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Vazquez M, Vassil A, Sirotkin I. Pyogenic Hepatic Abscess in an Immunocompetent Patient With Poor Oral Health and COVID-19 Infection. Fed Pract 2023; 40:182-185. [PMID: 37860073 PMCID: PMC10584407 DOI: 10.12788/fp.0382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background Pyogenic hepatic abscess (PHA) is a collection of pus in the liver caused by bacterial infection of the liver parenchyma. PHA is more common in immunosuppressed individuals and those with diabetes mellitus, cancer, and liver transplant. Case Presentation We present a rare case of PHA with Fusobacterium nucleatum in an immunocompetent patient with poor oral health, history of diverticulitis, and recent COVID-19 infection whose only symptoms were chest pain and a 4-week history of fever and malaise. The source of infection in this patient was likely dental caries and periodontal disease, with COVID-19 infection playing a role as a red herring in this patient's disease progression, delaying diagnosis. Conclusions Diagnosis and treatment of PHA must be prompt with drainage and empiric anaerobic coverage followed by a more tailored antibiotic regimen if indicated by culture and further drainage if indicated by computed tomography.
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Affiliation(s)
- Manuel Vazquez
- University of Central Florida College of Medicine, Orlando
| | - Alana Vassil
- University of South Florida Morsani College of Medicine, Tampa
| | - Igor Sirotkin
- University of South Florida Morsani College of Medicine, Tampa
- C.W. Bill Young VA Medical Center, Bay Pines, Florida
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2
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Mousa H, Al-Bluwi GSM, Al Drini ZFM, Gasmelseed HI, Alkoteesh JA, Babiker ZOE. Importation of Entamoeba histolytica and predominance of Klebsiella pneumoniae in liver abscesses: a 7-year retrospective cohort study from the United Arab Emirates. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2021; 7:17. [PMID: 34118991 PMCID: PMC8196433 DOI: 10.1186/s40794-021-00140-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/10/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is a dearth of information on liver abscesses in the United Arab Emirates. Herein, we describe the clinical features of liver abscesses and determine their incidence rates and clinical outcomes. METHODS We retrospectively reviewed the clinical charts of adult patients with a primary diagnosis of liver abscess at a major hospital over a 7-year period. RESULTS Amongst 45 patients, 82.2% (37/45) had a pyogenic liver abscess (PLA) and 17.8% (8/45) had amoebic liver abscesses (ALA). Overall, patients were young (median age 42 years, IQR 35-52), mostly males (77.8%, 35/45) from the Indian subcontinent (55.6%, 25/45), presented with fever (88.9%, 40/45) and abdominal pain (88.9%, 40/45), and had a solitary abscess on imaging (71.1% (32/45). Crude annual incidence rates were 35.9/100,000 hospital admissions (95% CI 26.2-48.0) and 5.9/100,000 inhabitants (95% CI 4.3-7.9). All ALA patients were from the Indian subcontinent (100%, 8/8). Klebsiella pneumoniae was the most frequent pathogen in PLA (43.2% [16/37], 95% CI 27.1-60.5%). The hospital stay was shorter in ALA (7.5 days, IQR 7-8.5) than in PLA (14 days, IQR 9-17). No deaths were recorded within 30 days of hospitalisation. CONCLUSIONS ALA was exclusively seen in migrants from the Indian subcontinent, suggesting importation. Further research to characterise K. pneumoniae isolates and assess potential risk factors is needed.
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Affiliation(s)
- Hussam Mousa
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Surgical Institute, Al Ain Hospital, Al Ain, United Arab Emirates
| | - Ghada Salameh Mohammed Al-Bluwi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Zainab Fathi Mohammed Al Drini
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | | | - Zahir Osman Eltahir Babiker
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates. .,Division of Infectious Diseases, Al Ain Hospital, Al Ain, United Arab Emirates. .,Present Address: Division of Infectious Diseases, Sheikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi, United Arab Emirates.
