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Ruan N, Shi C, Al-Momani Z, Jaber F, Ghaly R, Wooldridge D. Management of Severe Anemia in a Jehovah's Witness Patient With Lung Abscess Secondary to Malpositioned Laparoscopic Adjustable Gastric Band: A Case Report. J Investig Med High Impact Case Rep 2024; 12:23247096241231649. [PMID: 38353220 PMCID: PMC10868478 DOI: 10.1177/23247096241231649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/14/2024] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
Jehovah's Witnesses is a Christian denomination widely recognized for their steadfast refusal of blood transfusions, even when facing severe anemia. We describe a unique case of a 42-year-old Jehovah's Witness woman with severe iron deficiency anemia. She necessitated surgical correction of a malpositioned gastric band within the context of a complex necrotizing aspiration pneumonia secondary to esophageal obstruction. Medical management of this severe anemia has been a challenge as traditional approaches, like a blood transfusion, are not possible. Instead, a multifaceted approach has been described with intravenous iron infusions, recombinant human erythropoietin, vitamin B12, folate, and vitamin C administration. We emphasize the lack of consensus on guideline protocols regarding management of severe anemia for Jehovah's Witness patients and the subsequent need for more investigation into that matter. It also underscores the significance of respecting patient autonomy through close collaboration between patients and their health care providers to ensure effective patient-centered care.
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Affiliation(s)
- Nina Ruan
- University of Missouri-Kansas City, USA
| | - Chloe Shi
- University of Missouri-Kansas City, USA
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Kaneda M, Nagaoka K, Kawasuji H, Matsunaga K, Inomata M, Miyazaki Y, Nakashima A, Yamamoto Y. Pulmonary abscess caused by Cladosporium cladosporioides after receiving outpatient chemotherapy. J Infect Chemother 2023; 29:993-996. [PMID: 37331657 DOI: 10.1016/j.jiac.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 06/20/2023]
Abstract
Cladosporium cladosporioides is one of the most ubiquitous dematiaceous fungi that seldomly occur human infection. Here, we demonstrate a rare case of pulmonary phaeohyphomycosis with a distinctive pulmonary lesion during the nadir period of outpatient chemotherapy against endometrial cancer. In addition to severe neutropenia, excessive exposure to C. cladosporioides at patient's residence was considered as dominant causative factor. More caution is considered necessary for pulmonary phaeohyphomycosis in patients who receive outpatient chemotherapy and are homebound during neutropenic status.
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Affiliation(s)
- M Kaneda
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - K Nagaoka
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.
| | - H Kawasuji
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - K Matsunaga
- Department of Clinical Laboratory and Molecular Pathology, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - M Inomata
- First Department of Internal Medicine, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Y Miyazaki
- Department of Fungal Infection, National Institute of Infectious Diseases, Tokyo, Japan
| | - A Nakashima
- Department of Obstetrics and Gynecology, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Y Yamamoto
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
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Mahdaviani SA, Ghadimi S, Fallahi M, Hashemi-Moghaddam SA, Chavoshzadeh Z, Puel A, Rezaei N, Rekabi M, Daneshmandi Z, Sheikhy K, Kakhki AD, Saghebi SR, Pejhan S, Jamee M. Interventional pulmonary procedures and their outcomes in patients with STAT3 hyper IgE syndrome. BMC Surg 2023; 23:289. [PMID: 37741967 PMCID: PMC10517538 DOI: 10.1186/s12893-023-02193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 09/11/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND STAT3 hyperimmunoglobulin E syndrome (STAT3-HIES) also referred to as autosomal dominant HIES (AD-HIES) is an inborn error of immunity characterized by the classic triad of eczema, frequent opportunistic infections, and elevated serum IgE levels. As a consequence of lung sequels due to repeated infections and impaired tissue healing, patients may require interventional pulmonary procedures. METHOD Four patients with dominant-negative STAT3 mutations who had received interventional pulmonary procedures were enrolled. The demographic, clinical, and molecular characteristics were gathered through a medical record search. All reported STAT3-HIES patients in the literature requiring pulmonary procedures as part of their treatment were reviewed. RESULT Recurrent episodes of pneumonia and lung abscess were the most prevalent symptoms. The most common non-immunological features were scoliosis, failure to thrive, and dental problems such as primary teeth retention and disseminated decays. Bronchiectasis, lung abscess, pneumatocele, and cavitary lesion were the most prevalent finding on high-resolution computed tomography at the earliest recording. All patients underwent pulmonary surgery and two of them experienced complications. CONCLUSION Patients with STAT3-HIES have marked pulmonary infection susceptibility which may necessitate thoracic surgeries. Since surgical procedures involve a high risk of complication, surgical options are recommended to be utilized only in cases of drug resistance or emergencies.
