Thyroid abscess due to Acinetobacter calcoaceticus: case report and review of the causes of and current management strategies for thyroid abscesses. (Case Report).Abstract: Thyroid abscess abscess, localized inflamation associated with tissue necrosis. Abscesses are characterized by inflamation, which is due to the accumulation of pus in the local tissues, and often painful swelling. was a common condition in the era before antibiotics. In the current medical environment, however, it is a clinical entity that is seldom encountered. We report the case of a unique cause of thyroid abscess, the environmental Gram-negative bacterium Acinetobacter calcoaceticus. Review of the published causes of thyroid abscess since 1980 demonstrated that although Gram-positive bacteria (Staphylococcus staphylococcus (stăf'ələkŏk`əs), any of the pathogenic bacteria, parasitic to humans, that belong to the genus Staphylococcus. The spherical bacterial cells (cocci) typically occur in irregular clusters [Gr. and Streptococcus streptococcus (strĕp'təkŏk`əs), any of a group of gram-positive bacteria, genus Streptococcus, some of which cause disease. species) remain the most common causes, there has been a marked decrease in the number of cases caused by mycobacteria mycobacteria members of the genus Mycobacterium. anonymous mycobacteria see opportunist (atypical) mycobacteria (below). nontubercular mycobacteria see opportunist (atypical) mycobacteria (below). , Salmonella species, and anaerobes when compared with the early part of the 20th century. Patients infected with the human immunodeficiency virus human immunodeficiency virus n. HIV. Human immunodeficiency virus (HIV) A transmissible retrovirus that causes AIDS in humans. , however, still develop mycobacterial mycobacterial emanating from or pertaining to mycobacterium. mycobacterial granuloma may be caused by Mycobacterium tuberculosis (see cutaneous tuberculosis), M. and fungal thyroid infections with some regularity. Reported modes of management of thyroid abscess vary, but drainage remains an integral component of therapy for resolution of the infection. ********** Bacterial thyroid abscess is an uncommon condition. The microbiologic etiology of this process is usually a Grampositive organism such as Staphylococcus or Streptococcus species. Gram-negative suppurative suppurative pertaining to or emanating from suppuration; pus in e.g. suppurative arthritis, bronchopneumonia. thyroiditis Thyroiditis Definition Thyroiditis is inflammation of the thyroid gland, a butterfly-shaped organ next to the windpipe. Description The thyroid is the largest gland in the neck. is rarely reported. We describe what we believe to be the first reported case of primary thyroid-gland infection caused by the Gramnegative rod, Acinetobacter. In addition, we provide an update on the literature regarding the cause and management of thyroid abscess, including the microbiology of thyroid infections occurring in people infected with the human immunodeficiency virus (HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. ). Two large reviews of cases characterized by thyroid abscess or the presence of microorganisms in the thyroid gland have been published in the past 2 decades. Berger et al (1) reviewed 224 cases reported in the English-language literature from 1900 to 1980, and Yu et al (2) reviewed an additional 191 cases from 1980 to April 1997. In this report, we examine the remaining cases of suppurative thyroiditis from 1980 to 2000 not reviewed previously. We discovered 86 additional cases, including our own case report. We compare the pathogens infecting the thyroid (Table 1) found by our literature search with those reported by Berger et al' and Yu et al (2) and also review the treatment course of each case (Table 2). Discussion Thyroid abscess may develop as a complication of acute suppurative thyroiditis, a rare clinical form of thyroiditis. (40,41) Subacute thyroiditis subacute thyroiditis De Quervain's, giant cell, granulomatous thyroiditis Endocrinology Inflammation of thyroid post infection–eg, mumps, influenza, coxsackievirus, adenovirus Clinical Persistent neck pain, hyperthyroidism Risk factors Recent viral infection, (sometimes due to viral infection viral infection, n an infection by a pathogenic virus. A virus acts on the cell nucleus, taking over the genetic material within the nucleus and replicating itself. , sometimes HLA-related) and chronic (Hashimoto's) thyroiditis, an autoimmune disease autoimmune disease, any of a number of abnormal conditions caused when the body produces antibodies to its own substances. In rheumatoid arthritis, a group of antibody molecules called collectively RF, or rheumatoid factor, is complexed to the individual's own gamma , are more common causes of thyroiditis. In his review of 117 patients with thyroiditis, Hendrick (42) found that 28 patients (24%) had acute forms of the condition and that, of those, only 6 (5%) developed an abscess. Thyroid abscess is uncommon because of thyroid gland characteristics such as total encapsulation, secluded anatomic position anatomic position, n a reference posture of the human body, in which the anterior view of the human body is shown standing with legs slightly apart, feet forward, palms facing forward. , an iodine-rich environment, extensive lymphatic drainage lymphatic drainage (lim·faˑ·tik drāˑ·nij), n specific type of massage which supports and assists circulation in the lymphatic system. , and abundant blood flow from bilateral, anastamosing superior and inferior arteries that provide protection by hindering bacterial invasion and growth. (43-46) As a result, even the injection of live staphylococci and streptococci Streptococcus (plural, streptococci) A genus of spherical-shaped anaerobic bacteria occurring in pairs or chains. Sydenham's chorea is considered a complication of a streptococcal throat infection. into the superior thyroid arteries of dogs seldom produces an abscess. (47) Nonetheless, hematogenous hematogenous /he·ma·tog·e·nous/ (he?mah-toj´e-nus) 1. produced by or derived from the blood. 2. disseminated through the blood stream. he·ma·tog·e·nous adj. 1. spread from a distal sit e of infection is still considered to be the most common cause of thyroid infection, even though the exact infectious source or pathway is frequently unknown. (48-50) Cases of thyroiditis with abscess formation have also occurred as complications of congenital abnormalities, such as pyriform pyriform pear-shaped. pyriform apparatus pair of triangular structures in the eggs of anoplocephalid tapeworms surrounding the oncosphere. sinus fistual (51) direct trauma, such as fine-needle aspiration (52) and trauma caused by foreign bodies, such as fish bones (5) and chicken bones. (18) In his 1955 review of thyroiditis, Hazard (52) described streptococci and staphylococci as the two most common causes of acute suppurative thyroiditis. This was still true regarding abscesses in the second part of the 20th century, because these two species were most commonly responsible in the review of Yu et al (2) as well. (53) Regardless of these findings, a host of other organisms have been implicated im·pli·cate tr.v. im·pli·cat·ed, im·pli·cat·ing, im·pli·cates 1. To involve or connect intimately or incriminatingly: evidence that implicates others in the plot. 2. and identified in thyroid infection (Table 1), and abscesses may also be polymicrobial in nature. (38,54,55) Although the predominant causes of these infections are staphylococci and streptococci, there has been a shift in the frequency of other microbiologic causes. Specifically, there have been large decreases during the past century in the prevalence of Salmonella species (40 cases, decreasing to 0 in the current review), anaerobes (8 cases, decreasing to 1 case in the current review) and Mycobacterium tuberculosis Mycobacterium tuberculosis n. Tubercic bacillus. Mycobacterium tuberculosis (21 cases, decreasing