Urinary tract and genito-urinary suppurative infections due to anaerobic bacteria

Anaerobes have been involved in many different types of urinary tract infection. This review describes the microbiology, diagnosis and management of urinary tract and genito-urinary suppurative infections caused by anaerobic bacteria. The types of infections of the urinary tract in which anaerobes have been involved include para- or periurethral cellulitis or abscess, acute and chronic urethritis, cystitis, acute and chronic prostatitis, prostatic and scrotal abscesses, periprostatic phlegmon, ureteritis, periureteritis, pyelitis, pyelonephritis, renal abscess, scrotal gangrene, metastatic renal infection pyonephrosis, perinephric abscess, retroperitoneal abscess and other infections. The anaerobes recovered in these studies were Gram-negative bacilli (including Bacteroides fragilis and pigmented Prevotella and Porphyromonas sp.), Clostridium sp., anaerobic Gram-positive cocci and Actinomyces sp. In many cases, they were recovered mixed with coliforms or streptococci. The recovery of anaerobes requires the administration of antimicrobial therapy that is effective against these organisms. These antimicrobials include metronidazole, chloramphenicol, clindamycin, a carbapenem, cefoxitin and the combination of a penicillin and a beta-lactamase inhibitor. Percutaneous drainage, open surgical drainage or nephectomy might be indicated for abscesses.     

Audit of management of pyogenic liver abscess in a tertiary referral hospital

Aim: To review the management and clinical outcomes of patients with pyogenic liver abscess in Queen Elizabeth Hospital. Methods: This is a retrospective review of the management of patients with a diagnosis of pyogenic liver abscess in Queen Elizabeth Hospital from 2000 to 2004. Results: From 2000 to 2004, 143 patients with a diagnosis of pyogenic liver abscess were managed in Queen Elizabeth Hospital. Procedure‐related complications were 6/143 (4%). The success rate from percutaneous intervention was 122/143 (85%). The overall in‐hospital mortality was 18/143 (13%). Mean hospital stay was 30.1 days and the median was 23 days. Multivariate logistic regression analysis on risk factors for in‐hospital mortality showed high white cell count, large size abscess and prolonged activated prothrombin time as independent risk factors. Conclusion: In the present series, high white cell count, large size abscess and prolonged activated prothrombin time predicted poor outcomes in patients with pyogenic liver abscess.     

Diagnosis and treatment of abscess of the central ganglia.

The authors present four cases of abscess of the thalamus and basal ganglia and review an additional 10 cases from the literature. These abscesses appear to be metastatic and are usually associated with a cardiac septal defect or a preceding intrathoracic infection. Fever, elevated white blood count, and/or meningismus, in combination with angiography demonstrating an avascular mass, help distinguish abscess from tumor in this location. The authors advocate aspiration rather than excision.     

Spinal epidural abscess with myelitis and meningitis caused by Streptococcus pneumoniae in a young child

Abstract

Background

Spinal epidural abscess (SEA) in children is a rare infectious emergency warranting prompt intervention. Predisposing factors include immunosuppression, spinal procedures, and local site infections such as vertebral osteomyelitis and paraspinal abscess. Staphylococcus aureus is the most common isolate.

Design

Case report and literature review.

Findings

A 2.5-year-old boy with tetraparesis was found to have an SEA in the posterior lumbar epidural space with evidence of meningitis and myelitis on MRI spine in the absence of any local or systemic predisposing factors or spinal procedures. Streptococcus pneumoniae was isolated from the evacuated pus.

Conclusions

Definitive treatment of SEA is a combination of surgical decompression and iv antibiotics. Timely management limits the extent of neurological deficit.     

