Search Results (72)

Non-tuberculous mycobacteria (NTM) are saprophytes of both soil and water that may cause infection with a high risk of dissemination, mainly in immunocompromised patients. Most NTM infections occur in the lungs, while uncommon localizations are the skin, soft tissues, musculoskeletal apparatus, and lymphatic system. The possible relationship between NTM infections and dental procedures is still unclear. The authors reported a rare manifestation of NTM infection occurring in a 6-year-old girl who developed sub-mandibular swelling related to a necrotic tooth, thus mimicking an abscess of odontogenic origin. Fine-needle aspiration biopsy of the sub-mandibular swelling and the following microbiologic investigation showed infection sustained by the Mycobacterium fortuitum complex. After the medical and surgical treatment, the patient completely recovered after 8 months. A review of the relevant literature was carried out to deepen the clinical and microbiological aspects of such a rare occurrence. Full article

The ovine respiratory complex significantly affects lamb welfare and production efficiency, necessitating accurate diagnostic methods for pulmonary lesions. This study explores the relationship between clinical scoring, auscultation, ultrasonography, and macroscopic post-mortem evaluation to assess respiratory disease in 111 lambs. A standardized clinical scoring system, adapted from bovine models, evaluated ocular and nasal discharge, head tilt, cough, and rectal temperature. Auscultation categorized pulmonary sounds, while ultrasonography identified lung abnormalities, including B-lines, consolidations, pleural effusion, and abscesses. Macroscopic post-mortem examinations confirmed lesion extent. Kendall–Tau-B correlation coefficient analysis revealed significant associations between the methods (p < 0.01), with a high correlation between auscultation and clinical scoring τ of 0.634 (95% CI: 0.489 to 0.765), auscultation and ultrasonography τ of 0.611 (95% CI: 0.500 to 0.710), and ultrasonography and post-mortem findings τ 0.608 (95% CI: 0.460 to 0.731). While auscultation and clinical scoring provided useful insights, ultrasonography exhibited superior sensitivity in detecting subclinical and early-stage lesions, aligning closely with post-mortem evaluations. These findings emphasize ultrasonography as an effective tool for diagnosing respiratory disease in lambs, improving diagnostic accuracy and enabling timely interventions to mitigate disease impact and reduce antimicrobial use. Full article

Streptococcus intermedius is a Gram-positive coccus usually found in the normal digestive or respiratory flora of humans and in some animal species, including rabbits. In conditions of immunosuppression, it can cause serious infections that can be difficult to treat or can even lead to death if not treated properly. S. intermedius-induced infections must be taken seriously, and proper treatment needs to be provided as soon as the patient is diagnosed, because otherwise, these infections can evolve in such a dramatic way as to result in the death of the patient. This study reports the case of a young 5-month-old rabbit that was kept in good living conditions by its owner; however, the rabbit developed a respiratory infection that was not treated properly and was at first ignored by the owner. Due to the poor management, the infection became serious and ultimately ended with the death of the animal. The infection was caused by Streptococcus intermedius and affected the lungs, in which a large lung abscess developed, eventually leading to the animal’s death. Even though the etiological agent is a commensal of the digestive and respiratory flora, it can induce lethal infections in some cases. Full article

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of healthcare-associated infections in Europe. It has become increasingly prevalent in community settings, causing skin and soft tissue infections (SSTIs). Managing community-acquired (CA) MRSA infections is challenging due to its high virulence and resistance to common antibiotics, and prevention outside the hospital setting is complex. Combination therapy has demonstrated efficacy in the treatment of severe MRSA infections. Furthermore, surgical source control is critical in treating CA-MRSA infections, involving removing the primary infection site to interrupt bacterial replication. Timeliness and a correct surgical approach are essential for successful treatment outcomes and improved quality of life. Methods: This report details the case of a 15-year-old athlete who was admitted to the intensive care unit with septic shock caused by CA-MRSA. Results: Despite initial treatment, his condition rapidly worsened. A computed tomography (CT) scan identified multiple abscesses (in the lungs, limbs, thyroid, and subscapular region) along with other complications. To achieve adequate tissue concentrations at all affected sites, a triple-targeted antimicrobial therapy was initiated and adjusted based on therapeutic drug monitoring (TDM). At the same time, daily surgical debridement was performed. The patient responded significantly to this treatment, and blood cultures eventually returned negative. Conclusions: A multidisciplinary approach involving early source control, tailored antimicrobial therapy, and, if monotherapy fails to control infection, combination therapy is advisable to treat life-threatening CA-MRSA infections. Full article

