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INTRODUCTION:Gastric wall abscess (GWA) or localized suppurative gastritis is a purulent inflammatory process of the submucosa of the stomach associated with high mortality rates. GWA can be a rare complication of subepithelial lesions (SEL), such as ectopic pancreas (pancreatic rest), GIST, and leiomyosarcoma. Our report is the fourth demonstrated case of pancreatic rest associated GWA and the first in an extensive literature search with successful treatment without adjunctive surgical resection.CASE DESCRIPTION/METHODS:38-year-old healthy female presented to our Gastroenterology clinic for persistent abdominal pain with nausea and vomiting after being evaluated 3 days ago at an outside hospital (OSH) (Table 1). She was diagnosed with gastritis and sent home on omeprazole. At our institution, she described her pain as sharp, constant, non-radiating and diffuse, but worst in the epigastrium postprandially. Social history was remarkable for 1-2 drinks per day and recent travel to Peru 3-4 weeks prior. As she appeared acutely ill, the patient was referred to ED, with initial work up remarkable for blood pressure of 93/54 and WBC of 13.5. EGD revealed a large submucosal gastric mass in the distal gastric antrum with central umbilication and expressible white purulent material (Figure 1). She was started on pip/tazo and ID was consulted. Micro was largely negative; however, culture of purulent material was unable to be processed. Pathology showed active gastritis, focal ulceration, and necro-inflammatory tissue without evidence of malignancy. Cytology revealed purulent exudate associated with bacterial colonies consistent with abscess. The patient clinically improved and was discharged home on Augmentin. In outpatient follow up, patient reported continued improvement. Follow up EGD revealed resolution of abscess, however pancreatic rest was seen in the gastric antrum (Figure 2).DISCUSSION:GWA is a rare and highly morbid condition commonly located in the antrum or pylorus. Exact pathogenesis may be due to direct bacterial seeding or hematogenous spread. Strep species are the most commonly isolated bacteria. GWA is rarely also associated with a SEL, in our case being a pancreatic rest, or ectopic pancreatic tissue. Treatment for SEL associated GWA has traditionally been surgical removal with either partial gastrectomy or wedge resection. Our case report demonstrates the safety and efficacy of drainage and medical management alone.Table 1.Outside hospital imaging workup and findings

Brain abscesses (BA) are focal parenchymal infections that remain life-threatening conditions. Polymicrobial BAs (PBAs) are complex coinfections of bacteria or bacterial and nonbacterial pathogens such as fungi or parasites, with diagnostic and therapeutic challenges. In this article, we comprehensively review the prevalence, pathogenesis, clinical manifestations, and microbiological, histopathological, and radiological features of PBAs, as well as treatment and prognosis. While PBAs and monomicrobial BAs have some similarities such as nonspecific clinical presentations, PBAs are more complex in their pathogenesis, pathological, and imaging presentations. The diagnostic challenges of PBAs include nonspecific imaging features at early stages and difficulties in identification of some pathogens by routine techniques without the use of molecular analysis. Imaging of late-stage PBAs demonstrates increased heterogeneity within lesions, which corresponds to variable histopathological features depending on the dominant pathogen-induced changes in different areas. This heterogeneity is particularly marked in cases of coinfections with nonbacterial pathogens such as Toxoplasma gondii. Therapeutic challenges in the management of PBAs include initial medical therapy for possibly underrecognized coinfections prior to identification of multiple pathogens and subsequent broad-spectrum antimicrobial therapy to eradicate identified pathogens. PBAs deserve more awareness to facilitate prompt and appropriate treatment.

Three months later, the patient was admitted to our hospital with swelling in the right eye again. Pathological evaluation of the biopsy material was reported as mucormycosis. The patient was treated with liposomal amphotericin B. Due to insufficient clinical response and progression detected on control imaging, the patient underwent reoperation on the 31\" day of treatment. Since Aspergillus could not be excluded, voriconazole was added to the treatment. Liposomal amphotericin B is the first choice in the treatment of mucormycosis and the prognosis is determined by timely and appropriate surgery.

BackgroundThis multicentre case–control study aimed to identify risk factors associated with non-operative treatment failure for patients with CT scan Hinchey Ib-IIb and WSES Ib-IIa diverticular abscesses.MethodsThis study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed.ResultsFailure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P < 0.01), tobacco smoking (aOR 2.01, 95%CI 1.24;3.25, P < 0.01), and presence of air bubbles inside the abscess (aOR 1.59, 95%CI 1.00;2.52, P = 0.04) were independent predictors of failure. In the subgroup of patients with abscesses > 5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI − 0.66;3.70, P = 0.23).ConclusionsNon-operative treatment is generally effective for diverticular abscesses. Tobacco smoking's role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups.

