Fatal Klebsiella pneumoniae Meningitis and Emphysematous Brain Abscess After Endoscopic Variceal Ligation in a Patient with Liver Cirrhosis and Diabetes Mellitus

Abstract Background: Patients with primary brain abscess often present with atypical symptoms, and the outcome is varied. We investigated the demographic, laboratory, and neuroimaging features of patients with brain abscess at our hospital and identified factors associated with their outcome.Methods: We retrospectively collected the data of patients diagnosed with primary brain abscess at our hospital between January 2011 and December 2020. Their clinical characteristics, predisposing factors, laboratory and neuroimaging findings, treatment, and outcome were analyzed. Results: Of the 57 patients diagnosed with primary abscess, 51 (89.47%) were older than 40 years and 42 (73.68%) were male. Only eight patients (14.04%) showed the classical triad of headache, fever, and focal neurological deficit. Fourteen patients (24.56%) had comorbidities, of which diabetes mellitus was the most common. Positive pus cultures were obtained in 46.15% of the patients, and gram-negative enteric bacteria were found in 33.33% of them, with Klebsiella pneumoniae being the most frequently observed. Surgical treatment, most commonly in the form of stereotactic drainage, was received by 54.39% of the patients. Good outcomes were achieved in 75.44% of the patients. Multivariate logistic regression analysis showed that patients with headache were more likely to have a poor outcome (odds ratio 6.010, 95% confidence interval 1.114–32.407, p = 0.037).Conclusions: Male patients and those older than 40 years were more susceptible to brain abscess than female patients and those younger than 40 years, respectively. Only a few patients showed the classical triad of clinical symptoms. Diabetes mellitus was the most common comorbidity. Positive pus culture results were uncommon, with gram-negative enteric bacteria, especially Klebsiella pneumoniae, being the main organisms found. Most patients had a good outcome, and the presence of headache may influence the outcome.

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Clinical characteristics and outcome of primary brain abscess: a retrospective analysis

BMC Infectious Diseases ◽

10.1186/s12879-021-06947-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Junying Huang ◽

Haining Wu ◽

Honghong Huang ◽

Weiqi Wu ◽

Bowen Wu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Klebsiella Pneumoniae ◽

Brain Abscess ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Multivariate Logistic Regression Analysis ◽

Enteric Bacteria ◽

Focal Neurological Deficit ◽

Gram Negative ◽

Classical Triad

Abstract Background Patients with primary brain abscess often present with atypical symptoms, and the outcome varies. We investigated the demographic, laboratory, and neuroimaging features of patients with brain abscess at our hospital and identified factors associated with their outcomes. Methods We retrospectively collected the data of patients diagnosed with primary brain abscess at our hospital between January 2011 and December 2020. Their clinical characteristics, predisposing factors, laboratory and neuroimaging findings, treatment, and outcome were analyzed. Results Of the 57 patients diagnosed with primary abscess, 51 (89.47%) were older than 40 years, and 42 (73.68%) were male. Only eight patients (14.04%) showed the classical triad of headache, fever, and focal neurological deficit. Fifteen patients (26.31%) had comorbidities, of which diabetes mellitus was the most common. Positive intracranial purulent material cultures were obtained in 46.15% of the patients, and gram-negative enteric bacteria were found in 33.33% of them, with Klebsiella pneumoniae being the most frequently observed. Surgical treatment, most commonly in the form of stereotactic drainage, was received by 54.39% of the patients. Good outcomes were achieved in 75.44% of the patients. Multivariate logistic regression analysis showed that patients with headaches were more likely to have a poor outcome (odds ratio 6.010, 95% confidence interval 1.114–32.407, p = 0.037). Conclusions Male patients and those older than 40 years were more susceptible to brain abscess than female patients and those younger than 40 years, respectively. Only a few patients showed the classical triad of clinical symptoms. Diabetes mellitus was the most common comorbidity. Positive intracranial specimens’ culture results were uncommon, with gram-negative enteric bacteria, especially Klebsiella pneumoniae, being the main organisms found. Most patients had a good outcome, and the presence of headache may influence the outcome.

