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A patient with multiple pyogenic abscesses in both lobes of the liver secondary to asymptomatic sigmoid diverticulitis is presented. The rarity of this illness is noted. It is suggested that barium enema be performed in patients who present with pyogenic liver abscess of unknown etiology because of the association with asymptomatic sigmoid diverticulitis.
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The present study analyzed iNOS and eNOS mRNA expression and NO production during development of hepatic abscess caused by Entamoeba histolytica trophozoites. One 374-bp sequence, which displayed 88% identity to mammalian iNOS protein, was isolated from LPS-stimulated peritoneal hamster macrophages. A separate 365-bp cDNA sequence showed 99% identity with eNOS protein. iNOS mRNA was detected in hamsters during formation of amoebic liver abscesses, but not in control hamsters. eNOS mRNA expression was not modified. Serum nitrite concentration in hamsters infected with E. histolytica was 33 +/- 6 microM, in control hamsters was 20 +/- 3 microM. The study shows that iNOS mRNA expression and NO production are induced by E. histolytica trophozoites during amoebic liver abscess formation. However, in spite of iNOS mRNA expression and NO production, E. histolytica trophozoites induced liver abscess formation in hamster.
A 68-year-old healthy man was admitted because of liver abscess and aeromonas bacteremia accompanied by pulmonary embolism. Aeromonas sobria was isolated from blood. Coagulation parameters were normal and a lower limb venogram showed no evidence of thrombosis. Septic embolism originating from the liver abscess was considered as the possible cause of pulmonary embolism. The patient was successfully treated with antibiotics.
This report summarizes the results of percutaneous catheter drainage in 23 cases of primary or secondary pyogenic liver abscess. The overall success rate was 76%. Only three (60%) of five cases of secondary abscess (infected hematoma or infected tumor) were cured with catheter drainage, but 11 (91%) of the last 12 primary pyogenic abscesses were drained successfully. Six patients with abscesses of less than 4 cm in diameter required catheter drainage for less than 72 hr. Although six abscesses in the series appeared septated or multiloculated, only one required more than a single catheter for curative drainage. Diagnostic and technical considerations for successful drainage of hepatic abscesses are discussed. The differential diagnosis includes echinococcal disease and hepatic amebiasis. Therapeutically, specific measures should be taken to ensure proper catheter position to prevent contamination of the subphrenic, perihepatic, and pleural spaces. Percutaneous catheter drainage should be attempted as a first choice of treatment in all pyogenic hepatic abscesses.
Endogenous endophthalmitis is a rare, but devastating complication of septicemia. The prognosis of maintaining visual acuity in patients with septic endophthalmitis is poor in spite of an early diagnosis and the timely start of conventional therapeutic procedures because the intravitreous drug concentration remains low after the systemic administration of antibiotics due to the blood-ocular barrier. We treated an elderly female patient with endogenous endophthalmitis complicated with disseminated intravascular coagulation associated with a Klebsiella pneumoniae liver abscess. Endophthalmitis developed rapidly and we thus had to perform an enucleation of both eyeballs even though we made an early diagnosis and performed liver abscess drainage as well as the prompt systemic and subconjunctival administration of antibiotics. Our experience in treating this case emphasizes the need to perform the timely intravitreous infusion of antibiotics with a support therapy consisting of the systemic and subconjunctival administration of antibiotics for endogenous endophthalmitis associated with a Klebsiella pneumoniae liver abscess.
A 51-year-old man was treated with open surgical drainage and metronidazole for an amebic liver abscess. During therapy and while the original abscess was resolving, a second, noncontiguous amebic liver abscess developed. This second abscess eventually responded to emetine, chloroquine, and diodohydroxyquin therapy without surgical drainage. This unique case serves to document that new abscess may develop in the course of metronidazole therapy and illustrates the value of serial hepatoscanning in such patients.
