Emphysematous pyelonephritis (EPN) is a rare but serious infectious disease caused by anaerobic bacteria that is characterized by necrotizing renal parenchymal infection and has a high mortality rate. The initial management of EPN includes resuscitation, antibiotics, management of any diabetes, and minimally invasive procedures, such as percutaneous drainage. Surgery is required in the most severe cases. Here, we describe a male patient with type 2 diabetes who presented with fever and abdominal pain and was diagnosed with EPN based on laboratory results and a computed tomography (CT) scan showing distension of the left kidney, several small air bubbles in the perirenal space, and thickening of the perinephric fascia. A subcutaneous insulin infusion and meropenem were administered. Repeat CT imaging 13 days later showed gas and necrotic tissue in the renal parenchyma. Therefore, CT-guided renal puncture was performed, and Escherichia coli was cultured from the drained pus. Antibiotic treatment was continued for 20 days after admission when the patient's kidney function and clinical symptoms had significantly improved. Sixty days after diagnosis, left nephrectomy was performed. The perinephric abscess was under high tension, and the left kidney was very soft. Histopathological examination revealed severe inflammation and necrosis of the renal pelvis, with fibrosis. The patient recovered well after surgery and remained alive 5 months later. EPN is a very rare disease with a high mortality rate and is more likely to occur in patients with diabetes. Early diagnosis and treatment of the infection are extremely important. For patients in whom gas and/or necrosis continue to accumulate after conservative treatment, we recommend nephrectomy.
{"title":"Conservative treatment of emphysematous pyelonephritis and diabetes: A case report and literature review","authors":"Junqiong Peng, Yu-xi Ge, G. Yan","doi":"10.4103/rid.rid_9_21","DOIUrl":"https://doi.org/10.4103/rid.rid_9_21","url":null,"abstract":"Emphysematous pyelonephritis (EPN) is a rare but serious infectious disease caused by anaerobic bacteria that is characterized by necrotizing renal parenchymal infection and has a high mortality rate. The initial management of EPN includes resuscitation, antibiotics, management of any diabetes, and minimally invasive procedures, such as percutaneous drainage. Surgery is required in the most severe cases. Here, we describe a male patient with type 2 diabetes who presented with fever and abdominal pain and was diagnosed with EPN based on laboratory results and a computed tomography (CT) scan showing distension of the left kidney, several small air bubbles in the perirenal space, and thickening of the perinephric fascia. A subcutaneous insulin infusion and meropenem were administered. Repeat CT imaging 13 days later showed gas and necrotic tissue in the renal parenchyma. Therefore, CT-guided renal puncture was performed, and Escherichia coli was cultured from the drained pus. Antibiotic treatment was continued for 20 days after admission when the patient's kidney function and clinical symptoms had significantly improved. Sixty days after diagnosis, left nephrectomy was performed. The perinephric abscess was under high tension, and the left kidney was very soft. Histopathological examination revealed severe inflammation and necrosis of the renal pelvis, with fibrosis. The patient recovered well after surgery and remained alive 5 months later. EPN is a very rare disease with a high mortality rate and is more likely to occur in patients with diabetes. Early diagnosis and treatment of the infection are extremely important. For patients in whom gas and/or necrosis continue to accumulate after conservative treatment, we recommend nephrectomy.","PeriodicalId":101055,"journal":{"name":"Radiology of Infectious Diseases","volume":"20 1","pages":"68 - 74"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88999459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mycoplasma pneumoniae pneumonia (MPP) is the most common type of childhood community-acquired pneumonia. MPP is generally mild and self-limiting, but a small percentage of patients still develop a refractory or severe clinical course. Imaging is an important tool for confirmed pneumonia, and it plays an important role in the diagnosis of MPP and assessment of the clinical course. However, imaging features of MPP reported in the literature vary in their patterns to distribution. A comprehensive and deep understanding of imaging findings of MPP in children is beneficial for an accurate diagnosis and guidance of its treatment.
