[THE PLEURO-PULMONARY SIGNS OF AMEBIC LIVER ABSCESS].
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Humans↗
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Intrathoracic presentation of amebic liver abscess.
Amebic infection is endemic in tropical and subtropical countries and still remains a common cause of chronic morbidity in these areas. This is a report of 10 patients with different intrathoracic presentations of amebic liver abscess who were treated surgically after conservative measures had failed. Five of these patients had empyema when first seen, 3 had lung abscess, and 1 had intrathoracic shadow that proved on exploration to be an amebic liver abscess. All of these 9 patients had abscesses on the right side secondary to amebic liver abscess of the right lobe of the liver. The tenth patient had amebic pericarditis secondary to amebic abscess of the left lobe of the liver. Failure of conservative treatment in these patients is attributed to the thick nature of the amebic pus and the severe reaction of the pleura and pericardium to the amebic infection. To avoid the serious complication of pleuropulmonary amebiasis, early operation is advised for large liver abscesses that are unlikely to be controlled by conservative treatment. Transpleural drainage of such abscesses gives direct approach to their sites, which are commonly located in the superior part of the right lobe of the liver. Such drainage has proved to be safe provided that the patient is receiving antiamebic drug treatment.
Adolescent↗
Tuberculous liver abscess: a case report and review of literature.
Tuberculous liver abscess is rare worldwide. We report a 45-year-old man who presented with abdominal pain, fever and weight loss. Ultrasound and computed tomography of the abdomen showed multiple cystic lesions in the liver. Ultrasound guided needle aspiration revealed yellowish brownish aspirate, which was flooded with acid-fast bacilli. The abscess was drained under ultrasound guidance. Subsequent abdominal ultrasound a few days later showed resolution of the abscess cavity. He was concomitantly started on systemic antituberculous therapy. A tuberculous liver abscess has to be thought of in the differential diagnosis of liver abscesses and to consider the role of percutaneous drainage along with systemic antituberculous chemotherapy as an alternative to surgery in the management. A greater awareness of this clinical entity is required for successful treatment.
Antitubercular Agents↗
Amoebic liver abscess: ultrasonographic characteristics and results of different therapeutic approaches.
This prospective study was carried out on 33 patients with clinically, serologically and ultrasonographically confirmed amoebic liver abscess. All patients were randomly treated with metronidazole and chlorochin or a combination of medicamentous therapy and percutaneous drainage. Ultrasonographic characteristics of amoebic liver abscesses were rotound or oval shape, usually hypoechogenic content with specific dorsal sonic enhancement, and in the majority of cases, location near liver capsule. Shorter duration of amoebic liver abscess resolution time in the group of patients treated with the combined therapy was observed particularly in the first four weeks of the treatment. The authors concluded that percutaneous drainage in combination with medicamentous therapy represents a successful therapeutic approach in the treatment of amoebic liver abscesses.
Adult↗
Successful single antibiotic therapy in Actinomyces septicemia and liver abscess.
We are reporting on a 36-year-old man with septicemia and a liver abscess due to Actinomyces sp. The infection was most probably acquired while eviscerating a deer he had shot. The possibility of an infection involving Actinomyces bovis is discussed. The liver abscess was diagnosed on the basis of non-invasive procedures. Therapy consisted of high-dose penicillin without surgical drainage of the abscess. The infection did not recur during the three-and-a-half year follow-up period. No previous reports of successful antibiotic therapy for actinomycotic liver abscess without surgical procedures are known.
Actinomyces↗
Liver abscess caused by Klebsiella pneumoniae in siblings.
Klebsiella pneumoniae has been emerging as the leading cause of liver abscess in diabetic patients. Results of molecular typing of K. pneumoniae isolates from two siblings with liver abscess, their family members, and the environment suggest a possibility of cross infection of liver abscess by the fecal-oral route within diabetic patients.
Adolescent↗
Pyogenic liver abscess in the elderly.
Seventeen patients over the age of 60 years, admitted to the Aberdeen Teaching Hospitals between 1980 and mid-1988, were diagnosed as having pyogenic liver abscess. Eleven were women and the mean age was 73.5 years. The diagnosis of liver abscess was made by needle aspiration in seven patients and was an unexpected finding at laparotomy in three. Six patients were thought to be suffering from advanced malignant disease until autopsy. The overall fatality was 53%. Misleading results from special investigations reduced the chance of a correct diagnosis in several patients. Even in frail elderly patients, a filling defect in the liver should not be attributed to metastatic malignancy when there is no known primary site, until liver abscess has been excluded by aspiration biopsy under ultrasound or computerized tomographic scan guidance. The high fatality of pyogenic liver abscess seems to be at least in part due to a lack of clinical suspicion.
Aged↗
Amebic liver abscess--rare need for percutaneous treatment modalities.
