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PubMed2002

A note on indirect hemagglutination (IHA) antibody titers among hospitalized patients in Thailand with amebic liver abscesses.

Amebic hepatic abscess is a tropical disease with a wide spectrum of clinical presentations. A retrospective case review was performed on 39 hospitalized patients in Thailand with the diagnosis of amebic liver abscess. A total of 23 men (59%) and 16 women (41%), with a mean age of 44.56 +/- 21.81 years (range, 10 to 88 years), were involved in the study. The average duration of present illness was 7.33 +/- 0.83 days. Abscesses were discovered in the right lobe in 29 patients (74.4%), in the left lobe in 3 patients (7.7%), and in both lobes in 7 patients (17.9%). Thirty patients had single abscesses (76.9%) and 9 patients had multiple abscesses (23.1%). On admission, the average white blood count was 17.37 +/- 6.34 x 1000 WBC/mm3, serum albumin was 2.86 +/- 0.61 g/dL, prothrombin time was 16.52 +/- 5.8 seconds, serum aspartate transaminase (AST) was 92.62 +/- 118.74 U/L, serum alanine transaminase (ALT) was 83.74 +/- 107.84 U/L, serum alkaline phosphatase (ALP) was 407.68 +/- 343.42 U/L, and serum bilirubin was 2.44 +/- 2.08 g/dL. Average indirect hemagglutination (IHA) titer of the cases was 1:1190.35 +/- 895.42 (range, 1:256 to 2048). Concerning the multiple logistic regression analysis, no significant correlation was found between antibody titer and the other parameters. Of interest, pathogenic organisms were detected in stool in only 2 cases. This study shows the usefulness of serologic study in diagnosis of amebic liver abscess.

Adolescent↗
PubMed1976

Management of Postoperative Abscess Following Gynecologic Surgery.

Forty-nine postoperative abscesses were encountered following 1600 major pelvic procedures. Abdominal and vaginal procedures were complicated by abscess formation in 0.7% and 4% of cases, respectively. The average time between surgery and recognition of the pelvic abscess was 18 days. A positive correlation between surgery performed during the luteal phase and abscess formation was noted. Fifty-five percent of pelvic abscesses treated by primary vaginal drainage required eventful laparotomy for final eradiction of disease. An aggressive approach to abscess management is felt to be justified in this disease entity.

Abscess↗
PubMed2003

[Orbital abscess secondary to sinusitis in a child].

PURPOSE/METHOD: We present the case of a 10-year-old patient who was admitted as an emergency to our hospital with right ocular infection due to pansinusitis. He presented fever and malaise. Clinical, ophthalmic and radiologic examination confirmed the existence of an orbital abscess. Due to the poor evolution, surgical treatment was needed. RESULTS/CONCLUSION: Orbital cellulitis and orbital abscess are two different types of orbital infections. Being able to differentiate between then is very important for selecting the appropriate medical and surgical therapy. Medical treatment is a good solution for infections without abscesses, but surgery is usually needed for infections with an abscess. Abscess formation sometimes require surgical drainage of the orbital abscess with associated treatment of paranasal sinus.

Abscess↗
PubMed2003

Prostatic abscess in southern Taiwan: another invasive infection caused predominantly by Klebsiella pneumoniae.

Prostatic abscess, though rarely encountered since the introduction of broad-spectrum antibiotics, can cause significant morbidity and mortality. We retrospectively reviewed 17 cases of prostatic abscess treated during an 11-year period at 2 medical centers in southern Taiwan. Most of these patients were elderly (mean age, 59 years) with diabetes mellitus (10 cases, 59%) or hepatic cirrhosis (5 cases, 29%). Fourteen (82%) of the 17 patients were febrile, with chills occurring in about a half of these. Of the symptoms and signs referable to the lower urinary tract, dysuria (71%) was the most common complaint. Pain was usually localized in the suprapubic (35%) or perineal (18%) area. The common findings of digital rectal examination were prostatic enlargement (77%) and fluctuation (23%). Prostatic abscess was impressed from the findings of hypoechoic area with thick walls on transrectal ultrasound or an enlarged gland with fluid-density collections on computed tomography. All causative pathogens were gram-negative bacilli, including Klebsiella pneumoniae (10 cases), Escherichia coli (2), and Pseudomonas aeruginosa (1). Various measures were undertaken to allow drainage, including transurethral incision or resection of the prostate, open perineal incision, laparotomy, and transrectal ultrasound- or computed tomography-guided needle aspiration. In conclusion, K. pneumoniae was the predominant pathogen of prostatic abscess, and was frequently identified as the causative pathogen in patients with diabetes mellitus. Diagnosis of prostatic abscess based merely on symptomatology is implausible, and image studies, such as transrectal ultrasound or computed tomography scan, are warranted. Optimal management includes adequate drainage of abscess and antimicrobial therapy.

