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  • Aspiration and excision have been considered as the

    2018-10-22

    Aspiration and excision have been considered as the standard methods of surgical management for order Asiatic acid abscess. The choice between these two procedures has caused a debate about operative strategy. According to updated literature, aspiration is considered the first surgical choice in patients with supratentorial parenchymal brain abscesses. For deep-seated abscesses, multiple abscesses, and abscesses located in eloquent areas, CT-guided stereotactic aspiration is particularly useful because excision is inappropriate in such situations. However, on account of unavailability of proper equipment and techniques, it has been difficult, if not impossible, to perform stereotactic aspiration in resource-limited countries such as Swaziland. In contrast, the use of excision is indicated for lesions that are superficially located, large, solitary, and encapsulated. The advantages of excision include not only reduction of recurrence of the abscess, but also reduced occurrence and recurrence of seizures. Reviewing our case, treated by a combination of direct suction and quick suturing of the incision, we believe that the abscess capsule could be nucleated completely without additional brain damage. In view of the high mortality rate and poor outcome in the current study of HIV co-infection brain abscess management in South Africa, our patient had a superior outcome without significant complications after surgery. According to recent studies, the majority of patients with brain abscess operations yield isolated organisms, which may have formed a contiguous focus of infection. The most common organisms in brain abscess infection are Staphylococcus aureus and Streptococcus milleri, and Mycobacterium tuberculosis infection might also be taken into consideration in immunodeficient patients. In our case, the patient had no history of M. tuberculosis infection, and the content of the abscess was turbid, smelly, yellowish thick pus. However, because pathology and culture results are not easily available in resource-limited countries such as Swaziland, there are limitations in confirming the microbiological diagnosis.
    Introduction Invasive pulmonary aspergillosis (IPA) is a rare, life-threatening infection in liver transplant recipients. The incidence of IPA in liver transplant recipients has been reported to be 1–8%, with a mortality rate ranging from 83% to 88%. Major risk factors associated with IPA include renal insufficiency, requirement for dialysis, cytomegalovirus (CMV) infection, excessive immunosuppression, re-exploration, extensive use of broad-spectrum antibiotics, and organ dysfunction. Early diagnosis, fungicidal therapy, surgical debridement, and reduction in immunosuppression have been reported to contribute to successful treatment. The gold standard for diagnosis involves the use of invasive procedures, such as bronchoscopy and lung biopsy, to obtain tissue specimens for culture and histological examination. Laboratory examinations, such as polymerase chain reaction and detection of galactomannan, have been shown to be beneficial in the assessment of liver transplant recipients. Computed tomography, particularly high-resolution computed tomography (HRCT), has been reported to aid in the early detection of IPA. Hereby we present the case of a liver transplant recipient with primary cutaneous aspergillosis followed by lung involvement, who was managed successfully through detection with the aid of HRCT followed by the administration of a combination antifungal therapy. Surgical intervention was employed for removing the remaining pulmonary lesion.
    Case report Three months after the transplantation, the patient noticed a nodule on his back. Excisional biopsy showed cutaneous aspergillosis with necrotizing inflammation (Fig. 1). There was no fever, jaundice, or any other systemic symptom associated with this incidental finding. A chest radiograph revealed no abnormal finding (Fig. 2A). No antifungal medication was prescribed in the clinic.