Pyogenic liver abscesses and acute schistosomiasis mansoni: report on 3 cases and experimental study

Three children with acute schistosomiasis mansoni developed pyogenic liver abscesses. The abscesses were diagnosed by ultrasonography and confirmed during laparotomy. Staphylococcus aureus were the sole bacteria isolated from the abscesses. An experimental study was carried out in mice to establish whether schistosomiasis is a predisposing cause for pyogenic liver abscesses. Seventeen mice (group 1) were infected with 40 Schistosoma mansoni cercariae (LE strain) and 60 d later inoculated intravenously with a strain of Staph. aureus, isolated from a patient with bacteraemia; 17 mice infected with Sch. mansoni (group 2), 19 infected with bacteria alone (group 3), and 18 uninfected mice (group 4), served as controls. Thirteen group 1 mice (77%) developed multiple liver abscesses while none was observed in the controls. These results indicate that acute schistosomiasis mansoni concurrent with Staph. aureus bacteraemia favours the colonization of the liver by bacteria and the development of pyogenic hepatic abscesses.     

End-to-end pancreaticoduodenostomy: an alternative reconstruction for partial resection of the head of the pancreas

BACKGROUND: The mainstay of the management of liver abscesses has been intravenous antibiotics and radiologically guided percutaneous drainage. However, not all abscesses are treated successfully in this way, and some require surgical drainage. Laparoscopic drainage of liver abscesses may be an alternative to open surgical drainage. METHODS: Twenty consecutive patients with liver abscesses treated by laparoscopic drainage in combination with intravenous antibiotics were studied prospectively. Fifteen had had failed percutaneous drainage previously. RESULTS: There were 13 right lobe and seven left lobe abscesses ranging from 6 to 25 cm in diameter. Mean operating time was 38 min. Seventeen patients were drained successfully. Three patients developed recurrent symptoms of which two resolved with conservative measures, but one required a second laparoscopic procedure. There were no intraoperative or other postoperative complications in the 20 patients. Follow-up ranged from 5 to 12 months. CONCLUSIONS: Laparoscopic drainage of liver abscesses, in combination with systemic antibiotics, is a safe and viable alternative in all patients who require surgical drainage following failed medical or percutaneous treatment, and in those with large abscesses.     

Diagnostic testing for Prader-Willi and Angelman syndromes: response

Between 1992 and 1997, every year, approximately 30,000 examinations of the liver and bile ducts were done. Addition of colour Doppler imaging improves safety of procedures and allowed to perform ultrasound guided biopsy in 73 patients. On the basis of our experience we state that colour Doppler sonography guided percutaneous fine needle biopsy of the liver is useful, sufficient and safety diagnostic method of abscesses, cysts and malignant tumours of the liver.     

Conservative initial treatment for liver abscesses in children

A total of 124 children aged less than 14 years with a liver abscess were seen in a 16-year period (1974-1990) and treated by non-operative initial management. Of the abscesses 98 occurred in the right liver and 26 in the left. The abscesses were solitary in 93 patients. Overall, 77 of the solitary and 21 of the multiple abscesses were confined to the right liver. In 78 of the right-sided and 20 of the left-sided abscesses the infection was primarily pyogenic in nature with Staphylococcus aureus being the usual organism cultured. The remainder were of amoebic origin. Clinical features were similar in patients with amoebic and pyogenic abscesses. Clinical and ultrasonographic follow-up demonstrated successful non-operative management and healing in 37 per cent of all patients submitted to an initial protocol of medical supportive care and antibiotic therapy. Of the multiple abscesses 60 per cent responded to non-operative management. Fourteen of the 16 solitary left-sided liver abscesses required drainage and three left-sided abscesses ruptured before drainage. Patients with a solitary left-sided abscess warrant early operative intervention.     