Abscess↗
PubMedDate not supplied

Liver abscess due to acute cholecystitis. Report of five cases.

Acute cholecystitis is one of the most frequent causes of admissions to surgical departments. The development of liver abscesses is an uncommon and underrated complication of acute cholecystitis. In this study we report on our experience with the treatment of 5 cases of liver abscesses secondary to acute cholecystitis. All 5 cases were characterised by a lengthy period between the onset of acute cholecystitis symptoms and the subsequent diagnosis of a secondary liver abscess. In 4 out of 5 patients, admission for liver abscess occurred 12, 30, 50 and 120 days, respectively, after the acute cholecystitis episode. The liver abscesses were successfully treated with percutaneous drainage under US guidance (4 cases) and 4 patients underwent percutaneous cholecystostomy to treat the acute cholecystitis. After resolution of the acute phase, an elective cholecystectomy was performed in 4 out of 5 cases. Failure to diagnose acute cholecystitis at onset or inappropriate treatment of the condition could lead to the development of liver abscesses.

Acute Disease↗
PubMedDate not supplied

Liver abscess formation after transarterial chemoembolization for malignant hepatic tumor.

BACKGROUND/AIMS: To study and review the clinical manifestations, microbiology, comorbidity, and diagnosis of liver abscess after transarterial chemoembolization for malignant hepatic tumor. METHODOLOGY: We retrospectively reviewed 1374 patients who underwent 2581 transarterial chemoembolization procedures due to malignant hepatic tumors over an 8-year period. RESULTS: 7 patients had liver abscess after transarterial chemoembolization. The incidence was 0.27% (7/2581). Hepatocellular carcinoma was diagnosed in all 7 patients, whose liver function was classified as stage A by the Child-Pugh criteria. The clinical manifestations were intermittent fever, abdominal pain, and leukocystosis. All the patients had hyperechoic spots with reverberative shadows on sonograms or low attenuation areas with different Hounsfield units on computed tomography scan, which expressed the 100% incidence (7 of 7) of gas-forming abscesses. Percutaneous drainage or aspiration was done in 6 patients. One received laparotomy with local debridement due to suspicious organ rupture. The pus culture showed Gram-negative bacteria in all patients. Blood cultures were positive in only 3 of 7 patients (43%). No patients died of liver abscess after aspiration, drainage, or debridement of abscess combined with parenteral antibiotic treatment. Biliary tract diseases, found in 4 patients, were the most common comorbidity. CONCLUSIONS: Liver abscess after transarterial chemoembolization is a very rare complication, which usually develops in patients with biliary tract disease. Gram-negative bacteria are the main pathogens. The incidence of gas formation is higher after transarterial chemoembolization than in the general population. However, the prognosis is good after adequate clearance of pus and antibiotic treatment.

Biliary Tract Diseases↗
PubMed2003

Tubo-ovarian abscesses: spectrum of sonographic findings with surgical and pathological correlations.

