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PubMed1991

Epizootic of external and internal abscesses in a large goat herd over a 16-year period.

From 1973 through 1988, 518 external and internal abscesses were diagnosed in a large commercial goat herd. Of the 518 abscesses, 238 were primary and 280 were secondary abscesses in the same or other anatomic locations. During this period, the herd varied in size from 94 goats in 1973 to 431 goats in 1988. Abscesses in the jaw area were detected in 141 goats, 4 of which developed osteomyelitis of the mandible. Sternal abscesses were detected in 72 goats, with 2 also having osteomyelitis of the sternum diagnosed at necropsy. Most of the abscesses were in the jaw, sternal, facial, and cervical areas. Lung abscesses were diagnosed at necropsy in 20 goats that most recently had 1 or more superficial abscesses. Abscess incidence was 27.6% (112 of 406) in wethers and 22.9% (154 of 687) in does. Actinomyces pyogenes was isolated most frequently by bacteriologic culture of abscess specimens and about 3 times as often as was Corynebacterium pseudotuberculosis or Staphylococcus sp, usually coagulase-positive S aureus. Bacteriologic culture of blood samples, taken during abscess episodes, yielded A pyogenes (n = 3) or C pseudotuberculosis (n = 1) in 3 goats. Results of antibiotic treatment of abscesses were disappointing, with little evidence of altering the course of the disease or sterilizing the abscess, despite the fact that the bacteria were susceptible in vitro to the antibiotics used. Excision of intact abscesses was the preferred treatment for abscesses of the jaw and facial areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMedDate not supplied

Hepatic abscess.

Hepatic abscess--amebic or pyogenic--can be diagnosed with great accuracy by either ultrasonography or computed tomographic (CT) scanning. Ultrasound is the modality of choice and will detect almost 100% of abscesses. Confirmation of a diagnosis of amebic liver abscess is made by the indirect hemagglutination test that should be positive in almost 100% of cases. Cultures of pus from the abscess and from the blood must be obtained in cases of pyogenic liver abscess. A positive culture of pus from the abscess has been achieved in 90% of cases. Ultrasound or CT guidance is utilized in aspiration of a hepatic abscess. In the treatment of an amebic liver abscess, metronidazole is the amebicide of choice. Open drainage is contraindicated. For cases that fail to respond to therapy with amebicides, closed drainage guided by CT or ultrasound is performed. Secondary bacterial infection of an amebic liver abscess is an extremely rare event. The identification and determination of the antibiotic sensitivity of organisms responsible for pyogenic liver abscess is a crucially important step. Unless a celiotomy is necessary to correct an intraabdominal process or the abscess is extremely large, the initial treatment of pyogenic liver abscess is a 2 week course of appropriate antibiotics followed by a 1 month course of oral antibiotics. The majority of pyogenic liver abscesses will respond to such treatment. If drainage of a pyogenic abscess is required, the preferable technique is with a percutaneous CT- or ultrasound-directed catheter.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

A comparison of amebic and pyogenic abscess of the liver.

