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PubMed1992

Profile of amebic liver abscess.

Two hundred cases of amebic liver abscess diagnosed between 1989 and 1991 at the Kasturba Medical College, Manipal were analyzed in this retrospective study. The clinical features and investigation reports were studied and the treatment and its response were analyzed. Amebic liver abscess constituted 0.6% of total hospital admissions during the study period. The male to female ratio was 13:1 with the most common age group of presentation between the fourth and fifth decades of life. Abdominal pain was the most common symptom (92%) and hepatomegaly was observed in 94% of the cases. Ultrasonogram of the abdomen served as the most useful diagnostic aid. Right lobe abscess was observed in 87% of the cases. Abscess was single in 81.5% of cases. Abscess size of more than 4 cm was observed in 46.5% of the cases. Metronidazole and chloroquine were found to be effective in most cases. Aspiration was done in 35.5% of cases. The complications encountered in this study were pleural effusion (two cases), pneumonic consolidation (four cases), pericardial effusion (one case) and ascitis (two cases).

Adolescent↗
PubMed1992

[Lumbosacral pain revealing intramural rectal abscess. Apropos of 2 cases].

Intramural abscess of the rectum is an uncommon (7%) form of perianal abscess in which the suppuration moves upwards within the rectal wall. Diagnosis is usually readily established on the presence of prominent anorectal symptoms and on rectal examination findings. However, atypical cases occur occasionally. Two cases of intramural abscess with misleading presenting symptoms suggestive of rheumatologic disease are reported herein. Both patients had subacute lumbosacral pain suggestive of an inflammatory condition. In one patient, the correct diagnosis was established two years after onset of symptoms when the patient passed pus per rectum. In the other, endoscopic ultrasonography readily evidenced the abscess. Modern imaging techniques including endorectal ultrasonography, CT scan with enhancement and MRI are very helpful for the diagnosis of such difficult cases. Intramural rectal abscess should be added to the list of possible nonspinal visceral etiologies routinely looked for during the evaluation of patients with atypical lumbosacral pain.

Abscess↗
PubMed1992

Splenic abscess associated with endocarditis.

BACKGROUND: Refractory or recurrent sepsis in patients with endocarditis may be from splenic abscess. The purpose of this review is to assess this relationship. METHODS: Of 564 patients treated for documented endocarditis between 1970 and 1990, splenic abscesses developed in 27 patients. The mean age of the 18 men and nine women was 37 years. Etiologic factors included street drugs, dental abscess, and rheumatic fever. Symptoms included fever, myalgia, chills, and dyspnea; the prodrome averaged 2 weeks. Typical signs were heart murmur, left lower-lobe infiltrate, and leukocytosis. Splenomegaly was found in three patients. All patients had valve lesions, which involved the aortic valve alone in 10 patients, the mitral valve alone in eight patients, and multiple valves in nine patients. RESULTS: A splenic defect on computed axial tomographic scan was diagnosed correctly as an abscess in 10 patients, was indeterminant in three patients, and was incorrectly called an infarct in four patients. Thirteen patients died. All 10 patients treated without splenectomy died, including five patients who underwent valvular replacement. In contrast, only three of 17 patients treated by splenectomy with (11 patients) or without (six patients) valvular surgery died. CONCLUSIONS: Splenic abscess often accompanies endocarditis. The diagnosis is suspected by refractory fever and confirmed by abdominal computed axial tomography scan. Splenectomy is warranted before or after valvular surgery, depending on the patient's clinical response to antibiotics.

Abscess↗
PubMed2003

Hepatic abscess caused by Aspergillus fumigatus infection following splenectomy and immunosuppressive therapy.

