ABSTRACT
A 25-year-old male without prior co-morbidities was admitted to hospital with Fusobacterium necrophorum bacteremia, where he was found to have liver and splenic abscesses. Further evaluation with echocardiography revealed a bicuspid aortic valve with severe insufficiency and a 1.68 x 0.86 cm vegetation. The patient required abscess drainage, intravenous antimicrobial therapy and aortic valve replacement. Complete resolution of the infection was achieved after valve replacement and a prolonged course of intravenous antimicrobial therapy. A brief analysis of the patient's clinical course and review of the literature is presented.
Homem de 25 anos de idade, sem antecedentes mórbidos foi admitido ao hospital com bacteremia por Fusobacterium necrophorum e abscessos no fígado e no baço. Avaliação posterior com ecografia revelou válvula aórtica bicúspide com insuficiência severa e vegetação de 1,68 x 0,86 cm. Foi feita drenagem dos abscessos, terapia antimicrobiana intravenosa e substituição da válvula aórtica. Resolução completa da infecção foi conseguida após substituição valvular e curso prolongado de terapêutica intravenosa antimicrobiana. É apresentada breve análise do curso clínico do paciente e revisão da literatura.
Subject(s)
Adult , Humans , Male , Abdominal Abscess/microbiology , Bacteremia/microbiology , Endocarditis, Bacterial/microbiology , Fusobacterium Infections/complications , Fusobacterium necrophorum/isolation & purification , Splenic Diseases/microbiology , Severity of Illness IndexABSTRACT
We report a 46-year-old woman, subjected to a laparoscopic sleeve gastrectomy, that had to be converted to open surgery due to the presence of adherences. She required an immediate new intervention due to a hemoperitoneum caused by a liver tear and venous bleeding from the splenic hilus. Both lesions were successfully repaired. In the postoperative period the patient had fever, leukocytosis and sialorrhea. A CAT scan showed a splenic infarction and a huge intra abdominal collection that communicated with the stomach. Streptococcus anginosus was isolated from the collection. The patient was managed with antimicrobials and percutaneous drainage with a favourable evolution and closure of the communication with the stomach.
Subject(s)
Female , Humans , Middle Aged , Abdominal Abscess/microbiology , Gastrectomy/adverse effects , Splenic Infarction/pathology , Streptococcal Infections/microbiology , Streptococcus anginosus/isolation & purification , Gangrene , Gastrectomy/methods , Obesity, Morbid/surgery , Risk FactorsABSTRACT
Renal abscesses are infrequent event and may occasionally be fatal. In order to characterize its main clinical features, its diagnosis and evolution, a retrospective-descriptive study was done with cases identified between 1996 and 2006 in a teaching hospital. Forty-four cases were collected (mean age 49.9 years). Diabetes mellitus was present in 38.6 percent, urinary calculi in 36.4 percent, and previous urinary tract infection in 11.4 percent of the studied population. Enterobacteriaceae were the most frequent isolated microorganisms (44.4 percent), and 33.3 percent had a poli-microbial culture in abscess samples. S. aureus was rarely identified. Main therapeutic approaches were minimally invasive procedures (pigtails, percutaneous drainage or nephrostomy) in 50 percent followed by surgical interventions (nephrectomy or surgical debridement) in ~30 percent. Only 20.5 percent of patients were treated exclusively by antibiotics. Minimally invasive procedures were applied progressively after 2001 (p < 0.005). In this series case-fatality rate was 4.5 percent; 13.6 percent (n = 6) developed septic shock. Nephrectomy was performed in 9 cases (20.5 percent). Patients selected for nephrostomy had a lower risk for ICU admission (Odds Ratio 0.083 IC95 0.008-0.911). Renal abscesses are cause of morbidity but had a low case-fatality ratio; the therapeutic approach has changed in recentyears favoring at present minimally invasive procedures.
