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PubMed2006

Post-traumatic hepatic artery pseudo-aneurysm combined with subphrenic liver abscess treated with embolization.

A 23-year-old man with post-traumatic hepatic artery pseudo-aneurysm and subphrenic liver abscess was admitted. He underwent coil embolization of hepatic artery pseudo-aneurysm. The pseudo-aneurysm was successfully obstructed and subphrenic liver abscess was controlled. Super-selective trans-catheter coil embolization may represent an effective treatment for hepatic artery pseudo-aneurysm combined with subphrenic liver abscess in the absence of other therapeutic alternatives.

Adult↗
PubMed1994

Multiple liver abscesses due to Yersinia enterocolitica discloses primary hemochromatosis: three cases reports and review.

We report three cases of multiple liver abscesses due to Yersinia enterocolitica that led to previously unknown diagnoses of primary hemochromatosis. Y. enterocolitica is an iron-dependent bacterium that relies entirely on exogenous iron for growth. A review of the literature with use of MEDLINE (National Library of Medicine, Bethesda, MD) disclosed 35 cases of Y. enterocolitica liver abscesses; 21 (60%) of these cases were associated with hemochromatosis. In 11 of the remaining 14 cases, two common manifestations of hemochromatosis, diabetes mellitus and cirrhosis of the liver, also were present; these findings were significant. Finally, we emphasize that when iron overload cannot be documented at the time of diagnosis of the liver abscess, long-term follow-up for determination of increasing iron stores is mandatory. With this approach, most manifestations of hemochromatosis in asymptomatic patients can be prevented.

Adult↗
PubMed2005

The clinical significance of gas-containing liver abscesses converting from total gas content to gas and fluid content: a case report.

The first case of gas-containing liver abscesses converting from total gas content to gas and fluid content is reported, and the clinical significance of such a conversion is emphasised. A 58-year-old diabetic woman suffered from fever and chill due to totally gas-containing liver abscesses shown by computerised tomography (CT). The patient did not recover despite ultrasound-guided aspiration of the abscess. CT carried out 2 weeks later revealed that the initial totally gas-containing liver abscesses converted to ones with gas and fluid content. The patient recovered after CT-guided drainage of the abscesses.

Drainage↗
PubMed2001

Septic metastatic endophthalmitis complicating Klebsiella pneumoniae liver abscess in a non-diabetic Chinese man.

Septic metastatic endophthalmitis is a rare but serious disease. Endophthalmitis arising from Klebsiella pneumoniae liver abscess has been reported with diabetes mellitus as a major associated condition, but is rarely seen in patients without diabetes. A non-diabetic patient with liver abscess complained of right eye discomfort and floaters 3 days after admission. Both blood and liver aspirate cultured Klebsiella pneumoniae. The patient was treated initially with systemic and subconjunctival antibiotics followed by intravitreal antibiotics with successful visual salvation. Previous reports from the literature showed poor visual outcome despite treatment and delayed recognition was often the cause. Clinicians should be alert to endophthalmitis whenever a patient with Klebsiella pneumoniae liver abscess complains of ocular symptoms. Urgent ophthalmological assessment should be sought.

Endophthalmitis↗
PubMed1984

Pyogenic liver abscess caused by Streptococcus milleri. Case reports.

In recent years Streptococcus milleri has emerged as an important cause of pyogenic liver abscess. Whether this represents a changing epidemiological pattern or merely reflects the more widespread application of routine anaerobic bacterial culture techniques is unclear. The isolation of Strept. milleri on culture of a blood specimen from a patient presenting with a pyrexial illness should alert the clinician to the possibility of an underlying liver abscess. Although it is isolated anaerobically this organism should not be mistaken for an obligate anaerobe, especially since it is resistant to metronidazole. Two cases of primary pyogenic liver abscess caused by this organism are reported.

Female↗
PubMed1990

[Pyogenic liver abscess--report of 72 cases].

Seventy-two patients with pyogenic liver abscess treated from Jan. 1986 through June 1988 were reviewed retrospectively. The average age was 55 years with a male to female ratio of 1.4:1. Most patients presented with the typical fever, chills and RUQ pain, but unusual signs and symptoms were also common. The right lobe was more commonly involved than left lobe. Biliary tract stone was the most frequent etiology (44.4%) and association with DM was common (37.5%). An elevated alkaline phosphatase and leukocytosis were useful clues to a liver abscess, but diagnosis depended on imaging of an abscess cavity either by echo or CT scan. The average time from onset of Symptoms to diagnosis was 9.3 days and a delay in diagnosis by the doctors was common. The most common complication was septicemia and factors with poor prognosis were old age (greater than or equal to 60 yrs), septicemia, cancer, peritonitis, and serum bilirubin greater than or equal to 5 mg/dl. The overall mortality was 29% with no difference between the group with surgical drains (28.5%) and the group with percutaneous transhepatic aspiration or drains (29.4%).

