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PubMed1985

Cholestasis in amoebic liver abscess.

Two hundred and thirty six patients with amoebic liver abscess were investigated for cholestasis, its mechanism and the natural course of the disease. Cholestasis was seen in 29% of cases and it presented with some unusual features: it was frequently seen in young men (mean age 38.6 +/- 6.3 years) (87%) with acute onset (69%) and was associated with signs of peritonism, or peritonitis (28%), splenomegaly (12%) and hepatic encephalopathy (coma 13%). Raised diaphragm was seen only in 37% of cases. Alcoholism may have contributed to the cholestasis in 37% of cases. Multiple (43%) and single (32%) large liver abscesses, especially on the inferior surface of the liver (25%), were common in jaundiced patients with amoebic liver abscess, while size and number of abscesses were directly related to the raised serum bilirubin concentrations. Bromsulphalein excretion (BSP) was found to be significantly reduced (p less than 0.01) in patients with jaundice (60%). Retrograde injection of contrast media into the common bile duct during six necropsies showed compression by amoebic liver abscess on the hepatic ducts. The mortality (43%) and the complications were significantly higher (p less than 0.001) in patients with jaundice. The aspiration/surgical drainage of amoebic liver abscess together with a combination of metronidazole and di-iodohydroxyquinoline was more effective than either metronidazole alone, or dehydroemetine with chloroquine.

Adolescent↗
PubMed2002

A global emerging disease of Klebsiella pneumoniae liver abscess: is serotype K1 an important factor for complicated endophthalmitis?

BACKGROUND AND AIMS: Over the past two decades in Taiwan, pyogenic liver abscess has usually been caused by a single microorganism, Klebsiella pneumoniae, and is frequently associated with the serious complication of endophthalmitis, especially in diabetic patients. However, the relationship between the clinical presentation and bacterial factors remains unclear. The aim of this study was to investigate the clinical features of patients and the serotype and ribotype of K pneumoniae liver abscess. METHODS: From July 1991 to June 1998, a total of 134 cases of K pneumoniae liver abscess with 248 K pneumoniae isolates from the same patients were collected from two large medical centres in northern Taiwan. Clinical data were collected from medical records. Serotyping and ribotyping were performed using the countercurrent immunoelectrophoresis method and automated Riboprinter. RESULTS: Serotyping revealed that the most common serotypes were K1 (63.4%) and K2 (14.2%). K1 isolates occurred at a significantly higher frequency (p<0.01) than all other serotypes. Among 134 patients, 105 (78.4%) had suffered from diabetes mellitus for 3-15 years. Fourteen patients (10.4%) had metastatic infection to the eye causing septic endophthalmitis. Liver aspirates, and blood and vitreous pus cultures yielded the same serotype of K pneumoniae in all patients. Among patients with septic endophthalmitis, 92.3% (13/14) were diabetic, and 85.7% (12/14) of the isolates belonged to serotype K1. For molecular typing, different degrees of genetic polymorphism among isolates with the same K1 serotype suggested no particular prevalence of any one strain in K pneumoniae liver abscess. CONCLUSION: K pneumoniae serotype K1 was significantly associated with liver abscess and the complication of endophthalmitis, especially in diabetic patients. Physicians should request an immediate report of serotyping and susceptibility test results simultaneously if a diagnosis of pyogenic liver abscess has been made so that early and appropriate management for possible complications will not be delayed. The use of ceftriaxone because of its higher concentration in the aqueous humor is suggested to decrease the chance of septic endophthalmitis.

Adult↗
PubMed1999

Comparison of long term outcome in patients with or without aortic ring abscess treated surgically for aortic valve infective endocarditis.

