Tropical pyomyositis - outcomes and clinical profile

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a common and fatal complication occurring in cirrhotic patients with ascites. It is defined as infected ascites in the absence of any recognisable secondary cause of infection. This study was undertaken to find out the rate of occurrence of SBP in patients of cirrhosis with ascites,to find out relative frequency of variants of ascitic fluid infection, to study clinical presentation and laboratory profile and to determine relationship between MELD score and the occurrence of SBP.Methods & Materials: This hospital based cross-sectional study was carried out in a tertiary care hospital in Nagpur after taking approval from Institute's Ethics Committee. 100 patients of cirrhosis with ascites irrespective of age and gender were enrolled after taking their written informed consent.. 20 ml of ascitic fluid was aspirated in heparinised disposable syringe; out of it 10 ml was immediately inoculated into blood culture bottle at bedside and sent for bacterial culture along with the remaining 10 ml for routine biochemical and cytological examination.Results: Majority of the patients were between 40-49 years of age, mean age of patients diagnosed as SBP was 42.51 years. Out of total 42 cases of SBP, classical SBP was present in 16(38.09%), Culture negative neutrocytic ascites in 14 (33.33%) , Bacterascites in 12 (28.57%) patients with SBP. Escherichia.coli was the most frequently cultured organism isolated in 15 cases (53.570%), followed by pseudomonas in 9 (32.14%), Klebsiella pnuemoniae in 3(10.71%) cases . The common mode of presentation of SBP was abdominal tenderness(65.38%) followed by hepatic encephalopathy(58.82%) associated with abdominal pain(50%) and fever (46.66%) , distention of abdomen (44.30%) hematemesis and malena(45%). Hyponatremia with a serum was found to be associated with severe complications. In (52.63%) patients of SBP ascitic fluid protein was less than 1 mg/dl . MELD score was found to be a reliable index of disease severity .Conclusion: SBP is a fatal complication of cirrhosis with ascites. It has heterogenous clinical presentation. Ascitic fluid should be analysed routinely in all cases of cirrhosis with ascites for the early detection of SBP.

Piomiositis tropical del músculo ilíaco, obturador interno, piriforme y psoas mayor en un paciente inmunocompetente con claudicación

“…Entre los principales factores de riesgo predisponentes se encuentra lesión muscular, inmunodeficiencia (ya sea primaria o secundaria), uso de drogas intravenosas, infecciones como VIH, deficiencias nutricionales, diabetes mellitus, enfermedades hematológicas/oncológicas, enfermedades hepáticas, insuficiencia renal, enfermedad pulmonar crónica o enfermedades de tejido conectivo. 7,8,9,10,11,12 En nuestro paciente no logramos identificar un factor de riesgo claro, a pesar de presentar el antecedente de la fractura, es un antecedente de tres años y en fémur derecho. Sin embargo, el absceso dental podría estar involucrado en el desarrollo de la patología.…”