{"title":"Chest imaging characteristics of mycoplasma pneumoniae pneumonia in children","authors":"Caiting Chu, Lei Xu, Chengjin Gao","doi":"10.4103/rid.rid_3_22","DOIUrl":"https://doi.org/10.4103/rid.rid_3_22","url":null,"abstract":"Mycoplasma pneumoniae pneumonia (MPP) is the most common type of childhood community-acquired pneumonia. MPP is generally mild and self-limiting, but a small percentage of patients still develop a refractory or severe clinical course. Imaging is an important tool for confirmed pneumonia, and it plays an important role in the diagnosis of MPP and assessment of the clinical course. However, imaging features of MPP reported in the literature vary in their patterns to distribution. A comprehensive and deep understanding of imaging findings of MPP in children is beneficial for an accurate diagnosis and guidance of its treatment.","PeriodicalId":101055,"journal":{"name":"Radiology of Infectious Diseases","volume":"121 1","pages":"58 - 61"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78403162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nocardiosis, which is caused by the Nocardia bacterium, is an acute, subacute, or chronic purulent infection that mostly affects the lungs. The vast majority of these infections occur in people with impaired immune function. These infections are characterized by multiple areas of inflammation in both lungs. The initial examination of choice is chest computed tomography (CT), which can play an important role in early diagnosis and evaluation of the treatment's effectiveness. Since the disease is rare and lacks specific clinical manifestations, it is easily misdiagnosed or missed altogether, often resulting in poor patient outcomes, including death. Therefore, early diagnosis and evaluation of the effects of treatment by chest CT are essential to controlling disease progression and improving the prognosis.
{"title":"Computed tomography diagnosis of pulmonary nocardiosis: A case report of a rare disease","authors":"Qiu Yang, Ping Zhang, Xiaona Zhou, Xiao Chen, Hai-Yuan He, Zheng Miao, Zheng-Kai Li, Feng Zhang, Wenshuai Duan, Tengfei Ke, Bin Yang","doi":"10.4103/RID.RID_13_21","DOIUrl":"https://doi.org/10.4103/RID.RID_13_21","url":null,"abstract":"Nocardiosis, which is caused by the Nocardia bacterium, is an acute, subacute, or chronic purulent infection that mostly affects the lungs. The vast majority of these infections occur in people with impaired immune function. These infections are characterized by multiple areas of inflammation in both lungs. The initial examination of choice is chest computed tomography (CT), which can play an important role in early diagnosis and evaluation of the treatment's effectiveness. Since the disease is rare and lacks specific clinical manifestations, it is easily misdiagnosed or missed altogether, often resulting in poor patient outcomes, including death. Therefore, early diagnosis and evaluation of the effects of treatment by chest CT are essential to controlling disease progression and improving the prognosis.","PeriodicalId":101055,"journal":{"name":"Radiology of Infectious Diseases","volume":"13 1","pages":"31 - 33"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73508105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 45-year-old female patient was admitted to our hospital due to a space-occupying lesion which was found in a physical examination. Slight tenderness was found in her right lower abdomen for 1 month. On computed tomography (CT) imaging, a round, low-density lesion was observed in the liver. Several round cysts with lower density and thin wall were scattered in the center of the lesion. Linear calcification could be found in partial cystic wall. No significant enhancement was found in the lesion on contrast-enhanced CT imaging. A laparotomy was performed to remove the mass, which was sent to a pathological examination and hepatic cystic echinococcosis was diagnosed.