OBJECTIVE: To assess the long term prognostic significance of aortic valve ring abscess in patients with aortic endocarditis. PATIENTS: A consecutive series of 75 patients who had surgery for aortic infective endocarditis between 1981 and 1989; 35 had aortic ring abscesses (group 1) and 40 did not (group 2). Mean age did not differ between the two groups. Prosthetic valve endocarditis was present in 17% of group 1 and 5% of group 2. Pneumococcal or beta haemolytic streptococcal endocarditis was more common in patients with native valve endocarditis who had aortic ring abscesses (20% v 5%). DESIGN: Cohort analysis. RESULTS: In-hospital mortality (11.4% v 7.5%) and 10 year survival (56% v 66%) were not significantly different between groups 1 and 2. In patients with native valve endocarditis, 10 year survival was 62% and 66%, respectively for patients with or without ring abscess, and 10 year reintervention-free survival was 38% v 58% (p = 0.11). In these patients, the presence of an intercurrent illness, severe congestive heart failure before surgery, and use of valved conduits for surgical treatment were predictors of poorer long term survival. At follow up residual aortic regurgitation was documented in 72% of patients in group 1 and 26% in group 2 (p < 0.01). CONCLUSIONS: Aortic valve ring abscess is not an independent marker of poor long term outcome in patients with infective endocarditis. However, as residual aortic regurgitation appears frequent at follow up, specific surgical techniques should be considered in patients with paravalvar abscesses.

Abscess↗
PubMed1978

Brain abscesses in Northern Ireland: a 30 year community review.

One hundred and seventy-two cases of intracranial abscesses, obtained from Neurosurgical and Centralised Autopsy Records for Northern Ireland for the 30 years, 1947--1976, have been reviewed. The incidence of the disease has fallen from five to three per million of population per year over the past three decades. Intracranial abscesses were three times as common in males as in females. Twenty-nine per cent of the abscesses were in the temporal lobe, 25% frontal, 10% parietal, 6% cerebellar, 3% occipital, and 7% were either subdural or in deep sites such as the thalamus; the remainder (20%) were multiple. Multiple and occipital abscesses were all fatal, temporal and parietal abscesses were associated with a 65% mortality, and 45% of patients with frontal abscesses died. Chronic suppurative otitis media was the single largest cause, and it was the only aetiological factor to have shown a progressive decline over 30 years. For those seen and treated in the neurosurgical unit the mortality was 53%, but if those obtained from the necropsy records were included the overall mortality was 70%.

Adolescent↗
PubMed2003

Role of microbiological investigations in the management of non-perineal cutaneous abscesses.

BACKGROUND: Pus samples for microbiological examination are routinely sent after incision and drainage of abscesses. There is no evidence that microbiology reports influence treatment for non-perineal cutaneous abscesses. AIMS: This study assessed (1) how often the microbiology report is used to manage patients' treatment after incision and drainage of an abscess and (2) junior surgical trainees' opinions on sending pus for microbiological examination. METHOD: A retrospective analysis of the notes of all patients undergoing incision and drainage of abscesses from January 2001 to January 2002 was made. A telephone poll of junior surgical trainees was also undertaken. RESULTS: Most patients, 91%, had specimens referred for microbiology. Of these 43% yielded no growth. Staphylococcus aureus was the most common organism (55.9% of all positive cultures). Anaerobes were a frequent finding from axilla and groin abscesses. Mycobacterium tuberculosis was grown in two patients. Other less common organisms cultured were methicillin resistant S aureus (n=1) and Proteus sp (n=1). Follow up of microbiology reports was found to be inadequate. CONCLUSION: The bacteria present in non-perineal cutaneous abscesses are, for the most part, predictable. However, a significant number grow less common organisms. It is concluded that pus specimens should be sent routinely for culture and sensitivity and there should be further emphasis on following up microbiology reports by junior medical staff.

Abscess↗
PubMed1995

Sexually transmitted diseases including HIV infection in women with Bartholin's gland abscesses.

