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Pneumopericardium arises most commonly as a result of a bronchial or oesophageal neoplasm which erodes the pericardial cavity. A case of pneumopericardium associated with amoebic liver abscess, a complication of invasive amoebiasis not previously reported, is described.
This is a case report of a 36-year-old patient who developed an amebic liver abscess after a stay in the Sudan. He was first misdiagnosed as having pneumonia of the right lower lobe. Following establishment of the correct diagnosis, the patient recovered fully after metronidazole treatment. The fecal culture in Robinson's medium yielded extensive growth of Entamoeba histolytica. Electrophoretic characterization proved it to be a zymodeme XIX, which is one of the zymodemes associated with pathogenicity in the host. This first report of a zymodeme classification of E. histolytica in Germany should initiate further epidemiological studies.
Until 1985, morbidity and mortality from amebic infections were high in sub-Saharan Africa (2). The aim of this work was to describe the clinical, diagnostic and prognostic aspects of amebic liver lesions in a large town in tropical Africa, seven years after the last study of this disease in the area. We studied 96 amebic liver abscesses in 77 patients in a study with prospective and retrospective components. The patients were aged 20 to 65 years and the diagnoses were made on the basis of clinical radiological and biological criteria. Most of the patients were men (3:1). The most frequent clinical signs and symptoms were: pain on (100%), fever (92.2%), enlarged right hypochondrium (89.6%), heptomegaly (45.4%) and weight loss (39.6%). Ultrasound scans showed that the abscesses were most frequently found in the liver, on the right-hand side (65.6%) and that they were 20 to 125 mm in diameter. Between 80 and 2,500 ml of pus was drained from each abscess. We found pleuropulmonary lesions in 10.4% of cases. Serological tests for amebae were strongly positive in almost all cases and HIV tests (carried out prospectively) were positive in 11.6% of cases. The amebic liver lesions appeared to be primary in 66% of cases. The patients were treated with metronidazole, combined if necessary, with drainage under ultrasound surveillance. Two of the patients died. The others were completely cured after a mean of 13 days in hospital. Amebic infestations are cosmopolitan in nature. They occur most frequently in tropical areas. Amebic infections are rife in tropical Africa, with a prevalence of 1 to 2% (1). Liver amebiasis is the principal form of amebic infection outside of the intestine. Liver amebiasis is often detected at the stage of abscess formation.
A 28-year-old man with a history of Crohn's disease presented with right pleuritic pain and dyspnea. Chest radiography showed a right pleural effusion. Thoracocentesis yielded purulent fluid that subsequently grew Enterobacter aerogenes. Computed axial tomography of the abdomen revealed right subphrenic abscess and right hepatic lobe abscess. Antibiotic therapy and surgical drainage resulted in complete recovery. A review of the English literature produced 18 cases of liver abscess complicating Crohn's disease. Details of 14 of these cases are summarized.
The clinical features and management of 29 consecutive cases of liver abscess admitted to the Medical Division at the Rashid Hospital, Dubai, between February 1979 and March 1982 are reviewed and the value of CAT scan in the diagnosis and management is assessed.
The electrophoretic mobility patterns of four enzymes from trophozoites of Entamoeba histolytica were examined to determine the zymodeme of the amoebae populations involved. E. histolytica populations from aspirated liver pus belonged exclusively to types II and XI of eighteen zymodemes. E. histolytica from cases of amoebic dysentery--i.e., those patients presenting with intestinal ulceration and/or with haematophagous trophozoites in the faeces--also belonged to zymodemes II and XI. However, symptom-free cyst passers harboured E. histolytica belonging to one of several zymodemes none of which corresponded wth the zymodemes of the patients with liver abscesses or amoebic dysentery.
