1/15. Endoscopic stereotactic surgery for intraventricular loculated empyema: case report.BACKGROUND: Ventriculitis accompanied by formation of an intraventricular loculated empyema is a very unusual complication of purulent meningitis. CASE DESCRIPTION: A 62-year-old man presented with acute purulent ventriculitis secondary to a small paraventricular abscess. The well-documented computed tomography scans demonstrated the development of an intraventricular loculated empyema in the posterior portion of the left lateral ventricle. A stereotactically guided endoscopic procedure was performed to drain and rinse the empyema and to remove membranous tissue in order to establish free communication with the ventricular system. In the further course, a ventriculoperitoneal shunt was placed. The patient had recovered almost completely 1 year after the procedure. CONCLUSIONS: Ventriculitis frequently results in severe morbidity and often causes death. Intraventricular pathologies can be treated effectively by endoscopic stereotactic methods. To our knowledge, this is the first case of successful treatment of an intraventricular loculated empyema in an adult.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
2/15. Extensive subgaleal abscess and epidural empyema in a patient with acute frontal sinusitis.Acute frontal sinusitis can be a serious condition because of its potential life-threatening complications. These complications, including spread of infection to the frontal bone and intracranially, require prompt diagnosis and intervention to avoid morbidity and mortality. We report a case of acute frontal sinusitis in a 16-year-old girl who presented with fever, severe headache, and vomiting of 3 days' duration. Generalized fluctuant swelling of the nasal root, and bilateral supraorbital and frontoparietal regions was noted. Computed tomography (CT) demonstrated left pansinusitis, extensive subgaleal abscess and epidural empyema with osteomyelitis of the frontal bone. External frontoethmoidectomy with mucoperiostectomy were performed. Endoscopic sinus surgery was then conducted for intranasal ethmoidectomy. Intraoperative cultures grew viridans streptococci, coagulase-negative staphylococci and peptostreptococcus micros. The patient received 3 weeks of treatment with intravenous antibiotics (penicillin 3 MU 4-hourly, ceftriaxone 500 mg 12-hourly, metronidazole 500 mg 6-hourly) and was discharged uneventfully and prescribed additional oral antibiotics for 5 weeks (clindamycin 150 mg 6-hourly and chloramphenicol 250 mg 6-hourly). CT revealed complete resolution of the abscess and clear maxillary and ethmoid sinuses at 7 weeks posttreatment. The patient was free of sinus infection at 4-years follow-up, without noticeable cosmetic deformity.- - - - - - - - - - ranking = 5.1748038443847keywords = streptococcus (Clic here for more details about this article) |
3/15. diffusion-weighted imaging in acute bacterial meningitis in infancy.Bacterial meningitis is frequently fatal or leads to severe neurological impairment. Complications such as vasculitis, resulting in infarcts, should be anticipated and dealt with promptly. Our aim was to demonstrate the complications of meningitis by diffusion weighted imaging (DWI) in patients who deteriorated despite therapy. We studied 13 infants between the ages of 1 day and 32 months who presented with symptoms ranging from fever and vomiting to seizures, encephalopathy and coma due to bacterial meningitis, performing MRI, including DWI, 2-5 days after presentation. Multiple infarcts were found on DWI in 12 of the 13, most commonly in the frontal lobes (in 10). Global involvement was seen in four children, three of whom died; the fourth had a very poor outcome. In one case abnormalities on DWI were due to subdural empyemas. We diagnosed vasculitis in three of five patients studied with MRA. We think DWI an important part of an MRI study in infants with meningitis. Small cortical or deep white-matter infarcts due to septic vasculitis can lead to tissue damage not easily recognized on routine imaging and DWI can be used to confirm that extra-axial collections represent empyemas.- - - - - - - - - - ranking = 8keywords = meningitis (Clic here for more details about this article) |
4/15. pyelonephritis and urosepsis caused by streptococcus pneumoniae.This report presents the case of a patient with a massive pyelonephritis and a urosepsis caused by streptococcus pneumoniae. This case is unusual as the focus was distant from the respiratory tract, the usual primary site of infection caused by this organism. No other primary site of infection was documented.- - - - - - - - - - ranking = 2.9926909506317keywords = pneumoniae (Clic here for more details about this article) |
5/15. The syndrome of inappropriate secretion of antidiuretic hormone associated with anaerobic thoracic empyema.The syndrome of inappropriate secretion of antidiuretic hormone has been associated with many pulmonary diseases, including tuberculosis and bacterial and viral pneumonia: however, it has not been reported with anaerobic infections or empyema in the absence of pneumonia. We report a patient with empyema due to bacteroides melaninogenicus, bacteroides oralis, and peptostreptococcus who developed the syndrome. Eight hours before the start of therapy, his serum sodium concentration was 127 mEq per liter; serum osmolality, 255 mOsm per kg; urine osmolality, 522 mOsm per kg; urinary sodium concentration, 39 mEq per liter. The creatinine clearance and the adrenocorticotropic hormone stimulation test were normal, and there was no evidence of dehydration. No other causes of the syndrome of inappropriate secretion of antidiuretic hormone were apparent. With drainage and antimicrobial drug therapy, the empyema cleared, and the syndrome resolved in 8 days. The patient has been well, without evidence of inappropriate secretion of antidiuretic hormone, for 9 months. Anaerobic infections and/or empyema without pneumonia can be associated with the syndrome of inappropriate secretion of antidiuretic hormone.- - - - - - - - - - ranking = 5.1748038443847keywords = streptococcus (Clic here for more details about this article) |
