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Probable new species of Desulfovibrio isolated from a pyogenic liver abscess.

A fastidious, slowly growing, spiral gram-negative bacterium was isolated from the liver abscess of an 82-year-old man with a 3-week history of febrile illness. The organism was an obligate anaerobe that grew at 37 and 42 degrees C but not at 25 degrees C. Its vibrioid or spiral morphology on Gram staining, rapid progressive motility, electron micrograph features, and biochemical tests were all consistent with the organism belonging to the genus Desulfovibrio. 16S rRNA gene sequencing of this organism demonstrated a 97% similarity to Desulfovibrio desulfuricans with 45 nucleotide differences, suggesting that it is a new species of Desulfovibrio.

Aged↗

Pyogenic liver abscess with two normal ultrasound scans.

I report a case of a large liver abscess causing a severe debilitating condition in which the diagnosis was delayed by several weeks following two normal ultrasound scans at days 5 and 19 of the illness. Up to one in four cases of liver abscess can be missed on ultrasound. A high degree of clinical suspicion must be maintained and repeated or alternative imaging methods used if the diagnosis of this rare, curable but often fatal condition is not to be missed.

Adult↗

Septic pulmonary emboli secondary to pyogenic liver abscess in a diabetic patient.

A 70-year-old woman with poorly controlled diabetes mellitus was admitted because of persistent remittent fever. Soon a liver abscess was detected as the cause of the fever by ultrasonography, and antibiotic therapy was started. However, suddenly serious dyspnea with chest and back pain developed. The morbid condition was definitely diagnosed as septic pulmonary emboli (SPE) with pulmonary perfusion scan. It should be recognized that liver abscess can be a latent focus of systemic metastatic complications such as SPE, and not only early detection but also prompt appropriate drainage of liver abscesses is essential.

Aged↗

Successful non-surgical management of pyogenic liver abscess.

A 5-month-old infant presented with high fever, irritability, and poor feeding. Examination revealed an enlarged liver and neutropaenia. Ultrasonography was unhelpful, but a diagnosis of liver abscess was confirmed by computed tomography on day 4 of the illness. Gallium scan was normal on day 4 but showed a resolving liver abscess on day 6. Staphylococcus aureus was grown in blood culture. The infant recovered with antibiotic treatment alone.

Chloramphenicol↗

Effect of intracavitary injection of urokinase in the experimentally induced early pyogenic liver abscess of the rabbit.

This study was carried out to assess the effects of intracavitary injection of urokinase in the early liver abscess (ELA) of the rabbits. ELAs were induced on 25 in 47 New Zealand rabbits, which were divided into two groups, with 15 in group A, and 10 in group B. Urokinase was injected into the ELA of group A, and normal physiologic saline into those of group B. One and a half hours after the injections, the rabbits were sacrificed and evaluated by pathologists for the degree of fibrosis of the ELA wall, and fibrinolysis in the ELA itself. Statistical analyses were performed between the two groups. The following ELA sizes for each group were obtained: Group A, 4.3 x 2.9-10.1 x 7.2 mm (mean 7.1 x 4.1 mm); Group B, 4.6 x 2.7-15.0 x 9.7 mm (mean 8.5 x 4.57 mm). Eleven (73%) in group A showed grade II fibrosis of ELA wall, and 8 (80%) in group B showed grade III fibrosis of ELA wall (p=0.002). On pathological analysis, 5 (46%) in group A showed grade II fibrin, and 8 (80%) in group B showed grade III fibrin, of the ELA (p=0.09). In conclusion, injection of urokinase, into the ELAs, can reduce the degree of fibrosis of abscess walls.

Animals↗