We evaluated the clinical features of 96 cases of amebic liver abscess and 48 of pyogenic hepatic abscess. Most patients with amebic abscess were young Hispanic males. Those with pyogenic abscess were older, without any ethnic predominance. Symptoms tended to be acute and localized to the right upper quadrant in amebic infection. In pyogenic disease, symptoms were often nonspecific and chronic in nature. A marked shift to the left of the leukocyte count occurred more frequently in pyogenic abscess, as did markedly abnormal values of the serum albumin, direct bilirubin, lactic dehydrogenase and aspartate aminotransferase. Sonography detected all cases of amebic abscess and missed the lesions in 2 of 39 patients with pyogenic abscess. Abscess cultures yielded pathogens in 90% of cases of pyogenic disease, while blood cultures were positive in 50%. Five of 20 patients with positive blood cultures had additional organisms isolated from the abscess that would have required adjustment of antibiotics for optimal coverage. We believe that all pyogenic abscesses should be aspirated to guide antibiotic therapy. In amebic abscess, the diagnosis was usually based on clinical and sonographic findings, aspiration being performed in only 14% of cases. Ninety-eight percent of patients were treated with amebicidal agents alone, and all responded to therapy. Therapeutic needle aspiration is rarely necessary. In pyogenic abscess, prolonged fever was common during medical therapy. Even in those eventually cured without surgery, the median time to defervescence was 8 days. Though 19 patients underwent surgical drainage, only 2 clearly did not benefit from medical treatment, having high fevers after more than 2 weeks on a regimen of appropriate antibiotics. Surgery is often performed prematurely because physicians expect fever to resolve quickly, but persistent fever of less than 2 weeks' duration should not constitute an indication for surgical drainage. Seven patients with pyogenic abscess died, 5 as a result of hepatic abscess. In 3 of these cases, the diagnosis was unsuspected till autopsy. Improved awareness of this disease may decrease morbidity and mortality from this treatable condition.

Adult↗
PubMed2000

Pyogenic liver abscess.

BACKGROUND: A current assessment of liver abscesses should allow for better understanding of the pathogenesis of the disease and improve the effectiveness of diagnosis and treatment. Amebic liver abscess occurs more commonly than pyogenic liver abscess on a worldwide basis. However, in the United States, pyogenic liver abscess predominates. The purpose of our study was to evaluate the etiology, management, morbidity, and mortality of all patients admitted to our medical center with diagnoses of pyogenic liver abscess between 1983 and 1996. METHODS: A retrospective chart review was performed on all patients admitted to our medical center, Louisiana State University Medical Center, Shreveport, with diagnoses of pyogenic liver abscess. RESULTS: Twenty patients were admitted with diagnoses of pyogenic liver abscess. The subjects were 65% (13/20) male and 65% (13/20) African-American and had an average age of 52 years. The most common presenting symptoms were fever and pain. The most common physical finding was right upper-quadrant tenderness. The most common etiologies of pyogenic liver abscesses were cryptogenic, trauma, and biliary, while portal vein was the source for only 10% of the cases. The right lobe of the liver was involved in 95% of the cases, and 70% of these liver abscesses were solitary. Computed tomography (CT)-and ultrasound-guided percutaneous drainage were performed in 85% (17/20) of patients with liver abscesses. One patient was treated by open drainage, three patients were treated with antibiotics alone, and three patients did not respond to aspiration and catheter placement, which subsequently required open drainage. The culture results were as follows: 50% were gram-negative organisms, 25% were gram-positive organisms, 10% were anaerobic organisms, and 15% of the abscess were sterile. Sixty percent of the positive abscess cultures were polymicrobial. CONCLUSIONS: CT scan- and ultrasound-guided percutaneous drainage of pyogenic liver abscesses were safe and effective methods of treatment. The right lobe of the liver was involved in 95% of cases. Although no one species predominated, gram-negative bacteria were the most common organism cultured, and 60% of the abscesses were polymicrobial. There was no in-house mortality in this review.

Adult↗
PubMed2005

Identification of Staphylococcus aureus brain abscesses: rat and human studies with 1H MR spectroscopy.