to 5 in the present review) as causes of thyroid abscess. The HIV epidemic and its associated variety of unusual opportunistic infections Opportunistic infections Infections that cause a disease only when the host's immune system is impaired. The classic opportunistic infection never leads to disease in the normal host. related to immunosuppression immunosuppression Suppression of immunity with drugs, usually to prevent rejection of an organ transplant. Its aim is to allow the recipient to accept the organ permanently with no unpleasant side effects. have recreated the "old days" of thyroid infections in some ways. Although the introduction of highly active antiretroviral therapy Noun 1. highly active antiretroviral therapy - a combination of protease inhibitors taken with reverse transcriptase inhibitors; used in treating AIDS and HIV drug cocktail, HAART has halted and reversed the pattern of immunosuppression in many patients, patients who are not administered such therapy are at risk for opportunistic infection opportunistic infection n. An infection by a microorganism that normally does not cause disease but becomes pathogenic when the body's immune system is impaired and unable to fight off infection, as in AIDS and certain other diseases. . A recent autopsic study of 100 consecutive Brazilian acquired immunodeficiency syndrome acquired immunodeficiency syndrome, see AIDS. (AIDS) patients with "abnormal" thyroids revealed M. tuberculosis M. tuberculosis, n the bacterium responsible for tuberculosis, generally a respiratory infection in man; nonrespiratory tuberculosis is considered an indicator disease for AIDS. See also tuberculosis. in 23%, cytomegalovirus cytomegalovirus (sī'təmĕg'əlōvī`rəs), member of the herpesvirus family that can cause serious complications in persons with weakened immune systems. in 17%, Cryptococcus Cryptococcus /Cryp·to·coc·cus/ (-kok´us) a genus of yeastlike fungi, including C. neofor´mans, the cause of cryptococcosis in humans.cryptococ´cal Cryp·to·coc·cus n. species in 5%, Mycobacterium mycobacterium Any of the rod-shaped bacteria that make up the genus Mycobacterium. The two most important species cause tuberculosis and leprosy in humans; another species causes tuberculosis in both cattle and humans. avium in 5%, and Pneumocystis Pneumocystis /Pneu·mo·cys·tis/ (-sis´tis) a genus of yeastlike fungi. P. cari´nii is the causative agent of interstitial plasma cell pneumonia. pneu·mo·cys·tis n. carinji in 4%. (56) Other pathogens that have infected the thyroid in the setting of HIV infection include Rhodococcus equi Rhodococcus equi gram-positive rods of varying length; causes corynebacterial pneumonia and abscesses in foals and cervical lymphadenitis in pigs. It has also been associated with suppurative infections in cats. Previously called Corynebacterium equi. See also rattles. , (57) Streptococcus pneumoniae Streptococcus pneu·mo·ni·ae n. Pneumococcus. Streptococcus pneumoniae Microbiology A pathogenic streptococcus with 90 serotypes associated with pneumonia, bacteremia, meningitis Transmission Person to person Incidence , (58) as well as AIDS-related neoplasms, such as Kaposi's sarcoma Kaposi's sarcoma (käp`əshē', kəpō`sē), a usually fatal cancer that was considered rare until its appearance in AIDS patients. and lymphoma. (56) Hazard (52) observed thyroid abscesses more commonly in women than in men, especially in women 20 to 40 years of age. The age range may be considerably broader, however; Hazard cited the age range reported by Higbee (59) of 18 months to 77 years. Although Singer (60) reported similar figures in his review, Yu et a12 noted that the disease occurred in males and females in a 1:1 ratio, both in their review and that of Berger et al. (1) The sex ratio of our patients was 1.5:1 (46 females and 30 males), with an age range of 16 days to 79 years. Our figures may be different from the aforementioned reviews, however, because we had significantly fewer patients than Yu et al (2) and Berger et al. (1) Thyroid abscesses classically begin acutely, frequently after upper respiratory tract, pharynx pharynx (fâr`ĭngks), area of the gastrointestinal and respiratory tracts which lies between the mouth and the esophagus. In humans, the pharynx is a cone-shaped tube about 4 1-2 in. (11.43 cm) long. , or middle-ear infections. (61) Associated signs and symptoms include tenderness, dyspnea dyspnea /dysp·nea/ (disp-ne´ah) labored or difficult breathing.dyspne´ic paroxysmal nocturnal dyspnea , pain (which may radiate laterally and up to the ear), hoarseness, dysphagia dysphagia /dys·pha·gia/ (-fa´jah) difficulty in swallowing. dys·pha·gia or dys·pha·gy n. Difficulty in swallowing or inability to swallow. , fever, and chills. (62) Thyroid abscess has also presented as a pulsatile pulsatile /pul·sa·tile/ (pul´sah-til) characterized by a rhythmic pulsation. pul·sa·tile adj. Undergoing pulsation. pulsatile characterized by a rhythmic pulsation. mass, (63) and there have recently been two reports of vocal cord paralysis Vocal Cord Paralysis Definition Vocal cord paralysis is the inability to move the vocal cords and the resulting loss of vocal cord function. Description as well. (9,21) Although most patients are symptomatic, asymptomatic cases also have been reported. (38) Abnormal laboratory findings indicative of acute suppurative thyroiditis, such as leukocytosis Leukocytosis Definition Leukocytosis is a condition characterized by an elevated number of white cells in the blood. Description Leukocytosis is a condition that affects all types of white blood cells. , increased erythrocyte sedimentation rate Erythrocyte Sedimentation Rate Definition The erythrocyte sedimentation rate (ESR), or sedimentation rate (sed rate), is a measure of the settling of red blood cells in a tube of blood during one hour. , and thyroid scans showing hypofunctional areas with decreased uptake, may also be present. (64) Radiologically, plain x-rays may show esophageal (65) or tracheal tracheal pertaining to or emanating from trachea. tracheal aspiration see transtracheal aspiration. tracheal band sign on contrast radiography of a dilated esophagus, the impression made ventrally by the trachea. (66) displacement, and sonography sonography: see ultrasound and CT may identify the underlying structure and extent of the abscess. (67) Fine-needle aspiration can be performed to confirm the diagnosis of thyroid abscess and to determine both the causative organism and its antibiotic susceptibility. (68) A CT scan is frequently helpful, particularly in patients with recurrent abscesses who have not had such an examination before, in determining the extent of the lesion and possible abnormal local thyroid anatomy. (43) Takai et al (69) recommended that all patients with acute suppurative thyroiditis of unknown origin--especially young patients with recurrent neck abscesses--be evaluated for congenital pyriform sinus fistulae. Har-el et al (43) indicated that all patients who develop acute suppurative thyroiditis and/or thyroid abscess for the first time and those with noninfected cystic thyroid masses (especially left-sided masses) should be evaluated for the presence of congenital pharyngeal pharyngeal /pha·ryn·ge·al/ (fah-rin´je-al) pertaining to the pharynx. pha·ryn·geal or pha·ryn·gal adj. Of, relating to, located in, or coming from the pharynx. sinus fistulae. Park and Park (70) suggested that patients with recurrent thyroid abscess or perithyroidal abscess should be evaluated similarly. They agr eed that CT scan and barium swallow study after the acute phase of the infection are the radiologic studies of choice to demonstrate an occult fistula fistula (fĭs`ch  lə), abnormal, usually ulcerous channellike formation between two internal organs or between an internal organ and the skin. . In these cases of anatomic anomalies (ie, fistulae with the