Lactobacillus acidophilus is usually considered to be non pathogenic. We report a case of liver abscess due to Lactobacillus acidophilus in a 39 year-old man with chronic pancreatitis complicated by both endocrine and exocrine insufficiency, and with a choledoco-duodenostomy. Lactobacillus acidophilus was isolated in blood and liver samples. Complete recovery of the liver abscess occurred after antibiotherapy. We suggest that the abnormally low duodenal pH secondary to pancreatic insufficiency may have promoted both Lactobacillus acidophilus adhesion and multiplication in this patient. The choledoco-duodenostomy may then have promoted biliary tract colonisation.
The author analyses the results of study of the immune status in 100 patients with amebic abscess of the liver, who were divided into 2 groups. In an uncomplicated course of the disease (50 patients, Group 1) there were no essential shifts in the immune status in the preoperative period. In the postoperative period (1st-3rd day), however, the percentage and absolute number of T- and B-lymphocytes reduced. Due to this, immunostimulation therapy (decaris, gamma-globulin, hyperimmune antistaphylococcal plasma, activin) had to be applied. In a complicated course of amebic abscess of the liver (50 patients, group 2) the water-electrolyte metabolism was disturbed and the blood erythrocyte-globular volume was reduced and the cellular and humoral links of immunity were markedly depressed in the preoperative period. Intensive transfusion-infusion therapy had to be conducted along with immunostimulation treatment (decaris, T-activin, gamma-globulin, hyperimmune antistaphylococcal plasma, direct transfusion of blood) and prescription of anabolic hormones (pentoxyl, retabolil).
The concentrations of plasma proteins and the activities of liver enzymes were measured every 2 weeks from weaning to slaughter in 21 beef cattle, and their livers were examined ultrasonographically every 4 weeks. Eight of the 9 cases of single or multiple liver abscesses were detected by ultrasonography but some individual abscesses, particularly those in the left side of the liver, remained undetected. The time at which the abscesses were first detected ranged from 4 to 20 (mean 12.5) weeks. There were only slight variations in the blood constituents and they were of no significant value in the diagnosis of the liver abscesses.
Five patients with severe jaundice resulting from amoebic liver abscess are described. All had features of hepatic parenchymal damage and cholestasis, and 1 patient developed hepatic coma. In addition, acute tubular necrosis and renal failure occurred in 3 patients. Four patients in the series survived. The importance of early recognition and treatment of amoebic liver abscess in patients presenting with jaundice is emphasized, so that the serious and often fatal complications of hepatic and renal failure can be prevented.
Entamoeba histolytica trophozoites produce amoebapores, a family of small amphipathic peptides capable of insertion into bacterial or eukaryotic membranes and causing cellular lysis. Recently, E. histolytica trophozoites that are totally deficient in the production of amoebapore-A were created through a gene silencing mechanism (R. Bracha, Y. Nuchamowitz, and D. Mirelman, Eukaryot. Cell 2:295-305, 2003). Here we tested the virulence of amoebapore A(-) trophozoites in models of the two major forms of amebic disease: amebic liver abscess and amebic colitis. We demonstrate that amoebapore expression is required for full virulence in the SCID mouse model of amebic liver abscess, but E. histolytica trophozoites that do not express amoebapore-A can still cause inflammation and tissue damage in infected human colonic xenografts. These data are consistent with the concept that tissue damage may proceed by different mechanisms in amebic liver abscess compared to amebic colitis.
As most portal vein occlusion in hilar bile duct carcinoma is caused by tumor invasion to the portal vein, other mechanisms of its occlusion are very rare. We report the case of a 69-year-old man who underwent surgical resection for an advanced hilar bile duct carcinoma associated with unusual portal vein occlusion. Preoperative diagnosis was advanced hilar bile duct carcinoma with liver abscess and right portal vein occlusion due to tumor invasion. Extended right hepatectomy combined with resection of caudate lobe was performed. Intraoperatively, tumor invasion to the portal vein was not evident and resected margin of the right portal vein showed thrombosis and no evidence of malignancy histologically. To our knowledge, this is the first reported case of a patient with a combination of portal vein thrombosis and liver abscess in hilar bile duct carcinoma. Although portal vein occlusion due to thrombosis is an unusual complication in hilar bile duct carcinoma, the presence of liver abscess may be a useful diagnostic implication of this occlusion.