Hepatic abscess caused by Aspergillus fumigatus infection is rare. The incidence of fungal hepatic abscess has recently increased. We report a case of Aspergillus fumigatus infection in a 66-year-old man with aplastic anemia who presented with intermittent high fever. He had received splenectomy about 2 years before this admission followed by treatment with anti-human thymocyte globulin, corticosteroids, and cyclosporin. Abdominal sonography and computerized tomography scan of the liver revealed a hepatic abscess and empiric broad-spectrum antibiotics were administered, but fever persisted. Culture of abscess aspirate yielded Aspergillus fumigatus. Amphotericin B was administered, but the patient died of sepsis. With the increasing number of immunocompromised patients, various fungal infections, including Aspergillus fumigatus, are increasingly common, and this infection can be very serious with fatal outcome. Alertness to the possibility that fungal infection may be present when an immunocompromised patient with hepatic abscess presents in hospital is important to decreasing morbidity and mortality.

Aged↗
PubMed2003

Percutaneous drainage of liver abscess complicated by hepato-venous fistula.

Severe systemic sepsis after percutaneous drainage of liver abscess is rare. We report two cases of hepato-venous fistulas between hepatic abscesses and hepatic/portal veins documented on abscessography during percutaneous drainage of liver abscesses, which resulted in severe sepsis and a stormy post drainage clinical course. Liver abscesses can rupture into the portal and hepatic veins causing worsening of systemic sepsis especially when they are in close proximity to each other. During percutaneous drainage, care must also be taken to avoid overinjection of the abscess, which can worsen the fistula. The ensuing sepsis is severe and requires aggressive intensive medical care and ventilatory support to tide the patient over the septic episode.

Aged↗
PubMed2003

Portal vein thrombosis complicating neonatal hepatic abscess.

Hepatic abscess in a neonate is a rare but serious disorder. Diagnosis of hepatic abscess requires a high index of suspicion in any septic neonate. CT scan and ultrasound of liver are the most sensitive diagnostic tests in detection of hepatic abscess. Portal vein thrombosis and portal cavernoma formation is hitherto unreported complication of neonatal hepatic abscess in English literature. Present case report highlights the difficulty in diagnosis of neonatal hepatic abscess and describes the development of portal vein thrombosis and cavernoma during its treatment.

Female↗
PubMed2003

[Recent changes of organism and treatment in pyogenic liver abscess].

BACKGROUND/AIMS: With the advance of antibiotics and the development of newer imaging techniques, marked changes in etiology, diagnosis, treatment and prognosis of liver abscess have been reported. METHODS: We reviewed the clinical data related to 94 patients with pyogenic liver abscess. RESULTS: Of the 94 patients in the study group, the male to female ratio was 1.4:1 and the peak incidence of liver abscess was in the 7th decade. About three quarters (74.5%) of the abscesses were of unknown origin. The predominant location was in the right lobe (70.3%). Single lesion was found in 80 patients and multiple lesions in 14 patients. Pathogens were identified in 67 patients, of which Klebsiella pneumoniae (65.7%) and E. coli (16.4%) were the most common. The modalities of treatment were percutaneous drainage with antibiotics (73.4%), percutaneous aspiration with antibiotics (16.0%), or antibiotics alone (8.5%). The case fatality rate, mainly from associated underlying diseases, was 9 cases (9.6%). Associated diseases were diabetes mellitus (14.9%) and malignancy (10.6%). CONCLUSIONS: Our study revealed that the most common organism was Klebsiella pneumoniae and percutaneous needle aspiration and/or catheter drainage were safe and effective treatment modalities for pyogenic liver abscess. Prognosis was determined by the underlying condition.

Adolescent↗
PubMed1992

[A case of Bezold's abscess associated with cholesteatoma].

