scholarly journals Massive infected ascites in an immunocompetent patient with gastrointestinal tuberculosis

2019 ◽  
Vol 12 (8) ◽  
pp. e230794 ◽  
Author(s):  
Carmegie C Saliba ◽  
Isabelle Dominique Villegas Tomacruz ◽  
Mary Louise Margaret M Javier ◽  
Homer Co
Keyword(s):  
Immunocompetent Patient ◽  
The Philippines ◽  
Viable Option ◽  
Gastrointestinal Tuberculosis ◽  
Bacterial Peritonitis ◽  
Antituberculosis Therapy ◽  
Intravenous Antibiotics ◽  
Tuberculous Abscess ◽  
Large Volume Paracentesis ◽  
Seronegative Woman

Mycobacterium tuberculosisis highly endemic in the Philippines. The diagnosis is challenging with its non-specific presentation and the organism could extend to any of the organs. Interestingly, bacterial peritonitis arising spontaneously from gastrointestinal tuberculosis (TB) in an otherwise healthy, non-cirrhotic patient is quite unusual. In this paper, we discuss the case of a 27-year-old HIV-seronegative woman with massive intraperitoneal mixed bacterial and tuberculous abscess presenting 20 months after being diagnosed with bacteriologically confirmed gastrointestinal TB. Repeated large-volume paracentesis was done to drain out the infected ascites instead of inserting a percutaneously implanted catheter. Clinical improvement was noted and she was discharged after 12 days of intravenous antibiotics. She had completed 6 months of antituberculosis therapy and been well since then. The case has demonstrated that repeated paracentesis along with appropriate antibiotic regimen, may be a viable option for patients with TB and bacterial coinfected peritonitis. And possibly, peritoneal TB may increase the risk for (spontaneous) bacterial peritonitis.

scholarly journals Peritoneal Dialysis Zoonotic Bacterial Peritonitis with Staphylococcus pseudintermedius

2020 ◽  
Vol 10 (2) ◽  
pp. 65-70
Author(s):  
Layth Dahbour ◽  
Jeffrey Gibbs ◽  
Christian Coletta ◽  
Jeannine Hummell ◽  
Mohammad Al-Sarie ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Close Contact ◽  
Recurrent Infection ◽  
Antibiotic Sensitivity ◽  
Soft Tissue Infections ◽  
Staphylococcus Pseudintermedius ◽  
Bacterial Peritonitis ◽  
The Past ◽  
Intravenous Antibiotics ◽  
Human Infections

We present the first reported case of peritoneal dialysis-associated peritonitis caused by Staphylococcus pseudintermedius, an organism that had been misclassified as S. aureus in the past. S. pseudintermedius is well recognized in the veterinary literature and noted as flora in the mouth, nares, and anus of domesticated animals. It has been associated with soft tissue infections in pets and is now being reported in increased frequency as the causative agent in various human infections. It also has a different antibiotic sensitivity profile. The patient had close contact with her pet dog and was successfully treated with intravenous antibiotics in the hospital followed by oral doxycycline for 10 days after discharge. The patient has not had any recurrent infection after obtaining and applying appropriate hygienic education and precautions.

scholarly journals Abdominopelvic Tuberculosis Secondary to a Nontuberculous Mycobacterium in an Immunocompetent Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Beng Kwang Ng ◽  
Kembang Aziah Yakob ◽  
Wendy Yin Ling Ng ◽  
Pei Shan Lim ◽  
Rahana Abd Rahman ◽  
...  
Keyword(s):  
Abdominal Cavity ◽  
Cystic Teratoma ◽  
Foreign Worker ◽  
Exploratory Laparotomy ◽  
Immunocompetent Patient ◽  
Nontuberculous Mycobacterium ◽  
Diagnostic Dilemma ◽  
Common Location ◽  
Intravenous Antibiotics ◽  
History Of

