Post-acute COVID-19 associated with evidence of bystander T-cell activation and a recurring antibiotic-resistant bacterial pneumonia

Here, we describe the case of a COVID-19 patient who developed recurring ventilator-associated pneumonia caused by Pseudomonas aeruginosa that acquired increasing levels of antimicrobial resistance (AMR) in response to treatment. Metagenomic analysis revealed the AMR genotype, while immunological analysis revealed massive and escalating levels of T-cell activation. These were both SARS-CoV-2 and P. aeruginosa specific, and bystander activated, which may have contributed to this patient's persistent symptoms and radiological changes.

Changes in mucociliary clearance over time in children with cystic fibrosis

OBJECTIVES

(a) To quantify changes in mucociliary clearance (MCC) over time in children with cystic fibrosis (CF) and the relationship between MCC and rate of infection with Pseudomonas aeruginosa (PA); (b) to determine the impact of MCC on the evolution of CF lung disease; and (c) to explore the role of mucus composition as a determinant of MCC.

METHODS

Children with CF, who had previously undergone an MCC measurement (visit 1), underwent the following tests 3 to 10 years later: (a) second MCC measurement (visit 2); (b) multiple breath washout to assess ventilation inhomogeneity, expressed as lung clearance index (LCI); (c) high resolution computed tomography lung scan (HRCT); and (d) induced sputum test. Number of PA + cultures/year between visits was documented and mucus dry weight was quantified in the children and adult controls.

RESULTS

Nineteen children completed both visits. Median time between visits was 4.6 years. Clearance declined 30% between visits. Lower MCC on visit 2 was associated with more PA+ cultures/year between visits. Lower MCC values on visit 1 were associated with higher LCI values and higher HRCT scores on visit 2. Mucus dry weight was significantly higher in children with CF compared with controls. Higher dry weights were associated with lower MCC.

CONCLUSIONS

Mucociliary clearance declines significantly over time in children with CF. The decline is associated with PA infection rate and is affected by mucus composition. Children with early slowing of MCC appear to be at risk for developing ventilation inhomogeneity and parenchymal lung damage when they are older.

Severely infected pneumoceles of the frontal sinus in patients with mental retardation and brain atrophy treated by endoscopic sinus surgery

We herein present three cases of abnormally expanded frontal sinuses (pneumoceles) with severe infection in patients with mental retardation and brain atrophy. Two patients previously underwent laryngotracheal separation surgery, and bacteriological examinations of purulent nasal discharge revealed infections caused by drug-resistant bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii. As conservative medical treatments were ineffective, all three patients were treated by computed tomography-guided endoscopic sinus surgery. This navigation system is useful for safer surgery in the area of anatomic deformity. The clinical findings, possible etiologies and surgical treatment of these cases are discussed.

The First Case of Pseudomonas aeruginosa Bacteremic Pneumonia in a Cancer Patient Receiving Pegfilgrastim

A single dose of pegfilgrastim or the daily administration of colony-stimulating factors can be used to prevent febrile neutropenia. This may delay the detection of rapidly progressive infections among cancer patients undergoing chemotherapy. We report a case of Pseudomonas aeruginosa bacteremic pneumonia that occurred in a patient receiving pegfilgrastim.

Dermoscopy: a useful tool for assisting the diagnosis of Pseudomonas folliculitis

This report describes the usefulness of dermoscopy as a supportive diagnostic tool in a pseudomonas folliculitis case.

A patient with infective endocarditis caused by community-acquired Pseudomonas aeruginosa infection

An 85-year-old woman complaining of nausea was admitted to our hospital after being found to have complete atrioventricular block. We diagnosed the patient with infective endocarditis after observing vegetation on transesophageal echocardiography (TEE) and detecting Pseudomonas aeruginosa in a blood culture. The patient had no history of intravenous drug use, instrumentation or valvular disease. Although sensitive antibiotics were administered intravenously, the second TEE performed on the 10th day demonstrated increased vegetation. The patient developed septic shock and died on the 14th day. To our knowledge, this is the first report of infective endocarditis caused by community-acquired Pseudomonas aeruginosa in Japan.

