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Humans↗
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Solitary and multiple pyogenic liver abscesses: characteristics of the patients and efficacy of percutaneous drainage.
OBJECTIVES: Although percutaneous drainage has emerged as one of the first line of therapies for pyogenic liver abscesses, the presence of multiple abscesses may warrant surgical drainage, which remains controversial in the literature. We studied whether the multiplicity of the lesions influences the outcome of the treatment. METHODS: Ultrasonography-guided percutaneous drainage was carried out in 48 patients with pyogenic liver abscesses. The abscesses were solitary in 38 patients and multiple (two to seven lesions) in 10 patients. Clinical characteristics and the efficacy of the treatment were compared between these two groups. RESULTS: Biliary diseases and malignancies were more frequently observed in the solitary cases than multiple cases. A past history of surgery for cholelithiasis was seen exclusively in the multiple cases. E. coli was more frequently cultured from the abscesses in the multiple cases. Three of the multiple cases required more than a single catheter. All of the multiple cases and 36 of the 38 solitary cases were successfully treated. Two patients died of biliary peritonitis as a complication of the procedure, and three died of other underlining diseases. CONCLUSION: Ultrasonography-guided percutaneous drainage is effective even in patients with multiple pyogenic liver abscesses by adding catheters to obtain sufficient drainage.
Adult↗
Biochemical and biological characterizations and ribotyping of Actinomyces pyogenes and Actinomyces pyogenes-like organisms from liver abscesses in cattle.
Actinomyces pyogenes is the second most frequently encountered pathogen, next only to Fusobacterium necrophorum, in liver abscesses of feedlot cattle. Ninety-one isolates, presumptively identified as A. pyogenes, isolated from liver abscesses of cattle were studied. Biochemical characteristics determined by the API 20 Strep kit were similar to those reported previously for A. pyogenes isolated from other infections, except that 18% of isolates hydrolyzed esculin. Nine isolates that resembled A. pyogenes in morphology and in certain biochemical characteristics, but fermented mannitol and/or raffinose, were called A. pyogenes-like (APL) organisms. The five antimicrobial agents, bacitracin, chlortetracycline, oxytetracycline, tylosin, and virginiamycin were inhibitory to all strains of A. pyogenes and APLs. Generally, APL organisms had higher mean hemolytic and leukotoxic activities than A. pyogenes. All isolates of A. pyogenes and APLs produced proteases and neuraminidases. Ribotyping with endonucleases, including BstEII, ClaI, EcoRI, EcoRV, HaeIII, MboI, PvuII, SalI, and SmaI alone or in combinations, showed considerable genetic heterogeneity in both A. pyogenes and APLs. No specific ribopattern characteristic of each group was observed with any of the endonuclease used. The origin of A. pyogenes and APLs and the relative importance of APLs in causing liver abscesses in feedlot cattle are not known.
Actinomyces↗
A comparative evaluation of percutaneous catheter drainage for resistant amebic liver abscesses.
Resistance to drug treatment is a well-known problem in the management of patients with amebic liver abscesses. We undertook a comparison of the various modalities of treatment currently used for such cases on a prospective, randomized basis. Fifty patients with 56 amebic liver abscesses found to be resistant to drug therapy were included in the study. Repeat trial of conservative therapy, therapeutic needle aspirations, percutaneous catheter drainage, and open surgical drainage were the modalities of treatment employed. The responses to the various modalities were compared for clinical relief, morbidity, failure of response, period of hospital stay, and resolution of abscess cavity. The most impressive results were seen with percutaneous catheter drainage. This new modality of treatment is recommended for all resistant cases of amebic liver abscess.
Adult↗
Antigens of Entamoeba histolytica recognized by immune sera from liver abscess patients.
Immune sera from 11 patients cured of amebic liver abscess was used to identify antigens of Entamoeba histolytica. Strain HM1-IMSS, among the most virulent in axenic culture, was used. The 37 and 90 Kd antigens were surface glycoproteins as indicated by lactoperoxidase iodination and by Concanavalin A blotting; the 59 Kd antigen was a mannose containing glycoprotein that did not appear to be on the cell surface. Western blots of 11 different immune sera revealed specific binding of immune IgG to 9 amebic proteins. Most frequently recognized proteins were of molecular weight 37, 59, and 90 Kd. The immunoblot pattern in 5 patients was unchanged for up to 30 months post-treatment for liver abscess.
Animals↗
Long term survival of a patient with a regressed giant hepatocellular carcinoma after transcatheter hepatic artery embolization (TAE) complicated with liver abscess.
