmetric. Left leg is much weaker and engages antagonists and synergists muscles to compensate weaker rectus femoris, vastus medialis obliquus and vastus lateralis obliquus.
Alg, Varinder S; Demetriades, Andreas K; Naik, Sunil; Gunasekera, Lal
A tuberculous spinal epidural abscess is seen rarely as a late complication of Pott's disease or in immunocompromised patients. Such abscesses in isolation are rare indeed and very uncommon in the developed and developing world. We report a patient with an isolated subacute tuberculous spinal epidural abscess without disc or vertebral involvement and no primary focus or risk factors associated with the development of spinal tuberculosis.
Martínez-Lage, J F; Felipe-Murcia, M; Martínez-Lage Azorín, L
A 51-year-old man underwent a C5-C7 anterior decompression and fusion. Six years later the patient complained of dysphagia caused by displacement of the cervical plate. One week after the scheduled removal of the implanted material, the patient developed a painful cervical swelling and fever. His cervical radiographs showed that a screw was missing compared to previous studies. Computerized tomography showed a large prevertebral abscess anterior to C4-C7. He underwent emergency surgical drainage of the abscess that was followed by total recovery. This report is aimed at describing this unusual complication of cervical instrumentation and to briefly review its pathogenesis and management options.
Adegbiji, W. A.; Alabi, B. S.; Olajuyin, O. A.; Nwawolo, C. C.
BACKGROUND AND AIM: Preauricular sinus abscess is a common congenital external ear disease. This abscess is usually misdiagnosed because it is commonly overlooked during physical examination. In Nigeria, the prevalence was 9.3% in Ilorin, north central Nigeria This study is to determine the distribution and clinical presentation of the preauricular sinus abscess in Ekiti, south west Nigeria. MATERIALS AND METHODS: This is a prospective hospital based study of all patients with diagnosis of preauricular sinus abscess seen in our clinic carried out between April 2008 to March 2010. Detailed clinical history, administered interviewer’s assisted questionnaires full examination and. Data obtained were collated and analysed. RESULTS: Preauricular sinus were noticed in 184 (4.4%) out of 4170 patients seen during the study period. Preauricular sinus abscess were noticed in 21 (11.4%) of the preauricular sinuses especially in children. Unilateral preauricular sinus abscess accounted for 90.5%. Common presenting complaints were preauricular swelling (81.0%), 90.5% with recurrent earaches, 76.2% with ear discharges. All patients had antibiotic / analgesic while 17 out of 21 (81.0%) had surgical excisions. CONCLUSION: Preauricular sinus abscess were noticed among 11.4% of the preauricular sinuses especially in children, unilateral preauricular sinus abscess accounted for 90.5%. Common complaints were otorrhoea, earaches, and swelling and they were mostly managed surgically. PMID:24711764
Hansford, Jordan R; Phillips, Marianne; Cole, Catherine; Francis, Joshua; Blyth, Christopher C; Gottardo, Nicholas G
Bacillus cereus can cause serious infections in immunosuppressed patients. This population may be susceptible to B. cereus pneumonia, bacteremia, cellulitis, and rarely cerebral abscess. Here we report an 8-year-old boy undergoing induction therapy for acute lymphoblastic leukemia who developed multifocal B. cereus cerebral abscesses, highlighting the propensity for B. cereus to develop cerebral abscesses. A review of the literature over the past 25 years identified another 11 cases (3 children and 8 adults) of B. cereus cerebral abscess in patients undergoing cancer therapy. B. cereus cerebral abscesses were associated with a high mortality rate (42%) and significant morbidity. Notably, B. cereus bacteremia with concomitant cerebral abscess was associated with induction chemotherapy for acute leukemia in both children and adults (10 of 12 case reports). Our case report and review of the literature highlights the propensity for B. cereus to develop cerebral abscess(es). Therefore, early consideration for neuroimaging should be given for any neutropenic cancer patient identified with B. cereus bacteremia, in particular those with acute leukemia during induction therapy.
Takigawa, Aya; Kagawa, Narito; Kenri, Tsuyoshi; Yoshida, Shinji; Shibayama, Keigo; Aoki, Yasuko
Introduction: Mycoplasma hominis is associated with genito-urinary tract infection and adverse pregnancy outcomes. However, whether the species is a true pathogen or part of the genito-urinary tracts natural flora remains unclear. Case presentation: A 41-year-old pregnant woman was admitted to our hospital at 38 weeks and 5 days of gestation owing to premature rupture of the membranes. The patient delivered by caesarean section. Subsequently, the patient complained of lower abdominal pain and had persistent fever. Enhanced computed tomography revealed pelvic abscesses. Gram staining of pus from the abscess and vaginal secretions indicated presence of polymorphonuclear leucocytes but no pathogens. Cultures on blood agar showed growth of pinpoint-sized colonies in an anaerobic environment within 48 h. Although administration of carbapenem and metronidazole was ineffective and we could not fully drain the abscess, administration of clindamycin led to clinical improvement. The isolates 16S rRNA gene and yidC gene sequences exhibited identity with those of M. hominis. Conclusion: Physicians should consider M. hominis in cases of pelvic abscesses where Gram staining yields negative results, small colonies are isolated from the abscess and treatment with β-lactam antibiotics is ineffective. PMID:28348780
Kelleher, Martin G. D.; Bomfim, Deborah I.; Austin, Rupert S.
The prevalence and severity of tooth wear is increasing in industrialised nations. Yet, there is no high-level evidence to support or refute any therapeutic intervention. In the absence of such evidence, many currently prevailing management strategies for tooth wear may be failing in their duty of care to first and foremost improve the oral health of patients with this disease. This paper promotes biologically sound approaches to the management of tooth wear on the basis of current best evidence of the aetiology and clinical features of this disease. The relative risks and benefits of the varying approaches to managing tooth wear are discussed with reference to long-term follow-up studies. Using reference to ethical standards such as “The Daughter Test”, this paper presents case reports of patients with moderate-to-severe levels of tooth wear managed in line with these biologically sound principles. PMID:22315608
Simón-Yarza, I; Viteri-Ramírez, G; García-Lallana, A; Benito, A
Anastomoses often leak after esophageal surgery; if they are not detected in time, leaks can give rise to complications like fluid collections, superinfections, and mediastinitis. Although these complications usually require surgical treatment, different series of patients successfully treated with conservative or minimally invasive approaches have been reported. We present the case of a patient who developed a mediastinal abscess after epiphrenic diverticulectomy. We treated the abscess with US-guided percutaneous transhepatic drainage to avoid surgical reintervention. Although other cases of a transhepatic approach to thoracic lesions have been reported, to our knowledge this is the first report of this technique in mediastinal abscesses. We recommend that transhepatic drainage be considered a therapeutic option in the management of these complications.
Madhani, Kavi; McGrath, Eric; Guglani, Lokesh
INTRODUCTION: Pediatric lung abscesses can be primary or secondary, and there is limited data regarding response to treatments and patient outcomes. OBJECTIVES: To assess the clinical and microbiologic profile of pediatric patients with lung abscess and assess the differences in outcomes for patients treated with medical therapy or medical plus surgical therapy. METHODS: A retrospective review of all pediatric patients ≤ 18 years of age that were treated as an inpatient for lung abscess between the dates of August 2004 and August 2014 was conducted. Patients were divided into two subgroups based on the need for surgical intervention. RESULTS: A total of 39 patients with lung abscess (30 treated with medical therapy alone, 9 also required surgical interventions) were included. Fever, cough, and emesis were the most common presenting symptoms, and most of the patients had underlying respiratory (31%) or neurologic disorders (15%). Staphylococcus aureus was the most common organism in those that had culture results available, and ceftriaxone with clindamycin was the most common combination of antibiotics used for treatment. Comparison of medical and surgical subgroups identified the duration of fever and abscess size as risk factors for surgical intervention. CONCLUSIONS: Pediatric lung abscesses can be managed with medical therapy alone in most cases. Presence of prolonged duration of fever and larger abscess size may be predictive of the need for surgical intervention. Good clinical response to prolonged therapy with ceftriaxone and clindamycin was noted. PMID:27512508
Ijaz, Mohsin; Sakam, Sailaja; Ashraf, Umair; Marquez, Jose Gomez
Patient: Male, 47 Final Diagnosis: Bilateral psoas abscess • acute lower extremity deep vein thrombosis • bilateral pulmonary embolism Symptoms: Progressive left leg swelling • productive cough with whitish sputum • right flank pain Medication: Antibiotics and anticoagulation Clinical Procedure: CT-guided percutaneous drain placement Specialty: Internal Medicine/Critical Care Objective: Unusual presentation Background: Psoas abscesses are a known cause of back pain, but they have not been reported as a cause of acute lower extremity thromboses and bilateral pulmonary emboli. We report a patient with bilateral psoas abscesses causing extensive pulmonary emboli through compression of the iliac vein. Case Report: A 47-year-old man presented with bilateral leg swelling over 4 weeks. Physical examination revealed a thin male with bilateral leg swelling, extending to the thigh on his left side. He had hemoglobin of 10.5 g/dl, leukocytosis of 16 000/ml, and an elevated D-dimer. A computed tomography (CT) angiogram of his chest showed extensive bilateral pulmonary emboli and infarcts. He remained febrile with vague flank pain, prompting a CT of his abdomen and pelvis that showed large, multiloculated, septated, bilateral psoas abscesses with compression of the left femoral vein by the left psoas abscess and a thrombus distal to the occlusion. Two liters of pus was drained from the left psoas abscess by CT-guidance, and although the Gram staining showed Gram-positive cocci in clusters, cultures from the abscess and blood were negative. A repeat CT showed resolution of the abscesses, and the drain was removed. He was discharged to a nursing home to complete a course of intravenous antibiotics and anticoagulation. Conclusions: Although the infectious complications of psoas abscesses have been described in the literature, the mechanical complications of bilateral psoas abscesses are lacking. It is important to assess for complete resolution of psoas abscesses through
Kumar, K. Pavan; Nujella, Surya Kumari; Gopal, S. Sujatha
For patients who require removal of anterior teeth and their replacement various treatment modalities are available. With advancement in technology and availability of glass/polyethylene fibres, use of natural tooth as pontic with fibre reinforced composite restorations offers the promising results. The present case report describes management of periodontally compromised mandibular anterior tooth using natural tooth pontic with fibre reinforcement. A 1-year follow-up showed that the bridge was intact with good esthetics and no problem was reported. PMID:27195156
Hammond, Douglas; Parmar, Sat; Whitty, Justin; Pigadas, Nick
Whether to extract or retain wisdom teeth present in a fracture line is a controversial topic. This study reviewed the records of all patients who had mandibular wisdom teeth at the time of the injury, and had an open reduction and internal fixation procedure between January 2009 and January 2012. The cohort of patients who concomitantly had their wisdom tooth extracted at the time of fixation had a greater complication rate (24.3%) compared with patients who did not (14.9%). This suggests that if third molars in the line of a fracture have caries, are fractured, show signs of pericoronitis, are periodontally involved, or are interfering with the occlusion are extracted at the time of fixation, this will increase the incidence of complications.
Noh, Kwantae; Pae, Ahran; Lee, Jung-Woo; Kwon, Yong-Dae
An obturator prosthesis with insufficient retention and support may be improved with implant placement. However, implant surgery in patients after maxillary tumor resection can be complicated because of limited visibility and anatomic complexity. Therefore, computer-guided surgery can be advantageous even for experienced surgeons. In this clinical report, the use of computer-guided surgery is described for implant placement using a bone-supported surgical template for a patient with maxillary defects. The prosthetic procedure was facilitated and simplified by using computer-aided design/computer-aided manufacture (CAD/CAM) technology. Oral function and phonetics were restored using a tooth- and implant-supported obturator prosthesis. No clinical symptoms and no radiographic signs of significant bone loss around the implants were found at a 3-year follow-up. The treatment approach presented here can be a viable option for patients with insufficient remaining zygomatic bone after a hemimaxillectomy.
Nwosu, Jones N; Nnadede, Peter C
Background Nasal hematoma/abscess is an uncommon entity, but capable of leading to serious consequences if not handled meticulously, and with urgency. Objective To present the management, and outcome of nasal septal hematoma/abscess in a Nigerian tertiary institution. Method Consecutive patients diagnosed with nasal septal hematoma/abscess over a 10-year period, treated at the University of Nigeria Teaching Hospital, Enugu, Nigeria, were prospectively studied. The processes leading to diagnosis, treatment, and outcome were sequentially evaluated. Results Fifty-three patients (37 males and 16 females), age 5–65 years (with mean age of 23.10 years), were included. Surgical drainage of the hematoma/abscess, intranasal packing with insertion of drain was performed with total resolution of problem in all the cases. Conclusion Incision and drainage, and intranasal packing with insertion of drain was effective in treating nasal septal hematoma/abscess. PMID:26251577
Sawai, Madhuri Alankar; Bhardwaj, Ashu; Jafri, Zeba; Sultan, Nishat; Daing, Anika
Healthy teeth and gums make a person feel confident and fit. As people go about their daily routines and with different eating and drinking habits, the tooth enamel turns yellowish or gets stained. Polishing traditionally has been associated with the prophylaxis procedure in most dental practices, which patients know and expect. However, with overzealous use of polishing procedure, there is wearing of the superficial tooth structure. This would lead to more accumulation of local deposits. Also, it takes a long time for the formation of the fluoride-rich layer of the tooth again. Hence, now-a-days, polishing is not advised as a part of routine oral prophylaxis procedure but is done selectively based on the patients’ need. The article here, gives an insight on the different aspects of the polishing process along with the different methods and agents used for the same. PMID:26392683
Marchi, Luciana Manzotti De; Pini, Núbia Inocencya Pavesi; Hayacibara, Roberto Massayuki; Silva, Rafael Santos; Pascotto, Renata Corrêa
To evaluate functional and periodontal aspects in patients with unilateral or bilateral congenitally missing maxillary lateral incisors, treated with either implants or space closure and tooth re-contouring. The sample consisted of 68 volunteers, divided into 3 groups: SCR - space closure and tooth re-contouring with composite resin (n = 26); SOI - implants placed in the area of agenesis (n = 20); and CG - control group (n = 22). A modified Helkimo questionnaire and the Research Diagnostic Criteria for Temporomandibular Disorders were used by a single, previously calibrated evaluator to assess signs and symptoms of temporomandibular joint disorder. The periodontal assessment involved the following aspects: plaque index, bleeding upon probing, pocket depth greater than 3 mm, gingival recession, abfraction, periodontal biotype and papilla index. The data were analyzed using Fisher's exact test and the nonparametric Mann-Whitney and Kruskal-Wallis tests (α=.05). No differences in periodontal status were found between treatments. None of the groups were associated with signs and symptoms of temporomandibular joint disorder. Both treatment alternatives for patients with congenitally missing maxillary lateral incisors were satisfactory and achieved functional and periodontal results similar to those of the control group.
