Clostridial infection of renal cell carcinoma

Papillary renal cell carcinoma with abscess formation: A report of three cases

We report three cases of renal cell carcinoma (RCC) associated with abscess formation. Such association has been reported uncommonly in literature. Our cases were unique in that final histopathological report was papillary RCC in all of the patients.

Civilian gas gangrene: a clinical challenge

Gas gangrene due to clostridia infections is commonly seen in war injuries and is much less commonly seen in civilian life. When such problems do occur, they present a challenge to the surgeon due to the associated high morbidity and mortality associated. A case is presented where a patient developed gas gangrene in a limb consequent to trauma that had been treated surgically. It is vital to make a correct diagnosis at the earliest to limit disease progression and to avoid complications.

Microbiology and management of infected solid tumours

Infection has been recognized as one of the major obstacles to the successful management of patients with malignant tumours. Aerobic and anaerobic bacteria of endogenous source are a major cause of infections in the necrotic tumour, especially when they occur in proximity to a site where these bacteria reside as part of the normal flora. Although surgical removal or evacuation of the purulent fluid is preferred, this is not always feasible in a patient with a malignant tumour. Antimicrobial therapy against potential bacterial pathogens is often the sole therapy or is used along with surgical drainage or removal of the infected area. This review describes the microbiology and management of infection in necrotic tumours.

Urinary tract and genito-urinary suppurative infections due to anaerobic bacteria

Anaerobes have been involved in many different types of urinary tract infection. This review describes the microbiology, diagnosis and management of urinary tract and genito-urinary suppurative infections caused by anaerobic bacteria. The types of infections of the urinary tract in which anaerobes have been involved include para- or periurethral cellulitis or abscess, acute and chronic urethritis, cystitis, acute and chronic prostatitis, prostatic and scrotal abscesses, periprostatic phlegmon, ureteritis, periureteritis, pyelitis, pyelonephritis, renal abscess, scrotal gangrene, metastatic renal infection pyonephrosis, perinephric abscess, retroperitoneal abscess and other infections. The anaerobes recovered in these studies were Gram-negative bacilli (including Bacteroides fragilis and pigmented Prevotella and Porphyromonas sp.), Clostridium sp., anaerobic Gram-positive cocci and Actinomyces sp. In many cases, they were recovered mixed with coliforms or streptococci. The recovery of anaerobes requires the administration of antimicrobial therapy that is effective against these organisms. These antimicrobials include metronidazole, chloramphenicol, clindamycin, a carbapenem, cefoxitin and the combination of a penicillin and a beta-lactamase inhibitor. Percutaneous drainage, open surgical drainage or nephectomy might be indicated for abscesses.

Abscess formation in desmoid tumors of Gardner's syndrome and percutaneous drainage: a report of three cases

PURPOSE

To describe abscess formation complications in desmoid tumors of patients with Gardner's syndrome and percutaneous drainage.

METHODS

Three patients with Gardner's syndrome and intramesenteric desmoid tumors were diagnosed as having intratumor abscess formation. Percutaneous drainage was the initial method of treatment in each case. Two subsequently underwent surgical resection and one patient refused surgery and was lost to follow-up.

RESULTS

In each case, percutaneous drainage and antibiotics resulted in clinical improvement. In two, fistulous communication with the small bowel could be demonstrated, presumed to be the cause of abscess formation. Surgical resection confirmed fistula communication to the small bowel. In the third patient, no fistula was seen and only percutaneous drainage was performed.

CONCLUSION

Abdominal pain and fever in patients with Gardner's syndrome and desmoids is suggestive of abscess formation in these tumors. Percutaneous drainage is useful as initial management.

Medical therapy alone for the treatment of gas forming intrarenal abscess

Gas forming renal infections are severe, potentially lethal conditions. Gas formation in an intrarenal abscess is extremely rare. Formerly, these patients were uniformly treated by a combined medical and surgical approach. We describe 2 patients with intrarenal gas abscess who were successfully treated with antibiotics alone. We review the literature concerning intrarenal gas abscess and propose a pathophysiological mechanism for its formation as well as a treatment schema.

Clostridial infection of a locally recurrent renal cell carcinoma with sepsis

An association between clostridial sepsis and malignancy is well established in the literature. Although anaerobes are a relatively infrequent cause of renal abscess, there have been recent reports of anaerobic abscesses occurring in renal tumor masses. The present report describes a case of sepsis due to Clostridium perfringens infection of a locally recurrent renal cell carcinoma. The infection may have originated either from tumor invasion of the adjacent bowel or by hematogenous seeding of the mass at the time of colonoscopy. Patients with bulky, necrotic tumors who have invasive diagnostic procedures relating to either the gastrointestinal or urogenital tracts, as well as those having malignancies involving these systems, are at increased risk of infection with bowel anaerobes. Clostridial abscesses with accompanying sepsis occur in this setting, and empiric antibiotic regimens should include coverage for these organisms. Early, aggressive surgical intervention is essential.