pyriform sinus or trachea trachea (trā`kēə) or windpipe, principal tube that carries air to and from the lungs. It is about 4 1-2 in. (11.4 cm) long and about 3-4 in. (1.9 cm) in diameter in the adult. ), reparative re·par·a·tive also re·par·a·to·ryadj. 1. Tending to repair. 2. Relating to or of the nature of reparations. surgery is essential to prevent abscesses from recurring. (43,51,71) The most frequently recommended management of a thyroid abscess is surgery, consisting of either excision or incision and drainage Incision and drainage is a minor surgical procedure to release pus or pressure built up under the skin, such as from an abscess or boil. It is performed by treating the area with an antiseptic, such as iodine based solution, and then making a small incision to puncture the skin , combined with culture and appropriate antibiotic therapy (a minority view subscribes to the opinion that thyroid abscesses can be treated with antibiotics alone and that surgery should be used only if antibiotics fail).38 In all cases, empiric, broad-spectrum antibiotic therapy covering Gram-positive cocci cocci /coc·ci/ (kok´si) plural of coccus. cocci [L.] plural of coccus. should be initiated early when a thyroid abscess is suspected because of the acute nature of the infection and the serious complications, which include destruction of the thyroid or parathyroid glands, internal jugular vein internal jugular vein n. A vein that is a continuation of the sigmoid sinus of the dura mater and unites behind the cartilage of the first rib with the subclavian vein to form the brachiocephalic vein. thrombophlebitis thrombophlebitis: see phlebitis. , local or hematologic hematological, hematologic pertaining to or emanating from blood cells. hematological tests total and differential white cell counts, hematocrit estimation, erythrocyte count. spread to other organs, sepsis, and either abscess rupture or fistula formation into the esophagus or trachea. (61,72) Since 1950, fewer than 20% of reported thyroid abscesses were treated without either antibiotics or surgery, but the overall survival rate was still extraordinarily high. Szabo and Allen (73) found that the disease is commonly self-limiting, and lasts from weeks to months. Nevertheless, Robertson (62) reported a 22% mortality rate from suppurative thyroiditis in the era before antibiotics. The case described in this article is unique in that it is the first reported case of primary thyroid abscess caused by Acinetobacter. In 1968, Acinetobacter calcoaceticus was divided into two subspecies subspecies, also called race, a genetically distinct geographical subunit of a species. See also classification. : anitratus and lwoffi. (74) More recent categorization based on DNA-DNA hybridization studies, however, has recognized more than 17 distinct Acinetobacter strains. (75) Approximately 7% of adults and infants younger than 6 months of age display Acinetobacter species in their pharyngeal flora, and as many as one-fourth of adults have skin colonization. (76-78) The spectrum of infections caused by Acinetobacter species includes phlebitis phlebitis (fləbī`tĭs), inflammation of a vein. Phlebitis is almost always accompanied by a blood clot, or thrombus, in the affected vein, a condition known as thrombophlebitis (see thrombosis). , septicemia septicemia (sĕptĭsē`mēə), invasion of the bloodstream by virulent bacteria that multiply and discharge their toxic products. The disorder, which is serious and sometimes fatal, is commonly known as blood poisoning. , bacteremia bacteremia: see septicemia. bacteremia Presence of bacteria in the blood. Short-term bacteremia follows dental or surgical procedures, especially if local infection or very high-risk surgery releases bacteria from isolated sites. , native and prosthetic valve endocarditis prosthetic valve endocarditis, n See endocarditis, infective. , meningitis, osteomyelitis osteomyelitis (ŏs'tēōmī'əlī`tĭs), infection of the bone and bone marrow. Direct infection of bone usually occurs through open fractures, penetrating wounds, or surgical operations. , conjunctivitis conjunctivitis (kənjəngtəvī`təs), inflammation or infection of the mucosal membrane that covers the eyeball and lines the eyelid, usually acute, caused by a virus or, less often, by a bacillus, an allergic reaction, or an , endophthalmitis, corneal corneal pertaining to the cornea. See also keratitis, keratopathy. corneal anomaly includes microcornea, coloboma, megalocornea, dermoid, congenital opacity. corneal black body see corneal sequestrum (below). ulceration, and abscesses of the lung, brain, gut, kidney, pancreas, liver, and skin. (74, 75,79-81) Community-acquired pneumonia associated with Acinetobacter species had a mortality rate of approximately 65% in two case series. (82,83) Antibiotic treatment of Acinetobacter infections should be based on the particular sensitivities of individual isolates, because the organism has developed resistance to multiple drugs, including members of the penicillin, aminoglycoside aminoglycoside /ami·no·gly·co·side/ (-gli´ko-sid) any of a group of antibacterial antibiotics (e.g., streptomycin, gentamicin) derived from various species of Streptomyces , fluoroquinolone fluoroquinolone /flu·o·ro·quin·o·lone/ (-kwin´o-lon) any of a subgroup of fluorine-substituted quinolones, having a broader spectrum of activity than nalidixic acid. fluor·o·quin·o·lone n. , and cephalosporin cephalosporin (sĕf'əlōspôr`ĭn), any of a group of more than 20 antibiotics derived from species of fungi of the genus Cephalosporium and closely related chemically to penicillin. Cephalosporins, e.g. families. (75) This case of thyroid abscess caused by community-acquired Acinetobacter calcoaceticus was treated successfully with ciprofloxacin ciprofloxacin /cip·ro·flox·a·cin/ (sip?ro-flok´sah-sin) a synthetic antibacterial effective against many gram-positive and gram-negative bacteria; used as the hydrochloride salt. cip·ro·flox·a·cin n. . Considering the high prevalence of Acinetobacter species in the environment and the patient's history of intravenous drug use intravenous drug use Intravenous drug abuse The habitual IV injection of drugs of abuse Epidemiology In the US ± 2.5 million–population ± 235 million have used IVDs Infections Pyogenic–eg, endocarditis, pneumonia, sepsis Common agents and unprotected welding, it seems that he may have seeded his thyroid in one of two ways: 1) he may have developed a subclinical subclinical /sub·clin·i·cal/ (sub-klin´i-k'l) without clinical manifestations. sub·clin·i·cal adj. Not manifesting characteristic clinical symptoms. Used of a disease or condition. bacteremia due drug injection with seeding of the thyroid, or 2) the abscess may have developed after trauma after the patient was hit in the neck by particles of flying metal while welding, one or more of which, although too small to detect by current imaging techniques, may have pierced the skin and introduced the bacteria into his thyroid. It is important to note from this case and our review of the recent literature that even though physicians may initially focus on the usual Gram-positive cocci in their approach to and treatment of thyroid abscesses, it is important to exclude less common causes (eg, Gram-negative bacilli bacilli /ba·cil·li/ (bah-sil´i) plural of bacillus. bacilli see bacillus. such as Acinetobacter species). It is thus critical to obtain a specimen for appropriate microbiologic culture before instituting antibiotic therapy. In light of the increasing burden of highly resistant pathogens that the clinician faces, even "standard" pathogens such as Staphylococcus aureus can no longer be presumed to be susceptible to antimicrobial therapy, further complicating the management of infected patients. (84) In addition, the clinician must bear in mind that people with advanced HIV disease are at risk for the development of thyroid abscesses due to pathogens such as M tuberculosis and P. carinii, which are otherwise uncommon in the current clinical environment.