Marchi, Luciana Manzotti De; Pini, Núbia Inocencya Pavesi; Hayacibara, Roberto Massayuki; Silva, Rafael Santos; Pascotto, Renata Corrêa
To evaluate functional and periodontal aspects in patients with unilateral or bilateral congenitally missing maxillary lateral incisors, treated with either implants or space closure and tooth re-contouring. The sample consisted of 68 volunteers, divided into 3 groups: SCR - space closure and tooth re-contouring with composite resin (n = 26); SOI – implants placed in the area of agenesis (n = 20); and CG - control group (n = 22). A modified Helkimo questionnaire and the Research Diagnostic Criteria for Temporomandibular Disorders were used by a single, previously calibrated evaluator to assess signs and symptoms of temporomandibular joint disorder. The periodontal assessment involved the following aspects: plaque index, bleeding upon probing, pocket depth greater than 3 mm, gingival recession, abfraction, periodontal biotype and papilla index. The data were analyzed using Fisher's exact test and the nonparametric Mann-Whitney and Kruskal-Wallis tests (α=.05). No differences in periodontal status were found between treatments. None of the groups were associated with signs and symptoms of temporomandibular joint disorder. Both treatment alternatives for patients with congenitally missing maxillary lateral incisors were satisfactory and achieved functional and periodontal results similar to those of the control group. PMID:23346262
Swift, Edward J
This article presents a review of the basic concepts of tooth sensitivity and how those concepts apply to cervical dentin hypersensitivity and the sensitivity frequently associated with tooth whitening. The etiology and treatment of cervical dentin hypersensitivity are described. The clinical presentation, incidence, and predisposing factors for sensitivity associated with tooth whitening also are discussed.
Bando, Kazuhiko; Ebisutani, Daizo
We report a woman whose anterior communicating artery (AcomA) aneurysm was clipped via an anterior interhemispheric approach when she was 49 years old. At the age of 51, she presented with a subcutaneous abscess and osteomyelitis, so the cranioplastic bone was removed. Six months later, she underwent cranioplasty using hydroxyapatite. Her subcutaneous abscess recurred and the epidural abscess and hydroxyapatite were removed 11 years later after the first operation. The patient underwent observation therapy for the next 4 years, as the dura was ossified. She presented with frontal swelling 15 years after aneurysmal clipping, and neither abscess puncture nor the administration of antibacterial drugs was curative. The patient also complained of chill, thirst, and tremor, and developed disorientation 25 days later. Computed tomography (CT) and magnetic resonance imaging (MRI) showed extension of the epidural and subcutaneous abscesses to a frontal brain abscess. After consulting an otolaryngologist, we performed frontal drainage into the nasal cavity. After making a bicoronal skin incision, the subcutaneous, epidural, and intracapsular brain abscesses were removed while taking care not to damage the capsules. A silicone T-tube was placed in the bifrontal epidural cavity (previous frontal sinus), and its tip was inserted into the nasal cavity through the nasofrontal duct for abscess drainage. After 3 months, the tube was removed. A CT scan acquired 10 years later showed no brain abscess, perifocal edema, or epidural and subcutaneous abscesses.
Turunç, Tahsin; Turunç, Tuba; Demiroğlu, Y Ziya; Colakoğlu, Sule
Psoas abscesses are suppurative collections within the fascia surrounding the psoas and iliacus muscles. In this retrospective study it was aimed to evaluate the demographic characteristics, clinical and laboratory findings and treatment outcomes of 15 psoas abscess cases admitted to Baskent University Hospital, Ankara, Turkey during June 2003-January 2008 period. The mean age of the patients was 55.8 years (range 18 to 70 years) with a female to male ratio of 5/10. Thirteen of the cases (86.5%) were admitted with the complaints of fever and back pain. Thirteen of the cases were diagnosed by abdominal computerized tomography while the other two by abdominal ultrasonography. One of the 15 patients was considered as primary psoas abscess, while the remaining 14 as secondary psoas abscess. The most common accompanying disease was diabetes mellitus (66.6%). Fourteen patients with secondary psoas abscess had vertebral osteomyelitis which was due to tuberculosis in five cases, to urinary tract infection in five cases, to pneumoniae in two cases, to surgical infection in one case and to brucellosis in one case. The cultivation of the abscess material from the 14 secondary psoas abscess cases revealed growth of bacteria in 11 of them (5 Mycobacterium tuberculosis, 1 Escherichia coli, 1 methicillin-sensitive Staphylococcus aureus, 1 methicilin-resistant S. aureus, 1 Acinetobacter baumannii, 1 Brucella melitensis, 1 Serratia marcescens). The biochemical parameters of the cases (mean leukocyte counts: 14.500 cell/mm3; mean erythrocyte sedimentation rates: 78 mm/hour; mean C-reactive protein levels: 108 mg/dl) were also high. Thirteen patients underwent percutaneous drainage and received appropriate antibiotic treatment and the other two patients were treated with open surgical debridement. The duration of antimicrobial treatment was one year for M. tuberculosis cases and about 4-6 weeks in the others. One of the cases died due to complicating meningitis and sepsis. It is
Hayati, Shaharuddin Nor; Leong, Chee Loon; Kumar, Chidambaram Suresh; Lee, Christopher
Paraspinal abscess and spondylodiscitis due to Citrobacter koseri is a very rare condition. We report a remarkable case of Citrobacter koseri bacteraemia complicated by paraspinal abscess and spondylodiscitis in a patient who has successfully been treated in our hospital. Our patient demonstrates one of the common challenges in the practice of infectious disease medicine, wherein an innocuous presentation may and often underlie a serious infection. This case report elucidates to us that the diagnosis of a paraspinal abscess and spondylodiscitis requires a high index of suspicion in at risk patient presenting with compatible signs and symptoms.
Paladino, Joao Roberto; Nascimento, Fabio Jose; Gromatsky, Celso; Pompeo, Antonio Carlos Lima
A 23-year-old male patient with sickle-cell disease reported his third episode of priapism complicated by the presence of a corpus cavernosum abscess after the performance of a Winter procedure 20 days prior to his presentation. While in hospital for 11 days, two penile needle aspirations and three surgical drainages were performed with associated antibiotic therapy. He evolved with erectile dysfunction refractory to drug therapy and his infectious condition improved. An early penile prosthesis implantation followed after the use of a vacuum pump in an attempt to decrease the fibrotic process of the corpora cavernosa. Final results were positive. PMID:24515231
Glazer, Daniel Victor; Rømeling, Frans
Pleomorphic adenoma located in the soft palate is extremely rare. We report a 42-year-old woman, who presented to the ear nose & throat department with a mucosal swelling of the right soft palate mimicking a peritonsillar abscess. Drainage was attempted several times without significant results. Emergency tonsillectomy was carried out, which showed a tumour intraorally beside the right tonsil. The tumour and the tonsil were radically excised. Histological analysis of the tumour revealed a pleomorphic adenoma. At three-month follow-up the patient was doing well and MRI scan revealed a residual tumour of 6 mm.
Awotar, Gavish K.; Luo, Fuwen; Zhao, Zhengdong; Guan, Guoxin; Ning, Shili; Ren, Jinshuai; Liu, Yaqing; Wang, Guangzhi; Liu, Pixu
Abstract Background: The cancer of the splenic flexure of the colon is a rare medical entity with severe morbidity because of its insidious onset. Methods: We present the case of a 59-year-old male patient with dull left upper quadrant pain, leukocytosis, and anemia. A splenic abscess described as an air-fluid level with splenocolic fistula was found on CT scan imaging. Surgery was done for splenic pus drainage. He was again admitted 2 months later for intestinal obstruction. Results: An exploratory laparotomy showed multiple hard, gray liver nodules as well as a hard mass in the small bowel. Owing to extensive adhesions and a late stage of cancer involvement, the splenic flexure tumor was not resected. A loop transverse colostomy was done and a ColoplastTM Colostomy bag placed. We also reviewed the literature-linking colon cancer and splenic abscess with specific attention to the carcinoma of the splenic flexure. As the latter invades through the spleen matter, there is the creation of a splenocolic fistula, which allows the migration of normal gut flora into the spleen. This leads to the formation of the splenic abscess. Conclusion: This is the 13th case report pertaining to invading colonic cancer causing a splenic abscess. Although the treatment for splenic abscesses is shifting from splenectomy to image-guided percutaneous pus drainage, the few reported cases make the proper management of such complication still unclear. PMID:27661050
Ko, Yuki; Tobino, Kazunori; Yasuda, Yuichiro; Sueyasu, Takuto; Nishizawa, Saori; Yoshimine, Kouhei; Munechika, Miyuki; Asaji, Mina; Yamaji, Yoshikazu; Tsuruno, Kosuke; Miyajima, Hiroyuki; Mukasa, Yosuke; Ebi, Noriyuki
We herein report the case of 75-year-old Japanese female with a community-acquired lung abscess attributable to Streptococcus pneumoniae (S. penumoniae) which extended into the chest wall. The patient was admitted to our hospital with a painful mass on the left anterior chest wall. A contrast-enhanced chest computed tomography scan showed a lung abscess in the left upper lobe which extended into the chest wall. Surgical debridement of the chest wall abscess and percutaneous transthoracic tube drainage of the lung abscess were performed. A culture of the drainage specimen yielded S. pneumoniae. The patient showed a remarkable improvement after the initiation of intravenous antibiotic therapy. PMID:28049987
Pathak, Ashish; Singh, Poonam; Gehlot, Prateek; Dhaneria, Mamta
Spinal epidural abscess (SEA) is a rare clinical condition among children. Most patients do not present with classical signs. A 13-year-old boy without any predisposing factors presented with paraparesis, bladder and bowel involvement. MRI spine demonstrated an SEA at the C7 and D1 levels on both sides of the midline with cord oedema at the C2-3 to C6 level with minimal marrow oedema in the C6 vertebral body. We treated the patient with antibiotics (ceftriaxone and vancomycin) alone. The patient showed excellent response with only minimal residual gait disturbance at the end of 6 weeks of antibiotic therapy. This is the first paediatric report of complete recovery of a patient at clinical stage 4 following antibiotic treatment alone from India. However, caution should be exercised to closely monitor the patient's recovery as any progression in the neurological state warrants surgery.
Chen, Guangzhong; Zhan, Shengquan; Chen, Wei; Li, Zhaojie; Zhou, Dong; Zeng, Shaojian; Lin, Xiaofeng; Tang, Kai; Zhou, Dexiang; Shu, Hang
Endovascular embolization has become an important treatment option for cerebral aneurysms, along with surgical clipping. But few literatures mentioned infectious complications after coiling of aneurysms. We present a patient with a brain abscess that developed after endosaccular embolization of a left middle cerebral artery aneurysm. The brain abscess was located adjacent to the aneurysm and discovered more than 2 months after embolization. We discuss the clinical implications of this rare complication and review the literature for infections related to the coils used for embolization of aneurysms.
Domínguez-Borgúa, Andrés; González, Itzel; Morales, Lucero; Martínez-Carrillo, Francisco Manuel; Palacios, Paul
Pharmacologic hypersensitivities commonly express cutaneous manifestations, and the highest mortality is found in Stevens Johnson's syndrome and toxic epidermal necrolysis, mostly associated with antibiotics and anticonvulsive drugs. Toxic epidermal necrolysis is related in 80% of cases to pharmacologic hypersensitivity and systemic consequences may be found; hepatic injury has been described, but the finding of liver abscesses has not been reported among common injuries. The case of a patient with a rapid development of multiple liver abscesses in the clinical setting of hypersensitivity due to lamotrigine and the discussion of probable etiologies and management is presented.
Nierhaus, A; Pothmann, W; Pollok, J M; Schäfer, P; Mack, D
We report on a case of an amoebic liver abscess acquired during a holiday in Bali. Transdiaphragmatic migration and consecutive atelectasis of the right lung caused respiratory insufficiency, requiring immediate surgical intervention. Complications consisted of massive bleeding into the colon concomitant with a reactivated CMV-infection. In addition, toxins of Clostridium difficile and enterohaemorrhagic E. coli were seen in the faeces. In contrast to the majority of uncomplicated cases of amoebic liver abscess, usually treated with amoebicidal drugs only, surgical intervention was clearly indicated in our patient.
Lucas, Alexandra; Maung, Ko Ko; Ratts, Ryan
Intracranial abscesses are rare complications of Streptococcus pneumoniae infections, and to our knowledge, there have been no case reports of post-infectious vasculitis developing in such patients. Here we describe the case of a 48-year-old post-splenectomy male who developed post-infectious vasculitis following S. pneumoniae otitis media complicated by mastoiditis, osteomyelitis, meningitis, and intracranial abscess. Clinicians ought to be aware of the possible adverse outcomes of invasive S. pneumoniae and the limitations of current treatment options. PMID:28191299
Maeshima, Keisuke; Ishii, Koji; Inoue, Megumi; Himeno, Katsuro; Seike, Masataka
Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease, especially in Crohn's disease, and in other diseases. However, aseptic abscesses associated with Behçet's disease are extremely rare. We report a Japanese male diagnosed with an incomplete type of Behçet's disease who developed multiple aseptic abscesses of the spleen and liver. In 2002, the spleen abscesses were accompanied by paroxysmal oral aphthous ulcers and erythema nodosum. As the patient's response to antibiotic treatment was inadequate, a splenectomy was performed. Severe inflammatory cell infiltration, largely of polymorphonuclear neutrophils, was observed without evidence of bacterial or fungal growth. Although the patient had no history of ocular symptoms or genital ulcers, a diagnosis of incomplete Behçet's disease was made according to the Japanese diagnostic criteria because of the presence of paroxysmal arthritis and epididymitis since 2002. In 2005, multiple liver abscesses developed with right hypochondrial pain and seemed to be attributed to Behçet's disease because the abscesses yielded negative results during a microbiologic investigation and failed to go into remission under antibiotic therapy. Oral prednisone (15 mg/d) was started in May 2006, and the abscesses dramatically disappeared 4 wk after treatment. Although the patient had a relapse of the liver abscesses in association with the tapering of prednisone, the augmentation of prednisone dosage yielded a response. The abscesses of the liver and spleen were strongly suggested to be attributed to Behçet's disease. Clinician should be aware of the existence of aseptic abscesses as uncommon manifestations of Behçet's disease.
