amoxicillin-potassium-clavulanate-combination and Splenic-Diseases

Melioidosis caused by Burkholderia pseudomellei is an infection with protean clinical manifestations. Guillain-Barré syndrome [GBS] associated with melioidosis is very rare.. A 42-year-old woman with diabetes presented with abdominal pain, vomiting and intermittent fever for one month. Six months before presentation she had recurrent skin abscesses. Three months before presentation she had multiple liver abscesses which were aspirated in a local hospital. The aspirate grew "coliforms" resistant to gentamicin and sensitive to ceftazidime. On presentation she had high fever and tender hepatomegaly. Ultra Sound Scan of abdomen showed multiple liver and splenic abscesses. Based on the suggestive history and sensitivity pattern of the previous growth melioidosis was suspected and high dose meropenem was started. Antibodies to melioidin were raised at a titre of 1:10240. The growth from the aspirate of liver abscess was confirmed as Burkholderia pseudomellei by polymerase chain reaction [PCR]. After a week of treatment, patient developed bilateral lower limb weakness. Deep tendon reflexes were absent. There was no sensory loss or bladder/bowel involvement. Analysis of the cerebro-spinal fluid showed elevated proteins with no cells. There was severe peripheral neuropathy with axonal degeneration. A diagnosis of GBS was made and she was treated with plasmapharesis with marked improvement of neurological deficit. Continuation of intravenous antibiotics lead to further clinical improvement with normalization of inflammatory markers and resolution of liver and splenic abscess. Eradication therapy with oral co-trimoxazole and co-amoxyclav was started on the seventh week. Patient was discharged to outpatient clinic with a plan to continue combination of oral antibiotics for 12 weeks. At the end of 12 weeks she was well with complete neurological resolution and no evidence of a relapse.. Guillaine Barre syndrome is a rare complication of melioidosis and should be suspected in a patient with melioidosis who develop lower limb weakness. Plasmapharesis can be successfully used to treat GBS associated with active melioidosis.

Topics: Abdominal Pain; Administration, Oral; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Burkholderia pseudomallei; Ceftazidime; Drug Resistance, Bacterial; Female; Gentamicins; Guillain-Barre Syndrome; Humans; Injections, Intravenous; Liver Abscess; Melioidosis; Meropenem; Peripheral Nervous System Diseases; Polymerase Chain Reaction; Splenic Diseases; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of melioidosis with splenic abscesses caused by Burkholderia pseudomallei in an urban-dwelling, 54-year-old Taiwanese man. The patient presented with prolonged fever and abdominal pain. A splenectomy was performed, followed by successful treatment with ceftazidime and amoxicillin-clavulanate. The patient recovered fully.

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Asian People; Burkholderia pseudomallei; Ceftazidime; Humans; Male; Melioidosis; Splenectomy; Splenic Diseases; Treatment Outcome

Splenic abscess as a presentation of a Salmonella infection is described in children and adults. A combination of antibiotics and splenectomy is the standard treatment. We report a 12-year-old girl admitted to the hospital with fever, abdominal pain, and anorexia. White blood cell count was 17,900/microL and C-reactive protein level was 230 mg/L; abdominal ultrasound and abdominal computed tomographic (CT) scan showed a splenic abscess of 11.3 x 12.9 x 13.8 cm in the upper part of the spleen. She was treated with percutaneous drainage and antibiotics for 8 days. A week later, she represented with a recurrent abscess and identical symptoms. She was treated with percutaneous drainage and intravenous (i.v.) antibiotics for 21 days followed by oral therapy for another 2 weeks. Abscess culture grew Salmonella type B. Because of a persistent abscess on CT scan, she underwent a partial laparoscopic splenectomy with radiofrequency ablation to preserve functional splenic tissue. The operative and postoperative course was uneventful. Pathologic finding showed an inflammatory cystic reaction without epithelial cell lining. Splenic abscess in children is a rare condition. Long-term antibiotic therapy is needed. Percutaneous drainage can be a temporary solution, but (partial) splenectomy is the final treatment in most cases.

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Catheter Ablation; Child; Drainage; Female; Humans; Laparoscopy; Salmonella Infections; Splenectomy; Splenic Diseases; Ultrasonic Therapy

We present the case of a 51-y-old male with multiple splenic abscesses that failed to resolve despite antimicrobial therapy targeted at Burkholderia pseudomallei. Elective splenectomy was performed to clarify the diagnosis. Pus from the spleen was subjected to universal bacterial 16S rDNA amplification and sequencing. The sequence obtained was 99% identical to 16S rDNA sequences for Burkholderia pseudomallei. Sequencing of the 16S rDNA is a very promising diagnostic tool allowing quick identification of Burkholderia pseudomallei directly from clinical specimen.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Burkholderia pseudomallei; Ceftazidime; Humans; Male; Melioidosis; Middle Aged; RNA, Bacterial; RNA, Ribosomal, 16S; Splenic Diseases

Abscess formation in chronic pancreatitis is rare and the pancreas and liver are the most frequent localizations. We present a novel case of splenic abscess in chronic pancreatitis that led to diabetic ketoacidosis in an alcoholic patient. Percutaneous drainage and antibiotic treatment sufficed to resolve completely the abscess.

Topics: Abscess; Adult; Alcoholism; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Calcinosis; Chronic Disease; Diabetic Ketoacidosis; Drainage; Drug Therapy, Combination; Gentamicins; Humans; Male; Pancreatitis; Splenic Diseases