PURPOSE: To determine the feasibility of a statistical classification strategy (SCS) and the identity of metabolites of bacterial and host origins that potentially contributed to the most discriminatory regions of magnetic resonance (MR) spectra from Staphylococcus aureus abscesses of biopsy material from controls, gliomas, and staphylococcal abscesses. MATERIALS AND METHODS: Human and animal study received ethics committee approval, and informed patient consent was obtained. A rat model of S aureus brain abscess was developed. Histologic and microbiologic examination was performed to assess abscess development 3-4, 6-8, and 10-15 days after initiation. Metabolite profiles in pus (n = 62) and controls (n = 37) were characterized with ex vivo MR spectroscopy and compared with data from rat gliomas (n = 27). SCS, optimal region selection, and development of pairwise classifiers allowed MR spectra of abscesses (n = 42, day 6-8) to be distinguished from those of glioblastoma multiforme and controls. MR spectroscopy profiles of pus from animal abscesses were compared with in vivo MR spectra from patients with staphylococcal brain abscesses (n = 7, aged 6-67 years) and ex vivo pus MR spectra from patients with S aureus abscesses. RESULTS: Histologically confirmed abscesses were present 6-8 days after stereotactic injection of S aureus in 42 of 47 rats (89%). MR spectra of abscesses and glioblastoma multiforme in the animal model were similar. Typical metabolites of abscesses due to anaerobe bacteria (acetate, succinate, amino acids) were not detectable in S aureus abscesses in rats or humans. MR spectroscopic findings from controls, abscesses, and gliomas were distinguished by means of SCS with an accuracy of 99%. Analysis of the most discriminatory regions with two-dimensional correlation spectra indicated that glutamine and/or glutamate and aspartate potentially contributed to successful classification. CONCLUSION: S aureus is detectable in abscesses with a non-culture-based method in an animal model.

Aged↗
PubMed1995

Improved management of multiple brain abscesses: a combined surgical and medical approach.

Bacterial brain abscesses occur in approximately 1500 to 2500 patients each year in the United States. Multiple abscesses have been noted in 10 to 50% of these patients. The goal of this study was to better define the roles of surgery and medical management in patients harboring multiple brain abscesses and to develop an algorithmic approach to the treatment of these complex patients. Between 1976 and 1992, 16 patients with multiple brain abscesses were treated by a single physician (M.L.R.). The ages of the patients ranged from 1.5 to 73 years (median, 47 yr). In all patients, a diagnosis of multiple abscesses was made by computed tomography (15 patients) or magnetic resonance imaging (1 patient) brain scans. The number of abscesses per patient ranged from 2 to 30, and the abscesses were located in all regions of the brain. Thirteen received a combination of antibiotics and surgical drainage, and three received antibiotics only. Surgery was performed on abscesses larger than 2.5 cm or on those situated in critical areas of the brain or causing significant mass effect. Excision and open aspiration via craniotomy and stereotactic aspiration were analyzed on the basis of the location of the lesion and infecting organism. Any abscess that enlarged after 2 weeks of antibiotics or that failed to shrink after 3 to 4 weeks of antibiotics was again aspirated or excised. Forty-three surgical procedures were performed in 13 patients, and 8 (62%) of the patients operated on required more than one surgical procedure. No significant morbidity was observed in any of the surgical procedures. Antibiotics were administered intravenously for an average of 6 to 8 weeks and were adjusted according to organism type and sensitivity to antibiotics. One patient (6%) died, and the remaining 15 patients had resolution of all abscesses and good neurological recovery within 6 months. On the basis of these results, we propose a combined surgical and medical approach to the treatment of patients with multiple brain abscesses. We recommend the aggressive surgical drainage of all abscesses larger than 2.5 cm in diameter, combined with 6 to 8 weeks of intravenous antibiotics. Biweekly computed tomography or magnetic resonance imaging is necessary to closely monitor patients for evidence of abscess growth or failure to resolve despite antibiotics, prompting another operation. The application of this combined approach should yield cure rates of more than 90% in patients with multiple brain abscesses, a result similar to that expected when treating patients with solitary lesions.

Adolescent↗
PubMed2000

[Suburban amebiasis: the diagnostic aspects via computed tomography and echography and the percutaneous treatment of amebic liver abscesses].