Tuberculosis (TB) remained as one of the top 10 causes of death worldwide despite an overall decline in its incidence rate globally. Extrapulmonary TB is uncommon and only accounts for 10–20% of overall TB disease burden. Abdominopelvic TB is the sixth most common location of extrapulmonary TB. The symptoms and signs are often insidious and nonspecific. Diagnosing abdominopelvic TB can be very challenging at times and poses great difficulties to the clinician. Infection with nontuberculous Mycobacterium (NTM) is even rarer especially in an immunocompetent patient. We report a case of NTM in abdominopelvic TB. A 37-year-old foreign worker, para 3, presented with a one-week history of suprapubic pain associated with fever. An assessment showed presence of a right adnexal mass. She was treated as tuboovarian abscess with intravenous antibiotics. Unfortunately, she did not respond. She underwent exploratory laparotomy. Intraoperatively, features of the mass were suggestive of a right mature cystic teratoma with presence of slough and cheesy materials all over the abdominal cavity as well as presence of ascites. Diagnosis of NTM was confirmed with PCR testing using the peritoneal fluid. This case was a diagnostic dilemma due to the nonspecific clinical presentation. Management of such rare infection was revisited.

scholarly journals High Dose Oral Furosemide with Salt Ingestion in the Treatment of Refractory Ascites of Liver Cirrhosis

2016 ◽  
Vol 39 (6) ◽  
pp. 52 ◽  
Author(s):  
Tolga Yakar ◽  
Mehmet Demir ◽  
Ozlem Dogan ◽  
Alper Parlakgumus ◽  
Birol Ozer ◽  
...  
Keyword(s):  
Meld Score ◽  
Refractory Ascites ◽  
High Dose ◽  
Bacterial Peritonitis ◽  
Dose Oral ◽  
Group A ◽  
Large Volume Paracentesis ◽  
Group B ◽  
End Stage ◽  
A Prospective Study

Purpose: We aimed to evaluate and compare the efficacy and safety of high-dose furosemide+salt orally by comparing HSS+ furosemide (i.v.) and repeated paracentesis in patients with RA. Methods: This was a prospective study of 78 cirrhotic patients with RA, randomized into three groups: Group A (n= 25) i.v. furosemide (200-300 mg bid) and 3% hypotonic saline solution (HSS) (once or twice a day); Group B (n= 26) oral furosemide tablets (360-520 mg bid) and salt (2.5 g bid); and, Group C (n= 27) repeated large-volume-paracentesis (RLVP) with albumin infusion. Patients without hyperkalemia were administrated 100 mg of spironolactone/day. During the follow-up; INR, creatinine, and total bilirubin levels were measured to determine the change in MELD (model of end stage liver disease) score. Results: Hepatic encephalopathy (HE), severe episodes of spontaneous bacterial peritonitis (SBP) and pleural effusions (PE) occurred more frequently in Group C. Improvement in Child-Pugh and MELD score was better in Group A and B than Group C. In Group B, improvements were seen in the Child-Pugh and MELD score, reduction in body weight, duration and number of hospitalization. In Groups A and B, remarkable increases in diuresis were observed (706±116 to 2425±633 mL and 691±111 to 2405±772 mL) and serum sodium levels also improved. HE and SBP were occurred more often in group C (p

scholarly journals The Palliative Management of Refractory Cirrhotic Ascites Using the PleurX©Catheter

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Jason Reinglas ◽  
Kayvan Amjadi ◽  
Bill Petrcich ◽  
Franco Momoli ◽  
Thomas Shaw-Stiffel
Keyword(s):  
High Risk ◽  
Patency Rate ◽  
Spontaneous Bacterial Peritonitis ◽  
Treatment Options ◽  
Technical Success ◽  
Bacterial Peritonitis ◽  
Large Volume Paracentesis ◽  
Lost To Follow Up

Background. Treatment options are limited for patients with refractory cirrhotic ascites (RCA). As such, we assessed the safety and effectiveness of the PleurX catheter for RCA.Methods. A retrospective analysis was performed on all patients with RCA who have undergone insertion of the PleurX catheter between 2007 and 2014 at our clinic.Results. Thirty-three patients with RCA were included in the study; 4 patients were lost to follow-up. All patients were still symptomatic despite bimonthly large volume paracentesis and were not candidates for TIPS or PV shunt. Technical success was achieved in 100% of patients. The median duration the catheter remained in situ was 117.5 days, with 95% CI of 48–182 days. Drain patency was maintained in 90% of patients. Microorganisms consistent with spontaneous bacterial peritonitis (SBP) from a catheter source were isolated in 38% of patients. The median time to infection was 105 days, with 95% CI of 34–233 days. All patients were treated for SBP successfully with antibiotics.Conclusion. Use of the PleurX catheter for the management of RCA carries a high risk for infection when the catheter remains in situ for more than 3 months but has an excellent patency rate and did not result in significant renal injury.

