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1.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526521

RESUMO

Vertebral osteomyelitis is an infection of the vertebrae that can lead to spinal degeneration, most commonly caused by Staphylococcus aureus Here, we report an unusual case of pyogenic osteomyelitis caused by Gardnerella vaginalis and Streptococcus parasanguinis in a 61-year-old postmenopausal woman. The patient presented with a 2-week history of worsening lower back pain and fever and a recent episode of cystitis following re-engagement of sexual activity. Imaging revealed a deterioration of vertebrae discs and spinal canal stenosis at the L3-L4 levels with a formation of abscess in the right psoas muscle. Needle aspiration of the abscess identified G. vaginalis and S. parasanguinis and the patient was successfully treated with a 6-week course of ceftriaxone and metronidazole. This case describes an unusual coinfection of two pathogens that normally reside in the urogenital tract and oral cavity, respectively, and highlights the risk posed when these organisms breach the body's normal barriers.


Assuntos
Discite/microbiologia , Gardnerella vaginalis/isolamento & purificação , Vértebras Lombares , Osteomielite/microbiologia , Abscesso do Psoas/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Antibacterianos/uso terapêutico , Técnicas de Cultura , Discite/diagnóstico por imagem , Discite/tratamento farmacológico , Discite/fisiopatologia , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Osteomielite/fisiopatologia , Pós-Menopausa , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/tratamento farmacológico , Estenose Espinal/fisiopatologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico
2.
BMJ Case Rep ; 13(12)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33372019

RESUMO

A 71-year-old man presented with a 3-month history of low back pain radiating to his right hip and thigh associated with lower limb weakness and constitutional symptoms. Imaging confirmed a lumbosacral spondylodiscitis at L2-3 and L5-S1 as well as a right-side psoas abscess which was treated with urgent CT-guided drainage and intravenous antibiotics. His admission was complicated by a number of issues, including the development of osteomyelitis with vertebral body destruction at multiple sites, epidural abscess formation and deep vein thrombosis. Additionally, the patient developed severe sepsis which necessitated admission to the intensive care unit. The patient's clinical condition improved gradually with intravenous antibiotics until he was well enough for transfer to a rehabilitation centre, where he underwent regular occupational and physical therapy. Repeat imaging showed overall resolution of the aforementioned pathologies and is currently being followed up by the spinal surgeons on an outpatient basis.


Assuntos
Discite/complicações , Abscesso Epidural/complicações , Vértebras Lombares , Osteomielite/complicações , Sacro , Sepse/complicações , Infecções Estafilocócicas/complicações , Idoso , Antibacterianos/uso terapêutico , Discite/diagnóstico por imagem , Drenagem , Abscesso Epidural/diagnóstico , Abscesso Epidural/tratamento farmacológico , Humanos , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Abscesso do Psoas/complicações , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/tratamento farmacológico , Sacro/diagnóstico por imagem , Sepse/diagnóstico , Sepse/tratamento farmacológico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Tomografia Computadorizada por Raios X , Trombose Venosa
3.
BMJ Case Rep ; 12(11)2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31748364

RESUMO

Parvimonas micra (P. micra) is a Gram-positive anaerobic cocci, normally found in the oral cavity and rarely causes severe infections. We describe a rare clinical presentation of P. micra as spondylodiscitis and psoas abscess with haematogenous spread in an adult patient. MRI lumbar spine detected L2 and L3 spondylodiscitis. Blood cultures were positive at 48 hours of incubation and P. micra was identified on anaerobic culture after 72 hours. Isolates from bone biopsy confirms P. micra She was successfully treated with ceftriaxone, followed by oral metronidzole for a total of 8 weeks. The suspected origin of her P. micra was a dental cavity. Anaerobic bacteria tend to be underestimated in spondylodiscitis. In cases of slow growing organisms, we emphasise the importance of performing accurate identification including anaerobic bacteria to guide management. P. micra should be considered in patients with spondylodiscitis who had recent dental intervention or perioral infection.


Assuntos
Discite/complicações , Discite/microbiologia , Firmicutes/isolamento & purificação , Abscesso do Psoas/complicações , Abscesso do Psoas/microbiologia , Administração Intravenosa , Administração Oral , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Biópsia , Osso e Ossos/patologia , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Discite/diagnóstico por imagem , Discite/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Metronidazol/administração & dosagem , Metronidazol/uso terapêutico , Abscesso do Psoas/tratamento farmacológico , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(45): e17885, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702663

