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[A case of pneumopericardium complicating a liver abscess in a patient infected with HIV].

Pneumopericardium usually occurs in a traumatic context or, more rarely, in the course of benign or malignant bronchial or oesophagogastric diseases. Although the idiopathic spontaneous form is even rarer, pneumopericardium complicating liver abscess is exceptional, and is facilitated by impaired immune defenses (alcoholism, immuno-depression). The authors report a case of liver abscess complicated by pneumopericardium in an HIV seropositive patient. The nature of the abscess, the mechanism of the pneumopericardium and the therapeutic management are discussed.

AIDS-Related Opportunistic Infections↗

Patients treated for amebic liver abscess develop cell-mediated immune responses effective in vitro against Entamoeba histolytica.

We studied the afferent and efferent cell-mediated immune response in 15 patients treated for amebic liver abscess. Patients had a lower T4 to T8 ratio (1.25 +/- 0.65) compared with age- and sex-matched controls (1.89 +/- 0.44, p less than 0.01) due to a decrease in T4-"helper" cells and an increase in T8-"suppressor" cells (p less than 0.01). The in vitro proliferative response of patient T lymphocytes to the plant mitogen concanavalin A (Con A) was depressed; responses to phytohemagglutinin were not. The proliferative response of patient lymphocytes to an amebic soluble protein preparation (SPP) was greater than the mitogenic response seen in control lymphocytes (mean of 68,300 delta cpm and 22,300 delta cpm, respectively, p less than 0.001), correlated with the T4 to T8 ratio (p less than 0.05) and the duration of time from initiation of antiamebic therapy (p less than 0.01). Supernatants from patient lymphocytes exposed to the amebic SPP activated normal monocyte-derived macrophages to kill virulent axenic E. histolytica trophozoites (p less than 0.001); patient monocyte-derived macrophages activated by Con A-elicited lymphokine could also kill amebae. Finally, when incubated with the amebic SPP for 5 days, T lymphocytes from patients were able to kill virulent amebae (p less than 0.005); patient T lymphocytes not exposed to the amebic SPP or control T lymphocytes incubated for 5 days with the amebic SPP were not cytotoxic to E. histolytica trophozoites. In summary, after cure of amebic liver abscess, specific cell-mediated immune mechanisms develop that are effective in vitro against the parasite.

Adult↗

Liver abscess: a harbinger of Crohn's disease.

A 24-yr-old man with no previous history of Crohn's disease presented with a 5-wk history of fever and malaise. Computed tomographic scan of the abdomen revealed a liver abscess. Upon intraoperative examination, the terminal ileum was noted to have changes characteristic of Crohn's disease. This case report represents the first documented occurrence of liver abscess as the initial manifestation of Crohn's disease.

Adult↗

Percutaneous catheter drainage of liver abscess: an alternative to open drainage?

Percutaneous catheter drainage is still a new concept. Only 4 cases have been reported thus far and this paper reports 2 further cases. The technique of percutaneous catheterization of a liver abscess under CAT scan control is described, and the management of the catheter by a closed irrigation system is set out. Unless there is another compelling reason to do a laparotomy, we feel that this procedure is well worth a trial in view of the high mortality still associated with open drainage. Further experience may well prove percutaneous catheter drainage to be the procedure of choice for liver abscess.

Catheterization↗

Liver abscess and disseminated intravascular coagulation in tuberculosis.

We report the case of a 55-year-old man with chronic renal failure, and a history of prolonged fever and jaundice. Radiological studies revealed a multiloculated irregular liver abscess. Mycobacterium tuberculosis was isolated from the abscess on smear and culture of aspirated pus. Haematological studies revealed the presence of disseminated intravascular coagulation. A detailed search failed to identify any reason for this other than the tuberculous infection. The treatment of tuberculous liver abscess and pathogenesis of disseminated intravascular coagulation in tuberculosis are discussed.

Disseminated Intravascular Coagulation↗

Analysis by enzyme-linked immunosorbent assay and PCR of human liver abscess aspirates from patients in China for Entamoeba histolytica.

Aspirates of liver abscesses were analyzed for Entamoeba histolytica. PCR detected a gene encoding a 30-kDa protein in all samples but detected the ribosomal DNA gene in only 14 (33.3%) samples. Enzyme-linked immunosorbent assay detected antigen in 41 (97.6%) samples. PCR analysis of a strain-specific antigen (SSG) revealed that abscesses were caused by various strains.

Animals↗

[Liver abscess: clinical cases and review of the literature].

Personal experience with liver abscess is presented. After a review of the epidemiologic and aetiologic factors most commonly influencing hepatic abscesses formation, the Authors discuss their clinical and diagnostic aspects. Furthermore various surgical options are examined for the proper treatment of these conditions.

Adult↗

Gas-forming liver abscess after transcatheter arterial embolization for hepatocellular carcinoma: report of a case.

A case of a gas-forming liver abscess developing after transcatheter arterial embolization for recurrent hepatocellular carcinoma (HCC) in a 65-year-old man is presented herein. He was admitted to hospital with fever and jaundice, following which ultrasonography (US) and computed tomography revealed a gas-containing abscess in the posterior segment of the hepatic lobe with multiple HCC. Percutaneous transhepatic drainage was performed using US. Antibiotics which were sensitive to the Escherichia coli bacteria detected in the abscess were administered both intravenously and through the drainage tube into the abscess. Four months later, the abscess had diminished and the patient was discharged after receiving percutaneous ultrasonographically guided ethanol injection therapy for the recurrent HCC.