Los abscesos renales son eventos infrecuentes pero potencialmente letales. Objetivo: Conocer sus características clínicas, diagnóstico y evolución. Metodología: Se efectuó un trabajo descriptivo-retrospectivo con los casos detectados entre 1996 y el 2006 en un centro universitario. Resultados: Se identificaron 44 pacientes (edad promedio 49,9 años) asociados en algunos casos a diabetes mellitus (38,6 por ciento), litiasis urinaria (36,4 por ciento) o infección urinaria previa (11,4 por ciento). Los microorganismos más frecuentes fueron Enterobacteriaceae (44,4 por ciento) y 33,3 por ciento> de los cultivos fueron polimicrobianos. Staphylococcus aureus se identificó infrecuentemente. La estrategia terapéutica principal fue el uso de técnicas mínimamente invasoras (pigtails, drenaje percutáneo o nefrostomía; 50 por ciento), y luego quirúrgicas (nefrectomía o aseos quirúrgicos; ~30 por ciento>). Sólo 20,5 por cientoo fue tratado exclusivamente con antimicrobianos. Los procedimientos mínimamente invasores se usaron en forma progresiva después del 2001 (p < 0,005). La letalidad en esta serie fue 4,5 por ciento> (n = 2) y 13,6 por ciento (n = 6) desarrolló shock séptico. La nefrectomía se aplicó en 9 casos (20,5 por ciento). Los pacientes seleccionados para nefrostomía tuvieron menos riesgo de ingresar a UCI (Odds Ratio 0,083 IC95 0,008-0,911). Conclusiones: Los abscesos renales son causa de morbilidad mayor aunque de baja letalidad. Su estrategia terapéutica ha ido cambiando en los últimos años a favor de procedimientos mínimamente invasores como los drenajes percutáneos y/o endoscópicos.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Young Adult , Abdominal Abscess , Kidney Diseases , Abdominal Abscess/diagnosis , Abdominal Abscess/microbiology , Abdominal Abscess/therapy , Kidney Diseases/diagnosis , Kidney Diseases/microbiology , Kidney Diseases/therapy , Retrospective Studies , Young AdultABSTRACT
Actinomycosis is an unusual, chronic granulomatous disease. Actinomyces israelli has been found to be related to infectious processes in those patients with affected skin integrity leading to abscess formation, fistulae or mass lesions. Actinomycosis mainly presents in three forms cervicofacial (50%), abdominal (20%) and thoracic (15%). Pelvic cases have been rarely reported and are usually associated with the use of intrauterine devices. We describe a case of a 23 y/o female without history of intrauterine device use, who was admitted with an ovarian cyst following an appendectomy. An ovarian abscess was drained. The pathology showed a granuloma and focal sulfur granules like particles compatible with Actinomyces. This is a case of pelvic Actinomyces, not related to the use of an intrauterine device
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Abdominal Abscess/diagnosis , Abscess/microbiology , Actinomycosis/diagnosis , Ovarian Cysts/complications , Postoperative Complications/diagnosis , Ovarian Diseases/microbiology , Appendectomy , Abdominal Abscess/etiology , Abdominal Abscess/microbiology , Abscess/drug therapy , Abscess/surgery , Actinomycosis/drug therapy , Actinomycosis/surgery , Actinomyces/isolation & purification , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Amoxicillin/administration & dosage , Amoxicillin/therapeutic use , Ovarian Cysts/diagnosis , Ovarian Cysts/microbiology , Diagnosis, Differential , Drainage , Ovarian Diseases/drug therapy , Ovarian Diseases/surgery , Intrauterine Devices , Penicillin G/administration & dosage , Penicillin G/therapeutic use , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
El absceso retroperitoneal (AR) es una infección infrecuente, con letalidad hasta 50 por ciento si no se efectúa su drenaje oportuno. En más del 80 por ciento de los casos el AR es secundario a un foco de origen digestivo, renal, vertebral o de la musculatura iliopsoas y de etiología bacteriana mixta. Hasta 14 por ciento de los AR son primarios, por no detectarse un foco de origen al completar el estudio. Con frecuencia se presenta como un cuadro febril sin causa evidente por lo que son indispensables técnicas radiológicas como el ultrasonido y la tomografía axial computarizada, tanto en el diagnóstico como para guiar el drenage percutáneo. En los últimos años éste ha llegado a ser tratamiento de elección, reemplazando a la cirugía en centros con experiencia en este procedimiento. Presentamos dos casos comentando las dificultades en su diagnóstico y tratamiento. En un caso elorigen fue la infección del apéndice de localización retrocecal y retroperitoneal, variante anatómica presente en no más de 3 por ciento de la población, por lo que el cuadro de apendicitis es atípico. El segundo caso fue catalogado como primario ya que el estudio de foco de origen fue negativo. Ambos recibieron terapia antimicro-biana y drenaje quirúrgico con recuperación plena
Subject(s)
Humans , Male , Middle Aged , Adult , Abdominal Abscess/microbiology , Retroperitoneal Space/microbiology , Abdominal Abscess/surgery , Appendicitis/complications , DrainageABSTRACT
Analiza que el absceso intraabdominal es una complicación frecuente tras una laparotomía. Es cada vez mayor el número de pacientes que son sometidos a laparotomías exploradoras, tanto de forma electiva como de urgencia. Realizamos en este artículo una revisión bibliográfica enfatizando sobre los aspectos generales, la microbiología, la fisiopatología, el diagnóstico y el tratamiento que diversos autores recomiendan. Los principios básicos de cirugía general son aplicados estrictamente en las complicaciones infecciosas intraabdominales de pacientes con cáncer.