scholarly journals Empyema Necessitans in the Setting of Methicillin-Susceptible Staphylococcus aureus Causing Pneumonia and Bacteremia

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Sindhura Bandaru ◽  
Sukesh Manthri ◽  
Vidya Sundareshan ◽  
Vidhya Prakash
Keyword(s):  
Staphylococcus Aureus ◽  
Chest Wall ◽  
Subcutaneous Tissue ◽  
Parietal Pleura ◽  
Intravenous Drug Use ◽  
Rare Occurrence ◽  
Left Forearm ◽  
Gram Stain ◽  
Incision And Drainage ◽  
Prompt Diagnosis

Empyema necessitans (EN) is a rare phenomenon that refers to an insidious extension of the empyema through parietal pleura and subsequent dissection into subcutaneous tissue of the chest wall. A 29-year-old man presented to the hospital with fever and chills a few days after an inadvertent needle stick while injecting heroin. His left forearm was warm with an area of fluctuance. He underwent incision and drainage of the left forearm abscess with fluid submitted for Gram stain and culture. His condition rapidly deteriorated due to sepsis, and he required transfer to the intensive care unit. A new 4 × 3 cm area over the left pectoralis muscle had become increasingly indurated, fluctuant, and erythematous. CT of the chest demonstrated extensive cavitary lung lesions and a large loculated left-sided pleural effusion with extension through the chest wall. TEE revealed a 3 cm complex lesion on the superior septal leaflet of the tricuspid valve. The patient underwent incision and drainage of the pectoralis major EN with placement of a drain. Blood and sputum cultures grew methicillin-susceptible Staphylococcus aureus (MSSA) at which time antibiotic therapy was tailored to oxacillin. Our case highlights a rare occurrence of EN due to MSSA in a patient with intravenous drug use (IDU) and underscores the importance of prompt diagnosis and treatment.

scholarly journals Staphylococcal Sepsis with Multiple Abscesses, Urinary Tract Infection, and Bilateral Renal Vein Thrombosis in a Patient with Uncontrolled Diabetes Mellitus

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Malik A. A. Khan ◽  
Jonathan Michael Hunter ◽  
Christopher Tan ◽  
Mostafa Seleem ◽  
Peter J. O. Stride
Keyword(s):  
Diabetes Mellitus ◽  
Staphylococcus Aureus ◽  
Renal Vein ◽  
Medical Condition ◽  
Vascular Complications ◽  
Renal Vein Thrombosis ◽  
Intravenous Antibiotic ◽  
Incision And Drainage ◽  
Vein Thrombosis ◽  
Uncontrolled Diabetes

We report a case of staphylococcal sepsis with vascular complications including peripheral emboli and renal vein thrombosis. Bilateral renal vein thrombosis has not been reported as a complication ofStaphylococcus aureus(SA) axillary abscess. Uncontrolled diabetes was the only detected predisposing medical condition. The patient was treated successfully with incision and drainage of soft-tissue abscesses and intravenous antibiotic for six weeks and with anticoagulation for renal vein thrombosis.

Cystic Sebaceous Neoplasms in Muir-Torre Syndrome

2003 ◽  
Vol 127 (5) ◽  
pp. 614-617 ◽  
Author(s):  
Jared J. Abbott ◽  
Pablo Hernandez-Rios ◽  
Robin H. Amirkhan ◽  
Mai P. Hoang
Keyword(s):  
Chest Wall ◽  
Cyst Wall ◽  
Subcutaneous Tissue ◽  
Strong Association ◽  
Left Thigh ◽  
Colonic Adenocarcinoma ◽  
Cystic Neoplasms ◽  
Tumor Recognition ◽  
Sebaceous Tumor ◽  
Diagnostic Importance

Abstract Cystic sebaceous neoplasms have been seen only in patients with Muir-Torre syndrome (MTS) and have recently been characterized as marker lesions of MTS. Histologically, these lesions form a spectrum of tumors ranging from benign cystic adenomas to proliferative cystic sebaceous tumors. We describe 2 proliferative cystic sebaceous tumors in a 53-year-old man whose workup revealed colonic adenocarcinoma and other sebaceous tumors consistent with MTS. Both the chest wall and the left thigh masses were grossly cystic, measuring 1.0 and 1.5 cm, respectively. Histologic sections demonstrated well-circumscribed cystic neoplasms located in the deep dermis and subcutaneous tissue. Each had a focally infolded cyst wall composed of immature basaloid cells with prominent nucleoli and mitoses, consistent with a proliferative cystic sebaceous tumor. Recognition of cystic sebaceous neoplasm by pathologists and communication to clinicians of its strong association with MTS is of diagnostic importance.

