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While remaining a major problem in hospitals, Staphylococcus aureus is now spreading in communities. Strain MW2 (USA400 lineage) and other community methicillin-resistant S. aureus strains most commonly cause skin infections with abscess formation. Multidrug resistance (MDR) efltux pumps contribute to antimicrobial resistance but may also contribute to bacterial survival by removal of environmental toxins. In S. aureus, NorA, NorB, NorC, and Tet38 are chromosomally encoded efflux pumps whose overexpression can confer MDR to quinolones and other compounds (Nor pumps) or tetracyelines alone (Tet38), but the natural substrates of these pumps are not known. To determine the role of these efflux pumps in a natural environment in the absence of antibiotics, we used strain MW2 in a mouse subcutaneous abscess model and compared pump gene expression as determined by reverse transcription-PCR in the abscesses and in vitro, norB and tet38 were selectively upregulated in vivo more than 171- and 24-fold, respectively, whereas norA and norC were down-regulated. These changes were associated with an increase in expression of mgrA, which encodes a transcriptional regulator known to affect pump gene expression. In competition experiments using equal inocula of a norB or tet38 mutant and parent strain MW2, each mutant exhibited growth defects of about two- to threefold in vivo. In complementation experiments, a single-copy insertion of norB (but not a single-copy insertion of tet38) in the attB site within geh restored the growth fitness of the norB mutant in vivo. Our findings indicate that some MDR pumps, like NorB, can facilitate bacterial survival when they are overexpressed in a staphylococcal abscess and may contribute to the relative resistance of abscesses to antimicrobial therapy, thus linking bacterial fitness and resistance in vivo.

A case study of a 58-year old woman with fever and neck pain is discussed to better understand the causes and symptoms of spinal epidural abscess. The diagnosis and treatment suggested were also discussed.

Infection caused by the fungus Cryptococcus (C.) neoformans may result in a prostatic abscess. A prostatic abscess is the collection of pus within tissues of the prostate gland. A 55-year-old man was hospitalized because of a persistent urinary tract infection. He had painful urinations, urinary frequency and urinary hesitancy and he developed fatigue and nausea. He had a history of long-term use of suppressive therapy and was taking prednisone, cyclosporine, azathioprine, ampicillin, ranitidine, nicardipine, quinine sulfate and furosemide. On physical examination, his prostate was enlarged, irregular, slightly tender and draining pus. An ultrasonographic study of the prostate revealed a mass in the right lobe. Examination of prostate tissue removed during surgical resection of the gland showed severe inflammation and a blood sample showed evidence of C. neoformans infection. He improved greatly after the operation and with fluconazole therapy.

Anaerobic bacteria appear to play a role in abscesses of the kidney and surrounding tissues in children. An abscess is an accumulation of pus buried in the tissues or organs. A physician analyzed pus samples from six children with abscesses of surrounding tissues and four children with kidney abscesses to evaluate the microbiology of abscesses in children. The analyses identified 20 organisms, eight of which were aerobic bacteria and 12 of which were anaerobic bacteria. Seven organisms were of the Bacteroides fragilis group, four were Escherichia coli and two were Staphylococcus aureus. Anaerobic bacteria were more commonly isolated in abscess of the surrounding kidney tissues in children with previous abdominal surgery and kidney transplants. Anaerobic bacteria was also common in kidney abscesses related to malignant cancers, local kidney infections and oral infections., Objective. To investigate the aerobic and anaerobic microbiology of renal abscesses in children. Patients and methods. Aspirates from six children with perinephric and four with renal abscess were cultured for aerobic and anaerobic bacteria. Results. A total of 20 organisms were recovered, 8 aerobic or facultative bacteria and 12 anaerobic bacteria. Aerobic or facultative bacteria only were recovered in one patient, anaerobic bacteria only in two, and mixed aerobic and anaerobic bacteria in seven. Anaerobic bacteria were isolated in perinephric abscesses that were associated with previous abdominal surgery and renal transplant and in renal abscesses that were related to malignancy, pyelonephritis, and orodental infection. Conclusion. This study highlights the importance of anaerobic bacteria in perinephric and renal abscesses in children. Pediatrics 1994;93:261-264; abscess, renal, perinephric, Bacteroides fragilis, anaerobic bacteria, Staphylococcus aureus.

