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1.
BMC Infect Dis ; 21(1): 1267, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34930151

RESUMO

BACKGROUND: Streptococcus constellatus is a member of Streptococcus anginosus group (SAG) that tends to cause pyogenic infections in various sites. However, Streptococcus constellatus is easily ignored by routine clinical laboratory tests for its prolonged anaerobic culture environment. CASE PRESENTATION: A 71-year-old man was admitted to our hospital due to productive cough, fever, chest pain and shortness of breath for 3 weeks. Chest computed tomography showed patchy opacities and right-sided pleural effusion, so a chest tube was inserted and purulent and hemorrhagic fluid was aspirated. The routine etiological examinations of the pleural effusion were all negative, and next-generation sequencing (NGS) detected Streptococcus constellatus. Intravenous piperacillin-tazobactam 4.5 g every 8 h was used accordingly. The patient recovered and subsequent chest computed tomography confirmed the improvement. CONCLUSIONS: We reported a case of empyema secondary to Streptococcus constellatus infection, which was identified by NGS, instead of bacterial culture. This case highlights the utility of NGS in detecting pathogens negative in traditional bacterial tests.


Assuntos
Empiema , Infecções Estreptocócicas , Streptococcus constellatus , Idoso , Empiema/diagnóstico , Febre , Humanos , Masculino , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico
2.
BMJ Case Rep ; 14(11)2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34753723

RESUMO

Helcococcus kunzii is a Gram-positive anaerobic facultative coccus that colonises the skin. Human infection is rare, with very few cases being described in the literature. The authors present the case of a 17-year-old man, with a history of cholesteatoma, diagnosed with mastoiditis complicated by intracranial empyema. After urgent surgical drainage, Gram staining revealed a Gram-negative bacillus and a Gram-positive coccus. The latter exhibited fastidious growth, presented as small grey colonies in blood agar, and was afterwards identified as H. kunzii The patient was started on intravenous antibiotics, switched to oral route after 8 weeks and fully recovered. To the best of our knowledge, this is the third case of an intracranial infection in which H. kunzii is involved, two of them occurring in patients with cholesteatoma.


Assuntos
Empiema , Infecções por Bactérias Gram-Positivas , Cocos Gram-Positivos , Adolescente , Firmicutes , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino
3.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(8): 920-924, 2021 Aug 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34565740

RESUMO

Pasteurella multocida empyema is rare and easy to be misdiagnosed. An 81-year-old male patient showed symptoms with cough, sputum, and fever for 3 days. Community-acquired pneumonia was diagnosed firstly. After anti-infection treatment, the patient was still in fever. Chest radiography showed pleural effusion, closed thoracic drainage was performed and the reddish-brown fluid was drained out. The second-generation sequencing was performed on pleural fluid and Pasteurella multocida was detected. Pasteurella multocida has strict requirements for growth conditions and it difficult to cultivate. The application of second-generation sequencing is helpful to diagnose the pathogen rapidly.


Assuntos
Empiema , Infecções por Pasteurella , Pasteurella multocida , Derrame Pleural , Idoso de 80 Anos ou mais , Humanos , Masculino , Infecções por Pasteurella/diagnóstico , Pasteurella multocida/genética , Escarro
4.
BMC Infect Dis ; 21(1): 745, 2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344324

RESUMO

BACKGROUND: Empyema necessitans is a rare pulmonary condition described as the presence of pus in the pleural cavity with insidious extension into the surrounding soft tissue. The common microbial aetiology of empyema necessitans is tuberculosis. Nocardiosis a cause of empyema necessitans is rarely described in the literature. We herein present a case of an 80-year-old male with empyema necessitans with osteomyelitis of rib caused by Nocardia farcinica. CASE PRESENTATION: An 80-year-old male presented with complaints of soft swelling on the left lower posterior chest wall associated with dry cough and breathlessness on exertion. Computed Tomography (CT) thorax demonstrated empyema necessitans with features of left fifth rib osteomyelitis. Radiological guided aspiration of the chest wall collection revealed Nocardia species and surgical drainage of abscess was performed. Matrix-assisted laser desorption/ionization time-of-flight-mass spectrometry (MALDI-TOF-MS) identified the isolate as Nocardia farcinica. He was treated with three-drug regimen: Trimethoprim-sulfamethoxazole, amikacin and ceftriaxone for 2 weeks. After showing improvement patient was discharged and advised to take oral Trimethoprim-sulfamethoxazole for the next 6 months with periodic follow-up. CONCLUSIONS: As our case demonstrates, the possibility of invasive Nocardiosis should not be overlooked even in immunocompetent patients. Clinicians should aware of this rare entity while treating patients with empyema necessitans.


