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Pyomyositis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Pyomyositis is characterized by fever, swelling, tenderness and localized muscle pain, most often affecting the quadriceps or iliopsoas. In up to 20% of cases, multiple muscle groups are affected. Pyomyositis has three phases (see Table 4.54.1). Patients usually do not present in stage I because of the vague presentation, and when they do visit a doctor, they are often misdiagnosed as a muscle strain, contusion, cellulitis, haematoma, deep vein thrombophlebitis, osteomyelitis, septic arthritis or a soft tissue sarcoma. More than 90% of patients present in stage II or III, and in stage III, complications such as septic shock or septic emboli to other organs can be seen. Long-term sequelae are muscle scarring, residual weakness and functional impairment.
Encephalitis and Its Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Patients with bacterial endocarditis similarly can have CNS manifestations related more to involvement of the cerebral vasculature than of the brain itself. Signs and symptoms are typically non-specific—except when a septic embolism causes either a stroke or a mycotic aneurysm which ruptures. CSF examination can demonstrate minor abnormalities. Diagnosis can be quite challenging.
The cardiovascular system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Mary N Sheppard, C. Simon Herrington
Enterococci are now responsible for many cases of infective endocarditis and are more frequent than the viridans group in infections that follow urogenital and gastrointestinal tract surgery, and in drug addicts. In general, the disease is subacute in type but it may on occasion be more acute with septic emboli.
Lemierre’s syndrome in adulthood, a case report and systematic review
Published in Acta Clinica Belgica, 2021
Marco Moretti, Deborah De Geyter, Lode Goethal, Sabine D. Allard
The mean age of the patients in whom LS was diagnosed was 52.42 years old (±15.72). Only 33 studies expressed the medical history of the reported cases. The most frequent comorbidities were diabetes mellitus and history of ENT malignancies. The majority of the patients presented with clear signs of oropharyngeal or cervical infection. Approximately one-third of them had already an abscess or collections. Recent head or neck operation was present in 16% with more than half of them being dental intervention. Blood cultures were positive in 76.56%, the majority of them grew only one pathogen (Figure 5). Multiple pathogens were found in 13 of the positive blood cultures (20.31%), with 3 of them showing coexistence of aerobic and anaerobic species. Fusobacterium species were the most recurrent pathogen (Figure 6). Fusobacterium necrophorum was far more frequent than Fusobacterium nucleatum. Streptococcus species were the second most observed bacteria with Lancefield β-Hemolytic Group F being the predominant Streptococcus group. A large amount of cases experienced complications from metastatic septic emboli (36, 56.25%), mainly to the lungs (30, 46.88%) and the central nervous system (CNS) (7, 10.94%). Other sites affected by metastatic emboli were less frequently observed.
Diagnostic imaging in infective endocarditis: a contemporary perspective
Published in Expert Review of Anti-infective Therapy, 2020
Natalia E. Castillo Almeida, Pooja Gurram, Zerelda Esquer Garrigos, Maryam Mahmood, Larry M. Baddour, M. Rizwan Sohail
The utility of PET/CT in the diagnosis of CIED-IE has been based on findings from case reports and small cohorts [97]. In a small group of patients with CIED infection, for example, the sensitivity and specificity of PET/CT in patients with CIED-IE (n = 13) were 30.8% and 62.5%, respectively [98]. Inconsistent imaging protocols and data acquisition techniques are two of the significant weaknesses of PET/CT in the diagnosis of CIED-IE [96]. However, in patients with CIED where MRI is contraindicated, PET/CT is a potential diagnostic tool for the detection of septic emboli. For example, PET/CT identified 10 cases of septic emboli and four cases of spondylodiscitis [99]. Similar findings have been previously reported [100]. The sensitivity of embolism detection improves from 79% to 91% if a PET/CT is performed more than 6 days after the diagnosis of IE [101,102]. In a meta-analysis of 14 studies involving 492 patients, the pooled sensitivity of PET/CT for diagnosis of CIED infection was 83% and the pooled specificity was 89%. PET/CT demonstrated a higher sensitivity of 96% and specificity of 97% for the diagnosis of pocket infections. However, diagnostic accuracy for lead infections or CIED-IE was lower with pooled sensitivity of 76% and specificity of 83% (95% CI: 72–90) [103]. Therefore, a decision to obtain PET/CT should be individualized and based on the expected impact of its results on management decisions.
Impact of nuclear imaging on diagnosis and management of infective endocarditis
Published in Acta Cardiologica, 2020
Tom Bergmans, Pieter De Meester, Marie-Christine Herregods
Nuclear imaging was no standard of care in 2001, while in 2015 PET/CT was routinely planned in the work-up of IE. The reasons for not performing PET/CT in 2015 were urgent surgery and too long waiting time. Although there were almost no patients with PET in 2001, differences for result between 2001 and 2015 are PET alone versus PET-CT. It is well-known that CT improves the diagnostic accuracy and allows a more accurate localisation of the abnormal FDG-uptake. Moreover, before the introduction of the high-fat low-carbohydrate diet, suppression of the physiologic myocardial FDG-uptake was not guaranteed which makes evaluation of FDG-uptake at the level of the valves more difficult or even impossible. In 2015 whole-body (vertex to toe) acquisitions were performed which may be important to detect septic embolism at the lower extremities. Lastly, the difference in resolution and sensitivity between the systems may also explain the lower diagnostic yield of PET in early 2000.