Archive for December, 2012

Pyogenic liver abscess: an audit of 10 years’ experience.

World J Gastroenterol. 2011 Mar.28 V.17 N.12  P.1622-30.

Pang TC, Fung T, Samra J, Hugh TJ, Smith RC.

Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, University of Sydney, St Leonards NSW 2065, Australia.



To describe our own experience with pyogenic liver abscesses over the past 10 years and investigate the risk factors associated with failure of initial percutaneous therapy.


A retrospective study of records of 63 PLA patients presenting between 1998 and 2008 to Australian tertiary referral centre, were reviewed. Amoebic and hydatid abscesses were excluded. Demographic, clinical, radiological, and microbiological characteristics, as well as surgical/radiological interventions, were recorded.


Sixty-three patients (42 males, 21 females) aged 65 (± 14) years [mean ± (SD)] had prodromal symptoms for a median (interquartile range; IQR) of 7 (5-14) d. Only 59% of patients were febrile at presentation; however, the serum C-reactive protein was elevated in all 47 in whom it was measured. Liver function tests were non-specifically abnormal. 67% of patients had a solitary abscess, while 32% had > 3 abscesses with a median (IQR) diameter of 6.3 (4-9) cm. Causative organisms were: Streptococcus milleri 25%, Klebsiella pneumoniae 21%, and Escherichia coli 16%. A presumptive cryptogenic cause was most common (34%). Four patients died in this series: one from sepsis, two from advanced cancer, and one from acute myocardial infarction. The initial procedure was radiological aspiration ± drainage in 54 and surgery in two patients. 17% underwent surgical management during their hospitalization. Serum hypoalbuminaemia [mean (95% CI): 32 (29-35) g/L vs 28 (25-31) g/L, P = 0.045] on presentation was found to be the only factor related to failure of initial percutaneous therapy on univariate analysis.


PLA is a diagnostic challenge, because the presentation of this condition is non-specific. Intravenous antibiotics and radiological drainage in the first instance allows resolution of most PLAs; However, a small proportion of patients still require surgical drainage.


December 28, 2012 at 6:58 pm

Pyogenic spondylitis.

Int Orthop. 2012 Feb  V.36 N.2 P.397-404.

Cheung WY, Luk KD.


The Department of Orthopedics & Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.


Pyogenic spondylitis is a neurological and life threatening condition. It encompasses a broad range of clinical entities, including pyogenic spondylodiscitis, septic discitis, vertebral osteomyelitis, and epidural abscess. The incidence though low appears to be on the rise. The diagnosis is based on clinical, radiological, blood and tissue cultures and histopathological findings. Most of the cases can be treated non-operatively. Surgical treatment is required in 10-20% of patients. Anterior decompression, debridement and fusion are generally recommended and instrumentation is acceptable after good surgical debridement with postoperative antibiotic cover.


December 28, 2012 at 6:54 pm

Recommendations for treatment of human infections caused by Bartonella species.

Antimicrob Agents Chemother. 2004 Jun;48(6):1921-33.

Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D.


Unité des Rickettsies, Faculté de Médecine, 27, Boulevard Jean Moulin, 13385 Marseille Cedex 5, France.


December 28, 2012 at 6:51 pm

Consensus guidelines for the management of upper respiratory tract infections.

Medicina (B Aires). 2012 V.72 N.6 P.484-94.     

Lopardo G, Calmaggi A, Clara L, Levy Hara G, Mykietiuk A, Pryluka D, Ruvinsky S, Vujacich C, Yahni D, Bogdanowicz E, Klein M, López Furst MJ, Pensotti C, Rial MJ, Scapellato P.


Sociedad Argentina de Infectología (SADI).


