Brain abscess: clinical aspects of 100 patients.

OBJECTIVE: To verify if, in the last two decades, there have been any changes in epidemiological, clinical, diagnostic, therapeutic and prognostic aspects of patients with brain abscess. METHOD: We studied retrospectively 100 patients discharged over a 17-year period from Ca' Foncello Regional Hospital, Treviso, Italy with a diagnosis of brain abscess. RESULTS: Post-surgical abscesses were more frequent than those related to contiguous infections and the spectrum of etiologic agents was very heterogeneous. A cerebral neoplasm was the initial neuroradiological diagnosis in 13 patients; 72 patients underwent a neurosurgical procedure. A comatose state at presentation was associated with an unfavourable outcome. CONCLUSION: With the exception of some epidemiological aspects, which varied from the literature, in spite of the improvements in diagnostic procedures and treatment, no significant changes occurred in the prognosis of patients with brain abscess.

Conservative management of deep neck abscesses in adults: the importance of CECT findings.

OBJECTIVES: To review cases of DNAs with special emphasis on contrast-enhanced computed tomography (CECT) findings and their implications for treatment planning. STUDY DESIGN AND SETTINGS: Retrospective evaluation of adult patient records with diagnosis of DNAs on CECT at Treviso Regional Hospital. RESULTS: Eighty patients were identified. In 30.0% of cases, an immediate surgical drainage was performed. In 22.5% of cases, a surgical drainage was necessary because of the lack of clinical response to medical therapy alone. Almost half of the patients were treated with antibiotics alone with complete remission. DM was predictive for lack of response to medical therapy alone (P=0.014). Intraoperative findings confirmed the CECT diagnosis in 88.1%. CONCLUSIONS: Although the mainstay of treatment for deep neck abscesses remains surgical drainage, small abscesses can respond to antibiotics alone. CECT monitoring of DNAs was the essential steps in choosing the more appropriate treatment and, probably, the basis for the good prognosis of patients.

Which antibiotic prophylaxis to use for urologic procedures in patients at risk for infective endocarditis: a report on two cases.

In urologic surgery, antibiotic prophylaxis is generally recommended for transrectal prostate biopsies and transurethral prostate resection. While a fluoroquinolone (such as ciprofloxacin or levofloxacin) may be appropriate in most instances, patients at risk for infectious endocarditis (IE) may require a different regimen, effective also against Enterococcus species. We describe and comment on the cases of two patients who, following urologic procedures and antibiotic prophylaxis, developed Enterococcus faecalis endocarditis. We also propose an antibiotic prophylactic regimen for urologic procedures suitable for patients at risk for infectious endocarditis (IE).

Laryngeal tuberculosis: an often forgotten diagnosis.

OBJECTIVE: Clinical description of laryngeal tuberculosis. METHODS: Clinical case review. RESULTS: The authors report three cases of laryngeal tuberculosis with lung involvement in HIV-negative patients; symptoms were mostly laryngeal. Diagnosis was made in all cases through laryngeal biopsy and examination of the sputum. Patients fully recovered after being given standard antituberculosis therapy. CONCLUSIONS: Laryngeal tuberculosis almost disappeared after the 1950s, but, concomitant with the increase in pulmonary forms, may still be found and, being uncommon, is often misdiagnosed.

[Cholera epidemic in Brescia in 1836]. / L'epidemia di colera a Brescia del 1836.

Cholera first made its appearance in Italy in 1836. According to reports of the time the consequences were catastrophic: both the number of the people falling ill and the incidence of mortality were high. On the basis of extensive documentation from various archives, the disease appears to have been known in its clinical aspect but its aetiology remained obscure. Hence physicians were powerless to combat such a scourge. The sense of unease and confusion that accompanied the evolution of these sad events drove the population to the use of religious practices of various kinds. It is still possible to find signs of such devotion in churches, votive chapels and ex voto offerings.

Retinopathy in chronic hepatitis C patients during interferon treatment: a case report.

Ocular involvement, mainly as optic neuropathy or retinopathy, in the course of interferon therapy is clinically rare, while the subclinical retinal toxicity is quite frequent. We present a case of retinal toxicity during treatment with PEG-INF alpha 2b and ribavirin for HCV hepatitis. We suggest that all patients receive an ophthalmological examination at base-line and repeated ophthalmological examination only if clinically advisable.

Deep neck infections: a constant challenge.

