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Indian Pediatr 2013;50: 887 |
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Authors’ Reply: Primary Neonatal Psoas Abscess
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Rakesh Mondal and *Sumantra Sarkar
Department of Pediatrics, NBMCH Darjeeling, *Department
of Pediatrics, IPGMER Kolkata, India.
Email:
[email protected]
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This correspondence is in relation to the dilemma regarding
primary and secondary psoas abscess as pointed recently [1].
There remains no doubt that primary
abscesses are due to a hematogenous spread due to bacteremia
and secondary abscess occurs as a result of direct spread of
infection from an adjacent structure [2,3]. A case of
primary psoas abscess with spondylodiscitis was published
earlier by us [4]. Hernández-Ros, et al. commented
that all authors must use the recent classification criteria
and accordingly, that patient should have been diagnosed as
secondary rather than primary psoas abscess.
We disagree because our patient, a 26
day-old-neonate, presented with clinical features of
septicemia and it was clearly mentioned that the isolates of
methicillin resistant staphylococcus aureus (MRSA) was
detected in the blood culture. Hematogenous spread of
infection following the bacteremia resulted in the psoas
abscess. Discitis with vertebral body destruction following
primary abscess was a unique presentation in this age group.
Referring to the new classification criteria, as also
pointed out by Hernández-Ros et al., the hematogenous
spread of the infection in our case clearly established the
diagnosis of primary psoas abscess beyond any doubt. Our
diagnosis of primary was not on the basis of organism. It
was not the local spread of infection from nearby structure;
hence it cannot be labeled as secondary psoas abscess.
References
1. Hernández-Ros R, Hernández-Belmonte A.
Psoas Abscess: Primary or Secondary? Indian Pediatr.
2013;50:345-6.
2. Dos Santos VM, Silva Leao CE, Borges
Santos FH, Fastudo CA, Machado Lima RL. Iliopsoas abscess
and spondylodiscitis by Staphylococcus aureus: successful
clinical treatment. Infez Med. 2011;2:120-4.
3. Navarro López V, Ramos JM, Meseguer V,
Pérez Arellano JL, Serrano R, García Ordóñez MA, et al.
Microbiology and outcome of iliopsoas abscess in 124
patients. Medicine (Baltimore). 2009;88:120-30.
4. Mondal R, Sarkar S. Spondylodiscitis with primary
psoas abscess in a neonate. Indian Pediatr. 2012;49:681.
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