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Xu Z, Gao L, Xu D, Yang D, Chen Z, Wang Y. Clinical features of Streptococcus intermedius infection in children: a case series study. Front Microbiol 2023; 14:1207490. [PMID: 37608948 PMCID: PMC10440951 DOI: 10.3389/fmicb.2023.1207490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction Streptococcus intermedius is an opportunistic pathogen associated with prolonged hospital stays and high mortality rates in adults. However, little is currently known about the clinical features of Streptococcus intermedius infection in children. Methods This retrospective case series study included 40 children diagnosed with Streptococcus intermedius, confirmed through bacterial cultures or high-throughput sequencing. Antibiotic resistance was assessed through susceptibility testing. The site and clinical manifestations were evaluated for all patients. Results The common infection sites were the abdominal cavity, skin and soft tissue, intracranial, and invasive pulmonary, with the abdominal cavity being the most frequently affected. The drug susceptibility test showed 100% sensitivity to ceftriaxone, levofloxacin, chloramphenicol, vancomycin, and linezolid, 92.6% sensitivity to penicillin, 73.3% resistance to erythromycin, and 76.7% resistance to clindamycin. Besides antibiotic therapy, surgical intervention or pus drainage was often necessary. Lung imaging of four patients revealed pulmonary abscesses, nodules, or encapsulated pleura. Two cases yielded positive culture results, while three were identified as positive through high-throughput nucleotide sequencing of pleural effusion. Discussion In children with Streptococcus intermedius infection, emphasis should be placed on the risk of pus or abscess formation. In cases of pulmonary abscess and pleural effusion, especially in male children, Streptococcus intermedius should be suspected even if the culture is negative. Improvements in high-throughput nucleotide sequencing are required to reduce misdiagnosis rates.
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Affiliation(s)
- Zhufei Xu
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lichao Gao
- Department of Cardiology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Dan Xu
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Dehua Yang
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhimin Chen
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yingshuo Wang
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Dietler S, Willms J, Brandi G, Wang S, Burkerth A, Keller E. Spontaneous empyema and brain abscess in an intensive care population: clinical presentation, microbiology, and factors associated with outcome. Acta Neurochir (Wien) 2023; 165:651-658. [PMID: 35618853 PMCID: PMC10006247 DOI: 10.1007/s00701-022-05241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/02/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Data on critically ill patients with spontaneous empyema or brain abscess are limited. The aim was to evaluate clinical presentations, factors, and microbiological findings associated with the outcome in patients treated in a Neurocritical Care Unit. METHODS In this retrospective study, we analyzed 45 out of 101 screened patients with spontaneous epidural or subdural empyema and/or brain abscess treated at a tertiary care center between January 2012 and December 2019. Patients with postoperative infections or spinal abscess were excluded. Medical records were reviewed for baseline characteristics, origin of infection, laboratory and microbiology findings, and treatment characteristics. The outcome was determined using the Glasgow outcome scale extended (GOSE). RESULTS Favorable outcome (GOSE 5-8) was achieved in 38 of 45 patients (84%). Four patients died (9%), three remained severely disabled (7%). Unfavorable outcome was associated with a decreased level of consciousness at admission (Glasgow coma scale < 9) (43% versus 3%; p = 0.009), need of vasopressors (71% versus 11%; p = 0.002), sepsis (43% versus 8%; p = 0.013), higher age (65.1 ± 15.7 versus 46.9 ± 17.5 years; p = 0.014), shorter time between symptoms onset and ICU admission (5 ± 2.4 days versus 11.6 ± 16.8 days; p = 0.013), and higher median C-reactive protein (CRP) serum levels (206 mg/l, range 15-259 mg/l versus 17.5 mg/l, range 3.3-72.7 mg/l; p = 0.036). With antibiotics adapted according to culture sensitivities in the first 2 weeks, neuroimaging revealed a progression of empyema or abscess in 45% of the cases. CONCLUSION Favorable outcome can be achieved in a considerable proportion of an intensive care population with spontaneous empyema or brain abscess. Sepsis and more frequent need for vasopressors, associated with unfavorable outcome, indicate a fulminant course of a not only cerebral but systemic infection. Change of antibiotic therapy according to microbiological findings in the first 2 weeks should be exercised with great caution.