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3
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Islam MM, Farag E, Mahmoudi A, Hassan MM, Mostafavi E, Enan KA, Al-Romaihi H, Atta M, El Hussein ARM, Mkhize-Kwitshana Z. Rodent-Related Zoonotic Pathogens at the Human-Animal-Environment Interface in Qatar: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115928. [PMID: 34073025 PMCID: PMC8198466 DOI: 10.3390/ijerph18115928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/06/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022]
Abstract
Rodents are one of the most diversified terrestrial mammals, and they perform several beneficial activities in nature. These animals are also important as carriers of many pathogens with public health importance. The current systematic review was conducted to formulate a true depiction of rodent-related zoonoses in Qatar. Following systematic searches on PubMed, Scopus, Science Direct, and Web of Science and a screening process, a total of 94 published articles were selected and studied. The studied articles reported 23 rodent-related zoonotic pathogens that include nine bacterial, eleven parasitic, and three viral pathogens, from which the frequently reported pathogens were Mycobacterium tuberculosis (32 reports), Escherichia coli (23), and Salmonella spp. (16). The possible pathway of entry of the rodent-borne pathogens can be the land port, seaports, and airport of Qatar through carrier humans and animals, contaminated food, and agricultural products. The pathogens can be conserved internally by rodents, pets, and livestock; by agricultural production systems; and by food marketing chains. The overall estimated pooled prevalence of the pathogens among the human population was 4.27% (95%CI: 4.03–4.51%; p < 0.001) with significant heterogeneity (I2 = 99.50%). The top three highest prevalent pathogens were M.tuberculosis (30.90%; 22.75–39.04%; p < 0.001; I2 = 99.70%) followed by Toxoplasma gondii (21.93%; 6.23–37.61%; p < 0.001; I2 = 99.30%) and hepatitis E virus (18.29%; 11.72–24.86%; p < 0.001; I2 = 96.70%). However, there is a knowledge gap about the listed pathogens regarding the occurrence, transmission pathways, and rodent role in transmission dynamics at the human–animal–environment interface in Qatar. Further studies are required to explore the role of rodents in spreading zoonotic pathogens through the One Health framework, consisting of zoologists, ecologists, microbiologists, entomologists, veterinarians, and public health experts in this country.
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Affiliation(s)
- Md Mazharul Islam
- Department of Animal Resources, Ministry of Municipality and Environment, Doha P.O. Box 35081, Qatar; (K.A.E.), (M.A.)
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu Natal, Durban 4000, South Africa
- Correspondence: or (M.M.I.); (E.F.); Tel.: +974-660-64382 (M.M.I.); +974-440-70396 (E.F.)
| | - Elmoubashar Farag
- Ministry of Public Health, Doha P.O. Box 42, Qatar;
- Correspondence: or (M.M.I.); (E.F.); Tel.: +974-660-64382 (M.M.I.); +974-440-70396 (E.F.)
| | - Ahmad Mahmoudi
- Department of Biology, Faculty of Science, Urmia University, Urmia 5756151818, Iran;
| | - Mohammad Mahmudul Hassan
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh;
| | - Ehsan Mostafavi
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran 1316943551, Iran;
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan 6556153145, Iran
| | - Khalid A. Enan
- Department of Animal Resources, Ministry of Municipality and Environment, Doha P.O. Box 35081, Qatar; (K.A.E.), (M.A.)
- Department of Virology, Central Laboratory, The Ministry of Higher Education and Scientific Research, Khartum 7099, Sudan;
| | | | - Muzzamil Atta
- Department of Animal Resources, Ministry of Municipality and Environment, Doha P.O. Box 35081, Qatar; (K.A.E.), (M.A.)