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Affiliation(s)
- Seyed Alireza Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soodeh Ghadimi
- School of Medicine, Islamic Azad University of Medical Sciences, Tehran, Iran.
| | - Mazdak Fallahi
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Atefeh Hashemi-Moghaddam
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Chavoshzadeh
- Immunology and Allergy Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anne Puel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Rekabi
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Daneshmandi
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kambiz Sheikhy
- Lung Transplantation Research Center (LTRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolghasem Daneshvar Kakhki
- Lung Transplantation Research Center (LTRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Saghebi
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saviz Pejhan
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahnaz Jamee
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Laboratory for Pediatric Immunology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands.
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Zhao Z, Du J, Ying Z, Wang Y. A case of lung abscess with empyema due to Haemophilus influenzae infection. Asian J Surg 2023; 46:4006-4007. [PMID: 37076349 DOI: 10.1016/j.asjsur.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/06/2023] [Indexed: 04/21/2023] Open
Affiliation(s)
- Zhen Zhao
- Department of Respiratory, Wuxi Huishan District People's Hospital, Wuxi, China
| | - Jingyu Du
- Department of Respiratory, Wuxi Huishan District People's Hospital, Wuxi, China
| | - Zhanzhuan Ying
- Department of Respiratory, Wuxi Huishan District People's Hospital, Wuxi, China
| | - Yaping Wang
- Department of Gastroenterology, Wuxi Huishan District People's Hospital, Wuxi, China.
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Ribeiro MP, Duarte-Neto AN, Dolhnikoff M, Lindoso L, Lourenço B, Marques HH, Pereira MFB, Cristofani LM, Odone-Filho V, Campos LMA, Sallum AME, Carneiro-Sampaio M, Delgado AF, Carvalho WB, Mauad T, Silva CA. Major discrepancy between clinical diagnosis of death and anatomopathological findings in adolescents with chronic diseases during 18-years. Clinics (Sao Paulo) 2023; 78:100184. [PMID: 36972631 PMCID: PMC10091384 DOI: 10.1016/j.clinsp.2023.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/22/2023] [Accepted: 03/02/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES To evaluate the inconsistency between clinical diagnosis of death and autopsy findings in adolescents with chronic diseases. METHODS A cross-sectional study including a sample of adolescents' autopsies who died in a pediatric and adolescent tertiary hospital over 18 consecutive years. During this period, there were n = 2912 deaths, and n = 581/2912(20%) occurred in adolescents. Of these, n = 85/581(15%) underwent autopsies and were analyzed. Further results were divided into two groups: Goldman classes I or II (high disagreement between main clinical diagnosis of death and anatomopathological findings, n = 26) and Goldman classes III, IV or V (low or no disagreement between these two parameters, n = 59). RESULTS Median age at death (13.5 [10‒19] vs. 13 [10‒19] years, p = 0.495) and disease duration (22 [0‒164] vs. 20 [0‒200] months, p = 0.931), and frequencies for males (58% vs. 44%, p = 0.247) were similar between class I/II vs. class III/IV/V. The frequency of pneumonia (73% vs. 48%, p = 0.029), pulmonary abscess (12% vs. 0%, p = 0.026), as well as isolation of yeast (27% vs. 5%, p = 0.008), and virus (15% vs. 2%, p = 0.029) identified in the autopsy, were significantly higher in adolescents with Goldman class I/II compared to those with Goldman class III/IV/V. In contrast, cerebral edema was significantly lower in adolescents of the first group (4% vs. 25%, p = 0.018). CONCLUSION This study showed that 30% of the adolescents with chronic diseases had major discrepancies between clinical diagnosis of death and autopsy findings. Pneumonia, pulmonary abscess, as well as isolation of yeast and virus were more frequently identified at autopsy findings in the groups with major discrepancies.
