technetium-tc-99m-sulfur-colloid and Streptococcal-Infections

An 85-year-old male resident of a nursing home presented after a fall with a painful left hip, confusion, and fever. He had multiple medical problems including severe vascular disease and poor vision as a result of macular degeneration. An Austin Moore left hip prosthesis had been inserted for a fractured femoral neck several years before. A septic workup showed a raised leukocyte count but no other focal abnormality. Plain radiography showed a periprosthetic fracture of the left hip. Blood cultures grew beta-hemolytic group A Streptococcus sensitive to penicillin. Bone scintigraphy was thought to be consistent with loosening of the prosthesis without evidence of a recent fracture. Tc-99m leukocyte scintigraphy was markedly abnormal, with extensive soft-tissue uptake suggestive of a large periprosthetic infective collection. This was confirmed at surgery with drainage of 200 mL pus from the left hip, and deep and superficial soft tissues of the thigh. The trochanteric fracture was well granulated and thought to be of long standing. The prosthesis was removed and the patient was treated with appropriate antibiotics with good effect.

Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; False Negative Reactions; Femoral Fractures; Hip Prosthesis; Humans; Leukocytes; Male; Prosthesis Failure; Prosthesis-Related Infections; Radiopharmaceuticals; Streptococcal Infections; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

Most pyogenic liver abscesses appear to be 'not' in a 67Ga-citrate study; rarely, a 'warm' or 'cold' area may also be seen. We present a patient with a pyogenic liver abscess that had both 'cold' and 'hot' areas in the 67Ga-citrate study. This striking finding is probably related to the different stages of evolution of the abscess.

Topics: Drainage; Gallium Radioisotopes; Humans; Inflammation; Liver; Liver Abscess; Male; Middle Aged; Radionuclide Imaging; Streptococcal Infections; Streptococcus sanguis; Technetium Tc 99m Sulfur Colloid

We describe four cases of multiple, cryptogenic, and streptococcal liver abscesses which were cured with antibiotic therapy. Two of the patients were referred for medical management as a last resort after open surgical drainage failed to eradicate the suppurative process. The other two patients were treated from the time of diagnosis with antimicrobial agents alone. Blood cultures or needle aspirates of the abscesses yielded a pure growth of streptococci in all instances. All isolates were susceptible to penicillin G. Cryptogenic streptococcal abscesses may represent a subset of multiple hepatic abscesses particularly amenable to successful medical therapy consisting of a minimum of 6 weeks parenteral antibiotic therapy followed by a period of oral antibiotics until clinical, biochemical, and radiological resolution of the abscesses has occurred.

Topics: Adult; Biopsy, Needle; Chloramphenicol; Drainage; Feces; Female; Hepatomegaly; Humans; Liver; Liver Abscess; Male; Middle Aged; Penicillin G; Radiography; Radionuclide Imaging; Salmonella Infections; Salmonella typhimurium; Streptococcal Infections; Streptococcus; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid