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Mucormycosis is an opportunistic infection caused by saprophytic fungi of the order Mucorales. This infection is seen mainly in immunocompromised people with diabetes but can be seen rarely in immunocompetent hosts. Recently, this disease is frequently seen in many patients who had suffered from COVID-19. Among the different sites of mucormycosis, rhinocerebral mucormycosis is the most prevalent form, followed by cutaneous. Surgical debridement followed by antifungal therapy with amphotericin B and the control of the immunocompromised state is the recommended treatment. This case is an unusual presentation of mucormycosis involving the maxillary sinus and the cheek, presented without any nasal symptoms.

The use of high-grain diets in feedlots is associated with the development of acidosis and ruminitis, which can lead to the occurrence of liver abscesses (LAs). However, the effect of LA on carcass traits is not well known. This study assessed the effects of LA on the performance and carcass traits of beef cattle. Nine peer-reviewed publications with forty-seven treatment means were included in the data set. The effects of the LA were evaluated by examining the weighted mean difference (WMD) between LA (animal with LA) and control treatment (animal without LA). Heterogeneity was explored by meta-regression, followed by a subgroup analysis of the scores and percentages of liver abscess and concentrate level in the feedlot diet. Animals affected by LA showed a reduction in dry matter intake (−1.03%) and feed efficiency (−1.82%). Animals with an LA score of “A” (one or two small abscesses) exhibited a decrease in carcass weight (WMD = 3.41 kg; p = 0.034) and ribeye area (WMD = −1.37 cm2; p = 0.019). When assessing the impact of LA on carcass traits, the most reliable finding indicates a 1.21% reduction in the ribeye area, with no adverse effects observed on subcutaneous fat thickness or the marbling score in the carcass.

Abstract Objective The aim of this study was to investigate risk factors for the severity of breast abscess during lactation. Methods A cross-sectional study was conducted using data from the Questionnaire survey of breast abscess patients. According to whether the maximum abscess diameter > 5 cm, the patients were divided into two groups for univariate and multivariate regression analysis. Results 1805 valid questionnaires were included. Univariate and Binary logistic regression analysis demonstrated that low education (OR = 1.5, 95% CI 1.1–2.0, P = 0.005), non-exclusive breastfeeding (OR = 0.7, 95% CI 0.6–0.9, P = 0.004), fever > 37.5 ℃ (OR = 0.7, 95% CI 0.6–0.9, P = 0.003), flat or inverted nipples (OR = 0.7, 95% CI 0.6–0.9, P = 0.005), antibiotic used (OR = 0.7, 95% CI 0.6–0.9, P = 0.006), and non-medical massage (OR = 0.3, 95% CI 0.2–0.4, P 5 cm. Conclusion Low education, non-exclusive breastfeeding, fever > 37.5 ℃, inverted or flat nipples, antibiotic used, and non-medical massage history have adverse effects on the severity of breast abscess during lactation.

Abstract Background Anorectal fistula, which is a relatively common pathology, is the chronic manifestation of the acute perirectal process that forms an anal abscess. The development of a fistula after incision and drainage of an anal abscess is seen in approximately 26–37%. Its treatment is a relevant topic, and the role of the use of antibiotic therapy in its prevention remains controversial, after the publication of several studies with contradictory results and several methodological limitations. Our hypothesis is that the combination of amoxicillin and clavulanic acid will reduce the incidence of anal fistula. Method The aim of this study is to evaluate the efficacy of antibiotherapy after surgical drainage of perianal abscess in the development of perianal fistula. The PERIQxA study is a multicenter, randomized, double-blind controlled trial. The study has been designed to include 286 adult patients who will be randomly (1:1) assigned to either the experimental (amoxicillin/clavulanic acid 875/125 mg TDS for 7 days) or the control arm (placebo). The primary outcome measure is the percentage of patients that develop perianal fistula after surgery and during follow-up (6 months). Discussion This clinical trial is designed to evaluate the efficacy and safety of amoxicillin/clavulanic in the prevention of perianal fistula. The results of this study are expected to contribute to stablish the potential role of antibiotherapy in the therapeutics for anal abscess. Trial registration EudraCT Number: 2021–003376-14. Registered on November 26, 2021.

We report a clinical observation of intramuscular myxoma, mimicking a psoas abscess. Surgical minimally invasive treatment of the disease has been suggested. This clinical observation shows an example of the effective use of minimally invasive treatment methods in surgical practice, as an alternative to open surgery.

The abscess is a common complication of Crohn’s disease (CD), with the perianal form more frequent than gluteal or presacral which is relatively rare. There are few case reports of gluteal abscess combined with presacral abscess caused by CD and the treatment has not been established. A 21-year-old male was admitted with right buttock and lower back pain with a duration of 3 months. He had a history of CD in the small intestine diagnosed 10 months previously. He had poor compliance and had not returned for follow-up care during the previous 6 months. Abdominopelvic CT indicated newly developed multiple abscess pockets in right gluteal region, including piriformis muscle and presacral space. Additionally, fistula tracts between small bowel loops and presacral space were observed. Patient’s CD was moderate activity (273.12 on the Crohn’s Disease Activity Index [CDAI]). Treatment was started with piperacillin/ tazobactam antibiotic but patient developed a fever and abscess extent was aggravated. Therefore, surgical incision and drainage was performed and 4 Penrose drains were inserted. Patient’s pain and fever were resolved following surgery. Infliximab was then administered for the remaining fistulas. After the induction regimen, multiple fistula tracts improved and patient went into remission (CDAI was -0.12).

