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PubMed2003

Hepatic abscesses at the University Hospital of the West Indies. A 24-year autopsy review.

A retrospective review of all hepatic abscesses identified at autopsy over the 24-year period 1977-2000 at the University Hospital of the West Indies (UHWI), Kingston, Jamaica, was conducted. Post mortem and microbiology records were reviewed. Data collected included age, gender, predisposing factors, organisms isolated, number of abscesses and associated conditions, such as diabetes mellitus. Data for the adults was analyzed separately. Thirty-nine cases of pyogenic abscesses were identified from 7480 post-mortems. Thirty-three occurred in adults of mean age 59.5 years. Sixty per cent of the abscesses were solitary. Biliary tract disease was the predisposing factor in 33% of cases. Six per cent were cryptogenic: 11/33 patients were diabetic and these were significantly older than non-diabetics (p < 0.014) Klebsiella pneumoniae was the most common organism isolated from diabetics (6.9). Only 2/33 abscesses were diagnosed ante-mortem. The abscesses in children were more frequently multiple and associated with extra-abdominal infection. Gram positive cocci were the commonly isolated organisms in children. There were no cases of amoebic abscess. The prevalence of hepatic abscess was low. Diabetes mellitus was a significant contributing factor. A high index of clinical suspicion is therefore warranted particularly in elderly diabetics.

Abdomen↗
PubMed1992

Percutaneous versus open operative drainage of intra-abdominal abscesses.

This article has tried to provide some perspective on the results of surgical and percutaneous drainage of intra-abdominal abscesses and the impact of CT localization on the successful management of this problem. It is most likely that the recent decrease in mortality for intra-abdominal abscesses over the past decade is due to a variety of factors, including better antibiotics, more aggressive critical care, and earlier diagnosis and treatment of the intraabdominal problem. These factors combined to reduce the incidence of pre-drainage organ failure and the degree of physiologic derangement of these patients at the time of their abscess drainage. Percutaneous drainage and surgical drainage techniques should not be considered competitive but rather complementary. If an abscess is accessible by percutaneous techniques, it is reasonable to consider a nonoperative approach to the problem. It is also clear that patients should respond promptly to whatever technique is employed to drain their intra-abdominal abscess. An improvement should be seen clinically within 24 to 48 hours following drainage. Should improvement not be forthcoming, the patient must be aggressively re-evaluated with repeat CT and decisions made by the responsible surgeon in consultation with the radiologist as to the next appropriate course of action. As our review of the Wayne State University experience suggested, patients are never too sick for an appropriate operation. Although it appears that most abscesses can be successfully treated by percutaneous drainage, pancreatic abscesses with pancreatic necrosis should generally be treated by surgical debridement, usually accompanied by repeated explorations. In addition, splenectomy has not yet been replaced by percutaneous drainage of splenic abscesses.

Abdomen↗
PubMedDate not supplied

Renal abscess in children: a clinical retrospective study.

A renal abscess is rare in children and diagnosis is not readily apparent before hospitalization, because symptoms are often insidious and nonspecific. To evaluate the diagnostics and therapy of renal abscess in the pediatric group, we will report eight cases of renal abscess in children to illustrate the variable features of this condition. Eight patients, 6 to 156 (mean, 45.9) months old, with renal abscesses in 9 kidneys were identified. Ultrasound and computed tomography proved to be the most valuable diagnostic tool, revealing a hypoechoic or hypodense mass. Fever, abdominal pain, and leukocytosis were common presenting features, but no child presented symptoms of loin pain. Escherichia coli was identified in the urine culture among the 6 cases and blood culture in one case. Three children were associated with mild to moderate vesicoureteral reflux. All patients had an intensive antibiotic treatment, which led to resolution of the abscess in eight of the nine kidneys. In one case, the abscess had to be drained using the CT-guided percutaneous drainage. During follow-up, seven children received 99mTc DMSA renal SPECT and only two of them had complete remission without sequelae of renal scar. We concluded that the renal abscesses must be assumed, especially, in children with prolonged fever, abdominal pain, and a high value of CRP. Ultrasonography is just a screening test to detect renal swelling, bulging, and enlargement; however, a CT scan is more sensitive and can detect abscess formation, as well as define the extent of the disease for planning conservative antibiotic treatment or additional drainage. Finally, DMSA renal SPECT is the best and the most sensitive examination for detecting the extension area of renal inflammation and correlated with the renal outcome.

Abscess↗
PubMed2004

Diffusion-weighted imaging in the assessment of brain abscesses therapy.

