Pseudotumor toraco-abdominal asociado a Bartonella henselae y Eikenella corrodens en un paciente pediátrico inmunocompetente / Thoraco-abdominal pseudotumor associated with Bartonella henselae and Eikenella corrodens in an immunocompetent patient

Resumen Los pseudotumores inflamatorios son poco frecuentes y escasamente descritos en la literatura y han sido asociados a infecciones polimicrobianas. Se presenta el caso de un niño de 9 años, procedente de Bolivia, quien consultó por dolor abdominal, baja de peso y vómitos, diagnosticándose un pseudotumor tóraco-abdominal. El laboratorio clínico, mediante el estudio de biología molecular en tejido, permitió la identificación de uno de los probables agentes etiológicos.

Abstract Inflammatory pseudotumors are a rare pathology and scarcely reported in the literature and have been associated with polymicrobial infections. Here, we present the case of a 9 years old boy from Bolivia, who presented with abdominal pain, weight loss and vomiting, who was diagnosed with a thoraco-abdominal pseudotumor. The micro-biology and molecular laboratories in tissue allowed the identification of one of the probable etiological agents.

Absceso cerebral por Eikenella corrodens en un paciente pediátrico inmunocompetente / Cerebral abscess due to Eikenella corrodens in an immunocompetent pediatric patient

Resumen Introducción: Los abscesos cerebrales son una urgencia neurológica grave con alto riesgo de déficit neurológico permanente. Son patologías raras en la edad pediátrica, con una incidencia anual de 0.5 por 100,000 niños. Se han realizado pocos estudios de abscesos cerebrales de origen odontogénico y la mayoría de los pacientes son adultos con patología dental de base. Eikenella corrodens es un cocobacilo gramnegativo anaerobio facultativo de crecimiento fastidioso, que forma parte de la biota de la cavidad oral, pero es un patógeno frecuente en infecciones de cabeza y cuello, así como en infecciones dentales. Caso clínico: Paciente de sexo masculino de 16 años, previamente sano, que presentó cefalea de 2 meses de evolución acompañada de náuseas y vómitos. Antecedente de extracción del cuarto molar superior derecho 4 meses antes, sin uso de profilaxis antibiótica. La resonancia magnética de cráneo mostró una lesión compatible con absceso cerebral. Se realizó drenaje por punción guiada por estereotaxia, del que se aisló E. corrodens. El paciente completó un tratamiento con ceftriaxona y metronidazol por vía intravenosa durante 4 semanas y ampicilina-sulbactam por vía oral por 2 semanas más. Conclusiones: Los abscesos cerebrales de origen odontogénico causados por E. corrodens en la edad pediátrica son muy raros. Actualmente, el uso de antibióticos profilácticos en procedimientos dentales es controversial, ya que se ha documentado el aumento de la resistencia microbiana por su uso indiscriminado. La optimización de los estudios diagnósticos y el tratamiento multidisciplinario han mejorado el pronóstico de los pacientes con absceso cerebral.

Abstract Background: Brain abscesses are a serious neurological emergency with a high risk of permanent neurological deficit. The pathology is a rare in the pediatric age: the annual incidence is 0.5 per 100,000 children. There are a few studies of brain abscesses of oral origin mostly in adult patients with an underlying dental pathology. Eikenella corrodens, a slow-growing, Gram negative, facultatively anaerobic rod-bacillus, is part of the oral cavity biota, and common as a pathogen in head, neck, and dental infections. Case report: A previously healthy 16-year-old male presented a headache of 2 months of evolution accompanied by nausea and vomiting. Four months earlier, the fourth upper right molar was extracted, with no antibiotic prophylactic treatment. Magnetic resonance imaging of the skull showed a lesion compatible with brain abscess. Stereotaxy-guided puncture drainage was performed, isolating E. corrodens. The treatment was with ceftriaxone and metronidazole intravenously for four weeks and ampicillin sulbactam orally for two more weeks. Conclusions: Brain abscesses of odontogenic origin by E. corrodens in the pediatric age are very rare. Currently, the use of prophylactic antibiotics in dental procedures is controversial because the indiscriminate use increases antimicrobial resistance. The optimization of diagnostic studies and multidisciplinary treatment has improved the prognosis of patients with brain abscesses.

