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PubMed1991

Improvement in the diagnosis of abscesses associated with endocarditis by transesophageal echocardiography.

BACKGROUND: Echocardiography is recognized as the method of choice for the noninvasive detection of valvular vegetations in patients with infective endocarditis, with transesophageal echocardiography being more accurate than transthoracic echocardiography. The diagnosis of associated abscesses by transthoracic echocardiography is difficult or even impossible in many cases, however, and it is not known whether transesophageal echocardiography is any better. METHODS: To determine the value of transesophageal echocardiography in the detection of abscesses associated with endocarditis, we studied prospectively by two-dimensional transthoracic and transesophageal echocardiography 118 consecutive patients with infective endocarditis of 137 native or prosthetic valves that was documented during surgery or at autopsy. RESULTS: During surgery or at autopsy, 44 patients (37.3 percent) had a total of 46 definite regions of abscess. Abscesses were more frequent in aortic-valve endocarditis than in infections of other valves, and the infecting organism was more often staphylococcus (52.3 percent of cases) in patients with abscesses than in those without abscesses (16.2 percent). The hospital mortality rate was 22.7 percent in patients with abscesses, as compared with 13.5 percent in patients without abscesses. Whereas transthoracic echocardiography identified only 13 of the 46 areas of abscess, the transesophageal approach allowed the detection of 40 regions (P less than 0.001). Sensitivity and specificity for the detection of abscesses associated with endocarditis were 28.3 and 98.6 percent, respectively, for transthoracic echocardiography and 87.0 and 94.6 percent for transesophageal echocardiography; positive and negative predictive values were 92.9 and 68.9 percent, respectively, for the transthoracic approach and 90.9 and 92.1 percent for the transesophageal approach. Variation between observers was 3.4 percent for transthoracic and 4.2 percent for transesophageal echocardiography. CONCLUSIONS: The data indicate that transesophageal echocardiography leads to a significant improvement in the diagnosis of abscesses associated with endocarditis. The technique facilitates the identification of patients with endocarditis who have an increased risk of death and permits earlier treatment.

Abscess↗
PubMed2005

Changing bacteriology of adult community-acquired lung abscess in Taiwan: Klebsiella pneumoniae versus anaerobes.

BACKGROUND: Most literature regarding lung abscess focuses on anaerobic bacterial lung abscess, and aerobic gram-negative bacillary infection is less frequently discussed. This study was conducted to investigate the bacteriology of community-acquired lung abscess and to improve the empirical therapeutic strategy for adults with community-acquired lung abscess. METHODS: We reviewed and analyzed data on 90 consecutive adult cases of bacteriologically confirmed community-acquired lung abscess treated during 1995-2003 at a tertiary university hospital in Taiwan. RESULTS: We found that a high proportion (21%) of cases of lung abscess were due to Klebsiella pneumoniae infection, which differs from the findings of previous studies. Lung abscess due to K. pneumoniae was associated with underlying diabetes mellitus (odds ratio [OR], 4.3; 95% confidence interval [CI], 1.0-18.4; P = .039) and negatively correlated with a time from onset of symptoms to diagnosis of >30 days (OR, 0.2; 95% CI, 0.1-0.7; P = .008). A higher percentage of patients with K. pneumoniae lung abscess had concomitant bacteremia (OR, 9.4; 95% CI, 1.1-81.9; P = .032), delayed defervesence (OR, 9.2; 95% CI, 1.8-47.8; P = .004), and multiple cavities noted on radiographs (OR, 11.0; 95% CI, 1.3-94.9; P = .015), compared with patients with anaerobic bacterial lung abscess. The rate of nonsusceptibility to clindamycin and penicillin among anaerobes and Streptococcus milleri group isolates increased. CONCLUSION: K. pneumoniae has become a more common cause of lung abscess than before, and a high proportion of anaerobes and S. milleri strains have become resistant to penicillin and clindamycin. A beta-lactam/beta-lactamase inhibitor or second- or third-generation cephalosporin with clindamycin or metronidazole is suggested as empirical antibiotic therapy for community-acquired lung abscess.

