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PubMed2000

Direct amplification of Entamoeba histolytica DNA from amoebic liver abscess pus using polymerase chain reaction.

An important and serious complication of intestinal infection with Entamoeba histolytica is the involvement of the liver (hepatic amoebiasis). Hepatic amoebiasis is usually diagnosed by the clinical picture (pain in the right upper quadrant and fever), ultrasound examination and positive serology. However, none of these tests are definitive and the picture overlaps with pyogenic liver abscess caused by bacteria. It is for this reason that the feasibility of using polymerase chain reaction (PCR) for the detection of E. histolytica DNA in liver abscess pus was investigated. A comparative study was done to verify the sensitivity of ten pairs of primers specific for detecting E. histolytica in stools. Samples of liver abscess pus from 22 serology-positive patients were collected under ultrasound guidance; and these were used directly in PCR assays without any prior pre-treatment of the samples. Of the ten pairs of previously published primers tested, two pairs of primers (PI + P2 and P11 + P12) were found to give 100% sensitivity. Based on these results, we recommend that PCR assay can be successfully used to confirm the diagnosis of amoebic liver abscess with the primers identified.

Animals↗
PubMed2004

Pyogenic liver abscess: recent trends in etiology and mortality.

BACKGROUND: Pyogenic liver abscess, a potentially life-threatening disease, has undergone significant changes in epidemiology, management, and mortality over the past several decades. METHODS: We reviewed the data for patients admitted to Bellevue Hospital and New York University Downtown Hospital (New York, New York) over a 10-year period. RESULTS: Of 79 cases reviewed, 43% occurred in patients with underlying biliary disease. The most common symptoms were fever, chills, and right upper quadrant pain or tenderness. The most common laboratory abnormalities were an elevated white blood cell count (in 68% of cases), temperature >or=38.1 degrees C (90%), a low albumin level (70.2%), and an elevated alkaline phosphatase level (67%). Seventy percent of the abscesses were in the right lobe, and 77% were solitary. Klebsiella pneumoniae was identified in 41% of cases in which a pathogen was recovered. Eighteen (50%) of 36 Asian patients had K. pneumoniae isolated, in contrast to 6 (27.3%) of 22 non-Asian patients (not statistically significant). Fifty-six percent of cases involved treatment with percutaneous drainage. Although prior reports noted mortality of 11%-31%, we observed only 2 deaths (mortality, 2.5%). CONCLUSIONS: The data suggest that K. pneumoniae has become the predominant etiology of pyogenic liver abscess and that mortality from this disease has decreased substantially.

Female↗
PubMedDate not supplied

Pyogenic liver abscesses: have changes in management improved the outcome?

Pyogenic liver abscess is a serious condition with a high mortality rate. New diagnostic techniques have improved the diagnostic accuracy. Alternative therapeutic methods to open surgical drainage, such as percutaneous drainage and in certain cases antibiotics alone, are now available. Have changes in management of liver abscesses at our hospital improved the outcome? Two 5-year periods (I: n = 12; II: n = 14) were compared concerning diagnostic procedures, principles of treatment, and outcome. A shift from scintigraphy in the first period (I) to ultrasonography (US) in the second period (II) as prime diagnostic procedure was obvious. In I open surgical drainage dominated. 4/12, major surgical risks, were treated by anti-aerobic drugs alone, and died. In II US-guided percutaneous drainage was performed in 7/14, together with antibiotics active against aerobes as well as anaerobes, without complications. 4/14 were treated by an antibiotic combination alone and only 3/14 were treated by open surgical drainage. The change in management during these two periods has resulted in improved diagnostic and therapeutic routines as demonstrated by reduction in mortality rate.

Anti-Bacterial Agents↗
PubMed1981

Liver abscess complicating Yersinia pseudotuberculosis ileitis.

The occurrence of solitary liver abscess is described in a young farmer with subacute terminal ileitis mimicking Crohn's disease. Serologic tests showed high titers of antibodies for Yersinia pseudotuberculosis. Treatment with troleandomycin was successful. This case report suggests that: (a) Yersinia infection must be systematically searched for in all forms of subacute ileitis; (b) a classically benign Yersinia ileitis may be complicated by liver abscess; (c) antibiotic therapy must be undertaken in Yersinia pseudotuberculosis subacute ileitis to avoid severe infectious complications.