{"title":"A case of hepatic hydatid disease and imaging findings","authors":"Cong Zhou, Hong-Don Ju, Qian Chen, Linting Luo","doi":"10.4103/RID.RID_15_22","DOIUrl":"https://doi.org/10.4103/RID.RID_15_22","url":null,"abstract":"A 45-year-old female patient was admitted to our hospital due to a space-occupying lesion which was found in a physical examination. Slight tenderness was found in her right lower abdomen for 1 month. On computed tomography (CT) imaging, a round, low-density lesion was observed in the liver. Several round cysts with lower density and thin wall were scattered in the center of the lesion. Linear calcification could be found in partial cystic wall. No significant enhancement was found in the lesion on contrast-enhanced CT imaging. A laparotomy was performed to remove the mass, which was sent to a pathological examination and hepatic cystic echinococcosis was diagnosed.","PeriodicalId":101055,"journal":{"name":"Radiology of Infectious Diseases","volume":"25 1","pages":"34 - 36"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80082358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sepsis-associated encephalopathy (SAE) is a serious complication of sepsis, which is caused by a dysregulated host response to infection. The high morbidity and mortality of SAE severely diminish the quality of life of the affected patients and families, and therefore, early diagnosis and treatment are essential. The pathogenesis of SAE is complex, involving neuroinflammation, impairment of blood–brain barrier function, neurotransmitter imbalance, and mitochondrial dysfunction. Imaging studies have provided insight into the neuropathological changes by traditional computed tomography and magnetic resonance scans, which reveal changes in brain structure and function in patients with advanced SAE. Currently, SAE is mainly diagnosed by the presence of typical clinical symptoms and by laboratory examination; however, accurate diagnosis in the early stage of SAE remains difficult. With the development of new imaging technologies, there has been an increase in imaging options for the early identification of SAE as well as for studies into the pathogenesis and pathophysiology of the disease. Here, we review the pathogenesis of SAE and the main neuroimaging findings. Furthermore, we suggest how to use the new imaging techniques for early identification and for research into the pathogenesis of SAE, which may help to enhance diagnosis and improve the prognosis of the disease.
{"title":"Sepsis-associated encephalopathy: From pathogenesis to neuroimaging findings","authors":"Yazhi Zhong, Yan Cheng, R. Wu","doi":"10.4103/RID.RID_23_21","DOIUrl":"https://doi.org/10.4103/RID.RID_23_21","url":null,"abstract":"Sepsis-associated encephalopathy (SAE) is a serious complication of sepsis, which is caused by a dysregulated host response to infection. The high morbidity and mortality of SAE severely diminish the quality of life of the affected patients and families, and therefore, early diagnosis and treatment are essential. The pathogenesis of SAE is complex, involving neuroinflammation, impairment of blood–brain barrier function, neurotransmitter imbalance, and mitochondrial dysfunction. Imaging studies have provided insight into the neuropathological changes by traditional computed tomography and magnetic resonance scans, which reveal changes in brain structure and function in patients with advanced SAE. Currently, SAE is mainly diagnosed by the presence of typical clinical symptoms and by laboratory examination; however, accurate diagnosis in the early stage of SAE remains difficult. With the development of new imaging technologies, there has been an increase in imaging options for the early identification of SAE as well as for studies into the pathogenesis and pathophysiology of the disease. Here, we review the pathogenesis of SAE and the main neuroimaging findings. Furthermore, we suggest how to use the new imaging techniques for early identification and for research into the pathogenesis of SAE, which may help to enhance diagnosis and improve the prognosis of the disease.","PeriodicalId":101055,"journal":{"name":"Radiology of Infectious Diseases","volume":"23 1","pages":"1 - 6"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87931926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hui Guo, Pahati Tuxunjiang, Laihong Yang, Wenya Liu
This review focuses on the incidence, clinical manifestations, and radiographic features of bone hydatidosis at various sites. The clinical presentations and imaging features of bone hydatidosis differ depending on the site of involvement. The first goal of this review is to distinguish the radiographic features of bone hydatidosis in various bones. The second goal is to help radiologists understand the incidence of hydatid bone disease at various sites and to recognize the clinical manifestations through imaging features. Consideration of both the clinical and radiologic characteristics can help radiologists to diagnose hydatid disease of bone.
