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Chest computed tomography scan demonstrates a pleurocutaneous fistula communicating the posterior costophrenic recess and subcutaneous air pocket at the back (arrow)
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OBJECTIVE: The aim of this paper is to review the subject and to report on and discuss a case of bronchopleural cutaneous fistula due to Eikenella corrodens. DESCRIPTION: A 16-year-old girl was brought to our hospital with fever and blood-tinged sputum 2 weeks prior to her admission. She suffered from neurologic sequelae of herpetic encephalitis an...
Context in source publication
Citations
... Currently, the incidence of EWF in children is unknown. Studies which have suggested an increasing burden of disease have been limited to small, single-center experiences mainly focusing on management strategies [6,8,[11][12][13][14][15]. The associated underlying conditions are characteristic to the institutions that have published on their experience, and may not represent the general pediatric population. ...
... Some of these diagnoses are non-specific, such as ''thoracic fistula'' and ''lung fistula''. Others are exceedingly rare; thoracogastric [20,21], bronchocutaneous [13,22], hepatopleural [23,24], and thoracoabdominal [25] fistulas are almost exclusively reported as case studies. Due to the rarity of the other conditions listed in Table 1, the vast majority of this EWF cohort likely represents BPF. ...
Purpose:
The incidence and etiology of empyema with fistula (EWF) in children is unknown. We analyzed a national database to define the epidemiology and diagnoses associated with this condition.
Methods:
Discharge data from the Kids' Inpatient Database were reviewed for EWF (ICD-9 diagnosis code 510.0) in children ≤18 years from 2000 to 2012. Patient characteristics, institutional data, and accompanying conditions were evaluated. Weighted national estimates were calculated and incidence compared across years (2000, 2003, 2006, 2009) using the Rao-Scott Chi Square.
Results:
From 2000 to 2012, 908 children were hospitalized with EWF. Age distribution was bimodal. Common primary diagnoses related to the hospitalization were pneumonia/pulmonary abscess (31.2 %) and EWF (19.3 %). Manipulation of the pleural space (e.g. decortication, drainage) comprised 45.0 % of procedures. Incidence rates of EWF increased (Rao Scott Adjusted Chi Square: 16.13, p < 0.01) over the study period. Although not statistically significant, median length of stay and age of diagnosis decreased and increased, respectively.
Conclusion:
This first, national pediatric EWF study reveals rising incidence during the years 2000-2009. Despite limitations in ICD-9 coding, concomitant primary diagnoses and procedures suggest bronchopleural fistulae likely represent the vast majority of cases in this cohort. Multi-institutional studies are needed to confirm etiology and characterize outcome of EWF.
... Our case underscores the fact that pleuro-pulmonary infection is an important manifestation of Eikenella infection although the pericardial involvement was the presenting symptom in our case and also that it can be the sole organism involved, which was further substantiated by the isolation of the same in blood culture as well. One of the peculiarities of our case was that there was no apparent predisposing factor which was contrary to the observation made in the reported case series [2][3][4][5][6]. ...
Acute purulent pericarditis is rarely caused by anaerobic bacteria and it is almost always a complication of another disease process. Esophagomediastinal fistula, odontogenic, or pleuropulmonary infections have been reported to be the primary source of purulent pericarditis. If not diagnosed and treated promptly, purulent pericarditis is usually a fatal disease. We describe a case of bronchomediastinal fistula as sequels from a necrotizing parenchymal infection, leading on to secondary mediastinitis and pleuropericardial involvement in an immunocompetent patient.
ß 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
Abscess formation and empyema are serious sequelae of pneumonia. Colonisation of the pleural fluid occurs most frequently by aerobic organisms or mixed aerobic and anaerobic species including: Streptococcus pneumoniae, Streptococcus milleri, Bacteroides species and anaerobic fusobacteria. Actinomyces, Eikenella corrodens and Nocardia species are a rarely reported combination of anaerobic organisms resulting in empyema, especially in the Northern hemisphere. A 65-year-old man presented in a severely debilitated state with poor dentition and features of severe pneumonia. His past medical history included diabetes mellitus, peripheral vascular disease and cerebrovascular events. CT scan revealed consolidation, empyema and abscess formation. The patient was initially managed with intravenous dicloxacillin and metronidazole and a diagnostic aspirate was followed by chest drain insertion. Microscopy results showed Nocardia and antimicrobial therapy was altered to co-trimoxazole and ticarcillin/clavulanate. After additional nutritional support the patient was fit for video assisted thoracoscopy and decortication. Further culture results confirmed the growth of Actinomyces species and Eikenella corrodens and the therapy was modified to co-trimoxazole and benzylpenicillin. Pneumonia and empyema due solely to anaerobic organisms is rare but should be suspected if clinical onset is insidious. Anaerobic culture of specimens is indispensable to the rapid choice of appropriate antibiotic.
We report a case of Eikenella corrodens causing vulvar abscess in a diabetic patient. Eikenella corrodens is a slow growing, nonmotile, facultative anaerobic, Gram-negative bacillus which is commensal of the oral cavity, intestinal and genital tracts. The most common clinical sources of this organism are human bite wounds, head and neck infections and respiratory tract infections. In our knowledge, the presented case is the first report of Eikenella corrodens causing vulvar abscess in a diabetic patient.
