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Nakayama S, Wakabayashi Y, Yamamoto A, Ichinose T, Takasaki K, Nagasaka K, Kitazawa T. Tubo-ovarian abscess caused by Clostridioides difficile after eight months of surgery: Case report and review of extraintestinal abdominal abscess cases. J Infect Chemother 2024:S1341-321X(24)00144-2. [PMID: 38825001 DOI: 10.1016/j.jiac.2024.05.012] [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: 08/31/2023] [Revised: 03/29/2024] [Accepted: 05/29/2024] [Indexed: 06/04/2024]
Abstract
We present a case of tubo-ovarian abscess (TOA) caused by Clostridioides difficile (CD) in a 43-year-old female. Despite lacking a history of sexually transmitted diseases, the patient had undergone paraovarian cystectomy nine months before admission. Transvaginal ultrasonography performed eight months post-surgery revealed left ovarian enlargement, accompanied by subsequent lower abdominal pain and fever exceeding 38 °C. As oral antibiotic treatment was ineffective, the patient was admitted to our hospital. Computed tomography upon admission revealed a massive TOA. Surgical drainage of the abscess was performed, and CD was identified in the culture from the pus. The TOA was treated with a three-month course of metronidazole and oral amoxicillin/clavulanic acid. While CD is commonly associated with colitis, extraintestinal manifestations are exceptionally rare. This case represents the inaugural report of TOA resulting from CD. A literature review on abdominal and pelvic CD abscesses found that patients undergoing surgical drainage had a favorable prognosis. Therefore, surgical intervention plays an important role in the management of CD abscesses.
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Affiliation(s)
- Shin Nakayama
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshitaka Wakabayashi
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
| | - Ai Yamamoto
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Takayuki Ichinose
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuki Takasaki
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazunori Nagasaka
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo, Japan
| | - Takatoshi Kitazawa
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
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Lim J, Zaw C, Abramson S, Lichtenberger PN, John BV, Cuebas-Rosado L. Clostridium difficile Bacteremia as a Rare Presentation of Polymicrobial Pyogenic Liver Abscesses and Its Management Challenges. Case Rep Gastroenterol 2023; 17:264-268. [PMID: 37928967 PMCID: PMC10624945 DOI: 10.1159/000531892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/27/2023] [Indexed: 11/07/2023] Open
Abstract
Extracolonic manifestations of Clostridium difficile have been rarely reported. We herein report a case of a 60-year-old immunocompetent man presenting with fever, nausea, abdominal pain, and loose stools for 2 weeks. Triple-phase liver computed tomography demonstrated pyogenic liver abscesses and portal pylephlebitis. Blood cultures grew C. difficile and Bacteroides fragilis, and liver abscess cultures grew Proteus mirabilis, Escherichia coli, and the viridans group Streptococci. Antibiotics coverage was selected to direct at all identified organisms. This demonstrates an unusual case of C. difficile bacteremia in a patient with polymicrobial pyogenic liver abscesses and pylephlebitis.
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Affiliation(s)
- Junghyun Lim
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Catherine Zaw
- Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Simon Abramson
- Veterans Health Affairs National Teleradiology Program, Menlo Park, CA, USA
| | | | - Binu V. John
- Division of Hepatology, Bruce W. Carter VA Medical Center, Miami, FL, USA
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Zhang DT, Cai CW, Thomas DG, Rosenblatt J. Polymicrobial bacteraemia with Clostridioides difficile and Pseudomonas aeruginosa in an elderly man following antibiotic use. BMJ Case Rep 2022; 15:e248844. [PMID: 35387793 PMCID: PMC8987676 DOI: 10.1136/bcr-2022-248844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/06/2022] Open
Abstract
Clostridioides difficile is a micro-organism well known to cause pseudomembranous colitis with rare extraintestinal manifestations. We present the case of an elderly male with multiple comorbidities who presented with acute onset of fever/chills and hypotension, found to have polymicrobial bacteraemia with C. difficile and Pseudomonas aeruginosa He was treated with piperacillin/tazobactam for P. aeruginosa bacteraemia, oral vancomycin for C. difficile colitis and intravenous, followed by oral metronidazole for C. difficile bacteraemia. Pseudomonas cleared after 1 day, and Clostridioides cleared after 4 days. Following an initial septic presentation, he responded appropriately to antimicrobial therapy and did well in follow-up.