Pleural stress pressure as a force to control liquid accumulation and maintain lung expansion

1985 ◽  
Vol 58 (2) ◽  
pp. 339-345 ◽  
Author(s):  
K. Harada ◽  
T. Mutsuda ◽  
N. Saoyama ◽  
N. Hamaguchi ◽  
Y. Shimada
Keyword(s):  
Chest Wall ◽  
Mean Value ◽  
Pleural Space ◽  
Liquid Volume ◽  
Parietal Pleura ◽  
Elastic Recoil ◽  
Normal Range ◽  
Pleural Surface ◽  
Lung Expansion ◽  
The Relationship

Total gas pressure in the pleural space is more subatmospheric than that in the alveolar cavity. This pressure difference minus elastic recoil pressure of the lung was termed stress pressure. We investigated the relationship between stress pressure and a force that would hold the lung against the chest wall to prevent accumulation of liquid. The condition was a pleural space with an enlarged pleural surface pressure. Dogs anesthetized with pentobarbital sodium were placed in a box maintained subatmospherically at approximately -30 cmH2O and breathed atmospheric air for 4 h. Liquid volume in the pleural space of the dogs was measured under conditions of thoracotomy. In the normal group, the volume of the pleural liquid was within the normal range of approximately 2.0 ml and the visceral and the parietal pleura made contact. In the pneumothorax group, established by injecting 50 ml of air into the pleural space, the liquid increased significantly in all cases by a mean value of approximately 12 ml. Thus pleural stress pressure seems to be an important force holding the lung against the chest wall and aiding in the control of accumulation of liquid in a more subatmospheric pleural space.

Hydraulic conductivity of canine parietal pleura in vivo

1990 ◽  
Vol 69 (2) ◽  
pp. 438-442 ◽  
Author(s):  
D. Negrini ◽  
M. I. Townsley ◽  
A. E. Taylor
Keyword(s):  
Hydraulic Conductivity ◽  
Chest Wall ◽  
Body Position ◽  
Linear Regression Analysis ◽  
Isotonic Saline ◽  
Parietal Pleura ◽  
Autologous Plasma ◽  
Anesthetized Dogs ◽  
Spontaneously Breathing

The hydraulic conductivity (Lp) of the parietal pleura was measured in vivo in spontaneously breathing anesthetized dogs in either the supine (n = 8) or the prone (n = 7) position and in an excised portion of the chest wall in which the pleura and its adjacent tissue were intact (n = 3). A capsule was glued to the exposed parietal pleura after the intercostal muscles were removed. The capsule was filled with either autologous plasma or isotonic saline. Transpleural fluid flow (V) was measured at several transpleural hydrostatic pressures (delta P) from the rate of meniscus movement within a graduated pipette connected to the capsule. Delta P was defined as the measured difference between capsule and pleural liquid pressures. The Lp of the parietal pleura was calculated from the slope of the line relating V to delta P by use of linear regression analysis. Lp in vivo averaged 1.36 X 10(-3) +/- 0.45 X 10(-3) (SD) ml.h-1.cmH2O-1.cm-2, regardless of whether the capsule was filled with plasma or saline and irrespective of body position. This value was not significantly different from that measured in the excised chest wall preparation (1.43 X 10(-3) +/- 1.1 X 10(-3) ml.h-1.cmH2O-1.cm-2). The parietal pleura offers little resistance to transpleural protein movement, because there was no observed difference between plasma and saline. We conclude that because the Lp for intact parietal pleura and extrapleural interstitium is approximately 100 times smaller than that previously measured in isolated stripped pleural preparations, removal of parietal pleural results in a damaged preparation.