scholarly journals Clinical implications of prompt ascitic drain removal among cirrhosis with refractory ascites

2021 ◽  
Author(s):  
YJ Wong ◽  
HM Lum ◽  
PT Tan ◽  
EK Teo ◽  
JY Tan ◽  
...  
Keyword(s):  
Ascitic Fluid ◽  
Alcoholic Cirrhosis ◽  
Meld Score ◽  
Refractory Ascites ◽  
Decompensated Cirrhosis ◽  
Resistant Organism ◽  
Bacterial Peritonitis ◽  
Drain Removal ◽  
Large Volume Paracentesis ◽  
End Stage

Introduction: Large-volume paracentesis (LVP) is the first-line treatment for decompensated cirrhosis with refractory ascites. While ascitic drain removal (ADR) within 72 hours was once considered safe, it was uncertain if ADR within 24 hours could further reduce the risk of ascitic drain-related bacterial peritonitis (AdBP). This study aimed to investigate the association between the timing of ADR and the presence of AdBP. Methods: All cirrhotics with refractory ascites who underwent LVP in our institution from 2014 to 2017 were studied. AdBP was diagnosed based on ascitic fluid neutrophil count ≥ 250 cells/mm3 or positive ascitic fluid culture following recent paracentesis within two weeks. Results: A total of 131 patients who underwent LVP were followed up for 1,806 patient-months. Their mean age was 68.3 ± 11.6 years, and 65.6% were male. Their mean Model for End-Stage Liver Disease (MELD) score was 15.2. The overall incidence of AdBP was 5.3%. ADR beyond 24 hours was significantly associated with longer median length of stay (five days vs. three days, p < 0.001), higher risk of AdBP (0% vs. 8.9%, p = 0.042) and AKI following LVP (odds ratio 20.0, 95% confidence interval 2.4–164.2, p = 0.021). Overall survival was similar in patients with ADR within and beyond 24 hours. Conclusion: ADR within 24 hours is associated with reduced risk of AdBP and AKI. As AdBP is associated with resistant organism and AKI, we recommend prompt ADR within 24 hours, especially among patients who have Child-Pugh C with alcoholic cirrhosis.

scholarly journals Intravenous Albumin in Patients With Cirrhosis: Evaluation of Practice Patterns and Secular Trends of Usage in Ontario 2000 to 2017

2020 ◽  
Author(s):  
David Mario Rodrigues ◽  
Maya Djerboua ◽  
Jennifer A Flemming
Keyword(s):  
Hospital Setting ◽  
Population Level ◽  
Evidence Based ◽  
Bacterial Peritonitis ◽  
Chart Abstraction ◽  
Type 1 Hepatorenal Syndrome ◽  
Large Volume Paracentesis ◽  
Rate Ratios ◽  
The Impact

Abstract Background Intravenous (IV) albumin has evidence-based indications in cirrhosis that are limited in most guidelines to spontaneous bacterial peritonitis (SBP), type 1 hepatorenal syndrome (HRS) and large volume paracentesis (LVP). This study aimed to describe the trends of IV albumin usage in patients with cirrhosis at the population level and evaluate indications for IV albumin in the hospital setting. Methods A retrospective study identified albumin infusions in health care data from Ontario, Canada between 2000 and 2017 in those with and without cirrhosis. Annual rates of IV albumin by cirrhosis status were calculated per 10,000 person-years (PY) and described using Poisson regression and rate ratios. Secondly, patients with cirrhosis receiving IV albumin while hospitalized at Kingston Health Sciences Centre (KHSC) in 2017 were identified and underwent detailed chart abstraction to determine the reason for IV albumin administration. Results The overall rate of provincial IV albumin usage doubled over the study period (2000: 8.4/10,000 PY versus 2017: 16.3/10,000 PY; rate ratio 1.94, 95% confidence interval 1.90 to 1.99, P &lt;0.001). The majority of albumin was used during hospitalization (88%) and 22% was used in patients with cirrhosis. At KHSC, there were134 admissions where a patient with cirrhosis received IV albumin. Of these, 49% of prescriptions were for evidence-based indications (LVP 30%, type 1 HRS 10%, SBP 10%), whereas other indications included non-HRS renal failure, hypovolemia and sepsis. Conclusion IV albumin use has doubled over two decades and is frequently used in hospitalized patients with cirrhosis with only 50% being prescribed for evidence-based indications. These results highlight the impact of cirrhosis on albumin use and highlight potential quality improvement opportunities.

