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PubMed1994

[Multiple liver abscesses caused by Fusobacterium necrophorum infection].

A case of multiple liver abscesses caused by Fusobacterium necrophorum infection is presented. In cases with fever of unknown origin and biochemical signs of derangement of hepatic function, it is recommended that an abdominal scan is performed. Before initiating antibiotic treatment relevant specimens should be collected. Finally we describe how the use of resin-containing blood culture medium enhance the possibility of bacterial detection in patients receiving antibiotics.

Diagnosis, Differential↗
PubMed2001

[Pyogenic liver abscess: interventional versus surgical therapy: technique, results and indications].

For the therapy planning of liver abscesses both etiological factors and clinical symptoms have to be evaluated, with visualization via ultrasound, CT, or MRI. The indication for a percutaneous abscess drainage (PAD) is a solitary or complicated abscess with a safe drainage access. The success rate varies between 70 and 93%, the mortality rate between 1 and 11%. For complex abscesses, surgical therapeutic techniques (OSD) or liver resection have to be discussed. The OSD success rate varies between 51 and 70%, the mortality rate between 11 and 43%. In summary PAD is characterized by low complication and mortality rates, reduced risk of anesthesia, low cost, and short stay in the hospital.

Diagnostic Imaging↗
PubMed1999

Liver abscess secondary to fish bone penetration of the gastric wall: a case report.

An unusual case of liver abscess caused by fish bone perforation of the stomach is presented in this report. A 65-year-old woman was admitted to the Far Eastern Memorial Hospital for abdominal pain, fever and chills. Physical examination revealed anemia and tenderness in the epigastrium. Laboratory data showed leukocytosis and abnormal liver function. Computerized tomography of the abdomen disclosed a huge abscess in the left lobe of the liver. Exploratory laparotomy was performed and a fish bone, 3.7 cm in length, was found perforating the stomach with penetration into the left lobe of the liver, resulting in a hepatic abscess. Drainage of the liver abscess with removal of the fish bone and simple closure of the gastric perforation were performed. The patient recovered uneventfully.

Aged↗
PubMed1992

Plasma concentrations of fibronectin and C3d in patients with amoebic liver abscess.

By means of simple and specific ELISA techniques, the plasma concentrations of soluble fibronectin and C3d, a breakdown product of C3 complement, were determined in patients with amoebic liver abscesses (ALA) and in healthy controls. The mean plasma fibronectin concentrations in 23 patients with ALA and in 20 controls were found to be 441 +/- 89 mg/l and 442 +/- 66 mg/l, respectively. The difference between these two values was not statistically significant. The mean C3d value in 21 patients with ALA, however, was found to be 84 +/- 14 AU/l which was significantly different from the value of 12 +/- 4.7 AU/l noted in 20 healthy persons. Plasma concentrations of these two proteins are discussed in relation to their possible implications in the immunopathogenesis of amoebic liver abscess.

Complement C3d↗
PubMed2003

Alcohol consumption, hepatic iron load and the risk of amoebic liver abscess: a case-control study.

OBJECTIVE: It is unknown why most amoebic liver abscess (ALA) cases occur in alcohol drinkers. In experimental studies, the presence of 'iron' potentiates the in-vitro growth of Entamoeba histolytica (E. histolytica), and is also known to increase its in-vivo invasiveness in animal infections. Chronic alcoholism increases the hepatic iron deposition. We hypothesized that ALA occurs more commonly in livers with a high iron load as in alcoholics. To test this hypothesis we compared the levels of iron between ALA and non-ALA cases belonging to alcoholic and non-alcoholic groups. METHODS: Out of a total of 48 ALA cases, 34 (70%) were alcoholics and 14 (30%) were non-alcoholics. After applying exclusion criteria, serum iron and liver iron stores were quantified in 20 ALA cases (10 alcoholic and 10 non-alcoholics) and compared with 20 non-ALA cases (10 alcoholics and 10 non-alcoholics). RESULTS: All patients of ALA had serum iron values within the normal range but higher than non-ALA cases. In the liver tissue, most patients with ALA had higher (grade II or III) iron deposition, than non-ALA cases (mostly grade I). Thus, patients with ALA, with or without alcohol indulgence, had higher iron levels when compared to the non-ALA cases. CONCLUSION: It appears that the higher incidence of ALA in alcoholic livers is possibly due to their higher iron content.

Adult↗
PubMedDate not supplied

Identification of a 35 kDa glycoprotein from Entamoeba histolytica by sera from patients with amoebic liver abscess and with mouse monoclonal antibody.