Table 1
Comparison of pathogens described in the reviews of Berger et al, (1) Yu
et al, (2) and present report
Present review
Pure Mixed
Pathogen culture culture Total
Gram-positive aerobic bacteria
Streptococcus species 3 4 7
Staphylococcus species 7 l 8
Corynebacterium
Enterococcus 0 l 1
Gram-positive cocci not specified 0 2 2
Nocardia asteroides 1 0 1
Gram-negative aerobes
Enterobacterianceae
Salmonella species 3 0 3
Escherichia coli 1 2
Klebsiella pneumoniae
Acinetobacter baumanii
Acinetobacter species 1 0
Other not specified
Pseudomonas aeruginosa l 0 l
Haemophilus influenzae 0 1 l
Haemophilus parainfluenzae
Actinobacillus actinomycetemcomitans
Eikenella corrodens 1 2 3
Brucella species
Gram-negative rods unspecified
Gram-positive anaerobes
Peptostreptococcus species 1 0 l
Clostridium septicum 1 0 l
Actinomyces species 0 l 1
Gram-negative anacrobes
Prevotella buccallis 0 l l
Fusobacterium species 0 1 l
Bacteroides species 0 2 2
Gram-negative bacilli 0 l l
Other anaerobes
Fungi
Pneumocystis carinti 0 l l
Aspergillus species
Candida species 1 0 l
Coccidioides immitis 2 0 2
Allescheria boydii
Mycobacterium 5 0 5
Gumma
Parasite
No organism specified or detected 40
Yu et al
Pure Mixed
Pathogen culture culture Total
Gram-positive aerobic bacteria
Streptococcus species 14 14 28
Staphylococcus species 18 l 19
Corynebacterium 0 l l
Enterococcus 1 0 1
Gram-positive cocci not specified 0 1 1
Nocardia asteroides l 0 1
Gram-negative aerobes
Enterobacterianceae
Salmonella species 5 0 5
Escherichia coli 5 0 5
Klebsiella pneumoniae 4 0
Acinetobacter baumanii 1 0
Acinetobacter species 1 0 1
Other not specified
Pseudomonas aeruginosa 5 0 5
Haemophilus influenzae l 1 2
Haemophilus parainfluenzae 0 l l
Actinobacillus actinomycetemcomitans 0 0 0
Eikenella corrodens 2 2 4
Brucella species 3 0 3
Gram-negative rods unspecified 0 1 l
Gram-positive anaerobes
Peptostreptococcus species 4 0 4
Clostridium septicum 0
Actinomyces species
Gram-negative anacrobes
Prevotella buccallis
Fusobacterium species 0 4 4
Bacteroides species 0 3 3
Gram-negative bacilli
Other anaerobes 1 4 5
Fungi
Pneumocystis carinti 16 0 16
Aspergillus species 0 0 0
Candida species 3 0 3
Coccidioides immitis 0 0 0
Allescheria boydii 0 0 0
Mycobacterium 12 0 12
Gumma 0 0 0
Parasite 0 0 0
No organism specified or detected 0 0 0
Berger et al
Pure Mixed
Pathogen culture culture Total
Gram-positive aerobic bacteria
Streptococcus species 31 5 38
Staphylococcus species 20 6 26
Corynebacterium 0
Enterococcus 0
Gram-positive cocci not specified 0
Nocardia asteroides 0
Gram-negative aerobes
Enterobacterianceae
Salmonella species 40 0 40
Escherichia coli
Klebsiella pneumoniae 4
Acinetobacter baumanii l
Acinetobacter species l
Other not specified 6 2 8
Pseudomonas aeruginosa 1 0 1
Haemophilus influenzae 2 0 2
Haemophilus parainfluenzae 0
Actinobacillus actinomycetemcomitans l 0 l
Eikenella corrodens 0
Brucella species 0
Gram-negative rods unspecified 0
Gram-positive anaerobes
Peptostreptococcus species 0
Clostridium septicum l 0 l
Actinomyces species 2 0 2
Gram-negative anacrobes
Prevotella buccallis
Fusobacterium species 0
Bacteroides species 0
Gram-negative bacilli
Other anaerobes 5 3 8
Fungi
Pneumocystis carinti 0
Aspergillus species 0
Candida species 4
Coccidioides immitis 2
Allescheria boydii 0
Mycobacterium 17
Gumma 0
Parasite 0
No organism specified or detected 0 0 0
Table 2
Comparison of pathogens and treatment modalities used (a)
Case report (ref. no.) Causative organism
Chandrcharotensin and Nontuberculous Mycobacterium
Viranuvatti, 1981 (3)
Lalitha et al, 1988 (4) Salmonella cholerae-suis
Coret et al, 1993 (5) No organism specified or detected
Deshmukh et al, 1994 (6) Escherichia coli
Da'as et al, 1997 (7) Candida species
el-Naggar et al, 1997 (8) Gram-positive cocci and Gram-
negative bacilli, not specified
Boyd et al, 1997 (9) Prevotella buccae, Fusobacterium
nucleatum, Bacteroides
Ameh et al, 1998 (10) Streptococcus pyogenes
Pseudomonas
Staphylococcus aureus
No growth
Ahuja et al, 1998 (11) No organism specified or detected
Agarwal et al, 1998 (12) Staphylococcus aureus
Staphylococcus aureus
Diez et al, 1998 (13) No organism specified or detected
Nicollas et al, 1998 (14) No organism specified or detected
Kinoshita et al, 1998 (15) No organism specified or detected
Park et al, 2000 (16) No organism specified or detected
Bass and Muirhead, 2000 (17) No organism specified or detected
Yung et al, 2000 (18) Streptococcus milleri,
Peptococcus, Bacteroides
Chrobok et al, 2000 (19) Streptococcus alpha haeamolyticus
and enterococci
Cases et al, 2000 (20) No organism specified or detected
Myssiorek et al, 2000 (21) No organism specified or detected
Mok et al, 1999 (22) Streptococcus milleri
Carriere et al, 1999 (23) Nocardia asteroides
Pandita and Carson, 1999 (24) Mycobacterium chelonae
Jordan et al, 1998 (25) No organism specified or detected
Smilack and Argueta, 1998 (26) Coccidioides immitis
Coccidioides immitis
Golshan et al, 1997 (27) Haemophilus influenza.
