C Bures1, V Zielinski2, T Klatte3, N Swietek3, F Kober1, E Tatzgern1, R Bobak-Wieser1, E Gschwandtner1, M Gilhofer4, A Wechsler-Fördös4, M Hermann1. 1. II. Chirurgische Abteilung "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Wien, Österreich. 2. Hals-Nasen-Ohren-Abteilung, Krankenanstalt Rudolfstiftung, Wien Juchgasse 25, 1030, Wien, Österreich. valerie.zielinski@wienkav.at. 3. Universitätsklinik für Urologie, Allgemeines Krankenhaus Wien, Wien, Österreich. 4. Krankenhaushygiene, Krankenanstalt Rudolfstiftung, Wien, Österreich.
Abstract
INTRODUCTION: Surgical site infections after thyroid surgery are mostly superficial and can be well treated. Streptococcal mediastinitis in contrast is a rare but life-threatening complication. CASE REPORT: A 57-year-old female patient experienced septic fever, increase of inflammation parameters and erythema 2 days after thyroid surgery for Graves' disease. This process was triggered by a three-compartment infection by group A Streptococcus (GAS) with involvement of the mediastinum. Therapy over 6 weeks including seven wound revisions with the patient under general anesthesia, pathogen-adapted antibiotic treatment and cervical negative pressure treatment managed to control the infection. A total of 21 cases have been published on this phenomenon, 11 of which had a fatal outcome. CONCLUSION: High fever and surgical site erythema in the early postoperative period after thyroid surgery can be signs of a GAS infection, which might lead to necrotizing, descending, life-threatening mediastinitis. Early diagnosis with support of computed tomography (CT) scans, immediate therapy including wound opening, lavage, intravenous antibiotic treatment with penicillin and clindamycin are vital. If treatment resistance occurs, cervical negative pressure treatment should be considered.
INTRODUCTION: Surgical site infections after thyroid surgery are mostly superficial and can be well treated. Streptococcal mediastinitis in contrast is a rare but life-threatening complication. CASE REPORT: A 57-year-old female patient experienced septic fever, increase of inflammation parameters and erythema 2 days after thyroid surgery for Graves' disease. This process was triggered by a three-compartment infection by group A Streptococcus (GAS) with involvement of the mediastinum. Therapy over 6 weeks including seven wound revisions with the patient under general anesthesia, pathogen-adapted antibiotic treatment and cervical negative pressure treatment managed to control the infection. A total of 21 cases have been published on this phenomenon, 11 of which had a fatal outcome. CONCLUSION: High fever and surgical site erythema in the early postoperative period after thyroid surgery can be signs of a GASinfection, which might lead to necrotizing, descending, life-threatening mediastinitis. Early diagnosis with support of computed tomography (CT) scans, immediate therapy including wound opening, lavage, intravenous antibiotic treatment with penicillin and clindamycin are vital. If treatment resistance occurs, cervical negative pressure treatment should be considered.
Authors: Nikolaos D Nikolaos; Efstratios E Apostolakis; Markos N Marangos; Efstratios N Koletsis; Petros Zampakis; Konstantinos Panagopoulos; Dimitrios Dougenis Journal: Med Sci Monit Date: 2007-07
Authors: R Kaul; A McGeer; A Norrby-Teglund; M Kotb; B Schwartz; K O'Rourke; J Talbot; D E Low Journal: Clin Infect Dis Date: 1999-04 Impact factor: 9.079
Authors: R K Aziz; R Kansal; N F Abdeltawab; S L Rowe; Y Su; D Carrigan; M M Nooh; R R Attia; C Brannen; L A Gardner; L Lu; R W Williams; M Kotb Journal: Genes Immun Date: 2007-05-24 Impact factor: 2.676
Authors: C Bures; R Bobak-Wieser; C Koppitsch; T Klatte; V Zielinski; M Freissmuth; G Friedrich; R Repasi; M Hermann Journal: Br J Surg Date: 2014-09-16 Impact factor: 6.939
Authors: Nicola Avenia; Alessandro Sanguinetti; Roberto Cirocchi; Giovanni Docimo; Mark Ragusa; Roberto Ruggiero; Eugenio Procaccini; Carlo Boselli; Fabio D'Ajello; Francesco Barberini; Domenico Parmeggiani; Lodovico Rosato; Francesco Sciannameo; Giorgio De Toma; Giuseppe Noya Journal: Ann Surg Innov Res Date: 2009-08-05
Authors: T J Musholt; A Bockisch; T Clerici; C Dotzenrath; H Dralle; P E Goretzki; M Hermann; K Holzer; W Karges; H Krude; J Kussmann; K Lorenz; M Luster; B Niederle; C Nies; P Riss; J Schabram; P Schabram; K W Schmid; D Simon; Ch Spitzweg; Th Steinmüller; A Trupka; C Vorländer; T Weber; D K Bartsch Journal: Chirurg Date: 2018-09 Impact factor: 0.955