Diagnostic yield of stool culture and probable predictive factors.

BACKGROUND AND AIM: Stool analysis is commonly performed to diagnose certain gastrointestinal diseases. The diagnostic yield of stool culture,  a method of stool analysis, is variable worldwide and is unclear in the Kingdom of Saudi Arabia. This study was conducted to determine the diagnostic yield of stool culture from the year 2008 to 2020 and to determine the predictors for a positive stool culture. Furthermore, antibiotic susceptibility patterns of the detected copro-pathogens in the same time period were collected and studied. METHODS: This is a retrospective case-control study in which patients' data was collected from the hospital's electronic health record. The results of all stool analyses performed from 2008 to 2020 and associated patients' characteristics were collected.  Characteristics of cases with a positive stool culture were compared to the characteristics of those without to identify the predictors for positive stool cultures. RESULTS: Copro-pathogens were detected in 89.4% of cultured stool samples. Salmonella spp (1590/1775, 89.6%) was the most common organism followed by Shigella spp. (84/1775, 4.7%) and Campylobacter spp (45/1775, 2.5%). Male sex, the 1-5 age group, positive fecal occult blood test results, and positive stool leukocyte test results were associated with a positive stool culture result. Cultured copro-pathogens were highly sensitive to Trimethoprim/Sulfamethoxazole and Ampicillin. CONCLUSIONS: Stool analysis was found to be a test of high diagnostic yield. However, there is still a need for more studies on this subject with a focus on possible predictive factors for specific organisms.

Recurrent Non-Lactational Fungal Abscesses in a Systemic Lupus Erythematosus Patient: Causation or Mere Association? A Case Report and Literature Review.

Background: Systemic lupus erythematosus is a multisystemic autoimmune disorder that can present in many different ways that can be debilitating for many patients. These patients are at risk for developing infections following the introduction of immunosuppressive therapy. Breast infections, particularly of the fungal type, in nonlactating patients who are not in an immunosuppressive state are extremely rare. Objective: We report a case of recurrent right breast fungal infections manifesting in the form of multiple abscesses in a systemic lupus erythematosus patient. Case report: A 39 years old female patient presented with recurrent fungal breast abscesses. She was diagnosed with systemic lupus erythematosus nine years ago and was in remission being maintained with an antimalarial agent without the use of immunosuppressive therapy. Fluconazole was started for her prior to her visit to us, and she had no active complaints. She was not breastfeeding nor pregnant currently nor during any of the previous episodes. Examination was unremarkable, however cultures of samples from her previous lesions demonstrated growth of Candida albicans. A decision to manage her conservatively with the continuation of her antifungal therapy was made. Conlusion: Lactation and breastfeeding are well-known risk factors for infectious mastitis and there is sparse literature regarding this condition in the absence of these risk factors. Studies evaluating other risk factors, particularly systemic lupus erythematosus, need to be conducted to determine any relationship and how to best manage this condition in such patients.

Iliopsoas Hematoma and Abscess Formation as a Complication of an Anterior Abdominal Penetrating Injury: a Case Report and Review of Literature.

Background: Abdominal stab wounds are common in clinical practice. However, the development of psoas muscle abscess following such an injury is extremely rare. Moreover, literature surrounding psoas muscle hematoma formation as a consequence of penetrating abdominal injury is scarce. Objective: We report a case of psoas abscess formation following the development of psoas hematoma in a patient who suffered from a penetrating abdominal injury. Case presentation: A 40-year-old Indian male presented to the Emergency department with multiple abdominal cut and stab wounds as a result of physical assault. A computed tomography scan revealed injuries to the ascending colon along with hemoperitoneum and right psoas muscle hematoma. Exploratory laparotomy was performed in which a right hemicolectomy and a right psoas muscle evacuation were successfully achieved along with multiple drainage tubes placed. Six days later, a peritoneal fluid culture tested positive, and a computed tomography scan revealed right psoas muscle collection which was diagnosed as an abscess. Treatment of the abscess included antibiotics and ultrasound-guided drainage. Patient was eventually discharged but was lost to follow-up. Conclusion: The development of iliopsoas abscess and hematoma as a consequence of abdominal penetrating injuries is a rare occurrence. Diagnosis can be made by computed tomography imaging and examination of the drained fluid. Managing a case with both of these rare phenomena can be challenging due to the scarce literature highlighting and comparing the different management modalities.