Aseptic abscess syndrome is a rare and possibly underdiagnosed condition characterized by the presence of sterile neutrophilic collections in various tissues that do not respond to antimicrobial therapy but rather require anti-inflammatory treatment. There is limited literature linking this condition to rheumatoid arthritis. Here, we present the case of a patient with rheumatoid arthritis, presenting with prolonged febrile syndrome and multiple sterile abscesses. A diagnosis of aseptic abscess syndrome was made, and successful resolution of the abscesses was achieved following treatment with glucocorticoid pulses and infliximab. Clinicians should consider this condition in patients with inflammatory diseases who develop abscesses in different tissues where no causative microbiological agent can be identified.

INTRODUCTION: Patients with brucellosis present with nonspecific symptoms originating from different organs. In this study, we aimed to investigate the symptoms related to the head and neck region in patients with brucellosis. METHODS: The retrospective study analyzed 542 patients with a definitive diagnosis of brucellosis who were admitted to our hospital between January 2015 and April 2022 and received outpatient and/or inpatient care. Clinical symptoms localized to the ear-nose-throat and head and neck regions were evaluated. RESULTS: A neck mass was detected in 52 out of 542 patients included in the study. The prevalence of cervical lymphadenopathy and/or abscess was 9.6%. Only lymphadenopathy was present in 30 (57.7%) patients, while both neck abscess and lymphadenopathy were detected in 22 (42.3%) patients. No significant difference was found between the two groups with regard to treatment regimens (p=0.37). Mean duration of treatment was 30 +- 22.1 (range, 14-70) days in the lymphadenopathy group and was 22 +- 14.7 (range, 14-60) days in the abscess group. No significant difference was found between the two groups with regard to the length of time to clinical recovery (p=0.34). DISCUSSION AND CONCLUSION: Brucellosis affects many regions of the head and neck and can have a variety of imaging manifestations that mimic benign and malignant lesions. The diagnosis of brucellosis should be considered in the first-line differential diagnosis conducted based on imaging features in patients residing in endemic regions.

Introduction Perianal fistula and its recurrence is a challenging entity for surgeons. It is a well-establi1shed fact that magnetic resonance imaging (MRI) findings influence surgical procedures and reduce the rate of recurrence. In this study, we assessed the contrast-enhanced (CE) three dimensional T1 sequences [sampling perfection with application optimized contrast using different flip angle evolution (SPACE) and volumetric interpolated breath-hold examination (VIBE)] in a 3T MRI system to evaluate perianal fistulas and compared them with two-dimensional (2D) sequences.

Minipigs are valued alternatives to dogs and non-human primates in non-clinical safety and toxicity studies, and Göttingen minipigs are bred specifically for experimental purposes. They are bred under barrier conditions and monitored regularly for many pathogens and opportunistic agents, and spontaneous disease is rare when compared to what is seen in production pigs. Knowledge of spontaneous background lesions is important when toxicological pathologists evaluate microscopic findings in pre-clinical toxicity studies to avoid interference with study data interpretation. In this brief communication, intra-abdominal granulomas/abscesses were seen in Göttingen minipigs. The minipigs did not show any clinical signs, but nodules were present in the abdominal peritoneum at necropsy. Microscopic evaluation revealed chronic inflammation, with abscess or granuloma formation. Areas of inflammation, occasionally associated with the presence of the Splendore-Hoeppli material, were surrounded by a fibrotic capsule. Special stains were applied to investigate for the presence of microorganisms. [ABSTRACT FROM AUTHOR]

Background: This paper reports a 10-year series of spontaneous nasal septal abscesses in immune-competent children, with suggestions for optimal management. Methods: A retrospective case note review was conducted of children undergoing an operation for incision and drainage of nasal septal abscesses between 2013 and 2023. Results: Six children were identified via electronic hospital records during the 10-year review period, five with a spontaneous abscess. The children were aged 10–14 years. All were immunocompetent and none had active sinus infection. The most common presenting features were nasal swelling, facial swelling, headache, nasal congestion and fever. The most common bacterial isolate was Staphylococcus aureus. All children received prompt surgical drainage and intravenous antibiotic therapy. Complications were seen in three children, with one child developing significant intracranial complications. Conclusion: To our knowledge, this is the first series of spontaneous nasal septal abscesses in immunocompetent children. The high prevalence of Staphylococcus aureus suggests spread from the nasal mucosa or vestibule. Early recognition, computed tomography scanning, surgical drainage and antibiotic therapy are the mainstays of treatment, to prevent potentially life-threatening complications. [ABSTRACT FROM AUTHOR]

