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PubMed1984

Continuing changing patterns of disease in pyogenic liver abscess: a study of 38 patients.

Changes in the etiology, clinical features, methods of diagnosis, and treatment of pyogenic liver abscess have occurred slowly but continuously over the past century. The earlier changes are well documented in the literature, and continuing variations in the classic patterns of disease are now evident. These include 1) a recent increase in incidence reflecting more accurate diagnostic techniques; 2) changes in bacteriology with a high incidence of Klebsiella infection; 3) a reduction in mortality, reflecting earlier diagnosis and more refined therapeutic methods; and 4) changes in the population at risk namely a large population of terminal cancer patients. Thirty-eight patients treated at the Mount Sinai Hospital over the past 16 years, 1967-1982, have been divided into two groups, each of 8 years duration, reflecting an earlier era before routine use of scanning procedures, and a later period when technetium, gallium, sonographic, and more recently CT imaging procedures were regularly done. During the latter period there was a significant increase in both the total number of liver abscesses diagnosed and in the number estimated as a proportion of all hospital admissions. Mortality has continued to fall to more acceptable levels with a 25% reduction overall. In the early era, extrahepatic intra-abdominal infection caused all four deaths. In the past 8 years obstructing or metastatic cancer has caused four of the five deaths. Bacteremia occurred in six of the nine deaths, five of these being of biliary origin. The decrease in mortality may reflect earlier diagnosis, an increase in the number of solitary abscesses, and better therapy.

Adult↗
PubMed1976

The clinical presentation of pyogenic liver abscess.

The high mortality rate from pyogenic liver abscess is contributed to by delay in diagnosis. The widespread availability of radio-isotope liver scanning facilitates diagnosis once a hepatic abscess is suspected. This retrospective study identifies diagnostic features present at the time of admission to hospital in 28 patients who were subsequently found to have a hepatic abscess.

Adolescent↗
PubMed1989

Factors affecting in-transit shrink and liver abscesses in fed steers.

Live weight loss (shrink) and liver conditions (abscesses) were determined on 3,570 crossbred steers of predominantly British breeding over a 5-yr period. Starting in November 1979, steers were placed on feed at bimonthly intervals and provided one of three housing treatments: no shelter, access to overhead shelter or confinement. All steers were implanted with Synovex during the first 3 yr and Compudose the last 2 yr and fed a diet consisting of high-moisture corn grain, which provided 85% of the energy, and corn silage, along with a protein, vitamin and mineral supplement. Cattle were processed into beef after a feeding period of approximately 160 d. Year affected shrink (P less than .001), and month on feed and housing type tended to alter shrink. Cattle marketed during summer and fall and those outside without overhead shelter tended to shrink more. Year, month on feed and housing type affected liver condition (P less than .01). Cattle started on feed in November and January and cattle housed in confinement or outside without overhead shelter had higher incidences of liver abscesses and slower average daily gains (P less than .01). Daily gains for steers with normal and abnormal livers were not different (P greater than .19) for any month started on feed or housing treatment. These results indicate that under the conditions of this study a 2 or 3% weight loss should be expected during the marketing of finished steers and a 16% incidence of liver abscesses should be anticipated, with some modification of the latter due to time of year and housing. The presence of liver abscesses at the time of processing steers into beef did not reduce feedlot performance.

Animals↗
PubMed1985

Pyogenic liver abscess in Crohn's disease.

We describe six cases of pyogenic liver abscess occurring among 1227 Crohn's disease patients admitted to The Mount Sinai Hospital from 1960 through 1982, and review the features of the seven similar cases that have been previously reported. Mechanisms of formation of liver abscess in these 13 patients included direct extension of intraabdominal abscess (three cases), propagation via the portal vein (eight cases), biliary complications (one case), or metastatic cancer (one case). Five of the 13 patients died. All five deaths occurred among the eight patients with multiple abscesses; all five patients with solitary abscess survived. The mean age of the patients who died was 56 years, versus 37 years for the survivors. Three of the four patients treated with antibiotics only died; only two of the nine patients who underwent some form of drainage succumbed. Mortality was usually attributable to failure in making the diagnosis, especially as liver function test abnormalities were often subtle. Furthermore, the generally nonspecific clinical signs and symptoms were often obscured by underlying bowel disease. If a high index of suspicion is maintained, CT scanning and ultrasonography should reveal the lesion at an early stage, so that the necessary drainage procedure can be carried out, with or without concomitant resection of affected bowel and drainage of intraabdominal abscess.