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Affiliation(s)
- Sabeth Dietler
- Neurocritical Care Unit, Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Jan Willms
- Neurocritical Care Unit, Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Giovanna Brandi
- Neurocritical Care Unit, Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Sophie Wang
- Neurocritical Care Unit, Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Astrid Burkerth
- Neurocritical Care Unit, Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Emanuela Keller
- Neurocritical Care Unit, Dept. of Neurosurgery and Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
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Dodson DS, Heizer HR, Gaensbauer JT. Sequential Intravenous-Oral Therapy for Pediatric Streptococcus anginosus Intracranial Infections. Open Forum Infect Dis 2022; 9:ofab628. [PMID: 35028336 PMCID: PMC8753039 DOI: 10.1093/ofid/ofab628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/08/2021] [Indexed: 11/12/2022] Open
Abstract
Background Streptococcus anginosus group is a common cause of pediatric intracranial infections but treatment recommendations, including use of oral therapy, are poorly defined. Methods We performed a retrospective review from 2004 to 2019 of all patients with S anginosus group pyogenic intracranial infections at Children's Hospital Colorado, highlighting patients transitioned to oral therapy. The primary endpoint was worsening infection necessitating intravenous antibiotics or a source control procedure after transition to oral therapy. Results Of 107 patients with S anginosus intracranial infections, 61 were transitioned to exclusive oral therapy after a median intravenous duration of 37 days, overwhelmingly with a levofloxacin-based regimen. Only 1 treatment failure was noted in a patient who did not fill their prescription. Patients with epidural infections were more likely to be transitioned to oral therapy within the first 28 days of treatment (defined as "early"). Patients with parenchymal infections, bacteremia, co-pathogens, higher inflammatory markers, and requiring >1 source control procedure were less likely to be transitioned early to oral therapy. Complications of a central catheter and/or intravenous medications contributed to 56% of oral transitions. Conclusions Levofloxacin-based oral regimens were effective and well tolerated. Patients with less severe infections were more likely to be transitioned early to oral therapy. Criteria for transitioning patients to oral antibiotics for intracranial infections should be established to minimize risks inherent with central catheters.
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Affiliation(s)
- Daniel S Dodson
- Section of Pediatric Infectious Diseases, Department of Pediatrics, University of California, Davis, Sacramento, California, USA.,Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Heather R Heizer
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - James T Gaensbauer
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Zhao Y, Lian B, Liu X, Wang Q, Zhang D, Sheng Q, Cao L. Case report: Cryptogenic giant brain abscess caused by Providencia rettgeri mimicking stroke and tumor in a patient with impaired immunity. Front Neurol 2022; 13:1007435. [PMID: 36212658 PMCID: PMC9538924 DOI: 10.3389/fneur.2022.1007435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/01/2022] [Indexed: 02/05/2023] Open
Abstract
The highly lethal cryptogenic brain abscess can be easily misdiagnosed. However, cryptogenic brain abscess caused by Providencia rettgeri is rarely reported. We present the case of a cryptogenic Providencia rettgeri brain abscess and analyze the clinical manifestations, imaging findings, treatment, and outcome to improve the level of awareness, aid in accurate diagnosis, and highlight effective clinical management. A 39-year-old man was admitted to the hospital after experiencing acute speech and consciousness disorder for 1 day. The patient had a medical history of nephrotic syndrome and membranous nephropathy requiring immunosuppressant therapy. Magnetic resonance imaging revealed giant, space-occupying lesions involving the brain stem, basal ganglia, and temporal-parietal lobes without typical ring enhancement, mimicking a tumor. Initial antibiotic treatment was ineffective. Afterward, pathogen detection in cerebrospinal fluid using metagenomic next-generation sequencing revealed Providencia rettgeri. Intravenous maximum-dose ampicillin was administered for 5 weeks, and the patient's symptoms resolved. Cryptogenic Providencia rettgeri brain abscess typically occurs in patients with impaired immunity. Our patient exhibited a sudden onset with non-typical neuroimaging findings, requiring differentiation of the lesion from stroke and brain tumor. Metagenomic next-generation sequencing was important in identifying the pathogen. Rapid diagnosis and appropriate use of antibiotics were key to obtaining a favorable outcome.