This study aimed to provide insights into the main causes of postmortem carcass and organ condemnations in a pig slaughterhouse and evaluate the resulting financial impact of the rejection of edible parts of animals. A population of 307,866 pigs, admitted for slaughter between January 2021 and December 2022 in a Bavarian abattoir, was studied. Regarding the examined carcasses, 2.09% (n = 6422) presented pathological conditions. Of these, 8.12% (n = 522) and 91.88% (n = 5900) were totally and partially confiscated, respectively. The main reason for the complete rejection of carcasses was the occurrence of generalized diseases (62.6%), while the presence of abscesses and traumatic and/or tail lesions was the most frequently implicated (70.7%) in partial condemnations. In the case of the organs, 17.59% (n = 54,145) presented abnormalities, with distributions of 14.71% (n = 45,290), 1.94% (n = 5968), 0.72% (n = 2213), and 0.22% (n = 674) within the examined liver, lung, kidney, and heart specimens, respectively. The principal reasons for liver, lung, kidney, and heart condemnations were the occurrence of parasitic diseases (53.4%), bacterial/viral infections (63.5%), dystrophies/anomalies (98.4%), and bacterial/viral infections (98.5%), respectively. The total financial loss attributable to carcass and organ condemnations was estimated at EUR 392,744.2, which represents 0.40% of the total achievable net revenue without rejections. Of this, EUR 197,120 (0.20%) and EUR 195,624.2 (6.95%) were related to carcass and offal seizures, respectively. The study results offer useful information for veterinarians, stockowners, and epidemiologists to make and set up policies to increase the efficiency and benefits of the swine production system and protect public health. Full article

Objectives: This study aimed to investigate the association between nonalcoholic fatty liver disease (NAFLD), assessed by the Fatty Liver Index (FLI), and the occurrence of lung abscess within a large population-based cohort. Method: We conducted a nationwide retrospective study using data from 367,930 subjects who underwent National Health check-ups between 2009 and 2018. Cox proportional hazards regression was performed to evaluate the association between the FLI and the incidence of lung abscess and community-acquired pneumonia (CAP) after adjusting for age, sex, and relevant covariates. Results: Among the study population, 455 (0.12%) and 44,934 (12.2%) patients were diagnosed with lung abscesses and CAP, respectively. The cumulative incidence of lung abscess was higher in individuals with elevated FLI values (FLI < 30, 0.10%; 30 ≤ FLI < 60, 0.16%; FLI ≥ 60, 0.18%; p < 0.001), whereas the incidence of CAP decreased across FLI groups (FLI < 30, 12.4%; 30 ≤ FLI < 60, 12.3%; FLI ≥ 60, 11.0%; p < 0.001). After adjusting for covariates, the risk of lung abscess significantly increased in the 30 ≤ FLI < 60 (Hazard ratio (HR) = 1.26; 95% confidence interval (CI), 0.95–1.68; p = 0.115) and the FLI ≥ 60 (HR = 1.67; 95% CI, 1.37–2.29; p < 0.001) groups, although the risk of CAP was relatively small in both groups (30 ≤ FLI < 60; HR = 1.06; 95% CI, 1.03–1.09; p < 0.001) (FLI ≥ 60; HR = 1.13; 95% CI, 1.08–1.12; p < 0.001). Conclusions: Our study provides compelling evidence supporting a potential link between NAFLD, as measured by FLI, and the incidence of lung abscess. These findings suggest the importance of vigilant monitoring of respiratory health in patients with NAFLD and emphasise the need for early detection of possible complications. Full article

