Proteus mirabilis harboring carbapenemase NDM-5 and ESBL VEB-6 detected in Austria.

We describe a case of carbapenemase-harboring Proteus mirabilis together with detection of NDM-5 in Austria accompanied by other bacterial strains with a wide range of beta-lactamases including OXA-181 and VEB-6. Isolates were obtained from a subphrenic abscess from one patient who was previously treated with broad-spectrum antibiotics in Bangladesh.

Absceso transdiafragmático por Citrobacter freundii como complicación tardía de colecistectomía laparoscópica / No disponible

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Retroperitoneal abscess with retained gall-stones as a late complication of laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is the golden standard, considering treatment of cholelithiasis. During the laparoscopic procedure one may often observe damage to the gall-bladder wall, as well as presence of gall-stones in the peritoneal cavity, as compared to classical surgery. These gall-stones may be associated with the occurrence of various complications following surgery. The study presented a rare case of a retroperitoneal abscess, as a consequence of retained gall-stones, in a female patient who was subject to laparoscopic cholecystectomy two years earlier.

[Aspergillus peritonitis--a case report]. / Aspergillus peritonitis esete.

The incidence of fungal infections such as Aspergillosis is increasing among immunocompromised patients. Demand for diagnosis of mycotic diseases is steadily raising among clinicians and treatment of these patients represents a continually growing challenge. The authors present a case of a 53-year-old male patient with Aspergillus peritonitis. This case deserves attention because its extreme rarity in the medical literature and complex therapy of coinfections during the hospital stay which was difficult and relatively expensive. The importance of consultation and microbiological sampling is emphasized.

Subphrenic abscess secondary to Actinomycosis meyeri and Klebsiella ozaenae following laparoscopic cholecystectomy.

A case is reported of a subphrenic abscess 12 months post-laparoscopic cholecystectomy in a 72-year-old male with identification of Actinomyces meyeri and the oropharyngeal commensal Klebsiella ozaenae. The first organism is exceptionally rare following laparoscopic cholecystectomy and is presumed to be a result of inadvertent gallstone spillage. The second organism has not previously been reported in a subphrenic abscess. The etiopathogenesis and management of this condition are presented.

[Fungal liver abscesses in a patient with primary sclerosing cholangitis and Crohn's disease]. / Abscesos hepáticos fúngicos en un paciente con colangitis esclerosante primaria y enfermedad de Crohn.

Liver abscesses are a relatively infrequent complication of inflammatory bowel disease. These abscesses are usually multiple and of polymicrobial origin. The development of primary sclerosing cholangitis in inflammatory bowel disease, although provoking alterations in biliary morphology and a higher incidence of infections, does not predispose patients to the development of liver abscesses. We describe a new case of primary sclerosing cholangitis and Crohn's disease with multiple fungal liver abscesses caused by Candida albicans. The patient had developed a duodenal-biliary fistula. Antibiotic therapy produced clinical response and surgery was performed to repair the fistula.

Subphrenic abscess after cesarean section in term pregnancy complicated by chorioamnionitis.

BACKGROUND: Subphrenic abscess is rare after cesarean section. METHODS: Case report and review of the pertinent world literature CASE REPORT: A 22 year-old primigravida underwent a lower-segment cesarean section in the setting of chorioamnionitis, and had a good postoperative recovery initially. Eleven days after surgery, dyspnea and fever prompted a computed tomography scan, which revealed a large subphrenic abscess. The abscess resolved with percutaneous drainage and intravenous antibiotics. A placental swab, baby's skin swab, and abscess aspirate all grew group B Streptococcus. CONCLUSION: Although subphrenic abscess is rare in obstetric practice, it should be suspected in patients who remain unwell after chorioamnionitis.

Retroperitoneal abscess: an uncommon localization of tubercular infection.

We describe a rare case of a 29-year-old immunocompetent Nigerian male affected by an abdominal abscess due to Mycobacterium tuberculosis infection. Diagnosis was achieved with cultures from surgical drainage. No pulmonary, renal, or gastrointestinal involvement was identified. The patient was successfully treated with standard four-drug antitubercular therapy.

Perihepatitis and perinephric abscess due to Mycoplasma hominis in a kidney transplant patient.