{"title":"Hydatid disease of bone: Imaging features","authors":"Hui Guo, Pahati Tuxunjiang, Laihong Yang, Wenya Liu","doi":"10.4103/RID.RID_17_21","DOIUrl":"https://doi.org/10.4103/RID.RID_17_21","url":null,"abstract":"This review focuses on the incidence, clinical manifestations, and radiographic features of bone hydatidosis at various sites. The clinical presentations and imaging features of bone hydatidosis differ depending on the site of involvement. The first goal of this review is to distinguish the radiographic features of bone hydatidosis in various bones. The second goal is to help radiologists understand the incidence of hydatid bone disease at various sites and to recognize the clinical manifestations through imaging features. Consideration of both the clinical and radiologic characteristics can help radiologists to diagnose hydatid disease of bone.","PeriodicalId":101055,"journal":{"name":"Radiology of Infectious Diseases","volume":"175 1","pages":"18 - 24"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84581325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brain abscess is a serious infection of the brain parenchyma that can occur in children with cyanotic congenital heart disease (CCHD). In children with CCHD, brain abscesses are often caused by the direct extension of an adjacent infection, or by distant hematogenous dissemination. In the present review, we discuss the epidemiology, etiology, clinical features, radiologic features, current treatments, and outcomes of brain abscesses associated with CCHD in children. Common clinical presentations of brain abscesses with CCHD include a fever, vomiting, headache, hemiparesis, and focal seizures. The most common causative microorganisms of brain abscesses are Streptococcus and Staphylococcus species. The radiologic features of brain abscesses in children with CCHD are a ring enhancing, well-defined lesion with a hypodense center; this is usually accompanied by surrounding cerebral edema. Appropriate surgery and antibiotic treatment are the gold standard for treating brain abscesses in children with CCHD. In addition, the early recognition of such brain abscesses is very important for their timely clinical treatment. Brain imaging techniques, including magnetic resonance imaging and computed tomography, are crucial for the early recognition of brain abscesses in CCHD.
{"title":"Brain abscesses in children with cyanotic congenital heart disease","authors":"Kenneth G. Liu, Ming Zhu, S. Dong","doi":"10.4103/RID.RID_2_22","DOIUrl":"https://doi.org/10.4103/RID.RID_2_22","url":null,"abstract":"Brain abscess is a serious infection of the brain parenchyma that can occur in children with cyanotic congenital heart disease (CCHD). In children with CCHD, brain abscesses are often caused by the direct extension of an adjacent infection, or by distant hematogenous dissemination. In the present review, we discuss the epidemiology, etiology, clinical features, radiologic features, current treatments, and outcomes of brain abscesses associated with CCHD in children. Common clinical presentations of brain abscesses with CCHD include a fever, vomiting, headache, hemiparesis, and focal seizures. The most common causative microorganisms of brain abscesses are Streptococcus and Staphylococcus species. The radiologic features of brain abscesses in children with CCHD are a ring enhancing, well-defined lesion with a hypodense center; this is usually accompanied by surrounding cerebral edema. Appropriate surgery and antibiotic treatment are the gold standard for treating brain abscesses in children with CCHD. In addition, the early recognition of such brain abscesses is very important for their timely clinical treatment. Brain imaging techniques, including magnetic resonance imaging and computed tomography, are crucial for the early recognition of brain abscesses in CCHD.","PeriodicalId":101055,"journal":{"name":"Radiology of Infectious Diseases","volume":"39 1","pages":"7 - 11"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79356272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melioidosis is often referred to as “the great imitator,” and it is more likely to be misdiagnosed when multiple systems are involved. This report describes a patient with an 11-year history of diabetes with poor blood glucose control, a history of heavy smoking, and multi-systemic diseases including lung nodules, multiple enlarged mediastinal lymph nodes, bone destruction and soft-tissue swelling in the proximal right tibia, and intracerebral lesions. Computed tomography (CT) of the lung and tibia and head magnetic resonance imaging with enhanced magnetic resonance spectroscopy led to a misdiagnosis of lung cancer with metastasis to the brain and proximal tibia. The patient was admitted to the hospital on January 17, 2012 and hospitalized for 51 days. He was in stable condition but was not cured and requested to be discharged voluntarily. Head and lung CT was repeated on July 28, 2016. Although the patient's family members reported that he had not received regular treatment in the hospital, his intracerebral lesions, chest lesions, and right calf lesions had all improved. This case indicates that even when medical imaging is consistent with multi-systemic malignancy, imaging must be combined with clinical and laboratory tests to exclude the possibility of melioidosis.
