THE PATHOGENS OF LIVER ABSCESS IN TROPICAL TAIWAN.
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Enterobacteriaceae↗
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Ultrasound-guided needle aspiration of amoebic liver abscess.
This prospective study was carried out on 200 patients with clinically, ultrasonographically and serologically confirmed amoebic liver abscess. The role of ultrasound-guided needle aspiration in addition to medications was evaluated compared to drug treatment alone. Both the groups were monitored clinically and sonographically for up to 6 months after diagnosis. The initial response (after 15 days) was better in the aspirated group (P < 0.05) but resolution of abscess after 6 months were similar. There was a more rapid clinical response in the aspirated group, particularly in those with larger (> 6 cm) abscesses and there were no complications. Percutaneous ultrasound-guided needle aspiration is a safe diagnostic and therapeutic approach which enhances clinical recovery, accelerates resolution, especially in large abscesses, and prevents complications.
Biopsy, Needle↗
[Mimicry of a liver abscess as hepatocellular carcinoma].
HISTORY: We report on a 82 year-old male who presented with chronic pain in the right upper abdomen, nausea and vomitus. An uncomplicated laparoscopic cholecystectomy occurred eight years and a hepatitis 60 years before. Clinical examination showed a normal abdominal status without palpable liver, spleen, enlarged lymph nodes or masses. He had no icteric skin and sclera. INVESTIGATIONS: The patient was afebrile without leukocytosis. The tumour markers CEA, CA 19 - 9 and AFP were negative. Ultrasound of the abdomen showed a normal homogeneous echotexture of the liver without signs of cholestasis or cirrhosis. In segment 6 a 3 cm large hypoechoic cystic formation with a central echogenic structure with acoustic shadowing was noted. Magnetic resonance revealed a 2.8 x 3.6 cm large lesion in the dorsal region of segment 6 of the liver, infiltrating the perihepatic fat. Pathologic lymph nodes and metastases were not found. DIAGNOSIS AND TREATMENT: At laparotomy, the tumour appeared to be malignant with invasion to the perirenal fat. Complete resection with negative margins included segment 6 of the liver and the adjacent fat (the kidney itself was not infiltrated). The cut specimen also showed signs of malignancy with central necrosis. However, histology of the resected specimen revealed a sterile liver abscess without malignancy, but with microscopic foreign bodies. The patient had an uneventful recovery without postoperative complications. CONCLUSIONS: This case report demonstrates the difficulty encountered in the differential diagnosis of inflammatory processes and malignant tumours. Chronic inflammatory changes may mimic solid neoplasms. Despite adequate magnetic resonance imaging and thorough intraoperative examination, the correct diagnosis was finally found by histology. The most likely genesis of the abscess are lost gallstones during cholecystectomy.
Aged↗
Elective one-stage abdominal operations after percutaneous catheter drainage of pyogenic liver abscess.
During the past 10 years, 15 patients have had percutaneous catheter drainage (PCD) of pyogenic liver abscesses (PLA) at a major teaching hospital. Five PLA were related to biliary tract disease, two were secondary to colonic diverticulitis, two developed after abdominal surgery, and the remaining were associated with hepatic trauma, gastric ulcer, Crohn's ileitis, and colon cancer. Two abscesses were cryptogenic. Mean diameter of PLA was 8 cm and ranged from 2-14 cm. Three patients had multiple PLA. All patients were initially treated by PCD without major complications. However, one patient required a second PCD after developing a recurrent abscess. Fever and leukocytosis defervesced at a mean 3.6 days and 7 days, respectively, after PCD. Seven of the 15 patients subsequently had one-stage elective abdominal operations for treatment of diseases underlying PLA including two cholecystectomies, two colon resections, one gastrectomy, one ileostomy closure, and one laparotomy for unresectable gall bladder cancer. There were no postoperative complications. These results demonstrate that PLA are best treated by using PCD as primary treatment with surgical drainage reserved for patients who do not respond clinically to PCD. The need for operative treatment in diseases underlying PLA should not deter use of PCD as primary treatment.