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Affiliation(s)
- Yu Zhao
- Department of Neurology, Shenzhen Third People's Hospital, Shenzhen, China
- Department of Neurology, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Baorong Lian
- Shantou University Medical College, Shantou University, Shantou, China
| | - Xudong Liu
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Qizheng Wang
- Department of Neurology, Shenzhen Third People's Hospital, Shenzhen, China
- Department of Neurology, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Daxue Zhang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Qi Sheng
- Department of Neurology, Shenzhen Third People's Hospital, Shenzhen, China
- Department of Neurology, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Liming Cao
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- *Correspondence: Liming Cao
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Matta S, Rousseau A, Chenouard R, Lemarié C, Eveillard M, Kempf M, Mahieu R, Pailhoriès H. Cerebral epidural empyema due to Bartonella henselae: a case report. BMC Infect Dis 2021; 21:765. [PMID: 34362324 PMCID: PMC8344196 DOI: 10.1186/s12879-021-06488-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Stéphanie Matta
- Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU Angers, 4 rue Larrey, 49933, Angers cedex, France
| | - Audrey Rousseau
- Département de Pathologie Cellulaire et Tissulaire, CHU d'Angers, 4, rue Larrey, 49933, Angers, France
| | - Rachel Chenouard
- Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU Angers, 4 rue Larrey, 49933, Angers cedex, France
| | - Carole Lemarié
- Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU Angers, 4 rue Larrey, 49933, Angers cedex, France
| | - Matthieu Eveillard
- Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU Angers, 4 rue Larrey, 49933, Angers cedex, France.,CRCINA, INSERM, Université de Nantes, Université d'Angers, Angers, France
| | - Marie Kempf
- Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU Angers, 4 rue Larrey, 49933, Angers cedex, France.,CRCINA, INSERM, Université de Nantes, Université d'Angers, Angers, France
| | - Rafaël Mahieu
- Service de Maladies Infectieuses et Tropicales, CHU Angers, CHU, 4 rue Larrey, 49933, Angers cedex, France.,CRCINA, INSERM, Université de Nantes, Université d'Angers, Angers, France
| | - Hélène Pailhoriès
- Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU Angers, 4 rue Larrey, 49933, Angers cedex, France. .,Laboratoire HIFIH, UPRES EA3859, SFR 4208, Université d'Angers, Angers, France.
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Zeng T, Xu Z, Yan J. The value of asphericity derived from T1-weighted MR in differentiating intraparenchymal ring-enhancing lesions-comparison of glioblastomas and brain abscesses. Neurol Sci 2021; 42:5171-5175. [PMID: 33796946 DOI: 10.1007/s10072-021-05226-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Both brain abscess(BA)and glioblastoma (GBM) are common causative pathologies of intraparenchymal ring-enhancing lesions. Advanced MR sequences such as diffusion weighted image (DWI) were often used to increase distinguishability of both entities. PURPOSE To evaluate the value of asphericity (ASP) from conventional T1-weighted MR images in differentiating BA from morphologically similar ring-enhancing GBM. MATERIAL AND METHODS Twenty-one BA and twenty-nine GBM were retrospectively included in this study. Each region of interest (ROI) was delineated twice with the software of ITK-SNAP on the contrast-enhanced T1 images by two observers. ASP was calculated to define the relative deviation of the ROI's shape from a sphere. Intraclass correlation coefficients (ICC) for inter-observer and intra-observer were calculated. The diagnostic capabilities of ASP and conventional volume (VOL) of ROI were evaluated with receiver operating characteristic (ROC) curve analysis. In addition, areas under the ROC curves of ASP and VOL were compared. RESULTS ICC of intra-observer and inter-observer were 0.99 (95% confidence interval, [CI] 0.97-0.99) and 0.98 (0.95-0.99), respectively. Both ASP and VOL showed significant difference between BA and GBM. The mean ASP values for BA and GBM were 66.3±7.8 and 14.7±1.8, respectively. The mean VOL value of BA was also larger than that of GBM (47.2±7.4 vs. 20.7±1.5 mm3). The mean AUC of ASP and VOL were 0.977 (95% CI 0.944-1) and 0.86 (95% CI 0.746-0.974), respectively. The AUC of ASP was significantly higher than that of VOL (p=0.04). The optimal cut point values of ASP and VOL were 24.39 and 24.86 mm3, respectively. CONCLUSIONS ASP derived from routine MRI is useful in differentiating BA from GBM.