- College of Animal Production, Bahri University, Khartoum 11111, Sudan
| | - Abdel Rahim M. El Hussein
- Department of Virology, Central Laboratory, The Ministry of Higher Education and Scientific Research, Khartum 7099, Sudan;
| | - Zilungile Mkhize-Kwitshana
- School of Life Sciences, College of Agriculture, Engineering & Science, University of KwaZulu Natal, Durban 4000, South Africa;
- South African Medical Research Council, Cape Town 7505, South Africa
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4
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Myung HJ, Ryu SH, Liu CH, Yoo JH, Kim SH, Kim SH, Yoon WE, Park TY, Moon JS. Successful Medical Treatment for Peritonitis Resulting from a Large Pyogenic Liver Abscess Rupture. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 77:190-193. [PMID: 33896905 DOI: 10.4166/kjg.2021.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/03/2022]
Abstract
The rupture of a pyogenic liver abscess (PLA) with peritonitis is a rare occurrence but a surgical emergency with a high mortality rate in the case of gas-forming PLA. Rare cases of ruptured PLA that recovered completely with only medical treatment have been reported. This paper reports a case of a large PLA rupture with peritonitis. In this case, surgical intervention was too risky because of the patient's age and poor general condition. The patient recovered fully with appropriate antibiotic therapy and sufficient percutaneous drainage. Therefore, medical treatment may be considered an alternative option in cases of a ruptured large PLA with peritonitis if surgical intervention is too risky.
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Affiliation(s)
- Hee Jun Myung
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Soo Hyung Ryu
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Chung Hao Liu
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jung Hoon Yoo
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Seo Hyun Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Seung Hyuk Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Won Eui Yoon
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Tae Young Park
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jeong Seop Moon
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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5
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El Hattabi K, Bouali M, Sylvestre K, Bensardi FZ, El Bakouri A, Khalid Z, Fadil A. Lactococcus lactis ssp lactis a rare cause of liver abscesses: A case report and literature review. Int J Surg Case Rep 2021; 81:105831. [PMID: 33887845 PMCID: PMC8027286 DOI: 10.1016/j.ijscr.2021.105831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 11/30/2022] Open
Abstract
Lactococcus lactis is a rare cause of liver abscesses. Lactococcus lactis ssp lactis can cause liver abcesses in immunocompetent people. The exposition to unpasteurized dairy products may lead to liver abcess due to L. lactis ssp lactis. Young and immunocompetent people can develop liver abscesses, even for bacteria considered as non-pathogenic. Antibiotics and percutaneous drainage are the first line for treatment of liver abscesses and have improved the death rate.
Introduction We present a liver abscess due to Lactococcus lactis ssp lactis. Case presentation It is a 27-year-old male patient without history who presented the right hypochondrium pain over 10 days. The physical examination noted right hypochondrium pain and hépatomegally. The ultrasound showed hepatomegaly with liver abcess for the segments IV and V as well as VII and VIII measuring 13 × 8 cm and 7.6 × 4.3 cm respectively. A computed tomography (CT) revealed an abscess for segments IV and V and VI and VII measuring respectively 107 × 89 mm and 55 × 50 mm. He underwent a surgical drainage after a radiologic drainage and antibiotherapy failure with success. Discussion Liver abscesses are rare; affect men over 60 years with co-morbidities and those due to L. Lactis ssp lactis are exceptional. Their prevalence is 0.29–1.47% in series of autopsies and 0.008 to 0.16% in hospitalized patients. The most frequently found germs are gram-negative bacilli (40–60%) and anaerobic bacteria (40–50%). Ultrasound and CT scan make the diagnosis in 90% of cases and orients to the etiology. Percutaneous drainage is the first line for treatment, surgical drainage is reserved for percutaneous drainage failures. Conclusion Liver abscess due to Lactococcus lactis ssp lactis is very rare. The clinic, diagnostic methods and treatment of this abscess are identical to other abscesses due to other etiologies. The antibiotics and percutaneous drainage of abscesses have improved the death rate from 40% to 10%–25%.
