Use of PET-CT in diagnostic workup of periprosthetic infection of hip and knee joints: significance in detecting additional infectious focus

Introduction The diagnosis and management of periprosthetic knee and hip infections as well as the identification and management of possible additional infectious foci is of great importance for successful therapy. This study analyses the importance of 18F deoxyglucose PET-CT (PET-CT) in the identification of additional infectious focus and subsequent impact on management of periprosthetic infection (PPI). Material and methods A retrospective analysis of the clinical data and findings in the period from January 2008 to December 2018 was carried out. One hundred and four patients with in-hospital treatment due to PPI of a hip or knee joint were identified and included in this study. All patients underwent a standardized clinical examination and further surgical and antibiotic therapy. The reevaluation of performed PET-CTs was specifically carried out with regard to the local PPI or detection of secondary foci. Results PET-CT successfully verified the PPI in 84.2% of the patients. A total of 78 possible additional foci were detected in PET-CT in 56 (53.8%) of the examined patients. Predilection sites for possible secondary foci were joints (42.3%), pulmonary (15.4%), ear-nose-throat (15.4%), spine (11.5%), and the musculocutaneous tissues (11.5%). Fifty-four positive PET-CT findings were confirmed clinically with need of additional adequate treatment. Conclusion PET-CT is a valuable diagnostic tool to confirm periprosthetic joint infection. At the same time, the whole-body PET/CT may detect additional foci of infection with impact on subsequent treatment strategy. PET was of special value in detecting infections at distant locations far from the primary infected joint in significant number. These distant infection locations can be potential cause of a re-infection. This clearly reflects the need of their diagnosis.

Eye damage due to dental disease

Recently, a lot of space has been given in the literature to the question of oral sepsis; the possibility of disease of any organ and in particular the eye in the presence of an infectious focus of dental origin is considered established by experimental work and clinical observations.

Combined interventional method of air-plasma flow and exogenous nitric oxide for the debridement of intracardiac infectious sites

Prosthetic valve endocarditis is a clinically severe pathology, which, unless timely treated, rapidly leads to the development of heart failure. The severity of the disease is caused by the fact that the microorganisms and toxins bypass biological barriers and constantly enter the bloodstream, which subsequently results in sepsis with the development of systemic embolism and multiple organ failure. The conservative antibiotic therapy is often ineffective due to the location of the infectious focus in the avascular zone. The operations for prosthetic infectious valve endocarditis are technically challenging and require high qualifications of the operating surgeon. The article presents a clinical case of surgical treatment for infectious prosthetic endocarditis of the aortic valve. The combined treatment with air-plasma flow and exogenous nitric oxide (NO) using the Plazon device without any antiseptic solutions was used as a method for the debridement of infectious site.

The opportunities of third-generation cephalosporin usage in outpatient surgery

The adherence to the principles of rational antibacterial therapy is of great significance, namely the prescription of a medication to achieve the quickest possible clinical and bacteriologic convalescence, the spectrum of mechanisms of a drug should affect possible germ, overcome the possible mechanisms of resistance and make the highest concentration in infectious focus. Moreover, the prescribed drug should be convenient for outpatient usage. The important principle of infection treatment is a de-escalation therapy that provides clinical and economic benefits both for a patient and health facility. The usage of the antibiotic cefdinir is effective and safe in hospital and outpatient treatment.

Leukocytes Ratios in Feline Systemic Inflammatory Response Syndrome and Sepsis: A Retrospective Analysis of 209 Cases

Sepsis is a challenging condition in which hematological prognostic and diagnostic markers in cats are limited. The aims of this study were to test if there are any differences in leukocyte ratios (NLR, BLR and BNLR) between healthy, SIRS and septic cats (sick cats), and if, within sick cats, NLR, BLR and BNLR may be prognostic markers. A retrospective medical database study included 76 healthy cats (blood-donors), 54 SIRS and 79 septic cats. SIRS group was defined if cats fulfilled SIRS criteria. Sepsis was confirmed with an infectious focus on cytology or a positive culture for bacterial infection. Leukocyte ratios were compared among the three study groups and between survivors and non-survivors in sick cats. NLR resulted significantly higher in the sick group compared to healthy cats (p < 0.0001), although NLR was not different between SIRS and sepsis. An NLR > 4.53 had a sensitivity of 76% and a specificity of 93.4% to detect SIRS/sepsis (OR 44.8 95%CI 17–107). Only BLR and BNLR were significantly different between SIRS and sepsis. NLR was associated with mortality in the sick group (p = 0.04). Although NLR resulted higher in sick cats than healthy, BLR and BNLR demonstrated as promising tools in differentiating SIRS from sepsis. NLR was associated with mortality in sick cats.