Zakershahrak, Mehrsa; Moshari, Amirabbas; Vatanpour, Mehdi; Khalilak, Zohreh; Jalali Ara, Afsoon
Autogenous tooth transplantation (ATT) is a simple and reasonable choice for replacing the missing teeth when a proper donor tooth is available. This report presents a case of successful ATT of a maxillary right third molar for replacement of mandibular right second molar with a concomitant endodontic-periodontal disease. The mandibular second molar was believed to be hopeless due to a severe damage to coronal tooth structure, inappropriate root canal treatment and apical radiolucency. After extraction of mandibular second molar and maxillary third molar (the donor), the tooth was re-implanted into the extracted socket of second molar site. Root canal therapy was then performed. After 3 years, clinical and radiographic examinations revealed satisfying results, with no signs and symptoms. The patient is asymptomatic and the transplanted tooth is still functional with no signs of marginal periodontal pathosis. Radiographies showed bone regeneration in the site of previous extensive periapical lesion, normal periodontal ligament with no signs of root resorption. PMID:28179939
Dhariwal, Neha S.; Gokhale, Niraj S.; Patel, Punit; Hugar, Shivayogi M.
A traumatic injury to primary maxillary anterior tooth is one of the common causes for problems with the succedaneous tooth leading to it noneruption. A missing anterior tooth can be psychologically and socially damaging to the patient. Despite a wide range of treatment options available, sometimes, it is inevitable to save the natural tooth. This paper describes the immediate replacement of a right central incisor using a fiber-composite resin splint with the natural tooth crown as a pontic following surgical extraction of the dilacerated impacted permanent maxillary central incisor. The abutment teeth can be conserved with minimal or no preparation, thus keeping the technique reversible and can be completed at chair side thereby avoiding laboratory costs. It can be used as an interim measure until a definitive prosthesis can be fabricated as the growth is still incomplete. PMID:27433074
Jovanović, Predrag; Zerem, Enver; Zildzić, Muharem
Liver abscess is a rare complication of sigmoid diverticulitis and must be considered within the differential diagnosis. We report a case of a male patient, age 71, admitted to our hospital with chief complaints of a dull pain in upper right abdominal quadrant, fever and weakness of approximately 5 months duration. He had a history of a surgery 18 years ago after an episode of diverticulitis. Physical examination and biochemistry on initial work-up revealed tenderness on palpation in upper right abdomen, leukocytosis and a 39 degrees C fever. Ultrasound examination revealed round structure with low echo properties in the right lobe of the liver. Further CT scan examination confirmed an abscess collection. We performed ultrasound guided percutaneous catheter drainage with intravenous administration of broad spectrum antibiotics, resulting in a successful treatment of a liver abscess. Colonoscopy confirmed sigmoid diverticulitis which was the most likely the source of bacterial invasion through portal venous system.
Baker, M E; Blinder, R A; Rice, R P
With today's advanced technology, the clinician and radiologist have a number of techniques with which to evaluate the abdomen for fluid collections and/or abscesses. Three points are clear from the plethora of literature concerning this subject: the need to individualize the clinical and imaging approach to each patient suspected of an abnormal fluid collection or abscess, the need to individualize the imaging procedure based upon what is done best at the institution, and the need for percutaneous aspiration of all fluid collections for diagnosis. No single imaging test is totally sensitive or specific for the detection of an infected fluid collection. Overall, CT probably does provide the most accurate means to detect an intra-abdominal abscess. Because of this, and because it is less operator dependent than ultrasound, CT is used most often as the procedure of choice at our institution.
Briley, T F
It has been shown that direct bone anchorage of dental implants will provide long-term predictability for single tooth implants and multi-unit implants. The function of implant-supported restoration is now routinely achieved. The real challenge facing the restorative dentist and laboratory technician is to achieve optimal aesthetics. The learning objective of this article is to review the prosthodontic procedures essential to maximizing natural aesthetics in implant supported restorations. It will provide a review of master impression techniques, prepable titanium abutments and designing the cement on restoration. Particular emphasis is directed to the soft tissue model from which a series of sequenced techniques can be followed to achieve optimal aesthetics. Analysis of the implant alignment with regard to the neighboring teeth will result in having to make a choice of which prepable abutment will maximize the aesthetic result. The following case outlines how to replace a single missing tooth using an externally hexed implant system and a prefabricated titanium abutment on a 26-year-old male patient.
DeFroda, Steven F; DePasse, J Mason; Eltorai, Adam E M; Daniels, Alan H; Palumbo, Mark A
Spinal epidural abscess (SEA) is an uncommon and potentially catastrophic condition. SEA often presents a diagnostic challenge, as the "classic triad" of fever, spinal pain, and neurological deficit is evident in only a minority of patients. When diagnosis is delayed, irreversible neurological damage may ensue. To minimize morbidity, an appropriate level of suspicion and an understanding of the diagnostic evaluation are essential. Infection should be suspected in patients presenting with axial pain, fever, or elevated inflammatory markers. Although patients with no known risk factors can develop SEA, clinical concern should be heightened in the presence of diabetes, intravenous drug use, chronic renal failure, immunosuppressant therapy, or a recent invasive spine procedure. When the clinical profile is consistent with the diagnosis of SEA, gadolinium-enhanced magnetic resonance imaging of the spinal column should be obtained on an emergent basis to delineate the location and neural compressive effect of the abscess. Rapid diagnosis allows for efficient treatment, which optimizes the potential for a positive outcome.
dos SANTOS-ROSA, Otto Mauro; LUNARDELLI, Henrique Simonsen; RIBEIRO-JUNIOR, Marcelo Augusto Fontenelle
ABSTRACT Background: The pyogenic liver abscess has an incidence of 1.1/1,000 habitants. Mortality can reach 100%. The use of less invasive procedures diminish morbidity and hospital stay. Aim: Identify risk factors in patients who underwent percutaneous drainage guided by ultrasound as treatment. Method: Were analyzed 10 patients submitted to the method. Epidemiological characteristics, laboratory markers and imaging exams (ultrasound and CT) were evaluated. Results: The majority of the patients were men with mean age of 50 years old. Liver disease, alcoholism and biliary tract disease were the most common prodromes. Abdominal pain (90%), fever (70%) and jaundice (40%) were the most common clinical manifestations. Mortality of 20% was observed in this series. Hypoalbuminemia and days of hospitalization had a statistically significant positive association with death. Conclusion: The pyogenic liver abscess has subacute evolution which makes the diagnosis difficult. Image exams have high sensitivity in diagnosis, particularly computed tomography. Percutaneous drainage associated with antibiotic therapy is safe and effective therapeutic resource. PMID:27759785
Swanson, Amy; Lau, Kenneth K; Korman, Tony M; Kornman, Tony; Wallace, Euan M; Polyakov, Alex
Primary iliacus-psoas muscle abscess formation is very uncommon during pregnancy. We present a case of a primary iliacus-psoas muscle abscess in pregnancy causing back pain with delayed diagnosis and treatment. Understanding the clinical presentation of iliacus-psoas muscle abscess helps with considering it in the differential diagnosis of back pain during pregnancy.
Seng, Piseth; Quenard, Fanny; Menard, Amélie; Heyries, Laurent; Stein, Andreas
Splenic abscess is a rare disease that primarily occurs in patients with splenic trauma, endocarditis, sickle cell anemia, or other diseases that compromise the immune system. This report describes a culture-negative splenic abscess in an immunocompetent patient caused by Campylobacter jejuni, as determined by 16S rRNA gene sequencing.
Kandekar, Rahul Vilas; Tiwari, Ajeet Ramamani; Kadam, Rahul; Adhikari, Devbrata Radhikamohan
Tubercular liver abscess is generally secondary to some other primary foci in the body, most notably pulmonary and gastrointestinal system. To find primary tubercular liver abscess is rare, with prevalence of 0.34% in patients with hepatic tuberculosis. Abscess tracking into abdominal wall from spinal and para spinal tuberculosis is known, however primary liver tuberculosis rupturing into anterior abdominal wall has been reported only twice in literature. We report a case of 43-year-old female with direct invasion of the anterior abdominal wall from an isolated tubercular parenchymal liver abscess, caused by Mycobacterium tuberculosis complex, diagnosed primarily on smear for Acid Fast Bacilli (AFB), imaging and isolated by culture and BACTEC MGIT 960 KIT. We discuss here the diagnostic dilemma, management and outcome of primary tubercular liver parenchymal abscess with direct invasion into anterior abdominal wall. PMID:28050433
Cai, Tommaso; Giubilei, Gianluca; Vichi, Francesca; Farina, Umberto; Costanzi, Antonio; Bartoletti, Riccardo
Retroperitoneal abscesses are very uncommon clinical conditions. The characteristically vague symptomatology of retroperitoneal abscess and the inherent difficulty of identifying retroperitoneal disease by physical examination contributed to these dismal therapeutic outcomes. We present an unusual case of lethal retroperitoneal abscess, caused by Citrobacter diversus(koseri), treated with surgical drainage. Citrobacter species have rarely been involved in deep tissue infection and there is no reported case of lethal retroperitoneal abscess caused by C. koseri. This case is the only reported case of C. koseri as the sole pathogen associated with a lethal retroperitoneal abscess in immunocompetent patient. The case is also notable because it confirms the recent bacterial resistance to beta-lactam antibiotics and to other antimicrobial agents, like chloramphenicol or cotrimoxazol.
Yang, Tae Ki
Liver abscess following ventriculoperitoneal (VP) shunting occurs very rarely. We report an unusual case of multiple liver abscesses caused by Staphylococcus capitis in a 50-year-old compromised woman due to a complicating VP shunt infection. We reviewed the nine cases of VP shunt complications reported in the English literature, and speculated that the most likely pathogenetic mechanism in our case is an infected peritoneal tip that migrated to and penetrated the liver, which subsequently caused the formation of multiple liver abscesses. The patient was successfully treated with percutaneous aspiration, drainage of the abscesses, intravenous antibiotics, and shunt revision. Awareness and vigilance of the possibility of liver abscess formation caused by VP shunt infection will help establish an early accurate diagnosis and therapeutic strategy. PMID:24379956
Hanchnale, Pavan; Jain, Mayank; Vargese, Joy; V, Jayanthi; Rela, Mohamed
Nocardiosis is usually a disseminated disease seen in immunocompromised individuals. We herein present a rare case of isolated Nocardia liver abscess post liver transplantation. The patient responded well to treatment and is on long-term antibiotics for Nocardia infection. This article is protected by copyright. All rights reserved.
Ivan, Mihaela; Dancer, Craig; Koehler, Ann P; Hobby, Michaela; Lease, Chris
An outbreak of skin abscesses occurred in Adelaide, Australia, in association with biomesotherapy, an alternative therapy practice. Mycobacterium chelonae was identified in 8 patient and 3 environmental samples. Our findings show M. chelonae infection can be associated with alternative therapies when infection-control breaches occur. Tighter regulations of alternative therapy practices are needed.
Sykes, J T; Sage, M R; Burke, A M
Two cases in which patients presented with lower back pain and bacteraemia, and in which the diagnosis of iliopsoas abscess was made by computed tomography, are reported. Before the introduction of computed tomography, this diagnosis was difficult to establish by means of clinical and radiological investigations. Computed tomography makes it possible to obtain a clear view of the retroperitoneum.
Frenkel, Mark B.; Hsu, Wesley
Fungal meningitis transmitted through injections of methylprednisolone contaminated with Exserohilum rostratum affected 753 persons and caused 61 deaths in the United States in 2012. We report a case of infection recurrence after 24-months with the unique manifestation of an intradural fungal abscess. Fungal disease should remain on the differential diagnosis list for previously exposed patients. PMID:28221116
Ahmed, Zohair; Bansal, Saurabh K; Dhillon, Sonu
A 21-year-old male with no significant past medical history, presented with right upper quadrant (RUQ) abdominal pain along with fevers and chills. Lab work revealed leukocytosis, anemia, and slightly elevated alkaline phosphatase. Viral serology for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus were negative and he was immunocompetent. Computed tomography imaging revealed hepatic abscesses, the largest measuring 9.5 cm. Empiric antibiotics were started and percutaneous drains were placed in the abscesses. Anaerobic cultures from the abscesses grew Fusobacterium nucleatum. This is a gram negative anaerobic bacteria; a normal flora of the oral cavity. Fusobacterium is most commonly seen in Lemiere's disease, which is translocation of oral bacteria to the internal jugular vein causing a thrombophlebitis and subsequent spread of abscesses. Our patient did not have Lemiere's, and is the first case described of fusobacterium pyogenic liver abscess in a young immunocompetent male with good oral hygiene. This case was complicated by sepsis, empyema, and subsequent abscesses located outside the liver. These abscesses' have the propensity to flare abruptly and can be fatal. This case not only illustrates fusobacterium as a rare entity for pyogenic liver abscess, but also the need for urgent diagnosis and treatment. It is incumbent on physicians to diagnose and drain any suspicious hepatic lesions. While uncommon, such infections may develop without any overt source and can progress rapidly. Prompt drainage with antibiotic therapy remains the cornerstone of therapy.
Gumber, A; Ayyar, S; Varia, H; Pettit, S
A 50-year-old man with intractable anal pain attributed to proctalgia fugax underwent insertion of a sacral nerve stimulator via the right S3 vertebral foramen for pain control with good symptomatic relief. Thirteen months later, he presented with signs of sepsis. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large presacral abscess. MRI demonstrated increased enhancement along the pathway of the stimulator electrode, indicating that the abscess was caused by infection introduced at the time of sacral nerve stimulator placement. The patient was treated with broad spectrum antibiotics, and the sacral nerve stimulator and electrode were removed. Attempts were made to drain the abscess transrectally using minimally invasive techniques but these were unsuccessful and CT guided transperineal drainage was then performed. Despite this, the presacral abscess progressed, developing enlarging gas locules and extending to the pelvic brim to involve the aortic bifurcation, causing hydronephrosis and radiological signs of impending sacral osteomyelitis. MRI showed communication between the rectum and abscess resulting from transrectal drainage. In view of the progressive presacral sepsis, a laparotomy was performed with drainage of the abscess, closure of the upper rectum and formation of a defunctioning end sigmoid colostomy. Following this, the presacral infection resolved. Presacral abscess formation secondary to an infected sacral nerve stimulator electrode has not been reported previously. Our experience suggests that in a similar situation, the optimal management is to perform laparotomy with drainage of the presacral abscess together with simultaneous removal of the sacral nerve stimulator and electrode.
Imoto, Akira; Ooi, Yukimasa; Edogawa, Shoko; Ogura, Takeshi; Masuda, Daisuke; Mohamed, Malak; Takii, Michiaki; Umegaki, Eiji; Kawahara, Ryuji; Ukimura, Akira; Higuchi, Kazuhide
Liver abscesses secondary to Salmonella species are rarely described in the general population. We herein describe a case of a liver abscess caused by CTX-M-55-type extended-spectrum β-lactamase (ESBL)-producing Salmonella enteritidis, which has not been reported in the literature. A 54-year-old male was admitted due to a high fever and was clinically diagnosed with a liver abscess. Culture of the fluid from the liver abscess revealed CTX-M-55-type ESBL-producing S. enteritidis. Although the patient underwent percutaneous transhepatic abscess drainage and antibiotic therapy, he died one month later. It should be noted that liver abscesses are potentially fatal depending on the causative pathogen.