Abdomen↗
Amoebic liver abscess in Thailand, clinical analysis of 418 cases.
From 1975 to 1983, 418 cases of amoebic liver abscess were admitted to the Department of Medicine, Siriraj Hospital without definite increase or decrease in the overall incidence and without seasonal preponderance. The age range was 16-81 yrs and mean age 42.4 yrs. Male to female ratio was 5:1. Pertinent clinical features were pain, fever and hepatomegaly with predominant involvement of the right lobe. Principal treatment consisted of needle aspiration combined with amoebicidal drugs, i.e. metronidazole, tinidazole and ornidazole. The efficacy of each was similar. Surgical drainage was required in only 2.1 per cent of uncomplicated cases and mortality rate was 0.7 per cent. Ruptures into pleural, pericardial and peritoneal cavity were found in 15.4 per cent and secondary infection in 11.9 per cent. Mortality rate of cases with complication was 7.14 per cent. Length of hospital stay was 12.8 days for the uncomplicated cases and 24.1 days for cases with complications (excluding the nonsurvivals).
Adolescent↗
Amoebic liver abscess in Great Britain.
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Amebiasis↗
Contemporary management of amebic liver abscess.
In a retrospective review covering 16 years divided into two time periods, 133 patients with amebic liver abscess were evaluated. Most of the patients were young, Hispanic men, and one-third had coexistent disease. A reliable diagnosis can be established in 24 hours using ultrasound or computed tomography scans. Over the entire time period, antiparasitic therapy was evolved to occupy a primary role and surgery was reserved for management of abscess complications.
Academic Medical Centers↗
Comparative biological features of a rat liver abscess model induced with three Fusobacterium necrophorum strains.
Several biological features were compared in a rat liver abscess model, using intraportal inoculations with 3 bovine strains of Fusobacterium necrophorum which varied in virulence. Serum alanine aminotransferase activities were increased significantly (P less than 0.05) in rats inoculated with F necrophorum 2101 by postinoculation hours 6, 12, and 24. Thereafter, alanine aminotransferase values returned to base line for the remainder of the experiment. Also, rats inoculated with F necrophorum 2101 had a significantly greater (P less than 0.05) weight loss than did the control rats during the first 5 postinoculation days and developed leukocytosis characterized by a neutrophilia with a left shift. The duration of the bacteremia was related directly to the virulence of the F necrophorum strain. Fusobacterium necrophorum 2101, a biotype A which was the most virulent, induced the most persistent bacteremia; F necrophorum 2035, a biotype B which was the least virulent, produced the shortest bacteremia; and F necrophorum 2030, a biotype AB which was of intermediate virulence, led to bacteremia of intermediate duration. Plasma endotoxin was demonstrated intermittently during the first 24 hours, but did not correlate with the bacteremia.
Alanine Transaminase↗
Intestinal nematodes, Toxocara infection, and pyogenic liver abscess in children: a possible association.