Pulmonary abscess is a rare but serious condition in pediatric patients, caused by severe pulmonary infection that leads to tissue destruction and necrosis. It can be classified as primary or secondary depending on the cause. Establishing an etiology in pediatric pulmonary abscesses is challenging, underscoring the essential role of advanced imaging techniques, such as computed tomography, in achieving an accurate diagnosis and differentiating among various conditions that may mimic lung abscess. While conservative management with antibiotics is the first line of treatment, some cases may progress and require surgical intervention. We present two clinical cases of pediatric lung abscesses, emphasizing the importance of timely intervention, accompanied by a brief review of current knowledge that highlights key clinical features, diagnostic challenges, and therapeutic approaches in pediatric lung abscess. Full article

Background: Infections caused by S. aureus strains encoding Panton–Valentine leukocidin (PVL-SA) have become increasingly relevant in community settings and can cause severe conditions in pediatric populations. We present the pediatric case of an invasive disease caused by PVL-SA and provide a literature review of severe manifestations caused by these strains in children. Methods: A PubMed search (February 2024) found studies that included relevant clinical outcomes, diagnostics, and treatments, excluding cases of asymptomatic infection or in adult populations. A logistical multivariate analysis was used to find predictors of the need for intensive care. Results: A 10-year-old boy came to the attention of our Pediatric Infectious Diseases Unit with fever, chest pain, and tachypnea. A rapid worsening of his clinical conditions was observed, with the development of necrotizing pneumonia, osteomyelitis, deep vein thrombosis (DVT), and multiple abscesses. Blood cultures confirmed the presence of PVL-producing methicillin-resistant S. aureus (MRSA). The initial treatment included linezolid and ceftaroline and was later adjusted to clindamycin, daptomycin, and fosfomycin, with clinical improvement. Discussion: Our review collected 36 articles, including 156 pediatric cases of severe PVL-SA infection. Bacteremia was present in 49% of cases, lung infection in 47%, and osteomyelitis in 37%. The presence of pulmonary localization was predictive of the need for intensive care, O.R. 25.35 (7.46–86.09; p < 0.001). Anti-toxin molecules were used in about half the cases where information on treatment was reported. Our report highlights the capacity of PVL-SA to cause life-threatening complications in children, while also discussing the full range of its clinical spectrum and the most effective therapeutic approaches. Full article

Introduction: Invasive aspergillosis (IA) is an opportunistic fungal infection that typically occurs in the immunocompromised host and is associated with severe morbidity and mortality. Myocardial abscess formation is seldomly described. Detailed Case Description: We present a case of IA with purulent myocarditis. The patient was on long-term high-dose corticosteroid and mycophenolate mofetil therapy for severe lupus nephritis. After multiple visits to his general practitioner and nephrologist for general malaise, he was admitted to our hospital with visual complaints. Within several days, he developed atrial fibrillation, respiratory insufficiency, and, finally, a decreased level of consciousness. After admission to the intensive care unit, the broncho alveolar lavage (BAL) fluid galactomannan (GM) index was normal, but the serum GM index was severely elevated. Despite initiation of antifungal therapy, the patient passed away shortly thereafter. Autopsy revealed massive intracranial hemorrhage and disseminated IA affecting the lungs, brain, and myocardium, with macroscopic myocardial abscess formation. Discussion: This classic case of diagnostic uncertainty illustrates how invasive fungal infections can progress to disseminated disease while showing nonspecific symptoms only. It emphasizes the importance of vigilance for opportunistic fungal infections in a growing category of immunocompromised patients. Conclusion: Clinicians should have a low threshold of suspicion for fungal infections in patients on combination immunosuppressive medication, such as high-dose corticosteroid therapy in combination with T-cell inhibitors like MMF. Full article

