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1
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Reyes F, Pecora N, Weiss ZF. Duped by dumping syndrome: non-endemic Vibrio cholerae bacteremia in an immunocompetent host with gastric bypass surgery, a case report. Access Microbiol 2023; 5:000517.v3. [PMID: 37970081 PMCID: PMC10634482 DOI: 10.1099/acmi.0.000517.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 10/13/2023] [Indexed: 11/17/2023] Open
Abstract
Extra-intestinal infection with non-O1/non-O139 strains of Vibrio cholerae (NOVC) is rare, though bacteremia and hepatobiliary manifestations have been reported. Reduced stomach acid, or hypochlorhydria, can increase risk of V. cholerae infection. We describe a 42-year-old woman with hypochlorhydria due to untreated Helicobacter pylori infection, gastric-bypass surgery, and chronic proton pump inhibitors (PPI) exposure, who developed acute diarrhoea following raw oyster consumption. Her symptoms were attributed to rapid gastric emptying (dumping syndrome) after a negative limited stool work-up. She had persistent diarrhoea, weight loss, and after 5 months was admitted with acute cholecystitis and NOVC bacteremia, requiring cholecystectomy. This is the first reported case of NOVC bacteremia and cholecystitis in a patient with gastric bypass. This case highlights the potential for NOVC biliary carriage, the role of hypochlorhydria as a risk factor for Vibrio infection, and the importance of excluding infectious diarrhoea in patients with new onset of symptoms compatible with dumping syndrome and a relevant travel history.
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Affiliation(s)
- Fabiola Reyes
- Brigham and Women’s Hospital, Division of Infectious Diseases, 75 Francis St, Boston, MA, 02115, USA
- Tufts Medical Center, Department of Pathology, 800 Washington St. Boston, MA, 02111, USA
| | - Nicole Pecora
- Brigham and Women’s Hospital, Department of Pathology, 75 Francis St, Boston, MA, 02115, USA
| | - Zoe Freeman Weiss
- Brigham and Women’s Hospital, Division of Infectious Diseases, 75 Francis St, Boston, MA, 02115, USA
- Tufts Medical Center, Department of Pathology, 800 Washington St. Boston, MA, 02111, USA
- Brigham and Women’s Hospital, Department of Pathology, 75 Francis St, Boston, MA, 02115, USA
- Tufts Medical Center, Division of Geographic Medicine and Infectious Diseases, 800 Washington St. Boston, MA, 02111, USA
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Markaki I, Konsoula A, Markaki L, Spernovasilis N, Papadakis M. Acute acalculous cholecystitis due to infectious causes. World J Clin Cases 2021; 9:6674-6685. [PMID: 34447814 PMCID: PMC8362504 DOI: 10.12998/wjcc.v9.i23.6674] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/08/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder not associated with the presence of gallstones. It usually occurs in critically ill patients but it has also been implicated as a cause of cholecystitis in previously healthy individuals. In this subgroup of patients, infectious causes comprise the primary etiology. We, herein, discuss the pathophysiological mechanisms involved in AAC, focusing on the infectious causes. AAC associated with critical medical conditions is caused by bile stasis and gallbladder ischemia. Several mechanisms are reported to be involved in AAC in patients without underlying critical illness including direct invasion of the gallbladder epithelial cells, gallbladder vasculitis, obstruction of the biliary tree, and sequestration. We emphasize that multiple pathogenic mechanisms may concurrently contribute to the development of AAC in varying degrees. Awareness of the implicated pathogens is essential since it will allow a more focused examination of the histopathological specimens. In conclusion, additional research and a high degree of clinical suspicion are needed to clarify the complex spectrum of mechanisms that are involved in the pathogenesis of AAC.
