Mediastinal cyst infection followed by bacteremia due to Streptococcus anginosus after endobronchial ultrasound-guided transbronchial needle aspiration

Hashimoto, T.; Ando, Masayuki; Watanabe, Etsuo; Kadota, Jun‐ichi

doi:10.4103/atm.atm_42_20

Cited by 3 publications

(7 citation statements)

References 9 publications

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“…4 Infecciones por estas bacterias han reportado una variabilidad importante en sus presentaciones clínicas. 5 Estos organismos son cocos microaerofílicos, catalasa-negativos y gram-positivos que forman diminutas colonias y un olor característico a caramelo debido a la producción del metabolito diacetil cuando se cultivan en agar sangre. 4 Estos microorganismos son bacterias de baja virulencia que existen como comensales en la flora oronasal, surcos gingivales, tracto gastrointestinal y tracto urogenital de los humanos.…”

Section: Discussionunclassified

Abscesos múltiples en tórax y abdomen por Streptococcus anginosus: reporte de caso y revisión de literatura

Castañeda¹,

Gutiérrez²,

Cojab³

et al. 2022

Cirujano General

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Introducción: los abscesos intraabdominales se presentan principalmente de manera secundaria a una intervención quirúrgica que por alguna razón se contamina, puede ser como resultado de una apendicitis, perforaciones o trauma. Reporte de caso: se presenta un reporte de caso de abscesos asociados a Streptococcus anginosus en paciente masculino adulto que fue sometido a funduplictura por laparoscopia. Resultados: seis días posteriores a intervención quirúrgica laparoscópica se presenta paciente con datos de infección de origen abdominal con compromiso sistémico, identificándose y tratándose de manera satisfactoria la presencia de abscesos en abdomen y tórax. Conclusiones: se han identificado nuevos agentes capaces de diseminación por diferentes vías, el Streptococcus anginosus pasa cada vez a adquirir mayor relevancia al establecer un diagnóstico y línea de tratamiento.

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Section: Discussionunclassified

Abscesos múltiples en tórax y abdomen por Streptococcus anginosus: reporte de caso y revisión de literatura

Castañeda¹,

Gutiérrez²,

Cojab³

et al. 2022

Cirujano General

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“…[ 11 ] The use of EBUS-TBNA has related complications such as secondary infection and hemorrhage, especially for cystic lesions, which seems to have a greater potential to develop cystic infection, lung abscess, pleural infection or mediastinal infection than solid lesions of the mediastinum. [ 4 , 6 , 9 , 13 , 16 , 25 ] The reported infectious pathogens include Streptococcus, [ 5 – 6 , 16 – 17 , 24 – 25 , 30 – 31 ] Coryneform bacteria and Prevotella melaninogenica, [ 5 ] Staphylococcus, [ 4 , 24 ] Mycobacterium tuberculosis, [ 21 ] Haemophilus Influenza, [ 32 ] Eikenella corrodens, [ 24 , 33 ] Klebsiella pneumonia, Actinomyces odontolyticus, Gemella morbillorum, Prevotella buccae, Actinomyces, [ 30 ] among which the most of the reported bacteria are oral flora. During the procedure of EBUS-BNA, the bronchoscope and needle may be contaminated when passing through the oropharynx, thus carrying bacteria of the oral flora into the cyst.…”

Section: Discussionmentioning

confidence: 99%

“…However, another study reported an efficacy of no more than 46% after aspiration with EBUS-TBNA, with only 5.5% of patients achieving complete remission [11] . The use of EBUS-TBNA has related complications such as secondary infection and hemorrhage, especially for cystic lesions, which seems to have a greater potential to develop cystic infection, lung abscess, pleural infection or mediastinal infection than solid lesions of the mediastinum [4,6,9,13,16,25] . The reported infectious pathogens include Streptococcus, [5–6,16–17,24–25,30–31] Coryneform bacteria and Prevotella melaninogenica, [5] Staphylococcus, [4,24] Mycobacterium tuberculosis, [21] Haemophilus Influenza, [32] Eikenella corrodens, [24,33] Klebsiella pneumonia, Actinomyces odontolyticus, Gemella morbillorum, Prevotella buccae, Actinomyces, [30] among which the most of the reported bacteria are oral flora.…”

Section: Discussionmentioning

confidence: 99%

“…), hemorrhage, and pneumothorax, [12–14,16–17] unusual or rare complications include bronchoscope damage, [12] needle breakage, [18] pneumoperitoneum, [19] haemotympanum, [20] airway obstruction, [21] subcutaneous emphysema, [22] hemothorax, [23] and pericardial abscess [24] . The application of EBUS-TBNA in mediastinal cystic lesions is usually accompanied with a high incidence of infection [4,6,9,13,16,25] . Herein, followed by a literatue review, we reported a patient with severe infections including pneumonia, pleurisy, mediastinitis and mediastinal cyst infection secondary to EBUS-TBNA, aiming to state the utility and complications of EBUS-TBNA in mediastinal cyst settings.…”

