Hyalohyphomycosis caused by Paecilomyces variotii in an obstetrical patient

A case of hyalohyphomycosis, caused by Paecilomyces variotii, has been described in a 31-year-old female, who had undergone a cesarean section in her 39th week of pregnancy for a trial of labour. Five days following delivery, she complained of sharp, cramp-like pains, localized to the incisional site. She became febrile (38.2 °C). An ultrasound examination revealed a complex mass and fluid within the pelvis and upper abdomen. The fluid was drained by a needle aspiration and the patient was administered a regimen of antibacterial drugs. Microscopic examination did not reveal any bacteria in a gram stained preparation and cultures were negative as well. However, the fluid demonstrated a few segments of septate, hyaline hyphae, with cultures yielding a pure growth of P. variotii. An exoantigen procedure, currently under development, was helpful in confirming the identity of the patient's fungus. The patient's condition improved following needle aspiration and her recovery was uneventful. It is reiterated that certain infections, attributed to low-grade opportunistic pathogens, such as P. variotii, may be cured by proper surgical drainage.(now at the Microbiology Laboratory, Kasper Medical Laboratories, Calgary, Alberta)(now at the Department of Laboratory Medicine, Prince Rupert Regional Hospital, Prince Rupert, B.C.)Author for correspondence     

Studies on the epidemiology of Aspergillus fumigatus infections in a university hospital

The impact of the airborne opportunistic fungus pathogen, Aspergillus fumigatus in patients hospitalized at the university hospital of Parma, Italy, and its outpatients was investigated during a period of six months. Sputum and bronchial washings were collected from 986 patients. The 2,437 specimens were culturally examined for the presence of A. fumigatus regardless of the patient's clinical diagnosis. This fungus was isolated from 32 patients (3.2%). Subsequently, immunological tests for aspergillosis were performed on 22 of these culture-positive patients. Eight of these patients (36.4%) were serologically proven to be affected by aspergillosis. The 32 A. fumigatus isolates were epidemiologically investigated by the killer system to determine the mode of spread of these infections. Among the patients, fifteen different biotypes were differentiated, and their value in studying the epidemiology of aspergillosis in the hospital environment was investigated.Corresponding author.     

Two cases of severe acute pancreatitis-CT scan was useful to the assessment

We report two cases of severe acute pancreatitis; a 53-year-old man (Case 1) and a 60-year-old woman (Case 2). Case 1 was classified as "severe" according to the Ranson's criteria and he died of MOF on the 21st hospital day. Case 2 was classified as "moderate", but a large pancreatic abscess was observed by CT scan. She died of this abscess complicated with duodenal perforation on the 33rd hospital day. CT findings showed that this case was not "moderate" but "severe". Therefore, we believe that the findings of CT scan are an important factor for assessment of the severity of acute pancreatitis.     

A case of Candida mediastinitis after dental extraction

Acute mediastinitis is a serious infection involving the connective mediastinal tissue in the interpleural spaces and other thoracic structures. Candida albicans mediastinitis is a rare clinical entity associated with high mortality and morbidity. We present a rare case of a previously healthy and immunocompetent man with Candida mediastinitis due to retropharyngeal abscess after dental extraction, who presented with odynophagia and fever. Antibiotics were prescribed and surgical drainage was performed after diagnosis of mediastinitis by CT scan; however, the patient remained febrile. The second culture obtained during irrigation of the mediastinum was positive for Candida albicans and the patient was responsive to antifungal therapy and survived. This case illustrates the need to consider a fungal cause in immunocompetent patients with mediastinitis who are not responsive to broad spectrum antibiotics and surgical drainage.     

Brain abscess: a difficult diagnosis

A 40-year-old man had experienced headaches for 6 days and a 51-year-old man (2 weeks after an operation for perianal abscess) had experienced tingling sensations in the left hand for 10 days. After an epileptic seizure both underwent a CT scan of the brain. On these an abnormality was visible, probably a malignant astrocytoma. After several days of complaint reduction with dexamethasone, drowsiness and leftsided hemiparesis occurred. Emergency operations revealed a brain abscess. In the younger patient drainage and the administration of antibiotics were followed by fatal brain oedema. In the eldest drainage and the administration of antibiotics were followed by the extraction of infected teeth; he recovered with a slight loss of strength in the left hand. Brain abscesses are rare in the Netherlands. The diagnosis can be difficult because clinical signs and symptoms are not specific and because an underlying systemic infection is often not apparent. Diffusion-weighted magnetic resonance imaging can nowadays differentiate purulent brain processes from cystic brain tumors. Early treatment (burr hole aspiration and antibiotics) is usually curative. Nevertheless, mortality continues to be almost 10% and (permanent) morbidity 45%.     