Adult↗
PubMed2004

Mucoepidermoid carcinoma of the liver diagnosed as a liver abscess: report of a case.

Mucoepidermoid carcinoma of the liver is a rare variant of cholangiocarcinoma, containing both mucus-secreting glandular cells and squamous cells mixed in nests. We report a case of mucoepidermoid carcinoma of the liver in a 69-year-old woman who presented with a 1-week history of fever, chills, and right flank pain. On admission, she was not jaundiced, and under a provisional diagnosis of liver abscess, a pigtail catheter was inserted into the abscess cavity. We performed right hepatectomy and partial excision of the diaphragm 1 month later. Microscopically, the tumor was composed of solid and invasive nests of epidermoid and mucin-producing cells with desmoplastic stroma. The epidermoid component of the tumor contained intercellular bridges and individual cell keratinization. Alcian blue and Periodic acid-Schiff (PAS) staining confirmed that there was mucin in the cytoplasm of mucus-secreting cells. The tumor cells, intrahepatic bile ducts, and ductules were consistently reactive with cytokeratin (CK) 7 and negative for CK20. The adjacent nonneoplastic liver cells were CK 7-/CK20-, and P63 immunostaining was positive in the epidermoid cells. The tumor was diagnosed as mucoepidermoid carcinoma arising from the intrahepatic bile duct. Despite aggressive surgical treatment, the patient died of multiple liver metastases 4 months after the right hepatectomy.

Aged↗
PubMed1990

[Multiple liver abscesses due to Candida albicans in a patient with acute promyelocytic leukemia: percutaneous transhepatic intraportal administration of amphotericin B].

A 36-year-old male with acute promyelocytic leukemia in second relapse was admitted to receive reinduction therapy in June, 1985, and entered into third complete remission, but he developed spiky fever after chemotherapy. Ultrasonic tomography revealed multiple liver abscesses and culture of the aspirates demonstrated Candida albicans in the abscesses. He was treated with intravenous administration of amphotericin B (AMPH-B) but the effect on the liver abscesses was unsatisfactory and consolidation therapy was difficult to start. AMPH-B (30 mg/day) was administered by percutaneous transhepatic intraportal administration (PTIA). About two months later, multiple liver abscesses disappeared. No remarkable complications such as severe fever, chill and renal dysfunction were recognized during PTIA of AMPH-B. So PTIA of AMPH-B is considered to be useful and safe for the management of fungal liver abscesses.

Adult↗
PubMed1990

Liver abscess: a clinical study of 222 patients.

The medical records of 222 patients with liver abscess at Siriraj Hospital from 1978 to 1985 were analysed. Amoebic abscess was three times more prevalent than pyogenic abscess. In both groups middle aged males were affected more often than others. The main clinical manifestations were fever, right upper quadrant pain and hepatomegaly. History of colitis in the past, marked leukocytosis, elevation of alkaline phosphatase and a single abscess confined to the right lobe were suggestive of amoebic liver abscess. The presence of concurrent abdominal infection, marked anemia and jaundice were associated with pyogenic abscess. Patients with pyogenic abscess developed complications more often and the case fatality rate was greater than patients with amoebic abscess. Most of the patients were successfully treated with a combination of antimicrobials and drainage.

Adolescent↗
PubMed1983

Biliobronchial fistula following pyogenic liver abscess.

A 65-year-old man with malaise, chills and fever was found to have a pyogenic liver abscess. A fistula from the abscess to the bronchial tree was confirmed by bronchoscopy and thoracotomy. In spite of adequate drainage of the abscess, respiratory function deteriorated and the patient died 1 month after operation. Biliobronchial fistula resulting from a pyogenic liver abscess is rare and has not recently been reported in the English or French literature. Reports dating back to the first published case in 1857 are reviewed. Early supradiaphragmatic excision of the fistulous tract and drainage of the hepatic abscess are recommended.

Aged↗
PubMed2004

Community-acquired methicillin-resistant Staphylococcus aureus liver abscess in a patient with end-stage renal disease.