Polymicrobial Infection as a Rare Cause of Osteomyelitis: Case Presentation and Review of the Literature

This case report presents a 48-year-old patient with suspicion for chronic osteomyelitis caused by oral pathogens including species of Actinomyces, Eikenella and Stenotrophomonas. The symptoms included progressive swelling of the right thigh and hyperpyrexia with up to 41°C. Imaging methods included standard X-ray as well as MRI. Furthermore, two operations were necessary for surgical infection therapy. Histological and microbiological investigations of intraoperative samples showed polymicrobial osteomyelitis. Since local trauma could be excluded as the cause for the disease, the patient’s dental status was evaluated and proved as the possible infectious focus with a hematogenous spread. The patient was treated with intravenous antibiotics for two weeks and oral antibiotics for four further weeks. The patient’s clinical condition drastically improved with that treatment.

Automation of Infectious Focus Assay for Determination of Filovirus Titers and Direct Comparison to Plaque and TCID50 Assays

Ongoing efforts to develop effective therapies against filoviruses rely, to different extents, on quantifying the amount of viable virus in samples by plaque, TCID50, and focus assays. Unfortunately, these techniques have inherent variance, and laboratory-specific preferences make direct comparison of data difficult. Additionally, human errors such as operator errors and subjective bias can further compound the differences in outcomes. To overcome these biases, we developed a computer-based automated image-processing method for a focus assay based on the open-source CellProfiler software platform, which enables high-throughput screening of many treatment samples at one time. We compared virus titers calculated using this platform to plaque and TCID50 assays using common stocks of virus for 3 major Filovirus species, Zaire ebolavirus, Sudan ebolavirus, and Marburg marburgvirus with each assay performed by multiple operators on multiple days. We show that plaque assays give comparable findings that differ by less than 3-fold. Focus-forming unit (FFU) and TCID50 assays differ by 10-fold or less from the plaque assays due a higher (FFU) and lower (TCID50) sensitivity. However, reproducibility and accuracy of each assay differs significantly with Neutral Red Agarose Overlay plaque assays and TCID50 with the lowest reproducibility due to subjective analysis and operator error. Both crystal violet methylcellulose overlay plaque assay and focus assays perform best for accuracy and the focus assay performs best for speed and throughput.

Infectious Pseudoaneurysm of the Internal Carotid Artery in a Child Secondary to Parapharyngeal Abscess

Infectious pseudoaneurysm is a rare condition characterized by arterial wall dilation, usually due to an adjacent infectious focus. We present an 8-year-old male with a 3-day history of progressive, severe headache 2 weeks after treatment for a parapharyngeal abscess. Computed tomography revealed a left internal carotid artery (ICA) pseudoaneurysm inferior to the skull base and a small parapharyngeal abscess inferior to the pseudoaneurysm. The patient was admitted for intravenous antibiotic treatment and underwent transfemoral endovascular coil occlusion of the cervical ICA pseudoaneurysm without complications. We discuss the presentation and management of rare vascular complications of parapharyngeal abscesses involving major arteries of the neck and the role of neurointerventional embolization in these cases.

ILIOPSOAS ABSCESS: A CASE REPORT

Iliopsoas Abscess (IA) is a rare condition that predominantly affects young adults. It is a purulent collection that forms inside the iliopsoas muscle for several reasons. The primary form is due to hematogenous or lymphatic dissemination and the secondary form is the direct expansion of an infectious focus near the iliopsoas muscle. It is an insidious disease with a dragged clinical course, presenting with fever, thigh pain associated with abdominal and/or lower back pain, and there may be limitation of movements in the hip joint. The aim of this study is to demonstrate a case of IA in a 32-year-old female patient, admitted to the Palmas General Public Hospital (HGPP). After treatment, the patient evolved with symptomatic improvement and good clinical outcome.

Factors associated with mortality in Infections caused by Carbapenem-resistant Enterobacteriaceae

Introduction: There is little information about weigh of factors possibly associated with mortality, in infections caused by Carbapenem-resistant Enterobacteriaceae (CRE) in Latin America. Methodology: A case-controls study nested in a historical cohort was performed including all patients with CRE infections diagnosed between June 2013 and December 2018 at Hospital Universitario San Ignacio in Bogotá, Colombia. Univariate and multivariate analysis were performed to compare cases of mortality within the first month after the infection diagnosis with surviving patients. Results: A total of 131 patients were included. The overall 30-day mortality rate was 38.17%. In the multivariate analysis, a direct association was found between mortality and septic shock (OR 26.7 CI6.6-107.3 p < 0.01), post-chemotherapy febrile neutropenia (OR 3.3 CI1.06–10.8 p = 0.04) and Charlson Index ≥ 3 (OR 5.5 CI 1.5-20.06 p < 0.01). An inverse association was found with interventions to control the infectious focus (OR 0.3 CI0.1-0.7 p < 0.01). The MIC of different antibiotics and the use of combined antibiotic therapy (triple therapy vs. double therapy or monotherapy) were not associated with mortality. Conclusions: In patients with CRE infections, septic shock, a Charlson comorbidity index ≥ 3, and post-chemotherapy febrile neutropenia are independently related to an increase in mortality. The control of the infectious focus is a protective factor. A rapid identification of these patients, and the implementation of measures to control infectious focus and to detect CRE colonization in patients who are going to be taken to myelosuppressive chemotherapy could impact positively the prognosis of these patients.