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Affiliation(s)
- Ioulia Markaki
- Department of Emergency, General Hospital of Kythira “Trifyllio”, Kythira 80200, Greece
| | - Afroditi Konsoula
- Department of Emergency, General Hospital of Mytilene "Vostaneio", Lesvos 81132, Greece
| | - Lamprini Markaki
- Department of Pediatrics, "Agia Sofia" Children's Hospital, Athens 11527, Greece
| | | | - Marios Papadakis
- Department of Surgery II, University of Witten-Herdecke, Wuppertal 40235, NRW, Germany
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3
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Botea F, Kraft A, Popescu I. Pathophysiology and Diagnosis of Acute Acalculous Cholecystitis. DIFFICULT ACUTE CHOLECYSTITIS 2021:21-32. [DOI: 10.1007/978-3-030-62102-5_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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4
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Parola P, Anani H, Eldin C, Dubourg G, Lagier JC, Levasseur A, Casalta JP, Raoult D, Fournier PE. Case Report: Vibrio cholerae Biliary Tract Infections in Two North Africans in France. Am J Trop Med Hyg 2020; 102:1306-1308. [PMID: 32207400 DOI: 10.4269/ajtmh.19-0884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The origin of a cholera outbreak may be unclear, as recently in Algeria. In two patients from North Africa, Vibrio cholerae was isolated in the context of hepatobiliary tract infections without any known outbreak. Gallbladder and asymptomatic long-term carriers might play a role in the emergence of cholera.
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Affiliation(s)
- Philippe Parola
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Hussein Anani
- IHU-Méditerranée Infection, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Carole Eldin
- IHU-Méditerranée Infection, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Gregory Dubourg
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Jean-Christophe Lagier
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Anthony Levasseur
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | | | - Didier Raoult
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Pierre-Edouard Fournier
- IHU-Méditerranée Infection, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
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5
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Li CK, Wong OF, Ko S, Ma HM, Lit CHA. A case of nontyphoidal Salmonella gastroenteritis complicated with acute acalculous cholecystitis. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907918782241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Acute acalculous cholecystitis is an acute inflammation of the gall bladder in the absence of gallstones and is known to occur in those critically ill patients, including those after major surgery, patients with trauma or burn, and patients with sepsis and various infectious diseases. Salmonella infection is one of the commonest food-borne illnesses. Although cholecystitis is a well-reported complication of typhoidal Salmonella infection, it is rarely reported in nontyphoidal Salmonella infection. Case Presentation: We report a case of nontyphoidal Salmonella infection complicated by acute acalculous cholecystitis. Prompt diagnosis was made and the patient was recovered after percutaneous cholecystostomy. Conclusion: Acute acalculous cholecystitis is a rare, but potentially lethal, complication of Salmonella infection. The clinical presentation is often subtle; therefore, a high degree of suspicion should be maintained in managing patients with Salmonella infection and ongoing sepsis.
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Affiliation(s)
- Chun Kit Li
- Accident and Emergency Department, North Lantau Hospital, Lantau Island, Hong Kong
| | - Oi Fung Wong
- Accident and Emergency Department, North Lantau Hospital, Lantau Island, Hong Kong
| | - Shing Ko
- Accident and Emergency Department, North Lantau Hospital, Lantau Island, Hong Kong
| | - Hing Man Ma
- Accident and Emergency Department, North Lantau Hospital, Lantau Island, Hong Kong
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Ocampo-Alzate JA, Botero-González N, Botero-Rojas LE, Morales-Alba N. Neuroinfección por Vibrio cholerae no O1/ no O139 secundaria a la derivación ventriculoperitoneal. Reporte de caso. IATREIA 2019. [DOI: 10.17533/udea.iatreia.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
La infección de la derivación ventriculoperitoneal es una de las complicaciones más frecuentes en este procedimiento. Vibrio cholerae O1 y O139 es una bacteria gram negativa conocida principalmente por ser la responsable del cólera epidémico. No obstante, existen serotipos no O1/no O139 capaces de causar afecciones extraintestinales, entre ellas se han reportado casos de neuroinfección. Presentamos el caso de una paciente con 9 meses de edad que posterior a la colocación de una derivación ventriculoperitoneal como tratamiento de hidrocefalia obstructiva congénita, presentó un cuadro de neuroinfección y el síndrome de malfunción valvular; se pudo aislar la Vibrio cholerae no O1/ no O139 en el líquido cefalorraquídeo y en la punta del catéter. Es el primer reporte en la literatura en la que se aísla la Vibrio cholerae no O1/ no O139 en líquido cefalorraquídeo secundario a infección de una derivación ventriculoperitoneal.