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Affiliation(s)
- K El Hattabi
- Service of Emergency of the Visceral Surgery, Ibn Rochd University Hospital Centre, Morocco; Hassan II University of Casablanca, Medicine and Pharmacy Faculty, Morocco; Department of Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco
| | - M Bouali
- Service of Emergency of the Visceral Surgery, Ibn Rochd University Hospital Centre, Morocco; Hassan II University of Casablanca, Medicine and Pharmacy Faculty, Morocco; Department of Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco
| | - K Sylvestre
- Service of Emergency of the Visceral Surgery, Ibn Rochd University Hospital Centre, Morocco; Hassan II University of Casablanca, Medicine and Pharmacy Faculty, Morocco; Department of Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco.
| | - F Z Bensardi
- Service of Emergency of the Visceral Surgery, Ibn Rochd University Hospital Centre, Morocco; Hassan II University of Casablanca, Medicine and Pharmacy Faculty, Morocco; Department of Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco
| | - A El Bakouri
- Service of Emergency of the Visceral Surgery, Ibn Rochd University Hospital Centre, Morocco; Hassan II University of Casablanca, Medicine and Pharmacy Faculty, Morocco; Department of Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco
| | - Zerouali Khalid
- Hassan II University of Casablanca, Medicine and Pharmacy Faculty, Morocco; Service of Bacteriology-Virology and Hygiene's Hospital Laboratory, Ibn Rochd University Hospital Centre, Morocco; Department of Microbiology, Ibn Rochd-Casablanca University Hospital Centre, Morocco
| | - A Fadil
- Service of Emergency of the Visceral Surgery, Ibn Rochd University Hospital Centre, Morocco; Hassan II University of Casablanca, Medicine and Pharmacy Faculty, Morocco; Department of Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco
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Cao SA, Hinchey S. Identification and Management of Fusobacterium Nucleatum Liver Abscess and Bacteremia in a Young Healthy Man. Cureus 2020; 12:e12303. [PMID: 33520502 PMCID: PMC7834589 DOI: 10.7759/cureus.12303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 21-year-old previously healthy young man was admitted with five days of fever, persistent cough, worsening shortness of breath, and vomiting. On presentation, laboratory evaluation revealed extremely elevated procalcitonin and leukopenia followed by leukocytosis. The patient was started on empiric antibiotics. Further diagnostic evaluation after initiation of antibiotics included a computed tomography scan, which revealed a large hepatic abscess. Blood cultures obtained on admission grew Fusobacterium nucleatum; fluid obtained from the hepatic abscess also grew F. nucleatum. The patient’s antibiotic regimen was narrowed for specific coverage of F. nucleatum. The liver abscess was drained several times via image-guided percutaneous abscess drainage, with eventual resolution of the abscess. Patient received a prolonged course of intravenous antibiotics and, once stabilized, was discharged on two weeks of Augmentin. Here, we present a rare case of hepatic abscess and bacteremia due to F. nucleatum in a previously healthy young man with good oral hygiene. With this case, we aim to demonstrate the following: (1) the acute onset and rapid disease progression of F. nucleatum bacteremia and liver abscess; (2) how extreme procalcitonin elevation may serve to be a clinically useful early marker of F. nucleatum infection; and (3) the importance of early diagnosis, treatment, and definitive abscess drainage of F. nucleatum bacteremia and liver abscess.
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Affiliation(s)
- Shiliang A Cao
- Anesthesiology, Harvard Medical School, Boston, USA.,Anesthesiology, Massachusetts General Hospital, Boston, USA
| | - Sherifat Hinchey
- Internal Medicine, Signature Healthcare Brockton Hospital, Brockton, USA
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7
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Pérez-Escobar J, Ramirez-Quesada W, Calle-Rodas DA, Chi-Cervera LA, Navarro-Alvarez N, Aquino-Matus J, Ramírez-Hinojosa JP, Moctezuma-Velázquez C, Torre A. Increased incidence of and microbiologic changes in pyogenic liver abscesses in the Mexican population. World J Hepatol 2020; 12:816-828. [PMID: 33200019 PMCID: PMC7643219 DOI: 10.4254/wjh.v12.i10.816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/26/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pyogenic liver abscess (PLA) is a rare disease with an estimated incidence that varies widely across the globe, being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europe and Canada. Even though there are multiple microorganisms capable of producing an abscess in the liver, including Entamoeba histolytica, fungi, and viruses, most abscesses are derived from bacterial infections. The epidemiology of PLA in Mexico is currently unknown.