Adult↗
PubMed1999

Co-agglutination test for the detection of circulating antigen in amebic liver abscess.

We report here a simple and economical slide agglutination test, the co-agglutination (Co-A) test, for the detection of circulating amebic antigen in sera for the diagnosis of amebic liver abscess. Fifty serum specimens from cases of amebic liver abscess, 25 from other individuals with parasitic and miscellaneous infections, and 25 from healthy controls were tested for the presence of serum antigen by the Co-A test. Forty-five (90%) amebic liver abscess sera were found to be amebic-antigen positive by the Co-A test. None of 25 sera from healthy controls were positive for the antigen. However, false-positive results were seen with two sera from those with other parasitic and miscellaneous infection controls. These results show that the Co-A test can be used as a sensitive and specific rapid slide agglutination test for the detection of amebic antigen in the sera for diagnosis of cases of amebic liver abscess in a routine parasitology laboratory.

Agglutination Tests↗
PubMed2003

Pylephlebitis and liver abscess mimicking hepatocellular carcinoma.

OBJECTIVE: To characterize the clinical and radiographic findings in patients with pylephlebitis and liver abscess with an emphasis on the findings that help to differentiate this disorder from portal vein occlusion associated with hepatocellular carcinoma. METHODS: We analyzed the clinical findings and radiographic images of four patients with pylephlebitis and liver abscess(es) who had been misdiagnosed as having hepatocellular carcinoma with portal vein thrombosis. Their medical records were reviewed in terms of clinical presentation, physical findings, laboratory data, treatment, and follow up. RESULTS: All patients undergoing color duplex ultrasonography had an echogenic thrombus within an expanded portal vein with negative color-flow findings within the thrombus. Contrast enhanced CT in all the patients demonstrated portal vein thrombosis associated with "liver masses". An intra-abdominal site of infection responsible for the subsequent ascending infection of the portal vein and liver was not identified in any patient on initial CT scan. At presentation, all patients were febrile and three of them had an elevated white blood cell count as well. All patients showed abnormalities of liver function. CONCLUSIONS: Liver abscess(es) associated with pylephlebitis may mimic hepatocellular carcinoma with portal vein thrombosis. Clinical features that help to distinguish the two entities include presence or absence of fever, elevated white blood cell count, elevated alpha-fetoprotein, cirrhosis, and risk factors for hepatocellular carcinoma.

Adult↗
PubMed1999

[Amebic liver abscess in newborn. Report of a case].

The amebic liver abscess in newborns is an uncommon disease. There are few cases reported in the literature. This is a case of a 20 day-old female newborn who presented an abdominal mass, yellowish diarrheic depositions and jaundice. An abdominal CT scan showed a cystic mass located in the right hepatic lobe. The laboratory exams confirmed the amebic etiology. The clinical treatment failed and the surgery was decided. The pathologic results confirmed the diagnosis of an amebic liver abscess. Eight days after the resection the patient died because of a necrotizing enterocolitis.

Female↗
PubMed1997

Pyogenic liver abscess: treatment with needle aspiration.

OBJECTIVE: Percutaneous needle aspiration as an alternative to continuous percutaneous catheter drainage in combination with systemic antibiotics for the treatment of pyogenic liver abscess has never been popular. The authors report their experience with needle aspiration and evaluate its safety, effectiveness and role in treating pyogenic liver abscess. MATERIALS AND METHODS: The results of needle aspiration performed in 101 liver abscesses of 64 unselected consecutive patients with male to female ratio of 2.5:1 and average age 56.3 +/- 16 years were reviewed. The abscesses were pyogenic in 63 patients (98.4%), and multiple in 18 patients (28.1%). Thirty-nine abscesses (38.6%) were > or = 5 cm in diameter. Complete pus removal from each abscess was attempted with 18 gauge thin-walled trocar needles and ultrasound guidance. RESULTS: The percentage of abscesses requiring one, two and three, or more sessions of aspiration was 49.5%, 23.7% and 26.7%, respectively. The overall success rate was 96.8%. The success rate was unrelated to the largest size or number of abscess in the patient. Two patients died from uncontrolled sepsis. One serious complication of liver laceration requiring laparotomy occurred. CONCLUSION: Percutaneous needle aspiration in combination with systemic antibiotics is safe and effective in treating pyogenic liver abscess, it should be considered as a first line alternative to catheter drainage, especially for multiple abscesses. The need for repeat aspirations follows a 'fifty per cent rule'.