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Affiliation(s)
- Maira P Ribeiro
- Child and Adolescent Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - Amaro N Duarte-Neto
- Patology Department, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Marisa Dolhnikoff
- Patology Department, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Livia Lindoso
- Child and Adolescent Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Benito Lourenço
- Child and Adolescent Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Heloisa H Marques
- Child and Adolescent Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Maria F B Pereira
- Child and Adolescent Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Lilian M Cristofani
- Child and Adolescent Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Vicente Odone-Filho
- Child and Adolescent Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Lucia M A Campos
- Child and Adolescent Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Adriana M E Sallum
- Child and Adolescent Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Magda Carneiro-Sampaio
- Child and Adolescent Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Artur F Delgado
- Child and Adolescent Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Werther B Carvalho
- Child and Adolescent Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Thais Mauad
- Patology Department, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Clovis A Silva
- Child and Adolescent Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), São Paulo, SP, Brazil
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Zhu T, Yang W, Lu W. Risk factors associated with length of hospital stay and medical expenses in pulmonary abscess patients: retrospective study. PeerJ 2023; 11:e15106. [PMID: 37070093 PMCID: PMC10105557 DOI: 10.7717/peerj.15106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/28/2023] [Indexed: 04/19/2023] Open
Abstract
Background Pulmonary abscess carries a high mortality and requires long-term managements. A better understanding of the risk factors associated with the prolonged hospital stay and high medical expenses in these patients can improve the management strategy in individual patient and optimize the overall healthcare resources. Methods We performed a retrospective study and reviewed the medical records on consecutive patients hospitalized at the Department of Respiratory Medicine of the General Hospital of Northern Theater Command, Shenyang, Liaoning, China, between January 1, 2015, and December 31, 2020. Demographics, comorbidity, clinical symptoms, laboratory tests, length of hospital stay, and medical expenses were recorded. Their relationships with the length of hospital stay and medical expenses in pulmonary abscess patients were analyzed. Results There were 190 patients with the pulmonary abscess and 12,189 patients without the pulmonary abscess. Compared with patients without the pulmonary abscess, patients with the pulmonary abscess had longer hospital stays (21.8 ± SD vs 12.8 ± SD, P < 0.01), In patients with the pulmonary abscess, the mean length of hospital stay was 5.3 days longer in male vs female patients (P = 0.025). Multivariate linear regression analyses showed that extrapulmonary disease and clinical symptoms were associated with the length of hospital stay and medical expenses, respectively. In addition, anemia was associated with both the length of hospital stay and medical expenses. Sex and hypoproteinemia were associated with the medical expenses. Conclusions The mean length of hospital stay was longer in patients with the pulmonary abscess than those without the pulmonary abscess. The length of hospital stay and medical expense were associated with sex, clinical symptoms, extrapulmonary disease, and abnormal laboratory tests in patients with the pulmonary abscess.
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Chen M, Lai Z, Cheng M, Liang T, Lin Z. Rare brain and pulmonary abscesses caused by oral pathogens started with acute gastroenteritis diagnosed by metagenome next-generation sequencing: A case report and literature review. Front Cell Infect Microbiol 2022; 12:949840. [PMID: 36250052 PMCID: PMC9561126 DOI: 10.3389/fcimb.2022.949840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Odontogenic brain and pulmonary abscesses are extremely rare infectious diseases. It is mainly caused by the upward or downward transmission of local infection or blood-borne spread. In recent years, with the wide application of some novel testing methods in clinical practice, the diagnosis of unexplained infections such as odontogenic abscesses in different organs has gradually become clear. We report a case of a 21-year-old male who was healthy and had not received any oral treatment before onset. He started with acute gastroenteritis-related symptoms, then developed meningitis-related symptoms seven days later with septic shock. No obvious abscess lesions were found on head computed tomography (CT) at admission, and the etiology was not clear by routine examination, which was very easy to misdiagnose as a serious infection caused by intestinal pathogens. But odontogenic pathogens were found both in his blood and cerebrospinal fluid through metagenomic next-generation sequencing (mNGS) analysis. Subsequently, rechecked imaging examination displayed multiple brain and pulmonary abscesses. Finally, it was diagnosed as an odontogenic brain and pulmonary abscess. After an extremely lengthy anti-infection course (13 weeks of intravenous antibiotics plus 2 weeks of oral antibiotics) and surgery, the patient was improved and discharged from the hospital. From this case, we could see that the development of new diagnostic technologies such as mNGS plays an important role in the early and confirmed diagnosis of diseases previously difficult to diagnose such as odontogenic polymicrobial infections and ultimately helps to improve the prognosis of these patients.
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Affiliation(s)
- Minhua Chen
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Zhiyi Lai
- Intensive Care Unit, Ningbo Fourth Hospital (The Affiliated Xiangshan Hospital of Wenzhou Medical University), Ningbo, China
| | - Mingjun Cheng
- Intensive Care Unit, Chun’an First People’s Hospital (Chun’an Branch of Zhejiang Provincial People’s Hospital and Chun’an Hospital Affiliated to Hangzhou Medical College), Hangzhou, China
| | - Tianyu Liang
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- *Correspondence: Zongbin Lin, ; Tianyu Liang,
| | - Zongbin Lin
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- *Correspondence: Zongbin Lin, ; Tianyu Liang,
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Hayashi Y, Kitajima T, Marumo S, Fukui M. Adult T Cell Leukemia/Lymphoma Becoming Apparent during Treatment of Pulmonary Abscess and Empyema Caused by Nocardia asiatica: A Case Report and Review of the Literature. Intern Med 2022; 61:2227-2232. [PMID: 34980794 PMCID: PMC9381332 DOI: 10.2169/internalmedicine.8428-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Nocardia is a Gram-positive bacterium that causes opportunistic infections. Nocardia asiatica was newly isolated in 2004, and there have been no case reports describing the empyema caused by N. asiatica. Adult T-cell leukemia/lymphoma (ATL) is a peripheral T-cell malignancy caused by human T-cell leukemia virus type 1 (HTLV-1). We herein report a case in which immunosuppression attributable to ATL may have led to pulmonary abscess and empyema caused by N. asiatica. Our case demonstrates the need to investigate causes of immunosuppression, including ATL, in patients showing nocardiosis.
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Affiliation(s)
- Yusuke Hayashi
- Department of Respirology, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, Japan
| | - Takamasa Kitajima
- Department of Respirology, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, Japan
| | - Satoshi Marumo
- Department of Respirology, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, Japan
| | - Motonari Fukui
- Department of Respirology, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, Japan
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Zhou XQ, Fu YQ, Xu M, Zhou H, Zhou JY, Lu JJ, Zhu J. [Clinical and microbiological characteristics of hypervirulent Klebsiella pneumoniae lung abscess]. Zhonghua Jie He He Hu Xi Za Zhi 2022; 45:438-444. [PMID: 35527458 DOI: 10.3760/cma.j.cn112147-20210820-00580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To study the clinical and microbiological characteristics of hypervirulent Klebsiella pneumoniae (hvKP) lung abscess, and to compare with the classic Klebsiella pneumoniae (cKP) lung abscess. Methods: A total of 18 patients with Klebsiella pneumoniae lung abscesses admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from January 2017 to September 2020 enrolled. The strains with positive result of string test were defined as hvKP, and the negative strains were defined as cKP. The patients' basic diseases, symptoms, laboratory data and other clinical characteristics were collected. The microbiological characteristics of the strains included as following: VITEK method to determine the in vitro susceptibility of the strains to antibiotics; PCR to detect the capsular serotypes and virulence genes. The differences in clinical characteristics and microbiological characteristics of strains between hvKP group and cKP group were compared. Results: Among the 18 patients with Klebsiella pneumoniae lung abscess, 12 were hvKP infection, mainly male (10 cases), with a median age of 59.0 years; 8 cases in the hvKP group had an onset time of ≤2 weeks, and the median onset time was 10.5 days. There were significantly more diabetes (12 cases) and extrapulmonary abscesses (11 cases) in hvKP group than those in cKP group (both P<0.001). The extrapulmonary abscesses in the hvKP group were mainly liver abscesses (10 cases), and 4 cases were multi-site (≥3) abscesses. The number of indwelling catheters and invasive procedures before infection were higher in cKP group than those in hvKP group (both P=0.025). The imaging of Klebsiella pneumoniae lung abscess was mainly subpleural with the size of less than 10 cm. There were more multiple abscesses cases in hvKP group (9 cases) than cKP group (P=0.009). The median interval time between the detection of a pulmonary abscess and an extrapulmonary abscess was 1.0 day. The resistance rate of common antibiotics was significantly lower in hvKP than cKP. Conclusions: hvKP lung abscesses are more common in patients with diabetes, and the clinical manifestations are nonspecific. The lung imaging manifestations are multiple subpleural abscesses, indicating hematogenous dissemination. Liver abscesses were present in most cases, suggesting the source of infection. The main virulent gene of hypervirulent Klebsiella pneumoniae is aero. For patients with hvKP lung abscess, attention should be paid to finding hidden lesions.