Twenty-seven patients with Amobebic Liver Abscess were observed during the last two years and were analysed retrospectively with respect to diagnostic procedures and therapeutic strategies. Seven of the 27 patients had surgery and were subsequently referred to our hospital. Those patients with surgery had a longer duration of illness and hospitalization (3.3 months) compared to the other 20 patients with chemotherapy alone (2 months). Most important diagnostic parameters for extraintestinal amoebiasis were: typical clinical findings, time spent in tropical or subtropical countries, strongly positive Latex agglutination against Entamoeba histolytica antigen, and isotope and/or ultrasound scanning to confirm abscess formation in the liver. The vast majority of abscesses were found in the right liver lobe. Response to treatment with complete cure was seen in all patients, regardless of whether Metronidazole alone or combinations of Metronidazole with Chloroquine and Metronidazole and Dehydroemetine or Chloroquine and Dehydroemetine were used. There is a need for prospective therapeutic studies to compare the different drug regimen concerning side-effects, toxicity, costs, application, and duration of hospitalization. From the retrospective data it seems that surgery is not beneficial for the patients.
We report on a 20-month-old infant with a complicated lung and liver abscess caused by Pasteurella multocida after the child had been in close contact with a domestic cat. Surgical drainage confirmed lung and liver abscesses connected to each other, with involvement of the diaphragm.
A 45-years old man after having returned from Thailand was admitted to the hospital with a severe ulcerative, pyogenic colitis and multiple liver abscesses. In the endoscopically taken rectal biopsies as well as in the liver abscess aspirate gained by fine needle puncture Throphozoites of E. histolytica could be demonstrated. On the other hand stool specimens and serology were negative. The various diagnostic facilities in invasive Amebiasis are discussed. Because of the problems, which may arise from the examination of fresh stool specimens, the advantage of endoscopically gained biopsies in suspected amebic colitis is emphasized.
The objective of this work is to study factors of prognostic of mortality of abscesses of the liver. We have treated between 1990 and 2000 in our service, 38 patient for abscess of the liver. The symptoms are dominated by the pain of the right hypochondria (37 cases) and the fever (34 cases). An unique abscess has been recovered in 25 cases. Some multiple localizations have been observed in 12 cases. 21 patients have been operated. The bacteriological study at all patients revealed the presence of germ in 27 cases. In 6 cases, there were two germs. It was a bacillus negative gram in 26 cases and a cocci positive gram in 7 cases. Six complications have been observed at the operated patients. In 5 cases, it was a septic shock having leads to the death. After survey univariate and multivariate the only factor of bad prognostic recovered is the septic shock. The aetiology was identified in only 9 cases; it was abscess cholangiotis.
An enzyme linked immunosorbent assay (ELISA) is described for the detection of E. histolytica immune complexes in serum. Antiamoebic antibody purified by affinity chromatography was used both to precoat strips of nitrocellulose membrane and as an enzyme carrier. These strips were incubated with samples of concentrated test serum and the enzyme conjugate. Following treatment with the peroxidase substrate 3-amino-9-ethylcarbazole the presence of E. histolytica antigens was visualized as red spots. Blocking of positive test sera with excess antibodies inhibited this reaction. Serum samples from 47 patients with amoebic liver abscess, 43 patients with other enteric diseases and 35 healthy controls were investigated. The spot test was positive in 75 per cent of patients with amoebic liver abscess, and in 12 per cent diseased controls whereas all the healthy controls were negative. The spot test is simple and sensitive and does not require prior separation of the immune complexes. The test is recommended as an aid to the diagnosis in patients suspected to have amoebic liver abscess.