Stiffness of the pleural surface of the chest wall is similar to that of the lung

2003 ◽  
Vol 95 (6) ◽  
pp. 2345-2349 ◽  
Author(s):  
Andrew Gouldstone ◽  
Richard E. Brown ◽  
James P. Butler ◽  
Stephen H. Loring
Keyword(s):  
Chest Wall ◽  
Elastohydrodynamic Lubrication ◽  
Geometric Standard Deviation ◽  
Parietal Pleura ◽  
Shear Stresses ◽  
Membrane Tension ◽  
Similar Extent ◽  
Spatial Uniformity ◽  
Pleural Surface

To address the role of the parietal pleura in reduction of mesothelial shear stresses during breathing, we measured the stiffness of the parietal pleural surface of mammalian chest walls using microindentation. The pleural surface was indented over ribs and intercostal spaces with rigid flat punches (tip radii of 0.01, 0.02, and 0.1 cm) to probe stiffness at length scales comparable with those of surface asperities. We found a tissue shear modulus of 6,700 dyn/cm2 and pleural membrane tension of 4,900 dyn/cm, with a geometric standard deviation of 0.42. These values are similar to those measured for the lung by Hajji et al., using indentation (Hajji MA, Wilson TA, and Lai-Fook SJ. J Appl Physiol Respirat Environ Exerc Physiol 47: 175–181, 1979). Surprisingly, the pleural surface over ribs and intercostal spaces exhibited similar stiffness. In addition, caudal regions exhibited lower stiffness than cranial regions. In the context of elastohydrodynamic lubrication, these results suggest that shear-induced pressures during breathing deform the chest wall and lung surfaces to a similar extent, promoting spatial uniformity of pleural fluid thickness and reducing shear stresses.

scholarly journals 393. Changing Trends, Risk Factors, and Treatment Challenges in Staphylococcus aureus Septic Arthritis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S202-S202
Author(s):  
Valerie Gobao ◽  
Mostafa Alfishawy ◽  
Neel Shah ◽  
Karin Byers ◽  
Mohamed Yassin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Drug Use ◽  
Positive Result ◽  
Septic Arthritis ◽  
Intravenous Drug ◽  
Intravenous Drug Use ◽  
Retrospective Case ◽  
Factors Associated ◽  
Rule Out

Abstract Background Staphylococcus aureus is a common organism in native septic arthritis. It is traditionally believed to be self-limited with rapid and aggressive debridement and appropriate antibiotic selection. The incidence of S. aureus septic arthritis is increasing, and further characterization is needed to improve diagnosis and treatment. For patients presenting with native S. aureus septic arthritis, we evaluated the reliability of methicillin-resistant S. aureus (MRSA) screening as a predictor to rule out MRSA septic arthritis, the risk factors associated with this disease, and the treatment and surgical outcomes. Methods A retrospective case–control study of patients diagnosed with septic arthritis in the UPMC health system (Pittsburgh, PA) between 2012 and 2016 was completed. The primary outcomes of interest were surgical intervention and the need to alter antibiotic treatment. Patient demographics, characteristics, and outcomes were recorded. Results A total of 215 cases of septic arthritis were identified, and 64% (n = 138) had S. aureus cultured. In this set, 36% (50/138) of these patients were identified with MRSA. Of the patients diagnosed with MRSA septic arthritis, 50% screened prior to admission had a positive result (8/16) and 48% screened during admission had a positive result (14/29). Compared with septic arthritis with other organisms, risk factors associated with S. aureus included history of intravenous drug use (OR: 4.3, CI: 1.7 to 10.8, P = 0.002) and being immunocompetent (OR: 0.3, CI: 0.1 to 0.6, P = 0.002). These infections were associated with concurrent infections of the spine (OR: 5.7, CI: 2.1 to 15.1, P = 0.0005). As compared with other organisms, there was a high probability of switching antibiotics during treatment (OR: 3.7, CI: 1.1 to 13.0, P = 0.04) and relapse of infection (OR: 4.2, CI: 1.2 to 14.6, P = 0.02). Conclusion S. aureus septic arthritis is associated with intravenous drug use, and not with immunosuppression. A negative MRSA screen does not rule out this organism. Concurrent spine infections are common. There is a high likelihood of infection relapse and that antibiotics will need to be altered during treatment. With the opioid epidemic, the incidence is likely to increase further. More work is needed to improve diagnosis and overcome treatment challenges. Disclosures All authors: No reported disclosures.