BACKGROUND AND PURPOSE: Surgically or conservatively treated brain abscesses may resolve, or pus may re-accumulate, requiring further intervention or treatment change. We hypothesized that diffusion-weighted (DW) imaging is useful in depicting features of abscesses related to therapeutic success or failure. METHODS: Conventional contrast-enhanced T1- and T2-weighted imaging and DW imaging were performed in seven patients (aged 30-69 years) with proved pyogenic brain abscesses. The center of the abscess was qualitatively and quantitatively analyzed at initial and follow-up imaging in all patients. We correlated the signal intensity on trace DW images and the apparent diffusion coefficients (ADCs) with the clinical and laboratory data, particularly with respect to treatment failure and repeat therapy. RESULTS: Surgical drainage was performed in six patients; one patient was treated with only antibiotics. All abscess cavities initially had high signal intensity (restricted diffusion) on DW images, with a mean ADC value of 0.52 x 10 (-3)mm (2)/s. Low signal intensity at DW imaging with high ADC were seen on follow-up images in the patient receiving medication and in four patients in whom the abscesses were drained; this correlated with a good therapeutic response. Two patients underwent drainage; their second follow-up DW images showed areas of high signal intensity and low ADC values suggesting re-accumulation of pus. Increased C-reactive protein level and WBC count correlated well with DW image findings. CONCLUSION: DW imaging was superior to conventional MR imaging in evaluating the success or failure of abscess therapy. Restricted diffusion in a drained abscess corresponded to pus.

Adult↗
PubMed2004

Prostatic abscesses: radiographic findings and treatment.

OBJECTIVE: To analyze the medical images and therapeutic strategies in patients with prostatic abscesses. METHOD: From April 1999 to August 2002, 12 patients with prostatic abscesses at Srinagarind Hospital, Khon Kaen, Thailand were reviewed The average age was 47 years (range 29 to 75). Diagnostic procedures included analysis of midstream urine, abscess fluid for pathogens and medical imaging with TRUS, CT and MRI. Therapeutic options were transrectal ultrasound-guided drainage or conservative medical treatment. RESULTS: Almost all patients had predisposing diseases. All patients showed hypo-echoic masses, plus internal septation in 5 cases. Most lesions were located at the central gland. Their sizes ranged from 0.5 to 2.75 cm (average 1.51 cm) in diameter. The main pathogen was B. pseudomallei. On TRUS imaging, patients with melioidosis had one or more hypo-echoic areas with internal septation, thickened wall and surrounding multiple small daughter abscesses. All abscesses resolved within 4 weeks, with no difference in the duration of treatment, despite different sizes or pathogens. CONCLUSIONS: Transrectal ultrasonography is useful in the diagnosis of prostatic abscess as well as in the guidance for aspiration and the drainage of such abscesses. Our data showed sonographic patterns in prostatic abscess, especially with melioidosis.

Abscess↗
PubMed2005

Clinical management and outcome of childhood lung abscess: a 16-year experience.

In order to evaluate the clinical manifestations, management and outcome of childhood lung abscess, a retrospective chart review of 27 pediatric patients with International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9 CM) code of 503.1 (lung abscess) from August 1987 to August 2003 was conducted. Among the 27 patients (14 males and 13 females), 30% (8/27) were primary lung abscess and 70% (19/27) had underlying chronic diseases (secondary lung abscess). The predisposing factors of the primary group (n = 8) included 6 cases of respiratory tract infection, 1 with choking during swimming, and 1 with laceration wound. The underlying diseases in the secondary group (n = 19) included 10 cases of hematologic disorder (52%), 3 of congenital heart disease, 2 of central nervous system anomalies, and 1 each of hyperimmunoglobulin E syndrome, chronic lung disease, liver cirrhosis with fistula formation, and Swyer-James syndrome. Eleven patients (41%) underwent diagnostic tapping, including echo-guided aspiration (10 cases) and computed tomography-guided percutaneous needle aspiration (1 case). Positive yield rate from aspiration of lung abscess was 63.6% (7/11). Surgical intervention was performed in 8 (42%) of the secondary group and in 1 patient from the primary group. The pathogens were identified in 11 patients (41%): 5 with oral flora, 2 with Staphylococcus aureus plus other pathogens, 1 with S. aureus alone, 1 with Pseudomonas aeruginosa plus Proteus mirabilis, 1 with P. aeruginosa alone, and 1 with Aspergillus. The average duration of parenteral antibiotic use was 40 days. Five cases (18.5%) died due to poor control of the underlying diseases, and 4 of the patients (15%) had sequelae (2 with bronchiectasis and 2 with lung fibrosis). Seventy percent of lung abscess occurred in children with underlying medical conditions. Early percutaneous aspiration has an important role in identification of pathogens. Oral anaerobes and S. aureus are the core pathogens in primary lung abscess and gram-negative pathogens should also be considered in secondary lung abscess.