Microbiology of liver and spleen abscesses

To study the aerobic and anaerobic microbiology of liver and spleen abscesses and correlate the results with predisposing factors, potential causes and routes of infection, clinical and laboratory data of 48 patients with liver abscesses and 29 with spleen abscesses treated between 1970 and 1990 were reviewed retrospectively. In liver abscesses, a total of 116 isolates (2.4 isolates/specimen) was obtained; 43 were aerobic and facultative species (0.9 isolates/specimen) and 73 were anaerobic species or microaerophilic streptococci (1.5 isolates/specimen). Aerobic bacteria only were isolated from 12 (25%) abscesses, anaerobic bacteria only from eight (17%), and mixed aerobic and anaerobic bacteria from 28 (58%); polymicrobial infection was present in 38 (79%). The predominant aerobic and facultative isolates were Escherichia coli (11 isolates), Streptococcus group D (8), Klebsiella pneumoniae (5) and Staphylococcus aureus (4). The predominant anaerobes were Peptostreptococcus spp. (18 isolates), Bacteroides spp. (13), Fusobacterium spp. (10), Clostridium spp. (10) and Prevotella spp. (4). There were 12 isolates of micro-aerophilic streptococci. S. aureus and beta-haemolytic streptococci were associated with trauma; Streptococcus group D, K. pneumoniae and Clostridium spp. with biliary disease; and Bacteroides spp. and Clostridium spp. with colonic disease. In splenic abscesses, a total of 56 isolates (1.9 isolates/specimen) was obtained; 23 were aerobic and facultative species (0.8 isolates/specimen), 31 were anaerobic species or micro-aerophilic streptococci (1.1 isolates/specimen) and two were Candida albicans. Aerobic bacteria only were isolated from nine (31%) abscesses, anaerobic bacteria from eight (28%), mixed aerobic and anaerobic bacteria from 10 (34%) and C. albicans in two (7%); polymicrobial infection was present in 16 (55%). The predominant aerobic and facultative isolates were E. coli (5 isolates), Proteus mirabilis (3), Streptococcus group D (3), K. pneumoniae (3) and S. aureus (4). The predominant anaerobes were Peptostreptococcus spp. (11 isolates), Bacteroides spp. (5), Fusobacterium spp. (3) and Clostridium spp. (3). S. aureus, K. pneumoniae and Streptococcus group D were associated with endocarditis, E. coli with urinary tract and abdominal infection, Bacteroides spp. and Clostridium spp. with abdominal infection and Fusobacterium spp. with respiratory infection.     

Tropical liver abscess

Forty-one consecutive cases of liver abscesses seen at the National University Hospital, Singapore from 1988 to 1994 were reviewed. Twenty-seven cases (65%) were pyogenic, six (15%) amoebic, two (5%) tuberculous and six (15%) indeterminate. The predominance of pyogenic abscesses is in marked contrast to previous studies from the region a decade ago in which amoebic abscesses were the commonest type. The commonest pathogen causing pyogenic abscess was Klebsiella pneumoniae. Two cases were due to Mycobacterium tuberculosis, and this organism needs to be actively looked for in smears and cultures of aspirated material. As the majority of organisms isolated were resistant to ampicillin, empirical antibiotic treatment for suspected pyogenic abscess should include gentamicin or a cephalosporin. Percutaneous needle aspiration of the abscess was performed for 85% of pyogenic abscesses and surgery was necessary in only two cases because of complications. We found that percutaneous aspiration of liver abscess is helpful to confirm the diagnosis, provides a better bacteriological culture yield, gives a good outcome, and may uncover clinically unsuspected conditions like malignancy and tuberculoma which may mimic the presentation of liver abscesses. We recommend routine cytological examination of aspirated abscess material as well as stains and cultures for acid-fast bacilli.     

