Nosocomial enterococcal urosepsis in a compromised host

Article Abstract:

Urinary tract infections (UTIs) are very common. UTIs that are acquired during hospitalization (nosocomial UTIs) are most frequently caused by bladder catheters (tubes used for removing urine from the bladder) that are left in place for long periods of time. UTIs are diagnosed by the presence of bacteria and pus in the urine. Bacteremia (the presence of bacteria in the blood) rarely occurs in patients with UTIs, unless the patient has kidney disease or an obstruction that interferes with the normal flow of urine. Nosocomial UTIs are also uncommon among patients with leukopenia (abnormally low white blood cell count). This article describes the case report of a 60-year-old man with leukopenia and bladder cancer. The patient had a tumor that blocked the opening of the bladder so that the urine flow was inadequate. Catheters were used to restore the normal flow of urine and chemotherapy was begun. After six months of catheterization, the patient suddenly developed fever and chills, and had difficulty urinating. The patient was diagnosed with urosepsis (an infection that occurs when urine leaks out of the bladder or urethra into the surrounding tissue and begins to decompose). When urine cultures were performed, enterococcal bacteria were found in the urine. The urosepsis was caused by an obstruction in the catheter that blocked the flow of urine. The patient was treated successfully with a seven-day course of antibiotics. Since leukopenia is not usually associated with urosepsis, patients with leukopenia who develop urosepsis may have an underlying kidney disease or an obstruction of urinary flow. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Nosocomial infections, Cross infection, Urinary tract infections, Urinary catheterization

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Brain abscess mimicking brain tumor

Article Abstract:

A brain abscess is a localized collection of pus in the brain which usually occurs after infections of the middle ear, nasal sinuses, face, or skull. Classic symptoms and signs of brain abscess include fever, headache, vomiting, dizziness, and sensory or motor deficits affecting an isolated area of the body. Symptoms suddenly appear and the patient's condition may rapidly worsen to coma or death. Brain abscesses are less common than brain tumors, but may appear similar in both initial symptoms and diagnostic imaging results such as computed tomographic scan (CAT). Because of similar symptoms, brain abscesses may be misdiagnosed as brain tumors. A recent study reviewed the occurrence of brain abscesses presenting as brain tumor over a five-year period from 1983 to 1988 to determine what percentage of patients diagnosed with brain tumor actually had an abscess. Six percent of the patients diagnosed with brain tumor by CAT scan were found to have brain abscesses at the time of brain surgery. Two of these patients were found to have brain abscesses that originated from infection of the root of a tooth. The patients who were misdiagnosed had no symptoms of infection, but had CAT scan results and other symptoms consistent with brain tumor. It is suggested that physicians should suspect a brain abscess in patients diagnosed with brain tumor who do not have all of the characteristic symptoms of brain tumor. Additionally, brain abscesses arising from tooth infection are probably more common than previously suspected. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Diagnostic errors, Brain, Abscess, Brain abscess

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