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Affiliation(s)
- X Q Zhou
- Department of Intensive Care Unit, the First Affiliated Hospital of Zhejiang University Medical College (the second People's Hospital of Yuhang District, Hangzhou), Hangzhou 311121, China
| | - Y Q Fu
- Department of Respiratory Disease, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - M Xu
- Department of Microbiology, the First Affiliated Hospital, Zhejiang University Medical College, Hangzhou 310003, China
| | - H Zhou
- Department of Respiratory Disease, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - J Y Zhou
- Department of Respiratory Disease, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - J J Lu
- Department of Intensive Care Unit, the First Affiliated Hospital of Zhejiang University Medical College (the second People's Hospital of Yuhang District, Hangzhou), Hangzhou 311121, China
| | - Jianjun Zhu
- Department of Intensive Care Unit, the First Affiliated Hospital of Zhejiang University Medical College (the second People's Hospital of Yuhang District, Hangzhou), Hangzhou 311121, China
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Manasrah N, Nanja Reddy S, Al Sbihi A, Hafeez W. Streptococcus intermedius: unusual presentation and complication of lung abscess. BMJ Case Rep 2021; 14:e245675. [PMID: 34725064 PMCID: PMC8562500 DOI: 10.1136/bcr-2021-245675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 54-year-old immunocompetent male who had lung abscess secondary to Streptococcus intermedius that led to discitis by contiguous spread of infection. He initially presented with constant chest pain for 6 weeks that radiated to lower back, with no fever, chills or weight loss. He denied smoking cigarettes, alcohol use or any illicit drug. On investigation, a mass was identified on the posterior medial aspect of the right lower lobe with direct infiltration into right side of the T5-T6 vertebral bodies. Histopathology identified organising pneumonia with abscess. Tissue cultures showed S. intermedius, and were negative for other microorganisms. This case highlights a rare presentation of S intermedius discitis by contiguous spread of infection from posterior right lower lobe lung abscess. S intermedius usually occurs in older patients with pulmonary infections complicated with pleural effusion or lung abscess, but can present in young patients with no clear symptoms of lung infection, like our patient.
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Affiliation(s)
- Nouraldeen Manasrah
- Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA
| | - Sushmita Nanja Reddy
- Department of Internal Medicine, Sinai Grace Hospital, Detroit, Michigan, USA
- Wayne State University, Detroit, Michigan, USA
| | - Ali Al Sbihi
- Department of Internal Medicine, Sinai Grace Hospital, Detroit, Michigan, USA
- Wayne State University, Detroit, Michigan, USA
| | - Wasif Hafeez
- Department of Internal Medicine, Sinai Grace Hospital, Detroit, Michigan, USA
- Wayne State University, Detroit, Michigan, USA
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Soyak Aytekin E, Serin O, Cagdas D, Tan C, Aksu T, Unsal Y, Yeni S, Orhan D, Ozon ZA, Tezcan I. A Patient With AIRE Mutation Who Presented With Severe Diarrhea and Lung Abscess. Pediatr Infect Dis J 2021; 40:66-69. [PMID: 33284251 DOI: 10.1097/inf.0000000000002887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) (polyglandular endocrinopathy type 1) is a rare autosomal recessive disorder caused by mutations in the autoimmune regulator gene (AIRE). The major clinical features of APECED are hypoparathyroidism, adrenal insufficiency (Addison disease), and chronic mucocutaneous candidiasis. This disease is also associated with multiple other and uncommon autoimmune (autoimmune hepatitis, autoimmune enteropathy, atrophic gastritis with or without pernicious anemia, gonadal failure, diabetes mellitus, hypothyroidism, functional hyposplenism), ectodermal (alopecia and vitiligo), and inflammatory (intestinal lung disease, nephritis) features. Here, we report a case of a 13-year-old Turkish boy who presented wih enteropathy and lung abscess. Molecular genetic analysis demonstrated a homozygous frameshift mutation (p.Asp70fs, c.208_209insCAGG) in exon 2, in AIRE gene. APECED may present with severe, life-threatening infections due to functional hyposplenism. Multidisciplinary approach, careful follow-up, and molecular genetic studies are needed.
