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The present report describes a recent fatal case of multiple liver abscesses caused by adult Ascaris lumbricoides in a 21-month-old child. Most abscesses contained a large number of adult worms and one ruptured into the peritoneal cavity, causing purulent peritonitis.
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A case of a young man who developed a Streptococcus milleri liver abscess secondary to an occult colonic foreign body, which presented as fulminant community acquired pneumonia, is reported. The isolation of Streptococcus milleri, a normal member of the gastrointestinal flora, from an abscess, blood or sputum should prompt a search for pathology, foreign bodies or silent perforation in the gastrointestinal tract.
A series of 19 patients who had amebic peritonitis secondary to rupture of an amebic liver abscess is presented. This represents 2.4% of the patients treated for ALA during an 18.5-year period. Eighty-four percent were men and ages ranged from 6 to 70 years. Rupture occurred prior to admission in 17 patients. Abdominal pain and fever were the most common symptoms. Abdominal tenderness, liver enlargment, distention, and jaundice were the predominant physical findings. All patients underwent operation. Removal of necrotic and purulent material combined with wide drainage were carried out. In two patients with amebic cecal disease, intestinal bypass was also done. The mortality rate was 42%. It was significantly increased in patients over 50 years of age and in those in whom a correct preoperative diagnosis was not made.
A case of an isolated tuberculous abscess of the liver in a 47-years-old woman with a 2-year history of disease is presented. Only 17 similar cases have been reported previously in the literature. The symptomatology of this patient, confused initially with a chronic calculous cholecystitis and then with an hepatic pyogenic abscess exemplify what has been described for this rare disease presentation. A review of the pertinent literature is presented.
A 3-year-old girl with congenital choledochal dilatation, prehepatic portal occlusion, liver abscess, and cholelithiasis is reported. Ultrasonography, computed tomography, RI scintigraphy, endoscopic retrograde cholangio-pancreatography, and angiography were performed to get the diagnosis.
The curious symptom of a metallic cough in association with a pyogenic hepatic abscess should heighten awareness of a fistula. We describe a 78-year-old female with severe diverticular disease, on long-term steroid treatment for polymyalgia rheumatica. She developed a pyogenic liver abscess, treated initially by antimicrobial therapy, and subsequently drained by ultrasound and computed tomography-guided percutaneous transhepatic pigtail catheterization. This was complicated by a fistulous communication between the abscess cavity and the bronchus, confirmed by radiology. After repeated attempts at drainage and antimicrobial therapy the abscess cavity, including the hepatobronchial fistula, resolved.
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Yersinia enterocolitica is an important cause of multiple liver abscesses in iron-overloaded or debilitated patients. The condition has a high mortality rate and causes diagnostic and therapeutic problems. The successful management of an iron-overloaded patient presenting with jaundice and chronic renal failure is described.
Radiological and serological tests are valuable tools commonly used in diagnosing amebic liver abscess. The limitations in sensitivity and specificity of the various imaging procedures should be recognized in order to avoid misinterpretation of test results. Serodiagnostic methods present potential pitfalls primarily because of their frequent inability to differentiate previous disease from active infection, and must therefore be interpreted carefully.
Abscess of the liver is a comparatively rate, but very serious disease, necessitating the undertaking of diagnostic and therapeutic measures on an emergency basis. The principal diagnostic method currently in use includes two imaging techniques--echography and CT. In therapeutic respect the target puncture under echographic or CT control has rather limited scope of application. Surgical therapeutic approach is the leading one--laparotomy, drainage of the abscess, and arbitrary use of a Kerr drainage for the choledochus and regional antibiotic therapy.
A 20-year-old male with chronic granulomatous disease (CGD) was admitted with multiple liver abscesses. He had already been diagnosed as CGD, type X91-, when he was 10 years old. He was successfully treated with antibiotics and granulocyte colony-stimulating factor (G-CSF) combined with continuous drainage of abscess. Employing flow cytometry, respiratory burst by individual neutrophils was measured using 2', 7'-dichlorofluorescein. The fluorescence intensity in all individual neutrophils from the patient under G-CSF treatment was higher than the one without G-CSF. G-CSF can be one of effective therapies for infection in some patients with CGD such as X91-.