A 62-year-old male patient with histologically proven hepatocellular carcinoma, received transcatheter hepatic artery embolization (TAE) therapy. Development of right pyothorax and liver abscess at the tumor region occurred 4 months later after TAE. Aeromonas hydrophila was isolated from the liver abscess. After repeated percutaneous drainage, the abscess cavity disappeared and the tumor became undetectable by ultrasonography. Nineteen months after the initial presentation, a second tumor at the dome of the right lobe liver was found. TAE was repeated. Bile stasis with stricture of left intrahepatic ducts were found by Tc-99m HIDA cholangiography and endoscopic retrograde cholangiography. The patient had a normal lifestyle until the third tumor appeared at the right lower liver 18 months after the second TAE. TAE was conducted a third time. A shunting between the hepatic artery and vein developed at the new tumor area 3 months later. The patient is surviving today which is five and a half years after the initial diagnosis. We believe that the liver abscess after TAE contributed to the complete regression of the giant tumor, in addition to the anti-tumor effect of the successful TAE.
Carcinoma, Hepatocellular↗
Pyogenic liver abscesses: a comparison of older and younger patients.
OBJECTIVE: To evaluate whether older patients with pyogenic liver abscess have distinctive presenting features or if their management differs from that of younger patients. DESIGN: Retrospective chart review of all cases occurring from 1982 to 1992. SETTING: A regional trauma centre and two large community hospitals. PATIENTS: A total of 38 individuals with a final diagnosis of pyogenic liver abscess. Seventeen patients aged 70 or older comprised the study group and 21 patients under age 70 the comparison group. MEASUREMENTS: Clinical features, laboratory data, therapeutic interventions and outcomes were sought. The presumed aetiology of the abscess was determined. RESULTS: The study group had fewer men (47% vs 81%, P=0.028), less abdominal tenderness on physical examination (41% vs 76%, P=0.028) and fewer positive blood cultures in those sampled (31% vs 67%, P=0.04) than the comparison group. No study group patient had a history of trauma. Times to diagnosis were 3.2 and 5.9 days (P=0.14) and lengths of stay 21.6 and 29.3 days (P=0.08) for study and comparison groups, respectively. There were no differences in mortality or other demographic, clinical, laboratory or pathological variables. CONCLUSIONS: Elderly patients with pyogenic liver abscess have some subtle differences in clinical and laboratory presentation, but these do not appear to delay diagnosis. Active management is tolerated well, with no difference in mortality.
Adolescent↗
[Liver abscesses--complications after prosthesis and stent occlusions].
PURPOSE: Patients with malignant, unresectable biliary strictures and endoprosthesis or stents for drainage often develop liver abscess. The aim of the investigation was to assess the relationship and the factors causing the development of these abscesses. METHOD: 9 patients with a median age of 65.6 years, liver abscess and endoprosthesis or stents were studied retrospectively. The occlusions were made visible sonographically and by ERC or PTC. With sonography the abscess was diagnosed and punctured. RESULTS: 5 patients (56%) had a bile duct carcinoma, two patients had a distal tumor stenosis, one a tumor of the gallbladder and one an obstructive jaundice due to liver metastases. 8 patients required a percutaneous drainage (PTCD). 6 cases of occlusions were found. 1 patient had a biliary obstruction because of a broken endoprosthesis. On an average it took 11.6 months from the first endoprosthesis or stent placement to the formation of an abscess. Plastic endoprostheses tend to occlude more rapidly (5 months versus 17.6 with stents). After the sonographically guided puncture of the liver abscess, i.v. antibiotics were given for 5 to 14 days. The antibiotics were continued orally. Two cases required a sonographically placed percutaneous drainage. 78% of the abscesses could be cured. One patient died because of sepsis. CONCLUSIONS: Liver abscesses were connected with intrahepatic carcinomas (56%). In such cases drainage is difficult and requires many interventions. Furthermore, we find this especially after percutaneous transhepatic drainage and with plastic endoprostheses.
Adult↗
Primary liver abscesses in children and adolescents. Review of 12 years clinical experience.