Adolescent↗
PubMed2005

Efficacy of vaccination against Fusobacterium necrophorum infection for control of liver abscesses and footrot in feedlot cattle in western Canada.

A randomized and blinded field trial was carried out to evaluate the efficacy of a Fusobacterium necrophorum bacterin for control of liver abscesses and footrot under commercial feedlot conditions in western Canada. Half of the vaccinated and half of the unvaccinated control animals had ad libitum access to a forage-based (ALF) growing diet. The other half of each group was limit-fed a grain-based (LFG) growing diet. The overall prevalence of A and A+ liver abscesses in this trial was 16.7%. A strong association was found between diet group and presence of A or A+ liver abscessation at slaughter. Diet group modified the effect of vaccination on the prevalence of liver abscesses at slaughter, and on the incidence of footrot during the feeding period. The odds that a vaccinated animal in the ALF group would have an A or A+ liver abscess at slaughter were less than 1/3 the odds that an unvaccinated animal in the same diet group would have an A or A+ liver abscess at slaughter (OR = 0.27, [95% CI: 0.07 to 1.02], P = 0.05). The overall incidence of footrot in this trial was 6.5%. The odds that a vaccinated animal in the ALF group would be treated for footrot were less than 1/5 the odds that an unvaccinated animal in the same group would be treated for foot-rot (OR = 0.18, [95% CI: 0.04 to 0.82], P = 0.03). Within the LFG group there were no differences between vaccinated and unvaccinated animals in the odds of an animal being treated for footrot, or in the odds of having an A or A+ liver abscess score at slaughter. This trial suggests that vaccination against F. necrophorum infection may have applications to decrease the prevalence of severe liver abscesses at slaughter and decrease footrot treatments in certain diet situations.

Animals↗
PubMed2006

[A case of Salmonella liver abscess].

Liver abscess can be caused by bacterial, parasitic, or fungal infection. Amebic abscesses are more common, but pyogenic abscesses account for three quarters of hepatic abscess in developed countries. Most common pathogens of the pyogenic liver abscess are Escherichia coli, Klebsiella pneumoniae, Bacteroides, Enterococci, Streptococci, and Staphylococci. However, liver abscess caused by Salmonella species has rarely been reported. We experienced a case of Salmonella liver abscess which improved after antibiotic therapy and percutaneous drainage. The patient was 52 years-old man who had an episode of intermittent fever, chills and epigastric pain for 2 weeks. He was diagnosed as liver cirrhosis eight years ago and diabetes three years ago. Salmonella group D, non-typhi was cultured from blood and pus from the liver respectively at the same time. With percutaneous drainage and susceptible antibiotic therapy, liver abscess decreased in size with improvements in fever and abdominal pain.

Humans↗
PubMed2006

[Brain abscess: analysis of prevalence and clinical course].

The aim of the study was the analysis of the patients with bacterial meningitis and brain abscess who were treated in the Department of Infection Disease and Hepatology of Medical University in Lodz in years 1996-2005. We reviewed their clinical presentation, bacteriology treatment and outcome retrospectively. Among 135 patients who were confirmed cases of bacterial meningitis 16 identified as having brain abscesses. The prevalence rate of brain abscesses significantly increased in years: 2004-2005. The common predisposing factors were otic and teeth infections, sinusitis, penetrating head trauma, and bacterial endocarditis. Solitary abscess was found in 56% of the cases while in 44% of the cases multiple abscess were found. The most common presentation: headache, fever and neurological deficit were present in 37% of the cases. 75% of patients were disqualified from early neurosurgical intervention and antibiotic therapy were recommended. The antibiotic therapy was effective only in 1 patient. The mortality rate was 38% and 56% of the survivors had late neurological defects. The prevalence rate of brain abscesses significantly increased in years 2004-2005. Over all mortality was very high and antibiotic therapy hasn't been effective treatment in brain abscess at the late stage of its evolution. The early neurosurgical intervention is recommended. Late neurosurgical intervention strongly influences poor outcome in patients with brain abscess.

Adult↗
PubMed1991

Intra-abdominal abscesses in children.