Three indices of drug metabolism, antipyrine clearance in vivo, and aminopyrine N-demethylase and bilirubin UDP-glucuronyl transferase activity in liver biopsies, were studied in fifteen patients with amoebic liver abscess (with and without jaundice). The mean (+/- S.E.) antipyrine half-life in patients with jaundice was 21.64 (+/- 1.52) h and in patients without jaundice was 19.36 (+/- 0.93) h. It was significantly prolonged in both groups of patients as compared to controls (11.63 +/- 0.86 h). It showed a good correlation with serum albumin (p less than 0.01), prothrombin time index (p less than 0.01), and aminopyrine N-demethylase (p less than 0.05). Aminopyrine N-demethylase was found to be decreased in patients without jaundice but no significant change could be observed in patients with jaundice. Bilirubin UDP-glucuronyl transferase showed no significant change in either of the groups.
BACKGROUND: The epidemiology and management of liver abscess (LA) have evolved over time. AIM: To examine our experience over 10 years in a UK teaching centre. DESIGN: Retrospective review of patient records. METHODS: We reviewed the records of all patients aged >16 years discharged from Royal Hallamshire Hospital with a diagnosis of LA between April 1988 and December 1999. RESULTS: There were 69 patients with LA (65 pyogenic, 4 amoebic), giving a crude annual incidence rate of 2.3/100,000/year (18.15/100,000 hospital admissions). Median age was 64 years. Single lesions were found in 41 patients, multiple lesions in 28. Pre-admission, patients were symptomatic for a median 14 days, with the most common symptoms and signs being fever and abdominal pain/tenderness. Pathogens were identified in 74% and predisposing aetiology in 92% of those undergoing investigation. Spread of infection to the liver via the portal venous system was the commonest route of infection (46%), most frequently in patients aged >/=60 years (p=0.019). Abdominal ultrasound (US) was diagnostic for LA in >90% of cases. Treatment with anti-microbial therapy plus interventional radiology was optimal. The case fatality rate was 12.3%, mainly from associated underlying pathology. DISCUSSION: LA is commonly associated with underlying gastrointestinal pathology. Seeking out this underlying aetiology is an integral part of management. We recommend US as the first-line diagnostic tool with guided intervention plus antibiotic(s) as first-line treatment. Prognosis depends chiefly on the underlying pathology.
The activation of the alternative pathway of complement in the sera of patients with amebic liver abscess was studied. Of 11 sera examined, only six showed an activation of the alternative pathway. However, all sera showed diminished levels of complement (CH50) and C3, in spite of normal levels of C1q. The results suggest that the sera of patients with invasive amebiasis have a substance capable of activating the properdin pathway. The significance of these observations is not completely clear at the present time.
The effect of T-cell depletion on experimental hepatic amoebiasis in hamsters was investigated. Thymectomized and anti-T-cell (ATS) treated animals as well as sham-operated and unoperated controls were inoculated intrahepatically, following laparotomy, at 7 weeks of age with 1 x 10(5) axenic trophozoites of Entamoeba histolytica. In neonatally thymectomized hamsters the mean weight of the liver abscess 10 days post-inoculation was significantly greater than in neonatally sham-operated or unoperated controls, but there was no significant difference between these groups of animals in the size of metastatic foci to other organs. On the other hand, a combination of neonatal thymectomy and ATS treatment enhanced both the size of the primary abscess in the liver and the size of metastases to other sites. Adult thymectomy did not have a significant effect either on the size of the primary abscess or on metastatic dissemination of amoebae from the liver. Treatment of hamsters with ATS shortly before or after intrahepatic challenge increased significantly the size of the abscess, but similar treatment 2-3 weeks prior to challenge had no effect. These observations suggest that thymus-dependent cell-mediated immunity plays an important role in the host response to E. histolytica infection.