Twelve cases of liver abscess in children and adolescents presenting at Children's Hospital at Los Angeles from 1974 to 1983 were reviewed. Most occurred in children younger than 5 years of age. The time from onset of symptoms to presentation did not differ over the 10-year period examined. However, diagnosis was made more rapidly in the latter half of the decade due to the development of advanced noninvasive imaging techniques and serologic methods. A constellation of fever, abdominal pain (whether or not localized in the right upper abdomen), vomiting or anorexia, hepatomegaly, elevated white blood cell count and sedimentation rate, and an unexplained anemia should prompt the clinician to include occult liver abscess in the differential diagnosis and proceed to early use of ultrasound or isotopic liver-spleen scan. History of travel or immigration or exposure to food handlers harboring the infection is important to differentiate amebic abscess from bacterial abscess. This suspicion may greatly alter the course of treatment.
Abdomen↗
Pyogenic liver abscesses: successful non-surgical therapy.
Eleven consecutive patients with pyogenic liver abscesses were seen in a 20-month study period. Ten patients were treated with antibiotics alone. All ten had abscesses demonstrated by hepatic scintigraphy or sonography. In six patients purulent material was obtained by percutaneous aspiration of the liver. Blood-cultures were positive in each of the nine patients in whom they were obtained. Nine of the ten patients treated with antibiotics alone were cured; one died from complications of a liver biopsy. These results indicate that pyogenic liver abscesses can be effectively managed by medical therapy and that surgery is rarely required.
Adult↗
Analysis of 69 patients with amebic liver abscess.
All 69 patients with amebic liver abscess that we treated in 1981-1992 were studied retrospectively. Men predominated by a 10:1 ratio. Of our 227 patients with amebiasis, some 30% yearly had liver involvement. The incidence peaked in 1988, decreasing later but increasing again in 1992. Most patients were 30-50 years old, the overall mean age being 45 years (range, 22-79), and decreasing with time. Patients with the related factors of travel abroad, positive results of a test for Treponema pallidum hemagglutination, and homosexuality have increased in number in recent years. Fever, abdominal pain, and hepatomegaly were the most frequent findings, and 39 patients had neither bloody stools nor diarrhea. Only 8 patients had had amebiasis previously. A solitary abscess in the right lobe of the liver was found in 40 patients. Entamoeba histolytica was found in the stool of 31 patients and in the pus of 39 patients. Sixty-one patients had positive results for an amebic serological test(s). The abscesses ruptured into the peritoneal cavity in 4 patients. All patients received metronidazole. Percutaneous or surgical drainage (or both) was done in 62 patients. The outcome was good, with 1 exception, and only 2 patients had recurrences.
Adult↗
Favourable outcome of multiple pyogenic liver abscesses with conservative treatment.
We describe a patient with multiple pyogenic liver abscesses treated only with antibiotics with a favourable outcome. This conservative treatment may be an option in some patients with multiple pyogenic liver abscesses.
Aged↗
Kinetics of lymphocyte subpopulations and their functions in cases of amoebic liver abscess.
This study shows the relationship between lymphocyte subpopulations and their response to non-specific stimulant phytohaemagglutinin (PHA) and specific stimulant (amoebic antigen) in cases of amoebic liver abscess in relation to the duration of disease, based on the first appearance of symptoms and/or signs, 26 patients with amoebic liver abscess and 20 normal, healthy controls were studied. Five of the patients gave a history of alcohol intake for the last 10 to 15 years. Eight had a solitary abscess and five had multiple abscesses, as seen on liver scan. No change in the B cell count was noticed in any of the patients. Depression of the T cell number and function was noticed from two weeks onwards. A history of alcohol intake made no difference. Cases with multiple liver abscesses were more immunologically depressed than were those with a solitary abscess.
Alcoholism↗
Effect of Fusobacterium necrophorum leukotoxoid vaccine on susceptibility to experimentally induced liver abscesses in cattle.
The efficacy and the optimum dose of Fusobacterium necrophorum crude leukotoxoid vaccine required to immunize and protect steers against experimentally induced liver abscesses were evaluated. The vaccine consisted of cell-free culture supernatant of a high leukotoxin-producing strain of F. necrophorum, inactivated with formalin and homogenized with an adjuvant. Twenty-five steers were assigned randomly to the following five treatment groups: control; three doses (1.0, 2.0, and 5.0 mL) of the culture supernatant; and 2.25 mL of the concentrated supernatant (equivalent to 5 mL of the original supernatant). Vaccine was injected subcutaneously on d 0 and 21. Blood samples were collected weekly to monitor antileukotoxin antibody titers. Three weeks after the second vaccination (d 42), all steers were injected intraportally with F. necrophorum culture to induce liver abscesses. Three weeks later (d 63), steers were euthanatized and necropsied; livers were examined and protection assessed. Antileukotoxin antibody titers in the control steers generally did not differ from the baseline (wk 0) titers. The titers in the vaccinated groups increased, more so after the second injection, and the increase was generally dose-dependent. Necropsy examination revealed that all steers in the control group had abscesses in the liver. In the vaccinated groups, two of five steers in the 1.0-mL group and one each in the 2.0-, 5.0-, and 2.25-mL (concentrated) groups had liver abscesses. Antileukotoxin antibody titers were higher (P < .05) in steers that did not develop abscesses than in steers that developed abscesses. The difference suggested a protective effect of antileukotoxin antibodies against experimentally induced liver abscesses.
