RESUMEN
There have been no case reports of thoracic subcutaneous abscess after surgery for Mycobacterium abscessus complex associated empyema. We herein report a case of Mycobacterium abscessus subsp. abscessus (M. abscessus subsp. abscessus) induced subcutaneous abscesses following surgical treatment for concurrent M. abscessus subsp. abscessus -associated empyema and pneumothorax. A 75-year-old woman had M. abscessus subsp. abscessus -associated empyema and pneumothorax. She underwent surgical treatment of decortication and fistulectomy and suffered from M. abscessus subsp. abscessus -associated subcutaneous abscesses after thoracentesis/drainage. A multidisciplinary approach combined with surgical care, thermal therapy, and multidrug chemotherapy contributed to a successful result. An early multidisciplinary approach is believed to be important in cases of M. abscessus subsp. abscessus -associated empyema and subcutaneous abscess.
Asunto(s)
Absceso/microbiología , Empiema Pleural/microbiología , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Mycobacterium abscessus/aislamiento & purificación , Tejido Subcutáneo/patología , Absceso/diagnóstico , Absceso/terapia , Anciano , Antibacterianos/uso terapéutico , Empiema Pleural/complicaciones , Empiema Pleural/diagnóstico , Empiema Pleural/tratamiento farmacológico , Femenino , Humanos , Hipertermia Inducida/métodos , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Neumotórax/complicaciones , Neumotórax/diagnóstico , Neumotórax/microbiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/microbiología , Tejido Subcutáneo/microbiología , Tórax/diagnóstico por imagen , Tórax/patología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: We previously demonstrated that the pleural levels of proteins (neutrophil gelatinase-associated lipocalin/NGAL, calprotectin, bactericidal permeability-increasing/BPI, azurocidin 1/AZU-1) were valuable markers for identifying complicated PPE (CPPE). Herein, this study was performed to evaluate whether these proteins are useful as serological markers for identifying CPPE and empyema. METHODS: A total of 137 participates were enrolled in this study. The levels of NGAL, calprotectin, BPI and AZU-1 were measured in serum and pleural fluid by enzyme-linked immunosorbent assay. We also characterized the diagnostic values of these markers between different groups. RESULTS: The serum levels of NGAL, calprotectin, and BPI in PPE patients were significantly higher than those in transudates, noninfectious exudates, and healthy controls. The area under the curve (AUC) values of NGAL, calprotectin, and BPI for distinguishing PPE from transudates or noninfectious exudates were around 0.861 to 0.953. In PPE group, serum NGAL and calprotectin levels were significantly elevated in patients with CPPE and empyema than in those with UPPE, whereas the serum BPI levels were similar between these two groups. In CPPE and empyema patients, the serum NGAL showed a positive correlation with the pleural fluid NGAL (r = 0.417, p < 0.01). When combined with serum CRP, the sensitivity and specificity of serum calprotectin for identifying CPPE and empyema were the highest at 73.52% and 80.55%, respectively. CONCLUSIONS: We concluded that serum calprotectin and NGAL were adjuvant serological markers for CPPE and empyema diagnosis. Patients present with pneumonia and pleural effusion signs in the chest x-ray and the combination of serum calprotectin and CRP constitutes a more highly sensitive and specific assay for identifying CPPE and empyema.
Asunto(s)
Empiema Pleural/diagnóstico , Complejo de Antígeno L1 de Leucocito/sangre , Lipocalina 2/sangre , Derrame Pleural/diagnóstico , Neumonía/diagnóstico , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Biomarcadores/sangre , Estudios de Casos y Controles , Empiema Pleural/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derrame Pleural/etiología , Neumonía/complicaciones , Curva ROC , Sensibilidad y Especificidad , TaiwánAsunto(s)
Antibacterianos/uso terapéutico , Empiema Pleural/microbiología , Enterococcus faecalis/efectos de los fármacos , Enterococcus faecalis/genética , Infecciones por Bacterias Grampositivas/microbiología , Linezolid/uso terapéutico , Antibacterianos/farmacología , Empiema Pleural/diagnóstico , Empiema Pleural/tratamiento farmacológico , Genes Bacterianos/genética , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Linezolid/farmacología , Masculino , Pruebas de Sensibilidad Microbiana , Taiwán/epidemiología , Donantes de Tejidos , Adulto JovenAsunto(s)
Pleura/cirugía , Cavidad Pleural/cirugía , Punciones/métodos , Anestesia Local , Contraindicaciones , Empiema Pleural/diagnóstico , Empiema Pleural/diagnóstico por imagen , Empiema Pleural/cirugía , Humanos , Consentimiento Informado , Pleura/diagnóstico por imagen , Cavidad Pleural/diagnóstico por imagen , Derrame Pleural/diagnóstico , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/cirugía , Cuidados Posoperatorios , Cuidados Preoperatorios , Punciones/normas , UltrasonografíaRESUMEN
Spontaneous bacterial empyema is a complication of hepatic hydrothorax in cirrhotic patients. The pathogen, clinical course and treatment strategy are different to the empyema secondary to pneumonia. A 54-year-old man, who was a cirrhotic patient with hepatic hydrothorax, was admitted to National Taiwan University Hospital for fever, dyspnea and right side pleuritic pain. The image study revealed massive right pleural effusion and no evidence of pneumonia. The culture of pleural effusion yielded Aeromonas veronii biotype sobria. The diagnosis of spontaneous bacterial empyema caused by Aeromonas veronii biotype sobria was established. To our best knowledge, Aeromonas veronii biotype sobria had never been reported in English literature as the causative pathogen of spontaneous bacterial empyema.
Asunto(s)
Aeromonas/aislamiento & purificación , Cefotaxima/uso terapéutico , Cefalosporinas/uso terapéutico , Empiema Pleural/diagnóstico , Aeromonas/efectos de los fármacos , Cefotaxima/farmacología , Cefalosporinas/farmacología , Empiema Pleural/tratamiento farmacológico , Empiema Pleural/microbiología , Hepatitis B Crónica/complicaciones , Humanos , Hidrotórax/etiología , Cirrosis Hepática/complicaciones , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana EdadRESUMEN
A 63-year-old man was admitted to our hospital with fever and chest pain. Chest radiography revealed left pleural effusion with left pneumothorax and small nodular shadows in the right lung field. On CT of the chest and abdomen, multiple nodules were seen in both lung fields, and masses appeared in the liver and spleen. Fiberoptic colonoscopy showed obstruction at the end of the transverse colon. Biopsy of this obstruction proved it to be cancer. In this patient, a colo-pleural fistula was also diagnosed using thoracoscopy under local anesthesia and from the inflow of contrast medium from the colon into the thoracic cavity seen in abdominal radiographs. This was a rare case of a colo-pleural fistula without diaphragmatic deficiencies. Medical thoracoscopy is useful for the diagnosis of complicated pleural effusions as was seen in this case.