Since the advent of antibiotics, otogenic complications have decreased considerably. However, incomplete antibiotic therapy has altered the clinical course of middle ear disease so as to be more insidious. This paper reports a case of Bezold's abscess associated with cholesteatoma. A 48-year-old man visited our hospital presenting with a 4-day history of right otorrhea and a tender swelling in the right neck. Physical examination showed a febrile patient (38.8 degrees C) with right facial paresis and trismus. A hyperemic, hard and tender swelling was observed in his right neck from the lateral cervical to the mental region. The tympanic membrane was invisible because of granulation and swelling of the posterior wall of the external auditory canal. Intravenous clindamycin and ceftazidime therapy was started immediately. A CT-scan revealed a diffuse shadow with bony destruction in the right mastoid cortex. Extensive abscess formation was also found in the right sternocleidomastoid muscle, in the anterior neck and in the posterior neck. He was diagnosed as having Bezold's abscess associated with cholesteatoma. Radical mastoidectomy and drainage of the neck abscess was performed on the third day under general anesthesia. The mastoid cavity was found to be filled with pus and cholesteatoma debris. A small area of defective bone was found at the mastoid tip, through which there were communications between the mastoid cavity and the abscesses in the neck. Bony destruction was also found in the horizontal and vertical portion of the facial canal. Bacteroides and three kinds of gram-negative rods were cultured from the mastoid cavity.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMedDate not supplied

Liver abscess in children: a single institutional experience in southern Taiwan.

Liver abscess is uncommon in children. The purpose of this study is to evaluate the predisposing factors, pathogens, duration of hospitalization, and the managements of liver abscess in children. From 1986 to 2001, fifteen children were admitted to our hospital under the diagnosis of liver abscess. Thirteen cases were older than 8 years old and two were younger than one year old. Fever (15/15, 100%) and abdominal pain (13/15, 87%) were the most common symptoms. Twelve patients (80%) had prolonged fever (fever for 7 days or longer before diagnosis). Eleven (73%) cases were cryptogenic in origin. Most of the microorganisms were obtained solely from cultures of pus. Klebsiella pneumoniae was the most common organism isolated (6/15, 40%). Beside administration of antibiotics, percutaneous catheter drainage (PCD) was performed in 11 patients (73%); only one underwent surgical intervention due to poor response to PCD management. All of our patients were surviving after at least one year follow-up. In conclusion, liver abscess should be suspected in the patients with prolonged fever of unknown origin and abdominal pain. PCD combined with adequate antibiotics were sufficient for therapy of liver abscess in most cases. K. pneumoniae was the most common isolated pathogen in southern Taiwan.

Adolescent↗
PubMed2004

Pediatric lung abscess: a retrospective review of 23 cases.

Pulmonary abscess is a rare but critical problem in childhood. We did a retrospective review of 23 children with documented lung abscess who had been admitted and treated at the Taipei Veterans General Hospital over a 20-year period from April 1982 to April 2002. Among the 23 children, 11 cases were primary lung abscess, and 12 were secondary lung abscess. The pathogens were isolated in 16 patients (69.6%), and blood cultures yielded in only 3 patients (13.0%). The most common microorganism isolated in this series was Streptococcus pneumoniae. The 2 patients (8.7%) that died in our series had secondary lung abscess. We herein report the presenting symptoms, bacteriology, clinical management, and outcome of these 23 cases.

Adolescent↗
PubMed2004

[Diagnosis and treatment of liver abscess after orthotopic liver transplantation].

OBJECTIVE: To investigate etiology, diagnosis, treatment and prophylaxis of liver abscess after orthotopic liver transplantation (OLT). METHODS: Of 274 recipients of OLT from January 1993 to June 2003 in our transplant center, liver abscess were identified in 6 recipients (2.2%). The clinical presentation included fever, shiver, abdominal pain, jaundice, hepatic dysfunction, hypoalbuminemia, anemia, leukocytosis and neutrophilia. They were diagnosed mainly according to the clinical presentation and Ultrasonography or CT scan. The treatments included aspiration and drainage of abscess, removing bile sludge, antibiotics and supportive therapy. RESULTS: Of 6 patients, 2 were cured, 3 refused liver retransplantation and 2 died of serious systemic infection. The cure rate was 33.3%. CONCLUSIONS: the etiology of liver abscess after OLT is complicated. The predisposing factors might be included hepatic artery thrombosis or stenosis, MP pulse therapy, cholangitis and biliary interventional therapy. Its prognosis seemed disappointing. Strong prophylactic measures should be recommended to reduce the liver abscess after OLT.