Thyroid abscess: case report and review of the literature

A thyroid abscess is an infrequently encountered condition with a rarity that is attributable to anatomic and physiologic characteristics of the gland that impart a unique quality of infection resistance. The differential diagnoses for a painful thyroid is limited, with subacute and chronic thyroiditis being the most often-encountered processes. Acute suppurative thyroiditis with abscess formation, although rare, is a formidable clinical scenario with morbid complications. Because the diagnosis of a thyroid abscess is often delayed in lieu of investigating other more common etiologies of thyroiditis, this disease entity may portend to a dismal clinical outcome. The authors report the case of a 53-year-old woman with a thyroid abscess yielding a single microbial isolate believed to be resultant from a urinary tract bacteremia. They also review the literature for discussion of abscess etiologies, presentations, and management strategies.     

Splenic abscess: presentation, treatment options, and results

Pyogenic splenic abscess is a rare condition that tends to occur in patients with predisposing factors. The use of splenectomy or computed tomography-guided percutaneous drainage in 10 patients with splenic abscess is presented. In 8 of 10 cases, the diagnosis was based on abdominal computed tomography scan. Seven of 10 patients were treated with splenectomy, and 3 were managed with computed tomography-guided drainage. Abscess cultures included Escherichia coli, Enterobacter, Streptococcus viridans, Staphylococcus aureus, and Bacteroides fragilis. There were two morbidities and one death in the splenectomy group and no complications in those treated with percutaneous drainage. This review suggests a flexible approach in the management of splenic abscess. Although splenectomy remains the traditional treatment for bacterial splenic abscess, CT-guided drainage may be appropriate in carefully selected patients.     

Conservative management of a seminal vesicle abscess

A pure seminal vesicle abscess is a rare condition. We report case 7 in the literature and to our knowledge the first patient who has been managed successfully by noninvasive, conservative antibiotic treatment alone. All previously reported cases of seminal vesicle abscesses have been managed with invasive therapy. In 5 cases the seminal vesicle abscess was incised and drained surgically, while in 1 the abscess was drained percutaneously. We describe a patient with a seminal vesicle abscess, review the literature and recommend a more conservative method of management.     

Prostatic abscess: diagnosis and treatment of an infrequent urological entity

OBJECTIVE: To report two cases of prostatic abscess of difficult management and review the literature on diagnosis and management of this entity. METHODS /RESULTS: We describe two patients with prostatic abscess. The first one, a 73-year-old diabetic male, was treated using a more passive approach with percutaneous transrectal drainage; after a slow response, the patient passed away due to sepsis. The second case was a 59-year-old male who experienced a negative clinical response to antibiotic treatment. While under antibiotic ambulatory care the patient was treated with a transurethral resection of the prostate, which yielded a successful outcome. CONCLUSION: Prostatic abscess is a rare entity that affects individuals experiencing weakness and can be a serious condition. Measures taken to arrive at a resolution must be rapid and appropriate.     

Penetrating gastric ulcer presenting as a subcapsular liver abscess

This report describes a subcapsular liver abscess secondary to a penetrating gastric ulcer. The initial read on the CT scan misinterpreted the abscess cavity as an opacified loop of bowel, although it was very conspicuous on a retrospective review. A penetrating gastric ulcer was identified with esophagogastroduodenoscopy and the subcapsular liver abscess was subsequently detected using MRI. Although the conventional treatment of this condition is surgery, successful management was accomplished with a combination of percutaneous drainage, Helicobacter pylori eradication, and acid-suppressive therapy. A review of the literature is provided, including associated cases and the diagnostic modalities used in the evaluation of this condition. This case illustrates how one can arrive at the correct diagnosis with the use of multiple complementary modalities of investigation.     