Adult↗
PubMed1996

Multifocal metachronous epidural abscesses of the spine. A case report.

STUDY DESIGN: A retrospective case report of a patient who had a lumbar epidural abscess treated surgically who then developed a cervical epidural abscess that also required surgical treatment. OBJECTIVES: To describe a patient in whom treatment of a single epidural abscess with surgery and antibiotics was not sufficient to eradicate the systemic infection. SUMMARY OF BACKGROUND DATA: Epidural abscesses are most commonly seen after invasive procedures that violate the epidural space. Epidural abscesses are usually a solitary event occurring in only one location and are usually treatable with surgical drainage and parenteral antibiotics. METHODS: An elderly patient presented with neck and shoulder pain and fever. Evaluation revealed degenerative disease of the cervical spine. Within a week, she developed a cauda equina syndrome secondary to a lumber epidural abscess. The abscess was drained and intravenous antibiotics were given. Seventeen days later, while still receiving antibiotics, she developed a cervical epidural abscess which also required surgical drainage. RESULTS: The patient showed gradual improvement in her neurologic status. No recurrence of either epidural abscess was observed. CONCLUSIONS: An epidural abscess may represent a serious systemic infection that requires aggressive treatment. Close follow-up is necessary to ensure that the infection has been eradicated and that no recurrent abscess has formed in the same or a different location. Aggressive antibiotic treatment is also strongly recommended.

Abscess↗
PubMed2004

Liver abscess complicating transcatheter arterial embolization: a rare but serious complication. A retrospective study after 3878 procedures.

OBJECTIVES: Liver abscess is one of the complications of transcatheter arterial embolization (TAE) for hepatocellular carcinoma. We studied the clinical features and analysed the incidence, risk factors, helpful clinical clues, culture profiles and predictive factors of post-TAE liver abscess. The influence of abscess development on the evolution of the tumour process was also studied. METHODS: We retrospectively reviewed records of 3878 TAE procedures performed over a 6 year period. RESULTS: Ten cases of liver abscess developed in nine patients (eight males and one female). The incidence was 0.26% (10 episodes/3878 procedures). The main clinical presentations included fever (91.7%), chills (50%) and abdominal pain (33.3%). All but one febrile patient presented fever in a recurrent form. The positive culture rates were 41.7% for blood and 83.3% for pus. Gram negative bacteria were found in 80% of blood cultures and 68% of pus cultures. Polymicrobial infections were encountered in 60% of the blood cultures and 70% of pus cultures. Management included antibiotics, drainage and operation. Four patients died due to the direct complications of liver abscess. One patient experienced total tumour resolution after successful treatment for liver abscess. Patients with larger liver abscesses and patients with greater age carried higher mortality rates. CONCLUSIONS: Liver abscess is a rare complication after TAE for hepatocellular carcinoma. Recurrent fevers after an initial symptom free interval should arouse suspicion of an abscess. The mortality is high and a large abscess and higher age predict an unfavourable outcome. Abscess formation can lead to complete tumour resolution.

Adult↗
PubMed2003

Cholangitis and liver abscess after percutaneous ablation therapy for liver tumors: incidence and risk factors.

PURPOSE: To determine the risk factors of cholangitis and liver abscess occurring after percutaneous ablation therapy for liver tumors. MATERIALS AND METHODS: Between October 1995 and September 2002, 358 patients with 455 liver tumors underwent a total of 683 ablation procedures, such as percutaneous ethanol injection (PEI), percutaneous microwave coagulation (PMC), and radiofrequency (RF) ablation therapy. With a retrospective review of medical records, the rates and outcomes of cholangitis and/or liver abscess occurring after ablation therapy were evaluated. The relationship between cholangitis and/or liver abscess and multiple variables (age, disease, Child-Pugh class, size of nodules, multiplicity of nodules, history of transcatheter arterial embolization, presence of bilioenteric anastomosis, and lack of prophylactic antibiotics administration) were statistically analyzed. RESULTS: Cholangitis and/or liver abscess occurred in 10 sessions (1.5%) in 10 patients: six sessions after PEI, three sessions after PMC, and one session after RF ablation. Both cholangitis and liver abscess were noted in seven sessions, cholangitis was noted in two, and liver abscess was noted in one. Six patients recovered, but two developed recurrent cholangitis and liver abscess, one developed lung abscess complicated with liver abscess, and one died of septic shock associated with cholangitis. On stepwise regression analysis, bilioenteric anastomosis was the sole significant predictor of cholangitis and/or liver abscess formation (P <.001; odds ratio = 36.4; 95% CI = 9.67-136.9). CONCLUSION: Bilioenteric anastomosis strongly correlated with the development of cholangitis and/or liver abscess after percutaneous ablation therapy. Close posttreatment attention should be paid to this subgroup of patients.