Post traumatic rupture in patients with uretero pelvic junction obstruction. Case report

Authors report a case of post traumatic pelvic rupture occurring in an unknown ureteropelvic junction (UPJ) obstruction. Ultrasonography showed pyelectasia and fluid effusion in the anterior perirenal space. CT scan confirmed the diagnosis of UPJ obstruction and showed the rupture of the anterior pelvic wall communicating with a perirenal urinoma. The patient underwent a retrograde stenting for decompression and surgical drainage of the urinoma. Pyeloplasty was performed 4 months after injury. A follow up intravenous pyelogram showed good flow through the repair and the patient remaines asymptomatic 2 years after treatment. Post traumatic rupture of UPJ obstruction is a rare event with few reported cases in literature. Diagnosis is suggested on imaging studies. CT scan shows the rupture site in the ureteropelvic tract and guides percutaneous drainage.     

Cerebral empyema and abscesses due to Cutibacterium acnes

IntroductionCutibacterium acnes is a commensal bacterium of the skin, frequently reported in prosthetic shoulder or spinal implant infections, but rarely in cranial and intracranial infections.MethodsWe retrospectively reviewed patients with intracranial samples positive to Cutibacterium acnes managed in the neurosurgical units of our hospital of Lyon, France, between 2008–2016.ResultsWe included 29 patients, of whom 23 had empyema (with or without abscess), 17 had cranial osteomyelitis, and six only had abscess. Prior neurosurgery was reported in 28 patients, and the remaining patient had four spontaneous abscesses. Twelve patients had polymicrobial infections, including methicillin-susceptible Staphylococcus in 11 cases. The clinical diagnosis was difficult because of indolent and delayed symptoms: a CT scan or MRI was required. Thirteen patients (52%) had material at the infection site. All patients with bone flap implant or bones from biological banks had a bone flap-associated infection. Drainage was surgically performed in 25 cases or by CT scan-guided aspiration in four cases. All patients received an adapted antibiotic therapy (from three weeks to six months). The outcome was favorable in 28 patients. Three patients relapsed during the antibiotic therapy, requiring further surgery.ConclusionCutibacterium acnes can be responsible for postoperative empyema and cerebral abscesses, with particular indolent forms, which make their diagnosis difficult. They are often polymicrobial and associated with bone flap osteomyelitis. Their outcome is favorable after drainage and adapted antibiotic therapy.     

A case of huge duodenal leiomyosarcoma

A case of duodenal leiomyosarcoma with large central necrosis was reported. Tumor was 15 X 10 X 10 cm in size. Ultrasonography showed a cystic tumor with thick wall in the right upper abdomen. CT scan revealed a gas formation in the central cystic cavity of the tumor. The gas formation was probably caused by bacterial infection. The diagnosis was confirmed histologically.     

Clinical and laboratory evidence of the importance of the tick D. marginatus as a vector of B. burgdorferi in some areas of sporadic Lyme disease in Bulgaria

56 adult ticks D. marginatus and 38 adult ticks H. punctata were sampled by the flagging method, transferred to the laboratory, dissected and tested for infection with Lyme disease spirochetes. 3 (7.9%) of the adult H. punctata and 2 (3.57%) of the adult D. marginatus were infected with B. burgdorferi (Bb). This report also presents the case of a patient, who developed Lyme disease symptoms after he had been bitten by a D. marginatus tick. The clinical diagnosis was confirmed by serological testing and by a biopsy, taken from the patient's skin lesion. The skin biopsy was examined under an electron microscope and Bb was found in the sections of the deeper strata of the dermis in two structural forms: (a) cylindrical bodies (protoplasm cylinder) with circular ends covered with a three-layered membrane; (b) granules, situated among the collagenous fibres either closely adhered to them or covered with a membrane. The result of the study demonstrates that in single cases in some ecosystems, ticks D. marginatus might be implicated in Bb transmission to humans as secondary vectors.     

A case of tuberculous arthritis of shoulder

A rara case of tuberculous arthritis of right shoulder was reported. Plain X ray and CT showed bone destruction in humerus and glenoid process and soft tissue swelling with calcification was also demonstrated. T2 weighted images showed extension of abscess clearly. And extension to bone marrow was showed on CT and T1 weighted MR images.     