Assuntos
Empiema , Nocardiose , Nocardia , Osteomielite , Idoso de 80 Anos ou mais , Humanos , Masculino , Nocardiose/complicações , Nocardiose/diagnóstico , Nocardiose/tratamento farmacológico , Osteomielite/tratamento farmacológico , Costelas
5.
Kyobu Geka ; 74(8): 595-597, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34334601

RESUMO

A 69-year-old man had experienced right upper lobectomy for inflammatory granuloma. Three months after surgery, he was diagnosed with pleural empyema due to bronchopleural fistula and open window thoracostomy was performed. Since we could not decrease the dead space and the amount of pleural effusion, we introduced negative pressure wound therapy (NPWT). Before applying, we closed the fistula with suturing and cyanoacrylate products. Four weeks later, we performed an operation to close the open window with muscle transposition. NPWT is reported to be useful to treat pleural empyema, but control the air leakage from fistulas is essential to introduce this treatment. We think cyanoacrylate products may be useful in closing fistulas temporarily to introduce NPWT.


Assuntos
Fístula Brônquica , Empiema Pleural , Empiema , Tratamento de Ferimentos com Pressão Negativa , Doenças Pleurais , Idoso , Fístula Brônquica/cirurgia , Cianoacrilatos , Empiema Pleural/cirurgia , Humanos , Masculino , Doenças Pleurais/cirurgia , Pneumonectomia
6.
BMC Infect Dis ; 21(1): 765, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362324

RESUMO

BACKGROUND: Cat scratch disease frequently involves a benign, self-limited disease. Neurological forms associated with Bartonella henselae are uncommon, consisting mostly in neuroretinitis, encephalitis and meningitis. Cerebral epidural empyema has never described. CASE PRESENTATION: An adult patient was hospitalized for isolated headaches. Magnetic Resonance Imaging (MRI) identified typical features of cerebral epidural empyema. The diagnosis of B. henselae was performed incidentally by 16S rDNA gene sequencing on the abscess fluid, and confirmed by specific qPCR. We report here the first case, to our knowledge, of cerebral epidural empyema associated with B. henselae. Further follow-up visits allowed identifying frequent cat scratches on the scalp as the presumptive source of infection. CONCLUSIONS: This case report alerts about such atypical clinical presentation, which requires an extensive clinical investigation. It also emphasizes on the usefulness of additional molecular diagnosis techniques in such CNS infection cases.


Assuntos
Bartonella henselae , Doença da Arranhadura de Gato , Empiema , Retinite , Antibacterianos/uso terapêutico , Doença da Arranhadura de Gato/complicações , Doença da Arranhadura de Gato/diagnóstico , Doença da Arranhadura de Gato/tratamento farmacológico , Empiema/diagnóstico , Empiema/tratamento farmacológico , Humanos
7.
Medicine (Baltimore) ; 100(29): e26682, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398037