Compromiso del sistema nervioso central por Eikenella corrodens: revisión de la literatura médica a propósito de un caso clínico / Commitment of the central nervous system by Eikenella corrodens: literature review about a clinical case

Resumen Se presenta el caso de un paciente de 22 años sin antecedentes mórbidos que desarrolló un absceso cerebral secundario a una endocarditis por Eikenella corrodens. El diagnóstico se estableció mediante la detección por reacción de polimerasa en cadena universal en el líquido de la colección cerebral. La ecocardiografía transesofágica confirmó vegetaciones en la válvula mitral. Requirió la colocación de una derivación ventricular externa por vaciamiento del absceso a ventrículos cerebrales e hidrocefalia secundaria. Recibió 80 días de tratamiento antibacteriano efectivo. Su evolución fue favorable, con resolución completa de la infección verificada con imágenes y ecocardiografía de control. El seguimiento a los siete meses por una disfunción de válvula de drenaje ventrículo-peritoneal no demostró infección.

Abstract We present the case of a 22-year-old patient with no morbid history who developed a brain abscess secondary to endocarditis due to Eikenella corrodens. The diagnosis was established by detecting the microorganism by universal polymerase chain reaction in fluid from the brain collection. Trans-esophageal echocardiogram study confirmed vegetations in the mitral valve. External ventricular shunt placement was required due to emptying of abscess to brain ventricles and secondary hydrocephalus. He received 80 days of effective antibiotic treatment and his evolution was favorable with complete resolution of his infection verified with images and echocardiogram. Follow-up at seven months later due to ventricule-peritoneal drainage valve dysfunction did not confirmed infection.

Acute spontaneous suppurative thyroiditis caused by Eikenella corrodens presented with thyrotoxicosis / Tireoidite supurativa espontânea aguda causada por Eikenella corrodens acompanhada de tireotoxicose

ABSTRACT Acute suppurative thyroiditis is a very rare and life-threatening endocrine emergency. Thyrotoxicosis is a rare condition accompanying acute suppurative thyroiditis. While the majority of the cases in the literature are caused by different reasons, spontaneous development is very rare. We present a patient with acute suppurative thyroiditis who presented to our clinic with thyrotoxic findings, and we compared the case to the literature. A 31-year-old male patient was admitted to our clinic with a complaint of progressive neck pain, swelling and redness on midline neck, fever, and palpitations. On physical examination, swelling, redness and tenderness were detected on the neck region that was consistent with the thyroid location. He presented with tremor on the hands, tachycardia and agitation. Thyroid function tests were compatible with thyrotoxicosis, but there were findings supporting the presence of infection in biochemistry tests. On his radiological evaluations, a heterogeneous lesion divided with small septs was observed, with consolidation areas in the left thyroid lobe. In fine needle aspiration biopsy, 2mL of purulent fluid could be aspirated due to the presence of small, separated consolidation areas. He initiated on antibiotic therapy, propranolol, steroid and symptomatic treatment. Eikenella corrodens was detected on the culture antibiogram. Antibiotic therapy was continued for 14 days due to less symptoms and better biochemical values. After treatment, the patient had normal thyroid function, had relief of fever and redness of the neck, and was followed-up. It should be kept in mind that acute suppurative thyroiditis may develop spontaneously with the findings of thyrotoxicosis, with no risk factors.