Animals↗
Uncomplicated amebic liver abscess: prospective evaluation of percutaneous therapeutic aspiration.
The performance of therapeutic aspiration in the treatment of amebic liver abscess, advocated and practiced in many centers, is controversial. Previously, this practice has been evaluated in retrospective analyses. To test the potential benefit of therapeutic aspiration, the authors undertook a prospective randomized trial in 57 patients admitted for suspected amebic liver abscess during a 15-month period. Sixteen patients were excluded from the trial. The remaining 41 patients were randomly included in one of two study groups to receive amebicidal therapy alone or amebicidal therapy coupled with image-guided percutaneous therapeutic aspiration. All patients in the trial recovered. No statistically significant benefit was demonstrated in the aspiration group for the two objective parameters evaluated: length of hospitalization and duration of time to becoming afebrile. Subjective improvement in symptoms after aspiration was greater in the aspiration group at a marginally statistically significant level. These data do not support the adjunctive performance of percutaneous therapeutic aspiration in the treatment of uncomplicated amebic liver abscess. Amebicidals alone were equally efficacious in treating the group studied.
Humans↗
Amoebic liver abscess--results of a conservative management policy.
OBJECTIVE: To evaluate the safety and efficacy of conservative management of amoebic liver abscesses. DESIGN: A prospective study carried out over a 1-year period. SETTING: Inpatients and outpatients in a tertiary referral institution. SUBJECTS: Amoebic liver abscess was diagnosed on clinical, ultrasonographic, and serological features. All patients were treated with metronidazole. The indication for ultrasound-guided aspiration of the abscess was failure to improve clinically within 48-72 hours. MAIN OUTCOME MEASURES: Clinical improvement, clinical deterioration and failure of clinical improvement (persistent pain). RESULTS: In total 178 patients (male-to-female ratio 5:1) with 203 abscesses were treated during this period. Of these, 23 patients required percutaneous aspiration and 150 patients were managed without intervention and clinically resolved spontaneously. Abscesses requiring aspiration tended to be larger than those managed without aspiration (10.7 cm v. 8.2 cm) (p = 0.003). There were no complications following aspiration. Mean hospital stay was longer (12.3 days) for patients who underwent aspiration compared with those who did not (6.7 days) (p = 0.031). Only 5 patients presented with ruptured abscesses, 1 cutaneously and 4 intraperitoneally, with the only death in this latter category. CONCLUSION: Conservative medical management of amoebic liver abscess is safe. Percutaneous ultrasound-guided aspiration is indicated only in patients who fail to improve clinically after 48-72 hours rather than on rigid criteria.
Adult↗
Hepatic trauma and amoebic liver abscess.
A patient with a history of severe trauma over the hepatic area followed 2 weeks later by a large amoebic liver abscess of the right lobe is described. The possible role of hepatic trauma in the genesis of liver abscess is discussed. A history of hepatic trauma should not distract the clinician from diagnosing an amoebic liver abscess when suggestive symptoms and signs occur.
Adult↗
Liver abscesses associated with stromal tumour of the stomach in a young woman.
A 23-year-old Japanese woman was admitted to hospital because of pyrexia and anaemia. She was found to have liver abscesses and a gastric submucosal mass by computed tomography and ultrasonography. Gastroscopy and a barium swallow revealed a round submucosal mass with a giant ulceration in the body of the stomach. The liver abscesses were successfully treated by percutaneous transhepatic drainage and intravenous administration of antibiotics. Cultures of the fluid from a liver abscess and gastric juice yielded alpha-haemolytic streptococci. Three weeks after the drainage, partial gastrectomy was performed. The tumour was diagnosed as a stromal tumour of the stomach (leiomyosarcoma) in the final histological report. The patient was discharged on postoperative day 17 without receiving adjuvant radio-chemotherapy. There have been no signs of recurrence two years after surgery. This is a rare case of a liver abscess associated with a stromal tumour of the stomach in a young patient. The bacteriological examinations suggested a possible association between these diseases.
Adult↗