Upper respiratory tract infections are the most common source of antibiotic prescriptions. Acute pharyngitis is caused mainly by viruses, viral cases can be distinguished from acute streptococcal pharyngitis using Centor clinical epidemiological criteria, by rapid antigen tests or throat culture. Treatment of choice for streptococcal infection is penicillin V given in two daily doses. In children, acute otitis media (AOM) is the infection for which antibiotics are most often prescribed. Predominant causative pathogens include Streptococcus pneumoniae, Haemophilus influenzae non-type b and Moraxella catarrhalis. Diagnosis is based on history, physical examination and otoscopic exam. Antibiotic treatment should be initiated promptly in all children < 2 years of age, and in older children presenting bilateral AOM, otorrhoea, co-morbidities or severe illness. In Argentina, amoxicillin is the drug of choice given the low penicillin resistance rates for S. pneumoniae. In children who fail amoxicillin therapy, amoxicillin/clavulanate provides better coverage against beta-lactamase producing H. influenzae and M. catarrhalis. Rhinosinusitis is caused mainly by viruses, secondary bacterial complication occurs in less than 5% of cases. Diagnosis is based on physical examination and additional studies are not usually required. Acute bacterial sinusitis is caused by the same pathogens that cause AOM and amoxicillin is the drug of choice.


December 27, 2012 at 9:01 am

Group A beta-hemolytic Streptococcus frequency in the throat of symptomatic patients younger than 15 years, by age group.

Arch Argent Pediatr. 2012 Dec V.110 N.6 P.516-9.

Tellechea AL, Salvo MG, Méndez JH, Cavagnari BM.


Departamento de Pediatría, Hospital Alemán, Buenos Aires, Argentina.


Acute pharyngitis is a frequent pediatric consultation, being group A beta-hemolytic Streptococcus (GABHS) the main bacterial etiology. GABHS screening is controversial in children less than 5 years, because of the low frequency historically reported. Nevertheless, 24% prevalence was recently estimated in this group. The aim of this study was to estimate the GABHS frequency in symptomatic children less than 15 years, for which we performed a retrospective, cross sectional study, to evaluate its presence in the throat of 6691 patients, during 2010. The maximum frequency was observed in children from 5 to 11 years. For children aged 3 and 4, frequency was estimated at 36%, thus seeming to be mandatory to do the screening, as it is done in older children. In younger children, the epidemiology of each patient should be considered before asking for diagnostic tests.


December 27, 2012 at 8:59 am

Rapidly progressing subperiosteal orbital abscess: an unexpected complication of a group-A streptococcal pharyngitis in a healthy young patient.

Head Face Med. 2012 Oct 16;8:28.

Costantinides F, Luzzati R, Tognetto D, Bazzocchi G, Biasotto M, Tirelli GC.


Division of Oral Medicine, Department of Dental Sciences, Piazza dell’Ospitale 1, University of Trieste, Trieste 34100, Italy.




Complications associated to group-A streptococcal pharyingitis include non-suppurative complications such as acute rheumatic fever and glomerulonephritis and suppurative complications such as peritonsillar or retropharyngeal abscess, sinusitis, mastoiditis, otitis media, meningitis, brain abscess, or thrombosis of the intracranial venous sinuses.


We described a case of a 15-year-old patient with a history of acute pharyngodinia early followed by improvise fever and a progressive formation of a diffuse orbital edema, corneal hyperaemia, diplopia and severe decrease of visual acuity.The patient was surgically treated with functional endoscopic sinus surgery (FESS) after the response of a maxillofacial computed tomography scans that showed a pansinusitis complicated by a left orbital cellulites. Numerous colonies of Streptococcus pyogenes were found in the samples of pus and an antibiotic therapy with meropenem was initiated on the basis of the sensitivity test to antibiotics. The patient was finally discharged with diagnosis of left orbital cellulites with periorbital abscess, endophtalmitis and acute pansinusitis as a consequence of streptococcal pharyngitis.


The case highlights the possible unusual complication of a group-A streptococcal pharyingitis in a immunocompetent child and the needing of a prompt surgical and medical approach toward the maxillofacial complications associated to the infection.


December 27, 2012 at 8:56 am

A European survey of antibiotic management of methicillin-resistant Staphylococcus aureus infection: current clinical opinion and practice.

Clin Microbiol Infect. 2010 Mar;16 Suppl 1:3-30.

Dryden M, Andrasevic AT, Bassetti M, Bouza E, Chastre J, Cornaglia G, Esposito S, French G, Giamarellou H, Gyssens IC, Nathwani D, Unal S, Voss A.


Department of Microbiology and Communicable Diseases, Royal Hampshire County Hospital, Winchester, UK.