Background Escherichia coli (E. coli) is the most common causative bacteria of neonatal meningitis, but hematogenous intracranial E. coli infection is rare in adults. Moreover, intracranial abscess formation owing to E. coli, including brain abscesses and subdural empyema formation, is extremely rare. We herein present a case involving a patient with a brain abscess owing to E. coli following a simple renal cyst infection. A review of the literature is also presented. Case presentation A 77-year-old Japanese woman with a history of polymyalgia rheumatica was admitted to our hospital because of persistent fever, right flank pain, and pyuria. Intravenous antibiotics were administered; however, her level of consciousness deteriorated 6 days after admission. Contrast-enhanced magnetic resonance imaging showed a brain abscess in the left occipital lobe and pyogenic ventriculitis. Enhanced abdominal computed tomography revealed a right renal cyst with heterogeneous content. Culture of urine, blood, and aspirated pus from the infected cyst revealed E. coli with identical antibiotic sensitivity in all sites, suggesting that the cyst infection and subsequent bacteremia might have caused the brain abscess. The patient recovered after a 6-week course of meropenem. Conclusion The prognosis of patients with E. coli-associated intracranial abscess is usually poor. Advanced age and immunosuppression may be potent risk factors for intracranial abscess formation owing to the hematogenous spread of E. coli. PMID:24934996
Oates, E.; Sarno, R.C.
An unsuspected annular abscess at the base of a prosthetic aortic valve in a patient with endocarditis was identified by indium-111-labeled leukocyte scintigraphy alone. This highly sensitive and specific technique expediently demonstrated the surgically proven inflammatory focus.
Khan, S A; Gretchel, A; Govender, H; Hartzenberg, B
This report presents a rare complication of ventriculoperitoneal shunt, delayed development of brain abscess and foreign body granuloma formation adjacent to the intraventricular catheter. Both the complications occurring in the same patient is unusual.
Sauermann, Robert; Karch, Rudolf; Kjellsson, Maria C; Feurstein, Thomas; Püspök, Andreas; Langenberger, Herbert; Böhmdorfer, Michaela; Jäger, Walter; Zeitlinger, Markus
Abscesses are often treated with antibiotics in addition to incision or when incision is unfeasible, but accurate information about antibiotic abscess penetration in humans is missing. This study aimed at evaluating the penetration of moxifloxacin into human abscesses. After administration of a single dose of 400 mg moxifloxacin, drug concentrations were measured in 10 differently located abscesses at incision, and in plasma over 8 h. At incision performed 0.9-4.8 h after administration, moxifloxacin concentrations in abscesses ranged from ≤0.01 to 9.2 mg/l (1.9 ± 3.4 mg/l), indicating pronounced drug accumulation in some abscesses. The degree of abscess penetration could not be explained by covariates like the ratio of surface area to volume or pH of abscesses, or by moxifloxacin plasma concentrations. Concluding, moxifloxacin was detectable in most abscesses and may be a useful antibiotic for this indication. However, antibiotic abscess penetration was highly variable and unpredictable, suggesting surgical abscess incision whenever possible.
Carey, Clifton M.
Declarative Title Current research about tooth whitening shows that it is safe and effective when manufacturer’s protocol is followed, yet there are risks of which the profession and users should be aware. This update provides a summary of current research and assessment of the safety and efficacy of tooth whitening regimens. Background Tooth whitening has become one of the most frequently requested dental procedures by the public. The public has come to demand whiter, more perfect smiles and in response many choices for tooth whitening have been made available. These include home-based products such as toothpastes, gels, and films, as well as in-office based systems where products containing highly concentrated bleaching agents are applied under professional supervision. The profession and public have been aware of certain risks related to tooth whitening such as increased tooth sensitivity and gingival irritation. New research has shown that there are other risks such as tooth surface roughening and softening, increased potential for demineralization, degradation of dental restorations, and unacceptable color change of dental restorations. The new research is also focused on optimizing whitening procedures to reduce tooth sensitivity and to increase the persistence of the whitening. Methods Current reports in the literature are reviewed that are related to the use of peroxide based whitening methods. These reports include in vitro studies for method optimization and mechanism as well as clinical studies on effects of various whitening regimens. Conclusions When manufacturer’s instructions are followed, hydrogen peroxide and carbamide peroxide based tooth whitening is safe and effective. Patients should be informed of the risks associated with tooth whitening and instructed on identification of adverse occurrences so that they may seek professional help asneeded. PMID:24929591
Kern, Philip A
Summary Pituitary abscess is a relatively uncommon cause of pituitary hormone deficiencies and/or a suprasellar mass. Risk factors for pituitary abscess include prior surgery, irradiation and/or pathology of the suprasellar region as well as underlying infections. We present the case of a 22-year-old female presenting with a spontaneous pituitary abscess in the absence of risk factors described previously. Her initial presentation included headache, bitemporal hemianopia, polyuria, polydipsia and amenorrhoea. Magnetic resonance imaging (MRI) of her pituitary showed a suprasellar mass. As the patient did not have any risk factors for pituitary abscess or symptoms of infection, the diagnosis was not suspected preoperatively. She underwent transsphenoidal resection and purulent material was seen intraoperatively. Culture of the surgical specimen showed two species of alpha hemolytic Streptococcus, Staphylococcus capitis and Prevotella melaninogenica. Urine and blood cultures, dental radiographs and transthoracic echocardiogram failed to show any source of infection that could have caused the pituitary abscess. The patient was treated with 6weeks of oral metronidazole and intravenous vancomycin. After 6weeks of transsphenoidal resection and just after completion of antibiotic therapy, her headache and bitemporal hemianopsia resolved. However, nocturia and polydipsia from central diabetes insipidus and amenorrhoea from hypogonadotrophic hypogonadism persisted. Learning points Pituitary abscesses typically develop in patients who have other sources of infection or disruption of the normal suprasellar anatomy by either surgery, irradiation or pre-existing pathology; however, they can develop in the absence of known risk factors. Patients with pituitary abscesses typically complain of headache, visual changes and symptoms of pituitary hormone deficiencies. As other pituitary neoplasms present with similar clinical findings, the diagnosis of pituitary abscess is often not
Sosenko, A; Glassroth, J
To define the results of flexible fiberoptic bronchoscopy (FFB) in patients with lung abscess and to characterize those patients most likely to have an underlying carcinoma, we retrospectively studied the records of 52 consecutive patients undergoing FFB at our institution between 1975 and 1982. Nineteen patients (36.5 percent) had an associated bronchogenic carcinoma (group 1); 33 (63.5 percent) had no malignancy (group 2). The FFB aided in diagnosing 73.7 percent of group 1 patients, but added no information in group 2 patients. Group 1 and 2 patients differed significantly with respect to prevalence of systemic symptoms (15.8 percent vs 51.5 percent, p less than 0.01); predisposition to aspiration pneumonia (26.3 percent vs 60.6 percent, p less than 0.01); mean presenting white blood cell count (10.9 vs 14.2, p less than 0.05); mean oral temperature at presentation (37.5 vs 38.3 degrees C, p less than 0.05); and the prevalence of extensive infiltrates on the initial chest roentgenogram (17.0 percent vs 83.6 percent, p less than 0.05). Based on these data, we believe that by carefully considering the available clinical information, it is possible to identify those patients whose lung abscesses are likely to be related to bronchogenic carcinoma. Such individuals should be promptly evaluated. It is not necessary, however, to routinely order bronchoscopy for all patients with lung abscess.
Mascarenhas, Neil B.; Mulcahy, Mary F.; Lewandowski, Robert J.; Salem, Riad; Ryu, Robert K.
Infectious complications after yttrium-90 (y-90) radioembolization of hepatic tumors are rare. Most reports describe hepatic abscesses as complications of other locoregional therapies, such as transcatheter arterial embolization or chemoembolization. These usually occur in patients with a history of biliary intervention and present several weeks after treatment. We report a case of hepatic abscess formed immediately after y-90 radioembolization of a hepatic metastasis in a patient who had no history of previous biliary instrumentation.
Zhiyong, Zong; Xiufang, Lin; Jiajie, Lu
A 35-year-old Chinese female has a large thigh abscess without a clear source. No underlying diseases were revealed in the patient. The combination of clindamycin and cefazolin or vancomycin was administered but without a clinical response. Eikenella corrodens and Streptococcus intermedius were isolated from puncture drainage. Then, ceftriaxone was administered and a surgery of incision and further draining was carried. Eventually, the patient recovered. To our knowledge, this is the first case of thigh abscess in a previous healthy adult.
Byun, Jongkyu; Yang, John Jeongseok
Herein, we describe a bacteremia caused by Neisseria gonorrhoeae that presented as liver abscesses. The patient had no risk factors for disseminated gonococcal infection. Periodic fever, skin rashes, and papules were present and the results of an abdominal computed tomography scan indicated the presence of small liver abscesses. The results of blood culture and 16S rRNA sequencing of the bacterial isolates confirmed the presence of N. gonorrhoeae. The patient improved with antibiotic therapy. PMID:25844265
Sahu, Dinesh Kumar; Kaul, Vinca; Parampill, Reena
We report a case of “dry tap” during spinal anaesthesia in a patient posted for incision and drainage of lower limb with cellulitis. When the patient was being given sub-arachnoid block (SAB) for regional anaesthesia, it turned out to be a case of pyogenic ilio-psoas abscess extended up to the paravertebral and epidural spaces. The causative organism was Staphylococcus aureus. This is probably the first case reported when epidural abscess is diagnosed during SAB. PMID:22923830
Qazi, M S; Bowalekar, S S; Wanjare, V S; Shankar, A
We present a report of a 37-year-old female with lung abscess due to Acremonium species that responded to oral itraconazole. There was a marked clinical as well as radiological improvement in patient. To the best of our knowledge, this is the first case of lung abscess due to Acremonium species which was treated by oral itraconazole. This cost-effective treatment modality proved to be significant in improving symptoms as well as morbidity in this patient.
Abbas, T O
Intra-abdominal disease can present as an extra-abdominal abscess and can follow several routes, including the greater sciatic foramen, obturator foramen, femoral canal, pelvic outlet, and inguinal canal. Nerves and vessels can also serve as a route out of the abdomen. The psoas muscle extends from the twelfth thoracic and fifth lower lumbar vertebrae to the lesser trochanter of the femur, which means that disease in this muscle group can migrate along the muscle, out of the abdomen, and present as a thigh abscess. We present a case of a primary pelvic staphylococcal infection presenting as a thigh abscess. The patient was a 60-year-old man who presented with left posterior thigh pain and fever. Physical examination revealed a diffusely swollen left thigh with overlying erythematous, shiny, and tense skin. X-rays revealed no significant soft tissue lesions, ultrasound was suggestive of an inflammatory process, and MRI showed inflammatory changes along the left hemipelvis and thigh involving the iliacus muscle group, left gluteal region, and obturator internus muscle. The abscess was drained passively via two incisions in the posterior left thigh, releasing large amounts of purulent discharge. Subsequent bacterial culture revealed profuse growth of Staphylococcus aureus. The patient recovered uneventfully except for a moderate fever on the third postoperative day.
Widjaya, P; Bilić, A; Babić, Z; Ljubicić, N; Bakula, B; Pilas, V
This prospective study was carried out on 33 patients with clinically, serologically and ultrasonographically confirmed amoebic liver abscess. All patients were randomly treated with metronidazole and chlorochin or a combination of medicamentous therapy and percutaneous drainage. Ultrasonographic characteristics of amoebic liver abscesses were rotound or oval shape, usually hypoechogenic content with specific dorsal sonic enhancement, and in the majority of cases, location near liver capsule. Shorter duration of amoebic liver abscess resolution time in the group of patients treated with the combined therapy was observed particularly in the first four weeks of the treatment. The authors concluded that percutaneous drainage in combination with medicamentous therapy represents a successful therapeutic approach in the treatment of amoebic liver abscesses.
Valdesoiro Navarrete, L; Pineda Solas, V; Martín Martín, C; Sanfeliu Sala, I; Cabezas Maspoch, R M; Sánchez Oespina, M
Cat-scratch disease is caused by a Gram-negative bacillus known as Bartonella henselae. This disease is usually benign and causes regional adenitis that does not require treatment. However, some patients develop more serious atypical forms of the disease including prolonged systemic illness with hepatic and splenic abscesses.A 14-year-old girl was admitted to hospital with a 12-day history of persistent high fever and abdominal pain. Ultrasonography and computerized tomography of the abdomen revealed splenic abscesses. These findings, together with an antecedent of cat exposure, led to the suspicion of cat-scratch disease, which was confirmed by serology. The girl was treated with intramuscular ceftriaxone and clinical evolution was favorable. Splenic cat-scratch disease is infrequent. Cat-scratch disease sometimes presents as fever of unknown origin and consequently this disease should be considered in the differential diagnosis of prolonged fever. Although evolution is usually favorable, antibiotic therapy is recommended in systemic manifestations of cat-scratch disease.
Visscher, Arjan Paul; Felt-Bersma, Richelle J F
Endoanal ultrasound is a technique that provides imaging of the anal sphincters and its surrounding structures as well as the pelvic floor. However, endoanal magnetic resonance imaging (MRI) is preferred by most physicians, although costs are higher and demand easily outgrows availability. Endoanal ultrasound is an accurate imaging modality delineating anatomy of both cryptoglandular as well as Crohn perianal fistula and abscess. Endoanal ultrasound is comparable with examination under anesthesia and equally sensitive as endoanal MRI in fistula detection. When fistula tracts or abscesses are located above the puborectal muscle, an additional endoanal MRI should be performed. Preoperative imaging is advocated in recurrent cryptoglandular fistula because a more complex pattern can be expected. Endoanal ultrasound can help avoid missing tracts during surgery, lowering the chance for the fistula to persist or recur. It can easily be performed in an outpatient setting and endosonographic skills are quickly incremented. Costs are low and endoanal ultrasound has the potential to improve outcome of patients with both cryptoglandular and fistulizing Crohn disease; therefore, it values more attention.