RESUMO

RATIONALE: Nocardiosis is an uncommon and potentially life-threatening infection that usually affects immunocompromised hosts. No clinical guidelines have been established for managing this rare disease, and the optimal treatment modality remains unclear. Nocardia farcinica, a relatively infrequent pathogen of nocardiosis, causes a clinically aggressive infection. In addition to our patient data, our search of the literature for patients who presented with empyema caused by N. farcinica will provide fundamental information for optimal treatment modalities. PATIENT CONCERNS: A 64-year-old man was diagnosed with empyema, 4 days following surgery for sigmoid colon cancer. Brain lesions were evaluated only after N. farcinica was isolated and identified as the causative pathogen through repeated culture tests. DIAGNOSES: N. farcinica was isolated from the pleural effusion and confirmed as the pathogen through 16S rRNA sequencing. INTERVENTIONS: The patient was successfully treated with tube thoracotomy, neurosurgical evacuation, and a combination of trimethoprim/sulfamethoxazole plus imipenem. Long-term antibiotic therapy was required to prevent recurrence. OUTCOMES: Pyothorax showed a good clinical response to antimicrobial therapy and drainage of pleural effusion, whereas brain abscess did not respond to medical therapy and required surgery. The patient eventually recovered and continued chemotherapy as treatment for sigmoid colon cancer. LESSONS: Although extremely rare, this report demonstrates the importance of considering Nocardia infection as the differential diagnosis in immunocompromised patients who present with empyema. In particular, because of the N. farcinica infection's tendency to spread and the resistance of the organism to antibiotics, aggressive evaluation of metastatic lesions and standardized support from microbiological laboratories are important. Surgery may be required in some patients with brain abscesses to improve the chance of survival.


Assuntos
Adenocarcinoma , Abscesso Encefálico/diagnóstico , Neoplasias do Colo , Empiema/diagnóstico , Nocardiose/diagnóstico , Nocardia/isolamento & purificação , Anti-Infecciosos/uso terapêutico , Abscesso Encefálico/complicações , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Diagnóstico Diferencial , Empiema/complicações , Empiema/diagnóstico por imagem , Empiema/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Nocardiose/complicações , Nocardiose/diagnóstico por imagem , Nocardiose/tratamento farmacológico , Tomografia Computadorizada por Raios X , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
8.
Thorac Surg Clin ; 31(3): 293-302, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34304837

RESUMO

Several important complications of pneumonectomy are discussed in a case-based format. Topics include chylothorax, cardiac herniation, postpneumonectomy syndrome, postpneumonectomy pulmonary edema, bronchopleural fistula, and empyema.


Assuntos
Pneumonectomia , Complicações Pós-Operatórias , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Empiema , Humanos , Doenças Pleurais/diagnóstico , Doenças Pleurais/etiologia , Doenças Pleurais/cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia
9.
Pediatr Pulmonol ; 56(9): 2949-2957, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232567

RESUMO

AIM: The incidence of childhood empyema has been increasing in some developed countries despite the introduction of pneumococcal vaccination. This study aimed to document the incidence, bacterial pathogens, and morbidity/mortality of parapneumonic effusion/empyema in New Zealand. METHODS: A prospective study of 102 children <15 years of age requiring hospitalization with parapneumonic effusion/empyema between May 1, 2014 and May 31, 2016 notified via the New Zealand Paediatric Surveillance Unit. Parapneumonic effusion/empyema was defined as pneumonia and pleural effusion persisting ≥7 days, and/or any pneumonia, and pleural effusion necessitating drainage. Notifying pediatricians completed standardized questionnaires. RESULTS: Annual pediatric parapneumonic effusion/empyema incidence was 5.6/100,000 (95% confidence interval [CI]: 4.7-6.9). Most children (80%) required surgical intervention and 31% required intensive care. A causative organism was identified in 71/102 (70%) cases. Although Staphylococcus aureus (25%) and Streptococcus pneumoniae (25%) infection rates were equal, prolonged hospitalization and intensive care admission were more common in children with S. aureus PPE/E. Maori and Pasifika children were over-represented at 2.2 and 3.5 times, their representation in the New Zealand pediatric population. Pneumococcal vaccination was incomplete, with only 61% fully immunized and 30% unimmunized. Haemophilus influenzae type b vaccine uptake was near complete at 89/94 (95%), with influenza immunization only 3/78 (4%). CONCLUSIONS: New Zealand has a high incidence of pediatric complicated parapneumonic effusion/empyema with significant morbidity. S. aureus was a significant cause of severe empyema in New Zealand, particularly for Maori and Pasifika children. Improvements in vaccine coverage are needed along with strategies to reduce S. aureus disease morbidity.