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Affiliation(s)
- David T Zhang
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Catherine W Cai
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - David G Thomas
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Joshua Rosenblatt
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Sato R, Yamada K, Yokoyama T, Tanimoto K, Takeuchi S, Tatsuzawa N, Nakui S, Satoh H, Fadul M, Steiner A. Partial hepatectomy for treatment of multiple liver abscess in a calf: a case report. BMC Vet Res 2021; 17:67. [PMID: 33536012 PMCID: PMC7860206 DOI: 10.1186/s12917-021-02750-y] [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: 06/09/2020] [Accepted: 01/08/2021] [Indexed: 11/12/2022] Open
Abstract
Background Umbilical vein bacterial infections may cause liver abscesses during bacterial ascent. A single liver abscess can be surgically treated by marsupialization, but a risk of recurrence or non-healing remains. Moreover, there is no effective treatment for multiple abscesses. Case presentation A 17-day-old Holstein female calf exhibited reduced general condition, swelling and drainage of the umbilicus, and pressure sores in the area of the carpus, resulting in reluctance to stand up. The umbilicus showed pain at palpation; deep abdominal palpation indicated a swollen umbilical vein coursing from the umbilicus toward the liver. Ultrasonography confirmed a swollen umbilical vein with pus accumulation and multiple abscesses in the liver. Contrast-enhanced computed tomography (CT) examination confirmed that the swollen umbilical vein with fluid continued to the liver, and multiple unenhanced lesions, most likely abscesses, were confirmed in the liver. Partial hepatectomy was performed to remove as many abscesses as possible. For the resection, a vessel sealing device (LigaSureTM) was used to excise a part of the left liver lobe. As we could not remove all the abscesses in the liver during the operation, cefazolin sodium (5 mg/kg) was administered for 14 days after surgery. Post-operatively, blood accumulation was observed in the abdominal cavity, but no signs of peritonitis were found. The calf returned to the farm on day 38 after surgery. Follow-up information was obtained after 1 year, and complications were not reported. Conclusions To our knowledge, this is the first report of partial hepatectomy using a vessel sealing device for a calf with multiple liver abscesses. This case report suggests that the combination of partial hepatectomy and long-term administration of antibacterial drugs may restore the health of calves with multiple liver abscesses.
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Affiliation(s)
- Reiichiro Sato
- Faculty of Agriculture, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki, 889-2192, Japan.
| | - Kazutaka Yamada
- Faculty of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa, 252-5201, Japan
| | - Taiki Yokoyama
- Faculty of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa, 252-5201, Japan
| | - Koki Tanimoto
- Faculty of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa, 252-5201, Japan
| | - Shoko Takeuchi
- Faculty of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa, 252-5201, Japan
| | - Natsumi Tatsuzawa
- Faculty of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa, 252-5201, Japan
| | - Shiho Nakui
- Faculty of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa, 252-5201, Japan
| | - Hiroyuki Satoh
- Faculty of Agriculture, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki, 889-2192, Japan
| | - Mahmoud Fadul
- Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, Bremgartenstrasse 109a, 3012, Bern, Switzerland
| | - Adrian Steiner
- Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, Bremgartenstrasse 109a, 3012, Bern, Switzerland
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Kang MK, Kwon HJ, Kim MC. Gastric cancer and adenomatous colorectal polyp concomitant with pyogenic liver abscess and bacteremia. Yeungnam Univ J Med 2020; 37:246-249. [PMID: 32272010 PMCID: PMC7384915 DOI: 10.12701/yujm.2020.00094] [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: 02/27/2020] [Accepted: 03/25/2020] [Indexed: 11/16/2022] Open
Abstract
Synchronous gastric cancer and adenomatous colorectal polyp in patients with Klebsiella pneumoniae-induced pyogenic liver abscess (KP-PLA) and bacteremia is a rare presentation. A 58-year-old man with a 6-month history of diabetes mellitus (DM) presented with febrile sensation and dull abdominal pain in the right upper quadrant of the abdomen. Subsequent to laboratory test results and abdominal computed tomography findings, KP-PLA with bacteremia was diagnosed. After intravenous antibiotic administration, his symptoms improved, and upper endoscopy and colonoscopy were performed to evaluate the cause of KP-PLA. Biopsy specimens of the prepyloric anterior wall revealed a moderately differentiated adenocarcinoma. Endoscopic mucosal resection of the colon revealed high-grade dysplasia. Early gastric cancer (EGC) and adenomatous colorectal polyps with high-grade dysplasia concomitant with KP-PLA and bacteremia were diagnosed in our patient who had DM. Intravenous antibiotic treatment for KP-PLA, subtotal gastrectomy for EGC, and colonoscopic mucosal resection for the colon polyp were performed. After 25 days of hospitalization, subtotal gastrectomy with adjacent lymph node dissection was performed. Follow-up ultrasound imaging showed resolution of the abscess 5 weeks post-antibiotic treatment, as well as no tumor metastasis. Upper gastrointestinal endoscopy and colonoscopy should be performed to evaluate gastric cancer in patients with PLA or bacteremia, accompanied with DM or an immunocompromised condition.