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are an emerging problem. Although most liver abscesses are caused by Escherichia coli and Klebsiella pneumoniae, S. aureus can occasionally be isolated as the pathogenic organism. Liver abscess caused by MRSA is rarely reported. Here, we report a case of liver abscess due to MRSA in a 34-year-old man with end-stage renal disease and a 13-year history of hemodialysis treatment.

Adult↗
PubMedDate not supplied

Neonatal solitary liver abscess: report of one case.

We report a case of a solitary liver abscess in a 5-week-old female. She was full term, and there were no predisposing events or immune deficiencies. The only sign of her disease was a gradually distended abdomen. A prior episode of fever with possible occult bacteremia was implicated in the development of her abscess. The abdominal sonography and magnetic resonance image (MRI) did not provide any definite preoperative diagnostic information. Surgical resection of the abscess and a short course of antibiotic therapy cured the disease. This patient was still well following 2 years of check-ups by sonography. The possibility of a pyogenic liver abscess should be considered in the differential diagnosis of neonatal hepatic mass. That is, even if there is not a definite diagnostic focus on finding an infection.

Abdomen↗
PubMed2004

Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration.

This study aims to compare the therapeutic effectiveness of continuous catheter drainage versus intermittent needle aspiration in the percutaneous treatment of pyogenic liver abscesses. Over a 5-year period, 64 consecutive patients with pyogenic liver abscess were treated with intravenous antibiotics (ampicillin, cefuroxime, and metronidazole) and randomized into two percutaneous treatment groups: continuous catheter drainage (with an 8F multi-sidehole pigtail catheter); and intermittent needle aspiration (18G disposable trocar needle). There was no statistically significant difference between the two groups regarding patient demographics, underlying coexisting disease, abscess size, abscess number, number of loculation of abscess, the presenting clinical symptoms such as fever, abdominal pain, and pretreatment liver function test. Although not statistically significant, the duration of intravenous antibiotics treatment before percutaneous treatment was longer with the catheter group, and the change of antibiotics after the sensitivity test was more frequent with the needle group. The needle group was associated with a higher treatment success rate, a shorter duration of hospital stay, and a lower mortality rate, although this did not reach statistical significance. In conclusion, this study suggests that intermittent needle aspiration is probably as effective as continuous catheter drainage for the treatment of pyogenic liver abscess, although further proof with a large-scale study is necessary. Due to the additional advantages of procedure simplicity, patient comfort, and reduced price, needle aspiration deserves to be considered as a first-line drainage approach.

Adult↗
PubMed2006

Sexual dimorphism in the control of amebic liver abscess in a mouse model of disease.

Amebic liver abscess (ALA) is the most common extraintestinal manifestation of human infection by the enteric protozoan parasite Entamoeba histolytica. In contrast to intestinal infection, ALA greatly predominates in males but is rare in females. Since humans are the only relevant host for E. histolytica, experimental studies concerning this sexual dimorphism have been hampered by the lack of a suitable animal model. By serial liver passage of cultured E. histolytica trophozoites in gerbils and mice, we generated amebae which reproducibly induce ALA in C57BL/6 mice. Interestingly, all animals developed ALA, but the time courses of abscess formation differed significantly between the genders. Female mice were able to clear the infection within 3 days, whereas in male mice the parasite could be recovered for at least 14 days. Accordingly, male mice showed a prolonged time of recovery from ALA. Immunohistology of abscesses revealed that polymorphonuclear leukocytes and macrophages were the dominant infiltrates, but in addition, gamma,delta-T cells, NK cells, and natural killer T (NKT) cells were also present at early times during abscess development, whereas conventional alpha,beta-T cells appeared later, when female mice had already cleared the parasite. Interestingly, male and female mice differed in early cytokine production in response to ameba infection. Enzyme-linked immunospot assays performed with spleen cells of infected animals revealed significantly higher numbers of interleukin-4-producing cells in male mice but significantly higher numbers of gamma interferon (IFN-gamma)-producing cells in female mice. Early IFN-gamma production and the presence of functional NKT cells were found to be important for the control of hepatic amebiasis as application of an IFN-gamma-neutralizing monoclonal antibody or the use of NKT knockout mice (Valpha14iNKT, Jalpha 18(-/-)) dramatically increased the size of ALA in female mice. In addition, E. histolytica trophozoites could be reisolated from liver abscesses of Jalpha18(-/-) mice on day 7 postinfection, when wild-type mice had already cleared the parasite. These data suggest that the sexual dimorphism in the control of ALA is due to gender-specific differences in early cytokine production mediated at least in part by NKT cells in response to E. histolytica infection of the liver.