AIM To describe the clinical, demographic and microbiologic characteristics of PLA in Mexico.
METHODS This is a retrospective study carried out in two centers, and included patients seen between 2006 and 2018 with the diagnosis of pyogenic abscess. We collected demographic, clinical, and microbiological information, treatment, complications, and outcomes. A logistic regression analysis was used to determine the association between different variables and mortality rates.
RESULTS A total of 345 patients were included in this study. 233 (67.5%) had confirmed PLA, 133 (30%) patients had no positive culture and negative serology and 9 (2.5%) had mixed abscesses. The mean age was 50 years (ranging from 16-97 years) and 63% were female. 65% of the patients had positive cultures for Extended Spectrum Beta-Lactamases (ESBL)-Escherichia coli and Klebsiella pneumoniae. Cefotaxime was administered in 60% of cases. The most common sources of infection were ascending cholangitis and cholecystitis in 34 (10%) and 31 (9%), respectively. The median length of hospital stay was 14 d. 165 patients underwent percutaneous catheter drainage. The inpatient mortality rate was 63%. Immunocompromised state [OR 3.9, 95%CI: 1.42-10.46], ESBL- Escherichia coli [OR 6.7, 95%CI: 2.7-16.2] and Klebsiella pneumoniae [OR 4-8, 95%CI: 1.6-14.4] predicted inpatient mortality by multivariate analysis.
CONCLUSION The prevalence of PLA is increasing in Mexico and has a very high mortality rate. ESBL-Escherichia coli and Klebsiella pneumoniae are the most common microorganisms causing PLA and are independent predictors of inpatient mortality.
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Affiliation(s)
- Juanita Pérez-Escobar
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Wagner Ramirez-Quesada
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Daniel Alejandro Calle-Rodas
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Luis Alberto Chi-Cervera
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Nalu Navarro-Alvarez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Jorge Aquino-Matus
- Department of Internal Medicine, Hospital General Dr. Manuel Gea González, Mexico City 14080, Mexico
| | | | - Carlos Moctezuma-Velázquez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Aldo Torre
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
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Trillos-Almanza MC, Restrepo Gutierrez JC. How to manage: liver abscess. Frontline Gastroenterol 2020; 12:225-231. [PMID: 33912334 PMCID: PMC8040501 DOI: 10.1136/flgastro-2019-101240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/28/2019] [Accepted: 12/24/2019] [Indexed: 02/04/2023] Open
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Abstract
Pyogenic liver abscesses are classified by the bacteria that have caused the abscess because this guides treatment and can point to the underlying cause. The most common cause is biliary disease. The diagnosis is made by imaging. Treatment is a combination of antibiotics and percutaneous drainage. Amebic liver abscess is caused by extraintestinal spread of Entamoeba histolytica. E histolytica is spread by fecal-oral transmission and typically colonizes the gastrointestinal tract. It is diagnosed based on imaging and the mainstay of treatment is metronidazole. Only about 15% of cases require percutaneous drainage. The prognosis is good, with almost universal recovery.