Minarikova, A; Hauptman, K; Knotek, Z; Jekl, V
Abscesses of odontogenic origin in guinea pigs pose a serious health problem and need to be treated with a combination of surgical and medical therapy. The aim of this prospective study was to describe the microbial flora of odontogenic abscesses associated with osteomyelitis in 24 pet guinea pigs, to perform antibiotic sensitivity testing, and to make recommendations for practitioners on the antibiotics of first choice. Inclusion criteria for the study included the animal being diagnosed with an odontogenic abscess which underwent surgery and was not pre-treated with an antibiotic. Inclusion criteria matched for 24 guinea pigs. Samples (pus, capsule and affected tooth/bone) for bacteriological examination were collected under sterile conditions during the surgical procedure. The most commonly isolated bacteria from abscesses of odontogenic origin were Bacteroides fragilis in 12.8 per cent (6/47) of cases, Pasteurella multocida in 10.6 per cent (5/47) and Peptostreptococcus anaerobius in 8.5 per cent (4/47). Aerobic bacterial species only were isolated in 29.2 per cent (7/24) of cases, anaerobic bacteria only were isolated in 33.3 per cent (8/24), and mixed infection with anaerobic and aerobic bacterial species was seen in 37.5 per cent (9/24). Aerobes (n=20) were sensitive to enrofloxacin and marbofloxacin in 100 per cent of samples, benzylpenicillin potassium (penicillin G, PNCG) in 90 per cent, cephalotin in 85 per cent, amoxicillin-clavulanate in 75 per cent, doxycycline in 70 per cent, gentamicin in 65 per cent and trimethoprim-sulfamethoxazole in 55 per cent. Anaerobes (n=27) were sensitive to amoxicillin-clavulanate in 100 per cent of cases, clindamycin in 96.3 per cent, metronidazole in 92.6 per cent, PNCG in 92.6 per cent and cephalotin in 74.1 per cent. As guinea pigs are strictly herbivorous animals, based on the results of this study the recommended antibiotic treatment for odontogenic abscesses is a combination of fluoroquinolones and metronidazole.
Misra, P.; De, T.; Singh, R.
Optical spectroscopy in the ultraviolet, visible and mid-infrared spectral regions has been used to discriminate between healthy and diseased teeth of patients in the age range 15-75 years. Spectral scans of absorbance versus wavenumber and fluorescence intensity versus wavelength have been recorded and investigated for caries and periodontal disease. Such optical diagnostics can prove very useful in the early detection and treatment of tooth decay.
Koyama, Satoshi; Fujiwara, Kazunori; Morisaki, Tsuyoshi; Fukuhara, Takahiro; Kawamoto, Katsuyuki; Kitano, Hiroya; Takeuchi, Hiromi
Piriform sinus fistula (PSF) is a rare branchial anomaly that causes repetitive acute suppurative thyroiditis or deep neck abscess. The definitive treatment of PSF is open neck surgery. However, such surgery has a cosmetic problem and a high risk of recurrence. Furthermore, identifying the fistula is difficult due to previous repetitive infections. We report a case of esophageal submucosal abscess caused by PSF treated with endoscopic mucosal incision. The patient underwent transoral video laryngoscopic surgery (TOVS), and endoscopy as well as fluoroscopy revealed complete closure of PSF without any complication. TOVS is a novel surgical technique for the definitive treatment of PSF with esophageal submucosal abscess.
Höhne, Julius; Brawanski, Alexander; Schebesch, Karl-Michael
Background: Up to now, the feasibility and benefit of using fluorescein sodium under a dedicated surgical microscope filter (YE560, YELLOW 560 nm filter, Carl Zeiss Meditec, Germany) has never been clinically evaluated in infectious disorders of the brain. Case Description: Here, we report the case of a male patient with a brain abscess in the right parietal lobe that was removed under fluorescence-guidance (intravenous administration of fluorescein sodium 10%, 5 mg/kg bodyweight). The abscess capsule showed intensive yellow fluorescent staining, while − under white light − the cortex appeared normal. Conclusion: This technique may improve the identification and surgical removal of brain abscesses. PMID:28031990
Matamala, José Manuel; Núñez, Carolina; Ogrodnik, Rosa; Cartier, Luis
The etiology of brain abscesses is mostly polymicrobial. Streptococci and anaerobic bacteria are the most commonly isolated pathogens. We report a previously healthy female without predisposing factors, presenting with a bifrontal cerebritis caused by a Streptococcus anginosus group infection. The patient developed a brain abscess and a subdural collection with severe intracranial hypertension of fatal evolution. The etiologic diagnosis was made culturing the material obtained from the subdural collection. It is presumed that, within the Streptococcus anginosus group, Streptococus intermedius could have been the causing bacteria, given its central nervous system tissue tropism and its predisposition to form brain abscesses.
Malakoutian, Tahereh; Yarmohamadi, Maliheh; Mohammadi, Ronak; Asgari, Mojgan; Mahmoodian, Reyhaneh
Splenic abscess is one of the rare and potentially life-threatening complications after kidney transplantation. Splenic abscess generally occurs in patients who have immunodeficiency state. It becomes more important with the increased use of immunosuppressed drugs and organ transplantation. The clinical presentation of splenic abscess is insidious, often with constitutional symptoms. Left upper quadrant tenderness is an uncommon sign. Therefore, its diagnosis is difficult and requires a high degree of clinical suspicion. We report a case under renal transplantation with recurrent fungal infection in different organs with two episodes of fungemia who died after splenectomy. PMID:27689116
Bozbaş, Gülnur Taşcı; Ünübol, Ayşe İyiyapıcı; Gürer, Gülcan
Brucellosis is an infectious disease that affects many organ systems. Osteoarticular involvement, especially spondylitis, is the most common complication of brucellosis, but psoas abscess is very rare. Serological tests at diagnosis of the disease are very valuable and most widely used. Herein, we report a case of psoas abscess secondary to brucellar spondylitis. In this case, interestingly, the serological test results were negative, and the diagnosis could be made by abscess culture. In patients, particularly those who live in areas endemic for brucellosis, as in our case, it should be kept in mind that a negative serological test result should not exclude the diagnosis of brucellosis. PMID:28149665
Chaudhry, Saduf; Bolt, Roel
Renal abscesses are infrequently encountered in children. We describe a girl diagnosed with bilateral renal abscess. Although ultrasonography and computerised tomography are used to establish the diagnosis, in our case magnetic resonance imaging proved to be a useful additional diagnostic method. Using percutaneous aspiration, we were able to establish the correct diagnosis and identify the causative micro-organism. The patient was successfully treated with a combined intravenous and oral course of antibiotics. In conclusion, renal abscesses can occur in children without a history of reflux or urinary tract infection; this should be kept in mind when evaluating a child with fever. In addition, full recovery can be achieved solely with antibiotics.
Steinbach, L.S.; Schneider, R.; Goldman, A.B.; Kazam, E.; Ranawat, C.S.; Ghelman, B.
Bursae or abscess cavities communicating with the hip joint were demonstrated by hip arthrography or by computed tomography (CT) in 40 cases. The bursae or abscess cavities were associated with underlying abnormalities in the hip, including painful hip prostheses, infection, and inflammatory or degenerative arthritis. Symptoms may be produced directly as a result of infection or indirectly as a result of inflammation or pressure on adjacent structures. Hip arthrography can confirm a diagnosis of bursae and abscess cavities communicating with the hip joint in patients with hip pain or soft-tissue masses around the groin. Differentiation of enlarged bursae from other abnormalities is important to avoid unnecessary or incorrect surgery.
Fujino, Yasuhisa; Inoue, Yoshihiro; Onodera, Makoto; Yaegashi, Yasunori; Sato, Nobuhiro; Endo, Shigeatsu; Omori, Hiroaki; Suzuki, Kazuyuki
We studied 13 emergency cases of liver abscess. Five cases of septic shock or clouding of consciousness were identified on admission. Six patients had diabetes mellitus. Twelve patients met the diagnostic criteria for systemic inflammatory response syndrome, and nine met the criteria for disseminated intravascular coagulation. Plasma endotoxin levels improved rapidly after drainage. Causative organisms were isolated in all patients, and the most common organism was Klebsiella pneumoniae (seven cases). Percutaneous transhepatic abscess drainage (PTAD) was performed not only in single cases but also in multiple cases with main huge abscesses. Surgical treatment was performed in the following three cases: a ruptured abscess, an ineffective PTAD, and a case of peritonitis after PTAD. Irrigation of abscesses with strong acidic electrolyzed water revealed a significant decrease in treatment duration. In the majority of our cases, severe conditions were identified on admission. Strong acidic electrolyzed water was useful for management of PTAD.
Background This study assessed the ethnic differences of perianal abscess between Bedouin and the general population in southern region of Israel. Israeli-born Arabs have much less colorectal cancer than Israeli-born Jews. It is not clear whether other colorectal diseases have the same ethnic occurrence. Method This is a retrospective case series of patients who had perianal abscess. Patients' demographics, managements and course of disease were analyzed. Results Bedouin male constituted 29.7% of all patients, while they constitute only 15.7% of the population relative risk of 2.27 (p< 0. 001). 16.4% of the patients experienced perianal abscess recurrence. 39% of the males with recurrent abscess formation were Bedouin, relative risk of 1.8 (p<0. 001). Conclusion Bedouin males have high relative risk to develop perianal abscess. Bedouin males as others with first recurrence have high relative risk for recurrence. Thus for both groups of patients, there is an indication to operate in order to treat the abscess and coexisting fistula. PMID:24028279
Desmond, N M; Kingdon, E; Beale, T J; Coker, R J; Tanner, A G; Harris, J W
Pancreatic tuberculosis is unusual occurring in only 2.7% of autopsy studies of persons with miliary disease. Reports of focal pancreatic tuberculosis are rare, even in patients with the acquired immunodeficiency syndrome (AIDS) in whom abdominal tuberculosis is a frequent feature. We describe two patients infected with the human immunodeficiency virus (HIV) who developed tuberculous pancreatic abscesses. In both this was their AIDS-defining illness. Images Figure 1 PMID:7769586
Narra, Rama Krishna; Jehendran, Mary Varunya
We present a case report of splenic abscess causing pneumoperitoneum in a case of uncontrolled diabetes. The patient presented with chronic pain abdomen and fever which later evolved to acute abdomen during the course of hospital stay. An X-ray showed pneumoperitoneum and exploratory laparotomy was performed under a strong clinical suspicion of hollow viscus perforation. The patient was treated with antibiotics and had an uneventful recovery. PMID:25795751
Schwartz, J H; Brauer, J; Gordon-Larsen, P
In a sample of 48 adult Tigarans (1300-1700 A.D.) from Point Hope, Alaska, 33 exhibited various degrees of periodontal disease, which, in 25, resulted in tooth loss (Schwartz, unpublished data). Although extreme examples of tooth wear were prevalent in the sample, carious infection was noted in only one individual, in whom the lower central incisors (I1S) had been affected. In the left I1, infection had spread through the root's apex into the alveolar bone, causing an abscess. The buccal (labial) side of the root of this tooth, just below the crown, bears a shallow, relatively flat-bottomed depression, with a small perforation into, as well as a second hole that fully penetrates, the root canal. Both of these features appear to have been produced by an implement, and, as they are associated with a diseased tooth, and ritualistic tooth shaping or drilling of any sort was, and is, not practiced among Arctic groups, their purpose was probably therapeutic. As such, this specimen appears to represent a case of precontact New World Arctic dentistry.
Kuhajda, Ivan; Zarogoulidis, Konstantinos; Tsirgogianni, Katerina; Tsavlis, Drosos; Kioumis, Ioannis; Kosmidis, Christoforos; Tsakiridis, Kosmas; Mpakas, Andrew; Zissimopoulos, Athanasios; Baloukas, Dimitris; Kuhajda, Danijela
Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection. It can be caused by aspiration, which may occur during altered consciousness and it usually causes a pus-filled cavity. Moreover, alcoholism is the most common condition predisposing to lung abscesses. Lung abscess is considered primary (60%) when it results from existing lung parenchymal process and is termed secondary when it complicates another process, e.g., vascular emboli or follows rupture of extrapulmonary abscess into lung. There are several imaging techniques which can identify the material inside the thorax such as computerized tomography (CT) scan of the thorax and ultrasound of the thorax. Broad spectrum antibiotic to cover mixed flora is the mainstay of treatment. Pulmonary physiotherapy and postural drainage are also important. Surgical procedures are required in selective patients for drainage or pulmonary resection. In the current review we will present all current information from diagnosis to treatment. PMID:26366400
Antunes, Antonio Azoubel; de Santana Santos, Thiago; de Carvalho, Ricardo Wathson Feitosa; Avelar, Rafael Linard; Pereira, Carlos Umberto; Pereira, José Carlos
Brain abscess is a rare and threatening infection, which is in a suppuration area, caused either by trauma, neurosurgical complication, or by a secondary infection of dental origin complication. The infectious process spread from the start focus can occur in 2 ways: hematogenous or by contiguity. The treatment should ideally be based on the etiological factor excision, combined with drainage and antibiotics as adjuvant; this philosophy is not observed in the reports described in the 1960s, 1970s, and 1980s. This study's goal was to report a case of brain abscess consequent of an odontogenic outbreak, where an adequate treatment was set up, but it was already in advanced stages and had as a result the lethal outcome. Complications from the odontogenic infections have a low incidence, but should never be disregarded, because they can lead to death, as described in this manuscript.
Ahmed, Zohair; Bansal, Saurabh K; Dhillon, Sonu
A 21-year-old male with no significant past medical history, presented with right upper quadrant (RUQ) abdominal pain along with fevers and chills. Lab work revealed leukocytosis, anemia, and slightly elevated alkaline phosphatase. Viral serology for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus were negative and he was immunocompetent. Computed tomography imaging revealed hepatic abscesses, the largest measuring 9.5 cm. Empiric antibiotics were started and percutaneous drains were placed in the abscesses. Anaerobic cultures from the abscesses grew Fusobacterium nucleatum. This is a gram negative anaerobic bacteria; a normal flora of the oral cavity. Fusobacterium is most commonly seen in Lemiere’s disease, which is translocation of oral bacteria to the internal jugular vein causing a thrombophlebitis and subsequent spread of abscesses. Our patient did not have Lemiere’s, and is the first case described of fusobacterium pyogenic liver abscess in a young immunocompetent male with good oral hygiene. This case was complicated by sepsis, empyema, and subsequent abscesses located outside the liver. These abscesses’ have the propensity to flare abruptly and can be fatal. This case not only illustrates fusobacterium as a rare entity for pyogenic liver abscess, but also the need for urgent diagnosis and treatment. It is incumbent on physicians to diagnose and drain any suspicious hepatic lesions. While uncommon, such infections may develop without any overt source and can progress rapidly. Prompt drainage with antibiotic therapy remains the cornerstone of therapy. PMID:25834342
Livingston, Lachara V; Perez-Colon, Elimarys
Streptococcus intermedius is a member of the Streptococcus anginosus group of bacteria. This group is part of the normal flora of the oropharynx, genitourinary, and gastrointestinal tracts; however, they have been known to cause a variety of purulent infections including meningitis, endocarditis, and abscesses, even in immunocompetent hosts. In particular, S. intermedius has been associated with the development of liver and brain abscesses. There have been several case reports of S. intermedius liver abscesses with active periodontal infection. To our knowledge, however, there has not been a case following a routine dental procedure. In fact, the development of liver abscesses secondary to dental procedures is very rare in general, and there are only a few case reports in the literature describing this in relation to any pathogen. We present a rare case of S. intermedius bacteremia and liver abscess following a dental cleaning. This case serves to further emphasize that even routine dental procedures can place a patient at risk of the development of bacteremia and liver abscesses. For this reason, the clinician must be sure to perform a detailed history and careful examination. Timely diagnosis of pyogenic liver abscesses is vital, as they are typically fatal if left untreated.