BACKGROUND: Although the advent of antibiotics and improved dental care decreased the incidence and mortality, deep neck infections (DNIs) are not uncommon and present a challenging problem due to the complex anatomy and potentially lethal complications that may arise. OBJECTIVES: This study reviews our experience with DNIs and tries to identify the predisposing factors of life-threatening complications. METHODS: A retrospective review was conducted of patients who were diagnosed as having DNIs in the Department of Otolaryngology and in the Department of Infectious Diseases at Treviso Regional Hospital from 1995 to 2003. Associations between life-threatening complications and other factors were determined by chi(2) test, Fisher's exact test and Student's t test as appropriate. RESULTS: One hundred sixty-seven charts were recorded; 95 (56.9%) were men, and 72 (43.1%) were women, with a mean age of 49.6 +/- 20.4 years (range: 2-96). There were 39 patients (23.4%) who had associated systemic diseases, with 53.8% (21/39) of those having diabetes mellitus. The lateral pharyngeal and submandibular spaces were the most commonly involved spaces. Upper airway infections and odontogenic infections were the two most common causes of DNIs (47.5 and 27.9% of the known causes, respectively). The pathogenesis remained unknown in 45 patients (26.9%). Coagulase-negative staphylococcus (36.9%) and Streptococcusviridans (28.8%) were the most common organisms, identified through cultures. Of the abscess group (77 patients), 42 patients (54.5%) underwent surgical drainage under general anesthesia. Thirty-one patients (18.6%) developed life-threatening complications: airway obstruction (n = 18), descending mediastinitis (n = 6), jugular vein thrombosis (n = 4), and pneumonia (n = 3). Compared with other patients, the unique features of patients with life-threatening complications were as follows: older age (p = 0.04), a higher white blood cell count (p = 0.01), abscess formation (p = 0.02), associated systemic disease (p < 0.001), diabetes mellitus (p < 0.001), anterior visceral space involvement (p < 0.001), and multiple-space involvement (p < 0.001). CONCLUSIONS: DNIs continue to occur and these are associated with significant morbidity and mortality even in this era of antibiotics. Furthermore, the widespread and inappropriate use of antibiotics may change the clinical presentation and course of these infections, making them more elusive and less predictable also in complicated cases. The clinical assessment of patients who are older, with abscess formation, underlying systemic diseases, diabetes mellitus, visceral anterior space or multiple-space involvement requires careful consideration of potential complications.

Levofloxacin disposition in cerebrospinal fluid in patients with external ventriculostomy.

In vitro levofloxacin exhibits both potent or intermediate activity against most of the pathogens frequently responsible for acute bacterial meningitis and synergistic activity with some beta-lactams. Since levofloxacin was shown to penetrate the cerebrospinal fluid (CSF) during meningeal inflammation both in animals and in humans, the disposition of levofloxacin in CSF was studied in 10 inpatients with external ventriculostomy because of communicating hydrocephalus related to subarachnoid occlusion due to cerebral accidents who were treated with 500 mg of levofloxacin intravenously twice a day because of extracerebral infections. Plasma and CSF concentration-time profiles and pharmacokinetics were assessed at steady state. Plasma and CSF levofloxacin concentrations were analyzed by high-pressure liquid chromatography. The peak concentration of levofloxacin at steady state (C(max ss))was 10.45 mg/liter in plasma and 4.06 mg/liter in CSF, respectively, with the ratio of the C(max ss) in CSF to the C(max ss) in plasma being 0.47. The areas under the concentration-time curves during the 12-h dosing interval (AUC(0-tau)s) were 47.69 mg. h/liter for plasma and 33.42 mg. h/liter for CSF, with the ratio of the AUC(0-tau) for CSF to the AUC(0-tau) for plasma being 0.71. The terminal-phase half-life of levofloxacin in CSF was longer than that in plasma (7.02 +/- 1.57 and 5.51 +/- 1.36 h, respectively; P = 0.034). The ratio of the levofloxacin concentration in CSF to the concentration in plasma progressively increased with time, from 0.30 immediately after dosing to 0.99 at the end of the dosing interval. In the ventricular CSF of patients with uninflamed meninges, levofloxacin was shown to provide optimal exposure, which approximately corresponded to the level of exposure of the unbound drug in plasma. The findings provide support for trials of levofloxacin with twice-daily dosing in combination with a reference beta-lactam for the treatment of bacterial meningitis in adults. This cotreatment could be useful both for overcoming Streptococcus pneumoniae resistance and for enabling optimal exposure of the CSF to at least one antibacterial agent for the overall treatment period.