Adolescent↗
PubMed1979

The serum protein pattern in primary hepatoma and amoebic liver abscess.

A study of the serum proteins pattern of 30 patients with primary liver cell carcinoma and 11 with amoebic liver abscess was carried out. When compared with controls significant differences were found for both conditions in the values of pre-albumin, transferrin, albumin, haptoglobin, alpha 2-macroglobulin, and alpha 2HS-glycoprotein. In the differential diagnosis of amoebic liver abscess and primary hepatic carcinoma, the estimation of albumin, alpha 1-acid glycoprotein, haptoglobin ceruloplasmin, alpha 2H2-glycoprotein and transferrin was found helpful.

Adult↗
PubMed2002

Pyogenic liver abscess: retrospective analysis of 80 cases over a 10-year period.

BACKGROUND: A total of 80 patients with pyogenic liver abscess managed at a single institution over a 10-year period were studied. METHODS: The clinical features, laboratory, imaging, and microbiologic findings, management strategy, and final outcome were studied. RESULTS: Fever and chills, leucocytosis and elevated alkaline phosphatase were the most common clinical and laboratory findings. Forty-one percent of patients were diabetic and 61% had biliary pathology. Systemic antibiotics and image-guided aspiration had a success rate of 94%. By multiple logistic regression analysis, malignancy on presentation (P = 0.011) was an independent risk factor associated with mortality. A past history of endoscopic sphincterotomy was an independent factor associated with resolution of liver abscess within 6 weeks (P = 0.03). CONCLUSION: Pyrexia, leucocytosis, elevated alkaline phosphatase, presence of diabetes, and underlying biliary pathology are common clinical and laboratory findings in patients with pyogenic liver abscess. Malignancy was associated with a poor outcome. Previous endoscopic sphincterotomy was a good prognostic factor for early resolution.

Adult↗
PubMed2005

Refractory ulcerative colitis accompanied with cytomegalovirus colitis and multiple liver abscesses: a case report.

Various hepato-biliary complications are an increased incidence in patients with inflammatory bowel disease, and portal bacteremia is well documented in patients with ulcerative colitis (UC). However, few reports mention UC in association with liver abscesses. Recently, there are several reports describing cytomegalovirus (CMV) infection in association with disease exacerbation and steroid refractoriness in patients with UC. Here we present a case of refractory UC accompanied with multiple liver abscesses and CMV colitis. The patient, a 72-year-old male, with a five-year history of repeated admissions to our hospital for UC, presented with an exacerbation of his UC. Sigmoidoscopy performed on admission suggested that his UC was exacerbated, then he was given prednisolone and mesalazine orally, and betamethasone enemas. However, he had exacerbated symptoms. Repeat sigmoidoscopy revealed multiple longitudinal ulcers and pseudopolyps in the rectosigmoid colon. Although immunohistochemical staining of biopsy specimens and the serum testing for antigenemia were negative on admission and after the repeat sigmoidoscopy, they became histologically positive for CMV. Nonetheless, the patient developed spiking fevers, soon after ganciclovir was administered. Laboratory studies revealed an increased white cell count with left shift, and Enterococcus fecalis grew in blood cultures. An abdominal computed tomography (CT) scan was obtained and the diagnosis of liver abscesses associated with UC was made, based on CT results. The hepatic abscesses were successfully treated with intravenous meropenem for 6 wk, without further percutaneous drainage. To our knowledge, this is the first reported case of multiple liver abscesses that develop during UC exacerbation complicated by CMV colitis.

Aged↗
PubMed2000

Protection of gerbils from amebic liver abscess by vaccination with a 25-mer peptide derived from the cysteine-rich region of Entamoeba histolytica galactose-specific adherence lectin.

The protozoan parasite Entamoeba histolytica causes extensive morbidity and mortality through intestinal infection and amebic liver abscess. Here we show that immunization of gerbils with a single keyhole limpet hemocyanin-coupled 25-mer peptide derived from the 170-kDa subunit of the E. histolytica galactose-binding adhesin is sufficient to confer substantial protection against experimentally induced amebic liver abscesses. Vaccination provided total protection in 5 of 15 immunized gerbils, and abscesses were significantly smaller (P < 0.01) in the remaining vaccinated animals. The degree of protection correlated with the titer of antibodies to the peptide, and results of passive transfer experiments performed with SCID mice were consistent with a role for antibodies in protection. In addition, parenteral or oral vaccination of gerbils with 13-amino-acid subfragments of the peptide N-terminally fused to the B subunit of cholera toxin also significantly inhibited liver abscess formation (P < 0.05). These data indicate that small peptides derived from the galactose-binding adhesin administered by the parenteral or oral route can provide protection against amebic liver abscess and should be considered as components of a subunit vaccine against invasive amoebiasis.