Livingston, Lachara V.; Perez-Colon, Elimarys
Streptococcus intermedius is a member of the Streptococcus anginosus group of bacteria. This group is part of the normal flora of the oropharynx, genitourinary, and gastrointestinal tracts; however, they have been known to cause a variety of purulent infections including meningitis, endocarditis, and abscesses, even in immunocompetent hosts. In particular, S. intermedius has been associated with the development of liver and brain abscesses. There have been several case reports of S. intermedius liver abscesses with active periodontal infection. To our knowledge, however, there has not been a case following a routine dental procedure. In fact, the development of liver abscesses secondary to dental procedures is very rare in general, and there are only a few case reports in the literature describing this in relation to any pathogen. We present a rare case of S. intermedius bacteremia and liver abscess following a dental cleaning. This case serves to further emphasize that even routine dental procedures can place a patient at risk of the development of bacteremia and liver abscesses. For this reason, the clinician must be sure to perform a detailed history and careful examination. Timely diagnosis of pyogenic liver abscesses is vital, as they are typically fatal if left untreated. PMID:25197585
K, Lakshmi; R, Santhanam; S, Chitralekha
A brain abscess is a life threatening condition which can occur as a complication of various clinical conditions. An intra–cerebral abscess which occurs as a complication of pulmonary arterial hypertension is extremely rare. The present report has described such an uncommon case of an intra–cerebral abscess in a chronic pulmonary thrombo embolism patient with pulmonary hypertension. A–34–year old male who was a known case of chronic pulmonary thrombo embolism with pulmonary artery hypertension, who was diagnosed 6 months back, presented to the Out Patients Department (OPD) with headache and vomiting. He had right homonymous hemianopia. Contrast MRI (Magnetic Resonance Imaging) of brain showed a peripherally enhancing lesion in the left temporo-occipital lobe, with oedema and a mass effect. Left parieto–occipital craniotomy and excision of the abscess was done. Staphylococcus aureus was isolated from the aspirated pus. PMID:24179934
Chu, Andrew; Aung, Thu Thu; Shankar, Uday
Paraspinal and epidural abscesses are rare conditions often diagnosed later in the disease process that can have significant morbidity and mortality. Predisposing risk factors include diabetes, human immunodeficiency virus, intravenous drug abuse, and previous history of spinal surgery or injection. They can threaten the spinal cord by compressive effect, leading to sensory motor deficits and ultimately paralysis and death. Diagnosis may be a challenge due to the delayed presentation of nonspecific back pain or radicular pain such as chest pain or abdominal pain. We present a rare case on a patient with periumbilical pain, constipation, and urinary retention who was ultimately diagnosed with a paraspinal abscess extending into the epidural space from T1 to S2. He underwent decompressive laminectomy with incision and drainage of the abscesses. The patient made an excellent recovery postoperatively, and repeat magnetic resonance imaging at six weeks showed resolution of the abscess. PMID:26770847
Ugurlucan, Funda Gungor; Ozsurmeli, Mehmet; Bakir, Baris; Saygili, Halil; Yalcin, Onay
The transobturator tape operation has been the most popular method of SUI surgery worldwide owing to its low complication rate and high success rate. However, erosions and abscesses secondary to transobturator tape have been observed. Here we report a 36-year-old woman referred to our unit with fever, persistent swelling in the left groin, difficulty in walking, and a tape that came through the vagina, 4 years after the transobturator tape operation. She had a history of ischiorectal abscess and rectovaginal fistula. A recurrent obturator abscess with fistula formation and spontaneous expulsion of the mesh was diagnosed. The patient underwent antibiotic therapy, incision through the fistula tract, drainage of the abscess, and removal of the necrotic material. Patients should be informed about risks of erosion and infection and that pain and foul smelling vaginal discharge might be the first signs of severe infectious morbidities after transobturator tape operation.
Shin, Seung Kak; Jung, Young Kul; Yoon, Hyun Hwa; Kwon, Oh Sang; Kim, Yun Soo; Choi, Duck Joo; Kim, Ju Hyun
Hepatocellular carcinoma (HCC) is a critical global health issue and the third most common cause of cancer-related deaths worldwide. The majority of patients who present HCC are already at an advanced stage and their tumors are unresectable. Sorafenib is a multi-kinase inhibitor of the vascular endothelial growth factor pathway and was recently introduced as a therapy for advanced HCC. Furthermore, studies have shown that oral sorafenib has beneficial effects on survival. However, many patients experience diverse side effects, and some of these are severe. Liver abscess development has not been previously documented to be associated with sorafenib administration in HCC. Here, we report the case of a HCC patient that developed a liver abscess while being treated with sorafenib.
JUNG, Joohyun; CHOI, Mincheol
A one-year-old, castrated male domestic short hair cat was admitted with a history of anorexia, regurgitation and pyrexia for two days. Fever and leukocytosis were identified. There were a large soft tissue density oval mass in the caudal mediastinum on thoracic radiographs, a fluid-filled oval mass in the caudal mediastinum on ultrasonography, and left-sided and ventrally displaced and compressed esophagus on esophagram. On esophageal endoscopy, there were no esophageal abnormalities. CT findings with a fluid filled mass with rim enhancement indicated a caudal mediastinal paraesophageal abscess. The patient was treated with oral antibiotics, because the owner declined percutaneous drainage and surgery. The patient was admitted on emergency with severe respiratory distress; and ruptured abscess and deteriorated pleuropneumonia were suspected. With intensive hospitalization care and additional antibiotic therapy, the patient had full recovery. PMID:25648207
Leibman, A Jill; Misra, Monika; Castaldi, Maria
The purpose of this series was to review the spectrum of clinical and sonographic features associated with infection after nipple piercing. Between 2002 and 2010, 6 patients presented to our breast center with a breast abscess after nipple piercing. A retrospective analysis of the imaging findings was performed with clinical and pathologic correlation. Patients with breast infections after nipple piercing tend to be young, and the timing since piercing varies from 2 weeks to 17 months. Sonography showed a complex or hypoechoic mass in 5 of 6 patients. Treatment of breast abscesses included surgical incision and drainage, percutaneous drainage, and antibiotic therapy. Surgical evacuation is commonly performed; however, sonographically guided aspiration may be an appropriate management strategy.
Xiang, H; Ma, X; Shen, N; Yue, B; Zhang, G; Chen, B
Holocord spinal epidural abscess (SEA) is a rare condition. To our knowledge, five cases of SEA have been reported so far, and no consensus has been made on the treatment yet. In this article, we report a case of holocord SEA and review literature to further understanding of SEA. The advent of antibiotic treatment and the recognition of surgical debridement have been important in searching for alternatives to recovery, so the patient was treated surgically together with systemic antibiotics. The patient remained neurologically stable and continued to be clinically in good condition without any low back pain after 1 year. Surgical drainage, together with systemic antibiotics, is the main treatment choice for extensive SEAs. Although treatment should be considered that highlights the importance of examining the factors related to the health and condition of the patients and the anatomy and extent of the abscess, early surgical treatment associated with prolonged antibiotic treatment is necessary.
Rudnik-Schöneborn, S; Tölle, D; Senderek, J; Eggermann, K; Elbracht, M; Kornak, U; von der Hagen, M; Kirschner, J; Leube, B; Müller-Felber, W; Schara, U; von Au, K; Wieczorek, D; Bußmann, C; Zerres, K
We present clinical features and genetic results of 1206 index patients and 124 affected relatives who were referred for genetic testing of Charcot-Marie-Tooth (CMT) neuropathy at the laboratory in Aachen between 2001 and 2012. Genetic detection rates were 56% in demyelinating CMT (71% of autosomal dominant (AD) CMT1/CMTX), and 17% in axonal CMT (24% of AD CMT2/CMTX). Three genetic defects (PMP22 duplication/deletion, GJB1/Cx32 or MPZ/P0 mutation) were responsible for 89.3% of demyelinating CMT index patients in whom a genetic diagnosis was achieved, and the diagnostic yield of the three main genetic defects in axonal CMT (GJB1/Cx32, MFN2, MPZ/P0 mutations) was 84.2%. De novo mutations were detected in 1.3% of PMP22 duplication, 25% of MPZ/P0, and none in GJB1/Cx32. Motor nerve conduction velocity was uniformly <38 m/s in median or ulnar nerves in PMP22 duplication, >40 m/s in MFN2, and more variable in GJB1/Cx32, MPZ/P0 mutations. Patients with CMT2A showed a broad clinical severity regardless of the type or position of the MFN2 mutation. Out of 75 patients, 8 patients (11%) with PMP22 deletions were categorized as CMT1 or CMT2. Diagnostic algorithms are still useful for cost-efficient mutation detection and for the interpretation of large-scale genetic data made available by next generation sequencing strategies.
Wise, C.A.; Davis, S.N.; Heju, Z.; Pentao, L.; Patel, P.I.; Lupski, J.R. ); Garcia, C.A. )
Charcot-Marie-Tooth disease (CMT) is the most common inherited peripheral neuropathy. One form of CMT, CMT type 1A, is characterized by uniformly decreased nerve conduction velocities, usually shows autosomal dominant inheritance, and is associated with a large submicroscopic duplication of the p11.2-p12 region of chromosome 17. A cohort of 75 unrelated patients diagnosed clinically with CMT and evaluated by electrophysiological methods were analyzed molecularly for the presence of the CMT1A DNA duplication. Three methodologies were used to assess the duplication: Measurement of dosage differences between RFLP alleles, analysis of polymorphic (GT)[sub n] repeats, and detection of a junction fragment by pulsed-field gel electrophoresis. The CMT1A duplication was found in 68% of the 63 unrelated CMT patients with electrophysiological studies consistent with CMT type 1 (CMT1). The CMT1A duplication was detected as a de novo event in two CMT1 families. Twelve CMT patients who did not have decreased nerve conduction velocities consistent with a diagnosis of CMT type 2 (CMT2) were found not to have the CMT1A duplication. The most informative molecular method was the detection of the CMT1A duplication-specific junction fragment. Given the high frequency of the CMT1A duplication in CMT patients and the high frequency of new mutations, the authors conclude that a molecular test for the CMT1A DNA duplication is very useful in the differential diagnosis of patients with peripheral neuropathies. 61 refs., 4 figs.
[Autopsy case of a patient with Charcot-Marie-Tooth disease type 1A and suspected chronic inflammatory demyelinating polyradiculoneuropathy, which was later diagnosed as amyotrophic lateral sclerosis].
Higuchi, Yujiro; Sakiyama, Yusuke; Nishihira, Yasushi; Endo, Kazuhiro; Suwazono, Shugo; Suehara, Masahito
We report an autopsy case of a 74-year-old man with late onset Charcot-Marie-Tooth disease type 1A (CMT1A) diagnosed by genetic screening, later associated with amyotrophic lateral sclerosis (ALS). At the age of 70 years, the patient was admitted to our hospital because of progressive weakness and dysesthesia in the right upper limb. In the early stages of the illness, he was diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and transient improvement was achieved with intravenous immunoglobulin. However, the symptoms progressively worsened and became refractory. Gene analysis revealed PMP22 gene duplication, which confirmed CMT1A. On sural nerve biopsy, severe demyelinating neuropathy and abundant onion-bulb formations with endoneurial infiltration of inflammatory cells were observed. Thereafter, pseudo-bulbar palsy and respiratory muscle weakness developed insidiously and progressed rapidly along with muscle weakness in the limbs and trunk. The patient died about four years after the onset of this disease. Postmortem examination showed moderate neuronal cell loss, Bunina bodies, and TDP-43-positive inclusions in the anterior horn cells. The spinal cord revealed axonal loss and extensive macrophage permeation in the corticospinal tracts. On the basis of these findings, the final neuropathological diagnosis was ALS. This is the first report of an autopsy case of CMT1A complicated with ALS. We here discuss the significant clinical and neuropathological findings of this case.
McLaughlin, Heather M; Sakaguchi, Reiko; Giblin, William; Wilson, Thomas E; Biesecker, Leslie; Lupski, James R; Talbot, Kevin; Vance, Jeffery M; Züchner, Stephan; Lee, Yi-Chung; Kennerson, Marina; Hou, Ya-Ming; Nicholson, Garth; Antonellis, Anthony
Charcot-Marie-Tooth (CMT) disease comprises a heterogeneous group of peripheral neuropathies characterized by muscle weakness and wasting, and impaired sensation in the extremities. Four genes encoding an aminoacyl-tRNA synthetase (ARS) have been implicated in CMT disease. ARSs are ubiquitously expressed, essential enzymes that ligate amino acids to cognate tRNA molecules. Recently, a p.Arg329His variant in the alanyl-tRNA synthetase (AARS) gene was found to segregate with dominant axonal CMT type 2N (CMT2N) in two French families; however, the functional consequence of this mutation has not been determined. To investigate the role of AARS in CMT, we performed a mutation screen of the AARS gene in patients with peripheral neuropathy. Our results showed that p.Arg329His AARS also segregated with CMT disease in a large Australian family. Aminoacylation and yeast viability assays showed that p.Arg329His AARS severely reduces enzyme activity. Genotyping analysis indicated that this mutation arose on three distinct haplotypes, and the results of bisulfite sequencing suggested that methylation-mediated deamination of a CpG dinucleotide gives rise to the recurrent p.Arg329His AARS mutation. Together, our data suggest that impaired tRNA charging plays a role in the molecular pathology of CMT2N, and that patients with CMT should be directly tested for the p.Arg329His AARS mutation.