Background/Objectives: COVID-19-related pulmonary complications, such as lung abscesses and pleural empyema, are rare but serious. This study presents a case series of three patients with COVID-19-associated lung abscesses complicated by pleural empyema, managed conservatively with percutaneous intracavitary drainage (ICD) and lavage. We assess the efficacy and safety of this treatment and compare our findings with the current literature. Methods: A retrospective analysis of three cases treated at the Clinic of Thoracic Surgery and Intensive Care Unit in Cluj-Napoca, Romania, was conducted. All patients developed severe lung involvement post-COVID-19, with abscesses rupturing into the pleural cavity. Conservative management included percutaneous ICD and daily lavage with isotonic saline, avoiding extensive surgery due to the patients’ critical condition. Clinical, radiological, and functional outcomes were followed, and results were compared to similar cases in the literature. Results: Among 496 critically ill patients with COVID-19 infection, three patients (age 42–60) developed lung abscesses and bacterial superinfection. In all patients, the germs involved were identified (monomicrobial infection in 1, polymicrobial in 2 patients). The abscesses were treated with percutaneous ICD and lavage, leading to clinical improvement in all cases. Long-term drainage (94–290 days) was necessary to obtain healing, and none of the patients required lung resection or decortication. Serial CT scans showed resolution of the abscesses and empyema. All were successfully discharged, and long-term follow-up (30–32 months) revealed minor radiological sequelae and mild respiratory impairment. The literature review found three studies summarizing 45 patients with lung abscesses complicating COVID-19 infections, but only one study addressed the use of percutaneous ICD. The mortality reported in this group was high (50–65%). Conclusions: Conservative treatment with percutaneous ICD and lavage is effective in managing lung abscesses and pleural empyema in critically ill COVID-19 patients, offering a viable alternative to surgery in high-risk cases. This method may be beneficial in multidisciplinary care for non-surgical candidates. Full article

In CT-guided percutaneous punctures—an image-guided puncture method using CT images—physicians treat targets such as lung tumors, liver tumors, renal tumors, and intervertebral abscesses by inserting a puncture needle into the body from the exterior while viewing images. By recognizing two-dimensional CT images prior to a procedure, a physician determines the least invasive puncture route for the patient. Therefore, the candidate puncture route is limited to a two-dimensional region along the cross section of the human body. In this paper, we aim to construct a three-dimensional puncture space based on multiple two-dimensional CT images to search for a safer and shorter puncture route for a given patient. If all puncture routes starting from a target in the three-dimensional space were examined from all directions (the brute-force method), the processing time to derive the puncture route would be very long. We propose a more efficient method for three-dimensional puncture route selection in CT-guided percutaneous punctures. The proposed method extends the ray-tracing method, which quickly derives a line segment from a given start point to an end point on a two-dimensional plane, and applies it to three-dimensional space. During actual puncture route selection, a physician can use CT images to derive a three-dimensional puncture route that is safe for the patient and minimizes the puncture time. The main novelty is that we propose a method for deriving a three-dimensional puncture route within the allowed time in an actual puncture. The main goal is for physicians to select the puncture route they will use in the actual surgery from among the multiple three-dimensional puncture route candidates derived using the proposed method. The proposed method derives a three-dimensional puncture route within the allowed time in an actual puncture. Physicians can use the proposed method to derive a new puncture route, reducing the burden on patients and improving physician skills. In the evaluation results of a computer simulation, for a 3D CT image created by combining 170 two-dimensional CT images, the processing time for deriving the puncture route using the proposed method was approximately 59.4 s. The shortest length of the puncture route from the starting point to the target was between 20 mm and 22 mm. The search time for a three-dimensional human body consisting of 15 CT images was 4.77 s for the proposed method and 2599.0 s for a brute-force method. In a questionnaire, physicians who actually perform puncture treatments evaluated the candidate puncture routes derived by the proposed method. We confirmed that physicians could actually use these candidates as a puncture route. Full article