pneumocystis carnii
Winkler et al, 1994 (28) Mycobacterium tuberculosis
Svenungsson and Lindberg, Salmonella enteritidis
1981 (29)
Allan et al, 1990 (30) Mycobacterium (presumed)
Magboo and Clark, 1990 (31) Mycobacterium tuberculosis
Isenberg, 1994 (32) Coagulase-negative
Staphylococcus
Gudipati and Westblom, Salmonella typhimurium
1991 (33)
Taylor et al, 1982 (34) Eubacterium lentum
Streptococcus viridans
Cheng et al, 1988 (35) Eikenella corrodens
Michel et al, 1981 (36) Clostridium septicum
Appelbaum and Cohen, Eikenella corrodens,
1982 (37) Streptococcus, anaerobic
gram-positive cocci
Barton et al, 1988 (38) Escherichia coli,
Staphylococcus aureus
Vichyanoud et al, 1983 (39) Eikenella corrodens, [alpha]-
hemolytic streptococci,
mixed Gram-positive
and Gram-negative anaerobes
Acinetobacter calcoaceticus
Underlying cause of thyroid
Case report (ref. no.) abscess (if specified)
Chandrcharotensin and
Viranuvatti, 1981 (3)
Lalitha et al, 1988 (4)
Coret et al, 1993 (5) Transesophageal migration
of a fish bone
Deshmukh et al, 1994 (6)
Da'as et al, 1997 (7) Neutropenia secondary to
chemotherapy acute
lymphocytic leukemia
el-Naggar et al, 1997 (8) Phayrngeal fistula
Boyd et al, 1997 (9)
Ameh et al, 1998 (10)
Ahuja et al, 1998 (11) Congenital pyriform fossa sinus
Agarwal et al, 1998 (12) Right thumb paronychia
Finger infection
Diez et al, 1998 (13) Pyriform sinus fistula
Nicollas et al, 1998 (14) Fourth branchial pouch anomalies
Kinoshita et al, 1998 (15) Pyriform sinus fistula
Park et al, 2000 (16) Pyriform sinus fistula
Bass and Muirhead, 2000 (17) Pyriform sinus fistula
Yung et al, 2000 (18) Swallowed chicken bone
Chrobok et al, 2000 (19)
Cases et al, 2000 (20) Fourth branchial pouch fistula
Myssiorek et al, 2000 (21)
Mok et al, 1999 (22) Pyriform sinus fistula
Carriere et al, 1999 (23) Immunosuppression after
liver-kidney transplant
Pandita and Carson, 1999 (24)
Jordan et al, 1998 (25) Fourth branchial pouch sinus
Smilack and Argueta, 1998 (26) Immunosuppressed after
corticosteroid therapy
for sarcoidosis
Golshan et al, 1997 (27) AIDS
Winkler et al, 1994 (28)
Svenungsson and Lindberg, Immunosuppression after steroid
1981 (29) therapy for polymyalgia rheumatica
Allan et al, 1990 (30)
Magboo and Clark, 1990 (31)
Isenberg, 1994 (32) Previous fine-needle aspiration
Gudipati and Westblom,
1991 (33)
Taylor et al, 1982 (34) Cutaneous sinus tract leading to
distorted left sinus lobe
Cheng et al, 1988 (35)
Michel et al, 1981 (36) Hematogenous seeding
Appelbaum and Cohen,
1982 (37)
Barton et al, 1988 (38)
Vichyanoud et al, 1983 (39)
Case report (ref. no.) Treatment modality
Chandrcharotensin and I&D and lobectomy
Viranuvatti, 1981 (3)
Lalitha et al, 1988 (4) I&D
Coret et al, 1993 (5) I&D
Deshmukh et al, 1994 (6) Cefuroxime and excision of mass
Da'as et al, 1997 (7) Amphotericin B, I&D
el-Naggar et al, 1997 (8) Surgery to repair pyriform sinus
Boyd et al, 1997 (9) I&D, 7 days of intravenous
antibiotics
Ameh et al, 1998 (10) Empiric antibiotic therapy, I&D
Empiric antibiotic therapy, I&D
Empiric antibiotic therapy, I&D
Empiric antibiotic therapy, I&D
Ahuja et al, 1998 (11) Excision of sinus to level of
pyriform fossa
Agarwal et al, 1998 (12) Empiric antibiotic therapy, I&D
Aspiration plus cloxacillin and
gentamicin
Diez et al, 1998 (13) Antibiotic therapy and extirpation
of fistula
Nicollas et al, 1998 (14) Resection of cyst and fistulous
tract down to pyriform sinus
Kinoshita et al, 1998 (15) Partial thyroidectomy and piriform
sinus fistula closure
Park et al, 2000 (16) Antibiotic therapy (all);
1 patient had sinus tract
surgically excised; 15
had chemocauterization
of sinus or fistulous
tract; lost to follow-up
Bass and Muirhead, 2000 (17) Antibiotic therapy and
hemithyroidectomy with
resection of the fistulous tract
Yung et al, 2000 (18) Piperacillin/tazobactam, I&D
Chrobok et al, 2000 (19) Total left thyroid lobectomy, I&D,
imipenem, and metronidazole
Cases et al, 2000 (20) I&D, hemithyroidectomy, and
fistulectomy
Myssiorek et al, 2000 (21) Hemithyroidectomy
Mok et al, 1999 (22) I&D, excision of fistula with
hemithyroidectomy and inferior
thyroid laminectomy
Carriere et al, 1999 (23) Intravenous imipenem plus
amikacin, I&D, then oral
amoxicillin-clavulanic acid plus
cotrimoxazole
Pandita and Carson, 1999 (24) Thyroid lobectomy followed by
imipenem and clarithromycin
Jordan et al, 1998 (25) Intravenous antibiotic therapy,
I&D, and endoscopic
cauterization of sinus
Smilack and Argueta, 1998 (26) Fluconazole
Fluconazole
Golshan et al, 1997 (27) Ceftizoxime and gentamicin plus
pentamidine and thyroid
lobectomy and isthmusectomy
Winkler et al, 1994 (28) Isoniazid, rifampin, pyrazinamide
Svenungsson and Lindberg, Intravenous ampicillin followed by
1981 (29) intravenous trimethoprim-
sulfamethoxazole
Allan et al, 1990 (30) Rifampin and pyrazinamide
Magboo and Clark, 1990 (31) I&D, partial lobectomy, isoniazid
and rifampin
Isenberg, 1994 (32) Neck exploration and drainage,
vancomycin
Gudipati and Westblom, Intravenous ceftriaxone and
1991 (33) excisional biopsy
Taylor et al, 1982 (34) I&D, antibiotic therapy, subsequent
excision of sinus tract and
thyroid lobectomy
Methacillin plus gentamicin, I&D
Cheng et al, 1988 (35) I&D
Michel et al, 1981 (36) Intravenous penicillin and
gentamicin, right subtotal
lobectomy, and left inferior pole
I&D
Appelbaum and Cohen, I&D, amoxicillin
1982 (37)
Barton et al, 1988 (38) Intravenous gentamicin plus
trimethorpim-sulfamethoxazole
(patient died after
cardiopulmonary arrest before
symptoms resolved or surgery
could be performed)
Vichyanoud et al, 1983 (39) Penicillin
Ciprofloxacin
(a) I&D, incision and drainage; AIDS, acquired immunodeficiency syndrome. Accepted November 16, 2001. References (1.) Berger SA, Zonszein J, Villamena P, Mittman N. Infectious diseases of the thyroid gland, Rev Infect Dis 1983;5:108-122. (2.) Yu EH, Ko WC, Chuang YC, Wu TJ. Suppurative Acinetobacter baumanii thyroiditis with bacteremic bac·te·re·mi·a n. The presence of bacteria in the blood. bac  te·re pneumonia: Case report and review.
Clin Infect Dis l998;27:1286-1290.