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Engel MF, Muijsken MA, Mooi-Kokenberg E, Kuijper EJ, van Westerloo DJ. Vibrio cholerae non-O1 bacteraemia: description of three cases in the Netherlands and a literature review. ACTA ACUST UNITED AC 2017; 21:30197. [PMID: 27104237 DOI: 10.2807/1560-7917.es.2016.21.15.30197] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 01/22/2016] [Indexed: 11/20/2022]
Abstract
Vibrio cholerae non-O1 serogroup (VCNO) bacteraemia is a severe condition with a high case-fatality rate. We report three cases diagnosed in the Netherlands, identified during a national microbiological congress, and provide a literature review on VCNO bacteraemia. A search strategy including synonyms for 'VCNO' and 'bacteraemia' was applied to PubMed, Medline, Web of Science and Embase databases. The three cases were reported in elderly male patients after fish consumption and/or surface water contact. The literature search yielded 82 case reports on 90 cases and six case series. Thirty case reports were from Asia (30/90; 33%), concerned males (67/90; 74%), and around one third (38/90; 42%) involved a history of alcohol abuse and/or liver cirrhosis The presenting symptom often was gastroenteritis (47/90; 52%) which occurred after seafood consumption in 32% of the cases (15/47).Aside from the most frequent symptom being fever, results of case series concurred with these findings. Published cases also included rare presentations e.g. endophthalmitis and neonatal meningitis. Based on the limited data available, cephalosporins seemed the most effective treatment. Although mainly reported in Asia, VCNO bacteraemia occurs worldwide. While some risk factors for VCNO were identified in this study, the source of infection remains often unclear. Clinical presentation may vary greatly and therefore a quick microbiological diagnosis is indispensable.
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Affiliation(s)
- Madelon F Engel
- Medical Microbiology Department, Leiden University Medical Centre, Leiden, the Netherlands
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Deshayes S, Daurel C, Cattoir V, Parienti JJ, Quilici ML, de La Blanchardière A. Non-O1, non-O139 Vibrio cholerae bacteraemia: case report and literature review. SPRINGERPLUS 2015; 4:575. [PMID: 26543710 PMCID: PMC4627963 DOI: 10.1186/s40064-015-1346-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 09/16/2015] [Indexed: 01/12/2023]
Abstract
Non-O1, non-O139 Vibrio cholerae (NOVC) are increasingly frequently observed ubiquitous microorganisms occasionally responsible for intestinal and extra-intestinal infections. Most cases involve self-limiting gastroenteritis or ear and wound infections in immunocompetent patients. Bacteraemia, which have been described in patients with predisposing factors, are rare and poorly known, both on the clinical and therapeutic aspects. We describe a case of NOVC bacteraemia and a systematic literature review in PubMed conducted up to November 2014 using a combination of the following search terms: “Vibrio cholerae non-O1” and “bacter(a)emia”. The case was a 70 year-old healthy male subject returning from Senegal and suffering from NOVC bacteraemia associated with liver abscesses. Disease evolution was favourable after 2 months’ therapy (ceftriaxone then ciprofloxacin). Three hundred and fifty cases of NOVC bacteraemia have been identified in the literature. The majority of patients were male (77 %), with a median age of 56 years and presenting with predisposing conditions (96 %), such as cirrhosis (55 %) or malignant disease (20 %). Diarrhoea was inconstant (42 %). Mortality was 33 %. The source of infection, identified in only 25 % of cases, was seafood consumption (54 %) or contaminated water (30 %). Practitioners should be aware of these infections, in order to warn patients with predisposing conditions, on the risk of ingesting raw or undercooked seafood or bathing in potentially infected waters.