INTRODUCTION: Liver is the most common site of extraintestinal amebiasis and hepatic abscesses are the most frequent symptom, occurring in 3-9% of patients with amebic infection. Several studies have shown that drug treatment is more efficacious when combined with percutaneous drainage of the abscess, yielding quicker recovery and a positive body response. We report our US and CT findings in 16 patients with amebic abscesses, 12 of whom lived in a temperate peripheral area north-east of Naples. All patients had a clinical-diagnostic condition that we called "suburban amebiasis". Finally we report our personal experience with the US-guided therapeutic drainage of amebic abscesses with repeated cavity washings, which is important for positive parasitology. MATERIAL AND METHODS: We retrospectively reviewed the findings of 16 patients (11 men and 5 women; age range 36-78 years; mean 52) with amebic abscesses of liver examined with US and CT. US with a 3.5 MHz transducer was the technique of choice in all patients. 94% of liver abscesses and some extraintestinal complications were easily shown with this technique. CT angiography was then performed to detail and clarify US findings. Abscesses over 4 cm in diameter were submitted to US-guided percutaneous treatment which permitted abscess drainage, the collection of material for parasitology and repeated cavity washings. RESULTS: US showed multiple liver abscesses in 12 patients, which were multiseptate and formed by multiple hypo-/hyperechoic microabscesses in 4 of them. Four non-European patients had a single abscess, which is typical of tropical endemic forms. CT showed the amebic abscesses as hypodense roundish masses with clear-cut outline most often localized in the right lobe in the 12 multiple cases. After percutaneous drainage 13/16 patients (81%) reported less pain in the right hypochondrium and had a lower temperature; their hospitalization was also shorter. DISCUSSION AND CONCLUSIONS: Combined US and CT assessment facilitated the diagnosis of amebiasis and its differentiation from pyogenic abscess and hepatoma. The combination of US-guided drainage and drug treatment provides better results than either treatment alone and quicker improvement of patient conditions, with fewer extraintestinal complications. Percutaneous drainage should be used in abscesses bigger than 4-5 cm, those with questionable clinical-laboratory findings and finally those failing to respond to drug treatment alone. Positive parasitology of abscess content is related to repeated cavity washings after percutaneous drainage, likely because peripheral layers are much richer in amebae.

Adult↗
PubMed1995

Comparison of pyogenic liver abscesses caused by Klebsiella pneumoniae and non-K. pneumoniae pathogens.

A retrospective study on patients with pyogenic liver abscesses was conducted to clarify the different clinical presentations among patients with Klebsiella pneumoniae abscesses and those with non-K. pneumoniae abscesses. From 1981 to 1993, the medical records of 146 adults with culture-confirmed pyogenic liver abscesses who attended Tri-Service General Hospital in Taipei were studied. Abscesses due to K. pneumoniae accounted for 114 (78%) of pyogenic liver abscesses. When compared to patients with non-K. pneumoniae abscesses, patients with K. pneumoniae liver abscesses had significantly higher proportions of monomicrobial infections, unknown sources of infection and solitary abscesses. Patients with K. pneumoniae liver abscesses were found to have diabetes mellitus more often than patients with non-K. pneumoniae liver abscesses (66% vs 19%). Septicemia was found more frequently in patients with K. pneumoniae liver abscesses than in patients with non-K. pneumoniae liver abscesses (50% vs 27%). The clinical presentations among the two groups were, otherwise, not significantly different. Regardless of the microbial etiology, patients with diabetes mellitus had longer periods of fever after treatment and hospitalization than patients without diabetes. The reason for the high relative frequency of liver abscesses in Taiwan and its more frequent occurrence in diabetes mellitus remains unclear.

Adult↗
PubMed2002

Causative agents of liver abscess in those with liver cirrhosis: a 10-year case review of hospitalized patients in Thailand.