Single photon emission computed tomography/computed tomography of the skull in malignant otitis externa

Malignant otitis externa is a severe, rare infective condition of the external auditory canal and skull base. The diagnosis is generally made from a range of clinical, laboratory, and imaging findings. Technetium 99m methylene diphosphonate bone scintigraphy is known to detect osteomyelitis earlier than computed tomography. The authors present a patient with bilateral malignant otitis externa where the extent of skull base involvement was determined on 3-phase bone scintigraphy with single photon emission computed tomography/computed tomography.

Left-sided Pseudomonas aeruginosa endocarditis in patients without injection drug use

We aimed to determine the clinical features, predisposing factors, and outcome of left-sided Pseudomonas aeruginosa endocarditis in persons with no history of injection drug use. We performed a retrospective review of patient medical records from Mayo Clinic (Rochester, MN; Scottsdale, AZ; and Jacksonville, FL) for all cases of left-sided P. aeruginosa endocarditis. We identified 4 cases. We present these cases, as well as a review of the English-language medical literature. Data gathered included the year the case was reported; the valve involved; treatment, including valve replacement surgery; and outcome, if known. Left-sided P. aeruginosa endocarditis in persons without injection drug use is a rare but serious infection, with a history of instrumentation as a common predisposing condition. Valvular surgery is indicated, when possible, for the best chance of survival, along with extended therapy with combination antibiotics for complete recovery.

Piperacillin/tazobactam in treatment of brain abscess

Central nervous system (CNS) infection is a common complication following renal transplantation. Successful management of a brain abscess usually requires a combination of antibiotics and surgical drainage for both diagnostic and therapeutic purposes. We report the successful treatment of a patient with multiple brain abscesses with piperacillin/tazobactam without surgical intervention.

[Analysis of the clinical features and outcome of ventilator-associated Pseudomonas aeruginosa-related pneumonia in an intensive care unit]

The occurrence, the course, and outcome of ventilator-associated pneumonia (VAP) related to Pseudomonas aeruginosa were prospectively followed up in 51 patients treated at an intensive care unit. The characteristic feature of P. aeruginosa-induced VAP was its severe course and poor prognosis (mortality was 38%). More than half of cases were found to have bilateral lung injury with the upper left lung being involved. Lung tissue destruction and edema were rather frequent complications. The predictors of death in VAP caused by P. aeruginosa are admission to an intensive care unit, septic shock, and infection.

Haematogenous pseudomonas osteomyelitis of the hamate--treatment by radical debridement and bone grafting

A case of isolated chronic osteomyelitis of the hamate bone in a 13-year-old boy, who presented with a sinus on the dorsum of the hand, is reported. Radiological examination revealed multiple marginal and intra-osseous lytic areas with sclerotic rims in the hamate and at the fourth and fifth metacarpal bases. He was treated with excision of the sinus, curettage of the hamate lesion and hamato-metacarpal fusion which provided satisfactory control of infection while salvaging the function of the affected hand.

Left atrial appendage mimicking an intra-cardiac vegetation in preterm neonates

Infective endocarditis is emerging as a significant cause of morbidity in the neonatal intensive care with an incidence ranging from 0.07 to 4.3%. The rise in incidence may be explained by the increasing availability of echocardiography facilities in the neonatal unit. The diagnosis of infective endocarditis has major therapeutic implications as the neonate is treated with potentially toxic drugs and exposed to prolonged intravenous catheters. However, the consequences of a missed diagnosis of endocarditis in preterm neonates are unknown and may potentially lead to significant long-term cardiac complications. Onsite echocardiography in the neonatal unit by neonatologists may improve the speed of diagnosis in cases of endocarditis. However, lack of adequate training and experience in normal echocardiographic views may increase the false-positive rate. The posterior mitral valve leaflet is rarely affected due to the low velocity of blood passing through and because of the absence of prosthesis. We report 2 cases of the left atrial appendage rarely mimicking a posterior mitral valve leaflet vegetation, leading to an erroneous diagnosis of infective endocarditis. The features which distinguish the left atrial appendage from a posterior mitral valve leaflet vegetation are illustrated.

