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PubMedDate not supplied

Percutaneous treatment of pyogenic liver abscess: a critical analysis of results.

Nineteen patients who had pyogenic liver abscesses underwent percutaneous treatment assisted by computed tomography. Percutaneous drainage was performed with Fr 8-14 catheters in 12 patients and percutaneous aspiration in 7 patients. A solitary abscess was present in 15 patients and multiple abscesses were present in 4. The average drainage duration was 26 days. Successful treatment was obtained in 16 of 19 (84%) cases. One abscess recurred and was cured by repeat drainage. Two patients died. Reviewing 14 reports from the literature with a total of 252 patients treated percutaneously, an overall success rate of 77% and a mortality rate of 6% was found.

Catheterization↗
PubMed1991

Liver abscess in children--not an uncommon problem.

Thirty cases of amoebic liver abscess in children are being presented. Diagnosis was based on clinical presentation, ultrasound examination, detection of E.H. trophozoite in the aspirate and response to therapy. Aspiration of pus along with appropriate medication was found more appropriate management than medical therapy alone.

Child↗
PubMed1977

Resolution time of amoebic liver abscess by micro-opaque barium sulphate.

Resolution time of amoebic liver abscess in 20 males aged 20-80 yrs. as studied by intra-cavitary micro-opaque barium sulphate ranged from 24-284 days (mean 74.8 S.D. +/- 8.4). Sic of these patients also underwent Indium11m scanning. The resolution time by scanning varied from 24-114 days (Mean 58.3 days S.D. +/- 4.6). No correlation was found between the size of abscess and resolution time. Resolution time studied by two methods was statistically significant. Instillation of micro-opaque barium sulphate is an inexpensive, reliable and a safe method which does not require sophisticated equipment.

Adult↗
PubMed2002

A pilot study of oral fleroxacin once daily compared with conventional therapy in patients with pyogenic liver abscess.

The object of this open-label, randomized, comparative study was to evaluate the efficacy and safety of fleroxacin versus conventional therapy (cefazolin plus gentamicin/cephalexin) in the treatment of patients with bacterial liver abscess. Thirty-one adult patients (26 men and 5 women) received fleroxacin 400 mg orally once daily for 3 weeks, and 30 adult patients (21 men and 9 women) received conventional therapy for 3 to 4 weeks. Patients was assessed on day 3 of treatment, thereafter every week during treatment, and at 7 to 14 days (compulsory follow-up) after treatment for assessment of bacteriologic, clinical, and safety parameters. A total of 20 patients in the fleroxacin group and 22 patients in the conventional therapy group were evaluated. Klebsiella pneumoniae was the predominant pathogen isolated in all evaluable cases. Bacteriologic cure was achieved in 14 (70%) of 20 patients on fleroxacin therapy compared with 18 (81.8%) of 22 patients on conventional therapy (p=0.48). Clinical cure was achieved in 12 (60%) and 18 (81.8%) patients, and improvement in 2 (10%) and 1 (4.5%) patients in the fleroxacin and conventional therapy group, respectively. Most of adverse effects were of mild intensity. Oral fleroxacin once-daily administration is an effective, alternative treatment of bacterial liver abscess.

Administration, Oral↗
PubMed1992

Pseudomonas pseudomallei liver abscesses: a clinical, laboratory, and ultrasonographic study.

Ultrasonography revealed evidence of liver abscess in 126 patients who were admitted to one hospital in northeastern Thailand over a 3-year period. There were 50 cases for which a pyogenic bacterial etiology was confirmed; 34 cases (group 1) were caused by Pseudomonas pseudomallei (nine patients died) and 16 cases (group 2) were caused by other bacteria (two patients died). Melioidosis was associated with anemia and underlying diabetes or renal disease; right-upper-quadrant pain and jaundice were more common in group 2 (P less than .05). Blood cultures were positive for bacteria in 68% of group 1 and 50% of group 2. Chest radiographs revealed abnormalities in 17 of 30 group 1 patients and 6 of 12 group 2 patients. The radiographic appearances of a blood-borne pneumonia suggested melioidosis. The serum indirect hemagglutination assay for antibodies to P. pseudomallei was of limited value in differentiating the two types of abscesses. Multiple hypoechoic areas on ultrasonography were significantly associated with melioidosis (P less than .01); associated splenic abscess occurred in 19 group 1 patients but only one group 2 patient (2-107, 95% confidence interval; odds ratio, 19). In an area where P. pseudomallei is endemic, these characteristic ultrasonographic findings should prompt immediate treatment for melioidosis.

