1/18. spleen abscess caused by eikenella corrodens.A case is reported of splenic abscess due to eikenella corrodens, a gram-negative rod which is found as part of normal flora in human mucous surfaces. A 64-year-old man presented with fever, chills, anorexia and abdominal pain. Abdominal ultrasound examination showed a perisplenic fluid collection which was considered to be either blood or a subcapsular spleen abscess. The presence of a splenic abscess was later confirmed during surgery and a splenectomy was performed. Splenic purulent material and blood cultures yielded eikenella corrodens. The patient received cefotaxime for 19 days and was discharged asymptomatic.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
2/18. Septic arthritis of the ankle due to salmonella enteritidis: a case report.Salmonella septic arthritis in healthy individuals is a rare phenomenon in the united states. This case report chronicles the clinical course of a 41-year-old male farmworker who presented with a 3-week history of fever, chills, night sweats with pain, and swelling and redness of his left ankle. He had an open fracture of the ankle 2 years earlier that healed and was asymptomatic despite prior radiographic evidence of avascular necrosis of the talar dome. One month before presentation, he had an ipsilateral periungual abscess of the great toe that he opened and drained himself. Joint cultures were positive for salmonella enteritidis that was successfully treated with a 6-week course of i.v. ceftriaxone.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
3/18. Progressive staphylococcus lugdunensis endocarditis despite antibiotic treatment.A 68-year old man with fever chills and a diastolic murmur was diagnosed with aortic-valve endocarditis caused by coagulase-negative staphylococcus lugdunensis. The clinical condition initially improved with antibiotic therapy. On day seven, transoesophageal echocardiography revealed large abscesses extending from the aortic root to the left ventricular wall. Emergency cardiac surgery was performed successfully and a stentless bioprosthetic valve was inserted. S. lugdunensis endocarditis is known for its aggressive clinical course with valve destruction, abscess formation and embolic complications despite appropriate antibiotics. Antibiotic treatment alone is associated with a high mortality rate which can be reduced by early valve replacement.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
4/18. Cases from the Osler Medical Service at Johns Hopkins University.PRESENTING FEATURES: A 70-year-old African American man was admitted with a history of fever, chills, and malaise of several days' duration. His past medical history was notable for end-stage renal disease requiring hemodialysis, coronary artery disease, and aortic stenosis requiring a bioprosthetic aortic valve replacement. On the day of admission, the patient was noted to have a shaking chill while undergoing dialysis through his catheter and was admitted to the hospital. He complained of pain at the catheter insertion site, shortness of breath, and dyspnea on exertion, but denied chest pain. On physical examination, the patient had a temperature of 100.4 degrees F, with a heart rate of 64 beats per minute, blood pressure of 127/72 mm Hg, and an oxygen saturation of 97% on room air. He was a mildly obese man in no apparent distress. He had shotty cervical lymphadenopathy and a right subclavian dialysis catheter in place, with erythema and pus at the entry site. His jugular venous pressure was 10 cm H(2)O. lung examination showed bibasilar rales. heart sounds were normal, with no rub or gallop. He had a 2/6 systolic ejection murmur best heart at the left sternal border as well as a 3/6 holosystolic murmur at the apex that radiated to his left axilla. Examination of the abdomen and extremities was unremarkable. The patient's neurological examination was unremarkable, and he was alert and oriented to person, place, and time. Laboratory studies showed an elevated white blood cell count of 16,700 cells/microL. His blood urea nitrogen level was 43 mg/dL and his serum creatinine level was 4.9 mg/dL. Multiple blood cultures grew methicillin-resistant staphylococcus aureus. An admission, chest radiograph showed no infiltrate. An admission electrocardiogram showed normal sinus rhythm with first degree atrioventricular block, left anterior fascicular block, and left ventricular hypertrophy. shows rhythm strips from lead II electrocardiograms 5 months before admission (top), on admission (middle) and 5 days after admission (bottom). What is the diagnosis?- - - - - - - - - - ranking = 2keywords = chill (Clic here for more details about this article) |
5/18. Eyelid abscess as a presenting sign of occult sinusitis.PURPOSE: To describe 5 patients who presented with eyelid abscesses whose subsequent workup revealed occult sinusitis. methods: We reviewed the medical records of 5 patients who presented with eyelid abscess. Common presenting signs and symptoms were identified. Successful diagnosis and treatment was accomplished in each case. RESULTS: All patients were in good general health and did not appear to be systemically ill. Eyelid swelling was the chief presenting complaint of each patient. None of the patients complained of fevers or chills. Each patient had an upper eyelid abscess. Symptoms suggestive of sinusitis included purulent nasal discharge and headache. With appropriate radiologic studies, extensive occult sinusitis was identified in each case. Two patients demonstrated a small defect in the bone between the infected frontal sinus and the eyelid. All patients received intravenous antibiotics followed by oral antibiotics, incision and drainage of the abscess, and, after ENT consultation, functional endoscopic sinus surgery. All patients improved after treatment, and none had permanent visual loss. CONCLUSIONS: Clinical suspicion of sinusitis may be aroused with a thorough history and examination. Radiographic evaluation and prompt treatment of both the eyelid abscess and the sinusitis can result in good outcomes for such patients.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