Adolescent↗
PubMed2005

Experimental abscess formation caused by human dental plaque.

Human dental plaque consists of a wide variety of microorganisms, some of which are believed to cause systemic infections, including abscesses, at various sites in the body. To confirm this hypothesis experimentally, we examined the abscess-forming ability of native dental plaque in mice, the microbial features of the infectious locus produced by the plaque, and the anti-phagocytic property of microbial isolates. Aliquots of a suspension of supragingival dental plaque containing 6 x 10(6) colony-forming unit of bacteria were injected subcutaneously into the dorsa of mice. Abscess formation was induced in 76 of 85 mice using ten different plaque samples. Thirteen microorganisms were isolated from pus samples aspirated from abscess lesions. The microbial composition of pus, examined in 17 of 76 abscesses, was very simple compared to that of the plaque sample that had induced the abscess. The majority of the isolates belonged to the Streptococcus anginosus group, normally a minor component of plaque samples. S. anginosus was the most frequently detected organism and the most prevalent in seven abscesses, and Streptococcus intermedius and Streptococcus constellatus were predominant in one and three abscess samples, respectively. Each isolate of S. anginosus group produced abscesses in mice, and heat-treated supragingival dental plaque influenced the abscess-forming ability of S. anginosus isolate. These isolates possessed a high antiphagocytic capacity against human polymorphonuclear leukocytes. Our results suggest that human supragingival dental plaque itself is a source of the infectious pathogens that cause abscess formation.

Abscess↗
PubMed1999

Two-year study of bovine hepatic abscessation in 10 abattoirs in County Cork, Ireland.

The livers from 6337, 12- to 16-month-old heifers slaughtered in 10 domestic abattoirs over a period of two years were examined; 368 (5.8 per cent) had gross lesions, of which 120 (1.9 per cent) had abscesses, 74 (1.17 per cent) had only scarring, and 44 (0.7 per cent) had telangiectasis (so-called 'sawdust' liver). Of the 120 livers in which abscesses were detected, 53 (44 per cent) had a single large abscess (>4 cm diameter), 44 (36.6 per cent) had a single small abscess (<4 cm), and 23 (19 per cent) had more than two abscesses; in 20 of them (16.6 per cent) the abscesses were resolving, and in 10 (8.3 per cent) the abscesses were ruptured. Forty-three (35.8 per cent) of the livers with abscesses had adhesions to the diaphragm and diaphragmatic lung lobes, three (2.5 per cent) had adhesions to other abdominal organs, 12 (10 per cent) also had scarring and two (1.7 per cent) also had lesions due to liver fluke. There was no significant association between the liver fluke lesions and the abscesses. In 46 (38.3 per cent) of the livers the abscesses were located in the mid-dorsal diaphragmatic or dorsocranial area of the liver; 28 (23.3 per cent) were adjacent to the posterior vena cava and could as a result have caused thromboembolic disease. Clinical signs attributable to the abscesses were observed in only one animal.

Abattoirs↗
PubMed2004

Breast abscess in lactating women: US-guided treatment.