Although patients with cirrhosis of the liver show relative immunosuppression and therefore have increased susceptibility to most infections, they rarely develop liver abscesses. In a retrospective case review, the pathogens causing the liver abscesses observed, between January 1992 and December 2001 at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand, in 44 hospitalized patients diagnosed as cases of liver cirrhosis were investigated. The most common clinical symptoms and signs of the abscesses--abdominal pain (80%), fever and chills (73%), and abdominal tenderness (73%)--were similar to those seen in non-cirrhotic patients with abscesses. The frequency of liver abscess among the cirrhotic patients was low (0.46%). Most (71%) of the abscesses were in the right lobe and most (71%) of those with abscesses only had a single abscess. Surprisingly, many of the abscesses (36%) were apparently caused by amoebae. Bacterial pathogens were identified in eight patients (18%) by blood culture and 15 (34%) patients by pus culture. Seven (16%) of the blood cultures and 13 (30%) of the pus contained Gram-negative aerobes, indicating that such pathogens, particularly Klebsiella pneumoniae (in six pus and six blood cultures) and Escherichia coli (in three pus cultures and one blood), were the most common causes of the bacterial abscesses. Pus culture appeared more successful than blood culture for bacterial abscesses, and amoebic abscesses could always be identified by direct microscopical examination of pus samples. Aspiration of liver abscesses, to obtain pus samples for culture and microscopy, is therefore recommended.

Adolescent↗
PubMed1993

[Ultrasonography in the diagnosis of liver abscesses. Apropos of 32 cases].

A retrospective series of 32 cases of hepatic abscess was collected in the radiology department of Ibn Roch University Hospital (Casablanca), over a period of 43 months (May 1989-September 1992). Among these 32 cases, 16 were amebic (based on the dysenteric syndrome and especially positive amebic serology) and 16 had pyogenic causes. All patients underwent ultrasound examinations. Only two cases had CT scan. The confirmation of the hepatic abscess was made by ultrasound guided percutaneous aspiration in 30 cases and laparotomy in 2 cases. The right lobe was concerned in all cases. The pyogenic abscesses were multiple in 62.5% cases, while the amebic abscesses were double in only one case. The amebic abscesses were larger than the pyogenic ones. The average volume was respectively 10.5 cm and 7 cm. Three ultrasound aspects were found. Hypoechogenic aspect was the most frequent (76% of amebic abscesses and 61% of pyogenic abscesses). The heterogenic aspect was found in 21% of amebic abscesses and in 36% of pyogenic abscesses. The anechogenic aspect was found in only one case of pyogenic abscess. A light and regular wall was found in 70% of amebic abscesses and in 51% of pyogenic abscesses. Referring to the literature, the various ultrasound signs of orientation towards an amebic or pyogenic etiology were found in this series, but we emphasize the very important role of ultrasound-guided percutaneous aspiration and amebic serology for the etiological diagnosis of hepatic abscess.

Adolescent↗
PubMed1985

Expanded criteria for percutaneous abscess drainage.

The original criteria for percutaneous abscess drainage were limited to simple abscesses (well-defined, unilocular) with safe drainage routes. We expanded these entry criteria to include complex abscesses (loculated, ill-defined, or extensively dissecting abscesses), multiple abscesses, abscesses with enteric fistulas or whose drainage routes traversed normal organs, as well as complicated abscesses (appendiceal, splenic, interloop, and pelvic). Using these expanded criteria, cure was achieved nonoperatively in 92 (73.6%) of 125 abscesses with ten deaths (9%), and 11 complications (9%). Cure was achieved in 82% of simple abscesses, but only 45% of complex abscesses. There was no correlation between size, depth, drainage route, or etiology of the abscess (spontaneous v postoperative) with either cure or complications. We recommend a trial of percutaneous drainage in all simple abscesses and most complex abscesses with clinical response as the key determinant of the need for operative intervention.

Abscess↗
PubMed1995

Primary vs secondary iliopsoas abscess. Presentation, microbiology, and treatment.