Forty-one intra-abdominal abscesses in 30 Nigerian children seen over a 2-year period at the Obafemi Awolowo University Teaching Hospital were studied prospectively to determine their location, aetiology, microbiology and clinical course. Thirty-four abscesses (83%) were intraperitoneal with the subphrenic spaces and pelvis being the commonly involved intraperitoneal sites. Six abscesses (15%) were retroperitoneal while there was only one visceral abscess (2%). Diseases of the gastrointestinal tract occurring in 20 patients (67%) were responsible for the majority of intraperitoneal abscesses, while suppurating external iliac adenitis was the major cause of retroperitoneal abscesses. There were 62 microbiological isolates, with 52% being anaerobic bacteria and 47% aerobic bacteria. A fungus, Candida, was isolated once (2%). Escherichia coli and Staphylococcus aureus were the commonest aerobic bacteria, while Bacteroides and anaerobic streptococci were the commonest anaerobes. Sixteen patients (53%) had a mixed flora of aerobic and anaerobic bacteria, while in seven patients each (23%) only aerobic or anaerobic bacteria were isolated. The mortality rate in this series was 23%. Association of an intra-abdominal abscess with remote organ failure, postoperative anastomotic leakage, non-localization of the abscess within the peritoneal cavity and gastrointestinal perforation due to typhoid enteritis was found to portend poor prognosis.

Abscess↗
PubMed1991

Pyogenic liver abscesses: a retrospective review of 24 cases.

OBJECTS: to review our experience of pyogenic liver abscess with attention to the value of ultrasound and computerised tomography, and the duration of antimicrobial therapy. METHOD: retrospective review of all pyogenic liver abscesses in Christchurch hospitals between 1972 and 1989. RESULTS: twenty-four cases were identified. The presentation of these cases was typical of those described in other series. Ultrasound scanning was positive in 69% of cases, and computerised tomography in 94%. Enteric organisms were isolated from blood or abscess cavities in all but two cases. Two patients died soon after admission and three were treated with antimicrobial therapy alone. The remainder underwent either a percutaneous or surgical drainage procedure, and received antimicrobial therapy. The antimicrobial therapy was clearly inappropriate in two patients. Eight patients (67%) with single abscesses received less than 10 days of antimicrobial therapy. Four patients (50%) with multiple abscesses received less than 18 days therapy. No patient relapsed. CONCLUSIONS: ultrasound is a convenient initial imaging technique, but may give false negative results. Computerised tomography should be done promptly if clinical suspicion of a liver abscess persists. Both surgical and percutaneous drainage techniques gave good results in combination with antimicrobial therapy. It is probably unnecessary to give prolonged courses of antimicrobial therapy following drainage of single liver abscess, provided there is rapid resolution. Multiple abscesses, or those which are not drained, may require longer courses of antimicrobial therapy.

Adolescent↗
PubMed1990

Clinical profile of multiple amoebic liver abscesses.

Of 70 consecutive patients with amoebic liver abscess admitted over a 3 year period, 15 (21.4%) had multiple abscesses. This condition, like solitary abscess, was a disease of the 2nd to 5th decade with a male preponderance. Multiple abscesses were more frequently associated with fever, jaundice, upper abdominal pain, pneumonitis and tender hepatomegaly. The left lobe of the liver was always enlarged in patients with multiple abscesses and 86% of patients required drainage of an abscess cavity. The presence of more severe clinical course, jaundice and left lobe hepatomegaly should raise the suspicion of multiple abscesses. After confirmation of the diagnosis by imaging technique, the abscess cavity should be aspirated for quick relief and cure.

Adolescent↗
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↗
PubMed1989

Diagnostic and therapeutic approaches to pyogenic abscess of the liver.

A review was conducted of 33 patients with pyogenic hepatic abscesses seen during the past seven years to evaluate the effect of roentgenologic refinements on diagnosis and therapy. Cause, bacterial infection and clinical manifestations were determined. An ultrasonogram was positive in 27 of 29 patients; computed tomographic scan was diagnostic in 20 of 23 patients, and radionuclide studies were positive in eight of 13 patients. Abscesses were confined to the right lobe in 19 patients, to the left lobe in six and were diffuse in eight. In the group of patients with abscesses developing from a biliary route, one patient was successfully managed by roentgenologically controlled drainage while three others required subsequent surgical drainage. Five of seven patients in the biliary route category who were treated with primary surgical drainage were permanently cured. Twelve patients had an abscess emanating from the portal route. In five of these, drainage under roentgenologic control was successful. Two patients upon whom the procedure failed subsequently underwent drainage at operation. Five had primary surgical drainage, and two of these died. All nine patients with post-traumatic, cryptogenic abscesses or an abscess evolving from an arterial route were successfully drained surgically. Three patients with multiple or diffuse abscesses were successfully treated by primary hepatic resection. Refined roentgenologic techniques established the diagnosis of pyogenic abscess in almost all instances. Roentgenologically controlled drainage may be therapeutic in some patients, but surgical drainage remains the standard. Resection has been used as primary treatment in selected patients.