The case report is presented of a 48-year-old woman who visited an emergency room because she was virtually unable to open her mouth (trismus) and experienced a deep ache on the right side of her face. This occurred two weeks after the patient received local dental anesthesia prior to receiving two fillings on the right upper and lower jaws, respectively. Three days after the dental procedure, jaw stiffness and pain had started, and the patient's dentist prescribed ibuprofen (an anti-inflammatory, analgesic drug) and moist heat. A few days later, with intensification of symptoms, the patient consulted a physician, who eventually referred her to the emergency ward. Signs of bacterial infection were noted, and tests revealed the presence of an infection and abscess in the right lateral pharyngeal space (an area behind the mucosa at the back of the throat). The abscess was surgically drained and the material removed evaluated. Several bacterial agents were identified, which dictated the choice of antibiotic therapy for the patient. After 10 days, the patient was discharged with instructions to continue taking antibiotics. Mouth-opening exercises were also suggested. It is likely that the abscess and trismus developed as a consequence of the injection of local anesthesia prior to filling the patient's teeth. The important diagnostic signs for identifying such complications are reviewed. One cause of such infections is contamination of the injection needle with bacteria. These infections are potentially serious. (Consumer Summary produced by Reliance Medical Information, Inc.)

A 16-year-old boy from Bombay, India had suffered repeated seizures and was admitted to the hospital. A computed tomographic (CT) scan showed swelling and a mass in the left frontal region of the brain. The three most common conditions which could cause lesions in the brain of a child from India are tumor, tuberculoma (a tumor-like mass in the brain caused by Mycobacterium tuberculosis, which causes tuberculosis), and cysticercosis (caused by tape worms). The clinical features did not indicate diagnosis of a cerebral glioma, a type of tumor which occurs in children and causes seizures. It was thought that the mass was a tuberculoma as tuberculosis is endemic in Bombay and the clinical features were compatible with the diagnosis of tuberculoma without manifestations outside the brain. The patient had been vaccinated against tuberculosis in childhood, but vaccination is not an assurance that the disease will not develop later in life. However, the patient was given drugs for the treatment of tuberculosis and still had the seizures. Cysticercosis was still a possible diagnosis. Abscesses caused by infectious agents such as bacteria, fungi and protozoa, or parasites were also considered. A brain biopsy was performed and examination of the tissue revealed that the patient had cysticercosis, which was manifested as a granulomatous abscess in the brain. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidney presenting as an inflammatory mass without frank abscess formation, which may represent a relatively early stage [...]

Byline: A. Skoutelis (1), M. Marangos (1), T. Petsas (2), I. Chionis (3), G. Barbalias (3), H. Bassaris (1) Keywords: Key Words Epididymitis; Tuberculous; Complications; Psoas abscess; Addison's disease Abstract: Tuberculous epididymitis is a rare entity associated with minor complications. We present two cases of tuberculous epididymitis associated with serious complications (bilateral psoas abscesses and Addison's disease with psoas abscess). A review of the literature disclosed six additional cases associated with serious complications (Addison's disease, inappropriate antidiuretic hormone secretion, central nervous system involvement) which are discussed and compared to these cases. We conclude that tuberculous epididymitis represents a grave sequela of genital tract involvement and may be associated with serious and even fatal complications. Author Affiliation: (1) Section of Infectious Diseases, Dept. of Medicine, Patras University Medical School, University Hospital, GR-26500 Rio, Patra, Greece Phone: +30-61-999737, Fax: +30-61-999740, e-mail: skout@med.upatras.gr, GR (2) Dept. of Radiology, Patras University Medical School, University Hospital, GR-26500 Rio, Patra, Greece, GR (3) Dept. of Urology, Patras University Medical School, University Hospital, GR-26500 Rio, Patra, Greece, GR Article note: Received: October 20, 1999 * Revision accepted: February 23, 2000