In this work, we explored the relevance of a 35 kDa glycoprotein (Gm) of the outer membrane from E. histolytica in the diagnosis of the amoebic liver abscess (ALA) through ELISA and immunoblotting. We were interested in defining the relevance of this antigen in the immune response in patients with amoebic liver abscess and in exploring whether the mouse monoclonal antibody against this 35 kDa glycoprotein recognises the same epitope. We found that 87% of ALA patients had raised antibody levels to Gm antigen, whereas none of the healthy control subjects presented this same increase. We also found 90% sensitivity, 100% specificity, 100% positive predictive value, 90% negative predictive value, and 90% prevalence value for this Gm antigen. Nonetheless, we did not find any statistically significant differences in the levels of immunoglobulins against Gm, although IgG showed a tendency to increase, probably because we are dealing with a secondary immune response. Using electroimmunotransfer blot assay, we found that sera from ALA patients recognise the 35 kDa Gm protein in the same way as it is recognised by the mouse monoclonal antibody, suggesting that is a relevant molecule for the diagnosis of amebiasis, and eventually could lead to its use as protection against the disease.

Animals↗
PubMed1998

Subcapsular tubercular liver abscess.

A young female married for the last 2 years but without any issue presented with lump in the right upper abdomen. This was proved to be a subcapsular liver abscess on USG and CT scan and proved to be tubercular on needle aspiration cytology. She was given four drugs antitubercular treatment (ATT). After four months of ATT she conceived and it was decided by both parents to continue the pregnancy. The three drug ATT was continued throughout the pregnancy and she delivered a perfectly healthy baby. Upto three months follow up the mother and baby were perfectly healthy. The subcapsular tubercular liver abscess is extremely rare and conception during treatment may be the first case in literature.

Adult↗
PubMed1994

[Pyogenic liver abscess: a caseload contribution].

Pyogenic hepatic abscesses have been recognized since the time of Hippocrates, but an understanding of their etiology, bacteriology, diagnosis and treatment is an event of the twentieth century. Fortunately mortality rate has declined due to improvements in diagnosis, intensive care, medical and surgical management. In particular, the use of CT and ultrasound scanning has reduced the incidence of unrecognized and therefore untreated liver abscesses. Considering nine patients operated on for liver abscess, the Authors affirm that laparotomic surgical drainage is still the most effective therapy in the majority of cases.

Adult↗
PubMed2001

Protection of hamsters from amebic liver abscess formation by immunization with the 150- and 170-kDa surface antigens of Entamoeba histolytica.

A monoclonal antibody, EH3015, prevents in vitro adherence of Entamoeba histolytica trophozoites to mammalian cells and inhibits amebic liver abscess formation in hamsters. By immunoaffinity chromatography with the monoclonal antibody, purified E. histolytica antigens with molecular masses of 150 and 170 kDa under non-reduced conditions were obtained. Hamsters were immunized with these antigens (group I) or with fractions further purified by polyacrylamide gel electrophoresis (group II). Pooled immune sera from the two groups inhibited in vitro amebic adherence to Chinese hamster ovary cells by 98% at 1:10 dilutions. The immunized hamsters were challenged by the intrahepatic injection of E. histolytica trophozoites. Complete protection from abscess formation was observed in 38% of hamsters in group I and 67% in group II, whereas all control hamsters inoculated only with adjuvant developed amebic liver abscesses. In the immunized hamsters, the abscesses in the two groups were significantly smaller than in the controls. These results demonstrate that the E. histolytica antigens are possible vaccine candidates for amebiasis.

Animals↗
PubMed2006

Initiation of inflammation and cell death during liver abscess formation by Entamoeba histolytica depends on activity of the galactose/N-acetyl-D-galactosamine lectin.

The parasite Entamoeba histolytica colonizes the human intestine causing amoebic colitis and disseminates through the vascular route to form liver abscesses. The Gal/GalNAc lectin is an adhesion protein complex which sustains tissue invasion by E. histolytica. Disruption of the Gal/GalNAc lectin function in engineered parasites (HGL-2 trophozoites) changed the pathophysiology of hamster liver abscess formation. HGL-2 trophozoites produced numerous small inflammatory foci located in the vicinity of blood vessels. The low penetration of HGL-2 trophozoites into hepatic tissue was shown to be associated with weak attraction of neutrophils and macrophages to the infiltrated areas and absence of pro-inflammatory tumour necrosis factor, in contrast to wild type or control vector infections. The low host inflammatory response in HGL-2 infections correlated with a delay in apoptosis of hepatic cells, whereas apoptosis of endothelial cells was not detected. Triggering of apoptosis in both host cell types most likely has a central role in modulating inflammation, a major landmark in hepatic amoebiasis. These data highlight the key role of the Gal/GalNAc lectin in initiation of E. histolytica hepatic infection.

Animals↗
PubMed1985

Pyogenic liver abscesses: another look at medical management.

14 patients with 17 pyogenic liver abscesses were treated initially by non-surgical means. 3 patients received intravenous antibiotics alone, and 11 had intravenous antibiotics plus percutaneous aspiration. Non-surgical management alone was successful in only 1 patient. Among the 13 others 2 are well after percutaneous catheter insertion and 5 are well after surgical drainage. 6 patients died despite medical and surgical therapy. After large-needle aspiration 2 patients died and 3 had serious complications. Non-surgical management of infected space-occupying hepatic lesions or abscesses in immune-suppressed patients is unlikely to be successful. This report shows that medical management, with or without percutaneous aspiration, is not consistently successful even in patients with normal immune systems and no predisposing causes for their hepatic abscesses.