Adjuvants, Immunologic↗
PubMedDate not supplied

[Laparoscopic drainage of liver abscess. Initial experience].

BACKGROUND: Radiologically guided percutaneous drainage has proven to be simple and effective and currently is considered the gold standard of care with success rates between 80 and 87%. However, not all abscesses are amenable to or will resolve with percutaneous drainage. The purpose of this study is to report our 1-year initial experience with laparoscopic drainage of liver abscesses. METHODS: Patients with diagnosis of liver abscess and who had a surgical indication and were submitted to laparoscopic drainage were studied prospectively from January to December of 2004. RESULTS: Six patients underwent laparoscopic drainage. There were three men and three women with a mean age of 50.8 years. Four patients had single lesions and two had multiple lesions. Mean size of the abscesses was 10.9 x 7.7 cm, segments primarily affected were 5 and 8. Two patients had amebic and four pyogenic abscesses. Mean operative time was 142 min. All patients were eating by the day following surgery and were ambulating between 24 and 72 h postoperatively. All patients reported to be asymptomatic at the time of their last visit. There was one recurrence that resolved with a second procedure. CONCLUSIONS: Success rate with the laparoscopic drainage of liver abscesses (83.3%) makes this procedure an effective and viable surgical alternative as a primary approach in selected patients or after a failed percutaneous drainage.

Drainage↗
PubMed2006

Capsular serotype K1 or K2, rather than magA and rmpA, is a major virulence determinant for Klebsiella pneumoniae liver abscess in Singapore and Taiwan.

Capsular serotypes, magA, and rmpA have been documented in high prevalence for Klebsiella pneumoniae liver abscess. To investigate the regional difference and the correlation of capsular serotype, magA, and rmpA with virulence, 73 isolates were collected in Singapore and Taiwan. Capsular serotypes were determined by countercurrent immunoelectrophoresis, the presence of magA and rmpA was determined by PCR, and virulence was determined by phagocytosis and mouse inoculation. Isolates from Singapore were similar to those from Taiwan in genomic heterogeneity, prevalence of serotype, and the presence of magA and rmpA. The most common serotype was K1 (34/73; 46.6%), followed by K2 (15/73; 20.5%). magA was restricted to serotype K1. All K1 or K2 isolates and 66.7% (16/24) of isolates that were neither serotype K1 nor serotype K2 (non-K1/K2) carried rmpA. Serotype K1 or K2 isolates demonstrated significantly more phagocytic resistance and virulence than did rmpA-positive and -negative groups of non-K1/K2 isolates. In the non-K1/K2 group, the virulence profiles of rmpA-positive strains from Taiwan and Singapore were different by phagocytosis assay and in the mouse model, indicating that factors other than rmpA contributed to virulence. The characteristics of K. pneumoniae liver abscess in Singapore and Taiwan are similar. Capsular serotype K1 or K2 plays a more important role than magA and rmpA in determining virulence in K. pneumoniae liver abscess.

Animals↗
PubMed1998

Entamoeba histolytica induces host cell death in amebic liver abscess by a non-Fas-dependent, non-tumor necrosis factor alpha-dependent pathway of apoptosis.

Amebic liver abscess is characterized by extensive areas of dead hepatocytes that form cavities surrounded by a thin rim of inflammatory cells and few Entamoeba histolytica trophozoites. E. histolytica produces pore-forming proteins and proteinases, but how trophozoites actually kill host cells has been unclear. Here, we report that E. histolytica induces apoptosis in both inflammatory cells and hepatocytes in a severe combined immunodeficient (SCID) mouse model of amebic liver abscess. By studying infection in C57/BL6.lpr and C57/BL6.gld mice, we found that E. histolytica-induced apoptosis does not require the Fas/Fas ligand pathway of apoptosis, and by using mice with a targeted deletion of the tumor necrosis factor receptor I gene, we have shown that E. histolytica-induced apoptosis is not mediated by tumor necrosis factor alpha. Our data indicate that apoptosis plays a prominent role in the host cell death seen in amebic liver abscess in a mouse model of disease and suggest that E. histolytica induces cell death without using two common pathways for apoptosis.

Animals↗
PubMed1990

Severity of liver abscesses and efficiency of feed utilization of feedlot cattle.