6/15. mycoplasma pneumoniae infection complicated by empyema: a rare presentation.mycoplasma pneumoniae is a common causative agent for childhood pneumonia. However, empyema is a rare presentation. We report a case of a previously well child who presented with a right-sided empyema. M. pneumoniae was confirmed serologically with evidence of a four-fold rise in Mycoplasma IgM titre. The empyema required drainage procedures for more than two weeks. The infection resolved with a course of six weeks of treatment with erythromycin.- - - - - - - - - - ranking = 3.5912291407581keywords = pneumoniae (Clic here for more details about this article) |
7/15. Spontaneous bilateral bacterial empyema in a patient with nephrotic syndrome.Spontaneous bacterial empyema (SBEM), a rare infectious complication among liver cirrhosis patients, is characterized by infection in the presence of pleural effusion without evidence of pre-existing pneumonia. The prevalence of SBEM in cirrhotic patients with hydrothorax is about 13%. However, it has previously not been reported in medical literature in patients with nephrotic syndrome. The most common microorganism identified is escherichia coli, followed by Streptococcus species, enterococcus species, klebsiella pneumoniae, and pseudomonas stutzeri. We present a patient with a history of nephrotic syndrome caused by membranous nephropathy, who received steroids and cyclophosphamide. He developed bilateral SBEM due to aeromonas hydrophila and E. coli, which were isolated from the left- and right-side pleural fluid, respectively. The detailed clinical course, treatment, and outcome are described.- - - - - - - - - - ranking = 0.59853819012634keywords = pneumoniae (Clic here for more details about this article) |
8/15. Subdural and epidural empyema: diagnostic and therapeutic problems.OBJECTIVE: A clinical and microbiological review of cases of subdural and epidural empyema. DESIGN, SETTING, patients: A 10-year retrospective review of patients with subdural and epidural empyema in all Brisbane hospitals with neurosurgical units. In this period there were 14 cases. RESULTS: The paranasal sinuses were the primary focus in 8 of the 14 cases, the middle ear in 3 and a surgical or traumatic wound in 2. One case occurred as a complication of haemophilus influenzae meningitis. Streptococci, particularly Streptococcus milleri, were the causative organisms in all cases of sinus origin, most of which occurred in the second decade of life. An intracranial collection was considered in the differential diagnosis within 24 hours of admission in all 3 cases of otic origin but in only 2 of the 10 sinus or post-traumatic cases. The most common initial diagnosis was viral or partially-treated bacterial meningitis (8 of 13 cases). The initial computed tomographic (CT) scan was not diagnostic in 3 of 11 patients. No patient was successfully treated without surgery, and all 3 deaths in the series were associated with delayed surgery. CONCLUSIONS: Subdural and epidural empyema is an uncommon condition. The majority of the cases in this series were associated with sinusitis, and Streptococcus milleri was the commonest organism identified. The condition remains a diagnostic challenge; CT scanning cannot be relied upon although the use of intravenous contrast and more modern scanners has improved the diagnostic yield. Surgical drainage and early aggressive antimicrobial therapy are essential to avoid significant morbidity and mortality.- - - - - - - - - - ranking = 2keywords = meningitis (Clic here for more details about this article) |
9/15. Clinical manifestations of kingella kingae infections: case report and review.A patient with antecedent coccidioidal pulmonary cavitary disease who developed an empyema due to kingella kingae prompted our analysis of the literature regarding this unusual bacterial pathogen. Formerly classified among other genera and considered a nonpathogen, K. kingae has been increasingly recognized as a cause of human infection. While the most commonly diagnosed infections due to this organism are endocarditis and septic arthritis, there have also been isolated reports of bacteremia, diskitis, abscesses, meningitis, and oropharyngeal infections. The treatment of choice is penicillin, to which K. kingae strains are uniformly susceptible. Recognition of the potential pathogenicity of this microorganism in appropriate clinical settings will probably result in more prompt and specific therapy.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
10/15. New cause of penicillin treatment failure.A large empyema infected with a penicillin-sensitive haemolytic group B streptococcus failed to respond to high doses of penicillin. After two weeks' treatment the pus aspirated was found not only to contain no penicillin, but also to inactivate penicillin added to it. We believe that the inactivating agent is an enzyme that may destroy various penicillins and cephalosporins but has no effect on other common antibiotics. When treatment was changed to doxycycline the patient made a rapid recovery.- - - - - - - - - - ranking = 5.1748038443847keywords = streptococcus (Clic here for more details about this article) |
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