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Affiliation(s)
- Elif Soyak Aytekin
- From the Department of Pediatrics, Division of Pediatric Immunology, Hacettepe University Medical School, Ankara, Turkey
| | - Oguzhan Serin
- Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
| | - Deniz Cagdas
- From the Department of Pediatrics, Division of Pediatric Immunology, Hacettepe University Medical School, Ankara, Turkey
| | - Cagman Tan
- Institute of Child Health, Immunology, Hacettepe University, Ankara, Turkey
| | - Tekin Aksu
- Department of Pediatrics, Division of Pediatric Hematology, Hacettepe University Medical School, Ankara, Turkey
| | - Yagmur Unsal
- Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, Hacettepe University Medical School, Ankara, Turkey
| | - Selma Yeni
- Department of Clinical Pathology, Hacettepe University Medical School, Ankara, Turkey
| | - Diclehan Orhan
- Department of Clinical Pathology, Hacettepe University Medical School, Ankara, Turkey
| | - Zeynep Alev Ozon
- Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, Hacettepe University Medical School, Ankara, Turkey
| | - Ilhan Tezcan
- From the Department of Pediatrics, Division of Pediatric Immunology, Hacettepe University Medical School, Ankara, Turkey
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Costa AR, Silva J, Barata R, Reis JE, Calvinho P. Lung Necrosis After Paraffin Aspiration. Rev Port Cir Cardiotorac Vasc 2020; 27:131-133. [PMID: 32707623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Fire breather´s lung is a rare condition that occurs after hydrocarbon aspiration. Case reports published experienced a good clinical outcome with conservative treatment. To our knowledge, there are no reported cases treated with pulmonary resection. CASE PRESENTATION We report the case of a 35-year-old female trapeze artist, who suffered an accidental ingestion/ aspiration of liquid paraffin. Persistent fever and elevated inflammatory markers without clinical improvement with antibiotics and bronchoscopy was seen. Computed tomography scan showing middle lobe necrosis and abscess motivated a middle lobectomy for infection control. Postoperative recovery was uneventful. CONCLUSION There are some cases described in the literature, normally with a favourable evolution with conservative treatment. Therefore, it is important to acknowledge that, in patients where serious complications have arisen, despite medical therapy, surgery may have an important role, and resection of the necrotic lung may prevent its potential life-threatening consequences.
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Affiliation(s)
- Ana Rita Costa
- Cardiothoracic Surgery Department, Santa Marta Hospital, CHULC, Lisbon, Portugal
| | - João Silva
- Cardiothoracic Surgery Department, Santa Marta Hospital, CHULC, Lisbon, Portugal
| | - Rita Barata
- Cardiothoracic Surgery Department, Santa Marta Hospital, CHULC, Lisbon, Portugal
| | - João Eurico Reis
- Cardiothoracic Surgery Department, Santa Marta Hospital, CHULC, Lisbon, Portugal
| | - Paulo Calvinho
- Cardiothoracic Surgery Department, Santa Marta Hospital, CHULC, Lisbon, Portugal
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Yang W, Zhao L, Tang M, Jiang Y, Zhu Z, Brady TJ, Xiao H, Bai Q, Wakefield MR, Fang Y. Disseminated Nocardia Infection in an Old Male Patient with Nephrotic Syndrome. Clin Lab 2020; 66. [PMID: 32013360 DOI: 10.7754/clin.lab.2019.190638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Nocardia infection is a very rare bacterial infection caused by Gram-positive, aerobic nocardia species. However, in recent years, it has become a serious infection in immunocompromised patients. Earlier diagnosis plays a pivotal in the effective treatment of nocardia infection. METHODS In this study, we reported a 65-year-old male patient with nephrotic syndrome who had disseminated abscesses in the lungs, right lower limb, and right cheek. RESULTS Bacterial culture from these lesions confirmed the presence of nocardia. Timely administration of sensitive antibiotics resulted in a quick recovery for this patient. CONCLUSIONS Nocardia infection should be considered in the differential diagnosis of infectious lesions, especially when a patient has multiple abscesses and an underlying disorder in which the immune function of the patient may be compromised.
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Lisi G, Lauriti G, Cascini V, Lococo A, Chiesa PL. Intercostal muscle flap to protect the bronchial stump in pediatric lobectomy for lung abscess. Ann Ital Chir 2013; 84:197-200. [PMID: 22615041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Lung suppurative diseases in children are usually responsive to medical treatment or percutaneous drainage. Rarely, pulmonary resection is required for lung abscess in childhood, particularly in presence of co-morbidities. In these cases, a lobectomy is usually performed through an open thoracotomy, with a reported incidence of bronco-pleural fistula up to 9.1% of pediatric series. This consequence is mainly due to the inflammatory condition; however the lack of knowledge of pediatric and thoracic surgeons with this rare condition in childhood can also play a role. In adults with lung cancer, the buttressing of bronchial stump with the additional support of an intercostal muscle (ICM) flap has proved to prevent this complication, as well as to reduce post-operative pain. We report the first pediatric experience of ICM flap used in 2 immunocompetent children requiring lobectomy for suppurative lung conditions. Our preliminary experience confirms the feasibility of protecting the bronchial stump after lobectomy in children, especially in conditions at risk for bronco-pleural fistula development.