Taraxaci herba, as a traditional Chinese medicine, is the name of the Taraxacum genus in the Asteraceae family. Documented in the Tang Herbal Medicine (Tang Dynasty, AD 657–659), its medicinal properties cover a wide range of applications such as acute mastitis, lung abscess, conjunctival congestion, sore throat, damp-heat jaundice, and vision improvement. In the Chinese Pharmacopoeia (Edition 2020), more than 40 kinds of China-patented drugs containing Taraxaci herba were recorded. This review explores the evolving scientific understanding of Taraxaci herba, covering facets of ethnopharmacology, botany, phytochemistry, pharmacology, artificial cultivation, and quality control. In particular, the chemical constituents and pharmacological research are reviewed. Taraxaci herba has been certified as a traditional medicine plant, and its flavonoids, phenolic acids, and terpenoids have been identified and separated, which include Chicoric acid, taraxasterol, Taraxasteryl acetate, Chlorogenic acid, isorhamnetin, and luteolin; they are responsible for anti-inflammatory, antioxidant, antibacterial, anti-tumor, and anti-cancer activities. These findings validate the traditional uses of Taraxaci herba and lay the groundwork for further scientific exploration. The sources used in this study include Web of Science, Pubmed, the CNKI site, classic monographs, the Chinese Pharmacopoeia, the Chinese Medicine Dictionary, and doctoral and master’s theses. Full article

Mycobacterium abscessus complex (MABC), a rapidly growing Mycobacterium, is one of the most common causes of non-tuberculous mycobacteria (NTM) infections in the United States of America, and it has been associated with a wide spectrum of infections in immunocompetent and immunosuppressed individuals. Eradicating MABC is very challenging, even with prolonged combination therapies. The management of MABC infections in solid organ transplant (SOT) patients is usually complex given their net state of immunosuppression, associated comorbidities, and potential drug–drug interactions, among other things. In this manuscript, we discussed the antimicrobial management of pulmonary and extrapulmonary MABC infections. In addition, we reviewed promising novel therapies such as clofazimine, omadacycline, bedaquiline, and inhaled tigecycline that could join the existing antimicrobial armamentarium to fight this infection associated with significant morbidity and mortality. However, further studies are needed, especially among the immunocompromised host. Full article

Caseous lymphadenitis is a chronic debilitating disease typical of small ruminants, but it is also noted in several other domestic and wild species. In this report, we present the first documented case in Italy of pseudotuberculosis in a roe deer (Capreolus capreolus, Linnaeus 1758) found dead in the mountains of Forlì-Cesena province, Emilia Romagna region. The carcass underwent necropsy according to standard protocols, revealing generalized lymphadenopathy and severe apostematous pneumonia with multifocal and encapsulated abscesses. Corynebacterium pseudotuberculosis was isolated from the lung parenchyma, lymph nodes and abscesses. Additionally, severe parasitic bronchopneumonia of the caudal lobes and gastrointestinal strongyle infestation were detected. To our knowledge, this is the first documented case of CLA referable to C. pseudotubercolosis in a roe deer in Italy. Full article

The most common acute infection and leading cause of death in children worldwide is pneumonia. Clinical and laboratory tests essentially diagnose community-acquired pneumonia (CAP). CAP can be caused by bacteria, viruses, or atypical microorganisms. Imaging is usually reserved for children who do not respond to treatment, need hospitalisation, or have hospital-acquired pneumonia. This review discusses the imaging findings for acute CAP complications and the diagnostic role of each imaging modality. Pleural effusion, empyema, necrotizing pneumonia, abscess, pneumatocele, pleural fistulas, and paediatric acute respiratory distress syndrome (PARDS) are acute CAP complications. When evaluating complicated CAP patients, chest radiography, lung ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) can be used, with each having their own pros and cons. Imaging is usually not needed for CAP diagnosis, but it is essential for complicated cases and follow-ups. Lung ultrasound can supplement chest radiography (CR), which starts the diagnostic algorithm. Contrast-enhanced computed tomography (CECT) is used for complex cases. Advances in MRI protocols make it a viable alternative for diagnosing CAP and its complications. Full article