Liver abscesses in feedlot cattle: a review

Liver abscesses in slaughtered beef cattle result from aggressive grain-feeding programs. The incidence, averaging from 12 to 32% in most feedlots, is influenced by a number of dietary and management factors. Liver abscesses represent a major economic liability to producers, packers, and ultimately consumers. Besides liver condemnation, economic impacts include reduced feed intake, reduced weight gain, decreased feed efficiency, and decreased carcass yield. Fusobacterium necrophorum, a member of the ruminal anaerobic bacterial flora, is the primary etiologic agent. Actinomyces pyogenes is the second most frequently isolated pathogen. Ruminal lesions resulting from acidosis generally are accepted as the predisposing factors for liver abscesses. F. necrophorum possesses or produces a number of virulence factors that participate in the penetration and colonization of the ruminal epithelium and subsequent entry and establishment of infection in the liver. However, only a few virulence factors have been characterized well. Control of liver abscesses in feedlot cattle generally has depended on the use of antimicrobial compounds. Five antibiotics (i.e., bacitracin methylene disalicylate, chlortetracycline, oxytetracycline, tylosin, and virginiamycin) are approved for prevention of liver abscesses in feedlot cattle. Tylosin is the most effective and the most commonly used feed additive. Tylosin feeding reduces abscess incidence by 40 to 70%. The mode of action of antibiotics in preventing liver abscesses is believed to be via inhibition of ruminal F. necrophorum. Protective immunity against F. necrophorum induced by a variety of antigenic components has ranged from ineffectual to significant protection.     

Adjuvant intra-arterial chemotherapy with gastrin receptor antagonist after hepatic resection in colorectal cancer metastasis

The aim of this study was to determine whether chemo-endocrine therapy after the resection of liver metastasis from colorectal cancer would prevent recurrence in the remnant liver and prolong survival. Eleven colorectal cancer patients underwent hepatic resection for liver metastasis. Subsequently, they were administered Proglumide gastrin antagonist 1,200 mg/day + 5'-DFUR 800 mg/day for 2 years. In seven of them, MMC 6-10 mg and ADM 20 mg were infused intra-arterially every two weeks alternately for one year. In four of them, 5-FU 250 mg/day was infused for seven days continuously intra-arterially every two weeks for one year. Recurrence in the remnant liver occurred in four of 11 patients. All of these patients underwent repeated hepatectomy. The mean disease-free survival in the remnant liver was 37 months and the five-year survival rate was 91%. These results indicate that intra-arterial chemotherapy with gastrin receptor antagonist might be effective for adjuvant therapy in patients with resectable liver metastasis from colorectal cancer.     

Spread of the serotype 23F multidrug-resistant Streptococcus pneumoniae clone to South Korea

We report the case of 61-year-old woman with cryptogenic liver abscesses who had been profoundly ill with severe upper abdominal pain, impaired consciousness, prostration, continuous high fever secondary to sepsis, and thrombocytopenia (platelets, 1-5 x 10(4)/mm3) since admission. Ultrasonograms and computed tomograms revealed two separate multiloculated lesions in the right lobe of the liver, consistent with the liver abscesses. Immediately after diagnosis, percutaneous abscess drainage was performed under ultrasonographic guidance; however, only a small amount of pus was drained, prompting continuous irrigation of the abscess cavity. Four days later, transcatheter hepatic arterial infusion of antibiotics was attempted. However, the abscesses had enlarged and her general condition had worsened. On hospital day 8, she underwent right hepatectomy because the multiloculated lesions were refractory to drainage. The operation was successful in terms of hepatectomy, although she continued to suffer from sepsis, secondary right subphrenic abscess formation, and prolonged thrombocytopenia with associated coagulation disorders for two months. Examination of multiple cross sections of the resected specimen disclosed that the lesions consisted of aggregations of multiple small locules. There was no communication between the locules and there were true septations, rather than multiloculated lesions with pseudoseptations. The patient has been well for 2 years without recurrent abscess of the liver or any infectious disease.     

Portal vein thrombosis and multiple liver abscesses in Crohn's disease--an example for successful conservative treatment

We report about a 27-year-old patient with Crohn's disease presenting with two complications; Portal vein thrombosis and multiple liver abscesses. Conservative treatment with antibiotics and percutaneous catheter drainage was successful, the liver abscesses disappeared. 18 months later the patient presented in best condition. Ultrasound showed cavernous transformation of the portal vein system and splenomegaly, discrete esophageal varices were seen by esophagogastroscopy. This is an example for an excellent course under conservative therapy of liver abscesses, on the other hand it is the first reported case of a patient with a combination of portal vein thrombosis and multiple liver abscesses in Crohn's disease.     