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Affiliation(s)
- Min Kyu Kang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hee Jung Kwon
- Department of Pathology, Yeungnam University Hospital, Daegu, Korea
| | - Min Cheol Kim
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
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Urbán E, Terhes G, Gajdács M. Extraintestinal Clostridioides difficile Infections: Epidemiology in a University Hospital in Hungary and Review of the Literature. Antibiotics (Basel) 2020; 9:antibiotics9010016. [PMID: 31906470 PMCID: PMC7167916 DOI: 10.3390/antibiotics9010016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/26/2019] [Accepted: 12/31/2019] [Indexed: 12/27/2022] Open
Abstract
Extraintestinal manifestations of Clostridioides difficile infections (CDIs) are very uncommon, and according to the literature, poor outcomes and a high mortality have been observed among affected individuals. The objective of this study was to investigate the incidence rate of extraintestinal infections caused by C. difficile (ECD) in a tertiary-care university hospital in Hungary. During a 10-year study period, the microbiology laboratory isolated 4129 individual strains of C. difficile; among these, the majority were either from diarrheal fecal samples or from colonic material and only n = 24 (0.58%) were from extraintestinal sources. The 24 extraintestinal C. difficile isolates were recovered from 22 patients (female-to-male ratio: 1, average age: 55.4 years). The isolates in n = 8 patients were obtained from abdominal infections, e.g., appendicitis, rectal abscess or Crohn’s disease. These extraintestinal cases occurred without concomitant diarrhea. In all, but two cases C. difficile was obtained as a part of a polymicrobial flora. Our isolates were frequently toxigenic and mostly belonged to PCR ribotype 027. Resistance to metronidazole, vancomycin, clindamycin and rifampin were 0%, 0%, 20.5% and 9.7%, respectively. The increasing amount of reports of C. difficile extraintestinal infections should be noted, as these infections are characterized by a poor outcome and high mortality rate.
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Affiliation(s)
- Edit Urbán
- Department of Public Health, Faculty of Medicine, University of Szeged, Dóm tér 10., 6720 Szeged, Hungary
- Correspondence: ; Tel.: +36-62-342-861
| | - Gabriella Terhes
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Semmelweis utca 6., 6725 Szeged, Hungary;
| | - Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Eötvös utca 6., 6720 Szeged, Hungary;
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Al-Tawfiq JA, Babiker MM. Multi-focal Clostridioides (Clostridium) difficile osteomyelitis in a patient with sickle cell anemia: case presentation and literature review. Diagn Microbiol Infect Dis 2019; 96:114915. [PMID: 31699546 DOI: 10.1016/j.diagmicrobio.2019.114915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/11/2019] [Accepted: 09/22/2019] [Indexed: 11/16/2022]
Abstract
Clostridioides (Clostridium) difficile infection manifests as intestinal infections, namely pseudomembranous colitis. The occurrence of extra-intestinal disease is thought to be rare with a rate of 1.08% of 2034 isolates of C. difficile and an incidence of 4/100,000 admissions. C. difficile had been rarely associated with osteomyelitis. Here, we report the occurrence of C. difficile osteomyelitiin a patient with sickle cell disease. The patient had multiple surgeries and a prolonged antimicrobial therapy to achieve a cure. The patient had C. difficile infection of native bone and of a prosthetic joint. The patient received prolonged therapy with amoxicillin-clavulanic acid and metronidazole and she remained free of C. difficile infection for 3 years off antibiotics.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, Indiana, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA; General Internal Medicine Unit, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
| | - Mohamed M Babiker
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Johns Hopkins University School of Medicine, Baltimore, MD, USA; General Internal Medicine Unit, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
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Aziz M, Fatima R, Douglass LN, Abughanimeh O, Raza S. Current updates in management of Clostridium difficile infection in cancer patients. Curr Med Res Opin 2019; 35:473-478. [PMID: 29888965 DOI: 10.1080/03007995.2018.1487389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Clostridium difficile infection (CDI) is a significant health burden, now recognized as the leading cause of acquired diarrhea in patients receiving antibiotic therapy. Complications of infection with this pathogen include severe diarrhea, causing electrolyte imbalances, dehydration, hemodynamic instability, toxic megacolon, shock, and death. Hence it is extremely paramount to stay updated on management options for this infection, especially in cancer patients. REVIEW This article presents an in-depth review of literature on the treatment modalities available for CDI in cancer patients. Relevant articles highlighting therapeutic and symptomatic management of CDI patients with underlying malignancy have been summarized. CONCLUSIONS Despite the current options available, more studies are needed to assess the newer therapeutic options that are being employed for populations other than cancer patients.