Animals↗
PubMed1992

Fusobacterium nucleatum bacteraemia with multiple liver abscesses in an HIV-I antibody positive man with IgG2 deficiency.

Liver abscess formation due to Fusobacterium nucleatum is rare. We describe an HIV-I antibody positive man, with normal surrogate markers of cell-mediated immunity, who presented with F. nucleatum bacteraemia and liver abscess formation. He was found to have IgG2 subclass deficiency. This case illustrates the clinical importance of altered B-cell function in patients who are at an early stage of HIV disease.

Adult↗
PubMed1996

Protection against amebic liver abscess formation in the severe combined immunodeficient mouse by human anti-amebic antibodies.

We have used serum from patients with amebic liver abscess to investigate the role of antibody in the prevention of invasive amebiasis using the severe combined immunodeficient (SCID) mouse model of Entamoeba histolytica infection. The SCID mice were passively immunized with serum or purified antibody from patients with amebic liver abscess 24 hr prior to the direct intrahepatic challenge with 10(6) virulent E. histolytica trophozoites. This treatment reduced the mean abscess size in these animals from 24.5% to 3.5% (P < 0.0001). These results demonstrate that human anti-amebic antibodies are capable of exerting a protective effect in an animal model of amebic liver abscess formation.

Animals↗
PubMed1993

[Criteria of indication of puncture of amebic liver abscesses. 228 patients].

To clarify the therapeutic role of US-guided in the treatment of amebic liver abscess, three different approach to amebic liver abscess were tested in 228 patients (187 males and 31 females) along 3 years. In a west african endemic area (in Abidjan). All cases were correctly diagnosed by clinical and sonographic findings, and by the pus after percutaneous or chirurgical drainage. The three modes of therapy utilized segregated three distinct group. The first group consisted of 80 patients who were treated medically by metromidazole and ampicillin administered orally. In them, 33 patients have noncollected abscess with a diameter ranged from 2.3 to 12.7 cm (mean 6.6 cm), 23 patients have a collected abscess with a diameter less than 10 cm ranged from 4.1 to 9.7 cm (mean 7.1 cm), 24 patients have a collected abscess with a diameter equal or exceeding 10 cm ranged from 10 to 22.5 cm (mean 14.3 cm). In the second group, there were 124 patients, and they were treated with combined US-guided percutaneous evacuation and medical therapy. In them, 22 patients have a collected abscess with a diameter less than 10 cm ranged from 4.9 to 9.5 cm (mean 7.4 cm), and 102 patients have a collected abscess with a diameter equal or greater than 10 cm (measured 10 cm to 27.5, mean 15.3). There were twenty four patients in the last group, they were treated by open chirurgical drainage because they have an abdominal ruptured abscess. The results with each form of therapy were assessed clinically and by abdominal ultrasound.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Diagnostic performance of immunologic tests in amebic liver abscess using receiver operating characteristic curves].

Objectives. 1) To identify the tests of immunological diagnosis with a high diagnostic efficiency in amebic liver abscess. 2) To determine the ideal cutoff point for such tests. 3) To identify the influence degree of the antigen used over the test efficiency. Design. Comparative survey. Study units. Analysis of 24 articles identified in the medical literature about tests of immunological diagnosis in amebic liver abscess. Measurements. Starting from the articles, operating characteristics curves (ROC) were established derived from the test application to patients with amebic liver abscess. Results. A great variability in the diagnostic efficiency was identified between the various tests, even when the analysis was focused on the investigations of a specific test. It was not possible to conclude which test had a major degree of efficiency due to such variability. The cutoff level considered as relevant was higher than the one traditionally used for indirect hemagglutination and it had concordance with the one presently accepted for the fluorescence antibodies test. By maintaining steady the spectrum of the study patients and the type of test, variability among the tests persisted. This was due to the use of different antigens. Conclusions. A great variation in the diagnostic efficiency of the analyzed tests was identified. The variation source was the type of test, the antigen used and probably the illness spectrum.

Evaluation Studies as Topic↗