6/18. Management of splenic abscess in children by percutaneous drainage.BACKGROUND/PURPOSE: Isolated splenic abscesses are rare in pediatric patients. The recommended treatment in the literature has been in favor of splenectomy, although conservative treatment with splenic preservation is being increasingly reported. We report successful management of 4 pediatric patients with splenic abscess by needle aspirations and antibiotics. MATERIALS AND methods: Four children (aged 7-11 years; male-female, 3:1) were admitted in our institution with history of high-grade fever with chills, anorexia, left hypochondrial pain, and splenomegaly. One child was a known case of thalassemia, and one had a history of typhoid fever. The others did not have any predisposing condition. ultrasonography (USG) and computed tomographic scan of the abdomen showed a solitary abscess in the spleen in 2 patients and multiple abscesses in the other 2. ultrasonography-guided needle aspiration in 3 cases revealed purulent fluid, which, on culture, grew escherichia coli in 1 case, salmonella paratyphi a in 1 case, but sterile in 1 case. Blood culture was sterile in all the cases, but Widal's test was positive in 2 patients. Treatment protocol included USG-guided needle aspiration of pus along with intravenous ceftriaxone, metronidazole, and amikacin for 3 to 12 weeks. RESULTS: All 4 patients showed a good response to conservative treatment. Serial USG showed gradual resolution of abscess, and none was subjected to splenectomy. CONCLUSION: Isolated splenic abscess in children can be successfully treated with needle aspirations and intravenous antibiotics, thereby avoiding splenectomy.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
7/18. Absent Tc-99m ciprofloxacin (infecton) uptake in a renal abscess.A 40-year-old male diabetic presented with a 1-month history of flank pain, fever, and chills. Examination revealed pyrexia and left flank tenderness. Pus and red cells were seen on urine microscopy and klebsiella was isolated from the urine. The patient was treated with antibiotics, but the fever persisted and he was sent for an Infecton scan that showed a large cold area in the superolateral aspect of the left kidney. Whole-body imaging failed to reveal any other abnormal site. Computed tomography (CT) demonstrated a space-occupying lesion with an air-fluid level in the upper part of the left kidney. The patient responded to several weeks of antibiotic therapy.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
8/18. Postabortal paracervical abscess as a complication of paracervical block anesthesia. A case report.A paracervical abscess occurred after paracervical block anesthesia was administered for induced abortion in an 18-year-old multigravida. She presented with vaginal, low abdominal and low back pain and with nausea, vomiting, chills and fever. Incision and drainage of the abscess were performed and a vaginal drain inserted under antibiotic coverage. Cultures of the abscess contents revealed multiple anaerobic organisms. laparoscopy showed normal pelvic organs, and the peritoneal fluid cultures were negative. Postoperatively the patient became afebrile and was discharged after three days on antibiotics. To our knowledge, this case report is the first one on paracervical abscess as a complication of induced abortion with paracervical block anesthesia.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
9/18. Successful novel drainage treatment of mediastinal abscess complicating tracheostomy.drainage from an old tracheostomy stoma with occurrence of fever and chills in a patient led to the discovery of a mediastinal abscess behind the anterior chest wall, an unusual complication of tracheostomy. Successful treatment consisted of intravenous administration of an antibiotic and repeated aspiration of the abscess through a plastic tube inserted into the old tracheostomy stoma.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
10/18. Perinephric abscess. Modern diagnosis and treatment in 47 cases.The records of 47 patients with a perinephric abscess diagnosed from 1975 to 1986 at 8 san francisco Bay Area hospitals were reviewed. The mean age was 51 years. Fifty-five percent were females and 45%, males. The left kidney was affected in 47% of cases, the right kidney in 40%, both in 4%, and a transplanted pelvic kidney in 9%. Fever (55%), chills or diaphoresis (47%), flank pain (40%), abdominal pain (40%), and nausea or vomiting (32%) were the most common presenting symptoms. About half the patients had symptoms for 1 week or less and 12% had no symptoms. Fever was documented before diagnosis in 88% of patients. Abdominal mass (13%) or tenderness (49%), and flank mass (9%) or tenderness (42%) were seen less frequently, and 11% of patients did not have fever, flank, or abdominal findings. The most frequent underlying conditions included previous urologic surgery (45%), previous urinary tract infection (38%), diabetes mellitus (36%), and urinary tract stones (36%). Cultures of perinephric abscesses yielded gram-negative aerobes in 52% of patients, primarily escherichia coli. Staphylococcus aureus was isolated in 26% of patients and anaerobes in 17%. A single pathogen was isolated in 71% and multiple isolates in 29%. Of interest and great potential therapeutic importance was culture of anaerobes, primarily bacteroides spp. in 17%, enterococcus spp. in 7%, and candida albicans in 7%. Positive blood and urine cultures identified perinephric abscess organisms exactly in 58% and 37% of cases, respectively. Routine laboratory tests such as the white blood cell count and urinalysis were insensitive and non-specific for perinephric abscess. leukocytosis and anemia at admission were seen in slightly more than half of the patients. For radiologic diagnosis, computerized tomographic scanning was most helpful. Ultrasound and intravenous pyelography were falsely negative in about one-third of cases. mortality (13%) was low in this series when compared with earlier studies, and probably reflects modern medical care. Six patients (13%) died during hospitalization, 2 of whom had diagnosis of PNA established only at autopsy. drainage of the perinephric abscess was carried out by open surgical drainage in 64% of patients, percutaneous drainage in 19%, and both in 13%. The initial procedure, whether open surgical drainage or percutaneous catheter drainage, was usually successful. Late complications included nephrocutaneous fistulas in 3 patients and disseminated candidiasis in 1 patient.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
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