Assuntos
Empiema Pleural , Empiema , Derrame Pleural , Criança , Empiema Pleural/epidemiologia , Humanos , Lactente , Nova Zelândia/epidemiologia , Derrame Pleural/epidemiologia , Estudos Prospectivos , Staphylococcus aureus
10.
J Med Case Rep ; 15(1): 373, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34261534

RESUMO

BACKGROUND: Atopic dermatitis is a chronic inflammatory skin disease associated with pruritus. Skin affected by atopic dermatitis not only shows a high percentage of Staphylococcus aureus colonization, but corneal barrier dysfunction is also known to occur. It is considered a risk factor for bacterial infections in various areas of the body. However, the relationship between atopic dermatitis and bacterial infection following neurological surgery has not yet been reported. Here, we present a case of atopic dermatitis in which the surgical site became infected twice and finally resolved only after the atopic dermatitis was treated. CASE PRESENTATION: A 50-year-old Japanese woman with atopic dermatitis underwent cerebral aneurysm clipping to prevent impending rupture. Postoperatively, she developed repeated epidural empyema following titanium cranioplasty. As a result of atopic dermatitis treatment with oral antiallergy medicines and external heparinoids, postoperative infection was suppressed by using an absorbable plastic plate for cranioplasty. The patient's postoperative course was uneventful for 16 months. CONCLUSIONS: Atopic dermatitis is likely to cause surgical-site infection in neurosurgical procedures, and the use of a metal implant could promote the development of surgical-site infection in patients with dermatitis.


Assuntos
Dermatite Atópica , Empiema , Infecções Estafilocócicas , Dermatite Atópica/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Pele , Infecções Estafilocócicas/complicações , Staphylococcus aureus
11.
Can Vet J ; 62(6): 592-597, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34219765

RESUMO

A mixed-breed pygmy goat was presented for nonambulatory tetraparesis. Neurological examination was consistent with a C6 to T2 myelopathy. Initially, the goat was treated medically. Forty-three days later, magnetic resonance imaging (MRI) revealed an extradural mass compressing the cervical spinal cord. Magnetic resonance attributes of the mass were consistent with a slow-growing, fluid-poor lesion. The spinal cord was surgically decompressed. Epidural empyema secondary to Fusobacterium necrophorum was identified. Postoperative care consisted of anti-inflammatory medication, antimicrobials, and physical therapy. Ability to walk occurred by day 14 after surgery. Despite prolonged recumbency before surgery, the goat was clinically normal, and antimicrobials were discontinued on day 60 after surgery. Key clinical message: Epidural empyema can cause a compressive myelopathy which may result in varying degrees of paresis/paralysis. Clinical resolution and return of normal function occurred following the use of MRI to plan surgical decompression combined with extended use of antimicrobials.


Assuntos
Empiema , Doenças das Cabras , Compressão da Medula Espinal , Doenças da Medula Espinal , Animais , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/veterinária , Empiema/diagnóstico , Empiema/veterinária , Doenças das Cabras/diagnóstico , Doenças das Cabras/tratamento farmacológico , Cabras , Imageamento por Ressonância Magnética/veterinária , Compressão da Medula Espinal/cirurgia , Compressão da Medula Espinal/veterinária , Doenças da Medula Espinal/veterinária
12.
Respir Investig ; 59(5): 686-690, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34120847

RESUMO

Co-infections of Streptococcus anginosus group (SAG) bacteria and obligate anaerobes are observed in patients with empyema; however, their epidemiology and pathology remain unknown. A retrospective study was performed with 44 patients who underwent pleural effusion microbiota evaluation between January 2006 and March 2018, using the clone library method for detecting empyema caused by SAG bacteria. Based on culture analysis of pleural effusion, 12 patients were diagnosed with empyema caused by SAG bacteria. Obligate anaerobe phylotypes were detected in eight patients (66.7%) using the clone library method, whereas anaerobic culture analysis detected anaerobes in only two patients (16.7%). No significant difference was observed between the clinical features of SAG-mediated empyema with and without anaerobes using the clone library method, except for chest computed tomographic data. Co-infection of SAG bacteria and obligate anaerobes may be underestimated if conventional culture methods are used. SAG-mediated empyema with and without anaerobes may present different radiological features; therefore, further studies are required.