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Affiliation(s)
- Tao Zeng
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Zijun Xu
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Jianhua Yan
- Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China. .,Molecular Imaging Precision Medicine Collaborative Innovation Center, Shanxi Medical University, Taiyuan, 030001, Shanxi, China.
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Galvin CL, Normandin PA, Horn KS, Popso JC. Intracranial Infection Mimics Acute Stroke in an Adolescent Male. J Emerg Nurs 2019; 45:457-461. [PMID: 31280770 DOI: 10.1016/j.jen.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/25/2022]
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8
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Zheng Y, Shang W, Peng H, Rao Y, Zhao X, Hu Z, Yang Y, Hu Q, Tan L, Xiong K, Li S, Zhu J, Hu X, Zhou R, Li M, Rao X. Virulence Determinants Are Required for Brain Abscess Formation Through Staphylococcus aureus Infection and Are Potential Targets of Antivirulence Factor Therapy. Front Microbiol 2019; 10:682. [PMID: 31024479 PMCID: PMC6460967 DOI: 10.3389/fmicb.2019.00682] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/19/2019] [Indexed: 11/24/2022] Open
Abstract
Bacterial brain abscesses (BAs) are difficult to treat with conventional antibiotics. Thus, the development of alternative therapeutic strategies for BAs is of high priority. Identifying the virulence determinants that contribute to BA formation induced by Staphylococcus aureus would improve the effectiveness of interventions for this disease. In this study, RT-qPCR was performed to compare the expression levels of 42 putative virulence determinants of S. aureus strains Newman and XQ during murine BA formation, ear colonization, and bacteremia. The alterations in the expression levels of 23 genes were further confirmed through specific TaqMan RT-qPCR. Eleven S. aureus genes that persistently upregulated expression levels during BA infection were identified, and their functions in BA formation were confirmed through isogenic mutant experiments. Bacterial loads and BA volumes in mice infected with isdA, isdC, lgt, hla, or spa deletion mutants and the hla/spa double mutant strain were lower than those in mice infected with the wild-type Newman strain. The therapeutic application of monoclonal antibodies against Hla and SpA decreased bacterial loads and BA volume in mice infected with Newman. This study provides insights into the virulence determinants that contribute to staphylococcal BA formation and a paradigm for antivirulence factor therapy against S. aureus infections.
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Affiliation(s)
- Ying Zheng
- Department of Microbiology, College of Basic Medical Sciences, Army Medical University, Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Weilong Shang
- Department of Microbiology, College of Basic Medical Sciences, Army Medical University, Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Huagang Peng
- Department of Microbiology, College of Basic Medical Sciences, Army Medical University, Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Yifan Rao
- Institute of Modern Biopharmaceuticals, School of Life Sciences, Southwest University, Chongqing, China
| | - Xia Zhao
- Department of Microbiology, College of Basic Medical Sciences, Army Medical University, Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Zhen Hu
- Department of Microbiology, College of Basic Medical Sciences, Army Medical University, Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Yi Yang
- Department of Microbiology, College of Basic Medical Sciences, Army Medical University, Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Qiwen Hu
- Department of Microbiology, College of Basic Medical Sciences, Army Medical University, Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Li Tan
- Department of Microbiology, College of Basic Medical Sciences, Army Medical University, Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Kun Xiong
- Department of Microbiology, College of Basic Medical Sciences, Army Medical University, Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Shu Li
- Department of Microbiology, College of Basic Medical Sciences, Army Medical University, Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Junmin Zhu
- Department of Microbiology, College of Basic Medical Sciences, Army Medical University, Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Xiaomei Hu
- Department of Microbiology, College of Basic Medical Sciences, Army Medical University, Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Renjie Zhou
- Department of Emergency, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ming Li
- Department of Microbiology, College of Basic Medical Sciences, Army Medical University, Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Xiancai Rao
- Department of Microbiology, College of Basic Medical Sciences, Army Medical University, Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
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Diagnostic and therapeutic approach to infectious diseases in solid organ transplant recipients. Intensive Care Med 2019; 45:573-591. [PMID: 30911807 PMCID: PMC7079836 DOI: 10.1007/s00134-019-05597-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/06/2019] [Indexed: 12/18/2022]
Abstract
Purpose Prognosis of solid organ transplant (SOT) recipients has improved, mainly because of better prevention of rejection by immunosuppressive therapies. However, SOT recipients are highly susceptible to conventional and opportunistic infections, which represent a major cause of morbidity, graft dysfunction and mortality. Methods Narrative review. Results We cover the current epidemiology and main aspects of infections in SOT recipients including risk factors such as postoperative risks and specific risks for different transplant recipients, key points on anti-infective prophylaxis as well as diagnostic and therapeutic approaches. We provide an up-to-date guide for management of the main syndromes that can be encountered in SOT recipients including acute respiratory failure, sepsis or septic shock, and central nervous system infections as well as bacterial infections with multidrug-resistant strains, invasive fungal diseases, viral infections and less common pathogens that may impact this patient population. Conclusion We provide state-of the art review of available knowledge of critically ill SOT patients with infections.
