A middle-aged patient presented with persistent purulent discharge from a scalp incision five years after undergoing craniotomy with artificial dura mater implantation. The wound showed no significant improvement despite a month of systemic antibiotic therapy and local debridement. Subsequent superficial ultrasonography revealed complete separation of the artificial dura mater implant area from the surrounding flap tissue, with a loss of local blood supply. Based on these findings, the artificial dura mater was surgically removed, and a free skin flap transplantation was performed to successfully cover the wound. The wound was well-healed at the 10-month postoperative follow-up.
Humans ; Scalp/diagnostic imaging* ; Middle Aged ; Male ; Epidural Abscess/etiology* ; Ultrasonography ; Surgical Flaps ; Surgical Wound Infection/surgery* ; Dura Mater/surgery*

Humans ; Epidural Abscess/etiology* ; Acupuncture Therapy/adverse effects* ; Magnetic Resonance Imaging/adverse effects* ; Epidural Space ; Spinal Diseases

Objective: To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children. Methods: A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher's exact test, while non-normal distrituction numeric variables were compared with nonparametric test. Results: Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia, Escherichia coli, and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs. 17.3% (142/820), 13.0% (103/790) vs. 9.1% (75/820), 4.6% (36/790) vs. 2.7% (22/820), χ²=18.71, 6.20, 4.07, all P<0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P>0.05). Conclusions: The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae, and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.
Adolescent ; Brain Abscess ; Child ; Child, Preschool ; Escherichia coli ; Female ; Humans ; Hydrocephalus ; Infant ; Infant, Newborn ; Male ; Meningitis, Bacterial/epidemiology* ; Retrospective Studies ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Subdural Effusion ; beta-Lactamases

Brucella ; Brucellosis/diagnosis* ; Cervical Vertebrae/diagnostic imaging* ; Epidural Abscess ; Humans ; Magnetic Resonance Imaging ; Quadriplegia ; Spondylitis/diagnostic imaging*

Objective To investigate the factors affecting changes of Symptom Check List-90 （SCL-90） of patients with traumatic subdural effusion. Methods One hundred and forty-two cases of patients with traumatic subdural effusion from the Center of Forensic Identification, Wannan Medical College collected from 2007-2018 were tested with SCL-90. The differences between SCL-90 results and the national norm and the influences of gender, age, education level, the number of effusion sites and location on SCL-90 results were analyzed. Results The differences between the scores of somatization, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia and psychosis factors and total mean scores in SCL-90 of traumatic subdural effusion and that of the national norm had statistical significance （P<0.05）. The differences in depression and hostility factor scores between males and females had statistical significance （P<0.05）. The differences in compulsion, anxiety and terror factor scores and total mean scores among different age groups had statistical significance （P<0.05）. The differences in hostility, paranoia and psychosis factors among patients with different degrees of education had statistical significance （P<0.05）. The differences in depression, anxiety, hostility and terror factor scores and total mean scores among single-site group, double-site group and multi-site group had statistical significance （P<0.05）. The differences in somatization, depression and anxiety factor scores and total mean scores between the right cerebral hemisphere group and the left cerebral hemisphere group and bilateral hemisphere group had statistical significance （P<0.05）. Conclusion Traumatic subdural effusion can cause certain psychological changes, which are related to the primary trauma of arachnoid tear as well as the number and location of effusion sites. Attention should be paid to the influence of the above factors during the assessment of psychological symptoms.
Anxiety ; Depression ; Depressive Disorder ; Female ; Humans ; Male ; Subdural Effusion ; Surveys and Questionnaires

BACKGROUND: The clinical outcomes and safety of thoracic epidural catheterization in anesthetized adult patients has not yet been established. The purpose of this study was to compare clinical differences between epidural catheterization performed before and after anesthesia for postoperative pain control. METHODS: The medical records of 549 patients who received thoracic epidural catheterization before (awake group, n = 303) or after (anesthetized group, n = 246) induction of anesthesia for major abdominal surgery were reviewed retrospectively. RESULTS: The catheter insertion time (1.6 ± 1.5 vs. 1.1 ± 1.2 min; 95% confidence interval [95% CI], 0.3–0.8; effect size, 0.368; P < 0.001) and number of attempts required for successful epidural catheterization (1 [1, 3] vs. 1 [1, 2], P = 0.003) were increased in the awake group. The incidence rates of dural puncture, vascular injury and postoperative paresthesia were similar between the two groups. The median surgical site numerical rating scale pain score (0 = no pain, 10 = worst pain imaginable) was lower in the awake group than in the anesthetized group (3 vs. 4 on postoperative day 1, P < 0.001; and 2 vs. 3 on postoperative day 3, P = 0.002). Serious complications, including meningitis, epidural abscess, epidural hematoma, spinal cord injury, and paraplegia, were not observed in either group. CONCLUSIONS: Successful epidural catheterization before induction of anesthesia required more attempts versus after anesthesia. Overall complication rates of thoracic epidural catheterization were similar regardless of the timing of the procedure.
Adult ; Analgesia, Epidural ; Anesthesia ; Catheterization* ; Catheters* ; Epidural Abscess ; Hematoma, Epidural, Spinal ; Humans ; Incidence ; Medical Records ; Meningitis ; Pain, Postoperative ; Paraplegia ; Paresthesia ; Postoperative Complications ; Punctures ; Retrospective Studies* ; Vascular System Injuries

