RESUMO
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.