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Zhang M, Luo H, Tan S, Fei T, Tang Z, Li Q, Lin H. Report on the diagnosis and treatment of 3 cases of emphysematous pyelonephritis with two different outcomes. Front Med (Lausanne) 2024; 11:1410014. [PMID: 38994336 PMCID: PMC11236536 DOI: 10.3389/fmed.2024.1410014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 06/18/2024] [Indexed: 07/13/2024] Open
Abstract
Background Emphysematous pyelonephritis (EPN) is a rare acute severe necrotising infection of the kidneys in clinical practice. It is characterized by the presence of gas in the renal parenchyma, collecting system, or perirenal tissue. The prognosis is poor, with a high nephrectomy rate and a mortality rate of up to 20-40%. Methods Retrospective analysis of 3 cases of emphysematous pyelonephritis with two different outcomes. Results Three patients who we described were all female with diabetes mellitus, and their blood sugar was poorly controlled. One patient with the advanced age and poor general health died due to the patient's family choosing to terminate therapy. Two patients underwent surgical procedures achieved an excellent clinical recovery. Both of them underwent percutaneous nephrostomy and perinephric abscess puncture drainage before nephrectomy. Escherichia coli were the microorganisms implicated. Conclusion EPN is a rare and severe urinary system infection. Computed tomography (CT) and microbiological culture confirmed the diagnosis. Control of diabetes, sensitive antibiotic therapy, fluid resuscitation and prompt surgical intervention are crucial.
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Affiliation(s)
- Minna Zhang
- Department of Nephrology, Tongren Municipal People’s Hospital, Tongren, China
| | - Hongxing Luo
- Department of Urology, Tongren Municipal People’s Hospital, Tongren, China
| | - Su Tan
- Department of Urology, Tongren Municipal People’s Hospital, Tongren, China
| | - Tao Fei
- Department of Urology, Tongren Municipal People’s Hospital, Tongren, China
| | - Zhimin Tang
- Department of Urology, Tongren Municipal People’s Hospital, Tongren, China
| | - Qiang Li
- Department of Urology, Tongren Municipal People’s Hospital, Tongren, China
| | - Haixing Lin
- Department of Urology, Tongren Municipal People’s Hospital, Tongren, China
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McAteer J, Tamma PD. Diagnosing and Managing Urinary Tract Infections in Kidney Transplant Recipients. Infect Dis Clin North Am 2024; 38:361-380. [PMID: 38729666 PMCID: PMC11090456 DOI: 10.1016/j.idc.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
In the article, the authors review antibiotic treatment options for both acute uncomplicated UTI and complicated UTI. In addition, they review alternative regimens which are needed in the setting of drug-resistant pathogens including vancomycin-resistant Enterococcus, -extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales, and carbapenem-resistant Pseudomonas, which are encountered with more frequency.
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Affiliation(s)
- John McAteer
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine; Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pranita D Tamma
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Moffatt C, Maldonado ST, Evans LK, Azizyan A, Blackwell KE. Mucosal emphysematous head and neck infections: Scoping review and a case of emphysematous tonsillitis. Laryngoscope Investig Otolaryngol 2024; 9:e1274. [PMID: 38803461 PMCID: PMC11129548 DOI: 10.1002/lio2.1274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024] Open
Abstract
Objective This scoping review seeks to understand the existing research in otolaryngological mucosal emphysematous infections and to elucidate gaps in knowledge in the field. We also present a case of bilateral necrotizing tonsillitis in an immunocompromised patient with the first reported imaging findings of emphysematous abscess of the tonsils. Data Sources PubMed, Embase, Web of Science. Review Methods We conducted our review according to the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews. Patient presentation, management, and outcomes were summarized. We also describe the case of a patient with aplastic anemia found to have emphysematous tonsillitis, managed with intubation, broad spectrum intravenous antibiotics and bilateral tonsillectomy. Results We identified seven case reports or series, involving nine total patients, who presented with emphysematous epiglottitis, supraglottitis, or tonsillitis. The hallmark imaging characteristic was submucosal "gas bubble" on computed tomography. Presenting symptoms included dysphagia, odynophagia, dysphonia, cough, and fever. Both immunocompetent and immunocompromised patients were affected. All patients were treated with broad spectrum antibiotics, and most with steroids. Patients at risk of airway compromise also underwent intubation and surgical drainage or debridement of the emphysematous infection. Conclusion Emphysematous pharyngeal infections are rare but potentially life-threatening infections that can progress rapidly, resulting in airway compromise and sepsis in both immunocompetent and immunocompromised individuals. We highlight the importance of swift intervention, with intubation and surgical intervention often required for severe cases. More research is needed on common pathogens and patient risk factors to guide future medical and surgical management.