Zhang, W; Vazquez, B; Oreadi, D; Yelick, P C
Whole tooth regeneration approaches currently are limited by our inability to bioengineer full-sized, living replacement teeth. Recently, decellularized organ scaffolds have shown promise for applications in regenerative medicine by providing a natural extracellular matrix environment that promotes cell attachment and tissue-specific differentiation leading to full-sized organ regeneration. We hypothesize that decellularized tooth buds (dTBs) created from unerupted porcine tooth buds (TBs) can be used to guide reseeded dental cell differentiation to form whole bioengineered teeth, thereby providing a potential off-the-shelf scaffold for whole tooth regeneration. Porcine TBs were harvested from discarded 6-mo-old pig jaws, and decellularized by successive sodium dodecyl sulfate/Triton-X cycles. Four types of replicate implants were used in this study: 1) acellular dTBs; 2) recellularized dTBs seeded with porcine dental epithelial cells, human dental pulp cells, and human umbilical vein endothelial cells (recell-dTBs); 3) dTBs seeded with bone morphogenetic protein (BMP)-2 (dTB-BMPs); and 4) freshly isolated nondecellularized natural TBs (nTBs). Replicate samples were implanted into the mandibles of host Yucatan mini-pigs and grown for 3 or 6 mo. Harvested mandibles with implanted TB constructs were fixed in formalin, decalcified, embedded in paraffin, sectioned, and analyzed via histological methods. Micro-computed tomography (CT) analysis was performed on harvested 6-mo samples prior to decalcification. All harvested constructs exhibited a high degree of cellularity. Significant production of organized dentin and enamel-like tissues was observed in dTB-recell and nTB implants, but not in dTB or dTB-BMP implants. Micro-CT analyses of 6-mo implants showed the formation of organized, bioengineered teeth of comparable size to natural teeth. To our knowledge, these results are the first to describe the potential use of dTBs for functional whole tooth regeneration.
de Fernández, M I; Negroni, R; Arechavala, A
Disseminated histoplasmosis is the most serious form of the disease produced by the fungus Histoplasma capsulatum. Histoplasmosis was first described by Darling in 1906, and it is endemic in certain areas of Central and Southeastern regions of USA, and most Latin America countries, including the Pampa húmeda and Mesopotamia regions in Argentina, but in other continents it has a limited regional distribution. Lung involvement predominates in 90% of cases, but H. capsulatum may involve bone and soft tissues. Bone lesions without other signs of infection are very rare, and are often misdiagnosed as cancer. We report a case of disseminated histoplasmosis in a man with a myelodysplasia who presented a left tibial abscess, without any clinical evidence of pulmonary involvement. The patient was successfully treated with itraconazole.
Lai, Shih-Wei; Lin, Hsien-Feng; Lin, Cheng-Li; Liao, Kuan-Fu
abscesses when patients with splenectomy present with fever of unknown origin. PMID:27495069
Hernandez, Miguel; Berg, Andrew; Bhatia, Chandra
Spinal epidural abscesses are uncommon, but their incidence is increasing. They represent a collection of purulent material in the epidural space and most commonly occur in the lumbar spine, where they remain localised. Abscesses that affect all three spinal levels (holospinal or multiregional abscesses) are extremely rare, with only a few cases published in the literature. Epidural abscesses are particularly high risk infections as progressive neurological dysfunction can occur rapidly; early diagnosis and treatment is therefore essential to avoid long term neurological complications and reduce potential mortality. Given the uncommon nature of this condition, the treatment remains controversial with no definitive guidance on conservative versus surgical management. The literature mostly recommends surgical decompression along with intravenous antibiotics in patients with neurological abnormalities. We describe a case of a 77-year-old patient presenting with a delayed diagnosis of a multi-regional epidural abscess with associated upper motor neurone signs. The patient was successfully treated nonoperatively with a course of antibiotics resulting in complete radiological resolution of the abscess and full neurological recovery. PMID:26512341
Yamakado, Koichiro; Takaki, Haruyuki; Nakatsuka, Atsuhiro; Kashima, Masataka; Uraki, Junji; Yamanaka, Takashi; Takeda, Kan
This study evaluated the safety, feasibility, and clinical utility of transhepatic drainage of inaccessible abdominal abscesses retrospectively under real-time computed tomographic (CT) guidance. For abdominal abscesses, 12 consecutive patients received percutaneous transhepatic drainage. Abscesses were considered inaccessible using the usual access route because they were surrounded by the liver and other organs. The maximum diameters of abscesses were 4.6-9.5 cm (mean, 6.7 +/- 1.4 cm). An 8-Fr catheter was advanced into the abscess cavity through the liver parenchyma using real-time CT fluoroscopic guidance. Safety, feasibility, procedure time, and clinical utility were evaluated. Drainage catheters were placed with no complications in abscess cavities through the liver parenchyma in all patients. The mean procedure time was 18.8 +/- 9.2 min (range, 12-41 min). All abscesses were drained. They shrank immediately after catheter placement. In conclusions, this transhepatic approach under real-time CT fluoroscopic guidance is a safe, feasible, and useful technique for use of drainage of inaccessible abdominal abscesses.
Zárate, Mariela S; Yahni, Diego; Guevara, Martín; Smayevsky, Jorgelina
Brain abscesses by Propioni-bacterium acnes are rare. The rapid identification of this pathogen is important in order to choice the appropriate antibiotic therapy. We describe the case of a patient with excision of a multiform glioblastoma who 9 months later presented a tumor recurrence. A subtotal tumor excision was made and implants chemotherapy were placed in the residual tumor. After one month of surgery the patient presented a brain abscess. A craniotomy for drainage was performed. P. acnes was isolated from the biopsy and from purulent material. Identification was made by conventional biochemical tests and by the API system 20 A. The Minimum Inhibitory Concentration (MIC) to clindamycin, penicillin, amoxicillin and metronidazole was determined. The values of MIC (microg/ml) obtained were: 0.250, 0.040, 0.023 and 256, respectively. The patient received cefepime and metronidazole intravenously during 30 days and completed treatment with oral clindamycin for 60 days, considering the possibility of adjacent bone involvement. Eight months after the drainage the patient had no evidence of infection or tumor recurrence. Although P. acnes is a rare cause of post-neurosurgical infection, it should be considered as a possible pathogen in postoperative brain abscesses.
Dutto, Luca; Pomero, Fulvio; Allione, Attilio
We report a case of metastatic abscesses caused by a chronic form of brucellosis in a shepherd. When she was admitted the patient was cachectic with haematological signs of phlogosis. An abdominal computed tomography scan revealed the presence of multiple hepatic and renal abscesses with a fluid mass in the abdominal wall. The blood cultures, tuberculin skin test, and Wright reaction all gave negative results, but the brucellosis Coombs test for Brucella species was highly positive. Diagnosis was confirmed by a high titre of anti-Brucella IgM antibodies. The patient started antibiotic treatment with a progressive clinical improvement, but after discharge she was lost to follow-up and died 7 months later. PMID:21686889
Simms, M H; Curran, F; Johnson, R A; Oates, J; Givel, J C; Chabloz, R; ALexander-Williams, J
In the treatment of acute pyogenic soft-tissue abscess incision, curettage, and primary suture was compared with incision and drainage alone in a randomised prospective trial. Operations were performed under antibiotic cover by casualty officers, and patients were reviewed by an independent observer in a septic dressing clinic. Altogether 114 patients were studied, of whom 54 were treated by curettage and primary suture and 60 by simple drainage. The mean healing time was 8.9 days in those treated by primary suture and 7.8 days in those treated by simple drainage (p less than 0.05). Primary healing failed to occur in 19 (35%) of the sutured wounds, but there were no other complications in either group. It is concluded that incision and drainage alone is adequate treatment for acute soft-tissue abscess. PMID:6805714
Park, Sung Yong; Suh, Dong Won; Park, Chul Min; Oh, Min Seok
In this report, we describe a case of brain abscess due to odontogenic infection. A 53-year-old female who had been suffering from headache and trismus for two weeks visited the Department of Oral and Maxillofacial Surgery at the Sun Dental Hospital (Daejeon, Korea). Even after several routine tests, we still could not make a diagnosis. However, after the combined multidisciplinary efforts of oral surgeons and neurosurgeons, the patient was treated for odontogenic infection and made an uneventful recovery. Therefore, patients with infections in the head and neck region showing symptoms such as headache, changes in mental state, nausea, vomiting, seizures, hemiplegia, speech disturbance, and visual disturbance, a brain abscess should be included in the list of differential diagnoses. PMID:25045643
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Moskovitz, Moti; Birenboim, Ravit; Katz-Sagi, Hadas; Perles, Zeev; Averbuch, Diana
The purpose of the present report was to present a rare case of a brain abscess in a child with heterotaxy syndrome, severe cardiac anomalies, and extensive dental caries. The pathogen was Streptococcus intermedius isolated from the cerebrospinal fluid. The source of the pathogen was probably an infection of a primary molar with a dentoalveolar abscess involving the bud of the permanent successor. After a long course of antibiotic regimens followed by a craniotomy with abscess drainage, a shunt, and comprehensive dental treatment, the patient was discharged from the hospital without any neurological sequel. At home, she completed an additional 3 months of oral antibiotics. This is the only known documented case of a toddler with a brain abscess of probable odontogenic origin without previous dental intervention. It emphasizes the importance of collaboration between cardiologists and pediatric dentists, especially in referring children with congenital heart defects for early dental checkups.
Hwang, Roy; Yung, Brian H; Sedney, Cara; Miele, Vincent J
To date, this is the first reported case of the surgical management of a holocord epidural abscess done through level-skipping laminectomies. It is also the first reported case of these laminectomies being performed via an alternating side unilateral approach for this condition. A 51-year-old patient presenting with progressive lower extremity weakness secondary to a spinal epidural abscess extending from C4 to S1. A minimally disruptive method of relieving the spinal cord compression via evacuation of the abscess was employed successfully. This report demonstrates the efficacy of level skipping laminectomies via a unilateral approach for holocord epidural abscesses (extending 20 vertebral levels). Performing the laminectomies via a unilateral approach as well as alternating the side of the approach minimized iatrogenic instability risk. Both strategies were designed to minimize incision size, tissue disruption, and the amount of muscular weakness/imbalance postoperatively.
Cervera Escario, Javier; Calderón Nájera, Ramón; Enríquez de Salamanca, Javier; Bartolomé Benito, Margarita
Septal haematoma following nasal trauma is a complication that, if not diagnosed and treated early, may evolve into a nasal septal abscess. We present the case of a 10-year-old male who suffered nasal trauma with fracture and an undiagnosed septal haematoma that evolved into a septal abscess. During drainage of the abscess, necrosis of the quadrangular cartilage was noted. The patient later presented collapse of the nasal dorsum and deviation of the nasal septum. This sequela was corrected by means of an osteochondral costal graft. In the presence of any nasal trauma, it is important to explore the nasal septum correctly to discard the presence of a haematoma which, if not drained early, may evolve into an abscess due to compression of the quadrangular cartilage, leading to its necrosis in a few days and later collapse of the nasal dorsum as the child grows.
Yeom, Dong Han; Sohn, Ki Chang; Chu, Min Su; Jo, Dong Ho; Cho, Eun Young; Kim, Haak Cheoul
Idiopathic cecal ulcer is a rare disease entity of unknown cause diagnosed by ruling out other known causes of cecal ulceration. The most common complication of an idiopathic cecal ulcer is bleeding; perforation, peritonitis, abscess, and stricture formation have been noted. The authors treated a 53-year-old woman who presented with fever and intermittent right upper quadrant abdominal pain. Multiple pyogenic liver abscess and a solitary cecal ulcer were diagnosed by radiologic, endoscopic, and pathologic examination, followed by laparoscopic cecectomy. After extensive study, we concluded that this patient's liver abscesses were a complication of the idiopathic cecal ulcer. Herein, we report a case of multiple pyogenic liver abscess caused by microperforation of idiopathic cecal ulcer.
Grisar, Koenraad; Maes, Honorine; Politis, Constantinus
We report the case of a 65-year-old man presenting with generalised seizures after developing a right frontal brain abscess. Stereotactic aspiration and subsequent matrix assisted laser desorption/ionisation time-of-flight analyzer (MALDI-TOF) spectrometry revealed Porphyromonas gingivalis as the only causative anaerobe microorganism. Secondary incision and drainage was required due to neurological deterioration with increased dimensions of the abscess, intracranial pressure and formation of a subdural occipitoparietal empyema. Oral imaging was positive for apical periodontitis of multiple elements; therefore, the remaining dentition was removed. Targeted antibiotic treatment included intravenous ceftriaxone and ornidazole. The patient was discharged to our revalidation unit 59 days after admission to make a full recovery. To the best of our knowledge, this is the sixth reported case of P. gingivalis causing an intracranial abscess and the third case of a true intracerebral parenchymal abscess caused by this bacterium. PMID:28228396
SOUZA, Andréia Pereira; KOBAYASHI, Tatiana Yuriko; LOURENÇO NETO, Natalino; SILVA, Salete Moura Bonifácio; MACHADO, Maria Aparecida Andrade Moreira; OLIVEIRA, Thais Marchini
Patients with Vitamin D-resistant rickets have abnormal tooth morphology such as thin globular dentin and enlarged pulp horns that extend into the dentino-enamel junction. Invasion of the pulp by microorganisms and toxins is inevitable. The increased fibrotic content of the pulp, together with a reduced number of odontoblasts, decreases the response to pulp infection. The most important oral findings are characterized by spontaneous gingival and dental abscesses occuring without history of trauma or caries. Radiographic examinations revealed large pulp chambers, short roots, poorly defined lamina dura and hypoplastic alveolar ridge. These dental abscesses are common and therefore the extraction and pulpectomy are the treatment of choice. The purpose of this article is to report a case of Vitamin D-resistant rickets in a 5 year-old boy, describing the dental findings and the treatment to be performed in these cases. PMID:24473729
Arpaci, Ayse Hande; Isik, Berrin
Objective: The present study aims to evaluate intravenous ketamine and inhalation sedation in children, their unwanted side-effects and surgeon satisfaction. Methods: In this study, data of 922 children aged between 1-18 who underwent tooth extraction under sedoanalgesia in our department between September 2015-January 2016 were gathered and anesthesia approaches, unwanted side effects and surgical satisfaction was investigated. Postoperative recovery emergence agitation or delirium was evaluated with Watcha Behavior Scale (WBS). Results: Patients were grouped and compared according to acceptance of intravenous line placement (Group-1) or not (Group- 2). Group 1 received intravenous ketamine anesthesia (n=822), Group 2 received inhalation anesthesia with sevoflurane (n=100). Number of patients, age, weight and gender was significantly different in two groups. When side effects were investigated nausea was observed in 30 patients (3.6%), skin rashes were observed in 26 patients (3.2%) in Group-1 while skin rashes were observed in one patient (1%) in Group 2. 95% of surgeons reported intravenous anesthesia, 18% of surgeons reported inhalation anesthesia to be the anesthesia of choice. Emergence of postoperative recovery agitation (WBS≥3) was observed more frequent in Group 2 (p<0.05) than Group 1. Conclusion: Ketamine, which has analgesic, hypnotic and amnestic effects and which does not alter pharyngeal and laryngeal reflexes thus minimizes aspiration possibility, is a safe and effective anesthetic agent for tooth extractions of the pediatric population under sedoanalgesia. PMID:27882039
Manderwad, Guru Prasad; Kodiganti, Manjulatha; Ali, Mohammad Javed
Cardiobacterium hominis is a member of the HACEK (Haemophilus sp., Actinobacillus actinomycetemcomitans, C. hominis, Eikenella corrodens, and Kingella kingae) group commonly associated with endocarditits and is normally present in the respiratory tract. We describe the first case of acute dacryocystitis with lacrimal abscess caused by C. hominis along with a brief review of the literature. The patient responded to oral and topical ciprofloxacin after incision and drainage and awaits dacryocystorhinostomy. PMID:24008805
Leighton, P M; MacSween, H M
A 71-year-old woman who had been receiving iron injections for at least ten years was admitted to the Dr Everett Chalmers Hospital, Fredericton, New Brunswick. The initial diagnosis was metastatic tumors in the liver, but after further evaluation, the initial diagnosis was corrected to multiple hepatic abscesses due to Yersinia enterocolitica. The liver biopsy showed abundant iron deposition. With the appropriate antibiotic treatment, the patient recovered.