OBJECTIVE: Pelvic inflammatory disease (PID) is a serious condition that can lead to abscess formation. The purpose of this study was to identify the different sonographic markers on gray scale and color Doppler sonography in tubo-ovarian abscesses. MATERIAL AND METHODS: The study group consisted of 25 women in whom the presence of tubo-ovarian abscess was confirmed by surgery and histopathology and their ultrasound records were analyzed retrospectively. RESULTS: Presence of a mass was found in all cases. The maximum diameter of the mass was 5 cm in two cases and between 5 cm and 10 cm in 23 cases. The mass was demonstrated at the anatomic position of the ovary in 21 cases (84%) and at the cul-de-sac in four cases (16%). The mass was a simple cyst in two cases (8%), in four cases it was cystic with diaphragms (16%), in four cases it was a thickened tube-shaped structure with multiple internal echoes (16%) and in 15 cases it was a mixture of cystic and solid elements (60%). Pyosalpinges with fluid-fluid levels were found in two cases. Fluid in the cul-de-sac was observed at a rate of 48%. Color Doppler sonography demonstrated abundant blood flow in the borders and the septa of the tuboovarian abscesses in 90% of the studied cases. CONCLUSION: The ultrasonographic findings of tubo-ovarian abscesses are not specific. The presence of a mass at the anatomic position of the ovary or at the cul-de-sac in combination with an increased number of white blood cells, elevated erythrocyte sedimentation rate and clinical findings are helpful for a correct diagnosis. Also, the color Doppler flow can further characterize the nature of the pelvic mass by detecting a significant rich blood flow in most cases of tuboovarian abscesses.

Abdominal Pain↗
PubMed2003

Brain abscess: clinical analysis of 53 cases.

Fifty-three cases of brain abscess were treated at Mackay Memorial Hospital from January 1991 through December 2001. The ages ranged from 2 weeks to 84 years, with a peak at 40 to 50 years (11/53, 21%). The male to female ratio was 1.8:1 (34 males, 19 females). The most common presenting symptoms were fever (30/53, 57%), headache (29/53, 55%), and changed mental status (24/53, 45%). The duration of symptoms before hospitalization ranged from several hours to 2 months. A shorter duration of symptoms was associated with poor outcome. The common predisposing factors were otic infection (10/53, 19%), penetrating head trauma and neurosurgery (10/53, 19%), and bacterial endocarditis (5/53, 9%). The leading underlying diseases were diabetes mellitus (12/53, 23%) and/or liver cirrhosis (6/53, 11%), and both were independently associated with increased risk of mortality. Computed tomographic scanning and magnetic resonance imaging facilitated early diagnosis and proper management. Surgical intervention was used together with antibiotics in 33 (62%) of 53 patients in whom the average abscesses diameter was 3.75 cm (range, 2-6 cm). The remaining 20 (38%) patients whose average abscesses diameter was 2.3 cm (range, 1-3.5 cm) were treated with antibiotics only. Culture of material drained from abscesses isolated 27 microorganisms from 19 (58%) of the 33 patients, 81% (22/27) of which were aerobic and 19% (5/27) anaerobic bacteria. The most common pathogen was alpha-hemolytic Streptococcus spp. (6/27, 22%). Most of the patients with Klebsiella pneumoniae isolated from brain abscess, cerebrospinal fluid, and blood cultures were diabetic. A high mortality rate (9/20, 45%) was found in patients with medical treatment. A high index of suspicion is needed for the early diagnosis of brain abscess, particularly in patients with predisposing factors. In this series, early diagnosis using computed tomography and/or magnetic resonance scanning, optimal timing of surgery, and appropriate use of antibiotics were associated with improved outcome.

Adolescent↗
PubMed1992

[Laryngeal carcinoma with laryngeal abscess].

We had encountered 5 cases of laryngeal carcinoma associated with abscess. Four of them were advanced laryngeal cancer with abscess induced by mechanical injury, and one with post-radiation laryngeal perichondritis & abscess formation. Management included total laryngectomy in 3 patients, partial laryngectomy in 1 patient, and resection of post-radiation abscess in one. Laryngeal abscesses are seen rarely today. Endeavour should be made to decrease such complication. The authors had presented their experience in the management of laryngeal carcinoma associated with laryngeal abscess, together with a review of the history and some of the current ideas about this problem.

Abscess↗
PubMed1992

Percutaneous debridement of complex pyogenic liver abscesses.