PURPOSE: To retrospectively evaluate the use of ultrasonography (US)-guided treatment of breast abscesses in lactating women. MATERIALS AND METHODS: One hundred eight consecutive lactating women who were clinically suspected of having a breast abscess were examined with US. Abscesses depicted at US were treated with US guidance, and the success of US-guided treatment was retrospectively determined. RESULTS: Fifty-six abscesses were identified at US in 43 women; all abscesses were treated with US guidance: 23 with needle aspiration and 33 with catheter drainage. Treatment method was determined according to the size of the abscess. Abscesses that were smaller than 3 cm in maximum diameter were treated with needle aspiration, and abscesses that were 3 cm or larger in maximum diameter were treated with catheter insertion. One patient who was treated with needle aspiration subsequently underwent surgical intervention; all others were successfully treated with US intervention. Catheter placement was well tolerated (mean pain score 2.3 in 22 women by using a subjective pain scale of 0-10). CONCLUSION: US-guided needle aspiration of abscesses smaller than 3 cm and US-guided catheter drainage of abscesses 3 cm or larger are successful means of treating breast abscesses.

Abscess↗
PubMed1989

Pericholecystic abscess: classification of US findings to determine the proper therapy.

Sixteen patients with a pericholecystic abscess were classified into three groups according to the sonographic findings: Nine patients had an abscess in the gallbladder bed, three in an intramural location in the gallbladder, and four in an intraperitoneal cavity. In the gallbladder bed group, six patients with a localized abscess responded well to conservative therapy, followed by an elective operation. Two patients with a complicated abscess were initially treated with ultrasonically (US) guided percutaneous transhepatic gallbladder drainage and then with percutaneous transhepatic aspiration of the liver abscess, followed by an elective operation. A patient with a communicating abscess underwent an elective operation because the abscess completely disappeared after percutaneous transhepatic abscess drainage under US guidance. One of the three patients with an intramural abscess needed an immediate operation, and the other two were treated conservatively, followed by an elective operation. All four patients with an intraperitoneal abscess needed an emergency operation. Because each type of abscess received differing and successful treatments, the authors' method of classification of US findings seemed to provide a useful way to select the specific therapeutic procedure to achieve optimal results.

Abscess↗
PubMed2001

Single and multiple pyogenic liver abscesses: etiology, clinical course, and outcome.

BACKGROUND: Pyogenic liver abscesses are uncommon but they still carry a high mortality rate when encountered. This study was undertaken to evaluate the differences in the clinical behaviour of patients with single and multiple abscesses. METHODS: From January 1985 to December 1997, 133 patients with this disease were treated in the surgical departments of five hospitals, 97 had a single abscess and 36 had multiple abscesses. Clinical features, methods of treatment, and outcome were assessed and compared in both types of abscesses. RESULTS: A biliary origin from ascending cholangitis was most frequently found in multiple abscesses (p = 0.007). Mean age and duration of symptoms were higher in multiple lesions (p = 0.03 and p = 0.001). High levels of alkaline phosphatase were more frequently seen in multiple abscesses than in solitary ones (p = 0.02). They were both most frequently located on the right side. Antibiotic therapy alone was most frequently used in multiple abscesses (p = 0.01). Mortality rate was also higher in this type of patients (p = 0.01). The abscess-related morbidity rate was higher in multiple lesions as well but the statistical difference was not significant. CONCLUSIONS: These results suggest that multiple liver abscesses comprise a disease of biliary origin, higher age, longer symptomatic periods, and also higher mortality rate than in single abscess.

Aged↗
PubMed1988

Pediatric cerebral abscess.

Fifty-four consecutive cases of children with cerebral abscess from 1958 to 1987 are reviewed. Their average age was 6.6 years, ranging from 3 days to 19 years. A wide range of organisms and underlying diseases was encountered. The predominant mode of surgical therapy was craniotomy with resection of the abscess. Aspiration and craniotomy with drainage-evacuation were also employed in our series. No underlying disease was found in 10 (19%) of the children. Cyanotic heart disease (CHD) was present in 13 (24%) of the children. Four children had dental abscesses and 1 had otitis media. Seven (13%) children had abscesses secondary to hydrocephalus/shunt infections. Sinusitis and otitis accounted for 5 cases (9%). Four children (7%) had tuberculomas. One abscess was associated with a nasal dermal sinus and one was congenital. Fourteen (26%) patients had negative cultures. Fourteen (26%) abscesses contained streptococci of various types. Staphylococci were found in only 5 (9%) of the abscesses. The congenital abscess was caused by salmonella. Two abscesses (7%) were fungal. Both of these patients died. Six children (11%) were treated without surgical intervention. Three of them died. Forty-eight children had surgical intervention; 12 underwent aspiration, 14 underwent open evacuation of the abscess, and 22 had abscesses resected. Mortality in the aspiration group was twice that of the evacuation or resection group (17, 7 and 9%), respectively). The factor which correlated best with mortality was the patient's clinical status on admission. The advent of CT scan at our facility improved mortality by facilitating accurate diagnosis and surgical intervention. Overall mortality rates decreased from 31 to 5.7% and surgical mortality fell from 21 to 2.9%.