Fatalities in a stroke unit

During the first 4 years of the CV unit the mortality rate among 464 patients was 5.2 per cent. The records of the 24 fatalities were reviewed. In the 10 patients submitted to autopsy the clinician's opinion of the cause of death was confirmed in 6 cases. In 4 cases autopsy revealed brain abscess, pulmonary embolism, acute myocardial infarction and pneumonia, respectively. Other significant findings not registered clinically were made in 4 cases. Twenty-three patients underwent a cerebral CT scan which showed positive findings in 19 cases. In one patient a brain abscess was misinterpreted as a brain infarction and in 2 other patients with a negative CT scan, autopsy revealed a small pontine and hemispheric infarction, respectively. Apart from the misdiagnosis of the brain abscess the accuracy of the CT scan was acceptable. Extracranial complications as a cause of or contributing to death in stroke patients are common. Prevention, early detection and treatment of these complications are important. The findings underscore the importance of autopsy in the evaluation of stroke patients.     

产气荚膜梭菌感染引起肝脓肿和严重溶血性贫血1例及文献复习

探讨糖尿病患者产气荚膜梭菌(Cp)感染导致肝脓肿、溶血性贫血的临床特点及诊疗经过,提高对此类患者的认识和诊治水平。分析某院2022年8月收治的1例Cp感染引起肝脓肿、溶血性贫血、血流感染、多脏器功能衰竭的糖尿病患者临床资料,结合相关文献进行回顾性分析。共检索到19篇外文文献,结合本研究1例,共纳入20例患者。男性、女性各10例,平均年龄70.7岁,合并糖尿病12例。患者临床表现缺乏特异性,所有患者均有不同程度的溶血性贫血。死亡17例(85.0%),从就诊到死亡平均时间23.84 h,其中14例(82.4%)患者在明确病原菌诊断前已死亡,11例(64.7%)患者在入院≤8 h因抢救无效死亡;存活患者仅3例,均在疾病早期得到病原学结果,2例患者早期行肝脓肿穿刺引流术,另1例患者治疗过程中肝脓肿自行破溃至肝包膜下,肿块缩小。Cp感染肝脓肿合并溶血性贫血进展迅速,早期病死率极高,故早期诊断十分重要。怀疑Cp感染时,应立即行穿刺液/血液革兰染色,或经宏基因组二代测序(mNGS)等检测手段明确病原诊断,以期通过早期调整敏感抗菌药物和清除感染病灶改变患者生存结局。     

Massive gastric dilatation after a single binge in an anorectic woman

OBJECTIVE: Massive gastric dilatation is a very serious condition that is extremely rare in patients with no history of gastrointestinal disease. Several cases have been reported in patients with eating disorders, particularly after a binge. We report here the case of a young woman who developed severe gastric dilatation after a single binge. METHODS: A computed tomographic (CT) scan of the abdomen was done and a psychiatric evaluation was performed. RESULTS: The diagnosis of acute gastric dilatation was confirmed and superior mesenteric artery syndrome was excluded. The patient responded to nasogastric drainage and bowel rest. She was also found to have situational anxiety and depressive symptoms as well as a nonspecified eating disorder. CONCLUSION: This case illustrates the serious sequel of even a single binge in any patient with abnormal dietary habits, and demonstrates the useful role of the CT scan in the diagnosis.     

Clinical aspects and management of a retroperitoneal abscess]

14 patients with retroperitoneal abscess have been collected by the authors since June 1, 1988. The retroperitoneal abscess of multifactorial origin can be considered as a secondary disease. The physical clinical signs (e.g. psoas rigidity sign, palpable mass, costolumbal sensitivity) play central role in setting up of diagnosis, and these signs were present in more than 75% of the cases. The physical signs generally indicate advanced retroperitoneal abscess, and at the same time the contour of psoas muscle disappears and concavity of lumbal vertebras can be seen on plane abdominal X ray film. The exact diagnosis was achieved in mean 45 days after the on set of complaints, this fact urges, that the up-to-date imaging modalities (US, CT, NMR) should be applied earlier in septic conditions of unknown origin. Retroperitoneal surgical intervention was performed in their patients, in the future the percutaneous drainage procedure has to be considered as first intervention for retroperitoneal abscess. Retroperitoneal abscess secondary to malignant disease has unfavorable prognosis, 2 out of 14 patients with retroperitoneal abscess died, both of them had underlying malignancy.     

真菌性鼻窦炎临床及CT特征

目的:探讨真菌性鼻窦炎的临床及CT的特征性表现.方法:分析15例经手术病理证实的真菌性鼻窦炎的CT及临床表现.结果:真菌性鼻窦炎的临床表现有:女性11例(73.3%),病程3年以内13例(86.7%),涕血15例,头痛10例;CT表现有:单侧鼻窦发病14例(93.3%),1例累及双侧,以上颌窦为主,15例均见窦腔内软组织增生影(100%),内可见点状,结节状钙化,2例窦腔增大,骨质破坏.结论:真菌性鼻窦炎的临床表现特征性明显,CT表现有特异性,CT对该病的诊断有重要价值.     

