Multifaceted manifestations: A case report of MRSA pneumonia with sepsis, pyelonephritis, and ileus muscle abscess.

Methicillin-resistant staph aureus (MRSA) infections are challenging to treat, and with the emergence of community-associated MRSA (CA-MRSA) strains, early consideration of this pathogen in populations without typical risk factors is critical. Here we present a case of CA-MRSA pneumonia that resulted in Community-acquired pneumonia (CAP) with septic shock, pyelonephritis, and muscle abscess.

Skin abscess caused by Trueperella bernardiae: Case report and literature review.

We investigated a skin abscess caused by Trueperella bernardiae in a patient with comorbidities. Initial empirical therapy with Clindamycin did not yield a response, and follow-up culture revealed the presence of T. bernardiae through MALDI-TOF and NGS. Since no CLSI or FDA breakpoints have been published for this strain, resistant gene screening of the genetic sequence showed the presence of the erm(X) gene (with 95 % identity). This gene confers resistance to erythromycin, clindamycin, lincomycin, pristinamycin, quinupristin, and virginiamycin. Subsequent therapy with oral amoxicillin/clavulanate led to complete healing.

Application of a Malecot drain in the management of a vaginal cuff dehiscence: A case report and review of the literature.

Background: Vaginal cuff dehiscence (VCD) in the setting of acute infection is an uncommon but serious complication of total hysterectomy without clear guidelines for management. There is a need for further documentation of best practices around treatment, particularly when it comes to surgical drain utilization and placement. Case description: We present a case of a 68-year-old with primary peritoneal carcinoma who underwent a robot-assisted total laparoscopic hysterectomy as part of an interval debulking surgery and had a VCD. The cuff was repaired vaginally in the operating room with placement of a Malecot catheter for pelvic abscess drainage. Discussion: The literature is sparse in regard to clear guidelines for management of VCD. Surgical and expectant management approaches are dependent on patient stability, surgical experience, local practice norms, and evidence of intra-abdominal injury. Interventional radiology has become a primary source of drain placement in management of VCD and vaginal cuff abscess. Malecot drains are a low cost, and effective intervention for such management and an important resource for the gynecologic surgeon.

Molecular Identification of Fonsecaea monophora, Novel Agent of Fungal Brain Abscess.

A 3-year-old patient in India experiencing headaches and seizures was diagnosed with a fungal infection, initially misidentified as Cladophialophora bantiana. Follow-up sequencing identified the isolate to be Fonsecaea monophora fungus. This case demonstrates the use of molecular methods for the correct identification of F. monophora, an agent of fungal brain abscess.

An Immunodeficiency Disorder Presenting in the Neonatal Period.

Primary immunodeficiency (PID) Disorders include a variable group of diseases that are classified according to the functional defects encountered. Chronic granulomatous disease (CGD) is inherited as an X-linked recessive disorder in many cases, and it is the clinical model of disorders of phagocytosis. Skin and solid organs abscesses are the most common presenting symptoms; we will report the case of a four-day-old boy admitted to our hospital for a neck mass with purulent discharges associated with umbilical stump and circumcision site infection; the diagnosis of CGD was later confirmed by the Dihydrorhodamine (DHR) test that turned out to be positive.

Etiology and Demographic Distribution of Odontogenic Abscesses in the Maxillofacial Area in Patients Over 18 Years of Age: A Five-Year Retrospective Study.

Introduction Despite the constant development of medicine and the increasing accessibility to medical specialists, in the first quarter of the 21st century, odontogenic abscesses remain one of the leading causes of emergency hospitalization in maxillofacial surgery clinics. Because of the serious and lethal complications that this type of suppurative infection can lead to if not treated promptly, there is a need for constant updating of the knowledge of its origin, which is precisely what is addressed in this original article. Materials and methods It reports on a retrospective study conducted over a five-year period (2018-2023), during which 705 patients aged 18 years and older with a confirmed diagnosis of odontogenic soft tissue abscess of the head and neck underwent emergency surgery. Results The average age of the patients studied was 41 years, with the oldest being an 82-year-old woman. The proportion of males in the study population was higher - 54.18%. Young patients (18-44 years) were the most affected, with a total of 364 patients (213 males and 151 females), while the proportion of old people (75 years of age and older) was the lowest, with a total of 15 patients, including seven males and eight females. The first molars of both jaws (16, 26, 36 and 46) were the cause of the suppurative bacterial infection in the highest number among our study patients - 208 out of 705 (29.5%). Central incisors (teeth 11, 21, 31 and 41) were the least frequent direct cause of odontogenic infection, accounting for only 17 cases out of 705 (2.41%). Discussion The most logical reason for the decrease in the number of patients with odontogenic abscesses with increasing age is tooth loss in older individuals. Our study confirmed the knowledge that the first mandibular molars are the most common teeth leading to the formation of purulent exudate in the adjacent mandibular soft tissues. However, in contrast to the well-known fact for the maxilla that canines are the most frequent etiologic factor for the occurrence of odontogenic abscesses, we conclude that again the first molars (teeth 16 and 26) outnumber the other teeth of the maxillary dentition, with canines outnumbering only incisors. The teeth of the lower jaw are the cause of more than twice as many exudative infections as those of the upper jaw - the ratio between them is 2.54:1. Conclusions Knowledge of odontogenic abscesses - their demographic distribution, frequency and etiology, their diagnosis and treatment - is the basis for the prediction and treatment outcome of these diseases, mainly affecting young people. Their treatment is both surgical in order to evacuate the suppurative focus, and antibacterial.

