Liver abscess in children

Liver abscesses are frequently observed in pediatric clinical practice in tropics and subtropics especially in developing countries. Children have unique set of predisposing factors which have been highlighted. Expected microbiology and setting for unusual organisms are mentioned. Clinical presentations’, including importance of location and number of abscesses has been discussed. Role of each modality of treatment clarified. Importance and limitations of investigations and imaging explained, and complications and mortality discussed.     

Extra-intestinal infections caused by Clostridium difficile

The objective of this paper was to investigate the incidence of extra-intestinal infections caused by Clostridium difficile. During a 10-year period, the microbiology laboratory of our institution isolated 2034 isolates of C. difficile . Of the 2034 isolates, 21 (1.08%) were obtained from extra-intestinal sources. This represents an incidence of extra-intestinal isolation of four cases per 100 000 admissions. We were able to review the records of 17 patients for our study. The isolates in 12 patients were obtained from structures or fluids anatomically close to the colon and included the following infections: peritonitis in five cases (three primary and two secondary), intra-abdominal abscesses in three patients and abdominal wound infections in four cases. The infections in the other five patients were not in the anatomic vicinity of the colon. They included one case with a brain abscess, two episodes of bacteremia and two cases of foot infections (one chronic osteomyelitis). In all but one case, C. difficile isolation was obtained as part of a polymicrobial flora. The isolates were frequently non-toxigenic and the extra-intestinal infections occurred without concomitant diarrhea or prior anti-microbial therapy. Out of the 17 patients, eight died and nine survived. Death could not be directly attributed to C. difficile in any of the cases. The isolation of C. difficile outside the intestinal tract is very uncommon. Its clinical significance should be interpreted with caution.     

立体定向穿刺冲洗术治疗多发性脑脓肿的护理

目的:总结17例立体定向穿刺冲洗术治疗多发性脑脓肿的临床护理经验.方法:分析立体定向穿刺冲洗术治疗多发性脑脓肿的护理问题和措施.结果:17例手术均获得成功,其中合并肺部感染5例、先天性心脏病2例、梗阻性脑积水5例,所有患者均痊愈出院.结论:对此类手术患者实施细致而有效的围手术期护理,可以及时观察病情变化,避免护理并发症的发生,减轻患者心理负担,保证手术的效果.     

Identification of herpesviruses types 1 to 8 and human papillomavirus in acute apical abscesses

Introduction

It has been suggested that viruses, especially herpesviruses, can play a role in the pathogenesis of marginal and apical periodontitis. This study aimed to detect herpesviruses types 1 to 8, namely herpes simplex virus (HSV-1/2), varicella zoster virus (VZV), Epstein-Barr virus (EBV), human cytomegalovirus (HCMV), human herpesvirus-6 (HHV-6), human herpesvirus-7 (HHV-7), and human herpesvirus-8 (HHV-8) as well as human papillomavirus (HPV) in acute apical abscesses.

Methods

Twenty-four samples were taken by aspiration of the purulent exudate from acute apical abscesses. DNA extracted from clinical samples served as a template in single or nested polymerase chain reaction (PCR) assays for the detection of the target viruses.

Results

Control PCR reactions with β-globin gene primers revealed that all samples but one had detectable human DNA. Of the 23 abscess samples positive for the β-globin gene, 14 (61%) were positive for at least one of the target human viruses. Thirteen (56.5%) cases had herpesvirus: HHV-8 occurred in 11 (48%), VZV and HHV-6B in two (9%), and HHV-7 and HSV-1/2 in one (4%). EBV and HCMV were not present in any of the examined samples. HPV was detected in three (13%) abscess samples. Viral coinfection was found in five cases, with one case harboring three of the targeted viruses.

Conclusion

A large number of abscess samples were positive for at least one target virus. Unexpectedly, HHV-8 was for the first time detected and in a high prevalence. Papillomavirus and other herpesviruses were also found for the first time in endodontic abscesses. Although these findings suggest an association, the specific role of viruses in the pathogenesis of acute apical abscesses awaits further clarification.     