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10
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Suthar R, Sankhyan N. Bacterial Infections of the Central Nervous System. Indian J Pediatr 2019; 86:60-69. [PMID: 29297142 DOI: 10.1007/s12098-017-2477-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/05/2017] [Indexed: 12/21/2022]
Abstract
Bacterial infections of the central nervous system (CNS) continue to be an important cause of morbidity and mortality in children. The spectrum of bacterial infection of CNS includes; focal or multifocal infections like brain abscesses or subdural empyema; or more generalized or diffuse infections like pyogenic meningitis or ventriculitis. Focal and generalized infections may co-exist in an individual patient. Prompt and adequate antibiotic therapy and occasionally neurosurgical interventions are the cornerstone of effective management. The recent emergence of several multidrug-resistant bacteria poses a threat to the effective management of bacterial CNS infections. Several adjunctive anti-inflammatory and neuroprotective therapies are being tried, however; none has made a remarkable impact on the outcome. Consequently, bacterial CNS infections in children still remain a challenge to manage. In this review, authors discuss the current updates on the diagnostic and therapeutic aspects of bacterial infections of the CNS in children (post-neonatal age group).
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Affiliation(s)
- Renu Suthar
- Pediatric Neurology and Neurodevelopment Unit, Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Naveen Sankhyan
- Pediatric Neurology and Neurodevelopment Unit, Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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11
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Al Moussawi H, Krzyzak M, Awada Z, Chalhoub JM. Streptococcus Intermedius Brain and Diverticular Abscesses After Dental Manipulation: A Case Report. Cureus 2018; 10:e2061. [PMID: 29545984 PMCID: PMC5849355 DOI: 10.7759/cureus.2061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A brain abscess is defined as a focal intracerebral infection consisting of an encapsulated collection of pus, which can be a life-threatening complication of infections, trauma, or surgery. While immunocompromised patients can have a wide array of causative organisms, bacterial species represent the most common etiology in immunocompetent individuals. The incidence of brain abscesses ranges from 0.4 to 0.9 per 100,000, with a high predisposition among immunocompromised patients and in those with disruption of the blood-brain barrier. The most common causative organisms found were Streptococcus species, particularly S. viridians and S. pneumonia, Enterococcus, and Staphylococcus species, mainly S. aurieus and S. epidermidis. Microorganism can invade the brain through different mechanisms, either directly by contiguous spread and odontogenic infections, which usually cause a single brain abscess, or indirectly through hematogenous spread which can cause multiple brain abscesses. Both surgical and conservative dental procedures contribute to hematogenous spreading of oral microorganisms. Although most of those organisms are eliminated shortly after they gain access to the bloodstream, some can persist and contribute to the pathogenesis of abscesses in the appropriate environment. Odontogenic origins are rarely implicated in the formation of brain abscesses, and oral foci comprise approximately 5% of identified cases. We report a case of brain and diverticular abscesses due to S. intermidius occurring two months after dental extraction. This case highlights the fact that even usual dental workup can result in the development of bacteremia and disseminated abscesses including but not restricted to the brain. Consequently, in addition to identifying the possible source of bacteremia with an extensive history and physical exam, the diagnosis of Streptococcus milleri organisms should prompt the physicians to screen for sites of possible metastatic infection spread.