{"title":"Multi-systemic melioidosis mimics malignancy: A radiological case report","authors":"L. Fan, Yu-Hui Wu, Hong-Ru Lu, Y. Zhan","doi":"10.4103/RID.RID_1_22","DOIUrl":"https://doi.org/10.4103/RID.RID_1_22","url":null,"abstract":"Melioidosis is often referred to as “the great imitator,” and it is more likely to be misdiagnosed when multiple systems are involved. This report describes a patient with an 11-year history of diabetes with poor blood glucose control, a history of heavy smoking, and multi-systemic diseases including lung nodules, multiple enlarged mediastinal lymph nodes, bone destruction and soft-tissue swelling in the proximal right tibia, and intracerebral lesions. Computed tomography (CT) of the lung and tibia and head magnetic resonance imaging with enhanced magnetic resonance spectroscopy led to a misdiagnosis of lung cancer with metastasis to the brain and proximal tibia. The patient was admitted to the hospital on January 17, 2012 and hospitalized for 51 days. He was in stable condition but was not cured and requested to be discharged voluntarily. Head and lung CT was repeated on July 28, 2016. Although the patient's family members reported that he had not received regular treatment in the hospital, his intracerebral lesions, chest lesions, and right calf lesions had all improved. This case indicates that even when medical imaging is consistent with multi-systemic malignancy, imaging must be combined with clinical and laboratory tests to exclude the possibility of melioidosis.","PeriodicalId":101055,"journal":{"name":"Radiology of Infectious Diseases","volume":"67 1","pages":"25 - 30"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76319543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The global outbreak of coronavirus disease 2019 (COVID-19) has affected more than 200 million people worldwide, caused millions of deaths, and has threatened global economic stability. Vaccines against severe acute respiratory syndrome coronavirus 2, the causative agent of COVID-19, have been developed, and the rollout of widespread vaccination has curbed the epidemic in many countries. However, variants of the virus, including the Delta variant, have emerged that have triggered new rounds of infection. In this review, we discuss the epidemiological characteristics, pathogenicity, clinical symptoms, laboratory tests, and imaging manifestations of the Delta variant, with the aim of offering new insight into strategies for the early detection, diagnosis, and treatment of disease caused by this coronavirus variant.
{"title":"Research progress with the severe acute respiratory syndrome coronavirus 2 Delta variant","authors":"Ai-Guo Li, Hong-Ping Lu","doi":"10.4103/RID.RID_25_21","DOIUrl":"https://doi.org/10.4103/RID.RID_25_21","url":null,"abstract":"The global outbreak of coronavirus disease 2019 (COVID-19) has affected more than 200 million people worldwide, caused millions of deaths, and has threatened global economic stability. Vaccines against severe acute respiratory syndrome coronavirus 2, the causative agent of COVID-19, have been developed, and the rollout of widespread vaccination has curbed the epidemic in many countries. However, variants of the virus, including the Delta variant, have emerged that have triggered new rounds of infection. In this review, we discuss the epidemiological characteristics, pathogenicity, clinical symptoms, laboratory tests, and imaging manifestations of the Delta variant, with the aim of offering new insight into strategies for the early detection, diagnosis, and treatment of disease caused by this coronavirus variant.","PeriodicalId":101055,"journal":{"name":"Radiology of Infectious Diseases","volume":"70 1","pages":"12 - 17"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90351133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVE: The objective of this study was to investigate the clinical and imaging manifestations of melioidosis in children in Hainan Province, China, to improve its understanding. MATERIALS AND METHODS: We retrospectively analyzed 10 children with melioidosis in Hainan Province, China, from January 2002 to November 2021. We collected clinical and imaging data. These data were analyzed retrospectively by two radiologists with more than 10 years' radiology imaging experience. RESULTS: The patients' average age was 8.4 years (range: 17 days to 15 years), the male-to-female ratio was 6:4, and the average length of hospital stay was 31.5 days (5–96 days). Only two patients had underlying diseases, which were acute lymphocytic leukocyte hepatitis and hepatitis B. One patient had no onset of fever, and the other nine patients had a fever, with an average temperature of 39.5°C (38.4–40.3°C). Two patients had a low white blood cell count (0.27 × 109/L, 3.6 × 109/L), four had a normal white blood cell count, and two had a slightly high white blood cell count (13.6 × 109/L, 14.2 × 109/L). Two patients aged <1 year had a high white blood cell count >34 × 109/L and died. One patient was automatically discharged from the hospital and stopped treatment because of economic factors, and the rest improved after treatment. The neutrophil count was normal in two patients, but it was increased in the other patients. There were no data of C-reactive protein (CRP) measurements in three patients, and four of the other seven patients showed greatly elevated CRP concentrations. Among these four patients, two died and two were cured. One patient had sepsis, three had septicopyemia, and two had multiple organ dysfunction syndrome; among these six patients, one died and others improved. Four patients with pneumonia showed scattered exudation, consolidation, and nodules in both lungs, which developed into lung abscesses, as well as melioidosis and mumps. Three patients showed parotid swelling and abscess formation multilocular. One patient had liver and splenic abscesses. One patient had neck abscesses and one had perineal skin abscesses. One patient had purulent meningitis (clinical diagnosis) and disseminated intravascular coagulation (DIC), and this patient died. CONCLUSIONS: For patients in endemic areas, and those who have clinical manifestations of sepsis, pneumonia, mumps, and liver and splenic abscesses on imaging manifestations, the possibility of melioidosis should be considered. Microbial culture should be carried out as soon as possible, and these results of culture should be considered. Antibiotic treatment should be performed before a diagnosis. Mortality is more likely in patients who are aged <1 year and have considerably elevated CRP concentrations, multiple organ dysfunction syndrome, and central nervous system infection/DIC.