The incidence of vaccine-type Streptococcus pneumoniae carriage and disease have declined in vaccinated children as well as in unvaccinated children and adults. However, diseases caused by non-vaccine type (NVT) S. pneumoniae are increasing. In this study, we report an invasive pneumococcal disease (IPD) caused by NVT multidrug-resistant (MDR) S. pneumoniae transmitted from a vaccinated infant to an unvaccinated healthy woman, and the clinical characteristics of this serotype. A 29-year-old previously healthy woman visited our hospital with fever and headache. She had been breastfeeding her baby for 8 months. She was diagnosed with brain abscess and sinusitis caused by S. pneumoniae. Although the patient had no previous exposure to antibiotics, antibiotic susceptibility test identified the pathogen as MDR. The patient's family members were examined using nasopharyngeal swabs for bacterial culture. The serotype of S. pneumoniae identified from the blood, abscess, and sputum of the patient was 15B/C. After investing the patient's family members, we found that the serotype from nasopharyngeal specimen of her baby was the same. We described an invasive MDR pneumococcal disease in an immunocompetent young adult in the community. IPD likely spread to the patient by close contact with her baby, who harbored S. pneumoniae of NVT. The spread of NVT S. pneumoniae in the post-vaccine era has increased in the community, and resistance pattern for S. pneumoniae of 15B/C changed compared to the pre-pneumococcal conjugate vaccine era. The spread of MDR pathogens causing IPD among family members should be monitored.
Abscess ; Adult ; Anti-Bacterial Agents ; Brain Abscess ; Breast Feeding ; Child ; Epidural Abscess ; Female ; Fever ; Headache ; Humans ; Incidence ; Infant ; Pneumonia ; Serogroup ; Sinusitis ; Sputum ; Streptococcus pneumoniae ; Streptococcus ; Vaccination ; Young Adult

Child ; Community-Acquired Infections ; complications ; microbiology ; Epidural Abscess ; diagnostic imaging ; etiology ; microbiology ; Female ; Humans ; Magnetic Resonance Imaging ; Methicillin-Resistant Staphylococcus aureus ; pathogenicity ; Staphylococcal Infections ; complications ; microbiology

Cellulitis, one of most common diseases of everyday life, is often overlooked for its significance. Although cellulitis does not cause or lead to serious problems usually, its possibility to cause life-threatening problem should be known. In present case, a patient who had received acupuncture treatment a week earlier presented to the clinic with symptoms of facial cellulitis. The disease resolved within few weeks under empirical antibiotic treatment but recurred after 3 months. Under close history review of the patient, we found out that the patient had received craniectomy 20 years ago. The patient had blunt headache with no other neurological symptoms that could suspect cranial infection, but considering the risk originating from the patient’s surgical history, brain computed tomography (CT) was taken. CT images revealed abscess formation in the subgaleal and epidural spaces. Craniotomy with abscess evacuation was done promptly. With additional antibiotic treatment postoperatively, the disease resolved, and the 1-month postoperative follow-up brain CT showed no signs of abscess formation.
Abscess ; Acupuncture ; Brain ; Cellulitis ; Craniotomy ; Empyema ; Epidural Abscess ; Epidural Space ; Follow-Up Studies ; Headache ; Humans

STUDY DESIGN: Retrospective cohort study. PURPOSE: To describe our experience in the management and outcomes of vertebral column osteomyelitis (VCO), particularly focusing on the risk factors of early and late mortality. OVERVIEW OF LITERATURE: Previous reports suggest a global increase in spinal column infections highlighting significant morbidity and mortality. To date, there have been no reports from our local population, and no previous report has assessed the potential relationship of frailty with mortality in a cohort of patients with VCO. METHODS: We reviewed 76 consecutive patients with VCO between 2009 and 2016 in Waikato Hospital, New Zealand. Demographic, clinical, microbiological, and treatment data were collected. Comorbidities were noted to calculate the modified Frailty Index (mFI). Mortality at 30 days and 1 year was recorded. Univariate and multivariate analyses were used to identify the predictors of mortality. RESULTS: The mean age of patients was 64.1 years, with 77.6% being male. Most patients presented with axial back pain (71.1%), with the lumbar spine most commonly affected (46%). A mean of 2.1 vertebral bodies was involved. Methicillin-sensitive Staphylococcus aureus was the most common organism of infection (35.5%), and 15.8% of patients exhibited polymicrobial infection. Twenty patients (26.3%) underwent surgical intervention, which was more likely in patients with concomitant spinal epidural abscess (odds ratio [OR], 4.88) or spondylodiscitis (OR, 3.81). Mortality rate was 5.2% at 30 days and 22.3% at 1 year. The presence of frailty (OR, 13.62) and chronic renal failure (OR, 13.40) elevated the 30-day mortality risk only in univariate analysis. An increase in age (OR, 1.07) and the number of vertebral levels (OR, 2.30) elevated the 1-year mortality risk in both univariate and multivariate analyses. CONCLUSIONS: Although the mFI correlated with 30-day mortality in univariate analysis, it was not a significant predictor in multivariate analysis. An increase in age and the number of levels involved elevated the 1-year mortality risk.
Adult ; Back Pain ; Cohort Studies ; Coinfection ; Comorbidity ; Discitis ; Epidural Abscess ; Humans ; Kidney Failure, Chronic ; Male ; Mortality ; Multivariate Analysis ; New Zealand ; Osteomyelitis ; Retrospective Studies ; Risk Factors ; Spine ; Staphylococcus aureus