Section: Introductionmentioning

confidence: 94%

“…[ 24 ] The application of EBUS-TBNA in mediastinal cystic lesions is usually accompanied with a high incidence of infection. [ 4 , 6 , 9 , 13 , 16 , 25 ] Herein, followed by a literatue review, we reported a patient with severe infections including pneumonia, pleurisy, mediastinitis and mediastinal cyst infection secondary to EBUS-TBNA, aiming to state the utility and complications of EBUS-TBNA in mediastinal cyst settings.…”

Section: Introductionmentioning

confidence: 99%

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Pneumonia, pleurisy, mediastinitis, and mediastinal cyst infection secondary to endobronchial ultrasound-guided transbronchial needle aspiration

et al. 2021

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Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is less commonly used in nonmalignant diseases. In particular, its application in mediastinal cystic lesions has been reported less frequently. EBUS-TBNA is a reassuringly safe procedure with an overall complication rate less than 2%, and serious adverse event rate of 0.14% to 0.16%. The most common complications are infections (mediastinal cyst infection most seen). Patient concerns: A 28-year-old male presented to the hospital with mediastinal cyst that was incidentally discovered by computed tomography. There was no past history of the patient reviewed. Diagnosis: The cyst was identified as a round, anechoic structure by EBUS and serous fluid was aspirated. The carcino-embryonic antigen, mycobacterium tuberculosis DNA and cultures in the fluid were negative. Cytology analysis showed lots of lymphocytes and no malignant cells. The diagnosis of lymphangioma was confirmed based on the computed tomography and EBUS presentation, the nature of the aspirated fluid and the large number of mature lymphocytes within the cystic fluid. Interventions: Twenty-six hours after EBUS-TBNA, the patient complained of a fever with the highest temperature of 39°C, accompanied by a right-side chest pain, no other symptoms of were reported. The following examinations confirmed the diagnosis of pneumonia, pleurisy, mediastinitis and mediastinal cyst infection, while cultures from cyst and right pleural effusion were both negative. The patient was treated with Teicoplanin+Imipenem/cilastatin, and ultrasound guided transcutaneous catheterization drainage of mediastinal cyst and pleural effusion were performed. Outcomes: Seven days after the treatments, the patient's symptoms resolved, the complete blood count, C-reactive protein, erythrocyte sedimentation rate were lowered. The size of the cyst was slightly reduced on 17 June compared to that before EBUS-TBNA. Although the surgical resection of the cyst was recommended, the patient declined. After extracted the two drainage tubes, the patient was discharged on June 22. The patient was followed up by telephone 6 months after discharge and he remained asymptomatic. Conclusions: EBUS-TBNA is a useful diagnostic and therapeutic tool for the management of mediastinal cysts. However, considering the possibility of serious complications, the clinical procedure should be carried out scrupulously with appropriate patient selection and strict aseptic principles.

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Surgical approaches to mediastinal cysts: clinical practice review

Hsu¹,

Banks²,

Velotta³

2022

Mediastinum

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The traditional approach to mediastinal cyst and mass resection has been open via median sternotomy or thoracotomy. With the advent of minimally invasive techniques, there have been successful cases completed via video-assisted thoracoscopic (VATS) and robot-assisted thoracoscopic surgery (RATS). Although mediastinal cysts are uncommon, they are a significant and relevant topic in the practice of thoracic surgery. Thus, this clinical practice review aims to summarize and highlight some of the key case series and retrospective studies in order to provide insight on each of the approaches. In addition, there is a brief review of other approaches, such as subxiphoid, and the utility of endobronchial ultrasound in the management of mediastinal cysts. In this review, the identified benefits of VATS and RATS lie largely in quality improvement of the patient experience—decreased length of stay (LOS) and pain—without compromising patient outcomes. However, the open approach remains a viable option, particularly for the management of large cysts or as a bail-out option. When surgeons approach with VATS or RATS and encounter bleeding or difficult dissection planes, it is consistent in the literature that conversion to thoracotomy is the safe next step. Our clinical practice is to attempt VATS or RATS approach for mediastinal cysts when possible. The data used for this review relies heavily on case reports and case series, and thus is the main limitation of this clinical practice review.

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Mediastinal cyst infection followed by bacteremia due to Streptococcus anginosus after endobronchial ultrasound-guided transbronchial needle aspiration

Cited by 3 publications

References 9 publications

Abscesos múltiples en tórax y abdomen por Streptococcus anginosus: reporte de caso y revisión de literatura

Abscesos múltiples en tórax y abdomen por Streptococcus anginosus: reporte de caso y revisión de literatura

Pneumonia, pleurisy, mediastinitis, and mediastinal cyst infection secondary to endobronchial ultrasound-guided transbronchial needle aspiration

Surgical approaches to mediastinal cysts: clinical practice review

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