{"title":"Clinical and imaging manifestations of pediatric melioidosis in Hainan, China","authors":"L. Fan, Yehua Wu, Shengshi Mai, Hong Lu, Y. Zhan","doi":"10.4103/rid.rid_4_22","DOIUrl":"https://doi.org/10.4103/rid.rid_4_22","url":null,"abstract":"OBJECTIVE: The objective of this study was to investigate the clinical and imaging manifestations of melioidosis in children in Hainan Province, China, to improve its understanding. MATERIALS AND METHODS: We retrospectively analyzed 10 children with melioidosis in Hainan Province, China, from January 2002 to November 2021. We collected clinical and imaging data. These data were analyzed retrospectively by two radiologists with more than 10 years' radiology imaging experience. RESULTS: The patients' average age was 8.4 years (range: 17 days to 15 years), the male-to-female ratio was 6:4, and the average length of hospital stay was 31.5 days (5–96 days). Only two patients had underlying diseases, which were acute lymphocytic leukocyte hepatitis and hepatitis B. One patient had no onset of fever, and the other nine patients had a fever, with an average temperature of 39.5°C (38.4–40.3°C). Two patients had a low white blood cell count (0.27 × 109/L, 3.6 × 109/L), four had a normal white blood cell count, and two had a slightly high white blood cell count (13.6 × 109/L, 14.2 × 109/L). Two patients aged <1 year had a high white blood cell count >34 × 109/L and died. One patient was automatically discharged from the hospital and stopped treatment because of economic factors, and the rest improved after treatment. The neutrophil count was normal in two patients, but it was increased in the other patients. There were no data of C-reactive protein (CRP) measurements in three patients, and four of the other seven patients showed greatly elevated CRP concentrations. Among these four patients, two died and two were cured. One patient had sepsis, three had septicopyemia, and two had multiple organ dysfunction syndrome; among these six patients, one died and others improved. Four patients with pneumonia showed scattered exudation, consolidation, and nodules in both lungs, which developed into lung abscesses, as well as melioidosis and mumps. Three patients showed parotid swelling and abscess formation multilocular. One patient had liver and splenic abscesses. One patient had neck abscesses and one had perineal skin abscesses. One patient had purulent meningitis (clinical diagnosis) and disseminated intravascular coagulation (DIC), and this patient died. CONCLUSIONS: For patients in endemic areas, and those who have clinical manifestations of sepsis, pneumonia, mumps, and liver and splenic abscesses on imaging manifestations, the possibility of melioidosis should be considered. Microbial culture should be carried out as soon as possible, and these results of culture should be considered. Antibiotic treatment should be performed before a diagnosis. Mortality is more likely in patients who are aged <1 year and have considerably elevated CRP concentrations, multiple organ dysfunction syndrome, and central nervous system infection/DIC.","PeriodicalId":101055,"journal":{"name":"Radiology of Infectious Diseases","volume":"31 1","pages":"150 - 157"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81515775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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