Subject(s)
Anti-Bacterial Agents/administration & dosage , Boutonneuse Fever/diagnosis , Doxycycline/administration & dosage , Rickettsia conorii/growth & development , Adult , Animals , Anti-Bacterial Agents/therapeutic use , Antibodies, Bacterial/analysis , Arachnid Vectors/microbiology , Boutonneuse Fever/blood , Boutonneuse Fever/drug therapy , Boutonneuse Fever/epidemiology , Boutonneuse Fever/physiopathology , Boutonneuse Fever/transmission , Dogs/microbiology , Doxycycline/therapeutic use , Fever/blood , Fever/drug therapy , Fever/physiopathology , Humans , Immunoglobulin M/analysis , Male , Mediterranean Region , Middle Aged , Multilocus Sequence Typing , Polymerase Chain Reaction , Rickettsia conorii/drug effects , Rickettsia conorii/pathogenicity , Ticks/microbiology , TunisiaABSTRACT
Acute emphysematous pyelonephritis (AEP) is a severe form of urinary tract infection. It occurs usually in diabetics. The most concerned agents are the Gram-negative bacilli. We report a first case of bilateral AEP due to Candida glabrata, occurred in a 64-year-old diabetic woman. The clinical presentation started with fever and abdominal pains, without signs of urinary tract infection. Within six hours, the patient had developed a septic shock with renal failure and ketoacidosis. The diagnosis was confirmed by CT scan and the pathogen was isolated in urine. Despite antibiotic and antifungal treatment, she died from a septic shock. Acute emphysematous pyelonephritis due to Candida species is rare. However, the addition of antifungal therapy seems justified if a severe emphysematous pyelonephritis is associated with risk factors of Candida infection.
Subject(s)
Candida glabrata , Candidiasis/complications , Emphysema/microbiology , Pyelonephritis/microbiology , Fatal Outcome , Female , Humans , Middle Aged , Shock, Septic/microbiologyABSTRACT
OBJECTIVE: Our aim is to report the clinical aspects, the etiologies, the treatment and the evolution of the psoas abscess in the adult. METHODS: Our retrospective study concerns 38 cases of psoas abscesses collected in the Department of Infectious Diseases of Sfax (Tunisia), over a period of 16 years (January 1990 - December 2005). RESULTS: The average age is 44 years (extremes: 16-76 years). The sex-ratio is 1.4. Six patients were diabetics and one had a chronic renal injury at the stage of hemodialysis. The clinical manifestations were: a fever (76.4%), an abdomino-pelvic ache (84.2%) and a psoitis (34.2%). All patients had a biologic inflammatory syndrome with a hyperleucocytosis in 28 cases. The abscess was one-sided in 29 cases and bilateral in 9 cases. After microbiological study and/or histological study, pathogens were identified in 31 patients, they were Staphylococcus aureus (10 cases), Staphylococcus lugdunensis (1 case), Streptococci (3 cases), Escherichia coli (2 cases), Bacteroides fragilis (1 case), Actinomyces (2 cases), Brucella (3 cases), Mycobacterium tuberculosis (8 cases) and Candida glabrata (1 case). The psoas abscess was primary in 10 cases and secondary in 28 cases. All the patients received an antibiotherapy or an antifungal therapy adapted to the micro-organism in cause, with a drainage of the abscess in 25 cases (surgical in 9 cases and percutaneous in 16 cases). The evolution was favourable in 36 cases. One patient presented recurrences and one patient died. CONCLUSION: The psoas abscess of the adult is characterized by a polymorphe clinical presentation. Germs in cause are very variable.
