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At least 721 records · Page 40Linked to original sources
PubMed1999

[Clinical features and changing trends of bacterial liver abscess: analysis of 48 cases].

OBJECTIVE: To analyse and compare the changing of clinical feature, pathogenic bacteria, and so is diagnosis and treatment of bacterial liver abscess up date. METHODS: Retrospective study of forty-eight patients over 10 years in PUMC hospital. RESULTS: Compared with the patients in 1960s, the complication and mortality of this disease decreased remarkably. The main clinical manifestations and signs became less typical. Cholelithes and tumor of biliary tract instead of biliary ascariasis became chief pathogenic factor (29.2%). Patients with diabetes mellitus complicating bacterial liver abscess tended to increase (8.3%). The case with negative bacterial culture has increased (52.1%). Ultrasonography should be the first choice for diagnosis, the confirmed diagnosis rate is 79.2%. Percutaneous drainage of the abscess and combined using antibiotics are the effective treatment method. Septic shock was the chief complication causing death. CONCLUSIONS: This disease becomes less typical and difficult to early diagnosis attention should be paid to clinical medicine.

Adolescent↗
PubMed2003

Treatment of amoebic liver abscess with metronidazole alone or in combination with ultrasound-guided needle aspiration: a comparative, prospective and randomized study.

Thirty-nine patients with amoebic liver abscess (ALA), admitted to the Central Hospital of Hué (Vietnam), were evaluated in a comparative, prospective and randomized study for the treatment of ALA. Adult patients with an abscess located in the right liver lobe and an abscess diameter of 6 to 10 cm were included. Bacterial abscesses were excluded by microbiological examination of abscess fluid in all patients. Nineteen patients were treated with metronidazole for 10 days alone and 20 patients were punctured under ultrasound guidance with aspiration of abscess fluid in addition to drug administration. The clinical symptoms fever, pain in right upper abdomen and liver tenderness, and the laboratory parameters erythrocyte sedimentation rate, white blood cells, haemoglobin and C-reactive protein and the abscess size were determined on the day of admission and followed during an observation period of 38 days. Improvement of liver tenderness was significantly faster in the aspiration group during the first 3 days (P < 0.001), whereas all the other parameters showed no differences between the two groups. This minor benefit is obviously not sufficient to justify routine needle aspiration and advocates drug treatment alone for uncomplicated amoebic liver abscesses with a diameter up to 10 cm located in the right liver lobe.

Adolescent↗
PubMed1986

Nonresolution of an amebic liver abscess after parasitologic cure.

A 43-year-old Filipino male was admitted to a Manila hospital with a 1 month history of epigastric pain and fever, and was found to have a palpable epigastric mass. Computerized tomography revealed a large hepatic abscess which serologically was shown to be amebic. Chemotherapy resulted in clinical cure and an initial reduction in size of the liver abscess. However, resolution of the abscess cavity did not occur, and on closed needle aspiration, 80 cc of characteristic amebic pus was recovered. Parasitological cure without complete repair of the abscess cavity itself raises questions concerning the potential danger of clinically silent residua and the role of therapeutic aspiration in the management of amebic liver abscesses.

Adult↗
PubMed2001

Salmonella typhi liver abscess.

We report on the first case of a typhoid liver abscess treated at the Chris Hani Baragwanath Hospital in Johannesburg, which responded well to percutaneous catheter drainage and intravenous ampicillin therapy.

Diagnosis, Differential↗
PubMed1991

[Liver abscess and appendicular foreign body].

We report a case of liver abscess secondary to appendicitis which was due to a wire within the appendix. Appendicitis was asymptomatic, probably because of its retrocaecal position and/or previous antibiotic treatment. The abscess was treated with broad-spectrum antibiotics and percutaneous drainage, followed by a second stage appendicectomy. This case illustrates the value of gastrointestinal radiological investigations before considering the abscess as cryptogenetic.

Adult↗
PubMed1998

Amebic liver abscess: spare the knife but save the child.