[Nitrite test in Pseudomonas aeruginosa urinary tract infections]

Pseudomonas aeruginosa (PA) is considered to be bacteria with a low capability to produce nitrite.

OBJECTIVE

To investigate the incidence of a positive urine nitrite test in community-acquired urinary tract infections (UTI) in children, caused by PA.

METHODS

The medical records of 38 children (18 females) admitted for febrile PA UTI during a period of 7 years were reviewed. Urine nitrite tests were carried out using dipstrips, and results were reported as positive or negative.

RESULTS

Of the 38 patients, 17 had a positive nitrite test and 21 had a negative test (proportion of positive 0.45, 95% confidence interval 0.29 to 0.61). Pyuria was detected in 13/17 patients with a positive nitrate test vs. 5/21 with a negative test (p=0.003). Data regarding renal ultrasound (US) were available for 35 patients, and in 20 abnormalities were detected, 14/17 in the positive vs. 6/18 in negative nitrite group (p = 0.001).

CONCLUSION

The urine nitrite test may be positive in PA UTI, therefore, a positive test does not rule out Pseudomonas UTI.

Subretinal abscess after scleral buckling surgery: a rare risk of retinal surgery

CASE REPORT

Intraocular infections after scleral buckling surgery for retinal detachment are very rare.

COMMENTS

We document, on ultrasound B-scan, a rare case of subretinal abscess after scleral buckling surgery.

Cholesteatoma of the tympanic part of the temporal bone

This article presents accounts of two patients with cholesteatoma of the tympanic part of the temporal bone, located immediately lateral to the tympanic annulus (and with an intact tympanic membrane). The lesions were located deep in the anterior and inferior walls of the canal, especially in the vaginal process of the tympanic part. These more severe cases required surgical correction (removal of the sac of cholesteatoma) with very good results. Pathogenesis and differential diagnosis are discussed.

Acute renal failure associated with use of inhaled tobramycin for treatment of chronic airway colonization with Pseudomonas aeruginosa

Aminoglycoside nephrotoxicity is a well-known clinical entity that complicates the course of infectious diseases treated under this antibiotic regime. Recently, a new administration form of tobramycin, inhaled tobramycin (TOBI), has been approved to improve the antibacterial activity and reduce nephrotoxicity. We describe the clinical case of a 73-year-old woman with chronic-obstructive pulmonary disease (COPD) who developed acute renal failure (ARF) after using TOBI. Clinical presentation and biochemical parameters were compatible with aminoglycoside-induced renal failure. Based on the clinical findings presented here, a surveillance program should be established to monitor the presence of factors predisposing to renal failure, and to measure serum levels of tobramycin.

HIV-related bronchopulmonary infection by Pseudomonas aeruginosa in the HAART era: radiological findings

PURPOSE

To evaluate whether highly active antiretroviral therapy (HAART) modifies radiographic appearances of Pseudomonas aeruginosa bronchopulmonary infection in HIV-infected patients. P. aeruginosa is increasingly reported as a respiratory pathogen in HIV+ patients with very low levels of CD4 lymphocytes. Few studies have analyzed the radiological presentation of bronchopulmonary disease that occurs in HAART-treated patients.