BACKGROUND: Given the often unspecific symptoms of amebic liver abscess, an analysis was done to recognize the most common patterns of presentation. Since treatment recommendations are still inconsistent comparing conservative and interventional treatment modalities, we evaluated treatment modalities in our patients. METHODS: A retrospective case series of all patients with confirmed amebic liver abscess was conducted. Age, sex, country of origin or travel, symptoms, and physical and laboratory findings were recorded. Particular attention was given to the need for interventional measures. RESULTS: 62 patients were reviewed, and nearly all of them (95%) had a travel history. The most common findings were fever (97%), abdominal pain (95%), and hepatomegaly (79%). 11% still had no amebic antibodies on presentation but an increase in the follow-up examinations. In 5% needle aspiration was performed to allow differentiation between amebic and pyogenic etiology. Metronidazole alone quickly cleared symptoms in 92% of the patients. In 8% only, there was a therapeutic need for interventional procedures (3% already ruptured, 5% large abscess formation with the danger of rupture). CONCLUSIONS: In travelers with fever, abdominal pain, and hepatomegaly amebic liver abscess must be considered. Medical treatment with metronidazole is effective in more than 90%. Only in very few cases there is a need for invasive therapeutic modalities.
Abdominal Pain↗
Percutaneous drainage of pyogenic liver abscesses.
Twenty-one patients with liver abscesses were treated by percutaneous drainage over a 2 1/2-year period. Percutaneous drainage was successful in 18 (85%) of 21 patients. Complications include 2 inadvertently dislodged catheters, 1 septicemia and 1 pleural effusion. There were 2 deaths. The low morbidity and high success rate in treating hepatic abscesses by percutaneous drainage suggest that this therapy should be tried before operative intervention is considered.
Drainage↗
Liver abscess after radiofrequency ablation of tumors in patients with a biliary tract procedure.
AIM: The rate of liver abscesses after radiofrequency ablation (RFA) of liver tumors is probably high in patients with a biliary tract drainage procedure connecting the biliary duct system to the upper gastrointestinal tract. And yet, to date this rate, the time of onset of these abscesses, and the prior status of the bile ducts have never been reported in the literature. METHODS: Among 574 patients treated with RFA over 8 years, only 11 patients (with 13 sessions of RFA, 2 patients undergoing two different RFA sessions) presented with an enterobiliary anastomosis or biliary stenting at the time of RFA. This is a retrospective study of patients who were verified prospectively. RESULTS: Among the 9 patients in whom a biliary tract procedure preceded RFA, 4 developed a liver abscess at the site of RFA, which emerged between 13 and 62 days after RFA. It occurred in spite of different types of short-term antibiotic prophylaxis. Pathogenic bacteria were typical of the digestive flora. Abscesses were cured after percutaneous drainage. No abscess occurred among the 4 patients in whom a biliary tract diversion was performed synchronously with RFA. CONCLUSION: When RFA is performed in a patient with a preexisting biliary diversion, the risk of developing a liver abscess is high. Currently, we are unable to recommend any kind of preventive antibiotherapy. A preexisting biliary diversion is not an absolute contraindication for RFA, but the risk of developing a liver abscess is close to 40-50%. When RFA is performed synchronously with a biliary diversion, the risk of a liver abscess seems to disappear.
Anti-Bacterial Agents↗
[Primary pyogenic liver abscess in a child].
A case report describing a child with a primary pyogenic liver abscess is presented. Primary pyogenic liver abscess is a rare disease at this age. Furthermore the clinical picture only rarely reveals indications of liver disease. To establish the correct diagnosis within the proper time, one must remember this diagnostic possibility. The recommended treatment is shortly discussed.
Anti-Bacterial Agents↗
Successful medical treatment of pyogenic liver abscess.
Between 1976 and 1978, 6 patients with proven or probable pyogenic liver abscess were successfully treated at Los Angeles County-University of Southern California Medical Center without surgical drainage. Although surgical therapy is necessary in patients with coexisting intraabdominal pathology, antibiotic therapy without surgical intervention is an option to be considered in patients with pyogenic liver abscess and no evidence of other intraabdominal disease.
Adult↗
Effects of dietary virginiamycin on performance and liver abscess incidence in feedlot cattle.
The effects of dietary virginiamycin level on performance and liver abscesses in feedlot cattle were evaluated in seven dose-response studies. Steers and heifers were fed finishing diets ranging in energy content from 1.34 to 1.51 Mcal of NEg/kg of DM. In all studies, virginiamycin added to the diet improved average daily gain and(or) feed conversion, with no substantial effect on dry matter intake. Pooled analyses of four studies providing virginiamycin at 11.0, 19.3, and 27.6 mg/kg of DM in the complete diet indicated that growth and feed conversion were linearly improved (P < .05); feeding 19.3 mg/kg improved these measurements by 3.0 and 3.8%, respectively. Overall incidence (score 0 vs score 1, 2, and 3) and severity (score 0, 1, and 2 vs score 3) of liver abscesses were reduced (P < .01) by feeding virginiamycin at either 19.3 or 27.6 mg/kg. Linear plateau modeling indicated that the effective dose range for virginiamycin in feedlot diets (DM basis) was 19.3 to 27.3 mg/kg for increasing average daily gain, 13.2 to 19.3 mg/kg for improving feed conversion, and 16.5 to 19.3 mg/kg for reducing liver abscess incidence.