Purpose Deep neck infection is a potentially life-threatening condition, and thus, early identification and treatment are essential. This study explored the diagnostic challenges and preceding treatment in patients with repeated healthcare contacts due to an odontogenic or a peritonsillar abscess. Methods A retrospective study of oropharyngeal abscesses in hospitalized patients was conducted. Included were inpatients with an odontogenic or a peritonsillar abscess during 2019. Excluded were patients with other infection type and patients with an odontogenic abscess preceded by tooth removal. The main outcome variable was repeated healthcare visit(s) due to the current infection prior to hospitalization. The primary predictor variable was source of infection. Explanatory variables comprised age, sex, duration of symptoms (days), clinical findings, and referring unit. Additional analyses were conducted for patients with repeated healthcare visits. Study groups were compared using Fisher’s exact test, Student’s t -test, test where appropriate. A 2 × 2 risk analysis was performed. Results Altogether 294 patients, 153 (52.0%) with an odontogenic abscess and 141 (48.0%) with a peritonsillar abscess, were included in the study. Source of infection was unidentified more often in patients with an odontogenic than a peritonsillar abscess ( P  < .001). In all, 106 patients (36.1%) had repeated healthcare visits prior to hospitalization, which was significantly associated with an odontogenic abscess ( P  = .039). Active intervention was conducted in only 34.0% of the patients with repeated healthcare visits. Conclusions Clinicians have challenges in recognizing a developing odontogenic abscess, which remains essential for prompt and effective surgical intervention.

Introduction: Reports of hypermucoviscous Klebsiella pneumoniae (hvKP) isolated from fluids other than blood or abscess are rare. The aim of the study was to compare clinical and microbiological characteristics of hvKP found in blood or abscess fluid with those isolated from other loci. Methodology: A total of 24 non-repetitive hvKP isolates were collected from January 2013 to June 2014 from patients with hvKP infections. There were 15 in Group 1 (fluid other than blood or abscess) and 9 in Group 2 (blood or abscess fluid). Medical records of all patients were reviewed. Capsular polysaccharide (CPS) typing, virulence factor determination, and multilocus sequence typing (MLST) of hvKP isolates were performed. Results: Seventeen sequence types (STs) and 6 capsular serotypes were identified. Type K2CC65 was most commonly identified in Group 1 and type K2CC86 in Group 2. Deletion of pLVPK-derived loci were found in K2 and non-K1/K2 hvKP strains. Two virulent genes, fimH and ycfM, were identified more frequently in Group 2 than in Group 1. There was no difference in the frequency of other virulent genes or serotypes in the two groups. Two imipenem resistant hvKP isolates (cr-hvKP) were found in non-blood or abscess samples. Conclusions: hvKP isolated from different body fluids had similar clinical and microbiological characteristics. cr-hvKP identified in non-blood or abscess samples should raise our attention to the challenging situation and management of hvKP infection.

Bacterial infection often results in the formation of tissue abscesses, which represent the primary site of interaction between invading bacteria and the innate immune system. We identify the host protein calprotectin as a neutrophil-dependent factor expressed inside Staphylococcus aureus abscesses. Neutrophil-derived calprotectin inhibited S. aureus growth through chelation of nutrient Mn²⁺ and Zn²⁺: an activity that results in reprogramming of the bacterial transcriptome. The abscesses of mice lacking calprotectin were enriched in metal, and staphylococcal proliferation was enhanced in these metal-rich abscesses. These results demonstrate that calprotectin is a critical factor in the innate immune response to infection and define metal chelation as a strategy for inhibiting microbial growth inside abscessed tissue.

Syphilis has a wide range of possible symptoms, making it difficult to diagnose. We report a rare case of liver abscess secondary to Treponema pallidum in a man in Minnesota, USA, who had well-controlled HIV infection. This case emphasizes the importance of appropriate screening for syphilis, especially in high-risk populations.

In this randomized clinical trial in patients presenting to U.S. emergency departments with an acute uncomplicated cutaneous abscess, drainage plus trimethoprim–sulfamethoxazole therapy for a week was associated with modest clinical benefits as compared with drainage alone. Between 1993 and 2005, annual emergency department visits for skin and soft-tissue infections in the United States increased from 1.2 million to 3.4 million, primarily because of an increased incidence of abscesses. 1 , 2 During this period, community-associated methicillin-resistant Staphylococcus aureus (MRSA) emerged as the most common cause of purulent skin and soft-tissue infections in many parts of the world. 3 Trimethoprim–sulfamethoxazole, which has retained in vitro activity against community-associated MRSA, is among the most commonly prescribed antibiotics to treat these infections. 4 The primary treatment of a cutaneous abscess is drainage. 5 Whether adjunctive antibiotics lead to improved outcomes in patients with uncomplicated . . .