Risk factors for wound infections after genitourinary reconstructive surgery

In January through August 1983, eight children developed wound infections after they underwent genitourinary reconstructive surgery at one hospital. Cultures of purulent drainage yielded Pseudomonas aeruginosa in two cases, Streptococcus faecalis in one case, both S. faecalis and Staphylococcus epidermidis in one case, and S. faecalis and other Gram-negative rods in four cases. A study in which uninfected children who had had genitourinary reconstructive surgery were used as controls revealed that all cases and controls had received cephalosporin prophylaxis. Antibiograms revealed that all organisms were resistant to the cephalosporin antibiotics tested. Risk of infection was associated with shaving (p less than 0.001, Fisher's exact test) and exposure to one nurse (nurse X) (p = 0.003, Fisher's exact test) and one surgeon (surgeon X) (p = 0.007, Fisher's exact test). Nurse X was the private scrub nurse for surgeon X; she was present only at operations surgeon X performed (p less than 0.001, Fisher's exact test) and had no reported or observed practices different from those of other surgical nurses. However, surgeon X had two practices that were notably different from those of other surgeons: 1) he used quaternary ammonium compounds, acetone/alcohol, and 1 per cent hexachlorophene for preoperative skin preparation; and 2) he prepared the operative site himself. In addition, he was observed to prepare the operative site by beginning centrally, moving peripherally, and returning to the central area with the same sponge. These findings suggested that the shaving of the operative site and the use of certain agents and/or different preparatory techniques may have contributed to increased risk of wound infections. These wound infections were caused by organisms resistant to the prophylactic antibiotic(s) used.     

Diagnostic image (128). A boy who refused to walk. Spondylodiscitis LIV-LV

One week after a fall from his buggy, a 2-year-old boy was seen at the first-aid department because he refused to walk. A bone scan and MRI revealed spondylodiscitis at the left side of the discus Liv-Lv and a psoas abscess.     

Studies on histoplasmosis farciminosi (epizootic lymphangitis) in Egypt

Isolation of Histoplasma farciminosum from five horses, showing typical signs of histoplasmosis farciminosi (epizootic lymphangitis) was successfully attempted. The mycelial form of H. farciminosum was isolated on Sabouraud dextrose agar enriched with 2.5% glycerol, brain heart infusion (BHI) agar enriched with 10% horse blood and PPLO dextrose glycerol agar. The last medium proved to be the most effective, both for primary isolation and subculturing of the fungus. It was found that on primary isolation, the lag phase of the mycelial form of the fungus was relatively long, involving 4–8 weeks at 25°C. Colonies of the mycelial form of H. farciminosum appeared on subculture as a yellowish, light brown to deep brown, convoluted, waxy, cauliflower-like growth tending to form scant aerial growth.Conversion of the mycelial form to the yeast form of H. farciminosum was successful by subculturing either on BHI agar with 5% blood or on Pine's medium and incubating at 35–37°C. Complete conversion to the yeast form was achieved only after 4–5 repeated serial transfers onto fresh media every 8 days. The yeast colonies were flat, raised, slightly or deeply wrinkled, white to light gray to grayish brown, and were pasty in consistency.Corresponding author.     

前列腺脓肿的诊断和治疗(附3例报告及文献复习)

目的　探讨和提高对前列腺脓肿的认识。方法　分析 3例前列腺脓肿的临床资料 ,并复习有关文献。结果　3例均有比较典型的临床症状和体征 ,B超和 CT均显示了前列腺的肿大、脓肿的低回声区和低密度区 ,单纯抗感染、会阴部穿刺引流和经尿道汽化电切前列腺脓肿去顶术排脓治疗各 1例。结论　前列腺脓肿比较容易诊断 ,尽早足量的抗感染或脓肿排脓治疗 ,可取得相当满意的效果     

肺真菌病的CT表现

目的探讨肺真菌病的CT表现,以提高诊断水平。方法回顾性分析56例痰培养、纤维支气管镜、肺穿刺活检及手术病理证实的肺真菌病的病例资料,所有病例均行CT检查,其中49例平扫,7例增强。结果 CT显示,空洞伴结节的"空气新月征"8例占11.8%,不规则多发空洞病灶7例占12.5%,不规则空洞伴斑片影5例占8.9%,单发肺结节11例占19.6%,多发肺结节12例占21.4%,结节伴斑片状影7例占12.5%,6例呈实变样表现占10.7%;56例经痰培养证实15例,纤维支气管镜证实9例,肺穿刺活检病理证实26例,手术病理证实6例。结论 CT对于典型的肺真菌病可作出诊断,对于肺部难以确诊的肺真菌病例,应结合临床及其他检查以明确诊断。