Adolescent↗
PubMed1987

Recurrent infections and staphylococcal liver abscess in a child with C1r deficiency.

Complete absence of the C1r portion of the first component of complement was found in a 2 1/2-year-old boy of Puerto Rican origin who presented with a staphylococcal liver abscess. His medical history also included two episodes of pneumonia complicated by a pneumatocele and empyema, purulent staphylococcal lymphadenitis, recurrent otitis media, and pneumococcal bacteremia. The C1s component of complement was 50% of normal, and C4 was elevated. Other immunologic tests, including nitroblue tetrazolium test, and IgE were normal. This is the tenth patient reported with C1r deficiency. The patient differs from other reported patients with C1r deficiency in that he presented with a liver abscess, an infection that has not been reported in patients with complement deficiencies, and in that he has an apparent susceptibility to staphylococcal infection.

Child, Preschool↗
PubMed1984

Pyogenic liver abscess: new concepts of an old disease.

Early recognition of pyogenic liver abscess requires a high index of suspicion. The abrupt onset of hectic fevers and jaundice is rarely seen today; instead, an insidious progression of malaise, abdominal pain, and night sweats is more common. Biliary tract disease is the most frequent underlying disorder. An elevated alkaline phosphatase is a useful clue to the condition, but diagnosis depends on imaging of an abscess cavity followed by aspiration. Treatment involves antibiotics together with drainage, which can often be performed successfully by a nonsurgical percutaneous approach. However, prognosis continues to be poor unless the diagnosis is made promptly.

Alkaline Phosphatase↗
PubMed1975

Intestinal amoebiasis and amoebic liver abscess in Brisbane, 1956 to 1973. Clinical syndromes and the results of medical and surgical management.

Nineteen patients presented to teaching hospitals in Brisbane with symptomatic amoebiasis from 1965 to 1973. The majority of patients gave a history of overseas travel or residence. Intestinal amoebiasis most frequently occurred in its non-dysenteric form, so that there were some problems in differentiating it from more commonly occurring forms of colitis. The potential for amoeboma to be mistaken for a neoplasm was evident. Amoebic liver abscess was confirmed in 10 cases and, in nine of these, the abscess was localized to the right lobe of the liver. A total colectomy had been performed in one case and an abdominoperineal resection of the rectum in another before hospital admission in Brisbane and confirmation of the diagnosis of amoebiasis. Five of the patients with amoebic liver abscess underwent laparotomy soon after admission because of upper abdominal symptoms and signs which resembled those of other surgical conditions. Although the indirect haemagglutination test was of considerable assistance in diagnosing amoebiasis, it was apparent that attention to detail in the collection and examination of faecal specimens remained of major importance. A trial of metronidazole, which is both effective and relatively safe, is advocated in cases of diagnostic difficulty, when amoebiasis is suspected but unproven, and when the adoption of an alternative diagnosis would lead to the initiation of less satisfactory drug therapy or involve otherwise unnecessary surgery.

Adult↗
PubMedDate not supplied

Diagnostic and therapeutic strategies of pyogenic liver abscess.

The infectious routes and etiologies of 26 cases with pyogenic liver abscess were portal spread in one, hematogenous in three, biliary in 12, transarterial embolization (TAE) in three, posthepatectomy in one and cryptogenic in five cases. Portal and hematogenous cases tend to show solitary and cystic pattern on echogram, and the majority of the bacteria detected was Klebsiella. While most biliary cases show multiple and cystic with tumor pattern on echogram, and an unhomogeneous low density in CT feature, anaerobic bacteria and candida were isolated only from the biliary or TAE cases. Most cases could be cured completely by the various kinds of abscess drainage, but two TAE cases with PTAD (percutaneous transhepatic abscess drainage) and two biliary cases with PTBD (PT-biliary drainage) and PTAD died due to a delay in establishing a diagnosis and to the severity of the condition. An early diagnosis followed by PTAD or PTBD were thought to be of prime importance.

Anti-Bacterial Agents↗
PubMed1990

CT and US findings of a rare case of amoebic liver abscess rupturing into the pericardial cavity.

A rare case of amoebic liver abscess that ruptured into the pericardial cavity is reported. This is the first case in the world in which CT scan and ultrasonography were performed in conjunction with each other in demonstrating the fistulous tract. CT scan, ultrasonographic and echocardiographic findings were described in detail. Pericardectomy with surgical drainage and supportive measures led to complete recovery after 37 days of hospitalization.

Humans↗
PubMed1990

[Amebic liver abscess: presentation of 4 cases].