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Affiliation(s)
- Clare Moffatt
- Department of Head & Neck SurgeryDavid Geffen School of Medicine at UCLACaliforniaLos AngelesUSA
| | - Solymar Torres Maldonado
- Department of Head & Neck SurgeryDavid Geffen School of Medicine at UCLACaliforniaLos AngelesUSA
| | - Lauran K. Evans
- Department of Head & Neck SurgeryDavid Geffen School of Medicine at UCLACaliforniaLos AngelesUSA
| | - Avetis Azizyan
- Department of RadiologyDavid Geffen School of Medicine at UCLACaliforniaLos AngelesUSA
| | - Keith E. Blackwell
- Department of Head & Neck SurgeryDavid Geffen School of Medicine at UCLACaliforniaLos AngelesUSA
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Otiniano A, Tassin C, Serris A, Guennouni N, Lanternier F, Servais A, Parize P, Guinebert S, Van Huyen JPD, Bodard S, Boudhabhay I. Emphysematous pyelonephritis in a diabetic patient. J Nephrol 2023; 36:2621-2624. [PMID: 37193924 DOI: 10.1007/s40620-023-01639-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/03/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Armelle Otiniano
- Department of Nephrology and Transplantation, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, 149 rue de Sèvres, 75015, Paris, France
| | - Claire Tassin
- Department of Pathology, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Alexandra Serris
- Department of Infectious and Tropical Diseases, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
- Université Paris Cité, 75006, Paris, France
| | - Nadia Guennouni
- Department of Microbiology, Parasitology and Mycology, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Fanny Lanternier
- Department of Infectious and Tropical Diseases, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
- Université Paris Cité, 75006, Paris, France
| | - Aude Servais
- Department of Nephrology and Transplantation, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, 149 rue de Sèvres, 75015, Paris, France
| | - Perrine Parize
- Department of Infectious and Tropical Diseases, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Sylvain Guinebert
- Université Paris Cité, 75006, Paris, France
- Department of Adult Radiology, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Jean Paul Duong Van Huyen
- Department of Pathology, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
- Université Paris Cité, 75006, Paris, France
| | - Sylvain Bodard
- Université Paris Cité, 75006, Paris, France
- Department of Adult Radiology, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
- Sorbonne Université, CNRS, INSERM Laboratoire d'Imagerie Biomédicale, Paris, France
| | - Idris Boudhabhay
- Department of Nephrology and Transplantation, Necker Enfant-Malades University Hospital, Assistance Publique Des Hôpitaux de Paris, 149 rue de Sèvres, 75015, Paris, France.
- Université Paris Cité, 75006, Paris, France.
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Muacevic A, Adler JR, Akharume OM, Kanemo P. A Rare Case of Complicated Emphysematous Pyelonephritis. Cureus 2023; 15:e33941. [PMID: 36820121 PMCID: PMC9937790 DOI: 10.7759/cureus.33941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Emphysematous pyelonephritis is an acute severe necrotizing infection of the renal parenchyma and its surrounding tissues that results in the presence of gas in the renal parenchyma, collecting system, or perinephric tissue. The management of emphysematous pyelonephritis mainly depends on the extent of the disease. In this report, we present the case of a 48-year-old male who presented with left flank pain and imaging findings of left-sided emphysematous pyelonephritis with extensions of air into the pararenal space as well as a 5.6 cm bladder stone and severe right-sided hydroureteronephrosis. He initially received bilateral nephrostomy tubes, a left-sided perinephric draining tube, and intravenous antibiotics; however, his symptoms persisted. Ultimately, the patient underwent open cystolitholapaxy and left nephrectomy, with eventual resolution of symptoms.
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Ma LP, Zhou N, Fu Y, Liu Y, Wang C, Zhao B. Emphysematous pyelonephritis: Six case reports and review of literature. World J Clin Cases 2022; 10:3268-3277. [PMID: 35647118 PMCID: PMC9082711 DOI: 10.12998/wjcc.v10.i10.3268] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/11/2022] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Emphysematous pyelonephritis (EPN) is a severe acute necrotizing infection of the renal parenchyma and surrounding tissues that causes the presence of gas in the renal parenchyma, collecting system, or perinephric tissue and has a poor prognosis. EPN occurs primarily in people with diabetes mellitus (DM), but can occur in those without DM when the associated renoureteral unit is obstructed.