Although the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) varies across Europe, healthcare-associated MRSA infections are common in many countries. Despite several national guidelines, the approach to treatment of MRSA infections varies across the continent, and there are multiple areas of management uncertainty for which there is little clinical evidence to guide practice. A faculty, convened to explore some of these areas, devised a survey that was used to compare the perspectives of infection specialists from across Europe on the management of MRSA infections with those of the faculty specialists. The survey instrument, a web-based questionnaire, was sent to 3840 registered delegates of the 19th European Congress of Clinical Microbiology and Infectious Diseases, held in April 2009. Of the 501 (13%) respondents to the survey, 84% were infection/microbiology specialists and 80% were from Europe. This article reports the survey results from European respondents, and shows a broad range of opinion and practice on a variety of issues pertaining to the management of minor and serious MRSA infections, such as pneumonia, bacteraemia, and skin and soft tissue infections. The issues include changing epidemiology, when and when not to treat, choice of treatment, and duration and route of treatment. The survey identified areas where practice can be improved and where further research is needed, and also identified areas of pan-European consensus of opinion that could be applied to European guidelines for the management of MRSA infection.



The management of MRSA infection in Europe

December 22, 2012 at 1:58 pm

West Nile Virus Infection among Humans, Texas, USA, 2002–2011

Emerg Infect Diseases January 2013 V.19 N.1 P.137-139

Melissa S. Nolan, Jim Schuermann, and Kristy O. Murray

Baylor College of Medicine, Houston, Texas, USA (M.S. Nolan, K.O. Murray); Texas Department of State Health Services, Austin, Texas, USA (J. Schuermann)

We conducted an epidemiologic analysis to document West Nile virus infections among humans in Texas, USA, during 2002–2011. West Nile virus has become endemic to Texas; the number of reported cases increased every 3 years. Risk for infection was greatest in rural northwestern Texas, where Culex tarsalis mosquitoes are the predominant mosquito species.


December 22, 2012 at 1:56 pm

Klebsiella pneumoniae Antimicrobial Drug Resistance, United States, 1998–2010

Emerg Infect Diseases January 2013 V.19 N.1 P.133-136

Guillermo V. Sanchez, Ronald N. Master, Richard B. Clark, Madiha Fyyaz, Padmaraj Duvvuri, Gupta Ekta, and Jose Bordon

George Washington University, Washington, DC, USA (G.V. Sanchez); Quest Diagnostics Nichols Institute, Chantilly, Virginia, USA (R.N. Master, R.B. Clark); Providence Hospital, Washington (M. Fyyaz, P. Duvvuri, G. Ekta, J. Bordon)

We studied antimicrobial-resistant Klebsiella pneumoniae for 1998–2010 by using data from The Surveillance Network. Susceptibility results (n = 3,132,354) demonstrated significant increases in resistance to all antimicrobial drugs studied, except tetracycline. Cross-resistance among carbapenem-resistant K. pneumoniae was lower for tetracycline and amikacin.


December 22, 2012 at 1:53 pm

Linezolid Dependence in Staphylococcus epidermidis Bloodstream Isolates

Emerg Infect Diseases January 2013 V.19 N.1 P.129-132

Spyros Pournaras , Eleni Ntokou, Olympia Zarkotou, Kyriaki Ranellou, Katerina Themeli-Digalaki, Constantinos Stathopoulos, and Athanassios Tsakris

University of Thessaly Medical School, Larissa, Greece (S. Pournaras, E. Ntokou); Tzaneio General Hospital, Piraeus, Greece (O. Zarkotou, K. Themeli-Digalaki); University of Athens Medical School, Athens, Greece (K. Ranellou, A. Tsakris); University of Patras School of Medicine, Patras, Greece (C. Stathopoulos)

We document linezolid dependence among 5 highly linezolid-resistant (LRSE) Staphylococcus epidermidis bloodstream isolates that grew substantially faster at 32 µg/mL linezolid presence. These isolates carried the mutations T2504A and C2534T in multiple 23S rRNA copies and 2 mutations leading to relevant amino acid substitutions in L3 protein. Linezolid dependence could account for increasing LRSE emergence.


December 22, 2012 at 1:49 pm

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