Sa1595 The Safety of Diagnostic Large Volume Paracentesis in Patients With Spontaneous Bacterial Peritonitis

2016 ◽  
Vol 150 (4) ◽  
pp. S337
Author(s):  
Naemat Sandhu ◽  
Ramzi Mulki ◽  
Marvin Lu ◽  
Mary Rodriguez Ziccardi ◽  
Monil H. Patel ◽  
...  
Keyword(s):  
Large Volume ◽  
Spontaneous Bacterial Peritonitis ◽  
Bacterial Peritonitis ◽  
Large Volume Paracentesis

scholarly journals Isolated Mycobacterium Tuberculosis Tenosynovitis and Osteomyelitis of the Foot in an Immunocompetent Patient

2021 ◽  
Vol 8 (6) ◽  
Author(s):  
Elgazzar A ◽  
◽  
Cecchini A ◽  
Elmezayen RI ◽  
◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Delayed Diagnosis ◽  
Pulmonary Involvement ◽  
Immunocompetent Patient ◽  
Complete Healing ◽  
Radiological Findings ◽  
Intravenous Antibiotics ◽  
Healing Wounds ◽  
High Index Of Suspicion ◽  
Immunocompetent Patients

Tubercular osteomyelitis must be considered in the differential diagnosis of immunocompetent patients who present with non-healing wounds with underlying osteomyelitis. Clinical and radiological findings may be indistinguishable from typical bacteria osteomyelitis. A high index of suspicion may prevent delayed diagnosis, and early treatment may prevent subsequent complications. This is a case report of an immunocompetent patient who presented with a chronic non-healing foot wound complicated by abscess and osteomyelitis that did not improve with an appropriate course of intravenous antibiotics. Wound cultures subsequently grew Mycobacterium tuberculosis without evidence of pulmonary involvement. The patient was treated with an initial two-month regimen of rifampin, isoniazid, pyridoxine, pyrazinamide and ethambutol, followed by a tenmonth regimen of rifampin, isoniazid and pyridoxine. The patient experienced significant improvement and complete healing of the foot wound after approximately the first two months of therapy.

scholarly journals Paradoxical reactions during Antituberculosis therapy - A single-center prospective analysis

2015 ◽  
Vol 2 (2) ◽  
pp. 32-35
Author(s):  
Sanae Hammi ◽  
Naima Zimed ◽  
Khalid Bouti ◽  
Jamal Eddine Bourkadi
Keyword(s):  
Lymph Node ◽  
Infectious Diseases ◽  
Clinical Microbiology ◽  
Tuberculous Lymphadenitis ◽  
Paradoxical Reaction ◽  
Paradoxical Response ◽  
Antituberculosis Therapy ◽  
Tuberculous Abscess ◽  
Lymph Node Tuberculosis ◽  
Hiv Negative