The author's approach and technique in the treatment of complex liver abscesses that persisted or recurred following percutaneous drainage are described. Six patients were treated by percutaneous debridement using an instrument specially designed for that purpose. Four patients were chronically ill but stable, while the other two were septic, hypotensive and considered to be life threatened. All patients had primary pyogenic abscesses. Four had demonstrated mixed bacterial flora consisting of E. coli, Klebsiella, Proteus and gram-positive cocci and two were caused by E. coli only. Contrast enhanced CT of the abdomen in all cases revealed multiloculated or septated abscesses containing large central debris and peripheral shell or halo of compromised hepatic parenchyma. Debridement was successful in all cases, resulting in complete healing within 12 days. Follow-up for 1-4.5 years revealed no recurrences. Three cases of infected tumors of the liver were referred for treatment. CT findings in these cases demonstrated a well developed external capsule and internal septations, and the absence of a surrounding halo of compromised parenchyma distinguishes them from primary abscesses. This preliminary experience makes the authors to conclude that percutaneous debridement of pyogenic liver abscesses is a safe and curative procedure in selected cases of life-threatening chronic liver abscesses.

Debridement↗
PubMed1992

[Clinical aspects and management of a retroperitoneal abscess].

14 patients with retroperitoneal abscess have been collected by the authors since June 1, 1988. The retroperitoneal abscess of multifactorial origin can be considered as a secondary disease. The physical clinical signs (e.g. psoas rigidity sign, palpable mass, costolumbal sensitivity) play central role in setting up of diagnosis, and these signs were present in more than 75% of the cases. The physical signs generally indicate advanced retroperitoneal abscess, and at the same time the contour of psoas muscle disappears and concavity of lumbal vertebras can be seen on plane abdominal X ray film. The exact diagnosis was achieved in mean 45 days after the on set of complaints, this fact urges, that the up-to-date imaging modalities (US, CT, NMR) should be applied earlier in septic conditions of unknown origin. Retroperitoneal surgical intervention was performed in their patients, in the future the percutaneous drainage procedure has to be considered as first intervention for retroperitoneal abscess. Retroperitoneal abscess secondary to malignant disease has unfavorable prognosis, 2 out of 14 patients with retroperitoneal abscess died, both of them had underlying malignancy.

Abscess↗
PubMed2003

Perianal abscess and fistula in children in Zaria.

Perianal abscess (PAA) and fistula-in-ano (FIA) are not uncommon in children, but reports from tropical Africa are uncommon. In a period of 17 years, 17 children aged 12 years and below were treated for these conditions in Zaria, Nigeria. There were 14 boys and 3 girls, aged 4 months-12 years (median 3 years), Eight had PAA (median age 3 years), 5 ischiorectal abscess (median age 5 years) and 4 FIA (median age 10 months). FIA followed pull through for anorectal malformation in 2 patients and in one it was preceded by PAA. PAA was associated with chronic fissure-in-ano in one patient and uncontrolled diabetes mellitus in one. One 16-month girl with an ischiorectal abscess developed severe perineal necrotising fascitis and separation and retraction of the anorectum. Escherichia coli was cultured in 2 patients with abscesses and staphylococcus aureus in another 2. Culture was sterile in 7 patients with abscesses. Treatment was by adequate incision and drainage for abscesses. Fistulectomy was the treatment for FIA, but in one patient a diversion colostomy was performed in addition as the fistula was a high one. The child who developed necrotising fascitis had debridement and diversion colostomy. FIA recurred in one patient necessitating repeat fistulectomy. Although the number of patients is small, perianal sepsis appears to be less common in our environment compared to developed countries. Some differences are highlighted.

Abscess↗
PubMed2004

[Recurrent brain abscess associated with congenital pulmonary arteriovenous fistula: a case report].