Mycoplasma hominis has been incriminated in several genital and extragenital infections. Here, we report the first case of perihepatitis associated with a perinephric abscess in a woman who had received a kidney transplant. Four months after the transplant, the patient was admitted for perirenal allograft pain, fever, and elevated inflammatory parameters and liver enzyme levels. A renal ultrasonography found a collection of fluid. Results of blood and urine analyses were within normal limits. Fluid aspiration of the peritoneal cavity was performed, and the results of cultures for bacteria and fungi were negative. The patient was treated by surgical lavage of the peritoneal cavity. Her fever resolved 5 days later. Two months after surgical lavage of the peritoneal cavity, her liver enzyme levels returned to the normal range. Three months after surgical lavage, cultures of the perinephric fluid showed Mycoplasma hominis. We conclude that in patients who present with perinephric fluid suspected of being infected, bacteriologic analysis of the fluid (from surgical lavage of the peritoneal cavity) should be performed. Antibiotics active against intracellular bacteria should be administered.

Delayed recurrence of postoperative intra-abdominal abscess: an unusual case and review of the literature.

BACKGROUND: Although intra-abdominal abscess is one of the major complications of abdominal surgery, the literature documents only a few cases of recurrence after a long asymptomatic period. METHODS: Case report and literature review. RESULTS: A 66-year-old woman developed a primary subphrenic abscess secondary to anastomotic leakage after total gastrectomy. Percutaneous drainage succeeded in evacuating the abscess cavity, and broad-spectrum antibiotics apparently eradicated the infection. However, a recurrent subphrenic abscess appeared eight years later with no intervening signs or symptoms. CONCLUSIONS: The unexpected outcome in this case may call into question the appropriate follow-up period after treatment for subphrenic abscess. Our experience indicates that clinicians should be aware of the possibility of rare delayed recurrence of intra-abdominal abscess.

[African histoplasmosis (Histoplasma capsulatum var. duboisii): a case report from Mali]. / Histoplasmose africaine à Histoplasma capsulatum var. duboisii. A propos d'un cas au Mali.

We report a case of disseminated African histoplasmosis with lymph node and digestive involvement in a 19-year-old man living in the Kayes district of Mali. The patient, HIV-seronegative and not otherwise immunocompromised, presented voluminous cervical and axillary adenopathies as well as retrosternal and mesenteric tumor lesions. Direct examination of biopsy tissue showed numerous specimens of Histoplasma capsulatum var. duboisii. Because direct fungal techniques are the easiest and the most effective method of diagnostic investigation, no cultures were performed. Intolerance to therapy with amphotericin b and ketoconazole led its rapid replacement by surgical treatment: partial excision of the abdominal lesions led to partial remission of the symptoms.

[Anaerobic deep abscesses with unusual location: report of 5 cases]. / Abcès profonds à germes anaérobies de localisation inhabituelle: à propos de cinq cas.

OBJECTIVE: Anaerobic deep abscesses are rare and may have unusual location leading to severe outcome due to delayed diagnosis and treatment. In order to improve their diagnosis, we report and analyse 5 new cases. METHODS: Patients were seen from 1999 to 2003 in a single department of internal medicine of the university hospital of Marseille. RESULTS: Five new cases were diagnosed consisting in 3 females and 2 males with a medium age of 56,8 years, with unusual location in 4 cases: epidural (2), psoas (1) and sub-diaphragmatic (1) or circumstances in one case of pulmonary abscess unrelated to inhalation. Predisposing conditions thought to compromise resistance to infection were found in all cases: social poverty (4/5), alcoholism (3/5), smoking (4/5), teeth and periodontal disease (4/5), neoplasia (2/5), iatrogenic disease (2/5). Symptoms were insidious (5/5) and unspecific but were always related to the abscess location. Abscesses were frequently found distant from the initial focus of infection because of frequent hematogenous spread (4/5). Drainage of the collection led to bacterial identification in all cases (4/4), although blood cultures could be positive (3/5) and helpful in one case in which drainage was not possible (1/5). The isolated organisms always corresponded to the suspected initial focus (oropharynx 4/5 and digestive 1/5). Finally, combination of surgical drainage and double prolonged antibiotherapy (penicillin+metronidazole) was the elected treatment. CONCLUSION: Since hematogenous diffusion is frequent, anaerobic infection should be suspected in any case of deep abscess affecting patients with predisposing conditions such as poverty, severe teeth disease or iatrogenic procedure.