RESUMO

RATIONALE: Endograft infection following endovascular stent for aortic aneurysm is rare (0.6%-3%), but it results in high mortality rate of 25% to 88%. PATIENT CONCERNS: A 66-year-old hypertensive man underwent an endovascular stent graft for abdominal aortic aneurysm 18 months ago. Recurrent episodes of fever, chills, and abdominal fullness occurred 6 months ago before this admission. Laboratory data showed 20 mg/dL of C-reactive protein and abdominal computed tomography (CT) revealed an aortic endoleak at an urban hospital, so 4-day course of intravenous (IV) amoxicillin/clavulanic acid was given and he was discharged after fever subsided. He was admitted to our hospital due to fever, chills, and watery diarrhea for 1 day. Abdominal CT showed left psoas abscess associated with endograft infection. Blood culture grew Listeria monocytogenes. DIAGNOSIS: Left psoas abscess associated with endograft infection caused by bacteremia of Listeria monocytogenes. INTERVENTIONS: IV ampicillin with 8 days of synergistic gentamicin was prescribed and it created satisfactory response. Ampicillin was continued for 30 days and then shifted to IV co-trimoxazole for 12 days. OUTCOMES: He remained asymptomatic with a decline of CRP to 0.36 mg/dL and ESR to 39 mm/h. He was discharged on the 44th hospital day. Orally SMX/TMP was prescribed for 13.5 months. LESSONS: Only few cases of aortic endograft infection caused by Listeria monocytogenes had been reported. In selected cases, particularly with smoldering presentations and high operative risk, endograft retention with a prolonged antimicrobial therapy seem plausible as an initial therapeutic option, complemented with percutaneous drainage or surgical debridement if necessary.


Assuntos
Listeria monocytogenes/isolamento & purificação , Infecções Relacionadas à Prótese/diagnóstico , Abscesso do Psoas/diagnóstico , Idoso , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Gentamicinas/uso terapêutico , Humanos , Masculino , Infecções Relacionadas à Prótese/tratamento farmacológico , Abscesso do Psoas/tratamento farmacológico , Abscesso do Psoas/etiologia , Tomografia Computadorizada por Raios X
9.
Drug Discov Ther ; 12(1): 47-50, 2018 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-29479049

RESUMO

Iliopsoas abscess (IPA) is an uncommon diagnosis in medical wards. Herein, we present two unusual cases of IPA. First patient was an elderly diabetic patient who had gas-forming bilateral IPA caused by Escherichia coli. This infection proved fatal and patient succumbed on third day of hospital admission. Second patient was a young boy who had right sided sacroilitis with IPA. Staphylococcus aureus was isolated from the pus culture and patient was successfully treated without any sequelae.


Assuntos
Infecções por Escherichia coli/diagnóstico , Abscesso do Psoas/microbiologia , Infecções Estafilocócicas/diagnóstico , Vancomicina/administração & dosagem , Administração Intravenosa , Adolescente , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento , Vancomicina/uso terapêutico
12.
Pediatr Emerg Care ; 33(6): 437-439, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28570363

RESUMO

This case-report describes a 4-year-old girl brought to the emergency department for the evaluation of limp and elevated inflammatory markers. The patient's history and physical examination did not reveal a clear source of pathology. Point-of-care ultrasound identified a right-sided psoas abscess that was confirmed with computed tomography scan. This case demonstrates the potential utility of point-of-care ultrasound in the diagnosis and management of patients presenting to the emergency department with symptoms concerning for pathology in the hip or lower abdomen.


Assuntos
Quadril/patologia , Transtornos dos Movimentos/diagnóstico , Dor/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Abscesso do Psoas/diagnóstico por imagem , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Quadril/microbiologia , Humanos , Transtornos dos Movimentos/etiologia , Dor/etiologia , Abscesso do Psoas/tratamento farmacológico , Abscesso do Psoas/microbiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos
13.
BMJ Case Rep ; 20172017 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-28630219

RESUMO

A middle-aged man was admitted with worsening hip pain, fevers and reduced mobility. These symptoms were preceded by a mechanical fall but despite regular analgesia, symptoms did not resolve. His prior medical history included ischaemic heart disease, hypertension and hypercholesterolaemia. A trauma and orthopaedic review revealed a painful left hip with reduced range of motion. In addition, some mild tenderness in the left iliac fossa was noted. Blood tests revealed markedly raised inflammatory markers. Plain radiographs and ultrasound were normal. MRI scan found a massive left iliopsoas collection secondary to perforated diverticular disease of the sigmoid colon. The patient was managed with intravenous antibiotics and the collection was drained percutaneously. Approximately 500 mL of pus was aspirated. The patient made an excellent recovery with interval imaging showing a reduction in the collection size.