Diagnosis of an unusual orbital abscess following sub-Tenon's steroid injection: a case report.

Orbital abscesses are caused by infection within or near the orbit and show obvious signs of pain, proptosis and raised inflammatory markers. Diagnosis is based on clinical features and radiological imaging, and requires early antibiotics and often surgical drainage to save vision. Sub-Tenon's injections of triamcinolone acetonide (TA) have caused localized infections in previous reports, which have responded to therapeutic interventions. Here we report a case where a delayed presentation of an orbital abscess secondary to sub-Tenon's TA for persistent post-operative cystoid macular oedema, without obvious signs of infection, rapidly progressed to cause orbital compartment syndrome. Despite treatment, the patient lost complete vision in the affected eye. This case discusses the rare and unusual cause of abscess formation and a diagnostic dilemma.

Subscapular abscesses: A literature review and evidence-based treatment guidelines.

Background: An intramuscular abscess of the subscapularis is a rare phenomenon but important pathology for surgeons to be aware of because clinical deterioration can be rapid and diagnosis difficult. The presentation often mimics other common shoulder pathologies with subacute shoulder pain and stiffness. Early diagnosis, antibiotics and surgical drainage are critical to reduce the spread and joint destruction. Methods: A search of PubMed and Google Scholar databases identified cases of subscapular intramuscular abscess. Data collected about each case included patient demographics, presentation, pathology, surgical treatment and outcome. The authors report one additional subscapular abscess case. Results: Data from 17 cases of subscapular abscess were found, 16 in the literature and one case described by the authors. Sixteen of 17 cases (94.1%) presented with shoulder pain and reduced range of motion worsening over a mean of 6.7 days prior to presentation. Surgical approaches utilised included a posterior inferomedial approach, deltoid-pectoral approach and one posterior inferolateral approach. Discussion and conclusions: From the limited data available regarding subscapular intramuscular abscess, the authors make the following recommendations: (1) Empirical antibiotics covering Staphylococcus aureus +/- methicillin-resistant Staphylococcus aureus, (2) drainage is indicated in all cases; and (3) tendon-sparing approaches can access an abscess in most locations within the subscapular space.

Ultrasound biomicroscopic imaging parameters associated with outcome in equine infectious ulcerative keratitis and stromal abscesses.

OBJECTIVE: To determine the predictive value of corneal ultrasound biomicroscopy (UBM) findings for the outcome of equine corneal disease. ANIMALS: 46 horses with a clinical diagnosis of either infectious ulcerative keratitis or stromal abscess. METHODS: Corneal UBM (VevoMD; UHF70; VisualSonics) of horses with infectious corneal disease presenting to the North Carolina State University Equine Ophthalmology Service from 2019 to 2023 were evaluated. Size and depth of lesion, presence of Descemet membrane disruption (DMD), corneal thickness, and aqueous humor cell counts (AHCC) were assessed. Comparisons of UBM and clinical exam findings, presence of infectious organisms, and outcome (healed or enucleated) were performed. RESULTS: The UBMs from 46 horses were evaluated. Increased AHCC was significantly associated with increased size and depth of corneal lesions on UBM but not with DMD. Deep lesions and DMD were significantly associated with an enucleation outcome. Horses treated with systemic antibiotics had significantly lower AHCC on UBM, but there were no differences in AHCC with the use of other systemic or topical medications. There was no significant correlation between infectious disease results, clinical findings (aqueous flare or cells), outcome, and UBM AHCC. CLINICAL RELEVANCE: Parameters on UBM, such as depth of lesion, DMD, and AHCC, may be useful diagnostic and prognostic tools to augment the ophthalmic exam of horses with corneal disease. The UBM findings of deep corneal lesions and DMD suggest a poor prognosis and warrant aggressive surgical intervention.