MATERIAL AND METHODS

We retrospectively reviewed the chest radiographs of 46 HIV-infected patients with bronchopulmonary diseases in which P. aeruginosa was the sole respiratory pathogen that was isolated. All cases were community-acquired infection. Twenty-four of the patients were on HAART treatment, and 22 were not. Chest radiographs were assessed for the presence and distribution of parenchymal consolidation, reticular or reticulonodular infiltrates, bronchial wall thickening, ground-glass opacities, cavitation, pleural effusion, and adenopathies. Statistical analysis was done using Epi-Info version 6 (CDC, Atlanta, GA, USA).

RESULTS

Normal chest radiographs were observed in 11 patients. Eight of these 11 (73%) were receiving HAART, and 3/11 (27%) were not. The most common radiographic abnormality was bronchopneumonia, present in 24 of 46 patients (52%): in 10 of 24 (42%) patients with HAART and 14 of 22 (64%) without. Cavitation was seen in 1 of 24 (4%) patients with HAART and in 5 of 22 (23%) without HAART.

CONCLUSION

Cavitation was more frequent in patients that were not receiving HAART, and normal chest radiographs were more frequently seen in patients on HAART.

Calcium stone lithoptysis in primary ciliary dyskinesia

BACKGROUND

An association between lithoptysis and primary ciliary dyskinesia (PCD) has not been previously reported. However, reports of lithoptysis from 2 older patients (>60 yr) prompted a study of this association.

METHODS

We performed a prospective study of all PCD patients presenting to our institution between August 2003 and March 2006, seeking the symptom of lithoptysis or calcium deposition on radiology. A retrospective analysis of all PCD patients presenting prior to August 2003 was also performed. Patients age > or = 40 previously reviewed were recontacted. If a history of lithoptysis or calcium deposition was present, we further reviewed radiographic, microbiologic, and biochemical data, including serum calcium and phosphate. Broncholiths were analyzed by light and electron microscopy- and electron-dispersive X-ray analysis.

RESULTS

In total, 142 patients (n=28 age > or = 40) were included, 41 in the prospective and 91 in the retrospective study. Lithoptysis was reported in 5 patients (all age > or = 40). Chest CT scans identified calcification (4/5), involving bronchiectatic airways in 3 patients and focal nodular calcification in 1 patient. Two other patients (age 46, 59) were identified with airway calcification without lithoptysis. Available broncholiths from 2 of these patients were composed of calcite, whereas a broncholith from 1 patient with focal nodular calcification contained calcium phosphate. Sputum was positive for Pseudomonas aeruginosa in all 7 patients, but negative for mycobacterial and fungal cultures.

CONCLUSION

There is an association between lithoptysis and PCD in patients age > or = 40. We hypothesize that calcite stone formation is a biomineralization response to chronic airway inflammation and retention of infected airway secretions in PCD in a subset of PCD patients.

Pyogenic liver abscess in patients with schistosomiasis mansoni

Schistosomiasis mansoni has been described as a predisposing factor for pyogenic liver abscess formation. Previous experimental studies have shown that acute schistosomiasis concurrent with Staphylococcus aureus bacteremia favors the colonization of the liver by the bacteria, and subsequent pyogenic liver abscess formation. In addition, clinical studies and case reports have demonstrated the association of schistosomiasis mansoni with pyogenic liver abscesses. We describe a Brazilian patient with chronic schistosomiasis mansoni who developed recurrent pyogenic liver abscesses due to Pseudomonas aeruginosa. The authors review the clinical, diagnostic and treatment aspects of patients with schistosomiasis and pyogenic liver abscess reported in the medical literature.

Inflammation and infection: imaging properties of 18F-FDG-labeled white blood cells versus 18F-FDG

(18)F-FDG and (18)F-FDG-labeled white blood cells ((18)F-FDG-WBCs) are valuable radiopharmaceuticals for imaging focal sites of inflammation and infection. In the present study, the imaging properties of both radiotracers were compared in sterile and septic inflammation models.