Groin abscess secondary to trans obturator tape erosion: case report and literature review

AIMS: To report a case of groin abscess secondary to trans obturator tape erosion and review the literature on the incidence, predisposing factors, symptoms and management of tape erosion. METHODS: The clinical history, operative details, postoperative symptoms, findings and management of this case are reported. A thorough literature review of midurethral tape erosions and, in particular, transobturator tape erosions was performed. RESULTS: A 46-year-old woman with urodynamic stress incontinence underwent trans obturator tape insertion. Eight weeks later she developed vaginal discharge and was subsequently diagnosed with a left lateral vaginal wall tape erosion. The eroded section was excised under general anaesthetic. Two weeks later she presented with a large right sided groin abscess which required incision, drainage and debridement of necrotic areas of gracillis and adductor muscles. Short term results following trans obturator tape insertion report excellent efficacy rates (90-96% after 1 year), however there is a lack of long term data on safety and efficacy. Current literature on transobturator tape erosion is scanty and reported rates range from 1.9-7% depending on the tape inserted. Tape erosion commonly presents with vaginal discharge, bleeding or dyspareunia and several methods of management have been reported including conservative management, excision of the eroded section or removal of the entire tape. CONCLUSIONS: Groin abscess following tape erosion is a serious complication resulting in further surgery and months of morbidity for the woman. Prompt management of tape erosion is essential to minimise such complications and more data is required on the long term efficacy and safety of transobturator tapes.     

Spinal epidural abscess with myelitis and meningitis caused by Streptococcus pneumoniae in a young child

Background

Spinal epidural abscess (SEA) in children is a rare infectious emergency warranting prompt intervention. Predisposing factors include immunosuppression, spinal procedures, and local site infections such as vertebral osteomyelitis and paraspinal abscess. Staphylococcus aureus is the most common isolate.

Design

Case report and literature review.

Findings

A 2.5-year-old boy with tetraparesis was found to have an SEA in the posterior lumbar epidural space with evidence of meningitis and myelitis on MRI spine in the absence of any local or systemic predisposing factors or spinal procedures. Streptococcus pneumoniae was isolated from the evacuated pus.

Conclusions

Definitive treatment of SEA is a combination of surgical decompression and iv antibiotics. Timely management limits the extent of neurological deficit.     

Perinephric abscesses in the neurologically impaired

STUDY DESIGN: Retrospective chart review. OBJECTIVES: To document the occurrence and management of large perinephric abscesses in neurologically impaired patients at high risk for this infectious complication. SETTING: US Veterans Affairs hospital. METHODS: The records, radiographs, operative findings and outcomes of all patients who presented with perinephric abscesses evident on physical exam within the last 5 years were reviewed. RESULTS: Four patients presented with large perinephric abscesses evident on physical examination. All had severe neurologic impairment with high sensory levels; three had spinal cord injuries, one had advanced multiple sclerosis. All had neurogenic bladders and recurrent urinary tract infections. The diagnosis was made through a combination of history, physical examination and computed tomography (CT) examination. All were found to have upper tract obstruction. All were managed with immediate abscess drainage and three had elective nephrectomy once the infection had resolved. No patients died of their perinephric abscess. CONCLUSIONS: These four cases illustrate that although advances in antibiotics, imaging and percutaneous management have improved the speed of diagnosis and reduced the mortality in patients with perinephric abscesses, the neurologically impaired population continues to remain at significant risk for the development and the delayed diagnosis of these morbid renal infections.     

Hepatic abscess. Changes in etiology, diagnosis, and management.

Most recent reviews of pyogenic hepatic abscess emphasize percutaneous versus open surgical management and devote little time to studying the etiology or the clinical condition of the patient. In this study a detailed review was performed with a computerized analysis of multiple clinical parameters in 73 patients treated for pyogenic hepatic abscess during a 17-year period. The mean age of the patients was 55 years and 38 of them (52%) were male. The mortality rate was comparable for solitary (17%) and multiple (23%) abscesses. The likelihood of death was higher with antibiotic treatment alone (45%) or percutaneous treatment (25%) than with surgical treatment (9.5%). The primary determinant of outcome, however, was the underlying disease, i.e., malignancy or an immunocompromised patient, rather than solitary versus multiple abscesses. In addition the incidence of hepatic abscess seen at this center has doubled from the first half to the second half of the review, reflecting a population of more severely ill patients. It is apparent that in current clinical practice several methods of management are effective, and the choice of therapy should be determined by individualized selection. The principle of timely diagnosis and prompt institution of treatment appropriate to the specific patient remains the standard of care in this potentially grave disease.     

