Candida spondylodiscitis with epidural abscess is rarely reported and known to be the late complication of candidemia. A 48-years-old man presented with 4 weeks of progressively aggravating low back pain. He had a history of fungemia caused by Candida albicans 4 months earlier, for which he had been treated successfully with systemic fluconazole. The MRI of lumbar spine demonstrated the spondylodiscitis with multiple epidural abscesses at the L2/3 level. Along with the surgical interventions including abscess drainage, the intravenous amphotericin B administration was begun. Culture of drained pus yielded the growth of Candida albicans. After therapy with parenteral amphotericin B for 2 weeks followed by oral fluconazole for 8 weeks, the back pain resolved. However the low back pain and inflammation relapsed during oral fluconazole therapy. Thereafter oral voriconazole had been administered for 24 weeks and the patient showed complete recovery and no recurrence.
Abscess ; Amphotericin B ; Back Pain ; Candida ; Candida albicans ; Candidemia ; Discitis ; Drainage ; Epidural Abscess ; Fluconazole ; Fungemia ; Humans ; Inflammation ; Low Back Pain ; Pyrimidines ; Recurrence ; Spine ; Suppuration ; Triazoles

Candida spondylodiscitis with epidural abscess is rarely reported and known to be the late complication of candidemia. A 48-years-old man presented with 4 weeks of progressively aggravating low back pain. He had a history of fungemia caused by Candida albicans 4 months earlier, for which he had been treated successfully with systemic fluconazole. The MRI of lumbar spine demonstrated the spondylodiscitis with multiple epidural abscesses at the L2/3 level. Along with the surgical interventions including abscess drainage, the intravenous amphotericin B administration was begun. Culture of drained pus yielded the growth of Candida albicans. After therapy with parenteral amphotericin B for 2 weeks followed by oral fluconazole for 8 weeks, the back pain resolved. However the low back pain and inflammation relapsed during oral fluconazole therapy. Thereafter oral voriconazole had been administered for 24 weeks and the patient showed complete recovery and no recurrence.
Abscess ; Amphotericin B ; Back Pain ; Candida ; Candida albicans ; Candidemia ; Discitis ; Drainage ; Epidural Abscess ; Fluconazole ; Fungemia ; Humans ; Inflammation ; Low Back Pain ; Pyrimidines ; Recurrence ; Spine ; Suppuration ; Triazoles

Saccharomyces cerevisiae, also known as "baker's yeast" or "brewer's yeast", and is considered to be a frequent colonizer of human mucosal surfaces. Although it is a very uncommon cause of infections in humans, it can cause wide range of clinical syndromes, including pneumonia, empyema, liver abscess, peritonitis, urinary tract infection, cellulitis, unexplained fever, or septic shock, particularly in immunocompromised hosts. Fungemia is the most severe and well-proven manifestation of S.cerevisiae infections. According to previous studies, the conditions related to immunosupression, such as cancer, HIV infection, use of corticosteroid, neutropenia, stem cell transplantation, solid organ transplantation, burns and heart surgery, appear to be predisposing factors to fungemia. The antifungal agent of choice has not been established. We report two cases of S.cerevisiae fungemia in patients with hematologic malignancies. One was primary fungemia, and the other was presumed to be a catheter related one. Both cases showed a good prognosis with the complete negative conversion of fungemia.
Burns ; Catheters ; Cellulitis ; Colon ; Empyema ; Fever ; Fungemia ; Hematologic Neoplasms ; HIV Infections ; Humans ; Immunocompromised Host ; Liver Abscess ; Neutropenia ; Organ Transplantation ; Peritonitis ; Pneumonia ; Prognosis ; Saccharomyces ; Saccharomyces cerevisiae ; Shock, Septic ; Stem Cell Transplantation ; Thoracic Surgery ; Transplants ; Urinary Tract Infections

Despite the development of modern intensive care and new antimicrobial agents, the mortality of the patients with severe sepsis and septic shock remains high. The poor outcome is considered to be a consequence of an overactive systemic inflammatory response. Sepsis is now defined as systemic inflammatory response syndrome (SIRS) in which there is an identifiable focus of infection. As a consequence of the overactive SIRS response, the function of various organ systems may be compromised, resulting in multiple organ dysfunction syndrome (MODS) and death. Systemic inflammation is a consequence of activation of the innate immune system. It is characterized by intravascular release of pro-inflammatory cytokines and other vasoactive mediators, and the concurrent activation of the innate immune cells. In addition to the pro-inflammatory reactions, the host's anti-inflammatory mechanisms are also activated and aimed at counteracting the inflammatory response. The balance between pro- and anti-inflammatory reactions is critical for the outcome of the patient. Understanding the mechanisms of acute inflammatory responses in critical ill patients is necessary for the development of urgently needed therapeutics. The aim of this review is to provide a description of the key components and mechanisms involved in the inflammatory response in patients with SIRS and sepsis.
Anti-Infective Agents ; Cytokines ; Humans ; Immune System ; Inflammation ; Critical Care ; Multiple Organ Failure ; Sepsis ; Shock, Septic ; Systemic Inflammatory Response Syndrome