Case Presentation: A 57-year-old man with a history of bronchial asthma and eosinophilic sinusitis presented to the emergency department with an exacerbation of otitis media. His primary complaints were otopyorrhea, headache, and neck pain with redness. Contrast-enhanced computed tomography revealed a posterior neck abscess contiguous with the mastoid process. The patient underwent mastoidectomy and received antimicrobial therapy. Eosinophilic granulation tissue in the middle ear obstructed the middle ear aditus and directed the inflammatory process toward the mastoid tip. Discussion: Bezold abscess is a rare extracranial complication of acute mastoiditis. Therefore, clinicians should consider neck pain with redness as an important physical sign that suggests Bezold abscess in patients with otitis media. [ABSTRACT FROM AUTHOR]

Pilonidal sinus disease is typically located in the sacrococcygeal area, although it has been described in other locations. We present a rare case of pilonidal sinus on the scalp and its management. [ABSTRACT FROM AUTHOR]

Ectopic teeth arise from developmental abnormalities and can be supernumerary, deciduous, or permanent teeth. They can cause orofacial pain, swelling, and infection. There is a major paucity in literature about ectopic mandibular third molar (EMTM) and its causes, symptoms, and treatment. We present an unusual case of EMTM in the mandibular subcondylar region and its surgical management. A 58-year-old female reported with complain of pain and swelling in the right preauricular region. On radiographic assessment, the right mandibular third molar was ectopically present in the subcondylar region and associated with a small dentigerous cyst. Complete removal of cystic lining and extraction of EMTM was done under general anesthesia using a retromandibular approach. After surgery, there was a complete resolution of symptoms within 1 month with uneventful healing and no postoperative complications. [ABSTRACT FROM AUTHOR]

Retroperitoneal abscesses constitute an uncommon, complex, and life-threatening intra-abdominal infection. The insidious nature of the presentation, coupled with the presence of non-specific clinical symptoms, might result in misdiagnosis or delayed diagnosis, ultimately contributing to substantial morbidity and mortality. Herein we report a case of a 32-year-old intravenous drug user who presented to the emergency department complaining of high-grade fever, intense hiccough, and back pain due to retroperitoneal abscess formation after intravenous injection in the left femoral vein. [ABSTRACT FROM AUTHOR]

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Splenic abscess is a rare disease with growing incidence due to the increasing number of immunocompro-mised patients and usage of improved diagnostic imaging modalities. Hematogenous infections are the most common cause of splenic abscess. Because of nonspecific clinical presentation, diagnosis might be de-layed. CT-scan is the imaging method of choice for diagnosis. Ttreatment includes antibiotics alone or antibiotic therapy with percutaneous drainage or splenectomy. In this article, we present a rare case of multiple splenic abscess (MSA) in a patient undergoing hemodialysis in Bushehr.

Here we describe the first case of abscess infection caused by Nocardia beijingensis in China. The patient was immunocompetent but suffered from postoperative abscess for 6 years. This study highlights the necessity of long-term infected foci to be thoroughly examined to identify the pathogen, as well as the importance of accurate Nocardia identification and antimicrobial susceptibility tests for understanding the pathogen's epidemiology, clinical significance, and treatment strategy.

The ingested foreign body is a very unusual etiology of liver abscess. This clinical scenario is infrequently reported in the literature. A 66-year-old male patient presented to the hospital because of abdominal pain along with 7 days of right upper quadrant pain and intermittent low-grade fever. He was living in an epidemiological area of Fasciola infection. Physical examination showed right hypochondria tenderness without guarding or rebounding. Laboratory results were significant for leukocytosis, predominant neutrophils, and increased inflammatory markers. The liver function tests were within normal limits. Abdominal ultrasonography and CT scan were consistent with a hepatic abscess spread from segment 4B to segment 3. The patient was preliminarily diagnosed with a parasitic hepatic abscess. After management with fluid infusion and antibiotics, the patient was discharged in stable condition. Two weeks later, on the follow-up visit, the patient reported intermittent low-grade fever had persisted. After consulting the CT scan, an abnormal high-attenuation linear structure was identified inside the liver lesion, which is suspected of being a foreign body. Laparoscopic surgery was performed, and a fishbone was removed from the abscess cavity. Perforation was not found in the stomach, duodenum, or in the bowel. One week later, their condition was fully resolved. Liver abscess due to a foreign body should be suspected when a patient has radiology findings suggestive of an abscess, but the clinical presentation does not indicate the common etiologies. Meticulous observation on abdominal CT scans or ultrasonography can help with diagnosis and guide treatment.