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Affiliation(s)
- S Deshayes
- Service des Maladies Infectieuses et Tropicales, CHU Côte de Nacre, avenue Côte de Nacre, 14033 Caen Cedex 9, France
| | - C Daurel
- Service de Microbiologie, CHU Côte de Nacre, avenue Côte de Nacre, 14033 Caen Cedex 9, France
| | - V Cattoir
- Service de Microbiologie, CHU Côte de Nacre, avenue Côte de Nacre, 14033 Caen Cedex 9, France
| | - J-J Parienti
- Service des Maladies Infectieuses et Tropicales, CHU Côte de Nacre, avenue Côte de Nacre, 14033 Caen Cedex 9, France ; Unité de Biostatistiques, CHU Côte de Nacre, avenue Côte de Nacre, 14033 Caen Cedex 9, France
| | - M-L Quilici
- Centre National de Référence des Vibrions et du Choléra, Institut Pasteur, 28 rue du Docteur Roux, 75724 Paris Cedex 15, France
| | - A de La Blanchardière
- Service des Maladies Infectieuses et Tropicales, CHU Côte de Nacre, avenue Côte de Nacre, 14033 Caen Cedex 9, France
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9
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Chen YT, Tang HJ, Chao CM, Lai CC. Clinical manifestations of non-O1 Vibrio cholerae infections. PLoS One 2015; 10:e0116904. [PMID: 25602257 PMCID: PMC4300187 DOI: 10.1371/journal.pone.0116904] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/17/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Infections caused by non-O1 Vibrio cholera are uncommon. The aim of our study was to investigate the clinical and microbiological characteristics of patients with non-O1 V. cholera infections. METHODS The clinical charts of all patients with non-O1 V. cholera infections and who were treated in two hospitals in Taiwan were retrospectively reviewed. RESULTS From July 2009 to June 2014, a total of 83 patients with non-O1 V. cholera infections were identified based on the databank of the bacteriology laboratories of two hospitals. The overall mean age was 53.3 years, and men comprised 53 (63.9%) of the patients. Liver cirrhosis and diabetes mellitus were the two most common underlying diseases, followed by malignancy. The most common type of infection was acute gastroenteritis (n = 45, 54.2%), followed by biliary tract infection (n = 12, 14.5%) and primary bacteremia (n = 11, 13.3%). Other types of infection, such as peritonitis (n = 5, 6.0%), skin and soft tissue infection (SSTI) (n = 5, 6.0%), urinary tract infection (n = 3, 3.6%) and pneumonia (2, 2.4%), were rare. July and June were the most common months of occurrence of V. cholera infections. The overall in-hospital mortality of 83 patients with V. cholera infections was 7.2%, but it was significantly higher for patients with primary bacteremia, hemorrhage bullae, acute kidney injury, acute respiratory failure, or admission to an ICU. Furthermore, multivariate analysis showed that in-hospital mortality was significantly associated with acute respiratory failure (odds ratio, 60.47; 95% CI, 4.79-763.90, P = 0.002). CONCLUSIONS Non-O1 V. cholera infections can cause protean disease, especially in patients with risk factors and during warm-weather months. The overall mortality of 83 patients with non-O1 V. cholera infections was only 7.2%; however, this value varied among different types of infection.
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Affiliation(s)
- Yen-Ting Chen
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
- * E-mail:
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11
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Liu WL, Chiu YH, Chao CM, Hou CC, Lai CC. Biliary tract infection caused by Vibrio fluvialis in an immunocompromised patient. Infection 2011; 39:495-6. [PMID: 21710120 DOI: 10.1007/s15010-011-0146-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 06/09/2011] [Indexed: 12/17/2022]
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12
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Clinical manifestation and prognostic factors of non-cholerae Vibrio infections. Eur J Clin Microbiol Infect Dis 2011; 30:819-24. [PMID: 21258834 DOI: 10.1007/s10096-011-1162-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 01/04/2011] [Indexed: 12/17/2022]
Abstract
Infections caused by non-cholerae Vibrio are uncommon. From July 2004 to June 2010, a total of 218 isolates of Vibrio species were identified from 171 patients treated at Chi Mei Medical Center, Taiwan. A total of 173 isolates of non-cholerae Vibrio species were isolated from 127 patients. The most common type of infection was acute gastroenteritis (59.8%), followed by skin and soft tissue infection (SSTI) (26.0%) and primary bacteremia (11.0%). Other types of infection included biliary tract infection, peritonitis, and acute otitis media, each at a rate of less than 2%. For patients with acute gastroenteritis, V. parahaemolyticus comprised 92.1% of cases, but V. vulnificus was the most common pathogen causing SSTI. All episodes of bacteremia were caused by V. vulnificus. The all-cause mortality rate was 18.8% of 32 patients with SSTI and the fatality rate was significantly higher among patients with decreased albumin, elevated lactate, use of mechanical ventilation, intensive care unit (ICU) admission, and the presence of shock. In conclusion, non-cholerae Vibrio species caused protean manifestations that vary with the infecting Vibrio species. This epidemiological study helps physicians to better understand the clinical characteristics of infections caused by different non-cholerae Vibrio species.