OBJECTIVES: The aim of this study was to establish the prevalence of sexually transmitted infections including human immunodeficiency virus (HIV) infection in women with Bartholin's gland abscess. SETTING: Gynaecology Clinic of King Edward VIII Hospital, a large urban, referral hospital for the province of Kwa-Zulu Natal, serving an underprivileged population. METHODS: Thirty consecutive women presenting with unruptured Bartholin's gland abscesses were studied. Prior to surgical drainage, aspirates from the abscess cavity and swab specimens from the vagina and endocervix were collected for microbiological investigations. In addition peripheral venous blood samples were obtained for syphilis and HIV antibody testing. RESULTS: Antibody to HIV was detected in 9 of the 30 (30%) patients studied. Recognised sexually transmitted pathogens were detected in both aspirates and endocervical specimens: Chlamydia trachomatis was detected in 3 aspirate and 2 endocervical specimens whilst Neisseria gonorrhoeae was cultured in 5 aspirate and 7 endocervical specimens. When comparing microorganisms isolated from HIV antibody positive and negative women, only Bacteroides species yielded a significantly higher growth (p = 0.01) in the antibody positive women. CONCLUSION: Our findings show that women with Bartholin's gland abscesses have a high prevalence of HIV antibody. Furthermore, this is the only study that demonstrates a role for C trachomatis in the aetiology of Bartholin's gland abscesses. Health workers should be aware of the need for appropriate counselling, and comprehensive treatment of sexually transmitted infections including C trachomatis in women with Bartholin's gland abscesses.

Abscess↗
PubMed2004

Practice patterns in percutaneous image-guided intraabdominal abscess drainage: survey of academic and private practice centers.

PURPOSE: To evaluate current practice patterns of percutaneous image-guided abdominal and pelvic abscess drainage in academic and private practice centers. MATERIALS AND METHODS: The institutional review board did not require approval for this study. In a survey conducted between November 2002 and February 2003, 493 questionnaires were sent to 193 academic and 300 private practice radiology departments in the United States. All recipients were informed of the study purpose. The survey included questions about departmental demographics, patient selection criteria for percutaneous abscess drainage (eg, abscess diameter at imaging, laboratory parameters such as white blood cell count, and clinical indications such as fever), use of analgesia or conscious sedation, drainage method, and imaging technique. The statistical significance of differences between respondent subgroups was analyzed with a Pearson or Mantel-Haenszel chi(2) test. RESULTS: Academic centers returned 95 questionnaires (49%), and private practice centers, 72 (24%). Percutaneous abscess drainage is performed by a fellowship-trained radiologist at 92 (97%) of 95 academic centers and 41 (79%) of 52 private practice centers (P < .001). Among 95 academic respondents and 52 private practice respondents, respectively, 56 (59%) and 33 (63%) do not perform drainage if an abscess has a diameter of less than 3 cm; 30 (32%) and nine (17%), if the white blood cell count is normal; and 16 (17%) and six (12%), if the patient is afebrile. Most (90 [95%] of 95 academic, 45 [87%] of 52 private practice) respondents use conscious sedation. A transabdominal approach and 8-12-F catheters are most frequently used by both groups. Academic respondents more frequently use transvaginal and transrectal approaches (54 [57%] and 51 [54%] of 95, vs 16 [31%] and 15 [29%] of 52 private practice respondents; P = .003) and 14-F catheters (69 [73%] of 95 vs 18 [35%] of 52; P < .001). CONCLUSION: Percutaneous drainage is usually performed by fellowship-trained radiologists in abscesses of more than 3 cm in diameter, for appropriate clinical indications (multiple parameters above the established threshold), by using conscious sedation and 8-12-F catheters.

Abdominal Abscess↗
PubMed1982

High-resolution ultrasound evaluation of experimental brain abscess evolution: comparison with computed tomography and neuropathology.

Computed tomographic (CT) and high-resolution ultrasound (HRUS) imaging of experimental brain abscess were correlated with neuropathologic findings in nine mongrel dogs. The HRUS scan was more sensitive to different histologic features than the CT scan but both accurately delineated the evolution of the experimental brain abscess. All stages of abscess evolution were characterized by an appearance of an echogenic rim with a hypoechoic center. In the early stages the echogenicity of the abscess was related primarily to marked cellular infiltration, while in the late stages extensive collagen deposition correlated closely with the echo pattern. The size of the abscess in the cerebritis stages appeared smaller on the HRUS scan than on the CT scan because the latter modality detected the extensive cerebritis around the developing necrotic center whereas the HRUS scan did not. This discrepancy disappeared in the capsule stages. The HRUS scan provided a more accurate depiction of the neuropathologic characteristics of the necrotic than did the CT scan. Healing of the abscess, indicated by a decrease in size of the hypoechoic center, was accurately detected by the HRUS scan.