Pyelo-hepatic abscess is a rare complication of upper urinary tract infections (UTIs). We describe a case of polymicrobial pyelo-hepatic abscess in an immunocompetent patient. A 71-year-old male patient with a double-J stent for right ureteral lithiasis was admitted in our Infectious Diseases Department for a pyelo-hepatic abscess. Despite a targeted antibiotic therapy against an extended spectrum betalactamase-negative Escherichia coli, the patient did not improve. Further examinations revealed a possible polymicrobial aetiology, including Candida spp. and E. coli resistant to piperacillin/tazobactam but sensitive to third-generation cephalosporins. To date, a paucity of articles regarding pyelo-hepatic abscess exist, consisting mostly of case reports. Urinary stones and a ureteral stent indwelling time exceeding 90 days are known risk factors for upper UTIs and for bacterial dissemination in contiguous organs. Pyelo-hepatic abscesses usually involve Gram-negative bacilli, but they can be polymicrobial, including fungi. As a range of factors could limit the efficacy of antibiotics inside an encapsulated lesion and might contribute to the selection of resistant species during treatment, clinicians should be aware of this complication and try to prevent this event by acting on the main modifiable risk factor.

Objective: The aim of this study was to investigate risk factors for the severity of breast abscess during lactation. Methods: A cross-sectional study was conducted using data from the Questionnaire survey of breast abscess patients. According to whether the maximum abscess diameter > 5 cm, the patients were divided into two groups for univariate and multivariate regression analysis. Results: 1805 valid questionnaires were included. Univariate and Binary logistic regression analysis demonstrated that low education (OR = 1.5, 95% CI 1.1–2.0, P = 0.005), non-exclusive breastfeeding (OR = 0.7, 95% CI 0.6–0.9, P = 0.004), fever > 37.5 ℃ (OR = 0.7, 95% CI 0.6–0.9, P = 0.003), flat or inverted nipples (OR = 0.7, 95% CI 0.6–0.9, P = 0.005), antibiotic used (OR = 0.7, 95% CI 0.6–0.9, P = 0.006), and non-medical massage (OR = 0.3, 95% CI 0.2–0.4, P < 0.001) were the effective independent influencing factors for the maximum breast abscess diameter > 5 cm. Conclusion: Low education, non-exclusive breastfeeding, fever > 37.5 ℃, inverted or flat nipples, antibiotic used, and non-medical massage history have adverse effects on the severity of breast abscess during lactation. [ABSTRACT FROM AUTHOR]

Background: Anorectal fistula, which is a relatively common pathology, is the chronic manifestation of the acute perirectal process that forms an anal abscess. The development of a fistula after incision and drainage of an anal abscess is seen in approximately 26–37%. Its treatment is a relevant topic, and the role of the use of antibiotic therapy in its prevention remains controversial, after the publication of several studies with contradictory results and several methodological limitations. Our hypothesis is that the combination of amoxicillin and clavulanic acid will reduce the incidence of anal fistula. Method: The aim of this study is to evaluate the efficacy of antibiotherapy after surgical drainage of perianal abscess in the development of perianal fistula. The PERIQxA study is a multicenter, randomized, double-blind controlled trial. The study has been designed to include 286 adult patients who will be randomly (1:1) assigned to either the experimental (amoxicillin/clavulanic acid 875/125 mg TDS for 7 days) or the control arm (placebo). The primary outcome measure is the percentage of patients that develop perianal fistula after surgery and during follow-up (6 months). Discussion: This clinical trial is designed to evaluate the efficacy and safety of amoxicillin/clavulanic in the prevention of perianal fistula. The results of this study are expected to contribute to stablish the potential role of antibiotherapy in the therapeutics for anal abscess. Trial registration: EudraCT Number: 2021–003376-14. Registered on November 26, 2021. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility, safety, and efficacy of massive continuous irrigation (MCI) and endoscopic debridement for the treatment of refractory abscess–fistula complexes. Methods: This was a retrospective single‐center observational study involving 12 patients with refractory abscess–fistula complexes. All patients had experienced long‐term treatment failure or had failed multiple treatment modalities. We used over two catheters and inserted them via the gastrointestinal (GI) tract or percutaneously to form a circulation pathway to achieve MCI of normal saline, endoscopic debridement was then performed. The treatment success rate, irrigation volume and treatment duration, time to abscess–fistula complex closure, intra‐treatment complications, and recurrence rate were recorded. Results: The treatment success rates were 100%. The median time of previous treatment was 32 days (range 7–912 days). The mean time from the use of the novel treatment strategy to abscess–fistula complex healing was 18.8 ± 11.0 days. The mean volume of irrigation was 10 804 ± 1669 mL/24 h. The mean irrigation time was 16.5 ± 9.2 days, and a median of two irrigation tubes (range 2–5) were used. No complications occurred either during or after the procedure. During the follow‐up of 23.1 ± 18.1 months, no recurrence or adverse events were noted. Conclusions: MCI and endoscopic debridement may be a feasible, safe, and effective alternative treatment for refractory abscess–fistula complexes. Large prospective studies are needed to validate our results. [ABSTRACT FROM AUTHOR]