We report four patients with amebic liver abscess diagnosed in our hospital between January 1985 and January 1990. Mean patient age was 40 years. All patients had previously travelled to an endemic area. Fever, weight loss, right-upper-quadrant pain and hepatomegaly were the most frequent clinical manifestation. Two patients had a history of diarrhea. Diagnosis was made by epidemiology, clinical manifestation, ultrasonic scanning and computerized tomography and serologic test. Two patients received metronidazole exclusively and two patients required percutaneous catheter drainage under ultrasound guidance.

Adult↗
PubMed1989

[Pyogenic liver abscess. Review of 33 cases].

Thirty three cases of pyogenic liver abscess, (24 single and 9 multiple), diagnosed in our department during the past 6 years, were reviewed. Mean patient age was 54 years with a male predominance over females (1.5:1). The most frequently encountered underlying pathology was bile duct disease (33%), followed by previous liver disease (21%). Causal pathology could not be found in 4 cases (12%). The most frequent sign was fever (76%). Diagnosis was made by clinical picture and complementary exam (echography, CT scan and hepatic gammagraphy) in 29 cases (88%). Blood and pus cultures were positive in 47 and 67% of cases respectively. Thirty nine per cent of microbial abscesses were polymicrobial. E. coli and S. milleri were the most frequently isolated. No micro-organism were identified in 5 cases (15%). Antibiotic treatment was given to 33 patients. Surgical drainage was performed in 24 cases and percutaneous drainage in 7 patients. Two patients received antibiotics exclusively. Five patients died (15%), three of whom had a multiple abscess (33%) and the other two had a single abscess (8%). The efficacy of percutaneous drainage for diagnosis and treatment is analyzed reviewing recent literature.

Adolescent↗
PubMed1998

Hepatocellular carcinoma presenting as pyogenic liver abscess: characteristics, diagnosis, and management.

We performed a 17-year retrospective analysis of 10 cases of hepatocellular carcinoma presenting as pyogenic liver abscess. Spontaneous tumor necrosis and biliary obstruction caused by tumor thrombi, superimposed with bacterial infection, were the two major pathogeneses. Exact diagnosis of the underlying hepatocellular carcinoma was made for five of the 10 patients before management was attempted. Main clinical manifestations included fever, chills, right-upper-quadrant pain, malaise, anorexia, jaundice, and hepatomegaly. Characteristics such as middle age and male sex, seropositivity for hepatitis B and/or hepatitis C, chronic liver disease, unexplained anemia, marked weight loss, and a severely inversed albumin/globulin ratio raise suspicions about the underlying hepatocellular carcinoma. Management strategies included percutaneous drainage (n = 3), surgical drainage (n = 4), and hepatectomy (n = 3) in addition to administration of parenteral antibiotics in all cases. The prognosis was dismal, with a mean survival of 3.5 months (range, 8 days to 6 months).

Adult↗
PubMed2001

A case of glomerulonephritis in association with pyogenic liver abscess.

Glomerulonephritis associated with visceral abscess is being increasingly recognized. The association of glomerulonephritis with visceral suppuration in the absence of endocarditis was first described by Whitworth and associates. Abscesses were most frequently located in the respiratory tract but have been reported at numerous other sites, including appendix, uterus, aorto-femoral bypass graft and cutaneous wound. This report documents the apparently rare occurrence of glomerulonephritis with acute renal failure in association with pyogenic liver abscess. The need for awareness of glomerulonephritis as a cause of acute renal failure in pyogenic liver abscess is highlighted.

Aged↗
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↗
PubMed2000

Innate immunity to amebic liver abscess is dependent on gamma interferon and nitric oxide in a murine model of disease.

Evidence from in vitro studies suggests that gamma interferon (IFN-gamma) and nitric oxide (NO) are important in host defense against the protozoan parasite Entamoeba histolytica. We used SCID mice with targeted disruption of the IFN-gamma receptor gene and mice with targeted disruption of the gene encoding inducible NO synthase to show that IFN-gamma plays a role in the innate immunity to amebic liver abscess seen in SCID mice while NO is required for control of amebic liver abscess in immunocompetent mice.

Animals↗
PubMed1999

Visceral larva migrans syndrome complicated by liver abscess.

We describe a case of visceral larva migrans syndrome complicated by liver abscess, pericardial effusion and ascites. To our knowledge, these findings have not been reported previously. The structural and immunological alterations caused by visceral larva migrans are thought to lead to the development of visceral abscesses.

Animals↗