Peritonsillar abscess associated with Helicobacter cinaedi bacteremia: A case report.

Helicobacter cinaedi, a gram-negative spiral bacterium, has historically been associated with infections primarily in immunocompromised patients. Recently, however, its potential to cause infections in immunocompetent individuals has been recognized. We report a unique case of a man in his 20 s who reported having sex with men. He presented with symptoms of fever and throat discomfort and was diagnosed with a peritonsillar abscess. While the rapid antigen test for Group A Streptococcus was positive and antibiotics were administered, a puncture fluid from the peritonsillar abscess taken the day after antibiotic treatment revealed the presence of Group C Streptococcus. By the fifth day, the blood culture taken on the first day detected a gram-negative spirochete, which was subsequently identified H. cinaedi. The patient had engaged in oral sex with his male partner, suggesting a potential transmission route. This is significant as H. cinaedi was initially identified from rectal cultures in men who have sex with men (MSM), raising the possibility of pharyngeal transmission through oral sex. In our patient, although H. cinaedi was not isolated from the aspirate of the peritonsillar abscess, its presence in the blood culture and lack of other potential sources of bacteremia make the abscess a likely primary site of infection. This case highlights the importance of considering H. cinaedi as a potential pathogen in immunocompetent patients, particularly in cases of MSM. The potential for H. cinaedi transmission through oral sex and its role in the development of peritonsillar abscesses, a previously unreported association, requires further investigation.

Progression of Community-Acquired Pneumonia in a Morbidly Obese Patient With a History of Vaping and Asthma: A Multidisciplinary Approach to Management.

Lung abscess and empyema represent significant complications of community-acquired pneumonia, particularly in patients with comorbidities such as obesity, asthma, and vaping (which can lead to vaping-associated lung injury). While these conditions rarely occur simultaneously, their coexistence significantly escalates both mortality and morbidity. Management strategies typically involve a multidisciplinary approach, incorporating diagnostic evaluation through imaging, administration of antibiotics, and often surgical drainage. While antibiotics are fundamental in treating both conditions, empyema management almost invariably necessitates surgical intervention. Initial imaging usually involves plain radiographs, although ultrasound and lung CT scans provide heightened sensitivity and fluid characterization. Here, we present the case of a 24-year-old morbidly obese patient with a history of bronchial asthma initially presenting with community-acquired pneumonia, which subsequently deteriorated into lung abscess and empyema, ultimately requiring surgical intervention.

Lactococcus garviae in Lumbar Spondylodiscitis With Spinal Epidural Abscess Causing Paraparesis: A Case Report.

Spinal epidural abscess (SEA) can lead to a subacute onset of neurological deficits of the extremities and is commonly accompanied by spondylodiscitis if located anterior to the dura. Lactococcus garviae is a fish pathogen that is occasionally found in poultry, cattle, and swine. It is a rare cause of infection in humans. Most commonly it is associated with endocarditis. Until 2019, less than 30 cases of human Lactoccous garviae infection have been published. To the best of our knowledge, we present the second reported case of SEA with spondylodiscitis caused by Lactococcus garviae. How Lactococcus garviae caused SEA, remains unclear in this case.

Bilateral breast tuberculosis: A case report.

Key Clinical Message: Breast tuberculosis is a rare clinical condition that has the potential to imitate breast cancer or pyogenic abscess. It is crucial to consider this in patients who have resistant breast abscesses or persistent sinuses, particularly in high-risk groups or locations. The main treatment for breast tuberculosis is antitubercular treatment. Abstract: Bilateral breast tuberculosis is a rare form of the disease that affects breasts. It is most commonly seen in young females, including nulliparous and lactating women. Diagnosis of bilateral breast tuberculosis can be challenging due to its similarity to other breast diseases, such as granulomatous mastitis and breast carcinoma. Patients from high-risk groups and/or endemic locations who present with clinically suspicious breast lumps or refractory breast abscesses should have breast TB taken into consideration in their differential diagnosis. A 24-year-old Ethiopian female presented to the surgical outpatient department with a complaint of bilateral breast pain of 1-year duration associated with a low-grade fever, not associated with chills or rigor. She also has ulceration on the lower part of both breasts. It was followed by pus discharge from the right breast 6 months later. Investigations, including fine needle aspiration cytology, were suggestive of tuberculous mastitis. Later, the patient was treated with antituberculous drugs for 6 months, and the above symptoms subsided. Individuals with breast lesions who do not respond well to antibiotics should be suspected of having breast tuberculosis, especially if they are young and reside in or were born in a nation where the disease is prevalent.