Assuntos
Bactérias Anaeróbias , Empiema , Streptococcus anginosus , Bactérias , Empiema/microbiologia , Humanos , Estudos Retrospectivos
13.
Pediatr Pulmonol ; 56(8): 2700-2706, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33991059

RESUMO

INTRODUCTION: Community acquired pneumonia (CAP) is a leading cause of morbidity in children, despite advances in health care and anti-pneumococcal vaccine. Complicated pneumonia accounts for a significant burden with prolonged hospitalization. Finding risk factors for complicated pneumonia may help in tailoring management. We aimed to identify risk factors for developing complicated pneumonia and need for intervention. METHODS: A retrospective single tertiary center study. Children admitted with a diagnosis of CAP and/or complicated pneumonia (parapneumonic effusion, empyema, necrotizing pneumonia, and lung abscess) on January 2001-March 2020 were included. Demographic, clinical, and laboratory parameters were collected using MDclone, a data acquisition tool. Risk factors for complicated pneumonia (on admission or during hospitalization) and risk for intervention were analyzed. RESULTS: A total of 6778 children with pneumonia were included; 323 arrived at the Emergency Department with complicated pneumonia while 232 developed a complication during hospitalization. Risk factors for complicated pneumonia (on admission or during hospitalization) were Arab ethnicity, cardiac disease, increased age, and CRP and low O2 Sat (OR = 2.236 p < .001, OR = 4.376 p < .001, OR = 1.131 p < .001, OR = 1.065 p < .001 and OR = 0.959 p = .029, respectively). O2 Sat was lower, while fever and CRP were higher in patients with complicated pneumonia requiring intervention. CONCLUSIONS: Identifying children at risk for complicated pneumonia may help in decision-making in the Emergency Department and during hospitalization. The increased risk of the Arab population for complicated pneumonia requires further understanding. Addressing the underlying socioeconomic and ethnic health inequities may help to decrease the disease burden in this population.


Assuntos
Infecções Comunitárias Adquiridas , Empiema , Derrame Pleural , Pneumonia , Criança , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/epidemiologia , Hospitalização , Humanos , Pneumonia/complicações , Pneumonia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
14.
Pediatr Pulmonol ; 56(8): 2668-2675, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33963675

RESUMO

OBJECTIVES: To assess the diagnostic role of chest magnetic resonance imaging (MRI) for evaluating empyema in children with specific indications. METHODS: Nineteen children (5-16 years) with a diagnosis of empyema were enrolled in this prospective study from January 2018 to February 2020. MRI and multidetector computed tomography (MDCT) of the chest was performed within 48 h of each other. Two pediatric radiologists independently evaluated the MRI and CT images for the presence of fluid and air in the pleural cavity, septations within the fluid, pleural thickening, pleural enhancement, drainage tube tip localization, consolidation, and lymphadenopathy. Kappa test of agreement was used to determine the agreement between the MRI and MDCT findings. Chance-corrected kappa statistics were used for calculating the interobserver variation. RESULTS: The kappa test showed almost perfect agreement (κ = 1) between MRI and MDCT for detecting fluid, pleural thickening, pleural enhancement, drainage tube tip localization, consolidation, and lymphadenopathy. Septations within the fluid were detected in 16 (84.2%) patients on MRI, and in 14 (73.7%) patients on MDCT. Almost perfect agreement (κ = 0.81-1.00) was seen for all the findings on CT and MRI between the two radiologists, except for pleural thickening for which a strong agreement (κ = 0.642) was observed. CONCLUSION: MRI is comparable to MDCT for the detection of various findings in children with empyema. MRI may be considered in lieu of CT, as a problem-solving tool and as a radiation-reducing endeavor in children with empyema, specifically, only where CT is required for preoperative planning and evaluation of complications.


