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Klebsiella pneumoniae liver abscess associated with septic endophthalmitis.

Metastatic septic bacterial endophthalmitis is a rare, but devastating disease. We encountered seven cases of pyogenic liver abscess associated with septic endophthalmitis during a recent four-year period. The causative organism was a pure culture of Klebsiella pneumoniae. The diagnosis was made by results of a blood culture in seven of the cases, liver aspirate culture in four, and eye contents or conjunctival culture in four. Chest roentgenographic examination showed pulmonary embolization in four patients, purulent meningitis in one patient, and suspicious prostatic abscess in one patient. Despite diligent antibiotic therapy, six patients lost their vision and one had impaired vision. This poor outcome for septic endophthalmitis seems to result from delayed diagnosis and lack of scheduled periocular injections of antibiotics. A combination course of treatment by the internist and ophthalmologist acting aggressively, both diagnostically and therapeutically, is needed in the future. To have seven cases of K pneumoniae liver abscess complicated by septic endophthalmitis during a period of four years in one hospital is very unusual. To our knowledge, it has never been reported in the literature.

Adult↗

Cardiac tamponade due to intrapericardial rupture of an amebic liver abscess.

Pericardial abscess is rare in healthy individuals, especially the amebic type. We report a case of pericardial abscess and cardiac tamponade due to intrapericardial rupture of an amebic liver abscess. A 31-year old Japanese male complained of fever to a local hospital. A liver mass was discovered in his left hepatic lobe by an abdominal echogram. He was referred to the internal department of our hospital and was treated with quinolone antibiotics. Two weeks after medication, he suddenly complained of epigastralgia and severe orthopnea and was admitted. Abdominal computed tomographic scan showed an enlarged liver mass, and massive pericardial effusion suggested cardiac tamponade. He underwent an emergency subxiphoid partial pericardiectomy under local anesthesia. 1,000 ml of light brownish fluid was removed and his condition improved. Although no ameba was cultivated from the pus, the amebic serological test was positive. Metronidazole was administered and the patient was discharged 31 days after surgery.

Adult↗

Fusobacterium necrophorum infection in mice as a model for the study of liver abscess formation and induction of immunity.

A mouse model is described in which intraperitoneal injection of Fusobacterium necrophorum results in chronic liver abscesses. Viable bacterial counts from mouse lung, liver, and spleen were obtained after whole organ homogenization. From 2 h to 5 days postchallenge, liver was found to contain more bacteria than lung on a per gram basis. Bacterial counts from liver and spleen were about the same during the first 8 h; thereafter liver was found to contain more bacteria. By day 13, though bacterial counts were equivalent in the three organs, abscesses were only observed in liver. This predilection for the liver may be due to a nutritional and/or microenvironmental factor(s). Blood cultures of infected mice revealed a general lack of bacteremia. Extended immunization with formalin-killed cells was found to protect mice against F. necrophorum infection.

Animals↗

[Ultrasonics in the diagnosis of liver abscess].

Echography is a quick and simple method for the diagnosis and monitoring of liver abscesses. It provides accurate information on the nature of the lesion and permits echo-guided percutaneous aspiration of the abscess, a manoeuvre presenting almost no risk of complications. The latter technique has proved a valid alternative to surgery since it permits the introduction of the drug employed into the abscess cavity and the consequent healing of bacterial and amoebic lesions in a very few days. Some personal results are presented.

Anti-Bacterial Agents↗

Complex ruptured amebic liver abscesses: the role of percutaneous catheter drainage.

The failure of medical therapy for amebic liver abscess may be followed by its perforation, a complication associated with high mortality. We assessed the role of percutaneous catheter drainage in management of the sequelae of ruptured amebic abscesses in 13 critically ill patients; 22 intrahepatic lesions, three of which were multiloculated, were drained. Catheters were also placed in 17 extrahepatic collections: pleural space (n = 5), subphrenic (n = 7), perihepatic/subhepatic (n = 3), greater sac of peritoneum (n = 2). No attempt at percutaneous drainage failed. Prompt resolution of clinical features following drainage was a uniform feature. Successful resolution of the abscesses occurred within 20 days in 11 patients. In the remaining two, catheters needed to be retained in situ for 35 and 50 days. The mean hospital stay was 15 days (range 10-20 days). 100% patient survival was achieved, without a single morbid episode. Our results suggest that patients with ruptured amebic abscesses can be effectively and safely managed by percutaneous catheter drainage irrespective of the extent of extrahepatic contamination.