Cutaneonephrobronchial fistula: an unusual presentation of an inadequately treated perinephric abscess

We report a case of cutaneonephrobronchial fistula secondary to an inadequately treated perinephric abscess associated with a staghorn calculus. The patient, a 72-year-old lady, was initially treated for a superficial flank abscess by incision and drainage. She returned 4 months later with a persistent discharging flank sinus, at which time the above complex pathology was diagnosed. We review similar cases in the literature and discuss pathophysiology and current management of perinephric abscesses.     

Contemporary management of amebic liver abscess.

In a retrospective review covering 16 years divided into two time periods, 133 patients with amebic liver abscess were evaluated. Most of the patients were young, Hispanic men, and one-third had coexistent disease. A reliable diagnosis can be established in 24 hours using ultrasound or computed tomography scans. Over the entire time period, antiparasitic therapy was evolved to occupy a primary role and surgery was reserved for management of abscess complications.     

Renal abscess in patients with HIV infection in the era of highly active antiretroviral therapy

Renal abscess is a very rare complication of HIV infection, usually occurs in patients with severe immune deficiency. The immune status is the main factor that predict disease advancement. Highly activate antiretroviral therapy (HAART) improve the CD4 cell count. We present a case of renal abscess for Aspergillus niger in a HIV+ patient who complained of right flank mass and fever. We review relevant literature and the management of these patients.     

Abscess of the brain (2nd report)--special reference to surgical indication of extracapsular excision of brain abscess (author's transl)]

Brain abscess persists as a serious diagnostic problem and critical therapeutic challenge since pre-antibiotic era. After antibiotic agents has been introduced, abscess of the brain seems to be a surgical curable intracranial suppurative disease, although surgical mortality and morbidity due to brain abscess are still distressingly high. Recently, the incidence of brain abscess are gradually increasing. In this present situation, it is necessary to reevaluate the previous method and surgical results of brain abscess. Even with new surgical techniques and antibiotics, the mortality rate and number of neurological deficits remain high, as previously methods, it is most important how to eliminate these problems. It was undertaken to determine the significant factors affecting the clinical management of patients with this serious problem. The general outlines of our neurosurgical treatment are given, with emphasis on our surgical schedule of brain abscess, especially brain abscess in congenital heart disease. In this paper, a review of the current status of the surgical methods, operative mortality and morbidity, diagnostic methods and the therapy of brain abscess has been discussed.     

Facial nerve palsy due to a parotid abscess: Two case reports and a review of literature

Introduction and importanceParotid gland swelling with facial nerve palsy is highly suggestive of a malignancy. Facial nerve palsy is however rarely caused by a parotid abscess. We hereby present two cases, propose treatment and present a review of the literature.Case presentation and clinical discussionOne 75-year-old female and one 81-year-old female presented with a facial nerve paralysis, both caused by a parotid gland abscess. Broad-spectrum antibiotics and incision and drainage was commenced in both cases. Both patients showed good clinical improvement, however, without facial nerve improvement. Magnetic resonance imaging (MRI) scans showed no malignancies at presentation nor during follow-up after one year.ConclusionFacial nerve palsy is rarely caused by a parotid abscess. Incision and drainage in combination with antibiotic treatment is recommended. Chances of facial nerve recovery seem somewhat higher in patients with facial nerve paresis than those with a paralysis.     

Pneumatosis intestinalis after laparoscopic appendectomy: case report and review of the literature

Pneumatosis intestinalis (PI) is the presence of intraluminal gas within the wall of the intestine. As a marker for bowel injury owing to mucosal injury, PI may herald a severe underlying disease process in patients without a significant medical history. In other cases, PI is a benign process, and expectant management is appropriate. Here, we present the first reported case of pneumatosis associated with postoperative abscess after appendectomy and its successful management. Then, we describe the pathophysiology of pneumatosis and review the literature regarding its origin and management.