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Abstract
Acute acalculous cholecystitis (ACC) can develop with or without gallstones after surgery and in critically ill or injured patients. Diabetes mellitus, malignant disease, abdominal vasculitis, congestive heart failure, cholesterol embolization, shock, and cardiac arrest also have been associated with AAC. The pathogenesis of AAC is complex and multifactorial. Ultrasound of the gallbladder is most accurate for the diagnosis of AAC in the critically ill patient. CT is probably of comparable accuracy, but carries both advantages and disadvantages. Rapid improvement may be expected when AAC is diagnosed correctly and cholecystostomy is performed timely.
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Affiliation(s)
- Philip S Barie
- Division of Critical Care and Trauma, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY 0065, USA.
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Abstract
A rare case of acute cholecystitis caused by serogroup O1 Vibrio cholerae in an 83-year-old man is presented. His risk factors for cholecystitis included advanced age and previous abdominal surgeries. The patient had consumed raw oysters several days before presentation. The patient had a poor outcome after admission for this infection, likely due to his underlying illnesses that complicated his hospital course.
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15
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Lai CH, Huang CK, Chin C, Lin HH, Chi CY, Chen HP. Acute acalculous cholecystitis: A rare presentation of typhoid fever in adults. ACTA ACUST UNITED AC 2009; 38:196-200. [PMID: 16500779 DOI: 10.1080/00365540500372655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Adult typhoidal acute acalculous cholecystitis is rare with only 2 cases having been reported in the English literature. We present the case of a previously healthy 36-y-old female who suffered fever, chills, epigastralgia and progressive jaundice for 3 d, with acute acalculous cholecystitis subsequently diagnosed. In addition to antibiotic therapy with ceftriaxone, open cholecystectomy was performed. However, bile and blood culture both showed Salmonella typhi growth unexpectedly, and ileocolitis was revealed by colonoscopy. Careful tracing of the history of the patient recalled a history of travel to Indonesia. In adults without common risk factors for acalculous cholecystitis, a detailed history including travel to endemic areas and high index of suspicion for typhoidal acute acalculous cholecystitis are important, and appropriate antimicrobial therapy for covering Salmonella typhi should be considered.
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Affiliation(s)
- Chung-Hsu Lai
- Department of Infectious Disease, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan, Republic of China
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Yombi JC, Meuris CM, Van Gompel AM, Ben Younes M, Vandercam BC. Acalculous cholecystitis in a patient with Plasmodium falciparum infection: a case report and literature review. J Travel Med 2006; 13:178-80. [PMID: 16706951 DOI: 10.1111/j.1708-8305.2006.00023.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Acute acalculous cholecystitis (AAC) can occur without gallstones in critically ill or injured patients and has also been associated with various infectious agents.(1-4) We report here a case of AAC in a patient with Plasmodium falciparum malaria.
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Affiliation(s)
- Jean C Yombi
- Department of Internal Medicine, Unit of Infectious Diseases, St-Luc University Hospital, Brussels, Belgium
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Abstract
Acute acalculous cholecystitis is defined as acute inflammation of the gallbladder in the absence of gallstones. Patients are usually critically ill with atherosclerotic heart disease, recent trauma, burn injury, surgery, or hemodynamic instability. The presentation of acute acalculous cholecystitis may be insidious, characterized by unexplained fever, leukocytosis, hyperamylasemia, or abnormal aminotransferases, and patients often lack right upper quadrant tenderness. Diagnostic evaluation includes ultrasonography, computerized tomography, and cholescintigraphy. Given the high mortality of untreated disease, definitive treatment consists of cholecystectomy or, in poor surgical candidates, cholecystostomy. Endoscopic therapy with nasobiliary drainage and lavage is an effective treatment option in patients unable to tolerate surgery or cholecystostomy.
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Affiliation(s)
- Charles C Owen
- Department of Medicine, Presbyterian Hospital of Dallas, 8230 Walnut Hill Lane, Suite 610, Dallas, TX 75231, USA.