Adolescent↗
PubMedDate not supplied

Pathology of pyogenic liver abscess in children.

Little is known about preexisting lesions in livers of children with pyogenic liver abscess (PLA). Study of these lesions may elucidate possible predisposing factors for the disease. In Vitória, state of Espirito Santo, Brazil, PLA in children is frequently associated with helminthic infections and eosinophilia. We hypothesize that nematode infection with larvae migrating through the liver is a predisposing factor for PLA, because the infection induces immunomodulation and likely trapping of bacteria in liver granulomas. In this report, we describe observations of 22 cases of PLA in children studied at autopsy (16 cases) or in surgical biopsies (6 cases), including 17 boys and 5 girls ranging in age from 1 to 13 years (mean 4.6 years, median 3.5 years). Multiple abscesses in both lobes were found in 13 cases and a single abscess was found in the right lobe in 10 cases. All cases showed histologically classical pyogenic inflammation without morphological evidence of amoebiasis. In six cases there were granulomas similar to those caused by larva migrans visceralis (from Toxocara or other nematodes) in liver tissue not affected by the abscess. Nematode antigens in central areas of necrosis of granuloma in all six cases and fragments of a larva, possibly of Toxocara, were found on samples immunohistochemically stained with polyclonal anti-Toxocara antibodies. There were numerous eosinophils in abscesses with Charcot-Leyden crystals. Eosinophils were found frequently in portal triads far from the abscess wall. In four cases, in which bile duct ascariasis was found, worms were noted in the bile ducts, and eggs were found in liver parenchyma surrounding the abscess in two cases. Foreign-body granulomas were found in one case in which penetrating trauma was the cause of abscess. In one case there was one histiocytic granuloma whose origin was not determined. The observation of six cases of granuloma similar to larva migrans visceralis (or produced by other nematode larva) in liver tissue not directly affected by the abscess supports the hypothesis that helminth infections with larva migrating through the liver are a predisposing factor for pyogenic hepatic abscess in children.

Adolescent↗
PubMed1980

Amoebic antigen in immunodiagnosis and prognosis of amoebic liver abscess.

The detection of amoebic antigen by counterimmunoelectrophoresis is very useful and important in the immunodiagnosis of invasive hepatic amoebiasis. The antigen was demonstrated in 115 (92%) of 125 patients with amoebic liver abscess. All the 19 cases which showed Entamoeba histolytica in the 'pus' were positive for the antigen and 96 of 106 samples negative for the parasite by smear and culture were also positive for the antigen. In none of the controls was a falsepositive reaction obtained. 12 of 13 liver biopsy specimens were also positive for antigen. The persistence or disappearance of the antigen from the liver pus biopsy specimens was investigated: the antigen disappeared in eight of the 33 cases followed for intervals up to 60 days after cure, suggesting that this is also an important additional criterion for evaluating the prognosis of the disease. Further, it has been shown that amoebic infection is followed by the appearance of specific antigen or antigenic substances in the serum which were demonstrated in 23 of 89 proved cases of amoebic liver abscess cases. Its possible role in immune complex formation and the pathogenesis of the disease is discussed.

Amoeba↗
PubMed1971

[Liver abscess].

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Cholangitis↗
PubMed1992

Histological changes during healing of experimental amebic liver abscess treated with metronidazole.

Morphological changes during the healing of amebic liver abscess (ALA) in hamsters treated with metronidazole were studied. Animals with ALA of 4 days of evolution were treated orally with metronidazole (5 mg/100 g for 10 days). Liver samples were studied at different times from the beginning of treatment up to 22 days. The resolution of ALA was accompanied by chronic inflammatory reaction, increased number of foamy macrophages and gradual disappearance of the granulomas. Neoformed hepatocytes and blood vessels, and proliferation of biliary ducts were also observed. Foamy macrophages play an important role in the adequate healing of ALA.

Animals↗
PubMed1992

Multiple liver abscesses secondary to Yersinia enterocolitica.

A 37-year-old male, a poorly-controlled insulin-dependent diabetic patient, was admitted to our hospital with complaints of high fever and confusion. Laboratory data showed hyperglycemia, positive inflammatory reaction and liver dysfunction. Blood culture demonstrated Yersinia enterocolitica. Liver CT scan showed multiple low density areas. These data were consistent with a diagnosis of liver abscess secondary to Yersinia enterocolitica. He died of disseminated intravascular coagulation; subsequent autopsy confirmed the clinical diagnosis. Liver abscess secondary to Yersinia enterocolitica with septicemia is rare, but has been reported in compromised hosts. In the mechanism of this disease, the alimentary tract has been suggested to be the port of entry in most cases.

Adult↗