Adolescent↗
PubMed1988

[Otogenic brain abscesses in a patient sample of the otolaryngology clinic of the Poznan Medical Academy 1953-1984].

Between 1953-1984 we treated 64 otogenic brain abscesses (44 of the temporal lobe and 20 of the cerebellum). This material included 2 cerebral abscesses and 1 cerebellum abscess in children. In 3 cases the abscess was a complication of acute otitis media. 84% of patients with a temporal lobe abscess and 85% with a cerebellar abscess recovered. Treatment consisted of removal of the inflammatory process in the middle or inner ear with subsequent puncture of the abscess and replacement of the pus by antibiotic solution. Otologic, neurologic, ophthalmolgic, EEG and CT examinations were performed on 50 patients. Residual signs of epilepsy were found in 6 patients. Forty one patients resumed work or study. The merit of computer tomography (CT) in diagnosing brain abscesses is emphasized. Since CT has been used a successful outcome has been obtained in 8 cases and a fatal result in 1.

Adolescent↗
PubMed1987

Renal and perirenal abscesses.

Our knowledge of the spectrum of renal abscesses has increased as a result of more sensitive radiologic techniques. The classification of intrarenal abscess now includes acute focal bacterial nephritis and acute multifocal bacterial nephritis, as well as the previously recognized renal cortical abscess, renal corticomedullary abscess, and xanthogranulomatous pyelonephritis. In general, the clinical presentation of these entities does not differentiate them; various radiographic studies can distinguish them, however. The intrarenal abscess is usually treated successfully with antibiotic therapy alone. Antistaphylococcal therapy is indicated for the renal cortical abscess, whereas therapy directed against the common gram-negative uropathogens is indicated for most of the other entities. The perinephric abscess is often an elusive diagnosis, has a more serious prognosis, and is more difficult to treat. Drainage of the abscess and sometimes partial or complete nephrectomy are required for resolution.

Abscess↗
PubMedDate not supplied

Peritonsillitis: abscess or cellulitis?

Peritonsillitis encompasses both cellulitis and abscess. To determine the distinguishing factors for cellulitis and abscess, we reviewed 29 patients, 15 with cellulitis and 14 with abscess. Common presenting complaints included dysphagia, trismus, drooling, voice change and fever. Unilateral tonsillar enlargement was usually present, and uvular deviation was noted in 10 of 29 patients. The mean ages of patients with abscess was 15.0 years, and that of patients with cellulitis was 10.8 years. The two groups differed significantly by age (P = 0.02), and discriminant analysis showed age, dysphagia and drooling to be discriminators for abscess patients, while bilaterality or fever were not. Trismus was a discriminator for cellulitis patients. Etiology for abscess included Group A and non-Group A beta-hemolytic streptococci, Group D streptococcus, alpha-streptococcus, anaerobic diphtheroids and coagulase-negative staphylococci. The etiology of the cellulitis was Group A and non-Group A beta-hemolytic streptococci and Streptococcus pneumoniae. Peritonsillitis appeared to increase in frequency. On presentation patients with cellulitis are similar to patients with abscess. Abscess is more likely in adolescents. Recommended therapy is intravenous penicillin and prompt drainage for patients failing to respond.

Adolescent↗
PubMed1986

Pancreatic abscess: 10-year experience at the University of South Florida.

Pancreatic abscess is an uncommon but often catastrophic complication of acute pancreatitis. This study reviews the past 10 yr experience at the University of South Florida Teaching Hospitals involving patients diagnosed to have pancreatic abscess. The etiology, management, complications, and factors affecting mortality are discussed. The results indicate: the presentation of pancreatic abscess is variable; increased positive prognostic signs (by Ranson's criteria) on initial presentation correlate with increased mortality; complications are common (80%) and contribute significantly to morbidity and mortality; CT scan is more accurate than ultrasound in the diagnosis of pancreatic abscess; poorly localized phlegmonous pancreatic slough noted by CT scan, sonography, or exploratory laparotomy, carries a higher mortality than a well-localized purulent collection; negative blood cultures or abscess cultures do not rule out pancreatic abscess; infection of lesser sac fluid collections can occur in the hospital implying that strict attention must be paid to nosocomial infections; the timing of surgical drainage is critical, recurrent abscess requires repeat surgery, and resection is associated with a very high mortality (reflecting greater severity of underlying disease); there has been no change in mortality of pancreatic abscess in the last 10 yr.

Abscess↗