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Dhar R, Badawi M, Qabazard Z, Albert MJ. Vibrio cholerae (non-O1, non-O139) sepsis in a child with Fanconi anemia. Diagn Microbiol Infect Dis 2004; 50:287-9. [PMID: 15582302 DOI: 10.1016/j.diagmicrobio.2004.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2004] [Accepted: 08/20/2004] [Indexed: 10/26/2022]
Abstract
A 9-year-old female child who was a known case of Fanconi anemia was admitted to hospital because of fever and gastrointestinal symptoms. Blood culture at the time of admission yielded growth of Gram-negative curved rod that was identified as Vibrio cholerae (non-O1, non-O139), whereas repeated fecal cultures were negative for enteropathogens. To our knowledge, this is the first case of V. cholerae (non-O1, non-O139) septicemia associated with Fanconi anemia.
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Affiliation(s)
- Rita Dhar
- Department of Laboratories, Al-Adan Hospital, Hadiya, Kuwait.
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Wang AJ, Wang TE, Lin CC, Lin SC, Shih SC. Clinical predictors of severe gallbladder complications in acute acalculous cholecystitis. World J Gastroenterol 2003; 9:2821-3. [PMID: 14669342 PMCID: PMC4612061 DOI: 10.3748/wjg.v9.i12.2821] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the relationship between clinical information (including age, laboratory data, and sonographic findings) and severe complications, such as gangrene, perforation, or abscess, in patients with acute acalculous cholecystitis (AAC).
METHODS: The medical records of patients hospitalized from January1997 to December 2002 with a diagnosis of acute cholecystitis were retrospectively reviewed to find those with AAC, confirmed at operation or by histologic examination. Data collected included age, sex, white blood cell count, AST, total bilirubin, alkaline phosphatase, bacteriology, mortality, and sonographic findings. The sonographic findings were recorded on a 3-point scale with 1 point each for gallbladder distention, gallbladder wall thickness > 3.5 mm, and sludge. The patients were divided into 2 groups based on the presence (group A) or absence (group B) of severe gallbladder complications, defined as perforation, gangrene, or abscess.
RESULTS: There were 52 cases of AAC, accounting for 3.7% of all cases of acute cholecystitis. Males predominated. Most patients were diagnosed by ultrasonography (48 of 52) or computed tomography (17 of 52). Severe gallbladder complications were present in 27 patients (52%, group A) and absent in 25 (group B). Six patients died with a mortality of 12%. Four of the 6 who died were in group A. Patients in group A were significantly older than those in group B (mean 60.88 y vs. 54.12 y, P = 0.04) and had a significantly higher white blood cell count (mean 15885.19 vs. 9948.40, P = 0.0005). All the 6 patients who died had normal white blood cell counts with an elevated percentage of band forms. The most commonly cultured bacteria in both blood and bile were E. coli and Klebsiella pneumoniae. The cumulative sonographic points did not reliably distinguish between groups A and B, even though group A tended to have more points.
CONCLUSION: Older patients with a high white cell count are more likely to have severe gallbladder complications. In these patients, earlier surgical intervention should be considered if the sonographic findings support the diagnosis of AAC.
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Affiliation(s)
- Ay-Jiun Wang
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, China.
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Abstract
Acute cholecystitis can develop without gallstones in critically ill or injured patients. However, the development of acute acalculous cholecystitis is not limited to surgical or injured patients, or even to the intensive care unit. Diabetes, malignant disease, abdominal vasculitis, congestive heart failure, cholesterol embolization, and shock or cardiac arrest have been associated with acute acalculous cholecystitis. Children may also be affected, especially after a viral illness. The pathogenesis of acute acalculous cholecystitis is a paradigm of complexity. Ischemia and reperfusion injury, or the effects of eicosanoid proinflammatory mediators, appear to be the central mechanisms, but bile stasis, opioid therapy, positive-pressure ventilation, and total parenteral nutrition have all been implicated. Ultrasound of the gallbladder is the most accurate diagnostic modality in the critically ill patient, with gallbladder wall thickness of 3.5 mm or greater and pericholecystic fluid being the two most reliable criteria. The historical treatment of choice for acute acalculous cholecystitis has been cholecystectomy, but percutaneous cholecystostomy is now the mainstay of therapy, controlling the disease in about 85% of patients. Rapid improvement can be expected when the procedure is performed properly. The mortality rates (historically about 30%) for percutaneous and open cholecystostomy appear to be similar, reflecting the severity of illness, but improved resuscitation and critical care may portend a decreased risk of death. Interval cholecystectomy is usually not indicated after acute acalculous cholecystitis in survivors; if the absence of gallstones is confirmed and the precipitating disorder has been controlled, the cholecystostomy tube can be pulled out after the patient has recovered.