Pathogens with affinity for the central nervous system (CNS) in children are diverse in their mechanisms of infecting and attacking the brain. Infections can reach the CNS via hematogenous routes, transneurally thereby avoiding the blood-brain barrier, and across mucosal or skin surfaces. Once transmission occurs, pathogens can wreak havoc both by direct action on host cells and via an intricate interplay between the protective and pathologic actions of the host's immune system. Pathogen prevalence varies depending on region, and susceptibility differs based on epidemiologic factors such as age, immune status, and genetics. In addition, some infectious diseases are monophasic, whereas others may lie dormant for years, thereby causing a dynamic effect on outcomes. Outcomes in survivors are highly variable for each particular pathogen and depend on the vaccination and immune status of the patient as well as the speed by which the patient receives evidence-based treatments. Given pathogens cause communicable diseases that can cause morbidity and mortality on a population level when spread, the burden is often the greatest and the outcomes the worst in low-resource settings. Here we will focus on the most common infections with a propensity to affect a child's brain, the pathologic mechanisms by which they do so, and what is known about the developmental outcomes in children who are affected by these infections. [ABSTRACT FROM AUTHOR]

Background and Objectives: Extra-intestinal salmonellosis is associated with higher case fatality and is underestimated in the developing countries like India. Here we present a case series of bacteriologically proven extra-intestinal salmonellosis managed at our institute over the past two years. Materials and Methods: Retrospective analysis of bacteriologically proven extra-intestinal salmonellosis over two years between January 2020 to December 2021 was carried out. Medical records were reviewed for site of infection, evidence of any underlying or predisposing illnesses and antimicrobial susceptibility report. Results: Eight patients were diagnosed with extra-intestinal salmonellosis. Male to female ratio was 3:1. Mean age was 44 years. Four were typhoidal and four were nontyphoidal Salmonellae. The extra-intestinal sites involved were purulent aspirates from scrotum, caecum, perianal region, intraperitoneal collection, synovium, and urine. Predisposing factors include chronic myeloid leukemia, HIV and gastric malignancy. All deep seated abscess required surgical intervention. All typhoidal Salmonella (n=4) were sensitive to cotrimoxazole, ampicillin, ceftriaxone. Among nontyphoidal Salmonella, one was resistant to cotrimoxazole; two were resistant to ampicillin, ceftriaxone and three resistant to ciprofloxacin. Conclusion: The diagnosis of extra-intestinal salmonellosis requires a high degree of clinical suspicion and should be included in the differential diagnosis in patients with deep-seated abscesses. [ABSTRACT FROM AUTHOR]

Since the early 1990's, laparoscopic cholecystectomy has become the gold standard for the treatment of symptomatic gallbladder disease. Although the incidence of postoperative complications is generally lower with this approach, gallbladder perforation represents a serious risk that is among the most common complications of laparoscopic cholecystectomy. The sequalae that can follow iatrogenic perforation have not been well documented and only a few case reports exist in the current literature. In this paper we discuss two case reports of delayed perihepatic abscesses following prior laparoscopic cholecystectomy, ultimately resulting in fistulous tracts. The course of the disease is discussed along with the diagnostic workup and eventual successful management of the aforementioned complications. Treating enteric fistulae requires a systematic approach and is carried out in phases. Enteric fistula formation following laparoscopic cholecystectomy is a rare complication of retained gallstones that can present months to years following the index operation. Significant care should be taken to avoid perforation and all efforts should be made to retrieve stones if spillage occurs. [ABSTRACT FROM AUTHOR]

Hypervirulent Klebsiella pneumoniae (hvKP) causes multisite infections and abscesses. However, endocarditis is a rare presentation of hvKP infection. Herein, we report a case of K. pneumoniae native valve infective endocarditis secondary to community-acquired liver and prostate abscesses. The patient developed papillary muscle rupture, leading to mitral regurgitation, and underwent emergent mitral valve replacement. The diagnosis of endocarditis was confirmed microbiologically and histologically. The causative strain belonged to the hypermucoid K1 capsular genotype and possessed the rmpA gene. The genome sequence was deposited in GenBank under the accession number JAQZBZ000000000. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Congenital neutropenia syndromes encompass a group of genetic disorders characterized by persistent neutropenia and recurrent infections inherited in an autosomal recessive, dominant, or X‐linked manner. These syndromes arise from mutations in various genes, and one of the significant genes involved is glucose‐6‐phosphatase catalytic subunit 3 (G6PC3), giving rise to a condition known as Dursun syndrome. As per existing knowledge, a total of 92 cases of Dursun syndrome have been reported globally, including eight cases from Saudi Arabia. Our study identified two additional cases exhibiting neutropenia since the early postnatal period and recurrent admissions due to infections. Additionally, these patients presented with oral ulcers, chronic diarrhea, and anomalies affecting the cardiac and genitourinary systems. The rising incidence of congenital neutropenia on a global scale necessitates heightened vigilance among clinicians to ensure thorough follow‐up of patients with neutropenia. This proactive approach can lead to early detection and appropriate management of associated complications, ultimately improving patient outcomes. [ABSTRACT FROM AUTHOR]