Intramural gastric abscess is a rare condition representing a localized form of suppurative gastritis. According to the extent of the disorder, suppurative gastritis is classified into diffuse and localized types. The diffuse or phlegmonous type is more common and involves the entire stomach with inflammation spreading to all layers from the submucosa. The localized form referred to as "intramural gastric abscess" accounts for 5% to 15% of cases. The pathogenic mechanism includes direct invasion by microorganisms and hematogenous spread from a distant source. Cases are usually diagnosed with a combination of imaging modalities such as ultrasound, computed tomography, endoscopic ultrasound, and esophagogastroduodenoscopy. Herein we report a case of intramural gastric abscess that developed following ingestion of a fish bone. It was successfully treated with endoscopic incision and drainage of pus.
Abscess ; Cellulitis ; Drainage ; Eating ; Endoscopy, Digestive System ; Gastritis ; Inflammation ; Stomach ; Suppuration

Fever has been recognized as a cardinal feature of disease since antiquity, but only recently has the pathophysiology of fever come to be understood. It became clear that the ultimate cause of fever is not a bacterial product (a so-called exogenous pyrogen) but a product of host inflammatory cells (i.e., an endogenous pyrogen). Many studies have demonstrated that mononuclear phagocytes are the principal source of endogenous pyrogen and that a variety of mononuclear cell products can mediate the febrile response. Cytokines are also important as mediators of the acute-phase response to infection and inflammation.
Acute-Phase Reaction ; Cytokines ; Fever* ; Inflammation ; Phagocytes

Klebsiella pneumonia is an opportunistic pathogen that can lead to severe diseases such as septicemia, pneumonia, urinary and hepatobiliary track infection, in mainly hospitalized, immunocompromised patients. It has been reported to produce cellulitis, ecthyma gangrenosum in cutaneous manifestions, which are more commonly induced by bacteremia and spreading from other internal organs than primary inoculation. Herein, we present a case of a 75-year-old man with aplastic anemia, which progressed to septic shock and secondary cutaneous infection caused by Klebsiella pneumonia, but showed similar skin lesions to systemic fungal infection with dispersed erythematous macules and vesicular change on the center of his erythema.
Aged ; Anemia, Aplastic* ; Bacteremia ; Cellulitis ; Ecthyma ; Erythema ; Humans ; Immunocompromised Host ; Klebsiella* ; Pneumonia* ; Sepsis ; Shock, Septic ; Skin ; Track and Field

Pilonidal disease in the sacrococcygeal region usually presents as abscesses, recurrent inflammation, cellulitis or fistula tracks. However, few reports on actinomycosis affecting pilonidal sinuses have been published. We report a case of a 25-year-old woman who presented with a pilonidal abscess who underwent surgical drainage and debridement. Pus from the pilonidal abscess was sent for microbiology, which grew actinomyces turicensis associated with prevotella bivia and peptostreptococci. She was treated with oral amoxicillin-clavulanate after surgical drainage for one week and recovered well. Actinomycosis associated with pilonidal abscesses, though uncommon, should be recognized and can be satisfactorily treated with a combination of surgical drainage and antibiotics.
Abscess* ; Actinomyces ; Actinomycosis* ; Adult ; Anti-Bacterial Agents ; Cellulitis ; Debridement ; Drainage ; Female ; Fistula ; Humans ; Inflammation ; Pilonidal Sinus ; Prevotella ; Sacrococcygeal Region ; Suppuration

Sepsis remains a leading cause of death in critically ill patients, despite efforts to improve patient outcome. Thus far, no magic drugs exist for severe sepsis and septic shock. Instead, early diagnosis and prompt initial management such as early goal-directed therapy are key to improve sepsis outcome. For early detection of sepsis, biological markers (biomarkers) can help clinicians to distinguish infection from host response to inflammation. Ideally, biomarkers can be used for risk stratification, diagnosis, monitoring of treatment responses, and outcome prediction. More than 170 biomarkers have been identified as useful for evaluating sepsis, including C-reactive protein, procalcitonin, various cytokines, and cell surface markers. Recently, studies have reported on the usefulness of biomarker-guided antibiotic stewardships. However, the other side of these numerous biomarkers is that no novel single laboratory marker can diagnose, predict, and track the treatment of sepsis. The purpose of this review is to summarize several key biomarkers from recent sepsis studies.
Biomarkers* ; C-Reactive Protein ; Cause of Death ; Critical Illness ; Cytokines ; Diagnosis ; Early Diagnosis ; Humans ; Inflammation ; Magic ; Prognosis ; Sepsis* ; Shock, Septic

The authors report their experience with 22 cases of intracranial suppuration : 18 with brain abscess and four with subdural empyema. A small series of nine consecutive cases of intracranial suppuraion with one death is presented since Computed Tomographic brain scanning become a routine diagnostic procedure. These patient have been compared to 13 consecutive cases treated without benefit of CT analysis in order to determine the factors responsible for the recently improved prognosis. The mortality rate was 30.8% for al operated patients treated before availability of CT and 22.7% for the patient since advent of CT scan. Among the factors that may have contributed to the improved results for patients diagnosed with CT are : fewer patients with poor preperative clinical status, and a great incidence of total abscess removal. In addition, CT scanning provided more accurate diagnosis and localization of abscess and aided in the rapid detection of postoperative complication.
Abscess ; Brain ; Brain Abscess ; Diagnosis ; Empyema, Subdural ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Prognosis ; Suppuration* ; Tomography, X-Ray Computed