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Affiliation(s)
- Philip S Barie
- Department of Surgery, NewYork-Presbyterian Hospital, Weill Medical College of Cornell University, 525 East 68th Street, P-713A, New York, NY 10021, USA.
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21
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Rolain JM, Lepidi H, Harlé JR, Allegre T, Dorval ED, Khayat Z, Raoult D. Acute acalculous cholecystitis associated with Q fever: report of seven cases and review of the literature. Eur J Clin Microbiol Infect Dis 2003; 22:222-7. [PMID: 12687414 DOI: 10.1007/s10096-003-0899-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Q fever is a worldwide-occurring zoonosis caused by Coxiella burnetii. There are various clinical manifestations of acute Q fever, of which acute cholecystitis is a very rare clinical presentation. This study reports seven cases of acute cholecystitis associated with Coxiella burnetii and reviews two other cases from the literature. All patients were admitted to hospital for fever and abdominal pain in the right upper quadrant. Abdominal echography showed a distended gallbladder with biliary sludge without concrements in eight cases and with a single stone in one case. Diagnosis was made by specific serological investigation (microimmunofluorescence assay) for Coxiella burnetii. All nine patients were cured, six after laparoscopic cholecystectomy and three with antibiotics only. Histological examination of the gallbladders showed inflammation in five cases, although Coxiella burnetii was not detected by immunohistochemistry. The results show that laboratory investigations in patients admitted to hospital for symptoms consistent with acute acalculous cholecystitis should include a systematic search for Coxiella burnetii.
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Affiliation(s)
- J M Rolain
- Unité des Rickettsies CNRS UMR-A 6020, IFR 48, Faculté de Médecine, Université de la Méditerranée, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
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22
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Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) tends to have a fulminant course and be associated with critically ill diseases, there have been reports of AAC without any risk factors but good prognosis. GOALS To assess the risk factors, clinical features and prognosis of AAC. STUDY All patients who had a cholecystectomy due to acute cholecystitis at Pundang Jesaeng General Hospital during a 43-month period were prospectively enrolled. AAC was defined by ultrasonographic, intraoperative and pathologic findings of acute cholecystitis without evidence of gallstones. Clinical features and pathologic findings were analyzed and outcome was assessed. RESULTS 156 patients with acute cholecystitis were enrolled and 14% (22 of 156) met the criteria of AAC. Fifteen (68%) of the patients with AAC were male and the average age was 63 year old. Twenty patients were presented with AAC as outpatients of whom seven of them (35%) had atherosclerotic vascular disease. Laparoscopic cholecystectomy was performed in 126 patients (80.8%) with acute cholecystitis but was possible in only 12 patients (54.5%) with AAC. AAC was associated with a high incidence of gangrene (59%) but no patients died of acute cholecystitis. CONCLUSIONS We conclude that AAC frequently occurs in elderly male outpatients without critical illness and gangrene is common but the prognosis is better than reported previously.
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Affiliation(s)
- Ji Kon Ryu
- Digestive Disease Center, Pundang Jesaeng General Hospital, Sungnam, Korea.
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23
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Abstract
The authors present three patients with acalculous cholecystitis seen at a tertiary care center in Bangkok. The first patient was explored surgically because peritonitis was suspected. The two other patients were treated conservatively with antibiotics and supportive care, and they recovered fully. The diagnosis of leptospirosis was confirmed by increasing antibody titers in three patients and by blood culture in one patient. Leptospira were not detected in the surgical specimen. Leptospirosis is a systemic disease that can present with a multitude of symptoms and signs including right upper quadrant pain mimicking cholecystitis. A high level of awareness and appropriate laboratory studies should allow early diagnosis and may prevent unnecessary surgical intervention.
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Affiliation(s)
- R K Vilaichone
- Department of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand
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