Crohn's disease is an inflammatory condition characterized by accumulations of granular white blood cells into masses called granulomas. The granulomatous inflammation in Crohn's disease generally affects the intestines, but virtually all systemic organs may be involved. The cause of Crohn's disease is not known. The authors report the unusual case of an 18-year-old boy who developed meningitis as a result of Crohn's disease. The patient had developed severe back pain and urinary incontinence, generally suggestive of a problem in the sacral spine, or lowest portion of the spinal cord. CT scan revealed the presence of abscesses in the region of the cauda equina. (The cauda equina is the bundle of nerves leaving the sacral spinal cord and continuing to travel towards the abdomen and legs; it has the appearance of a horse's tail.) The patient underwent the surgical removal of a portion of the colon damaged by Crohn's disease, and some abscesses were drained at the same time. He appeared to be recovering normally, but on the 8th postoperative day he developed a severe headache; further examination suggested a diagnosis of meningitis (inflammation of the membrane of the brain and spinal cord). Magnetic resonance imaging and myelography revealed the presence of a cyst near the first sacral vertebra. In addition, a gastrointestinal fistula was discovered. (A fistula is an abnormal communication between two organs.) In this case, the gastrointestinal fistula permitted bacteria from the gastrointestinal tract to enter the cyst near the cauda equina. Material aspirated from the cyst revealed that it indeed contained bacteria that were representative of the species normally seen in the digestive tract. The patient's meningitis responded to antibiotic therapy. Further neurosurgery removed the cyst and corrected the fistula; the patient soon recovered and regained his self-sufficiency. (Consumer Summary produced by Reliance Medical Information, Inc.)

The number of patients treated for a soft tissue infection at San Francisco General Hospital increased over 100% between 1996 and 2000. These infections are commonly caused by injection drug abuse, and occur in as many as one-third of all intravenous drug addicts.

Multiple complications of varicella have been described. Musculoskeletal complications (osteomyelitis, septic arthritis, and necrotizing fasciitis) as well as neurologic complications (ataxia, encephalitis, and transverse myelitis) are well-known. We describe the cases of 2 children, ages 18 months and 5 years, who were admitted recently to 2 pediatric hospitals in Montreal with a resolving varicella, abdominal and lumbar pain, and a refusal to walk and in whom a diagnosis of epidural abscess caused by group A streptococcus (GAS) was established. No previous case of epidural abscess caused by GAS in the context of varicella has been reported. Epidural abscesses are rare in pediatrics and are caused mainly by hematogenous spread of Staphylococcus aureus. The diagnosis in pediatrics is challenging because it is rare and does not present as classically as in adults. The prognosis is related to the presence of neurologic deficits before surgery and to the rapidity with which the diagnosis and the intervention are made. These cases highlight a new clinical association in children of epidural abscess caused by GAS and varicella. An early clinical diagnosis requires a high index of suspicion when back or abdominal pain with or without neurologic signs and symptoms occurs during or soon after varicella. Pediatrics 2002;109(1). URL: http://www. pediatrics.org/cgi/content/full/109/1/e14; varicella, spinal epidural abscess, group A streptococcus.

In an unusual case, a 56-year-old woman was found to have a pericardial abscess which was linked to an infection of the mitral valve. Blood cultures had revealed the presence of Staphylococcus aureus. After admission to the coronary care unit the woman rapidly developed hypotension and atrial fibrillation, and soon died. An autopsy revealed a vegetative infection on the mitral valve and a subepicardial abscess (i.e. under the serous layer of the pericardium on the surface of the heart). While it is not rare for an abscess and mitral valve vegetation to be found within the same heart, in this case the two were connected, and it was clear that the infection travelled through a sinus tract to the pericardium. The pericardium is affected in roughly 20 percent of cases of endocarditis. However, this is the first case in which a sinus tract has been observed connecting the infected valve and the abscess. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fifty-four cases of abscesses infected with Mycobacterium abscessus illustrate the danger of using alternative health products not approved by the FDA. Fifty-two infections were associated with one doctor in Denver who injected each patient with adrenal cortex extract to induce weight loss. The product had not received FDA approval. All of the patients developed an abscess at the site of injection and more than one-third required surgical treatment. Mycobacterium abscessus is a common bacterium that can cause infection following puncture wounds. It can be treated with antibiotics.