Animals↗
Defective production of reactive oxygen intermediates (ROI) in a patient with recurrent amebic liver abscess.
Previously, we reported the case of a man in the fourth decade of life afflicted with three independent episodes of amebic liver abscesses over a period of 4 years. Previous evidence has indicated that the cellular immune response is involved in protection against recurrent invasive amebic infection, and macrophage-mediated effector mechanisms appear important for host resistance to Entamoeba histolytica infection. The aim of the present work was to investigate locomotor activity and oxidative burst function of peripheral mononuclear cells of this individual after healing of the third amebic liver abscess. A locomotion assay using Boyden chemotaxis chambers and the respiratory burst evaluated by chemiluminescence were performed in both mononuclear phagocytes (MPs) and polymorphonuclear (PMN) leukocytes. Levels of salivary IgA and serum IgG anti-amebic antibodies were followed during 48 months after the second amebic liver abscess. Results obtained showed a deficiency in MP but not in PMN leukocyte respiratory burst. Respiratory burst is a major microbicidal mechanism in MP leukocytes; this also has been considered as a host resistance strategy against E. histolytica. It may be at least one risk factor in our patient that was responsible for recurrence of amebic liver abscess.
Animals↗
Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in amoebic liver abscess.
We report here three cases of amoebic liver abscess with biochemical abnormalities of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). All three patients were febrile and had pain in the right upper abdomen radiating to the right shoulder. Liver function tests were disturbed. Chest X-ray showed raised right hemidiaphragm with obliteration of the right costophrenic angle. On ultrasound, an abscess 710 cm in diameter was located in the upper right lobe. SIADH was transient and improved with treatment. We believe this to be the first reported association of SIADH with amoebic liver abscess.
Adult↗
Liver abscesses due to Staphylococcus aureus in a patient with AIDS who underwent small bowel biopsy: case report and review.
A 36-year-old man with overgrowth of Staphylococcus aureus in the small bowel underwent a biopsy of the small bowel and presented 5 weeks later with multiple liver abscesses. To our knowledge, small bowel biopsy has never been associated with liver abscesses. We discuss the literature on liver abscesses in patients with AIDS and the risks of bacteremia following upper endoscopy and small bowel biopsy and propose that the etiology of the liver abscesses in our patient was seeding of the portal vein following biopsy of a small bowel that had significant bacterial overgrowth.
AIDS-Related Opportunistic Infections↗
[Percutaneous treatment of liver abscess. Apropos of 34 cases].
The authors report on a retrospective series of 37 liver abscesses treated via the percutaneous route in 34 patients, in order to assess the efficacy of this method. One or more aspiration punctures were undertaken in 24 patients (70.6%), while percutaneous drainage was performed in 10 patients (29.4%). In 27 cases (79.5%), this percutaneous treatment resulted in a cure. Further surgical drainage, carried out in 7 patients (20.5%) was only required in 3 cases, twice due to the inefficacy of percutaneous drainage and once in the presence of three liver abscesses containing particularly thick pus. Ultrasonographic monitoring demonstrated a return to normal in 66.6% of cases, the persistence of a slight residual collection in 26.6% patients and one relapse, two months after percutaneous drainage. Two complications inherent to the percutaneous treatment were noted: a pneumothorax and a case of septicemia, both of which had a favourable outcome.
Adolescent↗
A comparative study of different isolated fractions of Entamoeba histolytica in amoebic liver abscess.
Fifty six patients with amoebic liver ubscess were assessed for antibody production and lymphokine release using different antigenic fractions such as sephadex G-200 eluted fraction-I (F-I), shed of bile salt treated amoebae (SBSTA), amoebic membrane glycoprotein (AMG), amoebic RNA and whole amoebic lysate (WAL). Antibody production in response to WAL, F-I, SBSTA, AMG and RNA was assessed by indirect haemagglutination assay. Five and 53 fold increased titres of IHA was observed with F-I and SBSTA respectively compared to WAL. The difference between mean titres of F-I, SBSTA and WAL was found to be highly significant (P < 0.001). Amoebic RNA did not show pronounced antibody titres. Lymphokine release by T lymphocytes in response to F-I, SBSTA, AMG, RNA and WAL was assessed by leukocyte migration inhibition (LMI) test. A highly increased release of LMIF by RNA, AMG, F-I and SBSTA was observed compared to whole amoebic lysate. The difference between the means of the purified fractions and WAL, to release of LMIF was found to be highly significant (P 0.001). These findings suggest that SBSTA, F-I and AMG fractions might have an important role as a potent antigen in inducing humoral and cell mediated immunity in patients with amoebic liver abscess and these findings also confirm the multiple antigenicity of E. histolytica.
Adult↗