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Two uncommon cases of foreign body (a wooden clothespin and a toothpick) perforation of the gur with associated pyogenic liver abscesses are presented. These cases illustrate the difficulties of preoperative diagnosis. The lack of history of ingestion of foreign bodies, variable clinical presentation of the conditions and radiolucent natures of the foreign bodies all play a role in impeding the diagnosis preoperatively. This report emphasizes the role of ultrasound and computed tomographic scan in evaluating similar cases. Any patient with known risk factors for ingestion of foreign body should arouse suspicion and be investigated further.
A 72 yr-old man presented with clinical features suggestive of disseminated malignancy, and at autopsy was found to have hemosiderosis and multiple liver abscesses due to Yersinia enterocolitica. The literature is reviewed, with emphasis on the role of abnormal iron metabolism in disseminated infection with this organism.
RATIONALE AND OBJECTIVES: Computed tomographic (CT) enhancement of the liver, liver abscess, spleen, and major vessels was investigated between 2 and 48 hours after intravenous administration of perfluorooctylbromide (PFOB emulsion) in an animal model of 63 rabbits. METHODS: Twenty-one animals received 3 g/kg PFOB as a fast bolus injection. Using a slow infusion rate, the same number of animals received either the same dose (3 g/kg) or half the dose (1.5 g/kg). RESULTS: Vascular enhancement was best after bolus injection of 3 g/kg emulsion. The density peak occurred after 2 hours. A continuous enhancement of approximately 100 Hounsfield units (HU) was observed up to 24 hours in the animals receiving 3 g/kg, independent of the injection velocity. A density peak of 70 HU was found 2 hours after the infusion of 1.5 g/kg. The density peak of the liver, the spleen, and the abscess wall was observed 48 hours after emulsion administration in all groups receiving 3 g/kg. The peak was approximately 150 HU for the liver, 400 HU for the spleen, and 150 HU for the abscess wall. In animals receiving only 1.5 g/kg perflubron, the peak density of the abscess wall was 132 HU after 12 hours, approximately 80 HU for the liver between 2 and 48 hours, and approximately 280 HU after 48 hours for the spleen. CONCLUSIONS: PFOB emulsion produces the highest vascular enhancement within the first 2 hours after the bolus injection of 3 g/kg. For spleen and abscess wall imaging, even the relatively low dose of 1.5 g/kg produced a satisfactory enhancement level for a significant length of time, whereas liver enhancement was best after administration of the higher dose.
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The antibody patterns--obtained by enzyme immunoassay (EIA), complement fixation (CF), indirect hemagglutination (IHA), and latex agglutination (LA)--of 216 patients with amebic liver abscess (ALA) were related to the time of onset of illness and to epidemiological data. The usual period between the stay in an Entamoeba histolytica-endemic area and clinical manifestation of the disease was 8-20 weeks. Increasing antibody concentration affected the sensitivity rates for CF and LA in the first 3 weeks of clinical ALA. In comparison with CF, IHA, and LA, EIA was the most sensitive test, showed the most substantial changes in antibody concentration according to the stage of disease, and measured persisting antibodies for the longest period. Neither the duration of previous stay in tropical countries nor the time when specific chemotherapy was started influenced development or persistence of antibodies in ALA patients. ALA occurred with similar frequency regardless of whether the patient was a long-term resident of the tropics or a short-term visitor to an E. histolytica-endemic area.
Amoebiasis is an infection of the large intestine produced by the protozoan Entamoeba histolytica. More than 10% of the world population is estimated to be infected. The italian pattern of this infection is similar to the EEC trend: the prevalence is approximately 0.012% during the years '88 and '89. Hepatic abscesses usually present with moderate fever, weight loss and abdominal pain. During the last ten years nine patients with amoebic liver abscesses were admitted to our hospital, six males and three females (all had acquired the infection in tropical countries). After ultrasonographic and computed tomography scanning evaluation, all patients were treated with metronidazole at the dosage of 750 mg three times a day for a period ranging from 30 to 60 days. In five patients Chloroquine was added at the dosage of 1.2 g a day for fourteen days. In five patients became necessary a surgical drainage under ultrasonographic control.
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