Carcinoma, Hepatocellular↗

Amoebic liver abscess: serum immunoglobulins and complement in Northern Nigerian patients.

Immunoglobulins (IgG, IgA, IgM and IgD) and complement components of both the classical and alternative pathways (C1q, C3 and C4, and factor B) were measured in the sera of 15 Nigerian patients with proven amoebic liver abscess and compared with 30 age-matched controls. IgA, C3 and factor B were significantly higher in amoebic liver abscess patients. The differences in IgG, IgM, IgD, C1q and C4 levels between patients and controls were not significant.

Adolescent↗

[Liver abscess. Imaging and interventional radiology in French Polynesia].

23 cases of liver abscess are reported (13 pyogenous, 10 amoebic). Clinical feature is rather uniform and evocative; thanks to picture technics, diagnosis was easy in 22 cases but hesitating in one case. Semeiology revealed by scanner or echography is detailed. Both techniques are fairly equivalent considering accuracy but not really specific. The interventional radiology at the stage of diagnosis, consists in puncture (14 out of 23 cases), at the stage of therapy, in transcutaneous drainage (6/23 cases). They are performed with the assistance of scanner, echoscopy and/or radioscopy. Therapy has been medical in 13 cases/23, associated with transcutaneous drainage 6 times, surgical in 4 cases. A procedure is proposed, including early puncture to diagnose, drainage of pyogenous abscesses, only medical treatment against amoebiasis exceptionally help of surgery and controlled by echography.

Adolescent↗

Bacterial liver abscesses in Nigeria.

There has been no previous report on bacterial liver abscess (BLA) from West Africa. During the period 1972-1979, 13 patients were treated for BLA in Zaria, Nigeria. S. aureus was the most frequent pathogen but an anaerobic streptococcus was identified in one instance. The case fatality rate was 54%, similar to those reported in the literature. Since diagnosis was made without the benefit of the newer liver-imaging technologies it seems probable that BLA is underdiagnosed and therefore untreated in some patients.

Adolescent↗

Asymptomatic intestinal colonization by pathogenic Entamoeba histolytica in amebic liver abscess: prevalence, response to therapy, and pathogenic potential.

Since the application of isoenzyme electrophoresis to the study of Entamoeba histolytica, the prevalence and natural history of asymptomatic intestinal colonization in patients with amebic liver abscess (ALA) has not been addressed. We prospectively evaluated this enteric phase in 50 patients with ALA, using two dosage regimens of metronidazole. The overall prevalence of asymptomatic colonization was 72% (36/50). All these isolates, without exception, proved to express pathogenic zymodemes. Despite a 100% clinical response of the hepatic lesions, failure to eradicate the organism from the bowel occurred in 20 of these 36 subjects. During longitudinal posttreatment surveillance, three carriers returned with second bouts of invasive disease: one with dysentery and two with liver abscesses. Thus, in patients with ALA, there is a high prevalence of intestinal colonization with exclusively pathogenic strains, and treatment with metronidazole frequently results in a continued carrier state. These carriers have a propensity for developing recurrent invasive disease and constitute a public health hazard.

Adult↗

Multiple pyogenic liver abscesses associated with occult appendicitis and possible Crohn's disease.

Pyogenic liver abscesses (PLA) are important entities that require rapid diagnosis and treatment because of the significant associated morbidity and mortality. The epidemiologic, clinical, and prognostic features of PLA have changed over time since the advent of antibiotics, advances in noninvasive imaging techniques, and surgical and non-surgical treatments. Certain predisposing factors have been recognized such as age greater than 50 years, presence of hepatobiliary disease, and systemic illness such as diabetes mellitus and malignancy. We describe a case of a young, healthy woman, with no significant risk factors or comorbidities, who developed multiple hepatic abscesses as a result of a chronic inflammatory process in the cecum and appendix, with features consistent with an initial presentation of Crohn's disease.

Adult↗

Amebic liver abscess and circulating immune complexes of Entamoeba histolytica proteins.

An enzyme-linked immunosorbent assay (ELISA) has been developed to detect amebic antigen in polyethylene-glycol-precipitable circulating immune complexes. Seventy-nine percent of 191 patients with amebic liver abscesses and 46% of 26 Entamoeba histolytica cyst passers had positive tests. None of the samples from 43 apparently healthy controls, 8 patients with past amebic liver abscesses or 31 patients with Giardia lamblia infections were positive. One patient out of 32 with viral hepatitis and 1 patient out of 27 with intestinal tuberculosis had positive tests.

Animals↗

[New trends in the treatment of liver abscesses].

The authors share their experiences with treatment of 85 patients with abscesses of the liver aged from 17 to 83 years. The size of abscesses was from 2.5 to 23 cm in diameter. For the topical diagnostics the following methods were used: ultrasound scanning, computed tomography, scintigraphy, diagnostic puncture biopsy of the liver, laparoscopy etc. Decision between the methods of operative treatment depended on the concrete clinical situation. Both open and minimally invasive methods were used. Hydropressive technologies and ozone therapy were used for better sanitation of the abscess cavity. A new method of the assisted minimally invasive intervention was developed especially for treatment of patients with large abscesses of the liver. The new technologies allowed to reduce the amount of postoperative complications and to make the time of staying at the hospital substantially shorter.

Adolescent↗