(3.) Chandreharoensin C, Viranuvatti V. Tuberculous abscess of the retrosternal thyroid gland displacing the oesophagus oe·soph·a·gus n. Variant of esophagus. oesophagus see esophagus. oesophagus British spelling for esophagus, see there . Diaga Imaging 1981; 50:29-31. (4.) Lalitha MK, Ray AK, Anandi V, John M, Walter A, Devadatta JD. Abscess thyroid due to Salmonella cholerac-suis. A rare presentation of salmonellosis salmonellosis (săl'mənĕlō`sĭs), any of a group of infectious diseases caused by intestinal bacteria of the genus Salmonella, . Indian J Pathol Microbiol 1988;31:324-326. (5.) Coret A, Heyman Z, Bendet E, Amitai M, Itzchak 1I Kronberg J. Thyroid abscess resulting from transesophageal migration of a fish bone: Ultrasound appearance. J C/in Ultrasound l993;21:152-154. (6.) Deshmukh HG, Verma A, Siegel LB, Jacob S, Jankowski CR. Stridor Stridor Definition Stridor is a term used to describe noisy breathing in general, and to refer specifically to a high-pitched crowing sound associated with croup, respiratory infection, and airway obstruction. , the presenting symptom of a thyroid abscess. Postgrad Med J 1994;70:847 (letter). (7.) Da'as N, Lossos IS, Yahalom V, Rund D, Wolf DG, Zelig O, et al. Candida abscess of the thyroid in a patient with acute lymphocytic leukemia acute lymphocytic leukemia n. See acute lymphoblastic leukemia. acute lymphocytic leukemia Acute lymphoblastic leukemia, ALL A malignant lymphoproliferative process that commonly affects children and young adults . Eur J Med Res 1997;2:365-366. (8.) el-Naggar M, Flood LM, Naisby G, Wight R. Acute thyroid abscess in infancy as a complication of pharyngeal fistula. J Otalaryn gal 1997;26:136-138. (9.) Boyd CM, Eselamado RM, Telian SA. Impaired vocal cord mobility in the setting of acute suppurative thyroiditis. Head Neck 1997;19:235-237. (10.) Ameh EA, Sabo SY, Nmada PT. The risk of infective thyroiditis in nodular nodular marked with, or resembling, nodules. nodular dermatofibrosis see dermatofibrosis. nodular episcleritis see nodular fasciitis (below). nodular fasciitis a firm painless nodular swelling, 0. goitres. East Afr Med. J 1998;75:425-427. (11.) Ahuja AT, Griffiths JF, Roebuck DJ, Loftus WK, Lau KY, Yeung CK, et al. The role of ultrasound and oesophagography in the management of acute suppurative thyroiditis in children associated with congenital pyriform fossa sinus. C/in Radial 1998;53:209-211. (12.) Agarwal A, Mishra SK, Sharma AK. Acute suppurative thyroiditis with demonstrable distant primary focus: A report of two cases. Thyroid 1998;8:399-401. (13.) Diez O, Anorbe E, Aisa P, Saez de Ormijana J, Aguirre X, Paraiso M. Acute suppurative thyroiditis secondary to piriform sinus fistula: A case report. Eur J Radiol 1998;29:25-27. (14.) Nicollas R, Ducroz V, Garabedian EN, Triglia JM. Fourth branchial pouch anomalies: A study of six cases and review of the literature, fat J. Pediatr Otorhinalaryngol 1998;44:5-10. (15.) Kinoshita T, Ishii K, Naganuma H, Mon Y, Nakagawa H. Acute suppurative thyroidiris arising from a piriform sinus fistula: CT diagnosis. Rad/at Med 1998;16:217-219. (16.) Park SW, Han MH, Sung MH, Kim IO, Kim KH, Chang KH, et at. Neck infection associated with pyriform sinus fistula: Imaging findings. AJNR AJNR American Journal of Neuroradiology Am J Neuraradiol 2000;2 1:817-822. (17.) Bass J, Muirhead S. Radiological case of the month: Pyriform sinus fistula to the left lobe of the thyroid. Arch Pediatr Adalesc Med 2000; 154:523-524. (18.) Yung BC, Lake TK, Fan WC, Chan JC. Acute suppurative thyroiditis due to foreign body-induced retropharyngeal abscess presented as thyrotoxicosis thyrotoxicosis /thy·ro·tox·i·co·sis/ (thi?ro-tok?si-ko´sis) a morbid condition due to overactivity of the thyroid gland; see Graves' disease. thy·ro·tox·i·co·sis n. . Clin Nucl Med 2000;25:249-252. (19.) Chrobok V, Celakovsky P, Nunez-Femandez D, Simakova E. Acute purulent pu·ru·lent adj. Containing, discharging, or causing the production of pus. Purulent Consisting of or containing pus Mentioned in: Lacrimal Duct Obstruction purulent containing or forming pus. thyroidisis with retropharyngeal retropharyngeal /ret·ro·pha·ryn·ge·al/ (-fah-rin´je-al) 1. pertaining to the posterior part of the pharaynx. 2. posterior to the pharynx. ret·ro·pha·ryn·geal adj. and retrotracheal abscesses. J Laryngol Otol 2000;1 14:151-153. (20.) Cases JA, Wenig BM, Silver CE, Surks MI. Recurrent acute suppurative thyroiditis in an adult due to a fourth branchial pouch fistula. J Clin Endocrinol Metab 2000;85:953-956. (21.) Myssiorek D, Lee J, Shikowitz M, Samataro R. Immobile vocal fold secondary to thyroid abscess: A case report. Ear Nose Throat J 2000; 79:453-455. (22.) Mok JS, Soo G, van Hasselt CA. Recurrent suppurative thyroiditis secondary to piriform sinus fistula. Aust N Z J Surg 1999;69:893-894. (23.) Carriere C, Marchandin H, Andrieu JM, Vandome A, Perez C. Nacardia thyroiditis: Unusual location of infection. J Clin Microbiol 1999;37: 2323-2325. (24.) Pandita D, Carson PJ. Thyroid abscess caused by Mycobacterium chelonae. C/in Infect Dig 1999;28:1183-1184. (25.) Jordan JA, Graves JE, Manning SC, MeClay JE, Biavati MJ. Endoscopic en·do·scope n. An instrument for examining visually the interior of a bodily canal or a hollow organ such as the colon, bladder, or stomach. en cauterization cauterization /cau·ter·iza·tion/ (kaw?ter-i-za´shun) destruction of tissue with a cautery. cauterization destruction of tissue with a cautery. for treatment of fourth brachial brachial /bra·chi·al/ (bra´ke-al) pertaining to the upper limb. bra·chi·al adj. Relating to the arm. brachial pertaining to the forelimb. cleft sinuses. Arch Otalaryngol Head Neck Surg 1998;124:1021-1024. (26.) Smilack JD, Argueta R. Coccidjoidal infection of the thyroid. Arch Intern Med 1998;158:89-92. (27.) Golshan MM, McHenry CR, de Vente J, Kalajyiso RC, Hsu RM, Tomashefski JF. Acute suppurative thyroiditis and necrosis of the thyroid gland: A rare endocrine manifestation of acquired immunodeficiency syndrome. Surgery 1997;121 :593-596. (28.) Winkler S, Wiesinger E, Graninger W. Extrapulmonary tuberculosis with paravertebral abscess formation and thyroid involvement. Infection 1994;22:420-422. (29.) Svenungsson B, Lindberg AA. Acute suppurative Salmonella thyroiditis: Clinical course and antibody response. Scand J Infect Dig 1981;13:303-3 06. (30.) Allan R, O'Flynn W, Clarke SE. Tuberculosis of the thyroid bed presenting as recurrent medullary medullary /med·ul·lary/ (med´ah-lar?e) 1. pertaining to a medulla. 2. pertaining to bone marrow. 3. pertaining to the spinal cord. thyroid carcinoma. Tubercle tubercle (t  `bərkyl') [Lat.,=little swelling], small, usually solid, nodule or prominence. 1990;71: 301-302.