OBJECTIVE: To review the characteristics of patient presentation, microbiology, and treatment of primary iliopsoas abscess. DESIGN: A case series of patients with iliopsoas abscess diagnosed on computed tomographic scans from 1987 to 1994. SETTING: Tertiary care inner-city university hospital. PATIENTS: Eleven patients with secondary iliopsoas abscess, defined as being secondary to gastrointestinal or genitourinary causes or trauma, and seven patients with primary abscess, defined as the absence of the above causes. MAIN OUTCOME MEASURES: Patient characteristics, presenting symptoms and signs, microbiologic characteristics, treatment, and clinical course of patients with primary iliopsoas abscesses compared with those in patients with secondary abscesses. RESULTS: In the primary group, six patients (86%) were intravenous drug users and four (57%) were positive for human immunodeficiency virus. Staphylococcus aureus grew from cultures from five of seven patients with primary abscesses, whereas secondary abscesses had enteric flora. The typical patient presentation included fever, with complaints of pain in the flank, hip, or abdomen. Comparison of abscess drainage options showed shorter hospitalizations for surgical drainage than for percutaneous drainage (15.9 vs 28.5 days; P < or = .01). CONCLUSIONS: A patient who presents with pain in the flank, hip, or abdomen may have a primary iliopsoas abscess. Computed tomography is the standard method of diagnosis. Antibiotic regimens for patients with primary iliopsoas abscess should include coverage for S aureus, and patients with secondary abscesses should have antibiotic regimens tailored for enteric bacteria. Drainage of abscess is essential for appropriate treatment, and surgical drainage is superior to percutaneous drainage in achieving prompt recovery.

AIDS-Related Opportunistic Infections↗
PubMed1997

Perianal abscess in Crohn's disease.

PURPOSE: Perianal disease is frequent in patients with Crohn's disease, and many of these patients will eventually have abscess formation. In a prospective follow-up study, we evaluated factors influencing the occurrence and recurrence of perianal abscesses. METHODS: Of 126 consecutive patients with perianal Crohn's disease seen regularly in an outpatient clinic, 61 (48.4 percent) had at least one perianal abscess (mean follow-up, 32 +/- 17 months). In all, 110 episodes of an abscess with 145 anatomically distinct abscesses were documented. RESULTS: The occurrence of first abscesses was dependent on the type of anal fistula (ischiorectal, 73 percent; transsphincteric, 50 percent; superficial, 25 percent; P < 0.02). Surgical therapy consisted of seton drainage (34 percent), mushroom catheter drainage (49 percent), or incision and drainage (29 percent) and led to inactivation in all patients. Cumulative two-year recurrence rates after the first and second abscess were 54 and 62 percent, respectively. Abscess recurrence was less frequent in patients with a stoma (13 vs. 60 percent in patients without stoma after two years) and in patients with superficial anal fistulas (0 vs. 55 percent/56 percent in patients with transsphincteric/ischiorectal fistulas). Only two abscesses recurred within one year after removal of seton drainage, whereas 13 abscesses recurred with the seton still in place. Neither intestinal nor rectal activity of Crohn's disease significantly influenced the occurrence of an abscess. During the study period, only two patients developed partial stool incontinence. CONCLUSION: Development of perianal abscesses in Crohn's disease depends on the fecal stream and the anatomic type of anal fistula. Seton and catheter drainage are safe and highly effective in treatment. Long-term use of setons to prevent recurrent abscesses is not supported by our data.

Abscess↗
PubMed1984

Single and multiple pyogenic liver abscesses. Natural history, diagnosis and treatment, with emphasis on percutaneous drainage.