An unusual complication of CSOM — Lateral sinus thrombosis with lung abscess: A clinicoradiological study

Aims

To present a case report of a child presenting with lateral sinus thrombosis with bilateral multiple lung abscesses as a rare consequence of CSOM with an emphasis on the radiological findings.

Material and methods

An 11-year-old male child with a history of pyrexia of unknown origin, right-sided torticollis, cough with expectoration and right ear discharge was referred to us from department of paediatric medicine. Chest examination revealed dull areas on percussion and areas with bronchial breath sounds on auscultation bilaterally. Otological examination revealed right attic retraction pocket filled with cholesteatoma, post-auricular tenderness and Greisinger’s sign along with foul smelling muco-purulent discharge.

Results

Routine blood investigations revealed normocytic normochromic anaemia, polymorpho-nuclear leucocytosis and raised ESR. Audiological investigations showed a right-sided mixed hearing loss. Digital radiography of chest showed multiple thin walled cavities involving all of the lung zones bilaterally. USG (Ultrasonography) of neck showed thrombosis of right internal jugular vein. CT scanning of head, neck and thorax showed soft tissue collection within the right mastoid with erosion of posterior wall & presence of gas bubble in the right sigmoid sinus and thrombosis of right internal jugular vein and multiple abscess cavities occupying both lung parenchyma. The patient was initially managed with conservative antibiotic therapy for lung abscess followed by radical mastoidectomy and thromboembolectomy from the lateral sinus.

Conclusion

Otogenic lung abscess though rare in this present postantibiotic era, it can occur in underprivileged and poor population like our country.     

Pyoderma gangrenosum with spleen involvement and monoclonal IgA gammopathy

A 46-year-old man with a 3-year history of pyoderma gangrenosum was admitted with ulceration (6 x 5 cm), on the right leg. Previously he had been treated with tapering doses of prednisone (maximum dose 1 mg/kg per day); however, he had had a few exacerbations following each taper of prednisone dose. Immunoelectrophoresis demonstrated monoclonal IgA gammopathy of lambda light chains. Abdominal echography and abdominal computed tomographic scan revealed multiple splenic abscesses. Treatment was started with oral prednisone (1 mg/kg per day) and cyclosporin (5 mg/kg per day) and 6 weeks later complete remission was achieved. Systemic involvement in pyoderma gangrenosum is very rare, and according to our knowledge there are only a few cases with spleen involvement.     

肾周围脓肿49例诊断分析

我院1954年至1996年共收治肾周围脓肿病人49例,误诊14例,占28％。其原因与肾周围的特殊解剖位置、症状不典型,致病菌的改变有关。结合文献提出对早期诊断看法。     

Pulmonary Actinomycosis Imitating Lung Cancer on 18F-FDG PET/CT: A Case Report and Literature Review

Here we report a case of 41-year-old man with a soft tissue density mass at right upper lung and palpable abscesses at right upper backside and right wrist. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography demonstrated a 7.8 × 5.0 cm mass with soft-tissue density in the upper lobe of the right lung with high metabolic activity. The infiltrative mass extended to adjacent chest wall soft tissue. Final diagnosis of pulmonary actinomycosis with multiple abscesses was made. The patient responded well to antibiotics treatment.     

Er∶YAG激光治疗急性牙周脓肿的短期疗效观察

目的：评价Er∶YAG激光治疗急性牙周脓肿的效果.方法：72个病人随机分成两组,实验组使用Er∶YAG激光治疗,对照组常规引流后使用0.9％生理盐水冲洗.比较2组受试者的疼痛指数变化、有效率.结果：激光治疗组疼痛指数、总有效率均好于对照组（P＜0.01）.结论：Er∶YAG治疗急性牙周脓肿优于常规切开引流.