Aged↗
PubMed1995

The comparison of clinical course and results of treatment between gas-forming and non-gas-forming pyogenic liver abscess.

OBJECTIVES: To study and review the clinical manifestations, courses, and results of treatment in 83 cases of verified gas-forming pyogenic liver abscess. DESIGN: Case series. SETTING: Both primary and referral hospital care. PATIENTS: Four hundred twenty-four patients with clinical diagnosis of pyogenic liver abscess were enrolled in the study. Eighty-three patients had gas-forming abscesses and 341 had non-gas-forming abscesses. The clinical manifestations, duration of symptoms, incidence of septic shock, laboratory findings, concurrent diabetes mellitus, cause of abscess, size of abscess, and results of treatment were recorded. MAIN OUTCOME MEASURES: A chi 2 test for qualitative data and Student's test for quantitative data. RESULTS: Duration of symptoms were shorter (mean +/- SD, 5.2 +/- 5.3 vs 7.6 +/- 10 days) (P < .005) and the incidence of septic shock was higher in the gas-forming than in the non-gas-forming group (32.5% vs 11.7%) (P < .01). Laboratory findings revealed high levels of blood glucose, aspartate aminotransferase, alkaline phosphatase, and serum urea nitrogen in the gas-forming group. The size of abscess was usually bigger (> 5 cm) in this group. In the gas-forming group, 71 patients (85.5%) had diabetes mellitus and 65 patients (78.3%) had conditions of cryptogenic origin. Klebsiella pneumoniae was the main bacteria, in blood culture and liver aspirates, especially in gas-forming liver abscess. Medical treatment and/or aspiration carried a high mortality rate (44.4%) in the gas-forming group; also, the overall mortality rate was higher in this group than in the non-gas-forming group (27.7% vs 14.4%) (P < .01). CONCLUSIONS: The gas-forming liver abscess may be a disease of wide spectrum of severity and may run a fulminating course. Strong antibiotics with early adequate drainage are mandatory. Surgery should not be delayed if necessary.

Adult↗
PubMed1994

The development of a pyogenic liver abscess following radical resection of cholangiocellular carcinoma with ligation of the right hepatic artery: report of a case.

We present herein the case of a pyogenic liver abscess developing from hepatic ischemia caused by resection of the right hepatic artery when a left hemihepatectomy with caudate lobectomy and extrahepatic bile duct resection was performed for cholangiocellular carcinoma. Postoperative cholangiography revealed communication between the abscess cavity and the intrahepatic bile duct. The liver abscess was successfully treated by percutaneous transhepatic drainage. Thus, breakdown of the intrahepatic bile duct due to ischemia may play an important role in the development of a pyogenic liver abscess following hepatic arterial occlusion.

Bile Duct Neoplasms↗
PubMedDate not supplied

T cell subpopulations in amoebic liver abscess.

BACKGROUND: Cellular immunity may play a major role in the pathogenesis of amoebic liver abscess but there is little data on the effect of treatment on T cell subpopulations in such patients. METHODS: We performed a prospective, controlled study of the T lymphocyte subpopulations in 17 patients with amoebic liver abscess before, and at 4 and 8 weeks after treatment with metronidazole (30 mg/kg/day). T4 and T8 cells were studied using monoclonal antibodies by the alkaline phosphatase anti-alkaline phosphatase staining technique. RESULTS: The mean T4 cell percentages in the acute stage of illness and at 4 and 8 weeks after treatment were 27, 26 and 27 respectively and the mean T8 cell percentages were 19, 24 and 29. The T4:T8 ratio at the acute stage was 1.7, and 1.1 and 1.2 at 4 and 8 weeks of therapy. The T4:T8 ratio at the acute stage did not differ significantly (p > 0.05) from that in the control group. However, at 4 and 8 weeks after therapy there was a significant increase (p < 0.05) in the T8 cells with no significant change in the T4 cells. CONCLUSION: We suggest that sensitization of the T8 cells occurs in patients with amoebic liver abscess in the later phase of the disease. This may be responsible for the elimination of the parasite from the human host.

Administration, Oral↗