METHODS

Groups of adult male Sprague-Dawley rats (100-120 g) were injected in the left posterior thigh muscle with saline solution (group 1: controls, n = 15), 0.100 mL of turpentine oil (group 2: sterile inflammation, n = 26), 10(9) viable Escherichia coli bacteria (group 3: E. coli septic inflammation, n = 29), or 10(8) viable Pseudomonas aeruginosa bacteria (group 4: P. aeruginosa septic inflammation, n = 25). Twenty-four hours later, the animals were divided into 2 groups: One received (18)F-FDG intravenously and the other received human white blood cells (WBCs) labeled in vitro with (18)F-FDG injected intravenously. Biodistribution and microPET studies were performed 1 h after radiotracer injection. One hour after injection with cell-associated or free (18)F-FDG, phosphorimaging of abscess and contralateral muscle was performed in specimens collected from animals in groups 1, 2, and 3. The region of interest was selected within the abscess wall and values were converted to kBq/g using a (14)C calibration standard curve. Thin-layer radiochromatography (TLRC) was performed to study the chemical forms of (18)F within the WBCs.

RESULTS

Whole-body biodistribution demonstrated a significantly higher uptake ratio of (18)F-FDG-WBCs compared with (18)F-FDG in all sterile and septic inflammation models (t test: sterile, P = 0.048; E. coli, P = 0.040; P. aeruginosa, P = 0.037). microPET imaging confirmed the greater performance of (18)F-FDG-WBCs versus (18)F-FDG in the sterile inflammation model and in both E. coli and P. aeruginosa septic models. Phosphorimaging analysis showed higher (18)F-FDG-WBC uptake than (18)F-FDG in the sterile inflammation and P. aeruginosa septic models and similar tissue uptake in the E. coli septic model. Time course labeling and TLRC of lysed WBCs demonstrated that (18)F-FDG was retained as (18)F-FDG-6-phosphate inside WBCs for at least 2 h, corresponding to the time frame of analysis.

CONCLUSION

(18)F-FDG-WBCs gave better results compared with (18)F-FDG in all sterile and septic inflammation models. These data suggest that (18)F-FDG-WBC PET may be a useful technique for tracking focal inflammatory lesions in the body.

Giant urinoma in spinal cord injury: report of two cases

BACKGROUND

A urinoma is a cyst formed by the extravasation of urine from any constituent of the urinary tract; that is, via the kidney, ureter, urinary bladder, or the urethra. It may vary in its site and size according to its etiology, the point of the extravasation, and its duration and time of diagnosis. It commonly is associated with obstruction of the lower urinary tract by an impacted urinary calculus.

METHOD

Case reports.

FINDINGS

Two cases of fatal intra-abdominal urinomas in patients with spinal cord injury (SCI).

CONCLUSION

Complications of SCI place these patients at risk for the development of urinoma. Risk is highest among individuals with recurrent urinary tract infection, stone disease, and obstructive uropathy. Providers need to be alert to this potentially curable condition that may be obscured by the paucity of intra-abdominal findings due to the nature of the spinal cord syndrome.

Long-Term Results of Multiple-Stage Treatment for Posttraumatic Osteomyelitis of the Tibia

BACKGROUND

The treatment of posttraumatic osteomyelitis of the tibia requires meticulous debridement and adequate soft tissue coverage. At our institution, we perform a staged procedure consisting of surgical debridement followed by muscle coverage. If necessary, implantation of a cancellous iliac bone graft was always performed as a three-stage treatment.

METHODS

We performed a retrospective analysis of 47 patients treated for posttraumatic osteomyelitis of the tibia between 1987 and 1998.

RESULTS

Twenty-two patients originally had a Gustilo grade III fracture, 21 patients had a Gustilo grade I or II or closed fracture, the Gustilo grade was not known for 2 patients, and 2 patients had no fracture. Using the Cierny-Mader classification, most patients had a localized osteomyelitis. To cover the debrided area, 20 pedicled muscle transfers and 28 microvascular free flaps were used; one patient had two localizations of osteomyelitis (both proximal and distal) and received two muscle flaps. Flap failure was 8% and was successfully treated by additional flap coverage in two cases; one was closed by a split skin graft and one was closed by secundum. Twenty-six patients received a cancellous bone graft. During an average follow-up of 94 months, 9% had a recurrence of osteomyelitis for which additional surgical interventions were necessary. Finally, all the infections were eventually cured.