Adolescent↗
PubMed1988

A clinical prospective study of peritonsillar abscess in children.

Distinguishing peritonsillar abscess from cellulitis is an important clinical problem, particularly in children, who may require a general anesthetic for drainage of these abscesses. In order to identify those clinical factors most significant for peritonsillar abscess, we did a prospective study of 21 patients who presented with sore throat, fever, trismus, and tonsillar bulge; all symptoms that are consistent with the diagnosis of peritonsillar abscess. On admission, the following parameters were recorded: patient age, duration of sore throat, fever, white blood cell count, drooling, the degree of trismus (measured exactly as incisor-incisor distance), the degree of pharyngotonsillar bulge, and change in voice. After 24 to 48 hours of parenteral antibiotics, 12 patients (57%) had improved sufficiently and were continued on antibiotics until resolution (cellulitis group). Nine patients (43%) had no improvement and underwent surgery for drainage of the peritonsillar abscess (abscess group). At the end of the 18-month study period, the cellulitis and abscess groups were compared. On admission, no significant difference was found in age, duration of sore throat, fever, or white blood cell count. The pharyngotonsillar bulge was mild in 58% and moderate in 42% of the cellulitis group, while in the abscess group, the pharyngotonsillar bulge was mild in only 33% and moderate in 67%. After 24 to 48 hours of parenteral antibiotics, all patients in the cellulitis group had improvement of at least one symptom; whereas, all patients in the abscess group had no change or worsening of at least one symptom, including trismus, dysphagia, voice change, drooling, or pharyngotonsillar bulge. On admission, the precise measurement of trismus was not significantly different in the two groups (24.7 mm in cellulitis group vs. 22.5 mm in abscess group). However, after 24 hours of antibiotics, trismus averaged 7 mm more in the abscess group versus the cellulitis group (p less than 0.05).

Adolescent↗
PubMed1992

Epidural abscess of the cervical spine: MR findings in five cases.

Cervical epidural abscess is an uncommon infectious process of the spinal epidural space. Although this disorder is often unsuspected clinically, the patient's signs and symptoms may suggest other diagnoses that frequently lead to an MR examination. We retrospectively reviewed the MR examinations of five patients with surgically proved cervical epidural abscess in order to assist in the diagnosis of this clinically elusive disorder. Each epidural abscess was evaluated for MR signal intensity, location, extent, delineation, and enhancement pattern. We assessed the spinal cord for compression and signal intensity and analyzed the vertebrae, intervertebral disks, and paraspinal soft tissue. Compared with the spinal cord, the abscess was isointense or hypointense on T1-weighted spin-echo images and hyperintense on T2-weighted images. The abscess was hyperintense or isointense relative to the cord on T2* gradient-echo images. Enhancement of the abscess occurred in the two patients given an IV injection of gadopentetate dimeglumine. The epidural abscess was located anteriorly in three patients, posteriorly in one, and was circumferential in one. The abscess extended from two to nine vertebral bodies in length. In each case, the abscess caused some degree of spinal cord compression, and one patient had bright signal intensity within the cord on T2-weighted images. Three patients had MR changes of accompanying osteomyelitis and paravertebral abscess. MR imaging is useful in diagnosing cervical epidural abscess and in evaluating associated abnormality of the spinal cord, vertebral bodies, intervertebral disks, and paraspinal soft tissue.

Abscess↗
PubMed1993

Safety of intracavitary urokinase with percutaneous abscess drainage.