Kim, Yong Joon; Park, Se Young; Kim, So Young
A 78-year-old woman presented with periorbital swelling and visual loss in the right eye after a tooth extraction. Initial visual acuity was reduced to counting fingers in the right eye. No afferent pupillary defect was found on initial examination. Computed tomography revealed axial elongation due to increased orbital pressure caused by the orbital abscess. The authors present a case with a rare pattern of choroidal folds radiating 360° from the optic disc. Initial optical coherence tomography revealed a markedly folded Bruch's membrane and retinal pigment epithelium, which disappeared completely 2 months after surgical drainage of the orbital abscess. Retinal images in this report can provide a better understanding of the pathogenesis of the choroidal folds.
Background Current genetic test algorithms for Charcot Marie Tooth (CMT) disease are based on family details and comprehensive clinical and neurophysiological data gathered under ideal conditions for clinical assessment. However, in a diagnostic laboratory setting relying on external test requisitions and patient samples, such conditions are not always met. Our objective was therefore to perform a retrospective evaluation of the data given in laboratory request forms and to assess their quality and applicability with regard to the recommended algorithms for CMT diagnostics. As we are the main test centre for CMT in Norway our results also provide an overview of the spectrum of gene defects in the Norwegian CMT population. Methods Genetic testing was performed according to polyneuropathy type; demyelinating/mixed: PMP22 duplication, MPZ, EGR2, LITAF, NEFL, PMP22, GJB1, axonal: MFN2, MPZ, NEFL, and GJB1. Results Diagnostic testing of index patients was requested in 435 of the 549 cases. Seventy-two (16.6%) positive molecular genetic findings were made. The majority (94.6%) of mutation positive cases showed disease onset before 50 years of age. PMP22 (duplication), MPZ, GJB1 and MFN2 mutations constituted 95.8% of the positive findings. Within the nerve conduction study groups, mutation detection rates were; demyelinating 33.8%; mixed 29.0%; axonal 8.8%; unspecified 16.5%. Conclusion We suggest a simplified algorithm intended for referral centres, dealing with DNA/blood samples, which involves the assessment of age at onset and neurophysiological data followed by testing of four genes; PMP22 (duplication), MPZ, GJB1 and MFN2. Patients negative for mutations in those four genes should be subjected to evaluation at an interdisciplinary inherited neuropathy clinic with the capacity for extended molecular genetic analysis by next generation sequencing. PMID:24053775
Varghese, Lalee; Agarwal, Pratibha; Rupa, Vedantam
Acute lingual swelling is a potentially life threatening clinical condition which is encountered very rarely, the differential diagnosis of which includes hemorrhage, infarction, abscess, tumor and edema. Herein we report a case of lingual abscess that presented with acute tongue swelling and respiratory distress after extraction of lower two incisor teeth.
Bosnalı, Oktav; Moralıoğlu, Serdar; Pektaş, Osman
Neonatal liver abscess is a very rare condition associated with high morbidity and mortality rates. There seems to be an increasing trend of this rare condition amongst the newborns admitted to neonatal intensive care units. We report a case of liver abscess in a premature newborn and briefly review the literature and discuss its management. PMID:26023443
Gunaratne, G D Rajitha; Khan, Riaz J K; Tan, Cynthia; Golledge, Clayton
Introduction: Psoas abscess is a recognized but under-diagnosed complication of prosthetic hip joint infections. Case report: We report a case of a 68-year-old man with right and left hip arthroplasties performed 22 and 14 years ago, respectively, who presented with non-specific symptoms and was subsequently diagnosed with left psoas abscess on CT scan. Drainage of the psoas abscess was complicated by the formation of a discharging sinus connected to the left hip. He then developed an infected right thigh haematoma, which also formed a discharging sinus connecting to the right hip post-drainage. He was treated with bilateral two-stage revision total hip arthroplasties and multiple courses of prolonged antibacterial therapy. Both abscesses and hip joints cultured the same species of multi-sensitive Staphylococcus aureus. The causal link between the psoas abscess and the prosthetic hip infections is discussed, as well as the investigation and management. Conclusion: We recommend routine exploration of the iliopsoas bursa when revision of an infected total hip arthroplasty is performed to rule out intrapelvic spread of the infection . There should be high index of suspicion of prosthetic hip infection in patients presenting with Psoas abscess and vice versa. A CT scan might be warranted to rule out concomitant infection in both these patients. PMID:28116254
Cheng, Esther; Thorpe, Eric; Borrowdale, Richard
Introduction Spinal epidural abscess is an uncommon but potentially life threatening entity that rarely occurs after otolaryngology procedures. Presentation of case We report a case of a diabetic patient who presented with a lumbar spinal epidural abscess eight days after head and neck oncologic surgery. Magnetic resonance imaging revealed an L4 spinal epidural abscess. Cultures from the spinal epidural abscess, blood, urine, and the previous neck incision grew Klebsiella pneumoniae. The patient recovered neurologic function after surgical decompression and drainage, long-term intravenous antibiotics, and physical therapy. Discussion The development of postoperative spinal epidural abscess is rare after otolaryngology procedures but has been reported in the cervical epidural space. To our knowledge, lumbar spinal epidural abscess has not yet been reported after head and neck oncologic surgery. Even more unique is the presence of the pathogen K. pneumoniae. Conclusion A high index of suspicion of this potential outcome is paramount as early recognition and intervention are keys to recovery of neurologic function. PMID:26799413
Awad, Ahmed J; Rowland, Nathan Christopher; Mian, Matthew; Hiniker, Annie; Tate, Matthew; Aghi, Manish Kumar
Pituitary abscesses occurring in pre-existing pituitary pathology like Rathke's cleft cyst or adenomas (secondary pituitary abscesses) are rare and of unclear etiology. While surgery and antibiotics have been effective in some cases reported to date, leading to the suggestion that secondary pituitary abscesses are mostly indolent, we investigated the hypothesis that infected adenomas, given their propensity to invade the paranasal sinuses and subarachnoid space, could carry a worse prognosis than uninfected adenomas or secondary abscesses forming in other pituitary pathologies. We identified infected adenomas from our center through retrospective review. Given the rarity of this diagnosis at any single center, we also reviewed published cases of secondary pituitary abscesses occurring in pituitary adenomas to look for common features. Twenty-three cases (19 from the literature and four from our center) of infected adenomas were identified. The mean age at presentation was 46 years, with 65 % male. The most common presenting symptoms were visual disturbances (83 %) and headache (65 %), followed by infectious signs like fever (39 %) and meningitis (26 %). The sphenoidal sinus was the most common site of extrasellar invasion. While good outcome occurred in 74 % of patients, and most achieved vision improvement, the mortality was 26 %. Patients with infected pituitary adenomas commonly present with visual disturbances and headache, with symptoms of infection also occurring. Surgery and antibiotics are indicated for these lesions. While the infection is more indolent than other intracranial abscesses, it is associated with high mortality even after prompt operation and antibiotic treatment.
Chung, Hyunsook; Kim, Miri; Yang, Wonkyung; Ko, Hyunjung
A case of an avulsed upper left central incisor that was replanted after 3 h in a 7-year-old girl is presented. The tooth showed signs of an acute periapical abscess at 2 weeks after replantation. Apexification with mineral trioxide aggregate (MTA) following application of calcium hydroxide was attempted. At 3-year and 6-month follow-up, the tooth was asymptomatic with adequate clinical function. The radiograph showed resolution of the periapical lesion and apparent radiopaque tissue under MTA plug resembling root end morphology.
An eight-year-old Victorian koala was presented with a discharging mandibular sinus of at least one month duration. On examination, a dental abscess of the right mandibular incisor tooth was found. During the course of endodontic treatment, a size 2 Gates Glidden bur separated from the shank and was lodged in the canal. Due to the anatomy of the tooth the bur could not be removed and an apicoectomy was performed. Following the apicoectomy (follow-up period two years), the periapical pathology resolved.
Snyder, D E
1. Even from such a small sample as that reported in this study, it is evident that the fractured cusp and cracked-tooth syndrome are common problems. The large number of fractured cusps compared to the cracked-tooth syndrome suggests that some of the cases of fractured cusp could have been diagnosed earlier. 2. It is most important that dentists be aware of the cracked-tooth syndrome in order to relieve the patient's discomfort, prevent the possible eventual loss of the pulp or tooth, and avoid unnecessary and possibly damaging treatment for misdiagnosed facial pain. 3. Conservation of tooth structure in restorative procedures is most necessary in order to prevent the cracked-tooth syndrome or fractured posterior cusp.
Filiaci, Fabio; Riccardi, Emiliano; Mitro, Valeria; Piombino, Pasquale; Rinna, Claudio; Agrillo, Alessandro; Ungari, Claudio
Summary Aims Deep neck infections are rare but potentially fatal complication of pulpal abscess of the teeth. If an infection can progress rapidly from a toothache to a life threatening infection, then it is critical that dentists be able to recognize the danger signs and identify the patients who are at risk. Mediastinitis is a severe inflammatory process involving the connective tissues that fills the intracellular spaces and surrounds the organs in the middle of the chest. This pathology has both an acute and a chronic form and, in most cases, it has an infectious etiology. This study want to expose the experience acquired in the Oral and Maxillo-facial Sciences Department, Policlinico Umberto I, “Sapienza” University of Rome, regarding two clinical cases of disseminated necrotizing mediastinitis starting from an odontogenic abscess. Methods We report two clinical cases of disseminated necrotic mediastinitis with two different medical and surgical approaches. The radiographic and photographic documentation of the patients was collected in the pre-and post-operatively. All patients underwent a CT scan and MRI. Results Mediastinitis can result from a serious odontogenic abscess, and the extent of its inflammation process must be never underestimated. Dental surgeons play a key role as a correct diagnosis can prevent further increasing of the inflammation process. Conclusions A late diagnosis and an inadequate draining represent the major causes of the elevated mortality rate of disseminated necrotizing mediastinitis. PMID:26330907
Peltola, H; Salmi, I; Vahvanen, V; Ahlqvist, J
Ten patients with osteomyelitis and three with a subcutaneous abscess, all caused by BCG vaccination, are described. All patients were less than 3 years old and had as newborns been vaccinated intracutaneously in the left gluteal or hip area. Pain, limping, or a slightly tender subcutaneous induration were the primary symptoms. The sites of predilection of osteomyelitis were the metaphysis or epiphysis of the femur, these being affected in five out of 10 cases. All three subcutaneous abscesses were in the thoracic region. Prolonged (up to 30 months) combined tuberculostatic medication, in addition to appropriate surgical procedures, resulted in healing, but two cases of arthritis and two of secondary abscesses developed. In addition, sequestrectomy and two late operations, for coxa valga and hip subluxation, were deemed to be necessary. Radiographs showed femoral overgrowth of up to 1 cm in two symptomless patients three to seven years after the first discharge. We conclude that the benefits of BCG vaccination should be weighed against the risk of complications, especially in countries with a low incidence of tuberculosis. PMID:6703766
Robertson, D; Smith, A J
The acute dental abscess is frequently underestimated in terms of its morbidity and mortality. The risk of potential serious consequences arising from the spread of a dental abscess is still relevant today with many hospital admissions for dental sepsis. The acute dental abscess is usually polymicrobial comprising facultative anaerobes, such as viridans group streptococci and the Streptococcus anginosus group, with predominantly strict anaerobes, such as anaerobic cocci, Prevotella and Fusobacterium species. The use of non-culture techniques has expanded our insight into the microbial diversity of the causative agents, identifying such organisms as Treponema species and anaerobic Gram-positive rods such as Bulleidia extructa, Cryptobacterium curtum and Mogibacterium timidum. Despite some reports of increasing antimicrobial resistance in isolates from acute dental infection, the vast majority of localized dental abscesses respond to surgical treatment, with antimicrobials limited to spreading and severe infections. The microbiology and treatment of the acute localized abscess and severe spreading odontogenic infections are reviewed.
Poret, H A; Fabian, T C; Croce, M A; Bynoe, R P; Kudsk, K A
Over a 7-year period, 151 patients with gunshot wounds to the colon surviving beyond 24 hours were managed. The bullet was retained in the body in 66% and exited in 34%. Thirty-four (23%) developed major septic complications (diffuse peritonitis, 21%; intraperitoneal abscesses 24%; and extraperitoneal abdominal abscesses, 56%). The septic complication rate was 26% in the bullet-present group compared with 16% in the remainder (p less than 0.15). The increased septic rate in those with bullets present was the result of abscesses developing around the retained missile. That group with missile abscesses had a lesser degree of injury as measured by the abdominal trauma index compared with the other patients with septic complications (p less than 0.001). Fifteen (79%) of the 19 patients with missile and missile track abscesses had them develop in the psoas muscle. These abscesses occur by fecal contamination of the muscle following inoculation by the bullet, which passes through the large bowel. Computed tomography-guided and operative drainage tend to fail if the foreign body is not removed. Computed tomography-guided or operative drainage should be successful in draining missile track abscesses when the bullet has exited the patient.
Avanali, Raghunath; Ranjan, Manish; Ramachandran, Sudheesh; Devi, Bhagavatula I; Narayanan, Vinayak
Spinal epidural abscess is a rare clinical entity with considerable morbidity. Even with prompt diagnosis and treatment, many patients are left with persistent residual neurological deficits. The present study details the outcome in 23 patients of primary pyogenic spinal epidural abscess, addressing the outcome following late presentation at a neurological facility. At presentation only 2 patients had relatively preserved neurological status. Eleven patients were paraplegic. All the patients underwent laminectomy and evacuation of abscess. A good functional outcome was observed in almost half of the patients, and there was a significant reduction in the number of the patients with severe disability. Factors influencing the outcome are described in this study.
Peters, F; Flick-Filliés, D
In 11 puerperal women, a breast abscess was treated by drainage from the inframammary fold. Eight patients wished to continue breast feeding. During the healing period, the babies were not breast fed on the operated side. In 3 patients, the skin over the abscess necrotised, resulting in a defect of 1 to 2 cm. In 2 patients, a small seroma had to be punctured after removing the drainage tube. Aesthetic results were judged by the patients as good. Resumation of suckling on the operated side revealed only 15 to 20% milk yield compared to that of the other breast. This treatment meets aesthetic and function-preserving criteria.