This case report underscores the importance of utilizing E-VAC (endoscopic vacuum-assisted closure) in the treatment of a perforated duodenal ulcer complicated by the formation of a subphrenic abscess and septic shock. It showcases how E-VAC can effectively mitigate the risk of further complications, such as leakage, bleeding, or rupture, which are more commonly associated with traditional methods like stents, clips, or sutures. As a result, there is a significant reduction in mortality rates. A perforated duodenal ulcer accompanied by abscess formation represents a critical medical condition that demands prompt surgical intervention. The choice of the method for abscess drainage and perforation closure plays a pivotal role in determining the patient's chances of survival. Notably, in patients with a high ASA (American Association of Anesthesiologists) score of IV-V, the mortality rate following conventional surgical intervention is considerably elevated. The management of perforated duodenal ulcers has evolved from open abdominal surgical procedures, which were associated with high mortality rates and risk of suture repair leakage, to minimally invasive techniques like laparoscopy and ingestible robots. Previously, complications arising from peptic ulcers, such as perforations, leaks, and fistulas, were primarily addressed through surgical and conservative treatments. However, over the past two decades, the medical community has shifted towards employing endoscopic closure techniques, including stents, clips, and E-VAC. E-VAC, in particular, has shown promising outcomes by promoting rapid and consistent healing. This case report presents the clinical scenario of a patient diagnosed with septic shock due to a perforated duodenal ulcer with abscess formation. Following an exploratory laparotomy that confirmed the presence of a subphrenic abscess, three drainage tubes were utilized to evacuate it. Subsequently, E-VAC therapy was initiated, with the kit being replaced three times during the recovery period. The patient exhibited favorable progress, including weight gain, and was ultimately discharged as fully recovered. In the treatment of patients with duodenal perforated ulcers and associated abscess formation, the successful and comprehensive drainage of the abscess, coupled with the closure of the perforation, emerges as a pivotal factor influencing the patient's healing process. The positive outcomes observed in these patients underscore the efficacy of employing a negative pressure E-VAC kit, resulting in thorough drainage, rapid patient recovery, and low mortality rates. [ABSTRACT FROM AUTHOR]

Introduction: Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-preserving procedure for treating anal fistula of cryptoglandular origin. Our prospective study aimed to determine the postoperative outcomes of patients undergoing LIFT in emergency and elective settings. Methods: This was a single-centre prospective observational study of the LIFT procedure for the treatment of anal fistulas. The differences in the 6-month postoperative outcomes between the emergency and elective procedures were analysed, including the healing rate, healing time, recurrence rate, recurrence time, postoperative complications and length of hospital stay. Results: Twenty-two patients were recruited for this study: 11 patients underwent LIFT as an emergency procedure (EM-LIFT), while the others underwent LIFT as an elective procedure (EL-LIFT). The healing rate for the EM-LIFT group was 90.9% (n = 10), with a median healing time of 2 months (range 0.5-4). For the EL-LIFT group, the healing rate was 100% (n = 11), with the same median healing time of 2 months (range 0.5-4). Two of the patients in the EM-LIFT group developed recurrence, with a median recurrence time of 5 months (range 4-6) and three developed recurrence in the EL-LIFT group, with the same median recurrence time of 5 months (range 4-6). There were minor postoperative complications of pain and subcutaneous infection, with no faecal incontinence. There was no statistically significant difference in postoperative outcomes between the groups. Conclusion: EM-LIFT is a feasible and safe primary procedure for active cryptoglandular-type anal fistulas. [ABSTRACT FROM AUTHOR]

Introduction: Pyogenic liver abscess is a noteworthy health concern in North America, characterized by a mortality rate ranging from 2 to 12%. This condition is often polymicrobial, with Streptococcus species and Escherichia coli as the predominant causal pathogens in Western countries. Fusobacterium species, typically commensals of gastrointestinal, genital, and oral flora, have been implicated in the rare formation of tonsillar abscesses and Lemierre syndrome, including its gastrointestinal variant known as pylephlebitis. Case Presentation: We present the case of an immunocompetent male with a 2-week history of abdominal distention and pain. Abdominal magnetic resonance imaging revealed multiseptated cystic hepatic masses and portal vein thrombosis. A subsequent liver biopsy confirmed Fusobacterium nucleatum etiology. The patient was initiated on intravenous cefepime and oral metronidazole antibiotics. Unfortunately, the patient succumbed to cardiac arrest before a final diagnosis could be established. Conclusion:Fusobacterium species-associated liver abscess, coupled with the rare gastrointestinal variant of Lemierre syndrome (pylephlebitis), poses a significant mortality risk. This case underscores the rarity and clinical challenges associated with these conditions. Increased awareness among clinicians is crucial for early diagnosis and prompt intervention, potentially improving outcomes in such cases. [ABSTRACT FROM AUTHOR]

A 22-year-old male, with a history of recreational drug use, was admitted with a 24-hour history of sore throat, bilateral otalgia, fever, chills, sweats, and pain in the upper chest. The blood cultures were positive for Fusobacterium necrophorum. A thoracic and neck soft tissue computed tomography (CT) scan revealed an intratonsillar abscess and pulmonary septic emboli. Initial treatment with Piperacillin-tazobactam and Clindamycin was de-escalated after 5 days. The patient made a complete recovery after 22 days of antibiotic treatment. [ABSTRACT FROM AUTHOR]