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PFEFFER KH. Contribution to the conservative treatment of the lung abscess with special consideration of the Supronal (De-Ma). Ther Ggw 2008:104-9. [PMID: 18879693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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HICKEY BB, EVANS CJ, SHARP ME, ASHLEY DJ. Renal and pulmonary tuberose sclerosis: The relationship of the renal lesion to hæmangiopericytoma. Br J Surg 2005; 49:396-400. [PMID: 13907174 DOI: 10.1002/bjs.18004921609] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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KASSOWITZ KE, MUSCATO GH. The long range effect of antibacterial therapy on pneumonia, empyema, bronchiectasis and pulmonary abscess; an analysis of incidence and mortality in 74,489 admissions to a Children's Hospital in twenty years. ACTA ACUST UNITED AC 2004; 21:161-73. [PMID: 14896840 DOI: 10.1378/chest.21.2.161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Abstract
AIM Infectious disease represents one of the major causes of morbidity and mortality in hemodialysis patients. Extra-renal abscess constitutes a specific form of infection. The aim of this study was to evaluate and analyze the clinical characteristics of extra-renal abscess in chronic hemodialysis patients. METHODS We retrospectively studied the extra-renal abscess among chronic hemodialysis patients in Chang Gung Memorial Hospital at Kaohsiung, Taiwan. The records of 2,168 chronic hemodialysis patients from October 1986 to January 2000, were studied. The clinical features were reviewed and analyzed. RESULTS Sixteen patients who were enrolled during the study period developed extra-renal abscess. Ten of them were male. The mean age was 59.2 +/- 11.8 years old. More than half of the patients had diabetes (53.6%, 9/16). The locations of extra-renal abscess in these patients were liver (8/16), lung (5/16), spleen (1/16), perianal region (1/16), psoas muscle (1/16), and prostate (1/16). One patient had concurrent liver and spleen abscesses. All patients presented with fever and chills. Laboratory studies revealed leukocytosis and thrombocytopenia in 2/3 of the patients. The patients were associated with malnutrition status with lower serum albumin level (2.94 +/- 0.55 gm/dL) and lower nPCR (normalized protein catabolism rate; 0.84 +/- 0.11 gm/Kg/day) comparing to the other hemodialysis patients (albumin: 4.05 +/- 0.47 gm/dL; nPCR: 1.14 +/- 0.31gm/kg/day). There was no significant difference in kt/V between the patients with (1.28 +/- 0.34) or without abscess formation (1.47 +/- 0.36). The major causative pathogen was Klebsiella pnewnoniae. Parenteral antibiotic treatment is sufficient to treat most of the diseases, except 2 patients who needed surgical intervention. Twelve patients recovered after 2-3 weeks of treatment. CONCLUSIONS The study indicated that extra-renal abscess is rare in chronic hemodialysis patients. The abscesses occurred mostly in liver. Diabetes mellitus and poor nutrition status were the important predisposing factors. Gram-negative bacilli, K. pneumoniae, were the major pathogen. Most of the patients responded to parenteral antibiotics and surgical draining.
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Affiliation(s)
- Feng-Rong Chuang
- Division of Nephrology Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Kobayashi H. [Anaerobic pneumonia]. Ryoikibetsu Shokogun Shirizu 1999:392-5. [PMID: 10088425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- H Kobayashi
- Third Department of Internal Medicine, National Defense Medical School
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VILLAR TG, PIMENTEL JC, FREITAS E COSTA M. The tumour-like forms of aspergillosis of the lung (pulmonary aspergilloma). A report of five new cases and a review of the Portuguese literature. Thorax 1998; 17:22-38. [PMID: 13926014 PMCID: PMC1018667 DOI: 10.1136/thx.17.1.22] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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CONEN PE, WALKER GR, TURNER JA, FIELD P. Invasive primary aspergillosis of the lung with cerebral metastasis and complete recovery. ACTA ACUST UNITED AC 1998; 42:88-94. [PMID: 13880835 DOI: 10.1378/chest.42.1.88] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Abstract
Cytomegalic inclusion-body disease was found at necropsy in the lungs of a 57-year-old diabetic man. The characteristic large cells were found in all parts of the lungs. The alveolar walls showed no cellular infiltration, supporting Hamperl's suggestion that the cytomegalic virus alone may be incapable of causing pneumonitis. A small focus of aspergillosis was also found in one lung. The rarity of cytomegalic inclusion-body disease in adults was confirmed by re-examining histologically the lungs of 15 further cases of diabetes as well as 60 of other chronic diseases. No further example of pulmonary cytomegaly was found.