Adult↗
PubMed1992

[Abscesses and pseudocysts as a sequela of acute pancreatitis].

During studying the literature a big confusion around the item abscess can be recognized. Especially in the English publications it is used for sterile tissue necrosis, infected necrosis, infected pseudocyst or suppuration. Pancreas phlegmon means there a sterile mass of pancreas and peripancreatic oedema. With us an abscess still is a located plus collection surrounded by a more or less tight capsule and a phlegmon is a diffuse purulent infection in the tissue. This definition is important because the frequency and prognosis of a true abscess is far below an infected necrosis (with us 4 abscess in 48 necrotising pancreatitis but 54% infected necrosis). Abscess formation needs two to four weeks whereas pseudocyst develops rather fast in one to two weeks. Although spontaneous resorption of pseudocyst is possible, we recognized ten and operated on all of them either by internal drainage or by resection of the tail of the pancreas. Mortality of one series of 124 patients with acute pancreatitis was at 30 days 4% and 27%, respectively, when necrosis was present and overall mortality having treated all patients to final discharge was 5% and 44%, respectively. Mortality rate was constant in the last years but Ranson score was continuously increasing.

Abscess↗
PubMed2004

Non-septicemic Burkholderia pseudomallei liver abscess in a young man.

Melioidosis, caused by Burkholderia pseudomallei, has been increasingly recognized in Taiwan recently. Its isolation in liver abscess is rare compared to pulmonary melioidosis. We report a case of liver abscess due to B. pseudomallei in an immunocompetent 27-year-old male soldier admitted due to fever, sore throat and mild non-productive cough for 1 week. Physical examination was unremarkable except for congestion of the pharyngeal wall, moderate enlargement of the tonsils without pus coating, and palpable tender lymphadenopathy over bilateral submental regions. Antibiotic treatment with cefazolin 1 g every 8 hours intravenously was given without response. Left flank pain, followed by right flank pain associated with epigastric tenderness developed. Sonography and computed tomography scan of the abdomen demonstrated liver abscess. Aspiration of the liver abscess was performed and abscess culture yielded B. pseudomallei. Treatment with ceftazidime 2 g every 8 hours intravenously (4 weeks' duration) followed by oral regimens of amoxicillin-clavulanate was given. The patient was free of symptoms at 8 months' follow-up. Early awareness and definite diagnosis as well as institution of proper antimicrobial agents are imperative for successful treatment of melioidosis.

Adult↗
PubMedDate not supplied

Pyogenic liver abscesses in a child spreading to pulmonary and subcutaneous tissues: case report.

Pyogenic liver abscess is a rare and life-threatening disease in children. Our case is noteworthy because of the rapid advancement of liver abscesses without any other systemic disorder. A 16-year-old girl was admitted to the hospital with fatigue, pallor, weight loss and high fever. In physical examination a fluctuating mass was observed under the scapular area and hepatosplenomegaly was found. In computed tomography, three septated cystic lesions which looked like abscesses were demonstrated in the liver. The abscess was drained through percutaneous route. Right pleural empyema with clinical features of adult respiratory distress syndrome appeared after the first day of treatment. Bacteroides sp. was isolated from pus. On the twentieth day of the therapy, control abdominal computed tomography revealed two new abscesses in the liver. They were drained and the antibiotic therapy was continued with ticarcillin-clavulanate, fluconazole and levofloxacin. By the end of the first week of the therapy, the fever of the patient had abated. This therapy was continued for four weeks; 15 days after the end of the therapy there was prominent healing of the liver lesions with only one necrotic remnant 2 cm in diameter on abdominal computed tomography.