Assuntos
Antibacterianos/administração & dosagem , Colo Sigmoide/patologia , Perfuração Intestinal/complicações , Abscesso do Psoas/complicações , Administração Intravenosa , Antibacterianos/uso terapêutico , Artralgia/diagnóstico , Diagnóstico Diferencial , Doenças Diverticulares/complicações , Doenças Diverticulares/patologia , Drenagem , Quadril/diagnóstico por imagem , Quadril/patologia , Humanos , Perfuração Intestinal/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/tratamento farmacológico , Abscesso do Psoas/cirurgia , Radiografia/métodos , Resultado do Tratamento , Ultrassonografia/métodos
15.
Pan Afr Med J ; 28: 280, 2017.
Artigo em Francês | MEDLINE | ID: mdl-30402201

RESUMO

Psoas abscesses account for 5-10% of abdominal suppurations. They can be primary or secondary. Primary polymicrobic abscesses of the psoas muscle including, in particular, tuberculous abscesses and pyogenic abscesses, have never been reported in the literature. We report the case of a 35-year old patient, with no particular past medical history, admitted with pain in the right lumbar fossa associated with a fever of 40°C. Onset of symptoms had occurred 5 months before, but without fever. Abdominal CT scan showed an abscess of the right external transverse and oblique psoas muscles extended to the retroperitoneum and infiltrating the thoracoabdominal wall. Cytobacteriological examination of pus showed fast-growth monomorphic wild-type Escherichia coli strains. Systematically performed Real-time PCR test for the detection of Complex Mycobaterium tuberculosis was positive while direct examination after Ziehl-nelseen staining was negative. The culture on a solid Lowenstein Jensen medium was positive after one-month of incubation. The outcome of our patient was favorable under antibacillar quadritherapy and ceftriaxone. This study highlights that a tuberculous origin should be systematically suspected in patients living in endemic areas with chronic, recurrent psoas abscess not responding to antibiotics.


Assuntos
Antibacterianos/administração & dosagem , Abscesso do Psoas/diagnóstico , Tuberculose/diagnóstico , Adulto , Antituberculosos/administração & dosagem , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/patologia , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Abscesso do Psoas/tratamento farmacológico , Abscesso do Psoas/patologia , Reação em Cadeia da Polimerase em Tempo Real , Supuração/diagnóstico , Supuração/tratamento farmacológico , Supuração/patologia , Tomografia Computadorizada por Raios X/métodos , Tuberculose/tratamento farmacológico , Tuberculose/patologia
16.
BMC Infect Dis ; 16: 284, 2016 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-27297079

RESUMO

BACKGROUND: Early postpartum women are more likely to develop tuberculosis than nonpregnant women mainly due to immune reconstitution after delivery. Paradoxical response (PR) during antituberculosis treatment also arises via recovery from immunosuppression. However, no study focused on PR during antituberculosis treatment in a postpartum patient has been reported. CASE PRESENTATION: We present two sequential cases (Patient 1: 26-year-old; Patient 2: 29-year-old) of postpartum tuberculosis with pulmonary and extrapulmonary lesions (Patient 1: peritonitis; Patient 2: psoas abscess secondary to spondylitis). Both cases progressed to PR (worsening of pre-existing lung infiltrations (Patients 1, 2) and new contralateral effusion (Patient 2)) in a relatively short time after initiation of treatment (Patient 1: 1 week; Patient 2: 3 weeks), suggesting that immune modulations during pregnancy and delivery may contribute to the pathogenesis of both disseminated tuberculosis and its PR. The pulmonary lesions and effusion of both cases gradually improved without change of chemotherapy regimen. CONCLUSION: Physicians should recognize PR in tuberculosis patients with postpartum and then evaluate treatment efficacy.


Assuntos
Antituberculosos/uso terapêutico , Peritonite Tuberculosa/tratamento farmacológico , Abscesso do Psoas/tratamento farmacológico , Infecção Puerperal/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose da Coluna Vertebral/tratamento farmacológico , Doença Aguda , Adulto , Progressão da Doença , Feminino , Humanos , Peritonite Tuberculosa/diagnóstico por imagem , Peritonite Tuberculosa/imunologia , Período Pós-Parto/imunologia , Gravidez , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/etiologia , Abscesso do Psoas/imunologia , Infecção Puerperal/diagnóstico por imagem , Infecção Puerperal/imunologia , Radiografia Torácica , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/imunologia , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/imunologia
17.
Rev Argent Microbiol ; 48(2): 119-21, 2016.
Artigo em Espanhol | MEDLINE | ID: mdl-27086257

RESUMO

Staphylococcus lugdunensis is a coagulase-negative staphylococcus of growing importance and atypical behavior. The infections caused by this microorganism are becoming more frequent, having a broader spectrum. Psoas abscesses caused by this germ are rare, with few cases reported in the literature. In this work, we present a case of a psoas abscess caused by S. lugdunensis in a patient suffering from diabetes mellitus and rheumatoid arthritis, which was treated with intravenous cloxacillin with a good outcome.