CASE SUMMARY We describe our experience with six patients who developed EPN. Five patients had DM, including one with diabetic ketoacidosis, one with multisystem involvements, including eye, lung and brain. Bilateral urolithiasis was present in one case, along with emphysematous cystitis. Unilateral kidney stones were present in one patient. One patient was an older man in poor general health. Five individuals survived and underwent surgical procedures including ureteral stent installation (Double J stent placement), percutaneous nephrostomy and perinephric abscess puncture drainage, while one died because the patient’s family chose to terminate therapy. Klebsiella pneumoniae and Escherichia coli were the microorganisms implicated.
CONCLUSION We conclude that EPN is a potentially fatal illness. A positive outcome necessitates early detection. Therapeutic measures should be implemented as soon as a diagnosis is made.
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Affiliation(s)
- Li-Ping Ma
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Ning Zhou
- Department of Urology Surgery, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Yan Fu
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Yan Liu
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Cong Wang
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Bin Zhao
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
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Rahim MA, Ananna MA, Iqbal S, Uddin KN, Latif ZA. Emphysematous pyelonephritis: experience at a tertiary care hospital in Bangladesh. J R Coll Physicians Edinb 2021; 51:19-23. [PMID: 33877129 DOI: 10.4997/jrcpe.2021.106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma, collecting system and/or perinephric tissues, characterized by gas accumulation. We describe clinical, laboratory and imaging characteristics and in-hospital outcomes of patients with EPN. METHODS This retrospective observational study was carried out at BIRDEM General Hospital, Dhaka, Bangladesh between 2014 and 2020. RESULTS We followed 20 patients (mean age 49.4 years; females 70%). Risk factors for EPN were diabetes mellitus (in 100%) and renal stones (in 10%). Fever, loin pain, vomiting and dysuria were common. Complications included acute kidney injury (AKI, 70%; mostly stage 1, 78.6%), hyponatraemia (55%) and bacteraemia (15%). Escherichia coli was the most common (60%) urinary isolate. Most patients (80%) had class 2 EPN, with 15% class 3B and 5% class 3A. Besides medical management, four (20%) required surgery (nephrectomy in 3). Nephrectomised patients had a higher radiological class (p = 0.032) and incidence of AKI (p = 0.034). No deaths occurred. CONCLUSION EPN occurred predominantly in female diabetic patients, who presented with fever, loin pain, vomiting and dysuria. Two-thirds of patients had AKI and one-fifth required surgery, and there were no deaths.
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Affiliation(s)
- Muhammad Abdur Rahim
- Department of Nephrology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh,
| | | | - Sarwar Iqbal
- Department of Nephrology, BIRDEM General Hospital, Dhaka, Bangladesh
| | - Khwaja Nazim Uddin
- Department of Internal Medicine, BIRDEM General Hospital, Dhaka, Bangladesh
| | - Zafar Ahmed Latif
- Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh
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Thapa B, Bhusal N. Candidal emphysematous pyelonephritis: A case report on rare and challenging clinical entity. IJU Case Rep 2021; 4:259-262. [PMID: 34258544 PMCID: PMC8255287 DOI: 10.1002/iju5.12303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/05/2021] [Accepted: 04/16/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Emphysematous pyelonephritis is a rare, severe acute necrotizing infection characterized by the presence of gas within the renal parenchyma, collecting system, and perirenal tissue. It is an aggressive disease with high morbidity and mortality. Patients have female preponderance and commonly have uncontrolled diabetes. It is caused most commonly by Escherichia coli and very rarely by Candida species. Unlike others, candidal emphysematous pyelonephritis has an indistinctive presentation and diagnosed late, thus delaying prompt treatment. CASE PRESENTATION A 35-year-old Type 2 diabetic woman developed pyelonephritis. Computerized tomography revealed the gas in the renal parenchyma, establishing the diagnosis. Cultures isolated Candida albicans as a causative organism. The patient was treated successfully with nephrectomy as initial medical therapy and percutaneous nephrostomy failed. CONCLUSION Rare causative agent should be suspected if clinical presentation is indistinctive and conservative management fails. Nephrectomy is still preferred in such patients.
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