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Affiliation(s)
- Muhammad Aziz
- a Department of Internal Medicine , University of Kansas Medical Center , Kansas City , MO , USA
| | - Rawish Fatima
- b Department of Medicine , Dow University of Health Sciences , Karachi , Pakistan
| | - Lindsey N Douglass
- c Pharmacy Department , Saint Luke's Hospital of Kansas City , Kansas City , MO , USA
| | - Omar Abughanimeh
- d Department of Internal Medicine , Saint Luke's Hospital of Kansas City/University of Missouri , Kansas City , MO , USA
| | - Shahzad Raza
- e Department of Hematology & Oncology , St. Luke's Hospital of Kansas City/University of Missouri , Kansas City , MO , USA
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Son DJ, Hong JY, Kim KH, Jeong YH, Myung DS, Cho SB, Lee WS, Kang YJ, Kim JW, Joo YE. Liver abscess caused by Clostridium haemolyticum infection after transarterial chemoembolization for hepatocellular carcinoma: A case report. Medicine (Baltimore) 2018; 97:e0688. [PMID: 29742715 PMCID: PMC5959397 DOI: 10.1097/md.0000000000010688] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Liver abscesses caused by Clostridium species infection are extremely rare. PATIENT CONCERNS The authors report the first case of a liver abscess due to Clostridium haemolyticum, which occurred after transarterial chemoembolization (TACE) for hepatocellular carcinoma, in a 76-year-old woman who presented with right upper quadrant pain and fever. DIAGNOSES Computed tomography of the abdomen after the second TACE showed an air-filled abscess around a compact, lipiodolized lesion in the right hepatic lobe. Pus culture showed the growth of C haemolyticum. INTERVENTIONS Broad-spectrum antibiotics, including piperacillin/tazobactam and metronidazole, were administered, and a percutaneous 10-French pigtail catheter for pus drainage and culture was inserted in the liver abscess. OUTCOMES Despite administering intensive treatments, she presented with rapid deterioration in mental status, liver function, and infection markers. She was transferred to the local hospital for palliative conservative treatment. LESSONS Clostridia infections, including those involving C haemolyticum, are extremely rare, but should be considered as one of the causative organisms of liver abscess formation after TACE because of its rapid and fatal clinical course.
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Affiliation(s)
- Dong-Jun Son
- Department of Internal Medicine, Chonnam National University Medical School
| | - Ji-Yun Hong
- Department of Internal Medicine, Chonnam National University Medical School
| | - Ki-Hyun Kim
- Department of Internal Medicine, Chonnam National University Medical School
| | - Young-Hoon Jeong
- Department of Internal Medicine, Chonnam National University Medical School
| | - Dae-Seong Myung
- Department of Internal Medicine, Chonnam National University Medical School
| | - Sung-Bum Cho
- Department of Internal Medicine, Chonnam National University Medical School
| | - Wan-Sik Lee
- Department of Internal Medicine, Chonnam National University Medical School
| | - Yang-Jun Kang
- Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Jin-Woong Kim
- Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School
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