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Affiliation(s)
- Hassan Al Moussawi
- Department of Medicine, Staten Island University Hospital, Northwell Health
| | - Michael Krzyzak
- Department of Medicine, Staten Island University Hospital, Northwell Health
| | - Zainab Awada
- Department of Medicine, Staten Island University Hospital, Northwell Health
| | - Jean M Chalhoub
- Department of Medicine, Staten Island University Hospital, Northwell Health
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12
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Kim JH, Park SP, Moon BG, Kim DR. Brain Abscess Showing a Lack of Restricted Diffusion and Successfully Treated with Linezolid. Brain Tumor Res Treat 2018; 6:92-96. [PMID: 30381924 PMCID: PMC6212685 DOI: 10.14791/btrt.2018.6.e16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/28/2018] [Accepted: 09/28/2018] [Indexed: 01/23/2023] Open
Abstract
A 59-year-old patient with a history of hepatocellular carcinoma presented with decreased consciousness and left hemiparesis. A rim-enhanced mass lesion without diffusion restriction was observed in contrast-enhanced MRI including diffusion-weighted imaging. Based on these findings, metastatic brain tumor was suspected. However, brain abscess (BA) was diagnosed after multiple bacterial colonies were observed in aspiration biopsy. Initial conventional antibiotic treatment including vancomycin had failed, so linezolid was used as second-line therapy. As a result, infection signs and clinical symptoms were resolved. We report a case with atypical imaging features and antibiotic susceptibility of a BA in an immunocompromised patient undergoing chemotherapy.
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Affiliation(s)
- Joo Hyun Kim
- Department of Neurosurgery, Eulji University, Nowon Eulji Medical Center, Seoul, Korea
| | - Sang Phil Park
- Department of Neurosurgery, Eulji University, Nowon Eulji Medical Center, Seoul, Korea
| | - Byung Gwan Moon
- Department of Neurosurgery, Eulji University, Nowon Eulji Medical Center, Seoul, Korea
| | - Deok Ryeong Kim
- Department of Neurosurgery, Eulji University, Nowon Eulji Medical Center, Seoul, Korea.
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Fernandes FF, Alves VO, Sánchez TEG, Paula WDD, Santana ANC. CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS. Rev Inst Med Trop Sao Paulo 2017; 58:57. [PMID: 27410917 PMCID: PMC4964326 DOI: 10.1590/s1678-9946201658057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/10/2016] [Indexed: 11/22/2022] Open
Abstract
A previously healthy, 52-year-old woman presented with a nine months history of low fever and weight loss (> 30 kg). Physical examination disclosed generalized lymphadenopathy, skin lesions, abdominal distension, mild tachypnea and a left breast mass. Laboratory tests showed anemia; (prerenal) kidney injury, low serum albumin level; and negative serology for HIV and viral hepatitis. Computed tomography (neck/chest/abdomen) showed generalized lymph node enlargement, splenomegaly, pleural effusion and ascites. We performed thoracocentesis and paracentesis, and the findings were consistent with chylothorax and chylous ascites (with no neoplastic cells). Biopsies of the breast mass, skin and lymph nodes were performed and all of them showed large round yeast cells with multiple narrow-based budding daughter cells, characteristic of Paracoccidioides brasiliensis. Consequently, paracoccidioidomycosis was diagnosed, and liposomal amphotericin B was prescribed, as well as a high protein and low fat diet (supplemented with medium chain triglycerides). Even so, her clinical status worsened, requiring renal replacement therapy. She evolved with pneumonia, septic shock and respiratory failure and subsequently died. To our knowledge, this is the first description of a case with chylothorax and breast mass due to paracoccidioidomycosis. Additionally, we discuss: 1- the importance of the inclusion of this mycosis in the differential diagnosis of chylothorax and breast mass (breast cancer), especially in endemic areas; and 2- the possible mechanism involved in the development of chylous effusions.
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Affiliation(s)
- Flávia Fonseca Fernandes
- Escola Superior de Ciências da Saúde, Hospital Regional da Asa Norte, Medical School, Internal Medicine Unit. Brasília, DF, Brazil
| | - Victor Oliveira Alves
- Escola Superior de Ciências da Saúde, Hospital Regional da Asa Norte, Medical School, Internal Medicine Unit. Brasília, DF, Brazil
| | | | - Wagner Diniz de Paula
- Universidade de Brasília, Hospital Universitário de Brasília, Radiology Service. Brasília, DF, Brazil
| | - Alfredo Nicodemos Cruz Santana
- Escola Superior de Ciências da Saúde, Hospital Regional da Asa Norte, Medical School, Pulmonology Unit. Brasília, DF, Brazil. E-mail:
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