Adolescent↗
PubMed2004

Brain abscess after milk tooth self-extraction.

Brain abscesses are rare, especially in children, but they can be life-threatening infections. To date, dental pathology has been linked to only a small number of brain abscesses. To our best knowledge this is the first reported case of a brain abscess following self-extraction of a milk tooth. We are reporting on a 12-year-old previously healthy boy who developed a brain abscess in the vicinity of the left precentral gyrus. Clinical examination prior to surgery showed a severe right hemiparesis, more pronounced in his leg. We performed an ultrasonographically guided puncture and aspiration of the abscess through a small craniotomy. Immediately after the procedure he became hemiplegic. Bacteriological examination of the aspirated pus revealed Streptococcus intermedius, Streptococcus beta-haemolyticus group F, Fusobacterium species and gram-negative rods. The same species of microorganisms were identified in a smear from the vicinity of the extracted tooth. The patient was carefully screened for possible other sources of infection, but none was found. Following appropriate antimicrobial treatment he recovered completely and returned home without any neurological deficit.

Anti-Bacterial Agents↗
PubMedDate not supplied

The limited use of ultrasound in the detection of abdominal abscesses in patients after colorectal surgery: compared with gallium scan and computed tomography.

BACKGROUND/AIMS: Ultrasound has been suggested to be a first-line test for the detection of intra-abdominal abscess (IAA). However, according to our experience, ultrasound seemed not so effective when applied to the patients after colorectal surgery. Computed tomography (CT) and gallium scan have also been suggested as very useful for the detection of IAA. The purpose of this study was to evaluate the efficacy of sonography and gallium scan in diagnosing intra-abdominal abscess after colorectal surgery and to compare these results with CT. METHODOLOGY: Twenty-three patients with suspected IAA after colorectal surgery at our institution were eligible for the study. A positive IAA was verifed only if pus was drained or on postmortem examination. Negative reports of abscesses were verified by adequate outpatient review following hospital discharge that indicated the clinical absence of an abscess. Within 4 days of the clinical suspicion of abscess, all patients were evaluated by three techniques: sonography, CT and gallium scan. We compared the sensitivity, specificity and accuracy of these modalities. RESULTS: Fourteen of the 23 patients (60.9%) were verified as IAA. We found the sensitivity, specificity, and accuracy of CT scan for the detection of LAA in the patients with colorectal surgery to be 92.9%, 100%, and 95.7%, respectively. The sensitivity, specificity and accuracy of gallium scan were 100%, 77.8% and 91.3%, respectively. Ultrasound had a 42.9% sensitivity, 100% specificity, and 65.2% overall accuracy for diagnosing IAA. CONCLUSIONS: Sonography plays a small role in the detection of IAA in the patients after colorectal surgery. CT and gallium scan are more helpful than sonography for the detection of IAA.

Abdominal Abscess↗
PubMed2005

Spinal epidural abscess caused by group B Streptococcus in a diabetic woman presenting with febrile low back pain.

Because spinal epidural abscess is usually ignored in the preliminary differential diagnosis of low back pain, appropriate treatment may be delayed. Adult spinal epidural abscess is sparsely caused by the pathogen known as group B Streptococcus. In this paper, we report the case of a diabetic woman with lumbar epidural abscess and vertebral osteomyelitis caused by group B Streptococcus. Owing to the main manifestations of fever, pyuria and low back pain, which originally led us to suspect acute pyelonephritis, empirical antibiotics were applied. When the symptoms and signs persisted, other focal infections were considered. Magnetic resonance imaging led to the correct diagnosis. Group B Streptococcus was isolated from the blood but not from the abscess itself, probably due to the prior antibiotic treatment. The patient recovered well after surgical debridement followed by prolonged intravenous penicillin therapy. Therefore, despite the potential for fatality, our results suggest that epidural abscess can be successfully treated with surgery and antibiotic therapy provided that it is detected early enough.

Anti-Bacterial Agents↗