Exploring odontogenic brain abscesses: a comprehensive review.

INTRODUCTION: Whether in neurology or dentistry, odontogenic brain abscess stands as an ailment demanding undivided attention. The onset of this disease is insidious, with a relatively low incidence rate but a markedly high fatality rate. Moreover, its symptoms lack specificity, easily leading to misdiagnosis, oversight, and treatment delays. Hence, clinicians should maintain heightened vigilance when faced with pathogenic bacteria of dental origin in patients. AREAS COVERED: This paper encapsulates the latest research findings on the clinical manifestations and essential treatment points of odontogenic brain abscess. It may offer a crucial reference for prompt diagnosis and improved therapeutic approaches. EXPERT OPINIONS: Odontogenic brain abscess, an infection of the cerebral parenchyma, usually appears in immunocompromised patients with dental ailments or postdental surgeries. The main pathogenic microorganisms include Streptococcus intermedius, Fusobacterium nucleatum, Streptococcus anginosus, and Millerella. Given the undetectable and nonspecific symptoms in patients, the diagnostic process relies on microbiological methods. Therefore, clinicians should actively investigate and identify the pathogenic microorganisms of odontogenic brain abscess for early detection and selection of appropriate treatment regimens to avoid disease management delays.

Cholesteatoma Complicated by Parapharyngeal Abscess That Occurred After Temporal Bone Fracture.

Parapharyngeal abscess as a cervical complication of chronic otitis media with cholesteatoma is extremely rare. We present the case of a patient with chronic otitis media and cholesteatoma who developed a parapharyngeal abscess following a blunt head trauma. A 65-year-old man with a history of recurrent right purulent otorrhea presented with symptoms of profuse purulent otorrhea, headache, hoarseness, and difficulty swallowing. Imaging revealed the presence of a right parapharyngeal abscess alongside a temporal bone fracture, suggesting a potential direct spreading route of aggressive chronic suppurative otitis media infection through the bone fracture defects to the parapharyngeal space. The patient underwent abscess drainage via a transcervical approach with simultaneous emergency radical mastoidectomy. Despite the development of septic shock with acute renal failure in the postoperative period, the patient made a full recovery.

Empyema Resulting From a Nephro-Pleural Fistula in an Adult With Polycystic Kidney Disease With Obstructive Uropathy.

Nephropleural fistula, a rare complication of percutaneous nephrolithotomy (PCNL), occurred in a 45-year-old male with adult autosomal dominant polycystic kidney disease (ADPKD). The patient had undergone right PCNL in 2021 and 2023 and presented to the emergency department with symptoms of fever, breathlessness, and cough lasting one week. Imaging studies, including chest radiograph and contrast-enhanced computed tomography (CECT) of the abdomen and pelvis, revealed gross right pleural effusion, right perinephric abscess, multiple renal cysts, right renal calculi and right ureteric calculi causing severe right hydronephrosis and proximal hydroureter. The imaging also confirmed a nephropleural fistula, with the right kidney's perinephric abscess communicating with the right pleura via the right subhepatic space. Subsequent thoracic ultrasound showed a large effusion of 1500ml with underlying lung collapse. Diagnostic thoracocentesis confirmed empyema, necessitating immediate tube thoracostomy. CT intravenous urography confirmed a non-functioning right kidney. The perinephric abscess was drained with a PCNL tube and meanwhile, pleural fluid and perinephric abscess isolated Klebsiella pneumonia on cultures. The patient received parenteral antibiotics and intravenous fluids and had an intercostal drain and PCNL tube in place for drainage. A right nephrectomy was recommended due to the non-functioning right kidney and the patient is awaiting the procedure.

Pott's Puffy Tumor: A Case Report on Diagnosis Through Imaging.

Pott's puffy tumor (PPT) is a rare but life-threatening complication of chronic sinusitis, although it can be secondary to other entities such as trauma or insect bites. It is characterized by circumscribed frontal swelling associated with a subperiosteal abscess. Imaging plays a crucial role in diagnosis and early identification of complications, some of which can be life-threatening, including intracerebral and intra-orbital complications. We present a case of a 14-year-old male with non-specific frontal pain and swelling, where the diagnosis of PTT was confirmed through imaging studies. Upon admission, the patient exhibited orbital and intracerebral complications, as shown in MRI and CT scans. Treatment involved a combination of antibiotics and sinus surgery, with close monitoring for orbital and intracranial complications.