Absceso subfrénico izquierdo primario por Streptococcus intermedius / Primary left subphrenic abscess due to Streptococcus intermedius

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Severe Fusobacteria infections (Lemierre syndrome) in two boys.

UNLABELLED: Abscess formation is a rare cause of febrile illness in childhood but always has to be considered in such clinical presentations. Belonging to the resident flora of the oropharyngeal region, Fusobacteria are known to cause local infections; from here they may extend to other sites via the bloodstream or are aspirated into the lung (Lemierre disease). We report on two boys with Lemierre disease due to infection by Fusobacteria in monoculture causing two different clinical phenotypes. Case 1 presented with a large subphrenic abscess and pneumonic infiltration of the right middle lobe. Primary focus of infection was periodontal disease. Case 2 presented with a life-threatening septicaemia due to a retropharyngeal abscess and perforated otitis media followed by osteomyelitis of the atlas and thrombosis of the left sigmoid sinus and internal jugular vein. CONCLUSION: Fusobacteria should be considered in any abscess formation in children. A thorough examination of the oropharyngeal region as a possible site of primary manifestation is mandatory.

[Abdomino-pelvic actinomycosis: a case report]. / Actinomycose abdomino-pelvienne: à propos d'un cas.

The actinomycosis is a chronic suppurative granulomatosis disease. It is owed to a bacillus gram positive; actinomycès israelli. The cervical and thoracic localizations are most frequent. The digestive localization represents 20% of cases. It interest very rarely the pelvis and the genital tracts. We bring back the observation of a patient old of 30 years admitted for mass abdominal. To the exam, the patient had a sensibility of the left hypochondriac area and we found a mass of 6 cm of diameter. To the rectal touch, we found a mass in the bag of Douglas. The echography and the computed tomography revealed a collection under the spleen and a pelvic collection. A rectotomy is performed. The bacteriological study isolates actinomycès israelli. The collection under the spleen is drained under radiological control. Actinomycès israelli is also recovered in the pus brought back by the puncture. The patient is treated by Penicillin. The patient had a favourable evolution. No etiology is found at this patient. For this observation, the collection was accessible to a drainage permitting the diagnosis and the treatment of the actinomycosis while avoiding a mutilated surgery.

Microbiology of subphrenic abscesses: a 14-year experience.

The objective of the review was to study the aerobic and anaerobic microbiology of subphrenic abscesses in relation with predisposing conditions. A retrospective review of clinical and laboratory data of 52 patients treated between 1974 and 1988 was conducted. Forty-three (83%) patients developed the abscesses after an operative procedure. These included 11 patients after colonic, 9 patients after gastric or duodenal, 7 patients after abdominal trauma, 7 patients after biliary, and 6 patients after appendix surgery. A total of 194 organisms (3.7 isolates/specimen), 83 aerobic (1.6/specimen), and 111 anaerobes (2.1/specimen) were recovered. Aerobic bacteria only were recovered in 7 (13%) abscesses, anaerobic bacteria only in 11 (21%), and mixed aerobic and anaerobic bacteria in 34 (65%). Polymicrobial infection was present in 47 (90%). The predominant aerobic isolates were Escherichia coli (28 isolates), Enterococcus group D(9), and Staphylococcus aureus (9). The predominant anaerobes were Peptostreptococcus species (33 isolates), Bacteroides fragilis group (25), Clostridium species (13), and Prevotella species (6). The number of isolates/site varied. The number of anaerobic bacteria/site outnumbered or was equal to the number of aerobic or facultatives in all instances, except in abscesses after biliary surgery. Their number/site was especially high in abscesses after appendectomy, and the number of aerobic and anaerobic bacteria was the lowest after gastric or duodenal surgery. S. aureus predominated after gastric, duodenal and posttrauma surgery; B. fragilis predominated after colonic, appendix, and postabdominal trauma surgery; Enterococcus group D predominated after biliary surgery; Fusobacterium and Prevotella species predominated after gastric or duodenal surgery; and Clostridium species predominated after colonic or appendix surgery. These data highlight the polymicrobial aerobic-anaerobic nature of subphrenic abscesses and their correlation with predisposing surgery.