Assuntos
Empiema , Imageamento por Ressonância Magnética , Criança , Humanos , Projetos Piloto , Estudos Prospectivos , Tórax
15.
Vaccine ; 39(26): 3516-3519, 2021 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-34006409

RESUMO

BACKGROUND: Recently, emergence of a higher proportion of serotype 3 in children with parapneumonic pleural effusion/empyema (PPE/PE) were observed in Germany despite general immunization with 13-valent pneumococcal conjugate vaccine (PCV13) since 2009. The impact of PCV13 on the overall incidence of PPE/PE in children is unclear. METHODS: Annual incidence of PPE/PE in children were determined using secondary health care data for 2009-2018, provided by the Barmer statutory health insurer, serving about 11% of the German population. Temporal trends of the annual incidence were modelled applying generalized additive models. RESULTS: Overall incidence of PPE/PE in children ( ≤18 years) in the ten-year observation period was 18.17 per 100,000. The 0-1 year olds showed the highest incidence (43.09 per 100 000). PPE/PE incidence decreased from 2009 until 2013 (nadir 2013 was 15.36; 95% CI: 13.41-17.31). Since 2013, the data show an annual increase. The nadir of incidence for the 2-5 year olds (15.85; 95% CI: 11.27-20.43) and the 6-18 year olds (12.29; 95% CI: 10.23-14.36) was also in 2013, whereas for the 0-1 year olds it was found in 2014 (32.66; 95% CI: 23.79-41.54). The GAM across all age groups showed a nearly U-shaped curve between time and incidence of PPE/PE by calendar year (p-non-linear = 0.0017). The model confirms the nadir in the year 2013. DISCUSSION: We found a nonlinear temporal trend of PPE/PE incidence in children with a decrease from 2009 to 2013 and a subsequent increase until 2018. The former might be explained by a quasi elimination of serotype 1, the latter by an increase in the proportion of serotype 3 as demonstrated in German surveillance data of pediatric PPE/PE cases generated during the same observation period.


Assuntos
Empiema , Derrame Pleural , Adolescente , Criança , Pré-Escolar , Alemanha/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Seguro Saúde , Vacinas Pneumocócicas
16.
Diagn Interv Radiol ; 27(3): 401-407, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34003128

RESUMO

PURPOSE: We aimed to evaluate the results of percutaneous management of complicated parapneumonic effusions (PPE) and empyema after surgical tube thoracostomy failure in children. METHODS: A total of 84 children treated percutaneously after surgical tube thoracostomy failure between 2004 and 2019 were included to this retrospective study. Technical success was defined as appropriate placement of the drainage catheter. Clinical success was defined as complete resolution of infection both clinically and radiologically. Management protocol included imaging-guided pigtail catheter insertion, fibrinolytic therapy, serial ultrasonographic evaluation, catheter manipulations as necessary (revision, exchange, or upsizing), and appropriate antibiotherapy. All patients were followed up at least 6 months. RESULTS: Technical success rate was 100%. Unilateral single, unilateral double, and bilateral catheter insertions were performed in 73, 9, and 2 patients, respectively. Inserted catheter sizes ranged from 8 F to 16 F. Streptokinase, urokinase, and tissue plasminogen activator were used as fibrinolytic agent in 29 (34%), 14 (17%), and 41 (49%) patients, respectively. In order to maintain effective drainage, 42 additional procedures (catheter exchange, revision, reposition, or additional catheter placement) were performed in 20 patients (24%). Clinical success was achieved in 83 of 84 patients (99%). Median catheter duration was 8 days (4-32 days). Median hospital stay during percutaneous management was 11.5 days (7-45 days). Factors affecting the median catheter duration were the presence of necrotizing pneumonia (p < 0.001) and bronchopleural fistulae (p < 0.001). CONCLUSION: Percutaneous imaging-guided catheterization with fibrinolytic therapy should be the method of choice in pediatric complicated PPE and empyema patients with surgical tube thoracostomy failure. Percutaneous treatment is useful in avoiding more aggressive surgical options.