The presenting features, modes of treatment and clinical course were reviewed for 55 patients with pyogenic liver abscess, seen at Duke University Medical Center over a 15-year period. Thirty-three patients had a solitary abscess and 22 had multiple abscesses. Most patients were between the ages of 40 and 60 years. Males predominated, 2.4:1. Major underlying conditions included biliary tract disease, malignancy and colonic disease. Eight patients, each with a solitary abscess, had no identifiable underlying condition. Symptoms and signs were nonspecific: fever, chills, focal abdominal tenderness and hepatomegaly were common. A raised serum alkaline phosphatase level was the most consistent abnormal laboratory finding. CT with contrast enhancement, radioisotope scanning and ultrasonography all accurately defined solitary hepatic abscesses. However, CT scan was more successful than other imaging techniques in detecting multiple abscesses. In seven patients the diagnosis was made only at laparotomy. Overall, a diagnosis of liver abscess was made in 50 living patients (91%). Microorganisms were recovered from pus and/or blood cultures of 44 patients (80%). Most common were enteric gram-negative facultative rods, anaerobic gram-negative rods, and microaerophilic streptococci. Single abscesses were more likely than multiple abscesses to contain more than one organism. All patients received antibiotics; the choice of antibiotic does not appear to be critical provided the regimen has a broad spectrum including activity against anaerobes. Surgical or percutaneous drainage was successful when attempted in all patients with a single abscess, but the outcome was less favorable in those with multiple abscesses. Percutaneous drainage is currently replacing open operative drainage as the method of choice. Overall mortality in patients with single abscesses was 15% (5/33) and in those with multiple abscesses 41% (9/22).

Adolescent↗
PubMed1995

Ultrasonographic findings in 11 cows with a hepatic abscess.

The livers of 11 cows with a hepatic abscess were examined ultrasonographically. An abscess was observed in only one intercostal space in three cows, in two spaces in five, in three spaces in two, and in four adjacent intercostal spaces in one cow. In three cows the abscess was imaged in the caudodorsal aspect of the liver in the 11th and 12th intercostal space, in five cows the abscess was visible in the central part of the liver in the ninth and 10th intercostal space and in the three other cows the abscess was observed in the cranioventral region of the liver in the sixth, seventh and eighth intercostal spaces. The abscess had a distinct and well developed capsule in nine cows. The content of the abscess was echogenic in six cows, anechoic in two, and echogenic with hyperechoic foci in three. In four cows, the content of the abscess was partitioned by echogenic septa. In one cow, the echogenic content of the abscess was surrounded by a narrow anechoic rim of fluid. The diameter of the abscess was 5 to 10 cm in four cows, 11 to 15 cm in four, and more than 15 cm in three. In every case the diagnosis was confirmed by centesis and aspiration of the abscess which yielded pus. Ten of the cows were slaughtered after being examined and the ultrasonographic findings were confirmed. In addition, 10 of the cows had other lesions which included traumatic reticuloperitonitis, abscessation of the reticulum, thrombosis of the caudal vena cava, bronchopneumonia with abscessation, reticulo-omasal stenosis, ascites and suppurative omental bursitis.

Animals↗
PubMed2000

Treatment of bacterial brain abscess by repeated aspiration--follow up by serial computed tomography.

Bacterial brain abscess often requires repeated aspiration before the abscess finally resolves. However, there are no guidelines for treatment by aspiration; for example, when should the abscess be tapped again, or when can an abscess be treated by antibiotics alone without further aspiration. Eleven patients with bacterial brain abscess treated by aspiration were evaluated to establish treatment guidelines for brain abscess, in particular the abscess size on serial computed tomography (CT) after aspiration. CT was performed about 24 hours after aspiration to evaluate the size of the abscess, and almost weekly during follow up. The diameter of the brain abscess before and after the initial and last aspirations were reviewed. In eight of the 11 patients, abscesses were aspirated repeatedly: two to three times in most patients. The diameter of the abscesses was 2.5-4.5 cm (mean 3.5 cm) before the last aspiration, and 1.4-3.4 cm (mean 2.3 cm) after the last aspiration, or when continuous drainage was discontinued. Perifocal edema was moderately decreased within 3 weeks after the last aspiration by medical treatment alone, with a concomitant decrease in the volume of the abscess. There were no deaths, and most patients had a favorable outcome. These results suggest that after the diameter of the abscess becomes less than 2 to 3 cm and does not increase anymore on serial CT, medical treatment alone can be anticipated to give satisfactory results without further aspiration.

