title: Surgical management of psoas abscess in the Human Immunodeficiency Virus era.
abstract: OBJECTIVE
  Thai aims of this study were to provide an epidemiological and microbiological analysis of psoas abscess in the human immunodeficiency virus (HIV)-infected population, and to describe the optimal investigative and management approach of this condition.
  
  
  METHODS
  A retrospective chart analysis of 20 patients with a diagnosis of psoas abscess admitted to a regional academic hospital from January 2012 to December 2014 was performed.
  
  
  RESULTS
  Twenty patients with psoas abscess were identified, of which 14 were HIV positive (70%) and five HIV negative (25%). One patient remained untested (5%). The mean CD4 count was 402 cells/mL (range 150-796 cells/mL, median 367 cells/mL). Acid fast bacilli were positive in psoas abscess aspirates in 13 cases (65%). Staphylococcus aureus and Escherichia coli were identified in 15% of cases. The radioisotope bone scan showed increased vertebral uptake in 10 patients (62.5%), with the lumbar spine (L1-L4) being most commonly involved (31%). There was a statistically significant increase in radioisotope uptake in the lumbar vertebrae in tuberculous psoas abscess than in pyogenic psoas abscess (p=0.003). Ultrasound-guided percutaneous drainage was used in 16 patients (80%) with a success rate of 87.5%; only two cases required repeat drainage (12.5%). Open drainage was used in four patients (30%) with a 100% success rate. There were no mortalities at 30-day follow-up.
  
  
  CONCLUSIONS
  Tuberculous psoas abscess from underlying vertebral osteomyelitis is more common than pyogenic psoas abscess. Ultrasound has high diagnostic accuracy and guides percutaneous drainage with excellent success rates. Ultrasound-guided percutaneous drainage should be regarded as the first-line therapeutic modality.
authors.affiliation: King Edward VIII Hospital, Nelson R Mandela School of Medicine, University of Kwazulu Natal, College of Health Sciences, Durban, South Africa.
authors.forename: Raza
authors.initials: R
authors.lastname: Aboobakar
authors.affiliation: Madadeni Hospital, Nelson R Mandela School of Medicine, University of Kwazulu Natal, College of Health Sciences, Durban, South Africa. Electronic address: scheddie@gmail.com.
authors.forename: Shalen
authors.initials: S
authors.lastname: Cheddie
authors.affiliation: King Edward VIII Hospital, Nelson R Mandela School of Medicine, University of Kwazulu Natal, College of Health Sciences, Durban, South Africa.
authors.forename: Bhugwan
authors.initials: B
authors.lastname: Singh
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D015331:Cohort Studies; D015897:Comorbidity; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016659:Psoas Abscess / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D013019:South Africa / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult
keywords: human immunodeficiency virus; percutaneous drainage; psoas abscess; tuberculosis