We report a rare case of recurrent brain abscess associated with congenital pulmonary arteriovenous fistula. A 52-year-old man was admitted to our hospital in October, 1999 because of a sudden stroke-like onset of right hemiparesis, right hemiparesthesia, dysarthria and sensory aphasia. He had a history of previous brain abscess in the right cerebellar hemisphere. It had been removed in 1991. CT scan at the time of the current admission disclosed a low-density area in the left parietal region. The mass was ring-enhanced after injection of contrast medium. On MRI the mass lesion was depicted as low-intensity on T1-weighted image and high-intensity on T2-weighted image. The mass was ring-enhanced after administration of Gd-DTPA. In spite of conservative treatment the size of the abscess increased considerably with marked surrounding edema. The brain abscess was successfully treated with aspiration and drainage, and the residual mass was resected. The patient also had a history of arteriovenous fistula in the lower lobe of his right lung. This had been excised in 1965. However, he had no signs, symptoms or family histories of hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease). Contrast enhanced CT scan of the chest showed nodular lesions connected to vascular shadows in the right lower lung field. Pulmonary angiograms also revealed multiple arteriovenous fistulas in the lower lobe of the right lung. He was not dyspneic or cyanotic, but his hypoxia, polycythemia, and recurrent brain abscess were thought to be caused by pulmonary arteriovenous fistula. The fistulas were embolized with coils via a percutaneous catheter. Pulmonary arteriovenous fistula should be treated aggressively either by surgery and/or by coil embolization in order to prevent the complication of brain abscess.

Anti-Bacterial Agents↗
PubMedDate not supplied

Actinomycotic liver abscess. Case report and review of the literature.

Actinomycosis is a chronic suppurative, granulomatous disease, which is characterized clinically by extensive necrosis and abscess formation, and histologically by the presence of the so-called "sulphur granules". Actinomycosis is generally classified as being of cervicofacial, thoracic or abdominal type. The objective of this study is the presentation of a case of actinomycotic liver abscess that we encountered in our department 5 years ago, along with a brief review of this rare disease. A 39-year-old male non-Greek Caucasian patient presented with high fever, malaise, anorexia, vomiting after food ingestion and right upper quadrant pain. Leucocytosis with a left shift was present, and ultrasonography demonstrated a mass of mixed composition in the anterior part of the right hepatic lobe, measuring 6.8 x 4.6 cm, suggestive of an abscess or haemangioma. MRI scan confirmed the presence of a space-occupying lesion, suggestive of an abscess. The patient was submitted to surgical drainage of the hepatic abscess. The culture of the purulent material was found to be sterile, while the histochemical examination of the specimen demonstrated the presence of actinomycosis. The patient had an uneventful postoperative course and after discharge received prolonged chemoprophylaxis. Actinomycotic liver abscess is a very rare clinical entity, and only 57 cases have been reported in the English literature. Due to the rarity of the disease and the limited number of reported cases, we considered it useful to report this case.

Actinomycosis↗
PubMed2004

Use of percutaneous drainage to treat hepatic abscess after radiofrequency ablation of metastatic pancreatic adenocarcinoma.

Radiofrequency ablation (RFA) is well described in the treatment of primary hepatic malignancies and colorectal carcinoma hepatic metastases. A known complication of RFA is the development of hepatic abscess. The management of hepatic abscesses subsequent to RFA for metastatic disease is not well described. A 49-year-old female with pancreatic adenocarcinoma underwent pancreaticoduodenectomy followed by adjuvant chemoradiation. Following 6 months' treatment, a new liver metastasis was identified. It remained stable for 6 months during additional chemotherapy and thereafter was treated with RFA. Three weeks after RFA, the patient presented with malaise and leukocytosis, and a CT scan demonstrated a large hepatic abscess at the site of the RFA. She remained febrile despite needle aspiration and intravenous antibiotics. A percutaneous drain was placed and the symptoms resolved. Contrast injection of the drain 4 weeks later demonstrated resolution of the abscess cavity but communication with the biliary tree. The drain was removed and the tract embolized with Gel-foam to prevent complications of biliary-cutaneous fistula. She remains well without evidence of abscess or disease recurrence. Thus, RFA can be used in treatment of limited isolated hepatic metastases from previously treated pancreatic adenocarcinoma. However, the incidence of hepatic abscess is increased due to bilioenteric anastomosis; extended antibiotic prophylaxis should be considered.