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10
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Tharmaratnam T, Kumanan T, Iskandar MA, D’Urzo K, Gopee-Ramanan P, Loganathan M, Tabobondung T, Tabobondung TA, Sivagurunathan S, Patel M, Tobbia I. Entamoeba histolytica and amoebic liver abscess in northern Sri Lanka: a public health problem. Trop Med Health 2020; 48:2. [PMID: 31992948 PMCID: PMC6977265 DOI: 10.1186/s41182-020-0193-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/16/2020] [Indexed: 12/25/2022] Open
Abstract
Entamoeba histolytica (E. histolytica) is a facultative protozoan parasite implicated in amoebic liver abscesses (ALA), the most common extraintestinal manifestation of this infection. E. histolytica is endemic to sub-tropical and tropical countries and has been a major public health concern in northern Sri Lanka (SLK) for the last three decades. This has been attributed to a multitude of factors such as poor sanitation, hygiene, male sex, middle age, overcrowding, unsanitary practices in the production of indigenous alcoholic beverages, and alcohol consumption. Additionally, while rates of E. histolytica have declined substantially throughout the rest of the island, largely due to better infrastructure, it remains pervasive in the northern peninsula, which is generally less developed. Infection arises primarily from fecal-oral transmission through the consumption of contaminated drinking water containing cysts. Upon ingestion, cysts multiply into trophozoites and colonize the host colonic mucosa using lectin and cysteine proteases as virulence factors, leading to host invasion. Symptoms occur along a spectrum, from asymptomatology, to pyrexia, abdominal cramping, and amoebic dysentery. Colonization of the colon results in the formation of distinct flask-shaped ulcers along the epithelium, and eventual penetration of the lamina propria via the production of matrix metalloproteinases. ALA then develops through trophozoite migration via the mesenteric hepatic portal circulation, where microabscesses coalesce to form a single, large right-lobe abscess, commonly on the posterior aspect. The progression of infection to invasive disease is contingent on the unique interplay between host and pathogen factors, such as the strength of host-immunity to overcome infection and inherent pathogenicity of the Entamoeba species. As a preventable illness, E. histolytica complications such as ALA impose a significant burden on the healthcare system. This mini-review highlights epidemiological trends, risk factors, diagnostic modalities, treatment approaches, and opportunities for prevention of E. histolytica-induced ALA, to help address this endemic problem on the island of SLK.
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Affiliation(s)
- Tharmegan Tharmaratnam
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
| | - Thirunavukarasu Kumanan
- Department of Internal Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
- Teaching Hospital Jaffna, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Mina Amin Iskandar
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
| | - Katrina D’Urzo
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Prasaanthan Gopee-Ramanan
- Department of Diagnostic Radiology, Hamilton Health Sciences Centre, Hamilton, ON Canada
- Department of Radiology, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | - Mayura Loganathan
- Academic Family Health Team, Mount Sinai Hospital, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Tyler Tabobondung
- Department of Family Medicine, Brantford General Hospital, Hamilton, ON Canada
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | | | - Seyon Sivagurunathan
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
- Stonechurch Family Health Clinic, Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
| | - Mitul Patel
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
| | - Iqdam Tobbia
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
- Department of Pathology and Clinical Microbiology, School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Busaiteen, Bahrain
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11
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Neill L, Edwards F, Collin SM, Harrington D, Wakerley D, Rao GG, McGregor AC. Clinical characteristics and treatment outcomes in a cohort of patients with pyogenic and amoebic liver abscess. BMC Infect Dis 2019; 19:490. [PMID: 31159769 PMCID: PMC6547479 DOI: 10.1186/s12879-019-4127-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023] Open
Abstract
Background We describe the clinical features of a cohort of patients with liver abscesses and investigate relationships between clinical, radiological and microbiological findings and mortality. Methods Retrospective review of pyogenic (PLA) or amoebic liver abscesses (ALA) diagnosed and treated at a major infectious diseases department in London over 9 years. Results One hundred forty-one patient records were identified; 132 (93.6%) had PLA and 9 (6.4%) ALA. No organism was identified in 38.6% (51/132); a single bacterial species was isolated in 47.0% (62/132) of PLA, ≥ 2 in 14.4% (19/132). There was weak evidence of variation in abscess size by type of microorganism, with streptococcal PLA typically larger (p = 0.03 for Streptococcus milleri group, p = 0.05 for non-milleri streptococci). Patients with ALA were younger (median 41, IQR 37–51 years) than those with PLA (median 68, IQR 50.5–78 years) (p = 0.003) and all were male (9/9, 100%, (p = 0.03)), with a history of recent travel in the majority (6/9, 66.7% (p = 0.003)). C-reactive protein was higher in ALA than in PLA (p = 0.06). In the entire cohort, loculation (HR = 2.51 (95% CI 1.00–6.32), p = 0.04) and baseline ALP (HR = 4.78 (95% CI 1.19–19.2) per log10 increase, p = 0.03) were associated with mortality. 16S ribosomal RNA (rRNA) analysis was used in a subset of culture-negative cases and increased the diagnostic yield by 13%. Conclusions Clinical or radiological features cannot be used to distinguish between PLA and ALA, or help identify the bacterial cause of PLA. However, ALA is more common in young, male patients with a history of travel. 16S rRNA analysis of abscess fluid has a role in improving microbiological diagnosis in culture-negative cases. Electronic supplementary material The online version of this article (10.1186/s12879-019-4127-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lorna Neill
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK.