(31.) Magboo ML, Clark OH. Primary tuberculous tuberculous /tu·ber·cu·lous/ (too-ber´ku-lus) pertaining to or affected with tuberculosis; caused by Mycobacterium tuberculosis. tu·ber·cu·lous adj. 1. thyroid abscess mimicking carcinoma diagnosed by tine tine (tin) a prong or pointed projection on an implement, as on a fork. tine n. 1. The slender pointed end of an instrument, such as an explorer used in dentistry. 2. needle aspiration biopsy Needle aspiration biopsy (NAB), also known as fine needle aspiration cytology (FNAC), fine needle aspiration biopsy (FNAB) and fine needle aspiration (FNA . West J Med 1990;153:657-659. (32.) Isenberg SF. Thyroid abscess resulting from fine-needle aspiration. Otalaryngol Head Neck Surg 1994;1ll:832-833. (33.) Gudipati S, Westblom TU. Salmonellosis initially seen as a thyroid abscess. Head Neck 1991;13:153-155. (34.) Taylor WE Jr, Myer CM III, Hays LL, Cotton RT. Acute supporative thyroiditis in children. Laryngascope 1982;92: 1269-1273. (35.) Cheng AF, Man DW, French GL. Thyroid abscess caused by Eikenella corrodens. J infect 1988;16:181-185. (36.) Michel RG, Hall DM, Woodard BH. Gas-forming suppurative thyroiditis. Ear Nose Throat J 1981;60:127-130. (37.) Appelbaum PC, Cohen cohen or kohen (Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male. IT. Thyroid abscess associated with Eikenella corrodens in a 7-year-old child. Clin Pediatr (Phila) 1982;21:241-242. (38.) Barton GM, Shoup WB, Bennett WG, Williams IB, Vesely DL. Combined Escherichia coli and Staphylococcus aureus thyroid abscess in an asymptomatic man. Am J Med Sci 1988;295: 133-136. (39.) Viohyanond P, Howard CP, Olson LC. Eikenella corrodens as a cause of thyroid abscess. Am J Dis Child 1983;137:971-973. (40.) Hay ID. Thyroiditis: A clinical update. Mayo Clin Proc 1985;60:836-843. (41.) Hamburger JI. Thc various presentations of thyroiditis: Diagnostic considerations, Ann Intern Med 1986; 104:219-224. (42.) Hendrick JW. Diagnosis and treatment of thyroiditis. Ann Surg 1956; 144:176-187. (43.) Har-el G, Sasaki CT, Prager D, Krespi YP. Acute suppurative thyroiditis and the branchial branchial /bran·chi·al/ (brang´ke-al) pertaining to or resembling gills of a fish or derivatives of homologous parts in higher forms. bran·chi·al adj. apparatus. Am J Ololaryngol 1991;12:6-11. (44.) Burhans EC. Acute thyroiditis: A study of 67 cases. Surg Gynecol Obstet 1928;47:478-488. (45.) Williamson OS. The applied anatomy and physiology of the thyroid apparatus. Br J Surg 1926;13:466-496. (46.) Thompson L. Syphilis of the thyroid. Am J Syphilis 1917;1:179-191. (47.) Womack NA, Cole WH. Thyroiditis. Surgery 1944; 16:770 -782. (48.) Premawardhana LD, Vora JP, Scanlon MF. Suppurative thyroiditis with oesophageal oesophageal see esophageal. carcinoma. Postgrad Med J 1992;68:592-593. (49.) Cotran RS, Kumar V, Robbins SL. The endocrine system, in Cotran RS, Kumar V, Robbins SL (eds): Robbins Pathologic Basis of Disease. Philadelphia, W.B. Saunders, 1994, ed 5, pp 1125-1128. (50.) Hawbaker EL. Thyroid abscess. Am Surg 1971;37:290-292. (51.) Lucaya J, Berdon WE, Enriquez G, Regas J, Carreno JC. Congenital pyriform sinus fistula: A cause of acute left-sided suppurative thyroiditis and neck abscess in children. Pediatr Radiol 1990;21:27-29. (52.) Hazard JB. Thyroiditis: A review-Part 1. Am J Clin Pathol 1955;25: 289-298. (53.) Slatosky J, Shipton B, Wahba H. Thyroiditis: Differential diagnosis and management. Am Fam Physician 2000;61: 1047-1054. (54.) Kirkland RT, Kirkland JL, Rosenberg HS, Harberg FJ, Librik L, Clayton GW. Solitary thyroid nodules in 30 children and report of a child with a thyroid abscess. Pediatrics 1973;51:85-90. (55.) Levy RP, Kramer JC. Recurrent acute thyroiditis. Ant J Dis Child 1954; 88:81-83. (56.) Basilio de Oliveira CA. Infectious and neoplastic neoplastic /neo·plas·tic/ (ne?o-plas´tik) 1. pertaining to a neoplasm. 2. pertaining to neoplasia. neoplastic pertaining to neoplasia or a neoplasm. disorders of the thyroid in AIDS patients: An autopsy study. Braz J Infect Dis 2000;4:67-75. (57.) Martin-Davila P, Quereda C, Rodriguez H, Navas E, Fortun J, Meseguer M, et al. Thyroid abscess due to Rhodococcus equi in a patient infected with the human immunodeficiency virus. Eur J Clin Microbial microbial pertaining to or emanating from a microbe. microbial digestion the breakdown of organic material, especially feedstuffs, by microbial organisms. Infect Dis 1998; 17:55-57. (58.) DiNubile MJ, Albornoz MA, Stumacher RJ, Van Uitert BL, Paluzzi SA, Bush LM, et al. Pneumococeal soft-tissue infections: Possible association with connective tissue diseases. J Infect Dis 1991;163:893-900. (59.) Higbee D. Acute thyroiditis in relation to deep infections of the neck. Ann Otol Rhinol Larnyngol 1943;52:620-627. (60.) Singer PA. Thyroiditis: Acute, subacute, and chronic. Med Clin North Am 1991;75:61-77. (61.) Schweitzer VG, Olson NR. Thyroid abscess. Otolaryngol Heed Neck Surg 1981;89:226-229. (62.) Robertson WS. Acute inflammation of the thyroid gland. Lancet 1911; 1:930-931. (63.) Baker SR, van Merwyk AJ, Singh A. Abscess of the thyroid gland presenting as a pulsatile mass. Med J Aust 1985; 143:253-254. (64.) Rohn RD, Rubio T. Neck pain due to acute suppurative thyroiditis and thyroglossal duct abscess. J Adolesc Health Care 1980;1:155-158. (65.) Chandreharoensin C, Viranuvatti V. Tuberculous abscess of the retrosternal thyroid gland displacing the oesophagus. Diagn Imaging 1981; 50:29-31. (66.) Miyauchi A, Matsuzuka F, Takai S, Kuma K, Kosaki G. Piriform sinus fistula: A route of infection in acute suppurative thyroiditis. Arch Surg 1981;116:66-69. (67.) el-Silimy O, Corney C. The value of sonography in the management of cystic neck lesions. J Laryngol Otol 1993;107:245-251. (68.) Donato JO. Acute suppurative thyroiditis: Report of two cases. Int Surg 1972;57:750-752. (69.) Takai SI, Miyauchi A, Matsuzuka F, Kuma K, Kosaki G. Internal fistula as a route of infection in acute suppurative thyroiditis. Lancet 1979; 1:751-752. (70.) Park BW, Park CS. Pyriform sinus fistula. Yonsei Med J 1993;34:386-390. (71.) Lyerly HK. Thyroiditis, in Sabiston DC Jr, Lyerly HK (eds): Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Philadelphia, W.B. Saunders, 1997, ed 15, pp 623-626. (72.) Adler ME, Jordan G, Walter RM Jr. Acute suppurative thyroiditis: Diagnostic, metabolic and therapeutic observations. West J Med 1978;128: 165-168. (73.) Szabo SM, Allen DB. Thyroiditis: Differentiation of acute suppurative and subacute-Case report and review of the literature. Clin Pediatr (Phila) 1989;28: 171-174. (74.) Gradon JD, Chapnick EK, Lutwick LI. Infective endocarditis of a native valve due to Acinetobacter: Case report and review. Clin Infect Dis 1992;14:1145-1148. (75.) Allen DM, Hartman