Adolescent↗

Clinical significance and mechanism of gas formation of pyogenic liver abscess due to Klebsiella pneumoniae.

We enrolled 22 patients with gas-forming pyogenic liver abscess in a study to assess the mechanism of gas formation. Klebsiella pneumoniae was cultured from specimens from all patients. Gas and pus samples from abscesses revealed four major components: nitrogen, oxygen, carbon dioxide, and hydrogen; this implicates mixed acid fermentation of glucose as the mechanism of gas formation.

Adult↗

Percutaneous drainage of a tuberculous liver abscess.

The authors describe the management by percutaneous drainage of a rare solitary tuberculous liver abscess in a 37-year-old woman. Open surgical drainage of such abscesses can be avoided using percutaneous drainage combined with transcatheter infusions of antituberculous agents. For the safe and successful use of this method three criteria must be met: the abscess should be unilocular, there must be a safe access route and a previously sterile compartment must not be contaminated. In addition a small (22 or 23 gauge) needle should be used for the initial puncture.

Adult↗

Oral chloramphenicol therapy for multiple liver abscesses in hyperimmunoglobulinemia E syndrome.

In a patient with Hyper-IgE-syndrome multiple liver abscesses developed in spite of prophylactic treatment with trimethoprim and sulfamethoxazol. Ultrasound confirmed the clinical diagnosis and percutaneous needle aspiration under ultrasonographic guidance and culture of the aspirated pus allowed specific antibiotic treatment by oral chloramphenicol alone without surgical drainage. The isolated Staph.aureus strain was resistant to trimethoprim and sulfamethoxazol.

Candidiasis↗

Pyogenic liver abscess.

A retrospective study of 18 adults admitted to Meir General Hospital with pyogenic liver abscess during the years 1982-88 was conducted. Our most useful diagnostic tool was ultrasound, which was accurate in all 15 patients in whom it was performed. Only two patients presented with multiple abscesses. Increased alkaline phosphatase was the most predictive laboratory finding, seen in all but one patient. One person was treated conservatively by antibiotics only. In one patient the abscess drained spontaneously into the right thoracic cavity. Initial surgical drainage was done in nine patients and percutaneous catheter drainage in seven. Only one patient died, of septic shock, yielding a mortality rate of 5.5%. The treatment-related complication rate, observed in almost half of the patients, was high. All patients with such complications required repeated drainage, which was achieved surgically in all cases.

Adolescent↗

Indications for aspiration of amoebic liver abscess.

A two-part study was undertaken to determine whether aspiration of amoebic liver abscess (ALA) prevents complications. Eighty patients studied prospectively were randomised into aspiration or non-aspiration groups and were treated with metronidazole. Common factors in patients with complicated diseases were determined to formulate and test indications for aspiration. Records of all patients with ALA admitted to King Edward VIII Hospital, Durban, between October 1983 and December 1984 were analysed to test the validity of the criteria derived from the first part of the study. The findings suggest that aspiration influences the course and outcome of ALA and that the criteria are valid although not necessarily complete.

Evaluation Studies as Topic↗

Probable new species of Desulfovibrio isolated from a pyogenic liver abscess.

A fastidious, slowly growing, spiral gram-negative bacterium was isolated from the liver abscess of an 82-year-old man with a 3-week history of febrile illness. The organism was an obligate anaerobe that grew at 37 and 42 degrees C but not at 25 degrees C. Its vibrioid or spiral morphology on Gram staining, rapid progressive motility, electron micrograph features, and biochemical tests were all consistent with the organism belonging to the genus Desulfovibrio. 16S rRNA gene sequencing of this organism demonstrated a 97% similarity to Desulfovibrio desulfuricans with 45 nucleotide differences, suggesting that it is a new species of Desulfovibrio.

Aged↗

[An amebic liver abscess; early suspicion, late detection].

Two men aged 38 and 26 years developed symptoms including pain in the (upper) abdomen, malaise and fever 1.5-5 months after visiting the Caribbean. It was only after repeated ultrasonography that liver abscesses were observed. Adequate treatment was instituted and the patients recovered. The diagnosis of 'amoebic abscess of the liver' is usually based on the clinical presentation, the serological findings and characteristic observations at ultrasonography. However, if patients are seen at an early stage of development of the abscess, the serological findings may be negative and the ultrasonographic findings normal; consequently these findings do not justify exclusion of the diagnosis.

Adult↗