| | - Frances Edwards
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK
| | - Simon M Collin
- Healthcare-Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - David Harrington
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK
| | - Dominic Wakerley
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK
| | - Guduru Gopal Rao
- Department of Microbiology, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK.,Department of Medicine, Imperial College London, London, UK
| | - Alastair C McGregor
- Department of Infectious Diseases and Tropical Medicine, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK.,Department of Microbiology, London North West Healthcare NHS Trust, Northwick Park Hospital, Middlesex, Harrow, HA1 3UJ, UK.,Department of Medicine, Imperial College London, London, UK
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12
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Khilnani, GC, Zirpe, K, Hadda, V, Mehta, Y, Madan, K, Kulkarni, A, Mohan, A, Dixit, S, Guleria, R, Bhattacharya, P. Guidelines for Antibiotic Prescription in Intensive Care Unit. Indian J Crit Care Med 2019; 23:S1-S63. [PMID: 31516211 PMCID: PMC6734471 DOI: 10.5005/jp-journals-10071-23101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
How to cite this article: Khilnani GC, Zirpe K, Hadda V, Mehta Y, Madan K, Kulkarni A, Mohan A, Dixit S, Guleria R, Bhattacharya P. Guidelines for Antibiotic Prescription in Intensive Care Unit. Indian Journal of Critical Care Medicine 2019;23 (Suppl 1):1-63.
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Affiliation(s)
- GC Khilnani,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Zirpe,
- Neuro-Trauma Unit, Grant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Vijay Hadda,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Yatin Mehta,
- Indian Society of Critical Care Medicine, Medanta Institute of Critical Care and Anesthesiology, Gurugram, Haryana, India
| | - Karan Madan,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kulkarni,
- Department of Anaesthesiology, Division of Critical Care Medicine, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anant Mohan,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Subhal Dixit,
- Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Randeep Guleria,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Bhattacharya,
- Department of Anaesthesiology, Critical Care and Emergency Services, Bhopal, Madhya Pradesh, India
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13
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Hasan S, Fearn R. Fungal liver abscess in an immunocompetent patient who underwent repeated ERCPs and subtotal cholecystectomy. BMJ Case Rep 2018; 2018:bcr-2017-222013. [PMID: 29449266 DOI: 10.1136/bcr-2017-222013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a previously healthy female patient who initially presented with fever, jaundice and right upper quadrant pain three days after dilatation and stenting of a stricture of the common bile duct (CBD). During an earlier admission, the patient had undergone endoscopic retrograde cholangiopancreatography (ERCP) having presented with fevers and biliary dilatation on ultrasound. The ERCP features were more consistent with Mirizzi's Syndrome. The patient subsequently underwent subtotal cholecystectomy and later developed a CBD stricture, requiring repeat ERCP and stent insertion. At presentation, she had moderately deranged liver function tests and significantly elevated inflammatory markers and was found on cross-sectional imaging to have developed a liver abscess. Aspiration of the lesion cultured Candida albicans She was treated with intravenous antifungals, broad-spectrum antibiotics and further aspiration of abscess, which contributed towards her successful recovery. Fungal liver abscess should be suspected in immunocompetent patients who undergo ERCP and or cholecystectomy.