Animals↗
PubMed1983

Management of loculated abscesses that are difficult to drain: a new approach.

Fourteen critically ill patients underwent percutaneous drainage of abdominal abscesses. All 14 had one or more relative contraindications to external drainage procedure: (a) multiloculated abscesses; (b) multiple abscesses; (c) abscesses that form fistulae to surrounding organs; (d) abscesses containing viscous fluid, debris, or necrotic material. A total of 32 cavities was drained, usually using a multiple trocar/catheter system. Biplane computed tomography demonstrated a safe drainage route in all patients. In those patients in whom the contents of the abscess were too viscous to permit drainage, the contents were liquefied with acetylcysteine. Nine of the 14 patients (64%) recovered completely following the drainage procedure.

Abdomen↗
PubMed1985

Intrahepatic amebic abscesses: indications for and results of percutaneous catheter drainage.

Medical therapy is standard for intrahepatic amebic abscess and generally is effective. However, we have encountered a group of patients in whom percutaneous aspiration and drainage was indicated due to uncertainty of diagnosis or clinical deterioration of the patient. Twenty such patients underwent percutaneous drainage with ultrasound or CT guidance, and each patient was cured (appropriate antibiotics were administered concomitantly). The specific indications for intervention were to differentiate pyogenic from amebic abscess, pain and imminent rupture, poor response to medical therapy, false-negative results of serologic tests, noncompliance with medical treatment, left lobe abscess, and pregnancy. Diagnosis of amebiasis from examination of the fluid was seldom possible, while findings from core biopsy of the wall of the abscess led to diagnosis in three cases. Recurrence necessitating redrainage occurred in three patients; in each, catheters were removed the same day drainage was performed. There were three minor complications. Differences from percutaneous management of pyogenic abscesses included more rapid removal of catheters (four days), more frequent use of US guidance, and more common use of the prone angled approach to avoid pleural contamination. Catheter drainage may be curative and may expedite care for problematic amebic liver abscesses in selected cases.

Adult↗
PubMed2006

[Psoas abscesses. An up-dated perspective].

OBJECTIVE: To analyze the characteristics of abscesses of the psoas muscle and assess the differences between pyogenic and tuberculous abscesses. METHODS: Retrospective descriptive study of all patients with psoas abscess in our hospital over the period 1994 to 2004. RESULTS: Fourteen patients were studied (10 males), with a mean age of 42 years. Half of them had had an underlying disease. The most frequent clinical manifestations were abdominal pain (64%), fever (57%), and back pain (43%). All the abscesses were secondary. In 7 patients the origin was gastrointestinal, in 6 osteoarticular, and 1 was related with infection of an aortobifemoral bypass. Computed tomography was the diagnostic imaging method in all patients. Culture of drainage specimens was positive in 92% of patients undergoing this procedure. Causal microorganisms included Mycobacterium tuberculosis (5), Streptococcus intermedius (4), Staphylococcus aureus (3), Escherichia coli (3) and Bacteroides fragilis (2). Tuberculous abscesses originated in spondylitis and the clinical presentation was longer prior to diagnosis. Drainage was performed in 12 patients (8 percutaneous and 4 surgical). Mean duration of antimicrobial therapy was 4 weeks. The infection resolved in all patients. CONCLUSIONS: Psoas abscess commonly had a gastrointestinal and osteoarticular origin. We underscore the high percentage of tuberculous etiology, which had a more insidious clinical and analytical presentation and was usually secondary to spondylitis. Prolonged antimicrobial treatment associated with drainage was effective therapy.

Adolescent↗
PubMed1998

Pediatric intracranial epidural abscess secondary to an infected scalp vein catheter.