scholarly journals Outcome of the patients with post-operative cluster endophthalmitis referred to a tertiary level eye care center in Nepal

2013 ◽  
Vol 5 (2) ◽  
pp. 235-241
Author(s):  
Pragati Gautam ◽  
SN Joshi ◽  
M Thapa ◽  
AK Sharma ◽  
DN Shah
Keyword(s):  
Staphylococcus Aureus ◽  
Intravitreal Injection ◽  
Care Center ◽  
Visual Outcome ◽  
Causative Organism ◽  
Gram Stain ◽  
E Coli ◽  
Corrected Visual Acuity ◽  
Culture Positive ◽  
Gram Positive Cocci

Introduction: The causative organism and treatment outcomes of post operative endophthalmitis may vary depending on several factors. Objective: To find out the causative organisms and visual outcome after an outbreak of post-operative endophthalmitis. Materials and methods: An interventional prospective series of cases of clinically suspected endophthalmitis was studied. Eleven patients who presented within 48 hours after manual cataract surgery on the same day, by a one surgeon in a single center were enrolled in the study. They underwent both anterior chamber and vitreous aspiration and all of them received intravitreal Vancomycin, Amikacin and Dexamethasone. Samples were subjected to microbiological evaluation. All patients were followed up till 8 weeks for clinical and visual outcome. Results: Of the 11 eyes of suspected endopthalmitis, only one vitreous aspiration showed Gram negative bacilli on Gram stain and 3 vitreous aspirates showed Gram positive cocci. Of the 11 eyes, 3(42.85%) had culture positive on vitreous aspirate. In 2 cases E Coli was isolated and in 1 Staphylococcus aureus was isolated. After 48 hours of intravitreal injection, 10 out of 11 eyes improved and in one, intravitreal injection of vancomycin, amikacin and dexamethasone was repeated. The best corrected visual acuity of 6/9 was achieved in 2 patients, 5 had 6/18, 2 had 6/60 and 2 had 5/60 at the end of eight weeks. Conclusion: Staphylococcus aureus and E coli can cause endophthalmitis immediately on the first day post-operatively. Clinically suspected endophthalmitis treated with antibiotics and steroid intravitreal injection can result in better visual outcome. Nepal J Ophthalmol 2013; 5(10): 235-241 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8735

scholarly journals Neonatal Acute Paronychia

Hand ◽  
2017 ◽  
Vol 12 (5) ◽  
pp. NP99-NP100 ◽  
Author(s):  
Luke Grome ◽  
Gregory Borah
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Pediatric Population ◽  
Treatment Strategies ◽  
Initial Therapy ◽  
Age Group ◽  
Predisposing Factor ◽  
Incision And Drainage ◽  
Amoxicillin Clavulanate ◽  
Neonatal Patient

Background: Paronychia is defined as infection afflicting the eponychial nail folds of the hand or foot. Such infections are rarely reported in the perinatal age group, and not previously described in a neonate younger than 2 weeks. Trauma resulting in inoculation of the nail fold is the most common predisposing factor to paronychia. Oral trauma in the pediatric population from finger sucking predisposes this population to a different set of bacterial pathogens than adults. Contamination can progress to infection and abscess formation within the nail fold with the most prevalent vector in adult infections being Staphylococcus aureus. Comparatively, mixed anaerobic and aerobic infections tend to afflict children with oral soothing habits. Methods: This is a case report will present the rare occurrence of a paronychia in a neonate caused by methicillin-resistant Staphylococcus aureus. Results: The management and treatment strategies for paronychia in this atypical neonatal patient consisted of incision and drainage and antibiotic therapy. Conclusion: Neonates with oral self-soothing behaviors may be more at risk for developing paronychia of mixed anaerobic and aerobic infections. Initial therapy with broad-spectrum antibiotics amoxicillin/clavulanate or clindamycin is suggested. Incision and drainage in the perinatal setting coupled with antibiotics is curative.

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