Adolescent↗
PubMed1984

Hepatic and systemic metabolic responses to aerobic and anaerobic intra-abdominal abscesses in a highly reproducible chronic rat model.

A single, uniform abscess was formed in 100% of the animals inoculated with a fecal pellet made of sterile rat feces, agar, and a known number and strain of bacteria. The effects of monoclonal Escherichia coli abscess (83 rats) were compared to those of sterile abscess (34 rats) and sham operation (35 rats without abscess). Bacteroides fragilis was added to the sterile pellet to study the effect of an anaerobic monoclonal abscess (16 rats) or of a biclonal abscess containing both aerobes and anaerobes (32 rats). After inoculation, a peritonitis stage with leucopenia, hypoglycemia, body weight loss, and slight fever was followed by the abscess stage with leucocytosis and a slight hyperglycemia. Mild hepatic energy charge deficiency and hepatic lactic acidosis were observed in sterile abscess rats, and slightly enhanced energy charge was seen in monoclonal E. coli abscess rats. The addition of B. fragilis to the sterile pellet, alone or together with E. coli, produced hepatic energy charge deficiency and hepatic lactic acidosis, which were significantly enhanced compared with the monoclonal E. coli abscess rats. The greatest effect was seen in the biclonal E. coli plus B. fragilis abscess, suggesting that anaerobic or combined aerobe and anaerobe abscesses may produce a greater hepatic injury than an aerobic organism abscess alone. This may account for the apparent synergic interaction between aerobic and anaerobic organisms.

Abdomen↗
PubMed1995

Intraperitoneal abscesses: diagnostic dilemmas and therapeutic options.

BACKGROUND: The diagnosis of intraperitoneal abscesses is difficult, resulting in delay in treatment and poor prognosis. Although recent advances in the management have led to significant improvement in prognosis, the choice of therapeutic modality is unclear. AIMS: The role of clinical features and investigations in the diagnosis of intraperitoneal abscesses was studied. The relation of prognosis to delay in diagnosis was also analyzed. Also assessed was the efficacy of various therapeutic modalities. METHODS: Thirty consecutive patients diagnosed to have intraperitoneal abscesses were analyzed. Abscesses were analyzed. Abscesses were divided on the basis of ultrasonography findings into simple and complex (with or without fecal fistula). The following points were evaluated: clinical features, and hematological, biochemical and microbiological reports, imaging findings and the role of therapeutic modalities like percutaneous aspiration (single or multiple), catheter drainage and operative drainage (transperitoneal, extraperitoneal and percutaneous). RESULTS: Clinical features and hematological investigations, though sensitive, were non-specific in diagnosis. Klebsiella was the commonest organism cultured, followed by Proteus, E coli and Pseudomonas. Blood culture was positive in only 6 percent of cases. Real-time ultrasonography had an accuracy of 84%. Contrast X-rays were required in 43% of cases. All the deaths (4 of 30) occurred when the diagnosis and treatment were delayed by more than 4 days. USG-guided aspiration (single and multiple) and USG-guided catheter drainage were effective in simple abscesses but failed in complex abscesses. Transperitoneal operative drainage was successful in 15 of 18 cases (6 of 8 simple abscesses and 9 of 10 complex abscesses). The mortality in patients with simple and complex abscesses was 2 of 17 and 2 of 13 respectively. CONCLUSIONS: Early detection with consequent early treatment is vital for good prognosis of intraperitoneal abscesses. Early diagnosis requires a high degree of clinical suspicion and appropriate use of imaging modalities. USG-guided percutaneous drainage is effective for simple abscesses whereas complex abscesses require operative drainage, sometimes in combination with initial USG-guided drainage.

Abscess↗