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MALMBERG R, ALBRECT G, BALTAZAAR A, BUCKINGHAM WB, LEVINE H, CUGEL DW. THE VALSALVA MANEUVER AS A TEST OF CARDIAC FUNCTION IN PATIENTS WITH PULMONARY DISEASE. Am Rev Respir Dis 1996; 89:64-72. [PMID: 14117679 DOI: 10.1164/arrd.1964.89.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
In the immunocompromised patient, early diagnosis of a lung cavity is essential for appropriate treatment. Rhodococcus equi (formerly Corynebacterium equi) is a variably acid-fast bacterium that can produce cavitary disease in an immunocompromised host. The two cases presented here demonstrate the clinical and radiographic features of R equi lung abscess. The first patient was on long-term corticosteroid therapy for rheumatoid arthritis. The second patient had AIDS. The correct diagnosis in both cases was delayed because acid-fast bacilli seen on smears of sputum were presumed to be Mycobacterium tuberculosis.
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Affiliation(s)
- J E Takasugi
- Department of Radiology, Seattle Veterans Administration Medical Center, WA 98108
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Yee KC, Lee MK, Chua CT, Puthucheary SD. Melioidosis, the great mimicker: a report of 10 cases from Malaysia. J Trop Med Hyg 1988; 91:249-54. [PMID: 3184245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Between 1981 and 1986, 10 consecutive cases of melioidosis were seen at the University Hospital, Kuala Lumpur, Malaysia. They illustrate the amazing guises of melioidosis presenting as: abscesses of the supraspinatus muscle, psoas muscle, brain and liver; three different pulmonary forms; an acute suppurative dermal lesion; an acute septicaemia; and chronic lymphadenitis. The majority had underlying diseases: diabetes mellitus, the commonest, was present in six, out of whom three had previous pulmonary tuberculosis; other predisposing conditions were renal failure, corticosteroid therapy and malnutrition. Three patients who died had pre-existing renal impairment and developed renal failure later, suggesting that the former is a bad prognostic sign. Clinical diagnosis was difficult: all cases were diagnosed bacteriologically. A high level of clinical awareness is necessary, especially when presentation simulates pulmonary or extrapulmonary tuberculosis in patients with diabetes or other compromised states.
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Affiliation(s)
- K C Yee
- Department of Medicine, University of Malaya, Kuala Lumpur
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Smith IM, Habte-Gabr E. Life-threatening infections: how to choose the right antibiotics. Geriatrics (Basel) 1977; 32:83-6. [PMID: 844691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pneumococcal pneumonia in two or more lobes in frail, elderly patients; staphylococcal and Gram-negative rod pneumonia in patients of any age; lung abscesses; septicemia; endocarditis; peritonitis; and meningitis are life-threatening infections. To save patients with these infections, the physician should know the causative organism and educate himself by cultures; estimate the whole body bacterial burden and decrease bacterial numbers by incision and drainage where large collections of pus are accessible; choose antibiotics with care and use two antibiotics if serious prognostic signs are present initially, if there is a change for the worse, or if the laboratory report indicates that multiple organisms are present; check the serum bactericidal level and repeat this test if the route of antibiotic administration is changed; watch for and treat underlying disease; and always monitor for septic shock. Aged patients need special care, as they often have severe underlying disease. The bacterial burden is often high before infection is recognized in elderly patients, and age itself interferes with host defenses.
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Nair S, Nair K, Roberts M. Non-traumatic cerebrospinal fluid rhinorrhea with lung abscess: report of a case and review of literature. Conn Med 1973; 37:611-5. [PMID: 4767358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Nikulin GK. [Clinical forms of chronic nonspecific lung inflammations]. Klin Med (Mosk) 1971; 49:10-3. [PMID: 5159910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Aslam PA, Eastridge CE, Hughes FA. Pulmonary cavitation after embolism. Int Surg 1970; 53:157-61. [PMID: 4906339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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