BACKGROUND/PURPOSE: Amebic liver abscess (ALA), the most common extraintestinal manifestation of infection with Entameba histolytica, carries significant morbidity and mortality in the pediatric age group. The efficacy of metronidazole in the treatment of ALA is well established, but the role of surgical intervention remains controversial. Many investigators still advocate aggressive surgical therapy for complicated and ruptured ALA. Reports regarding management of ALA in children are sparse and deal with small numbers of patients. The objective of this study was to assess the effectiveness of parenteral metronidazole combined with judicious aspiration of ALA in obviating the need for surgical intervention. METHODS: The medical records of all children admitted with the diagnosis of ALA between 1986 and 1997 to the Aga Khan University Hospital were reviewed retrospectively. The diagnosis of ALA was confirmed in 48 patients by an ultrasound scan together with elevated indirect hemagglutination (IHA) titres (>250). Ages ranged from 3 weeks to 14.5 years. RESULTS: Thirty-seven (75%) children were below the fifth percentile for height and weight, and 45 (93.7%) presented with a hemoglobin level of less than 10.0 g/dL. Comorbid factors included pulmonary tuberculosis (n = 2, chicken pox (n = 1), tetralogy of Fallot (n = 1), and thalassemia major (n = 2). There was a mean delay of 13 days before presentation to the hospital. All patients were treated with parenteral metronidazole and broad-spectrum antibiotics. The latter were discontinued on confirmation of the diagnosis. The duration of treatment with metronidazole ranged from 2 to 5 weeks. Percutaneous aspiration of the ALA was performed under ultrasound guidance using sedation in 28 patients for one or more of the following indications; ALA greater than 7.0 cms (n = 20), left lobe involvement (n = 8), and no response after 48 hours of medical therapy (n = 6). Nine patients required more than one aspiration. One patient with peritoneal rupture of the ALA additionally underwent percutaneous aspiration of the peritoneal cavity under ultrasound guidance. One patient required insertion of a chest tube after rupture of the ALA into the right pleural cavity, and another underwent urgent bronchoscopy after rupture of the abscess into the tracheobronchial tree. The hepatobronchial fistula closed spontaneously with medical therapy. No patient required open surgical drainage, and all recovered without relapse. The mean duration of hospitalization was 12 days. CONCLUSION: Our experience suggests that parenteral metronidazole combined with timely aspiration of the abscess can obviate the need for surgical intervention in large and complicated ALA even in malnourished children who present late for treatment.

Adolescent↗
PubMedDate not supplied

Ultrasonography in the diagnosis and management of 52 patients with amebic liver abscess in Cairo.

Clinical characteristics of 52 patients with amebic liver abscess are reported. Forty-two percent had an acute illness, usually with high fever, vomiting, sweating, pain in the abdominal right upper quadrant, and leukocytosis. The other 58% had a more chronic illness, usually with a dull ache in the right upper abdomen, weight loss, fatigue, moderate or low-grade pyrexia, and anemia. Hepatomegaly and hepatic tenderness were present in all patients; fever occurred in 75%. The diagnosis was strongly suggested by amebic antibodies in high titer and hepatic abscesses demonstrated by sonography. Mean abscess diameter was 9.2 cm; 37% were larger than 10 cm. Most abscesses were solitary (81%), in the right lobe (73%), rounded or oval (78%), cystic (57%), and had a well-defined wall (53%). However, 43% were initially solid or heterogeneous. The latter lesions always developed a cystic pattern when ultrasonography was repeated. The diagnosis was confirmed by a good clinical response to metronidazole in 50 patients. Complications included right-sided pleural effusions or empyema (13%), ascites (13%), and jaundice (13%). Drainage of large abscesses was performed in four patients. All 52 patients survived and were cured.

Adolescent↗
PubMedDate not supplied

Amebic liver abscess in a homosexual man.

A case report of a 36-year-old black homosexual man with right upper- and lower-quadrant abdominal pain is presented. When exploratory surgery for appendicitis was performed, an abscess, consistent with an amebic abscess, was encountered in the right lobe of the liver. This abscess was evacuated, and a drain was placed. A serum sample taken at the time of surgery showed high titers of antibody to Entamoeba histolytica; metronidazole therapy was instituted, and the patient made an uneventful recovery. Since amebiasis is epidemic in the gay community, health care personnel should be aware of the various modes of transmission, as well as of the diagnoses, optimal management, and indications for surgery in patients with amebic liver abscess. It is noted that amebic liver abscess appears to be a less frequent complication of amebiasis among the male homosexual population than among other groups.

Adult↗
PubMed2001

Entamoeba histolytica: production of nitric oxide and in situ activity of NADPH diaphorase in amebic liver abscess of hamsters.

Entamoeba histolytica trophozoites were inoculated into the liver of hamsters and serum nitrate/nitrite levels [expressed as nitric oxide (NO) production] were determined at different times during amebic liver abscess (ALA) development. We also tested the effects of NO synthase (NOS) inhibitors such as N(G)-nitro-L-arginine methyl ester (L-NAME), aminoguanidine, and dexamethasone during ALA production. Since NOS activity has been correlated with expression of reduced nicotinamide adenine dinucleotide phosphate diaphorase (NADPHd) in tissues, we performed histochemistry studies to determine the activity of the latter in livers infected with E. histolytica trophozoites. Production of NO in serum was directly proportional to the size of ALAs, and NOS inhibitors caused low levels of NO and smaller ALAs. Our data suggest that NO does not have any lytic effect on E. histolytica trophozoites and is therefore incapable of providing protection against the amebic liver infection. In addition, NADPHd activity was detected histochemically in hepatocytes and inflammatory cells associated with focal necrosis containing trophozoites. The positive reactivity observed in these parasites may be attributable to a close biochemical similarity of NADPHd to the NADPH:flavin oxidoreductase described in E. histolytica by other investigators.