RESUMO A tireoidite supurativa aguda é uma emergência endócrina muito rara e com risco de vida. A tireotoxicose é uma doença rara, que acompanha a tireoidite supurativa aguda. A maioria dos casos descritos na literatura tem diferentes causas, mas o desenvolvimento espontâneo é muito raro. Relatamos o caso de um paciente com tireoidite supurativa aguda, que veio a nossa clínica apresentando achados tireotóxicos, e o comparamos com a literatura. Trata-se de paciente do sexo masculino, 31 anos, que foi internado em nossa clínica com queixa de dor progressiva, edema e vermelhidão na linha média do pescoço, febre e palpitações. Ao exame físico, foram observados edema, vermelhidão e sensibilidade à dor na região do pescoço, consistente com a localização da tireoide. Apresentava tremor de mãos, taquicardia e agitação. Embora os exames de função tireoidiana fossem compatíveis com tireotoxicose, houve achados que sustentavam a presença de infecção nos exames bioquímicos. Nas avaliações radiológicas, observou-se lesão heterogênea dividida por pequenos septos, com áreas de consolidação no lobo tireoidiano esquerdo. Na biópsia por aspiração por agulha fina, foi possível aspirar apenas 2mL de líquido purulento, devido à presença de pequenas áreas de consolidação separadas umas das outras. Iniciaram-se antibioticoterapia, administração de propranolol e esteroides, além de tratamento sintomático. Eikenella corrodens cresceu na cultura do antibiograma. A antibioticoterapia foi estendida por 14 dias devido à melhora nos sintomas e dos valores bioquímicos. Após o tratamento, o paciente se apresentava eutireoideo, com melhora na febre e na vermelhidão no pescoço, sendo então acompanhado. Deve-se ter em mente que a tireoidite supurativa aguda pode se desenvolver espontaneamente com achados de tireotoxicose, sem nenhum fator de risco.

Epidural Abscess Caused by Eikenella corrodens in a Previously Healthy Child

Eikenella corrodens rarely causes invasive head and neck infections in immunocompetent children. We report a case of epidural abscess caused by E. corrodens in a previously healthy 13-year-old boy who presented with fever, headache, and vomiting. On physical examination upon admission, there was no neck stiffness, but discharge from the right ear was observed. Brain magnetic resonance imaging (MRI) revealed approximately 4.5-cm-sized epidural empyema on the right temporal lobe as well as bilateral ethmoid and sphenoid sinusitis, right mastoiditis, and right otitis media. During treatment with vancomycin and cefotaxime, purulent ear discharge aggravated, and on follow-up brain MRI, the empyema size increased to 5.6×3.4 cm with interval development of an abscess at the right sphenoid sinus. Burr hole trephination was performed, and foul-smelling pus was aspirated from the epidural abscess near the right temporal lobe. Pus culture yielded E. corrodens. Endoscopic sphenoidotomy was also performed with massive pus drainage, and the same organism was grown. The patient was treated with intravenous cefotaxime for 3 weeks and recovered well with no other complications. Therefore, E. corrodens can cause serious complications in children with untreated sinusitis.

Eikenella Corrodens Cervical Spinal Epidural Abscess Induced by a Fish Bone

Cervical spinal epidural abscess, caused by fish bone injury and a secondary infection by Eikenella corrodens which is part of the normal flora, has not been reported. A 72-yr-old man came to the hospital with pain in his posterior neck and both shoulders for 2 months. He also was experiencing weakness on his right side for 3 days. A fish bone had been stuck in his throat for about 2 months. Neurological examination revealed right hemiparesis, hypesthesia on the left extremities and neck stiffness. Laboratory findings showed an elevated ESR/CRP and leukocytosis, and magnetic resonance imaging revealed a retropharyngeal abscess and cervical myelitis. The patient was treated with emergency surgical decompression and antibiotics. A fish bone was removed from the C3-C4 intervertebral disc space. In the culture of chocolate blood agar and 5% sheep blood agar plate, E. corrodens was detected as a causative organism.