OBJECTIVE: Percutaneous drainage of abscesses is an effective treatment, but the success rate is lower for abscesses that have septa and are multilocular. Several clinical and in vitro studies suggest urokinase may be useful in such cases. Our study was designed to determine the safety of urokinase administered into an abscess cavity during the course of percutaneous drainage. SUBJECTS AND METHODS: Our study included 26 consecutive patients with 31 abscesses treated with percutaneous drainage. Exclusion criteria included age less than 18 or more than 95 years, CNS disorders (e.g., tumor, vascular problems), coagulation impairments, hepatic failure, pregnancy, and abscesses in the spleen, pancreas, or interloop area. Three doses were used: group 1 (nine patients), 1000 IU of urokinase per centimeter of abscess diameter; group 2 (11 patients), 2500 IU of urokinase per centimeter of abscess diameter; and group 3 (nine patients), 5000 IU of urokinase per centimeter of abscess diameter. These doses were administered every 8 hr for 3 days along with percutaneous drainage. Charts were reviewed to determine success and to detect adverse clinical events. Studies included sequential CT scans; serial serum determinations of hematocrit, prothrombin time, partial thromboplastin time, platelet count, fibrinogen levels, and levels of fibrin degradation products; and serial laboratory analysis of purulent material for fibrinogen and fibrin degradation products. Percutaneous drainage was considered successful if no surgical intervention was required. RESULTS: Our results showed no significant change in hematologic studies and no bleeding complications. Analysis of purulent material indicated that urokinase remained active in the abscess milieu. Drainage was successful in seven of 11 patients in group 1, all nine patients in group 2, and 10 of 11 patients in group 3. All eight abscesses with septa were successfully drained. CONCLUSION: Intracavitary urokinase can be given safely during percutaneous drainage of an abscess, with no associated bleeding complications or changes in coagulation parameters.

Abscess↗
PubMed1987

Effect of dexamethasone on experimental brain abscess.

Dexamethasone has been used to manage brain edema in patients with intracranial abscess. However, its administration has often been delayed or avoided for fear of adverse effects upon normal host responses to infection. An experimental model of brain abscess in the rat was developed to determine if dexamethasone produced adverse effects on immune competence and collagen deposition in the region of the abscess. Sprague-Dawley rats were inoculated with Staphylococcus aureus and treated intraperitoneally each day with either dexamethasone (0.25 mg/kg) or saline solution. Surviving animals were sacrificed at 4, 8, 12, or 18 days after treatment. The brains were examined grossly for abscess formation and microscopically for intensity of the inflammatory response, abscess diameter, and wall thickness. There were no differences in mortality rates, abscess production rates, or abscess diameters when groups were compared. The intensity of inflammatory response was similar in both groups. In the group sacrificed 8 days after inoculation, a delay in collagen deposition was apparent, manifested as a thinner abscess wall in the experimental group (mean: 17.8 mu in dexamethasone-treated animals and 85 mu in saline-treated control animals: p = 1.0041). At 12 and 18 days after inoculation, there was no difference in abscess wall thickness between the control and experimental groups. Therapeutic doses of dexamethasone had little effect on mortality rates, incidence of abscess production, or intensity of inflammatory response in the experimental animals. Thus, dexamethasone did cause a delay in collagen deposition in the walls of experimental brain abscesses, but wall thickness 18 days after inoculation was not affected.

Animals↗
PubMed2003

CD4+ T cells mediate abscess formation in intra-abdominal sepsis by an IL-17-dependent mechanism.