Animals↗
PubMed2006

A "fishy" cough: hepatobronchial fistula due to a pyogenic liver abscess.

A hepatobronchial fistula is an anatomic communication between the liver parenchyma and the bronchial tree. Major causes of such fistulae include inflammatory conditions resulting from obstruction of the biliary tract and infectious processes, such as pyogenic liver abscesses, amoebiasis, and hydatid cysts. We report a rare case of a patient (with a chronic, recurrent hepatic abscess) who suffered a persistent, productive cough resulting from a hepatobronchial fistula.

Anti-Bacterial Agents↗
PubMedDate not supplied

Standardization and evaluation of ELISA for the serodiagnosis of amoebic liver abscess.

An ELISA test for the serological diagnosis of amoebic liver abscess (ALA) was standardized and evaluated in sera from three groups of patients: (1) three patients with diagnosis confirmed by isolation of the parasite, (2) thirty seven patients with diagnosis established by clinical findings and ultrasound studies and (3) seven patients whose diagnosis were established by clinical findings and a positive double immunodifusion test. Ninety one serum samples from healthy subjects and 22 from patients with other liver or parasitic diseases were also included in the study. The optimum concentration of Entamoeba histolytica antigen was 1.25 micrograms/ml and optimum dilutions of serum and anti-human IgG -alkaline phosphatase conjugate were 1:400 and 1:4000 respectively. The cut-off point of the ELISA test in this study was an absorbance value of 0.34. The test parameters were: sensitivity = 95.7%, specificity = 100%, positive predictive value = 100% and negative predictive value = 98.2%. The ELISA test was found to be of great use as a diagnostic tool for the establishment of amoebic etiology in patients with clinical supposition of ALA. The test could also be used for seroepidemiological surveys of the prevalence of invasive amoebiasis in a given population, since it allows the processing of a greater number of samples at a lower cost than other serological tests.

Animals↗
PubMed2006

Portal vein thrombosis and liver abscess due to Lactococcus lactis.

A 26-year-old man was admitted with fever and abdominal pain. Abdominal ultrasonography and Doppler ultrasound eventually revealed portal vein thrombosis and a pyogenic liver abscess (17x11x11 cm). Lactococcus lactis was isolated from a culture of the abscess material. This organism is not a common pathogen in humans. This is the first published description of portal vein thrombosis and pyogenic liver abscess due to L. lactis.

Adult↗
PubMed1979

Amebic liver abscess with hemobilia.

A patient with hemobilia complicating an amebic liver abscess is described. The diagnosis was based on selective arteriography. The hemobilia did not stop with antiamebic treatment or ligation of the right hepatic artery. Successful results followed right hemihepatectomy.

Adult↗
PubMed1989

Isolation of Eikenella corrodens from a liver abscess. Case report.

Eikenella corrodens was isolated from a posttraumatic liver abscess in a man with previous hemicolectomy for sigmoid adenocarcinoma. Escherichia coli was the initial isolate, but sepsis persisted after its eradication by cefuroxime and metronidazole. A second specimen yielded E. corrodens which responded promptly to combined ampicillin and netilmicin. The patient died of disseminated cancer 6 months later.

Athletic Injuries↗
PubMedDate not supplied

Ultrasound-guided percutaneous drainage of liver abscess in children.

This study's purpose was to investigate the effectiveness of ultrasound-guided percutaneous drainage (US-PD) as treatment modality for pediatric pyogenic liver abscess when compared with other modalities. Ten consecutive patients, aged from 2 months to 22 years, were enrolled in this study. In addition to antibiotics, US-PD was attempted in each case unless the procedure was judged unsuitable. Six patients were treated with US-PD while four were not, for various reasons. US-PD was performed under an intravenous anesthesia and with the aid of real-time sonography. An indwelling pigtail catheter was usually inserted during US-PD. Fever subsided within one to six days, but the abscess cavity closed later. Failure to respond to US-PD may relate to the huge size of abscess cavity; surgical drainage provides an option. A trend toward a shorter hospital stay and defervescence day was found in the US-PD group than in the non-US-PD group. Prognosis was generally good and none in this series died of this disease or the procedure. Klebsiella pneumoniae was the pathogen most frequently encountered. Seven of the ten patients had underlying disease, and hemoglobinopathy was frequently associated. In conclusion, adequate drainage is recommended as the most effective treatment modality for pediatric liver abscess, and US-PD is the first choice.

Adolescent↗