Vascular endothelial growth factor receptor tyrosine kinase inhibitors are known to cause perforation as one of their severe side effects, and postoperative and postradiation therapy are known risk factors. However, there are few studies on perforation following tumor shrinkage. A 78-year-old woman with postoperative recurring left collecting duct carcinoma of the right hilar lymph nodes and mediastinum underwent eight courses of nivolumab plus cabozantinib, resulting in tumor shrinkage. Three days after the last administration, she developed fever and cough and was hospitalized for right lobar pneumonia. The patient received long-term antibiotics for bronchial fistula with the destruction of the bronchial wall and secondary lung abscess. When using nivolumab plus cabozantinib combination therapy for a tumor with bronchial invasion, physicians should be aware of bronchial perforation as the tumor shrinks. [ABSTRACT FROM AUTHOR]

Invasive bacterial disease is associated with significant morbidity and mortality. In winter 2022, there was an apparent increased rate of invasive bacterial disease compared to preceding years. Cross-site retrospective analysis of the three Children's Health Ireland (CHI) hospitals looking at children admitted between 1st October 2022–31st December 2022 (Q4) with community-acquired invasive bacterial disease, defined as an abscess in a normally sterile site in the head, neck and chest or isolation or PCR detection of Streptococcus pneumoniae, Neisseria meningitidis, Streptococcus pyogenes (Group A streptococcus) or Haemophilus influenzae from a normally sterile site. Case numbers were compared to Q4 in each of 2018–2021. Eighty-two children met the case definition in Q4 2022 vs 97 (Q4 2018–2021). In 2022, 42/82 (51%) were female, median age 3.75 years (1.5–8.25 years). Only 2 (2%) were immunosuppressed and 2 others (2%) had underlying neurodisability. Fifty (61%) were admitted on second or subsequent presentation to a healthcare setting. Fifty-six (68%) had an abscess in a sterile site. Bloodstream infection (positive blood culture or PCR: 24 (29%)) was the most common site of infection, followed by neck 22 (27%) and intracranial 12 (15%). Group A streptococcus (GAS) 27 (33%) was the most common organism isolated. Seven cases (9%) died in 2022 compared to 2 patients (2%) from 2018 to 2021 (p < 0.05). More children had Paediatric Overall Performance Category (POPC) scores > 1 in 2022 than 2018–2021 (p = 0.003). Conclusion: Invasive bacterial diseases increased in Q4 2022 with higher morbidity and mortality than in the preceding 4 years. Group A streptococcal infection was the most significant organism in 2022. What is known: • Invasive bacterial disease is the leading cause of childhood mortality globally. • There was an increase in cases of invasive Group A streptococcus infections reported in many countries (including Ireland) during the winter of 2022/23. What is new: • Head, neck and chest abscesses increased in Q4 of 2022 compared to the previous 4 years combined. • Invasive bacterial infections in Q4 of 2022 were associated with higher rates of mortality (9%), paediatric intensive care unit (PICU) admission (24%) and requirement for surgical drainage or intervention (67%) than in the preceding years. [ABSTRACT FROM AUTHOR]

Mucormycosis is an opportunistic infection caused by saprophytic fungi of the order Mucorales. This infection is seen mainly in immunocompromised people with diabetes but can be seen rarely in immunocompetent hosts. Recently, this disease is frequently seen in many patients who had suffered from COVID‑19. Among the different sites of mucormycosis, rhinocerebral mucormycosis is the most prevalent form, followed by cutaneous. Surgical debridement followed by antifungal therapy with amphotericin B and the control of the immunocompromised state is the recommended treatment. This case is an unusual presentation of mucormycosis involving the maxillary sinus and the cheek, presented without any nasal symptoms. [ABSTRACT FROM AUTHOR]

Introduction Perianal fistula and its recurrence is a challenging entity for surgeons. It is a well-establi1shed fact that magnetic resonance imaging (MRI) findings influence surgical procedures and reduce the rate of recurrence. In this study, we assessed the contrast-enhanced (CE) three dimensional T1 sequences [sampling perfection with application optimized contrast using different flip angle evolution (SPACE) and volumetric interpolated breath-hold examination (VIBE)] in a 3T MRI system to evaluate perianal fistulas and compared them with two-dimensional (2D) sequences. Materials and Methods Forty-four patients (mean age, 38.8 ± 15.3 [standard deviation]; 32 males, 12 females) with perianal fistula were included in this prospective study. The patients underwent conventional noncontrast, 2D sequences, diffusion-weighted imaging, followed by postcontrast, 2D T1 images in both axial and coronal planes, and 3D sequences at 3T. Acquisition times were recorded for each sequence. Each postcontrast sequence was evaluated in terms of image quality, presence of artifacts, fistula type, presence of an abscess, visibility, and number of internal orifices. The surgical findings were considered the gold standard. The imaging findings were compared with the surgical findings. Results In all three sequences, the fistula type and abscess were identified correctly in all patients. The sensitivity value for identification of ramifications utilizing CE 3D T1 VIBE sequence, CE 3D T1 SPACE, and CE 2D T1 images was 100, 86, and 36%, respectively. The number of internal orifices was identified by the CE 3D T1 VIBE and CE 3D T1 SPACE sequences in 100 and 92% of patients, respectively. CE 2D T1 images correctly identified internal orifices in 80% of patients. The overall scan time for each 3D sequence was shorter than for the combined postcontrast 2D sequences. Conclusion CE 3D T1 SPACE and CE 3D T1 VIBE sequences outperformed conventional CE 2D sequences in the evaluation of perianal fistulas in terms of visibility and the number of internal orifices with a shorter scanning time. Among the 3D sequences, CE 3D T1 VIBE is slightly superior to CE 3D T1 SPACE sequence. [ABSTRACT FROM AUTHOR]