Assuntos
Empiema , Derrame Pleural , Tubos Torácicos , Criança , Drenagem , Empiema/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Humanos , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/cirurgia , Estudos Retrospectivos , Toracostomia , Ativador de Plasminogênio Tecidual , Resultado do Tratamento
17.
BMJ Case Rep ; 14(5)2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34035027

RESUMO

A 44-year-old man presented to the emergency department with fever and right anterior chest pain. He reported a persistent cough and the development of sudden-onset right anterior chest pain after coughing. The inspiratory pain in the right lung was severe, and therefore deep breathing was impossible. Chest CT revealed a fracture in the right seventh rib with consolidation and pleural effusion. A pleural fluid culture test result was positive for methicillin-susceptible Staphylococcus aureus He was diagnosed with empyema associated with a cough-induced rib fracture. Thoracic drainage tube placement and intravenous antibiotic therapy successfully ameliorated his condition. He was discharged on day 13 and switched to an 8-week course of oral antibiotic therapy. There was no clinical relapse at the 6-month follow-up.


Assuntos
Empiema , Derrame Pleural , Fraturas das Costelas , Adulto , Tosse/etiologia , Humanos , Pulmão , Masculino , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico por imagem
18.
Kyobu Geka ; 74(4): 313-316, 2021 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-33831893

RESUMO

The case was a 57-year-old woman. She visited a local doctor with a chief complaint of sore throat. A retropharyngeal abscess was suspected, and she was referred to our otolaryngology. Contrast-enhanced computed tomography(CT) scan revealed continuous fluid retention from the retropharyngeal space to the neck and the superior and posterior mediastinum with bilateral pleural effusion. The patient was diagnosed with descending necrotizing mediastinitis with empyema, and on the same day cervical drainage, thoracoscopic bilateral mediastinal drainage, empyema curettage and tracheostomy was performed. Postoperative contrast-enhanced CT scan revealed a widespread residual mediastinal abscess and thoracoscopic bilateral mediastinal drainage was performed again on the 11th postoperative day. After reoperation, the inflammation gradually subsided and she was discharged 47 days after reoperation.


Assuntos
Empiema , Mediastinite , Abscesso , Drenagem , Empiema/complicações , Empiema/diagnóstico por imagem , Empiema/cirurgia , Feminino , Humanos , Mediastinite/complicações , Mediastinite/diagnóstico por imagem , Mediastinite/cirurgia , Mediastino , Pessoa de Meia-Idade , Necrose
19.
Pediatr Allergy Immunol Pulmonol ; 34(1): 33-37, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33734873

RESUMO

Introduction: Hyperimmunoglobulin E syndromes (HIESs) are characterized by a high serum immunoglobulin E (IgE) level, eczematoid rashes, recurrent staphylococcal skin abscesses, and recurrent pneumonia and pneumatocele formation. Autosomal dominant HIES is the most common form of HIES and mainly occurs due to loss-of-function mutations in the Signal Transducer and Activator of Transcription 3 (STAT3) gene (STAT3 LOF). Case Presentation: We report the case of an 11-year-old Peruvian girl diagnosed with STAT3 LOF caused by p.R382W mutation. She presented with recurrent staphylococcal pneumonia and empyema caused by the rarely reported Achromobacter xylosoxidans, which led to severe destruction of the lung parenchyma, multiple lung surgeries, and the development of bronchopleural fistulas. A laparotomy was also performed, which showed evidence of sigmoid colon perforation. The patient received immunoglobulin replacement therapy (IRT) and antibiotic prophylaxis, and the frequency of her infections has decreased over the past 3 years. Conclusion: This is the first case of STAT3 LOF diagnosed by genomic sequencing in Peru. Patients with this mutation have recurrent pulmonary infections, and require multiple surgical procedures with frequent complications. A. xylosoxidans infection could be related to the prolonged stay in intensive care leading to high mortality; therefore, additional care must be taken when treating patients with this infection. In addition, colonic perforation is a rare complication in STAT3 LOF patients. IRT and antibiotic prophylaxis appear to decrease the frequency of infections and hospitalizations.


Assuntos
Achromobacter denitrificans/isolamento & purificação , Empiema/microbiologia , Síndrome de Job/diagnóstico , Síndrome de Job/genética , Mutação com Perda de Função , Pneumonia Estafilocócica/cirurgia , Fator de Transcrição STAT3/genética , Criança , Empiema/diagnóstico , Humanos , Imunoglobulina E/genética , Masculino , Mutação , Pneumonia Estafilocócica/microbiologia , Complicações Cognitivas Pós-Operatórias , Análise de Sequência de DNA
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