CONCLUSION

Our staged surgery proved to be an excellent method of treating osteomyelitis after open or closed fractures of the tibia.

Diagnosis of renal and hepatic cyst infections by 18-F-fluorodeoxyglucose positron emission tomography in autosomal dominant polycystic kidney disease

BACKGROUND

Infection of a renal or hepatic cyst is a serious complication of autosomal dominant polycystic kidney disease (ADPKD). Although crucial for successful management, early diagnosis is difficult, largely because of nonspecific symptoms and limitations of conventional imaging techniques. Because of an increased metabolic rate, inflammatory cells take up large amounts of glucose. 18-F-fluorodeoxyglucose (FDG), therefore, represents a promising agent for detection of cyst infections using positron emission tomography (PET).

METHODS

The authors studied the results of 7 FDG PET scans in 3 ADPKD patients suspected of renal or hepatic cyst infection. Two PET scans were performed in patient A (PET 1 and 2), one PET scan was performed in patient B (PET 3), and 4 PET scans were performed in patient C (PET 4, 5, 6 and 7).

RESULTS

FDG PET identified the infected cysts in 2 episodes of renal cyst infection (PET 2 and 3), 2 episodes of hepatic cyst infection (PET 6 and 7), and 1 episode of both renal and hepatic cyst infection (PET 1). In patient C, FDG PET was normal after 6 weeks of antibiotic treatment for hepatic cyst infection (PET 4) and again at a time when hepatic cyst infection was suspected, but eventually colchicine intoxication was diagnosed (PET 5).

CONCLUSION

In these patients, FDG PET proved very helpful in diagnosing and in excluding renal and hepatic cyst infections. It is concluded that FDG PET is a promising new imaging technique enabling early identification of renal and hepatic cyst infections in ADPKD patients.

Infecton: a 99mTc-ciprofloxacin radiopharmaceutical for the detection of bone infection

OBJECTIVE

To evaluate Infecton scintigraphy, with technetium-99m-radiolabeled ciprofloxacin, as a means to detect bone infection, in comparison with other conventional scintigraphic and radiologic methods.

METHODS

Forty-five patients with known or suspected bone infection underwent 50 scans with Infecton. Almost all were also subjected to a three-phase 99mTc-methylene diphosphonate bone scan and most of them to a 99mTc-human polyclonal immunoglobulin scan as well as to a gallium-67-citrate scan, plus computerized tomography or magnetic resonance imaging or both. Clinical laboratory criteria for the presence of osteomyelitis were based on the definitions of the Centers for Disease Control and Prevention.

RESULTS

Staphylococcus aureus and Pseudomonas aeruginosa were the most frequently isolated pathogens. Based on the CDC clinical laboratory criteria as well as on conventional scan results, Infecton was characterized in 35 studies as 'true positive', in eight as 'true negative', in two as 'false positive', in one as 'false negative', and in four as 'indeterminate'. The sensitivity and specificity of Infecton scintigraphy were found to be 97.2% and 80%, respectively, with positive and negative predictive values of 94.6% and 88.9%.

CONCLUSIONS

It is concluded that Infecton is a very sensitive and quite specific marker of bone infection, but care must be taken in cases of excessive new bone formation and primary bone tumors, where false-positive results may be obtained.

