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Mousselli M, Chiang E, Frousiakis P. Epidural phlegmon and iliopsoas abscess caused by Salmonella enterica bacteremia: A case report. Int J Surg Case Rep 2022; 96:107287. [PMID: 35696819 PMCID: PMC9194579 DOI: 10.1016/j.ijscr.2022.107287] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/04/2022] [Accepted: 06/05/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Iliopsoas abscesses (IPA) are rare and typically present with a non-specific triad of fever, back pain, and antalgic gait. Staphylococcus aureus is the organism responsible for nearly 90 % of IPA cases. We present a case of primary IPA with progression to osteomyelitis and discitis due to Salmonella enterica bacteremia, an exceedingly rare etiology occurring in an otherwise healthy individual. CASE PRESENTATION This patient presented with fever, back pain, and hip pain. Initial imaging and laboratory workup did not reveal any source of infection. He became septic within 72 h of admission, and blood cultures were confirmed as Salmonella enterica. However, the etiology of the infection remained unclear. Computed Tomography (CT) imaging revealed a right-sided psoas abscess measuring 7 mm × 7 mm and an epidural phlegmon. He was discharged home with intravenous ceftriaxone and levofloxacin. However, the patient was readmitted due to L2-L3 osteomyelitis and discitis with an eccentric disc bulge causing compression of the right L3 nerve root and neutropenia. CLINICAL DISCUSSION This case in unique in the fact that this occurred in a healthy patient with no significant risk factors or exposure to this bacteria. Additionally, this case highlights the rapid progression of IPA and the spread to adjacent spinal structures with the potential to cause nerve compression with successful medical management. CONCLUSION Salmonella enterica is rare cause of iliopsoas abscess. This case emphasizes the importance of including iliopsoas abscesses as a differential diagnosis in patients with a high index of clinical suspicion.
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Detection of mecA and 16S rRNA Genes Using Real-Time PCR Can Be Useful in Diagnosing Iliopsoas Abscess, Especially in Culture-Negative Cases: RT-PCR for Iliopsoas Abscess. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2209609. [PMID: 35187161 PMCID: PMC8856790 DOI: 10.1155/2022/2209609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/31/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022]
Abstract
The rapid detection of etiological agents is important for the successful treatment of iliopsoas abscess (IPA). The purpose of this study was to investigate the clinical utility of a real-time polymerase chain reaction (PCR) that targets the mecA gene for methicillin-resistant staphylococci (MRS) and the 16S rRNA gene for pan-bacteria. Our retrospective diagnostic study included 22 patients exhibiting IPAs and four patients with noninfectious iliopsoas mass regions who underwent computerized tomography or ultrasonography-guided biopsy and/or surgical treatment. Clinical symptoms, serum data, imaging analysis, and tissue microbiological culture were utilized for the diagnosis of IPA. The diagnostic accuracy of real-time PCR was determined based on the diagnosis of IPA and microbiological culture results. The microbiological culture was positive for 12 IPA cases that included 2 MRSA infections. Among 12 culture-positive IPA cases, 16S rRNA-PCR was positive in 12 and MRS-PCR in two. Among 10 culture-negative IPA cases, including 3 TB cases, 16S rRNA-PCR was positive in 8 and MRS-PCR in 2. In noninfectious iliopsoas mass patients, neither 16S rRNA nor MRS-PCR detected bacterial DNA. The sensitivity, specificity, positive predictive, and negative predictive values of 16S rRNA-PCR for diagnosing IPA were 0.91, 1.00, 1.00, and 0.67, respectively, while those for the diagnosis of MRS infection with MRS-PCR were 1.00, 0.92, 1.00, and 0.50, respectively. Real-time PCR targeting bacterial DNA can detect bacterial DNA in culture-negative cases and offer improved detectability of MRS infection in IPA patients.
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McAvoy M, Doloff JC, Khan OF, Rosen J, Langer R, Anderson DG. Vascularized Muscle Flap to Reduce Wound Breakdown During Flexible Electrode-Mediated Functional Electrical Stimulation After Peripheral Nerve Injury. Front Neurol 2020; 11:644. [PMID: 32793094 PMCID: PMC7385241 DOI: 10.3389/fneur.2020.00644] [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: 04/08/2020] [Accepted: 05/29/2020] [Indexed: 11/15/2022] Open
Abstract
The success of devices delivering functional electrical stimulation (FES) has been hindered by complications related to implants including skin breakdown and subsequent wound dehiscence. Our hypothesis was that a vascularized muscle flap along the dorsal surface of an epimysial electrode would prevent skin breakdown during FES therapy to treat atrophy of the gastrocnemius muscle during peripheral nerve injury. Resection of a tibial nerve segment with subsequent electrode implantation on the dorsal surfaces of the gastrocnemius muscle was performed on ten Lewis rats. In five rats, the biceps femoris (BF) muscle was dissected and placed along the dorsal surface of the electrode (Flap group). The other five animals did not undergo flap placement (No Flap group). All animals were treated with daily FES therapy for 2 weeks and degree of immune response and skin breakdown were evaluated. The postoperative course of one animal in the No Flap group was complicated by complete wound dehiscence requiring euthanasia of the animal on postoperative day 4. The remaining 4 No Flap animals showed evidence of ulceration at the implant by postoperative day 7. The 5 animals in the Flap group did not have ulcerative lesions. Excised tissue at postoperative day 14 examined by histology and in vivo Imaging System (IVIS) showed decreased implant-induced inflammation in the Flap group. Expression of specific markers for local foreign body response were also decreased in the Flap group.
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Affiliation(s)
- Malia McAvoy
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Massachusetts Institute of Technology, Boston, MA, United States
| | - Joshua C Doloff
- Department of Biomedical Engineering, Translational Tissue Engineering Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Materials Science and Engineering, Institute of NanoBioTechnology, Johns Hopkins University, Baltimore, MD, United States
| | - Omar F Khan
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Joseph Rosen
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Lebanon, NH, United States
| | - Robert Langer
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Biomedical and Materials Science Engineering, Translational Tissue Engineering Center, Wilmer Eye Institute and the Institute for NanoBioTechnology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Daniel G Anderson
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Biomedical and Materials Science Engineering, Translational Tissue Engineering Center, Wilmer Eye Institute and the Institute for NanoBioTechnology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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