Assuntos
Abscesso do Psoas/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus lugdunensis/isolamento & purificação , Antibacterianos/uso terapêutico , Artrite Reumatoide/complicações , Técnicas de Tipagem Bacteriana , Cloxacilina/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Abscesso Epidural/tratamento farmacológico , Abscesso Epidural/microbiologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Pessoa de Meia-Idade , Abscesso do Psoas/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus lugdunensis/patogenicidade
18.
J Med Case Rep ; 10: 12, 2016 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-26786137

RESUMO

BACKGROUND: Pyogenic abscess of psoas muscles is a rare condition. Psoas abscess due to methicillin-resistant Staphylococcus aureus is an emerging and rare infection and so far the related data are scarce. CASE PRESENTATION: We report the rare case of primary and bilateral large psoas abscesses due to methicillin-resistant Staphylococcus aureus in a 54-year-old Arab Jordanian woman with breast cancer who had neutropenia after starting chemotherapy. She was diagnosed 50 days after onset of symptoms. However, despite this delay in diagnosis and the large size of the abscesses, she had a full recovery. She was treated with antibiotics and percutaneous drainage and was doing very well at a follow up of 18 months. CONCLUSIONS: Psoas abscess due to methicillin-resistant Staphylococcus aureus might have insidious presentation with extensive disease especially in immunocompromised patients. However, it can be managed effectively with percutaneous catheter drainage and appropriate antibiotic therapy.


Assuntos
Antibacterianos/uso terapêutico , Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Neutropenia/induzido quimicamente , Abscesso do Psoas/microbiologia , Infecções Estafilocócicas/complicações , Neoplasias da Mama/complicações , Neoplasias da Mama/imunologia , Drenagem/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Neutropenia/imunologia , Abscesso do Psoas/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Resultado do Tratamento
19.
Intern Med ; 55(1): 73-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26726090

RESUMO

A 68-year-old man with persistent bacteremia accompanying a large iliopsoas abscess, vertebral osteomyelitis, discitis and central venous port infection caused by methicillin-resistant Staphylococcus aureus (MRSA) was admitted to our hospital. During the course of treatment, the emergence of a daptomycin (DAP)-resistant MRSA strain was confirmed; the minimum inhibitory concentration was 1 to 2 µg/mL for vancomycin and more than 1 µg/mL for DAP. Although the bacterial cell wall was not significantly thickened, an increased positive surface charge and single-nucleotide polymorphism within mprF have been confirmed in DAP-resistant strains. Still rare, but clinicians need to be cautious of the emergence of DAP-resistant MRSA during treatment.


Assuntos
Antibacterianos/administração & dosagem , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/microbiologia , Linezolida/administração & dosagem , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Osteomielite/tratamento farmacológico , Abscesso do Psoas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Idoso , Antibacterianos/farmacologia , Bacteriemia , Cateteres de Demora/efeitos adversos , Parede Celular , Daptomicina , Evolução Fatal , Humanos , Linezolida/farmacologia , Masculino , Testes de Sensibilidade Microbiana , Infecções Estafilocócicas/complicações
20.
Turk J Pediatr ; 58(5): 562-565, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28621103

RESUMO

After bone marrow aspiration procedure; some complications like pain and bleeding at the puncture site may be expected but some serious complications like osteomyelitis and soft tissue infections may also rarely occur. In this case we present a boy with recurrent fever. During etiologic investigation, familial Mediterranean fever (FMF) gene M694V mutation was +/+. Patient was treated with oral colchicine however fever persisted. The patient was considered as colchicine resistant FMF and steroid treatment was planned. Bone marrow aspiration procedure was executed to rule out malignancy. Three months after bone marrow aspiration, he was readmitted with complaint of left pelvic pain, difficulty in walking without support and standing on his left foot. Radiological imaging demonstrated left iliopsoas abscess and left sacroiliac osteomyelitis. Patient was successfully treated with intravenous ampicillin-sulbactam and clindamycin treatment for 6 weeks. Then oral amoxicillin-clavulanic acid treatment was continued for 2 weeks. Patient was discharged without any surgical procedure. On 1-year follow-up he could walk without any support.


Assuntos
Antibacterianos/uso terapêutico , Exame de Medula Óssea/métodos , Osteomielite/etiologia , Abscesso do Psoas/etiologia , Articulação Sacroilíaca/patologia , Medula Óssea , Humanos , Lactente , Masculino , Osteomielite/tratamento farmacológico , Abscesso do Psoas/tratamento farmacológico , Tomografia Computadorizada por Raios X
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