Abscess formation associated with intra-abdominal sepsis causes severe morbidity and can be fatal. Previous studies have implicated T cells in the pathogenesis of abscess formation, and we have recently shown that CD4(+) T cells activated in vitro by zwitterionic capsular polysaccharides from abscess-inducing bacteria such as Staphylococcus aureus and Bacteroides fragilis initiate this host response when transferred to naive rats. In this study, we show that mice deficient in alphabetaTCR-bearing T cells or CD4(+) T cells fail to develop abscesses following challenge with B. fragilis or abscess-inducing zwitterionic polysaccharides, compared with CD8(-/-) or wild-type animals. Transfer of CD4(+) T cells from wild-type mice to alphabetaTCR(-/-) animals reconstituted this ability. The induction of abscesses required T cell costimulation via the CD28-B7 pathway, and T cell transfer experiments with STAT4(-/-) and STAT6(-/-) mice demonstrated that this host response is dependent on STAT4 signaling. Significantly higher levels of IL-17, a proinflammatory cytokine produced almost exclusively by activated CD4(+) T cells, were associated with abscess formation in Th2-impaired (STAT6(-/-)) mice, while STAT4(-/-) mice had significantly lower levels of this cytokine than control animals. The formation of abscesses was preceded by an increase in the number of activated CD4(+) T cells in the peritoneal cavity 24 h following bacterial challenge. Confocal laser-scanning microscopy analysis revealed that CD4(+) T cells comprise the abscess wall in these animals and produce IL-17 at this site. Administration of a neutralizing Ab specific for IL-17 prevented abscess formation following bacterial challenge in mice. These data delineate the specific T cell response necessary for the development of intra-abdominal abscesses and underscore the role of IL-17 in this disease process.

Abdominal Abscess↗
PubMed1992

The prognostic factors of severe amebic liver abscess: a retrospective study of 125 cases.

One hundred twenty-five cases of amebic liver abscess were diagnosed at Chang Gung Memorial Hospital in Taiwan from January 1981 to December 1989. An analysis of possible prognostic factors for severe amebic liver abscess was done retrospectively. The majority of the patients came from the southern part of Taiwan. Severe amebic liver abscess was defined as the rupture of an abscess that was resistant to 72 hr of medical treatment, or complicated by secondary bacterial infection. The results showed significant differences between patients with severe liver abscess and those with more moderate forms of amebic liver abscess in indices such as jaundice, hemoglobin and serum bilirubin levels, and dyspnea, as well as in pulmonary changes (right diaphragm elevation, right pleural effusion) seen on chest radiographs. Those patients with diabetes mellitus also had greater evidence of severe liver abscess. Moderate cases that were treated with amebicides showed excellent responses (no mortality). Severe cases required, in addition to amebicide therapy, either percutaneous or surgical drainage of pus, especially in those patients with ruptured abscesses. Those patients with abscesses that ruptured into the thoracic cavity were treated by either thoracostomy or needle aspiration, and all were cured. Three patients died of abscess rupture into the abdominal cavity, associated with secondary bacterial infection. The overall mortality rate was 2.4%. These symptoms and signs of severe liver abscess are indicators of the need for intensive treatment such as aspiration or surgical drainage.

Adult↗
PubMed1999

Computerized tomography-guided stereotactic aspiration of brain abscesses: experience with 28 cases.

BACKGROUND: Computerized tomography (CT)-guided stereotactic techniques allow accurate identification of brain abscesses and provide promising results for the management of brain abscesses. METHODS: We reviewed the results of stereotactic aspiration of brain abscesses in 28 consecutive patients from 1984 to 1995. In all patients, the diagnosis of brain abscess was made by computerized tomography (CT). All patients underwent stereotactic aspiration of abscesses as the primary surgical therapy. Intravenous antibiotics were administered preoperatively and adjusted according to organism type and sensitivity to antibiotics. In patients with multiple lesions, aspirations were performed on abscesses larger than 2 cm in diameter or on those causing significant mass effects. CT was performed weekly to monitor abscess growth or failure to resolve. Patients were followed on an outpatient basis. This report is a retrospective review of clinical features, diagnostic methods, treatment and postoperative results. RESULTS: A total of 19 patients had good recoveries and six patients had mild neurologic sequelae. One patient had persistent conscious impairment. Intracranial hemorrhage occurred in one patient. Two deaths occurred during hospitalization. One patient with a fungal infection underwent additional surgical excision of the abscess. Most patients had resolution of abscesses after stereotactic treatment within two months. The cure rate was 92% in patients with bacterial brain abscesses treated with stereotactic aspiration and intravenous antibiotics for six weeks. CONCLUSIONS: Stereotactic surgery is a procedure with minimal morbidity and mortality, and can be the treatment of choice for brain abscesses when combined with appropriate antibiotic therapy.

Adult↗