Adenocarcinoma↗
PubMed2004

Comparison of pyogenic liver abscess caused by non-Klebsiella pneumoniae and Klebsiella pneumoniae.

From January 1996 to April 2002, a total of 248 patients with pyogenic liver abscess were enrolled in this study. Abscesses caused by Klebsiella pneumoniae accounted for 69% (171) of cases. Abscesses caused by K. pneumoniae were more strongly associated with diabetes mellitus or impaired fasting glucose than liver abscesses caused by non-K. pneumoniae (70.2% vs 32.5%). Solitary abscess and monomicrobial isolates were more frequent in the K. pneumoniae group than that in the non-K. pneumoniae group. A total of 42 patients were treated with antibiotics alone. Antibiotics treatment was combined with other procedures, including single aspiration in 23 patients, percutaneous drainage in 176 and surgical drainage in 7. A higher incidence of metastatic infections occurred in the K. pneumoniae group than in the non-K. pneumoniae group (14.6% vs 3.8%). By contrast, the mortality rate of the K. pneumoniae group was lower than that of non-K. pneumoniae group (4.1% vs 20.8%). There was no significant difference in the relapse rate between these 2 groups (6.5% vs 6.4%). We also found that the presence of respiratory symptoms (including cough, dyspnea, or chest distress), size of abscess > or =5 cm in diameter and non-K. pneumoniae pathogens were significant prognostic factors for mortality.

Adolescent↗
PubMed2004

[Periodontal abscess: etiology, diagnosis and treatment].

The periodontal abscess is an acute destructive process in the periodontium resulting in localized collections of pus communicating with the oral cavity through the gingival sulcus or other periodontal sites and not arising from the tooth pulp. The prevalence of periodontal abscess is relatively high and it affects the prognosis of the tooth. Periodontal abscesses can develop on the base of persisting periodontitis but can also occur in the absence of periodontitis. The cause of the development of periodontal abscess originating from chronic periodontitis is the marginal closure of a periodontal pocket, or the pocket lumen might be too tight to drain the increased suppuration due to changes in the composition of subgingival microflora, alteration of bacterial virulence or host defenses. Diagnosis of a periodontal abscess is based on medical and dental history as well as oral examination (pocket depth, swelling, suppuration, mobility, sensibility of the tooth). The most prevalent group of bacteria: P. gingivalis, P. intermedia, B. forsythus, F. nucleatum and P. micros. Previous studies have suggested that the complete therapy of the periodontitis patients with acute periodontal abscess has to do in two stages: the first stage is the management of acute lesions, then the second stage is the appropriate comprehensive treatment of the original and/or residual lesions. The management of acute lesions includes establishing drainage via pocket lumen, subgingival scaling and root planing, curettage of the lining pocket epithelia and seriously inflamed connective tissue, compressing pocket wall to underlying tooth and periodontal support, and maintaining tissue contact. Some authors recommend the incision or to establish drainage and irrigation, or a flap surgery, or even extraction of hopeless teeth. We recommend the use of systemic antibiotics as a preventive measure of systemic disease or in case of systemic symptoms.

Acute Disease↗
PubMedDate not supplied

[Tuberculous psoas abscess in a patient with HIV].

Psoas abscess is an uncommon disease with varied etiology. The most common pathogen in primary abscess is Staphylococcus aureus. Crohn's disease is the most common cause of a secondary abscess. Recently, drug abuse and HIV infection have become important risk factors in identification of a patient with psoas abscess. Mycobacterium tuberculosis is considered an extremely rare cause of psoas abscess, but it is reported in HIV patients. Physical presentation is insidious; classical symptoms are pain and fever. Computed tomography (CT) is the most important tool for diagnosis. Preferred treatment is percutaneous drainage guided by CT. Open surgical drainage should be reserved if percutaneous drainage fails, if possible by extraperitoneal approach; in secondary abscess, the transperitoneal approach is preferred to correct the possible disease.

Adult↗