Eikenella corrodens: patogénesis y aspectos clínicos: [revisión] / Eikenella corrodens: pathogenesis and clinic aspects: [review]

El ambiente microbiológico oral es único y tiene una dinámica compleja. Se calcula que cerca de 500 especies de bacterias habitan la cavidad oral humana, y alrededor de 22 géneros son los predominantes. Las bacterias que se aíslan con más frecuencia de los sitios infectados de la cavidad oral, y que son también patógenos potenciales, forma un grupo pequeño de microorganismos gramnegativos, entre los que se incluyen los siguientes: Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Campylobacter spp., Capnocytophoga spp., Eikenella corrodens, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia y el grupo-Streptococcus milleri. E. corrodens se reconoce como un microbio patógeno oportunista en la cavidad oral; también, puede causar infecciones extra orales, como un agente infeccioso solo o en combinaciones con diversas bacterias. La presente revisión, con un énfasis en E. corrodens, mostrará varios aspectos de sus características microbiológicas y bioquímicas, también se sistematizan y discuten el conocimiento actual sobre los mecanismos de patogénesis, como los lipopolisacáridos, proteínas externas de membrana, complejo de adesina, pili y otros; infecciones oral y extra oral; factores predisponentes; endocarditis; osteomielitis, infecciones intra-abdominales; diagnóstico y agentes antimicrobianos.

The oral microbiological environment is unique and has a complex dynamic. It has been estimated that about 500 species of bacteria inhabit the human oral cavity and about 22 genera of them are the most dominant. The most frequently isolated from infected pockets of the oral cavity bacteria which are also potential pathogens form a small group of gramnegative microorganisms among which are included the following: Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Campylobacter spp., Capnocytophoga spp., Eikenella corrodens, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, and Streptococcus milleri-group. E. corrodens is distinguished for being an opportunistic oral pathogen. It can also produce extra-oral infections acting either as an infectious agent itself or together with other bacteria. Referring to E. corrodens the present review will not only demonstrate different aspects about microbiological and biochemical characteristics, but also the actual knowledge on pathogenesis mechanism, like polysaccharides, outer membrane protein, lectin-like adhesin complex, pili, and other mechanisms will be systematized and discussed. Oral and extra-oral infections and other risking factors like endocarditis; osteomyelitis, intra-abdominal infections, their diagnosis and antimicrobial agents will be also considered in this paper.

A Case of Liver Abscess due to Eikenella corrodens Caused by Human Bites / 감염과화학요법

Eikenella corrodens is a slow growing, facultatively anaerobic gram-negative rod that is part of the normal flora of the oral cavity and upper respiratory tracts. In most patients with E. corrodens infections, host defenses are compromised due to surgery, or chronic debilitating illness such as malignancies, or immunosuppressive therapy. This organism causes abscesses and infections that are at times fatal. We experienced a case of E. corrodens isolated from liver abscess in an immunocompetent patient. A 50-year-old man who is a dentist, was hospitalized because of fever and myalgia of 10 days' duration. Abdominal ultrasonography showed non-septated, 3.8x4.6 cm sized abscess in the segment 6/7 of the liver. E. corrodens was isolated from aspiration of liver abscess. This organism was presumably acquired from his patient's oral cavity during dental procedure. We hope that increased awareness to E. corrodens will raise the index of suspicion, and contribute to optimal management of these infections, minimizing the significant morbidity associated with this organism.

A Case of Liver Abscess due to Eikenella corrodens Caused by Human Bites / 감염과화학요법

Eikenella corrodens is a slow growing, facultatively anaerobic gram-negative rod that is part of the normal flora of the oral cavity and upper respiratory tracts. In most patients with E. corrodens infections, host defenses are compromised due to surgery, or chronic debilitating illness such as malignancies, or immunosuppressive therapy. This organism causes abscesses and infections that are at times fatal. We experienced a case of E. corrodens isolated from liver abscess in an immunocompetent patient. A 50-year-old man who is a dentist, was hospitalized because of fever and myalgia of 10 days' duration. Abdominal ultrasonography showed non-septated, 3.8x4.6 cm sized abscess in the segment 6/7 of the liver. E. corrodens was isolated from aspiration of liver abscess. This organism was presumably acquired from his patient's oral cavity during dental procedure. We hope that increased awareness to E. corrodens will raise the index of suspicion, and contribute to optimal management of these infections, minimizing the significant morbidity associated with this organism.