Eosinophilia and intestinal helminths are frequent in children with pyogenic liver abscess (PLA) diagnosed in Vitória (Brazil). For these reasons we hypothesized that nematode infection with larvae migrating through the tissues (Ascaris, Strongyloides, Ancylostoma, Necator and Toxocara) may be a predisposing factor for PLA in children. We compared the prevalence of intestinal helminth and Toxocara infection between children with PLA and a control group of children with no evidence of PLA at the Children's Hospital N.S. da Glória in Vitória. From October 1996 to February 1998, 13 children with PLA and 110 children with diseases other than PLA provided five stool samples (Hoffman, Baerman and Kato-Katz methods) and one blood sample for anti-Toxocara antibodies (ELISA IgG, with previous adsorption with Ascaris suum antigen). All PLA and comparison children belonged to a low socioeconomic class and lived in similar conditions. The frequency of intestinal nematodes and anti-Toxocara antibodies were significantly higher in PLA patients than in controls (intestinal helminths: 10/13 or 76.9 per cent in PLA cases and 31/110 or 28.1 per cent in controls; OR = 8.94; 95 per cent confidence interval (CI): 1.97 < OR < 50.06; anti-Toxocara antibodies: 9/13 or 69.2 per cent in PLA and 31/110 or 28.1 per cent in controls; OR = 6.59; 95 per cent CI: 1.65 < OR < 31.05). Moreover, the degree of eosinophilia was higher in PLA patients. Malnutrition was present in both groups. Hemoglobin was 9.5 g/dl in PLA patients and 9.7 g/dl in controls; p = 0.900. Serum levels of IgA and IgM were normal or above normal, with no difference between the two groups, but the levels of IgG and IgE were higher in PLA patients. Although there is some missing data in respect to some socioeconomic parameters in affected and comparison groups. these results support the hypothesis that helminth infection with larvae migrating through tissues may be a predisposing factor for PLA in children. Th2 cell activation and downregulation of Th1 cells, induced by helminths, thus reducing the microbicidal activity of phagocytes, as well as the granulomatous reaction around the larvae (mainly of Toxocara sp.) causing the trapping of bacteria in liver, may be possible explanations for the increased risk for PLA in children with intestinal nematodes and/or Toxocara infection.
Animals↗
CpG-oligodeoxynucleotide is a potent adjuvant with an Entamoeba histolytica Gal-inhibitable lectin vaccine against amoebic liver abscess in gerbils.
The protozoan parasite Entamoeba histolytica causes invasive amoebiasis characterized by amoebic dysentery and liver abscesses (ALA). The E. histolytica galactose/N-acetyl-D-galactosamine-inhibitable lectin (Gal-lectin), an immunogenic surface molecule involved in colonization and invasion, is a promising vaccine candidate against amoebiasis. Gal-lectin is known to induce Th1 cytokines in macrophages and spleen cells in vitro, and a Th1 response is thought to be protective against ALA. In this study, we report the use of cytosine guanine oligodeoxynucleotide (CpG-ODN) as adjuvant to augment Th1 responses against Gal-lectin in the gerbil model of ALA. Gerbils were vaccinated intramuscularly with the native Gal-lectin plus CpG-ODN or a paired non-CpG control GpC-ODN, and control gerbils received CpG-ODN alone. One week after the last boost gerbils were challenged intrahepatically with 10(6) amoebae. Gerbils receiving CpG-ODN as adjuvant with Gal-lectin were completely protected against the development of ALA, whereas 50% of gerbils receiving GpC-ODN and Gal-lectin developed ALA and 85% of controls developed ALA. Stronger lymphoproliferation in response to the Gal-lectin and higher prechallenge titers of serum Gal-lectin-specific antibodies, capable of blocking amoebic adherence, were observed when CpG-ODN was used as adjuvant. Gerbils vaccinated with CpG-ODN and Gal-lectin also had significantly higher levels of gamma interferon, interleukin-12 (IL-12), and IL-2 mRNA than controls. These data indicate that CpG-ODN can enhance the Th1 responses, which improve the protective effects of Gal-lectin. This is the first report of the use of CpG as a potent Th1 adjuvant with Gal-lectin to increase protection against ALA formation.
Adjuvants, Immunologic↗
[HEALED MULTIPLE LIVER ABSCESSES].
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Adolescent↗
[Pyogenic liver abscess].
The objective of this study was to investigate and report changes in presentation, management and outcome of patients with pyogenic liver abscess (PLA). Between 01.01.1995-31.12.1999, 27 patients with PLA were treated in the General Surgical Service of the Fundeni Clinical Hospital. The incidence of cryptogenic abscesses was dominant (55.5%). The symptoms and the biological status are frequently nonspecific. The CT scan and echographic examination sensibility in the diagnosis of the PLA was 89.5% and 78.3%. The aerobe germs are most involved. All patients received antibiotic treatment in preoperative as in postoperative period. The surgical treatment was performed in 24 patients: in 9 patients (33.3%), the abscess was surgically evacuated and drained and in 15 patients (55.5%), a liver resection was performed. Percutaneous catheter drainage under CT or echo-guidance was performed in three patients (11.1%). The clinical evolution was good in 21 patients (77.7%). There was four complications (14.8%) and two death (7.4%). Although with a better prognostic, the PLA remains an important pathology.