[1] Hawkey CR, Yap T, Pereira J, Moore DA, Davidson RN, Pasvol G, et al. Characterization and management of paradoxical upgrading reactions in HIV-uninfected patients with lymph node tuberculosis. Clinical infectious diseases. 2005;40(9):1368-71. [2] Breton G. Syndrome inflammatoire de reconstitution immune (IRIS) associé à la tuberculose. Journal des Anti-infectieux. 2012;14(4):180-5. [3] Cheng V, Ho P, Lee R, Chan K, Woo P, Lau S, et al. Clinical spectrum of paradoxical deterioration during antituberculosis therapy in non-HIV-infected patients. European Journal of Clinical Microbiology and Infectious Diseases. 2002;21(11):803-9. [4] Al-Majed S. Study of paradoxical response to chemotherapy in tuberculous pleural effusion. Respiratory medicine. 1996;90(4):211-4. [5] Campbell I, Dyson A. Lymph node tuberculosis: a comparison of various methods of treatment. Tubercle. 1977;58(4):171-9. [6] Memish Z, Mah M, Mahmood SA, Bannatyne R, Khan M. Clinico‐diagnostic experience with tuberculous lymphadenitis in Saudi Arabia. Clinical microbiology and infection. 2000;6(3):137-41. [7] Choremis C, Padiatellis C, ZOU MLD, Yannakos D. Transitory exacerbation of fever and roentgenographic findings during treatment of tuberculosis in children. American review of tuberculosis. 1955;72(4):527. [8] Orlovic D, Smego J. Paradoxical tuberculous reactions in HIV-infected patients. The International Journal of Tuberculosis and Lung Disease. 2001;5(4):370-5. [9] Park I-S, Son D, Lee C, Park JE, Lee J-S, Cheong M-H, et al. Severe paradoxical reaction requiring tracheostomy in a human immunodeficiency virus (HIV)-negative patient with cervical lymph node tuberculosis. Yonsei medical journal. 2008;49(5):853-6. [10] Martinez V, Bricaire F. Réactions paradoxales. La Presse Médicale. 2006;35(1):1753-6. [11] Narita M, Ashkin D, Hollender ES, Pitchenik AE. Paradoxical worsening of tuberculosis following antiretroviral therapy in patients with AIDS. American journal of respiratory and critical care medicine. 1998;158(1):157-61. [12] Vidal CG, Garau J. Systemic steroid treatment of paradoxical upgrading reaction in patients with lymph node tuberculosis. Clinical infectious diseases. 2005;41(6):915-6. [13] Rakotoarivelo R, Vandenhende M-A, Michaux C, Morlat P, Bonnet F. Réactions paradoxales sous traitement antituberculeux chez des personnes non infectées par le VIH: quatre nouvelles observations et revue de la littérature. La Revue de médecine interne. 2013;34(4):202-8. [14] Cheng V, Yam W, Woo P, Lau S, Hung I, Wong S, et al. Risk factors for development of paradoxical response during antituberculosis therapy in HIV-negative patients. European Journal of Clinical Microbiology and Infectious Diseases. 2003;22(10):597-602. [15] Rao GP, Nadh BR, Hemaratnan A, Srinivas T, Reddy PK. Paradoxical progression of tuberculous lesions during chemotherapy of central nervous system tuberculosis: report of four cases. Journal of neurosurgery. 1995;83(2):359-62. [16] Fontanilla J-M, Barnes A, Von Reyn CF. Current diagnosis and management of peripheral tuberculous lymphadenitis. Clinical Infectious Diseases. 2011;53(6):555-62. [17] Guinchard A-C, Pasche P. Lymphadénite tuberculeuse cervicale et réaction paradoxale: diagnostic et traitement. ORL. 2012;356(34):1860-5. [18] Colebunders R, John L, Huyst V, Kambugu A, Scano F, Lynen L. Syndrome inflammatoire de reconstitution immunitaire de la tuberculose dans les pays à ressources limitées. Int J Tuberc Lung Dis. 2006;10(9):946-53. [19] Malone J, Paparello S, Rickman L, Wagner K, Monahan B, Oldfield E. Intracranial tuberculoma developing during therapy for tuberculous meningitis. Western Journal of Medicine. 1990;152(2):188. [20] Valdez LM, Schwab P, Okhuysen PC, Rakita RM. Paradoxical subcutaneous tuberculous abscess. Clinical infectious diseases. 1997;24(4):734-. [21] Bouchez B, Arnott G, Colover J. Paradoxical expansion of intracranial tuberculomas during chemotherapy. The Lancet. 1984;324(8400):470-1. [22] [Recommendations of the French Language Pneumology Society for tuberculosis management in France: consensus conference. Nice, France, 23 January 2004]. Revue des maladies respiratoires. 2004;21(3 Pt 2):S3-104. [23] Rabar D, Issartel B, Petiot P, Boibieux A, Chidiac C, Peyramond D. Tuberculomes et méningoradiculite tuberculeuse d’évolution paradoxale sous traitement. La Presse Médicale. 2005;34(1):32-4. [24] Chambers S, Record C, Hendrickse W, Rudge P, Smith H. Paradoxical expansion of intracranial tuberculomas during chemotherapy. The Lancet. 1984;324(8396):181-4. [25] Safdar A, Brown AE, Kraus DH, Malkin M. Paradoxical reaction syndrome complicating aural infection due to Mycobacterium tuberculosis during therapy. Clinical infectious diseases. 2000;30(3):625-7. [26] Hejazi N, Hassler W. Multiple intracranial tuberculomas with atypical response to tuberculostatic chemotherapy: literature review and a case report. Infection. 1997;25(4):233-9.

Sign in / Sign up

Export Citation Format

Share Document