Therapeutic approach to hepatic abscesses

Thirty-five patients with hepatic abscesses were treated at our institution during an 8-year period. Twenty-nine patients had bacterial abscesses, and six patients had amoebic abscesses. The patients were admitted with fever (95%), right upper quadrant pain (63%), and nausea and vomiting (40%) as the most common symptoms. Eleven patients had some inciting cause for the abscess formation; the remaining 18 bacterial abscesses were cryptogenic. The primary abnormal test results were leukocytosis (91%) and liver enzyme elevations (80%). All patients with amoebic abscesses were serologically positive for amoebic infection. Computed tomography (CT) was the most effective imaging modality for diagnosis. Twenty patients were treated with open surgical drainage, 11 with percutaneous drainage, and 4 with antibiotics alone. Three of the four latter patients had amoebic abscesses. Abscesses in two patients initially treated with percutaneous drainage did not resolve, and the patients ultimately required surgery. The remaining indications for surgery were concomitant conditions requiring surgical intervention or inaccessibility of the abscess to percutaneous drainage. Antibiotics were given to all patients, with treatment duration from 10 to 60 days. The hospital mortality was 6% due to sepsis and a postoperative myocardial infarction in one patient, and perioperative myocardial infarction in another; overall morbidity was 20%. At a mean follow-up of 13 months, all surviving patients had resolution of the abscess shown by either CT (11 patients) or clinical examination (22 patients). We conclude that effective drainage, whether it be surgical or percutaneous, and appropriate antibiotic coverage are the mainstays of therapy for hepatic abscesses.     

Induction of hepatocellular carcinomas in the Egyptian toad Bufo regularis by an antifungal drug (griseofulvin)

Neoplastic lesions (hepatocellular carcinomas) were induced in the liver in 18 of 100 experimental toads (Bufo regularis) force fed with the antifungal drug griseofulvin, at a dose level of 0.4 mg/50 g every day. Maximal time of exposure and observation was 12 weeks. The first tumors appeared in 2 male toads 4 weeks after the initiation of feeding.     

MRI appearances in amoebic granulomatous hepatitis: a case report

Amoebiasis is a common cause of liver disease usually presenting as single large or multiple smaller abscesses. Cases with granulomatous hepatitis have rarely been described. We report the case of a 7-year-old girl with amoebic granulomatous hepatitis in which multiple liver abscesses were demonstrated by MRI. A total of 14 abscesses were identified, ranging from 5 mm to 3 cm in diameter. The largest lesions appeared to T2-weighted images as heterogeneous, low-intensity areas surrounded by a double-layered wall, the inner layer of which was hyperintense and the outer layer hypointense. These signs, which have never been described in classic amoebic abscess, represent, we believe, a pattern of hepatic granulomatous amoebiasis lesions. We suggest that MRI should always be performed in cases of amoebic infection.     

Collection control in three steps

Data on 32 diagnostic punctures of the liver, pancreas and spleen under ultrasonographic US control are available. False diagnosis was registered in 1 case. 16 curative procedures under US control were carried out in patients with hepatic abscesses (7), suppurative pseudocysts of the pancreas (4), abscesses of the abdominal cavity (5); in 4 patients external drainage extrahepatic bile ducts was carried out. This method, being not much traumatic, produces good results in definite group of surgical patients.     

Fulminant septicemia caused by Yersinia enterocolitica

A lethal case of septicemia caused by Yershia enterocolitica serotype 3 is described. A 59-year-old male, previously healthy, presented with 6 weeks of fever, abdominal pains and gradual prostration ending in overhelming septicemia and death before a conclusive diagnosis was established. Necropsy showed cirrhosis, haemochromatosis and numerous abscesses in the liver.     