BJ. Acinetobacter species, in Mandell GL, Bennett JE, Dolin R (eds): Mandell. Douglas, and Bennett's Principles and Practice of Infectious Diseases. New York, Churchill Livingstone, 1995, vol 2, ed 4, pp 2009-2013. (76.) Rosenthal S, Tager IB. Prevalence of gram-negative rods in the normal pharyngeal flora. Ann Intern Med 1975;83:355-357. (77.) Baltimore RS, Duncan RL, Shapiro ED, Edberg SC. Epidemiology of pharyngeal colonization of infants with aerobic gram-negative rod bacteria. J Clin Microbial 1989;27:91-95. (78.) Al-Khoja MS, Darrell JH. The skin as the source of Acinetobacter and Moresella species occurring in blood cultures. J Clin Pathol 1979;32:497-499. (79.) Henriksen SD. Moraxella. Acinetobacter, and the Mimeae. Bacterial Rev 1973;37:522-561. (80.) Albu E, Moreira D, Faltous A, Saraiya RJ, Gerst PH. Intramural intramural /in·tra·mu·ral/ (-mu´r'l) within the wall of an organ. in·tra·mu·ral adj. Occurring or situated within the walls of a cavity or organ. abscess of the duodenum duodenum: see intestine; pancreas. duodenum First and shortest (9–11 in., or 23–28 cm) segment of the small intestine. It curves down and then up from the pylorus of the stomach, where chyme enters it. resulting from perforated peptic ulcer. South Med J 1995;88: 1078-1080. (81.) Glew RH, Moellering RC Jr, Kunz LJ. Infections with Acinetobacter calcoaceticus (Herellea vaginicola): Clinical and laboratory studies. Medicine (Baltimore) 1977;56:79 -97. (82.) Cordes LG, Brink EW, Checko PJ, Lentnek A, Lyons RW, Hayes PS, et al. A cluster of Acinetobacter pneumonia in foundry workers. Ann intern Med 1981;95:688-693. (83.) Anstey NM, Curie Curie (kürē`), family of French scientists. Pierre Curie, 1859–1906, scientist, and his wife, Marie Sklodowska Curie, 1867–1934, chemist and physicist, b. BJ, Withnall KM. Community-acquired Acinetobacter pneumonia in the Northern Territory of Australia. Clin Infect Dis 1992;14:83-91. (84.) Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. . Staphylococcus aureus with reduced susceptibility to vancomycin: Illinois, 1999. MMWR MMWR Morbidity & Mortality Weekly Report Epidemiology A news bulletin published by the CDC, which provides epidemiologic data–eg, statistics on the incidence of AIDS, rabies, rubella, STDs and other communicable diseases, causes of mortality–eg, Morb Mortal Wkly Rep 2000;48:1165-1167. RELATED ARTICLE: Case Report A previously healthy 34-year-old male smoker with an 11-year history of intravenous cocaine use was admitted to the hospital because of 2 days of fever, cough, neck swelling, and pain. The patient reported having last injected drugs into his forearm 1 week before admission, and stated that 5 days before admission he had been hit in his upper body by numerous particles while welding metal without a protective mask. He denied a history of thyroid disease, recent infections, dental work, prior hospitalizations, sharing needles, alcohol abuse, or injecting drugs in any site other than his forearms. At admission to the hospital, he appeared acutely ill and diaphoretic diaphoretic /di·a·pho·ret·ic/ (-fo-ret´ik) 1. pertaining to, characterized by, or promoting sweating. 2. an agent that promotes sweating. di·a·pho·ret·ic adj. . Vital signs included a fever of 39.4[degrees]C. Examination of his neck revealed submandibular submandibular /sub·man·dib·u·lar/ (sub?man-dib´u-ler) below the mandible. submandibular (sub´mandib´y lymphadenopathy lymphadenopathy /lym·phad·e·nop·a·thy/ (-op´ah-the) disease of the lymph nodes. angioimmunoblastic lymphadenopathy , angioimmunoblastic lymphadenopathy with dysproteinemia and a smooth, palpable, firm, tender, anterior mass on the left side (Fig. 1). No injection sites were noted in the neck. The oral cavity was intact, with no obvious oral or dental lesions or abscesses. Cardiac examination revealed no murmurs. The remainder of the patient's physical examination was normal. The white blood cell (WBC WBC white blood cell; see leukocyte. WBC abbr. white blood cell WBC, n stands for white blood cell. ) count was 19,500/[mm.sup.3] (78% granulocytes Granulocytes White blood cells. Mentioned in: Blood Donation and Registry granulocytes (granˑ·y and 10% lymphocytes), and results of the remainder of the routine laboratory tests were normal. Urine toxicology screening was positive for benzoylecgonine. X-rays of both the neck and chest were unremarkable. Computed tomography (CT) of the neck with contrast demonstrated a low-attenuation, fluidlike mass spanning the left lobe of the thyroid and extending down to the midthorax (Fig. 2). Subsequently, a fineneedle aspiration of the thyroid fluctuance was p erformed, and the fluid was sent for culture and histopathologic examination. Empiric therapy with intravenous clindamycin (600 mg every 8 h) was then begun. During the next 24 hours, the patient defervesced, improved clinically, and his WBC count decreased to 17,400/[mm.sup.3]. On the third hospital day, the thyroid aspirate as·pi·rate v. To take in or remove by aspiration. n. A substance removed by aspiration. Aspirate The removal by suction of a fluid from a body cavity using a needle. culture grew Acinetobacter calcoaceticus subsp twoffi, and treatment with intravenous ciprofloxacin (500 mg every 12 h) was added to the clindamycin therapy. The HIV antibody test was negative, and two blood cultures drawn at admission showed no growth. The patient subsequently signed himself out of the hospital and was given a prescription to continue his ciprofloxacin in tablet form. He was lost to subsequent follow-up. Key Points * Staphylococcus and Streptococcus species remain the most common causes of bacterial thyroid abscesses. * In the era of antibiotics, thyroid abscesses caused by mycobacteria, Salmonella species, and anaerobes are rare. * Spontaneous abscess formation is rare; there is frequently a history of preceding trauma, bacteremia, or the presence of congenital structural abnormalities of the thyroid. * Surgical drainage is an integral component of therapy. * Coinfection with human immunodeficiency virus puts the patient at risk for unusual types of thyroid abscesses (eg, Pneumocystis carinii). From the Department of Medicine, The Johns Hopkins University School of Medicine The Johns Hopkins University School of Medicine, located in Baltimore, Maryland, USA, is a highly regarded medical school and biomedical research institute in the United States. , and the Department of Medicine, Sinai Hospital, Baltimore, MD. Reprint requests to Jeremy D. Gradon, MD, Department of Medicine, Sinai Hospital of Baltimore, 2401 W. Belvedere Avenue, Baltimore, MD 21215. Copyright [C] 2003 by The Southern Medical Association 0038-4348/0319603-0300 |
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