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495 THE IMPACT OF DIABETES MELLITUS ON THE DEVELOPMENT OF HEPATOCELLULAR CARCINOMA AMONG PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS AND DIABETES MELLITUS

Journal of Hepatology ◽

10.1016/s0168-8278(11)60497-2 ◽

2011 ◽

Vol 54 ◽

pp. S202-S203

Author(s):

H.C. Kim ◽

E.Y. Cho ◽

J.Y. Lee ◽

T.H. Kim

Keyword(s):

Diabetes Mellitus ◽

Hepatocellular Carcinoma ◽

Liver Cirrhosis ◽

Alcoholic Liver Cirrhosis ◽

The Impact

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Factores relacionados con infecciones: pacientes quirúrgicos en ventilación mecánica con neumonía nosocomial

Revista Ciencia Multidisciplinaria CUNORI ◽

10.36314/cunori.v5i2.164 ◽

2021 ◽

Vol 5 (2) ◽

pp. 1-12

Author(s):

Wilfredo Medina Peña ◽

Douglas Ernesto Sánchez

Keyword(s):

Diabetes Mellitus ◽

Klebsiella Pneumoniae

OBJETIVO: presentar los factores más comunes relacionados con infecciones nosocomiales en pacientes ventilados y quirúrgicos. MÉTODO: Estudio descriptivo transversal. Se tomaron un total de 75 pacientes quirúrgicos sometidos a ventilación mecánica en unidad de cuidados intensivos de Hospital Roosevelt de marzo 2017 a abril 2018. RESULTADOS: El único factor que se asoció significativamente a la incidencia de infecciones nosocomiales en pacientes quirúrgicos con ventilación mecánica fue el tiempo prolongado de intubación (> 8 días, p = 0.002); sin embargo, la incidencia de infecciones nosocomiales fue mayor en pacientes con enfermedad respiratoria de base (100%) e insuficiencia renal (83.3%). Las características sobresalientes fueron sexo masculino (62.7%), y edad promedio de 43 años. Las patologías o condiciones clínicas observadas con mayor frecuencia fueron trauma craneoencefálico (58.7%), patología abdominal (41.3%), diabetes mellitus (32.0%) e hipertensión arterial (29.3%), obesidad (22.5%) y un promedio de 13 días de intubación. La frecuencia acumulada de infecciones nosocomiales asociadas a ventilación mecánica correspondió al 68.0% (neumonía nosocomial), y el microorganismo aislado con mayor frecuencia fue Klebsiella pneumoniae (66.2%). Se observó una importante tasa de mortalidad asociada a ventilación mecánica en pacientes quirúrgicos correspondiente al 42.7%. CONCLUSIÓN: Se concluye que la neumonía nosocomial y la muerte son eventos frecuentes en pacientes quirúrgicos con ventilación mecánica y a la vez no se identificaron predictores individuales de infección nosocomial.

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Psoas abscess and bacterial peritonitis caused by urinary tract infection in a patient of liver cirrhosis and diabetes mellitus

Clinical Journal of Gastroenterology ◽

10.1007/s12328-009-0073-0 ◽

2009 ◽

Vol 2 (3) ◽

pp. 242-245 ◽

Cited By ~ 1

Author(s):

Chiaki Kamikado ◽

Shuuhei Taguchi ◽

Tomomi Wakiyama ◽

Akira Nakamura ◽

Osamu Sawatani ◽

...

Keyword(s):

Diabetes Mellitus ◽

Urinary Tract Infection ◽

Liver Cirrhosis ◽

Urinary Tract ◽

Tract Infection ◽

Psoas Abscess ◽

Bacterial Peritonitis

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Non-Insulin-Dependent Diabetes mellitus and Liver Cirrhosis.

Frontiers in Diabetes - Molecular and Cell Biology of Type 2 Diabetes and Its Complications ◽

10.1159/000060908 ◽

1998 ◽

pp. 168-171

Author(s):

L. Gentile ◽

S. Turco ◽

E. Rossi ◽

R. Torella

Keyword(s):

Diabetes Mellitus ◽

Liver Cirrhosis ◽

Insulin Dependent Diabetes Mellitus ◽

Insulin Dependent Diabetes ◽

Dependent Diabetes Mellitus ◽

Insulin Dependent

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Endoscopic injection sclerotherapy improves liver function compared with endoscopic variceal ligation

Scientific Reports ◽

10.1038/s41598-021-99855-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tsuguru Hayashi ◽

Tatsuyuki Watanabe ◽

Michihiko Shibata ◽

Shinsuke Kumei ◽

Shinji Oe ◽

...