A patient with generalized actinomycosis

A 36-year-old man was admitted because of haemoptysis and weight loss. Despite elaborate investigations, including multiple biopsies of affected organs (pleura, lung, kidney and liver) no diagnosis was established. The patient refused further diagnostic procedures and left hospital for winti treatment in Surinam. He did not take the prescribed pheneticillin and returned after seven weeks in a very poor condition. The second admission was complicated by septic shock. Despite intensive treatment he died. On autopsy actinomycosis abscesses were found in lung, liver and kidney. Even when suspected, an infection with Actinomyces is difficult to diagnose. Without adequate treatment this infection can lead to life-threatening complications.     

The diagnosis and treatment of liver abscesses

An analysis of results of treatment of 15 patients with abscesses of the liver of different genesis is given in the article. The ultrasonic method of examination was shown to be highly efficient for diagnosis of liver abscesses. The authors stress the necessity of differential approach to treatment of such patients based on etiopathogenesis of the disease. In most cases the method of choice for treatment of liver abscesses was found to be the percutaneous puncture and drainage under control of echography.     

Neutrophils play a critical role in early resistance to amebic liver abscesses in severe combined immunodeficient mice

Animal models of liver abscess formation with Entamoeba histolytica suggest that the neutrophil is the first cell of the host immune system to interact with the invading ameba. In vitro studies have suggested that lysis of neutrophils by virulent amebae may exacerbate the damage seen in amebic liver abscesses. To investigate the role of neutrophils in vivo, we used the severe combined immunodeficient (SCID) mouse model of amebic liver abscess formation and compared liver damage in neutrophil-depleted and control mice. We found that neutrophil-depleted animals have significantly larger amebic liver abscesses at early stages of infection and that abscesses in neutrophil-depleted SCID mice lack the prominent inflammatory cell ring seen in amebic liver abscesses in control SCID mice. These data suggest that neutrophils play a protective role in the early host response to amebic infection of the liver.     

Accumulation of O6-methylguanine in non-target-tissue deoxyribonucleic acid during chronic administration of dimethylnitrosamine

1. BD-IV rats were given labelled dimethylnitrosamine (2 mg/kg) by stomach tube on weekdays (Monday to Friday) for up to 24 weeks. The rats killed after 2, 4, 8, 16 and 24 weeks of treatment (72 h after the final dimethylnitrosamine gavage) and DNA was isolated from the pooled livers, kidneys and lungs. Purine bases were released from the DNA by mild acid hydrolysis and separated by Sephadex G-10 chromatography. 2. Throughout the experiment, the content of 7-methylguanine in liver DNA was approx. 16 times that in kidney and lung. The amount of this product increased in the DNA of all three tissues up to 16 weeks, but by 24 weeks had decreased by 20% in the liver and 46% in the other tissues. 3. O6-Methylguanine was not detected in liver DNA, but was easily measured in kidney and lung DNA after 4 weeks of dimethylnitrosamine administration. The amount of O6-methylguanine in kidney and lung DNA increased relative to that of 7-methylguanine, and by 24 weeks was 60% of the 7-methylguanine content in both tissues. 4. Incorporation of radioactive C1 breakdown products of dimethylnitrosamine into normal purines in DNA increased continuously in all three tissues. 5. The results are discussed with respect to the specific hepatocarcinogenic effect of chronic administration of dimethylnitrosamine and the possible contribution of increased DNA repair and DNA synthesis.     

Value of punch biopsy in diagnosis of palpable breast tumors. A prospective analysis of 150 patients

A 65-year-old female received recombinant interferon (IFN) alpha-2b daily for the treatment of chronic hepatitis C. Fever (39 degrees C or higher) developed 14 days after the start of administration. Abdominal computed tomography suggested multiple liver abscesses, which had not been detected before IFN administration. An autopsy revealed an amoebic liver abscess. A subclinical infection of Entamoeba histolytica in this case developed into amoebic liver abscess during IFN administration.