Adolescent↗
Serum alpha-feto protein in amoebic liver abscess.
Serum alpha-feto protein (AFP) levels were determined using a sensitive and specific ELISA technique in healthy persons (40), patients with amoebic liver abscess (ALA, 70) and hepatocellular carcinoma (HCC, 20). The AFP levels in normal persons ranged between 0 to 20 ng/ml. Most of ALA patients had AFP levels in the normal range; only a small proportion (14.3%) showed elevated levels (range 20-75 ng/ml). Sera from HCC patients had significantly high AFP values in the range of 25 to 340 ng/ml as compared to normal controls and ALA patients. An analysis of serial samples from 10 ALA patients in convalescent phase showed no difference in AFP level during acute and convalescent phase of infection.
Carcinoma, Hepatocellular↗
Human amebic liver abscess: expression of intercellular adhesion molecules 1 and 2 and of von Willebrand factor in endothelial cells.
Liver invasion by amebas with production of amebic liver abscess (ALA) is the most common extraintestinal lesion produced by the protozoan parasite Entamoeba histolytica. This hepatic damage is characterized by the presence of extensive tissue necrosis. However, little is known about the parasite and host factors involved in the process of tissue damage. During the early establishment of amebas in the liver parenchyma as well as during the extension of the tissue necrosis, parasites interact with sinusoidal endothelial cells. As a consequence of ameba-endothelial cell interactions, the latter can be activated and express proinflammatory factors that could be related to tissue destruction. We studied by immunohistochemistry the localization of antigenic molecules of E. histolytica trophozoites and of molecules such as intercellular adhesion molecule 1 (ICAM-1), ICAM-2, and von willebrand factor in activated endothelial cells of human ALA, which could be related to the pathophysiological mechanisms of tissue destruction in amebiasis.
Adolescent↗
Dehydroemetine in amebic dysentery and amebic liver abscess.
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Dysentery↗
Role of prostaglandin E2 on amoebic liver abscess formation in hamsters.
Entamoeba histolytica can modulate macrophage functions and cytokine production by a prostaglandin E2 (PGE2) mechanism. To study the participation of PGE2 on amoebic liver abscess formation, we tested the effect of the PG synthesis inhibitor indomethacin (INDO) on abscess development in hamsters infected intrahepatically with E. histolytica trophozoites. Male infected animals had higher levels of plasma PGE2 (5.7 +/- 0.7 pg/ml pre-infection; 26.0 +/- 2.0 pg/ml 7 days postinfection; p < 0.001). INDO prevented this increase, so that infected-treated and control non-infected animals had similar levels of plasma PGE2. INDO reduced liver and abscess weight by 18% and 30% respectively (p < 0.05). Cyclooxygenase (COX) activity determination by thin layer chromatography using (1-14C) arachidonic acid (AA) showed that liver microsomes from infected animals produced more PGE2 than controls. COX activity was considerably inhibited in infected INDO-treated animals. Our data suggest that E. histolytica can stimulate the hepatic production of PGE2 which contributes to pathogenesis of amoebic abscesses through generation and support of the inflammation. The partial effect of INDO treatment suggests that additional factors are involved.
Animals↗
Amebic liver abscess ruptured into the digestive tube.
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Amebiasis↗
Hepatic hematoma after blunt trauma--a case of nonoperative management to prevent liver abscess formation.
In an eighteen-year-old boy with a high fever, an intra-hepatic infectious hematoma following blunt hepatic trauma was treated twice with intrahepatic arterial injection chemotherapy in an attempt to prevent conversion of the hematoma to an abscess. A decrease in body temperature occurred after the arterial injections, and the hematoma was gradually diminished in size. In selected patients with blunt hepatic trauma, intrahepatic arterial injection chemotherapy seems to be an effective treatment for prevention of liver abscess formation.
Adolescent↗