Keyword(s):

Liver Cirrhosis ◽

Liver Function ◽

Confidence Interval ◽

Linear Regression Analysis ◽

Meld Score ◽

Injection Sclerotherapy ◽

Endoscopic Variceal Ligation ◽

Endoscopic Injection Sclerotherapy ◽

Endoscopic Injection ◽

Liver Functions

AbstractLiver function is a most important prognostic factor in patients with liver cirrhosis. Also, portal hypertension is a fatal complication of liver cirrhosis and variceal treatment is indispensable. However, changes of liver functions after endoscopic variceal treatments are unknown. The aim of this study was to evaluate prognosis and liver functions after endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL). A total of liver cirrhotic 103 patients who underwent prophylactic EIS and EVL were enrolled. Overall survival rate was higher in EIS group than EVL group (p = 0.03). Multivariate analysis showed that EIS was a negative factor for death (HR: 0.46, 95% confidence interval: 0.24–0.88, p = 0.02). Liver functions were assessed by blood test taken at before and 3 months after treatment. In EIS group, albumin and prothrombin time improved (p < 0.01), leading to improvement of Child–Pugh score, ALBI score and MELD score (p < 0.05). However, these did not improve in EVL group. EIS was a significant factor related to the elevated value of albumin after treatment in linear regression analysis (estimated regression coefficient: 0.17, 95% confidence interval: 0.05–0.29, p = 0.005). These results revealed that EIS could improve liver functions and prognosis.

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Angina de Ludwig no paciente diabético: evidências da literatura

Research Society and Development ◽

10.33448/rsd-v9i8.6871 ◽

2020 ◽

Vol 9 (8) ◽

pp. e980986871

Author(s):

Lucas Nunes de Brito Silva ◽

Ingrid Torres de Almeida ◽

Matheus Corrêa da Silva ◽

Lucya Giselle Costa Moreira ◽

Eryck Canabarra Ávila ◽

...

Keyword(s):

Diabetes Mellitus ◽

Klebsiella Pneumoniae ◽

Ludwig’S Angina ◽

Ludwig's Angina

Introdução: Angina de Ludwig (AL) é uma infecção da cabeça e pescoço, potencialmente fatal, que acomete os espaços fáscias submandibulares, sublinguais e submentoniano. A diabetes mellitus (DM), por suas repercussões imunológicas e microvasculares, pode predispor a AL ou modificar a resposta do paciente a essa infecção. Objetivo: avaliar o impacto da diabetes melittus nos pacientes com AL. Metodologia Trata-se de uma revisão de literatura na qual foi proposta uma estratégia de busca que utilizou, como base de dados, o MEDLINE, acessado via PUBMED, limitada ao idioma inglês e a publicações do período de 1954 a 2020. Na pesquisa foram utilizados os seguintes descritores: “Ludwig’s angina” e “diabetes”. Incluíram-se relatos de caso e estudos observacionais que abordavam a angina de Ludwig em pacientes diabéticos. Resultados: foram encontrados 26 artigos e, após a leitura dos seus resumos, foram eliminados 12 artigos que não estabeleceram nenhuma relação entre AL e DM. Em relação ao tempo de internação hospitalar, os pacientes diagnosticados com hiperglicemia passam mais dias no hospital, devido a complicações e acompanhamento clínico. As bactérias do gênero Klebsiella pneumoniae foram encontradas em maior quantidade na cultura de pacientes diabéticos. A terapêutica medicamentosa mais utilizada empiricamente foi a associação entre amoxicilina, clavulanato de potássio e metronidazol. Conclusão: é possível observar que a Angina de Ludwig tem seu curso clínico modificado pela diabetes mellitus. As complicações envolvendo a associação DM e AL ocorrem tanto em pacientes diabéticos sem controle glicêmico, como naqueles diabéticos controlados, ainda que em menor grau.

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