Imaging lung inflammation in a murine model of Pseudomonas infection: a positron emission tomography study

We tested the hypothesis that the uptake of [18F]fluorodeoxyglucose (FDG), as measured by positron emission tomography (PET) imaging, would correlate with inflammation caused by increasing doses of instilled Pseudomonas aeruginosa (PA) into the lungs of mice. PA-laden agarose beads were instilled via the trachea into 1 lung of each mouse (dose range 0.5-15 x 10(4) CFU) and imaging was performed 3 days later (at the peak of the inflammatory response). Lung uptake of [18F]FDG correlated significantly with the dose of bacteria instilled in mice infected with the M57-15 strain of PA (n = 18) (r2 = .62), but not in mice infected with the PA01 strain (n = 20). The overall lung uptake of [18F]FDG was higher in mice infected with the M57-15 strain than in those infected with the PA01 strain (P < .05). Total white blood cell concentrations in bronchoalveolar lavage were also higher in the M57-15-infected mice. We conclude that PET imaging can detect and quantify differences in host inflammatory response to 2 different strains of PA. The combination of PET imaging with murine models should be a useful new tool to study neutrophil trafficking and kinetics in lung inflammation.

Portal-venous gas unrelated to mesenteric ischemia

The aim of this study was to report on 8 patients with all different non-ischemic etiologies for portal-venous gas and to discuss this rare entity and its potentially misleading CT findings in context with a review of the literature. The CT examinations of eight patients who presented with intrahepatic portal-venous gas, unrelated to bowel ischemia or infarction, were reviewed and compared with their medical records with special emphasis on the pathogenesis and clinical impact of portal-venous gas caused by non-ischemic conditions. The etiologies for portal-venous gas included: abdominal trauma ( n=1); large gastric cancer ( n=1); prior gastroscopic biopsy ( n=1); prior hemicolectomy ( n=1); graft-vs-host reaction ( n=1); large paracolic abscess ( n=1); mesenteric recurrence of ovarian cancer superinfected with clostridium septicum ( n=1); and sepsis with Pseudomonas aeruginosa ( n=1). The clinical outcome of all patients was determined by their underlying disease and not negatively influenced by the presence of portal-venous gas. Although the presence of portal-venous gas usually raises the suspicion of bowel ischemia and/or intestinal necrosis, this CT finding may be related to a variety of non-ischemic etiologies and pathogeneses as well. The knowledge about these conditions may help to avoid misinterpretation of CT findings, inappropriate clinical uncertainty and unnecessary surgery in certain cases.

An infected hip prosthesis in a dog diagnosed with a 99mTc-ciprofloxacin (infecton) scan

This case report describes the use of the 99mTc-labeled radiopharmaceutical ciprofloxacin (Infecton) in a case of hip prosthesis loosening in a dog. Serial planar radiographs were not conclusive, and culture of the synovial fluid was negative. Antibiotic treatment did not result in improvement of the lameness. Scintigraphy was performed with 99-Tc-Infecton, a tracer claimed to be specific for infection. Antibiotic treatment was interrupted 6 weeks prior to the examination. Planar and tomographic images at 3 h and at 24 h postinjection showed increased activity along the acetabulum and the proximal femoral bone surrounding the femoral prosthesis, indicating focal infection. Bacteriology performed after removal of the implant revealed Pseudomonas aeruginosa.