The authors present a case of a 5-week-old infant developing a retrotorcular epidural abscess as a result of an infected scalp vein catheter. The abscess developed in the absence of sinusitis, otitis, trauma, or prior surgery. The diagnosis of epidural abscess was made on the basis of magnetic resonance imaging and ultrasound-guided aspiration of the fluid collection. An identified strain of Staphylococcus epidermidis was cultured from both the intravenous catheter and the abscess. The patient underwent a suboccipital craniectomy with drainage of the abscess and a 6-week total course of intravenous antibiotics. Magnetic resonance imaging 4 months after the procedure and 2.5-year pediatric clinic follow-up have demonstrated no evidence of neurologic deficit or recurrence. When present, a scalp vein catheter must be considered as an etiologic agent for an intracranial epidural abscess in this age-group.

Brain Abscess↗
PubMed2006

Lactobacillus acidophilus as a cause of liver abscess in a NOD2/CARD15-positive patient with Crohn's disease.

INTRODUCTION: The development of a fistula and/or an abscess are major complications in patients with Crohn's disease. An abscess can involve any of the major viscera, including the liver and spleen. CASE REPORT: A 27-year-old male patient with a 6-month history of NOD2/CARD15-positive Crohn's disease with stenosis of the terminal ileum, previously treated with corticosteroids, was admitted with fever, chills, diarrhea, fatigue and cachexia. Diagnostic work-up revealed sepsis, an abscess in the right hepatic lobe, multiple abdominal collections and right-sided pleural effusion. It was felt that his poor general condition prevented surgical intervention and complex conservative treatment was initiated. It consisted of total parenteral nutrition, antibiotics, percutaneous drainage of the liver abscess, and thoracocentesis. Pus and blood cultures showed Lactobacillus acidophilus. There was a gradual improvement in the patient's condition and the liver abscess decreased in diameter from 14 to 2 cm. Aminosalicylates and enteral nutrition were gradually introduced. The patient was discharged after 9 weeks in good general condition. CONCLUSION: Although extremely rarely, L. acidophilus can cause hepatic abscess and sepsis. This can be explained by immunologic incompetence due to corticosteroid treatment of Crohn's disease.

Adult↗
PubMed2006

Parapharyngeal abscess: comprehensive management protocol.

Parapharyngeal infections are rare, but they cause serious morbidity and mortality. Therefore, until now, the recommended treatment of parapharyngeal abscess has been early open surgical drainage. The purpose of this study is to review the clinical course and outcome of treatment in parapharyngeal abscess according to method of treatment. A prospective study was designed for parapharyngeal abscess in patients admitted for deep neck infection. During an 8-year period, from June 1994 to January 2003, 34 patients were enrolled. All had contrast-enhanced computed tomography (CT) imaging and confirmation of an abscess in the parapharyngeal space. All patients were treated with intravenous antibiotics. We treated 19 cases (conservative group) with antibiotics only or needle aspiration and 15 (surgical group) with intraoral or external drainage. The mean duration of hospitalization was 8.2 days in the conservative group and 11.6 days in the surgical group. There was no complication except mediastinitis in 1 case of the conservative group. Because of severe dyspnea, 5 patients required tracheotomy. Neck CT scan is a useful diagnostic tool to detect and establish the treatment plan of parapharyngeal abscess. Parapharyngeal abscess may, in some cases, respond to antibiotics, become localized to the parapharyngeal space and be treated conservatively with no need for early open surgical drainage.

Adolescent↗
PubMed1983

Penicillin failure in the treatment of Bacteroides fragilis lung abscess. Experimental study in rabbits.