Relationships of gain, intake, feed efficiency and severity of liver abscesses were evaluated in 12 experiments involving 566 head of individually fed cattle. Concentrate level in the diets ranged from 64 to 95%. In all experiments, livers were scored as unabscessed (0), one or two small abscesses (A-), two to four small active abscesses (A) or one or more large, active abscesses (A+). Based on homogeneity of variances, nine of the experiments were divided into two groups. In one group (four experiments) the incidence of liver abscesses was 32.1% and no significant (P greater than .25) effects of liver abscess severity score on feedlot performance variables were found. In the second group (five experiments), the incidence of liver abscesses was 77.7%. In the second group, liver abscess severity score affected final live weight (P less than .10), hot carcass weight (P less than .0001), dry matter intake (P less than .10), daily gain based on live weight recorded 24 h prior to slaughter (P less than .10), daily gain based on live weight estimated from hot carcass weight with a 62% dressing percentage (P less than .0001), feed efficiency using final live weight estimated from hot carcass weight (P less than .0001) and dressing percentage (P less than .01). In all cases, performance means for cattle with A+ liver scores were the only ones that differed significantly from those of non-abscessed cattle.

Analysis of Variance↗
PubMed1998

Pyogenic liver abscess in children--South Indian experiences.

PURPOSE: Eighteen cases of pyogenic liver abscess (PLA) admitted at JIPMER hospital, South India, over a 6-year period were analyzed to document the clinical profile and to evaluate the management of PLA among children. METHODS: Records of all these patients were reviewed for presenting signs and symptoms, any associated condition, investigative results, management, and follow-up findings. RESULTS: The overall incidence of PLA was 78.9 per 100,000 pediatric (under 12 years) admissions. One patient had aplastic anemia and was on long-term steroid therapy, whereas another had measles in recent past. Moderate to severe malnutrition was present in five (27.8%) and ascariasis in seven (38.9%) children. Common presentations were fever (100%), abdominal pain (76.9%), and tender hepatomegaly (83.3%). Ultrasonography results were positive in all cases. Fourteen patients (77.8%) had solitary liver abscess, and four had multiple abscesses. Organism was isolated in 11 cases (63.6%), and Staphylococcus aureus was the commonest isolate (66.7%). All patients received antibiotics. Twelve cases were managed conservatively with antibiotics alone, of these only two (16.7%) required drainage later on. Percutaneous aspiration was also undertaken in four additional (22.2%) cases and open drainage in two (11.1%), at presentation. The overall mortality rate was 11.1%. Time taken for complete resolution ranged from 10 days to 40 days. CONCLUSIONS: Any child presenting with fever, abdominal pain, and tender hepatomegaly should be subjected to ultrasound scan for early detection of PLA. S aureus is the commonest causative agent. Enterobacteriaceae contribute significantly during infancy. A combination of cloxacillin and gentamicin or a third generation cephalosporine and gentamicin, especially in infants, is a satisfactory initial coverage. Therapeutic drainage is not a must in all cases of PLA. When required, percutaneous needle aspiration is safe and effective. Resolution and significant reduction in mortality has been made possible by early detection and optimum antibiotics therapy.

Child↗
PubMed1997

Right hepatectomy for pyogenic liver abscesses with true multiloculation.

We report the case of 61-year-old woman with cryptogenic liver abscesses who had been profoundly ill with severe upper abdominal pain, impaired consciousness, prostration, continuous high fever secondary to sepsis, and thrombocytopenia (platelets, 1-5 x 10(4)/mm3) since admission. Ultrasonograms and computed tomograms revealed two separate multiloculated lesions in the right lobe of the liver, consistent with the liver abscesses. Immediately after diagnosis, percutaneous abscess drainage was performed under ultrasonographic guidance; however, only a small amount of pus was drained, prompting continuous irrigation of the abscess cavity. Four days later, transcatheter hepatic arterial infusion of antibiotics was attempted. However, the abscesses had enlarged and her general condition had worsened. On hospital day 8, she underwent right hepatectomy because the multiloculated lesions were refractory to drainage. The operation was successful in terms of hepatectomy, although she continued to suffer from sepsis, secondary right subphrenic abscess formation, and prolonged thrombocytopenia with associated coagulation disorders for two months. Examination of multiple cross sections of the resected specimen disclosed that the lesions consisted of aggregations of multiple small locules. There was no communication between the locules and there were true septations, rather than multiloculated lesions with pseudoseptations. The patient has been well for 2 years without recurrent abscess of the liver or any infectious disease.

Drainage↗
PubMed1990

[Multiple amebic liver abscesses: ultrasound diagnosis and ultrasound-controlled puncture].

Amebic colitis and amebic liver abscess were diagnosed in a 45-year-old patient who had returned from Thailand. Ultrasound scans performed after starting treatment with metronidazole showed an abscess located above the right kidney that had enlarged to a maximum diameter of 9.7 cm. Since rupture of this lesion was felt to be imminent, ultrasound-guided needle biopsy was performed and 300 ml of abscess fluid evacuated. The patient experienced rapid relief of his symptoms. The role of ultrasound imaging in the diagnosis and follow-up of amebic liver abscesses and the indications for ultrasound-guided needle aspiration are discussed.

Animals↗