Spectrum of CT findings in nosocomial Pseudomonas aeruginosa pneumonia

The purpose of this study was to evaluate CT findings in nosocomial Pseudomonas aeruginosa Pneumonia (PAP) and to compare features of PAP in patients with isolated P. aeruginosa cultures and those with coexistent infections. A retrospective database search revealed 28 patients with nosocomial PAP (12 men, 16 women; mean age, 57 years) in which thoracic CT had been performed within a mean of 1.7 days from the time of respiratory culture. Two chest radiologists blinded to culture data performed a consensus reading noting distribution and pattern of consolidation, ground-glass opacity, nodules, peribronchial infiltration, necrosis, effusions, and pleural enhancement. Coexistent respiratory cultures were recorded. Consolidation was present in all patients, involving multiple lobes in 23 (82%) and demonstrating upper zonal involvement in 23 (82%). Nodular features were present in 14 (50%), including tree-in-bud patterns with centrilobular distributions in 9 (64%) and larger, randomly distributed nodules in 5 (36%). Five of five patients with consolidations limited to the lower lung zones had associated upper lung nodules. Ground-glass opacity was seen in nine (31%) and peribronchial infiltration in 16 (57%). Necrosis was present in eight (29%). Thirteen (46%) bilateral and five (18%) unilateral pleural effusions were present with enhancement occurring in two (1%). Coexistent positive respiratory cultures were identified in 13 patients. The distribution of consolidation, frequency and distribution of nodules, and frequency of necrosis did not differ significantly between patients with and without other positive cultures. With CT, PAP most commonly presents with multifocal airspace consolidation. Nodular features were identified in half, with one-third demonstrating tree-in-bud opacities. Unsuspected necrosis occurred in one-third of cases. CT findings in patients with and without other respiratory isolates did not differ in the distribution and frequency of consolidations, nodularity, or necrosis.

[Purulent arthritis of the knee joint and septic microembolism of the foot as postoperative complications of an infected femoral anastomosis aneurysm]

Septic peripheral embolism due to infective complication of vascular infrainguinal procedures has been occasionally reported. The combination, however, of purulent arthritis of the knee joint and septic microembolism of the foot, as consequence of an infected pseudoaneurysm, is a very rare entity. We report a case of an infected anastomotic femoral aneurysm, following an iliofemoral "in situ repair" which was complicated with purulent arthritis of the knee joint and multiple small necrotic lesions of the plantar surface of the foot. Treatment included removal of the infected graft, an extra-anatomic revascularization and arthrotomy with pus evacuation. The patient had an uneventful postoperative course and remained well at four-year follow-up, with a mild dysfunction in the knee joint flexion.

Subdural and intraventricular traumatic tension pneumocephalus: case report

Simple pneumocephalus most frequently arises as a complication of a head injury in which a compound basal skull fracture with tearing of the meninges allows entry of air into the cranial cavity. It can also follow a neurosurgical operation. Tension traumatic pneumocephalus with intraventricular extension is an extremely rare, potentially lethal condition that requires prompt diagnosis and treatment. We report the case of subdural and intraventricular accidental tension pneumocephalus occurring in a 26-year-old man as a result of skull fracture. This case is combined with rhinorrhea and meningitis that suggest some difficulties to treat. The operative procedure associated with medical treatment was performed and a good result was obtained.

Pyogenic infection of the pubic symphysis in a diabetic patient

A 51-year-old woman with diabetes mellitus had swelling in the inguinal area leading to discharge. Insulin, irrigation of the wound and intravenous antibiotics had no effect. Fistulography and a fistula-CT showed a fistula connecting to the pubis symphysis. After curettage of the pubic symphysis, the wound was closed.

Pseudomonas osteomyelitis of the symphysis pubis after inguinal hernia repair

Osteitis pubis (OP) is a term used to describe an entity characterised by severe pelvic pain, a wide-based gait and bony destruction of the margins of the pubic symphysis. It is usually assumed that OP is a non-infectious, self-limiting, relatively benign condition. Infectious osteomyelitis of the symphysis pubis (IOSP) is very unusual and the clinical presentation can resemble OP. IOSP following inguinal hernia repair is extremely rare. A case of IOSP caused by Pseudomonas aeruginosa is described. We reiterate the assumption that IOSP can be misdiagnosed as OP.

Community acquired Pseudomonas aeruginosa pneumonia

Pseudomonas aeruginosa is an uncommon cause of community acquired pneumonia in immunocompetent hosts. We report two cases that did well once appropriate and prolonged antimicrobial therapy was initiated. They had no evidence of immune deficiency. The initial consideration was pulmonary tuberculosis in both cases given the subacute presentation, significant weight loss, and findings on chest roentgenogram.