Carbenicillin, chloramphenicol, doxycycline, and clindamycin were compared with penicillin for the treatment of lung abscess in an animal model produced by transtracheal inoculation of a mixture of anaerobes: Bacteroides fragilis, Peptococcus morbillorum, Eubacterium lentum and Fusobacterium nucleatum. Both chloramphenicol and doxycycline eliminated the bacteria but failed to close the abscess cavity. Carbenicillin, although it eradicated B. fragilis, failed to close the abscess cavity in 3 of 6 animals. In all animals tested, clindamycin sterilized the abscess cavities and healed the lung abscesses, while penicillin failed to eradicate the infection. Clindamycin was significantly more effective than penicillin in the elimination of anaerobic bacteria from the lung (p less than 0.05). Clindamycin also closed the abscess cavity faster than penicillin (p less than or equal to 0.02). The superior efficacy of clindamycin may have been the result of accumulation in the lung tissue in concentrations four- to eightfold higher than in the serum.

Animals↗
PubMed1995

Minimal invasive therapy of prostatic abscess by transrectal ultrasound-guided perineal drainage.

Prostatic abscess is a rare but severe disease. Conventional therapy is transurethral resection of the prostatic abscess. Since the advent of transrectal ultrasound (TRUS) a minimal-invasive treatment of prostatic abscess by TRUS-guided perineal drainage under local anesthesia is available. We report on our experience in 6 patients with prostatic abscess. TRUS is a simple, rapid, easily accessible, and accurate method for diagnosis, therapy and follow-up of a prostatic abscess. TRUS-guided perineal drainage of a prostatic abscess is an effective, minimal-invasive and cost-effective treatment without adverse side effects.

Abscess↗
PubMed1995

Polysaccharide-mediated protection against abscess formation in experimental intra-abdominal sepsis.

Abscess formation is a major complication of intra-abdominal sepsis that causes significant morbidity and mortality. In such cases, Bacteroides fragilis is the predominant anaerobic isolate. In a rat model of intra-abdominal sepsis, the capsular polysaccharide complex (CPC) from B. fragilis promotes abscess formation and when administered sub-cutaneously, protects against this host response by a T cell-dependent immune mechanism. In the present study, the polysaccharide A (PS A) component of CPC protected animals against challenge with live heterologous bacterial species (mixtures of anaerobes and facultative organisms) that are most commonly isolated from intra-abdominal abscesses in humans. Protection against heterologous bacterial challenge was transferred by T cells. Administration of PS A shortly before or even after challenge with B. fragilis protected against this host response. In experiments designed to simulate fecal contamination of the human peritoneal cavity, PS A protected animals against abscess formation induced by a rat cecal contents inoculum. The surprisingly broad protective activity of PS A indicates that this molecule is likely suppressing a nonspecific host tissue reaction that forms in response to a variety of abscess-inducing organisms and that it might be useful in preventing abscess formation associated with intra-abdominal sepsis in the clinical setting.

Abdominal Abscess↗
PubMed2005

Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department.

UNLABELLED: Peritonsillar abscess (PTA) can be a life-threatening disease and may lead to significant complications without drainage. OBJECTIVES: To describe the utility of ultrasound (US) in the evaluation of potential PTA and US-guided PTA drainage. METHODS: The authors performed a retrospective US quality assurance review of all patients over 18 years of age scanned by emergency physicians for possible PTA. All patients presenting with PTA signs and symptoms including erythema and swelling of the tonsillar pillar and uvular deviation were eligible to be scanned. Patients confirmed to have an abscess on US had US-guided drainage followed by intravenous antibiotics in the emergency department and discharge home on oral antibiotics. Scans were performed by credentialed attending emergency physicians and residents. Researchers recorded patient symptoms, US findings, results of abscess drainage if performed, and any complications of drainage. All US examinations were performed with sheathed endocavity broadband US transducers on minimum depth and maximum resolution settings. Statistical analysis included descriptive statistics. RESULTS: Forty-three patients received intraoral US examinations for suspected PTA. Thirty-five (81%) were diagnosed as having abscess on US. All abscesses were drained with an 18- or 14-gauge needle under US guidance. There were no drainage complications. There was one false positive with a focal area of edema yielding no pus on needle aspiration under direct US visualization. No patient returned unexpectedly after drainage. CONCLUSIONS: These data suggest that intraoral US of suspected PTA allows for reliable diagnosis and safe and accurate abscess drainage.

Anti-Bacterial Agents↗