This report describes the clinical presentation and progression of a Serratia marcescens‐associated subcutaneous abscess in a dog with hypothyroidism, hyperadrenocorticism and diabetes mellitus. The S. marcescens isolate was resistant to several antibiotics. Treatment with antibiotics and topical antiseptics was not successful. [ABSTRACT FROM AUTHOR]

Abscess of the corpus cavernosum is a rare condition. We describe the case of a 36-year-old male presenting with bilateral corpus cavernousm abscesses, on a background of distal shunt procedures for recurrent priapism, that was managed with a bilateral corporotomy and systemic antibiotic therapy. Level of Evidence: Level 4 [ABSTRACT FROM AUTHOR]

A wide variety of community- and hospital-associated infections of the central nervous system (CNS) may be encountered on the neurointensive care unit (NICU). Distinguishing between the potential infectious aetiologies and differentiating from non-infectious causes can be challenging. Specific elements of the history and establishing early the immune status and travel history of an individual with possible infection can guide targeted additional testing. Increasing prevalence of iatrogenic immunosuppression means that familiar pathogens can present atypically. In addition, epidemiology of pathogens is changing with rising antimicrobial resistance and autochthonous cases of previously travel-associated pathogens. [ABSTRACT FROM AUTHOR]

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Background: Although tuberculosis (TB) of the central nervous system is quite common, tuberculous pyogenic ventriculitis is not only rare; it is a devastating disease in an immunocompetent patient if left untreated. Case Description: We present the case of a 43-year-old man who underwent successful treatment for tuberculous pyogenic ventriculitis that presented with meningeal syndrome and loss of consciousness. Conclusion: Tuberculous pyogenic ventriculitis is a rare manifestation of intracranial tuberculous infection. Despite advances in imaging techniques, the diagnosis of intraventricular TB is essentially biological. [ABSTRACT FROM AUTHOR]

Background: Ventriculoperitoneal (VP) shunt placement is one of the most performed procedures in neurosurgery to treat various types of hydrocephalus (HC). Immediate or late postoperative complications may quite commonly occur, especially in immunosuppressed patients, who are predisposed to develop rare and difficult-to-treat conditions. Case Description: Herein, we report the case of a 41-year-old female patient with a prior history of acute myeloid leukemia, followed by a tetra-ventricular acute HC due to a spontaneous non-aneurysmal subarachnoid hemorrhage. After an urgent external ventricular drainage placement, she underwent careful testing of "shunt dependency," which ended with a VP shunt placement. After 2 months, she presented at the emergency department with worsening abdominal pain and fever. She underwent a computed tomography scan with contrast administration, which has shown abscesses in the abdominal cavity. An urgent surgical revision of the VP shunt and antibiotics administration followed this. After inflammatory markers normalization, due to the high risk of post-infective peritoneal adherence and consequent impairment of cerebrospinal fluid absorption, a ventriculoatrial shunt was considered the most appropriate solution. Conclusion: Abdominal abscesses are a rare but subtle complication after VP shunt placement. Their management depends on etiology, patient clinical characteristics, and manifestations. Prompt interventions have been shown to improve clinical outcomes and optimize quality of life in such delicate patients. [ABSTRACT FROM AUTHOR]

Introduction: Patients with brucellosis present with nonspecific symptoms originating from different organs. In this study, we aimed to investigate the symptoms related to the head and neck region in patients with brucellosis. Materials and Methods: The retrospective study analyzed 542 patients with a definitive diagnosis of brucellosis who were admitted to our hospital between January 2015 and April 2022 and received outpatient and/or inpatient care. Clinical symptoms localized t o the ear-nose-throat and head and neck regions were evaluated. Results: A neck mass was detected in 52 out of 542 patients included in the study. The prevalence of cervical lymphadenopathy and/or abscess was 9.6%. Only lymphadenopathy was present in 30 (57.7%) patients, while both neck abscess and lymphadenopathy were detected in 22 (42.3%) patients. No significant difference was found between the two groups with regard to treatment regimens . Mean duration of treatment was 30 ± 22.1 (range, 14-70) days in the lymphadenopathy group and was 22 ± 14.7 (range, 14-60) days in the abscess group. No significant difference was found between the two groups with regard to the length of time to clinical recov ery. Conclusion: Brucellosis affects many regions of the head and neck and c an have a variety of imaging manifestations that mimic benign and malignant lesions. The diagnosis of brucellosis should be considered in the first -line differential diagnosis conducted based on imaging features in patients residing in endemic regions. [ABSTRACT FROM AUTHOR]