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Affiliation(s)
- Sundas Hasan
- Department of Acute Medicine, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Robert Fearn
- Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK
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14
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Abstract
Background Fusobacteriae are facultative anaerobic gram-negative bacilli which cause a range of invasive infections, amongst which pyogenic liver abscesses are rare. We describe a case of Fusobacterium nucleatum liver abscess and review the relevant literature. Case presentation A 51-year-old lady presented with a 4-day history of abdominal pain, diarrhoea, fever, rigors, and lethargy. Imaging revealed an abscess which was drained. Cultures of the blood and abscess aspirate grew Fusobacterium nucleatum and Prevotella pleuritidis respectively. She achieved full recovery following treatment. A MEDLINE search was undertaken using free-text and Medical Subject Headings (MeSH), keywords “Fusobacterium” and “Liver abscess”. Non-English language reports and cases without confirmed growth of Fusobacterium species were excluded. Additional cases were identified by surveying the references of each report and by using the same keywords in a web-based search. Forty-eight cases were identified, 41 in men. The median age was 42.5, with an interquartile range of 33. F. nucleatum and F. necrophorum were in involved in 22 cases each, and 4 cases were not further speciated. Among cases of F. nucleatum liver abscess, nine were attributed to periodontal disease, four to lower gastrointestinal tract disease, one to Lemierre’s Syndrome, and eight were considered cryptogenic. All patients treated made a full recovery. Antimicrobial treatment duration ranged from 2 weeks to 6 months with a median of 6 weeks. Conclusion Fusobacterium nucleatum is an uncommon cause of liver abscess generally associated with good clinical outcomes with contemporary medical and surgical care.
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Affiliation(s)
- Dilip Jayasimhan
- Department of Medicine, Waikato Hospital, Level 2 Waiora Waikato Building, Pembroke Street, Hamilton, 3204, New Zealand.
| | - Linus Wu
- Department of General Surgery, Waikato Hospital, Level 2 Waiora Waikato Building, Pembroke Street, Hamilton, 3204, New Zealand
| | - Paul Huggan
- Department of Medicine, Waikato Hospital, Level 2 Waiora Waikato Building, Pembroke Street, Hamilton, 3204, New Zealand.
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15
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Liu L, Chen W, Lu X, Zhang K, Zhu C. Pyogenic Liver Abscess: A Retrospective Study of 105 Cases in an Emergency Department from East China. J Emerg Med 2016; 52:409-416. [PMID: 27765437 DOI: 10.1016/j.jemermed.2016.09.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/09/2016] [Accepted: 09/15/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pyogenic liver abscesses have become common in emergency departments (EDs) in recent years in Shanghai, China due to a variety of risk factors contributory to the disease. OBJECTIVE To review our experience in managing pyogenic liver abscesses to aid in the current management of this complex condition. METHODS This retrospective study was conducted to collect and analyze information from adult patients diagnosed with liver hepatic abscesses who were admitted to Ren Ji Hospital during the period from January 1, 2010 to December 31, 2015. The demographic data, etiology, underlying diseases, clinical presentation, imaging features, laboratory examinations, microbiological tests, treatment, and clinical outcomes were analyzed. RESULTS The data of a total 105 patients were retrospectively analyzed. The mean age of the patients was 62.0 ± 13.5 years. The etiology was predominantly hepatobiliary disease (43/105, 40.1%) or diabetes mellitus (42/105, 40.0%). During hospitalization, 12 patients (11.4%) with septic shock required intensive care. One patient died, yielding a 0.9% fatality rate. In addition to empiric antimicrobial therapy, 66/105 (62.9%) patients underwent ultrasound-guided percutaneous drainage of the liver abscess at diagnosis. Only 3 patients required surgical intervention. Bacterial culture of pyogenic fluids revealed 25 positive results of 66 cases (37.9%). Among them, Klebsiella pneumoniae was the primary pathogen detected in 15 cases (60.0%). CONCLUSIONS Pyogenic liver abscesses have become common in EDs in Shanghai, China. The early recognition of the disease, prompt use of empirical antimicrobial therapy, initiation of drainage in the appropriate patients, and controlling the underlying conditions were crucial for preventing severe sepsis and improving the outcome.
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Affiliation(s)
- Li Liu
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Wanjun Chen
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Xiaoye Lu
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Keji Zhang
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Changqing Zhu
- Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
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