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Louis M, Ayinde B, Grabill N, Gibson B. Complex presentation of Bouveret syndrome: Gastric outlet obstruction and septic complications. Radiol Case Rep 2025; 20:2422-2427. [PMID: 40129800 PMCID: PMC11930516 DOI: 10.1016/j.radcr.2025.02.039] [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: 12/09/2024] [Revised: 02/05/2025] [Accepted: 02/10/2025] [Indexed: 03/26/2025] Open
Abstract
Bouveret syndrome, a rare form of gastric outlet obstruction, occurs when a large gallstone migrates through a cholecystoenteric fistula into the duodenum, causing obstruction. We report a 31-year-old female who initially presented with nausea, vomiting, and abdominal pain. Imaging identified a large, calcified gallstone, a hepatic abscess, and acute cholecystitis. Initial treatment involved drainage of the hepatic abscess and antibiotics, with plans for elective cholecystectomy. Three years later, she returned with recurrent symptoms, including early satiety, significant weight loss, and gastric outlet obstruction. Endoscopy confirmed duodenal obstruction, and further imaging revealed a cholecystoduodenal fistula. She underwent an open cholecystectomy with fistula excision, duodenal repair, and nasojejunal feeding tube placement. Her postoperative recovery was smooth, with a gradual return to enteral nutrition. This report presents essential diagnostic and treatment approaches for Bouveret syndrome, including the roles of imaging, endoscopy, and surgery in managing complex cases. Early recognition and a coordinated, individualized treatment plan are crucial to optimizing outcomes in this rare condition.
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Affiliation(s)
- Mena Louis
- Northeast Georgia Health System, Graduate Medical Education Department, 743 Spring Street NE Gainesville, GA 30501
| | - Bolaji Ayinde
- Northeast Georgia Health System, Graduate Medical Education Department, 743 Spring Street NE Gainesville, GA 30501
| | - Nathaniel Grabill
- Northeast Georgia Medical Center, Graduate Medical Education Department, 743 Spring Street NE Gainesville, GA 30501
| | - Brian Gibson
- Northeast Georgia Health System, Trauma and Acute Care Surgery Department, 743 Spring Street NE Gainesville, GA 30501
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Wang XL, Liu QB. [Clinical characteristics and risk factors of pyogenic liver abscess complicated by sepsis in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2025; 27:328-333. [PMID: 40105079 PMCID: PMC11928035 DOI: 10.7499/j.issn.1008-8830.2410025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/20/2025]
Abstract
OBJECTIVES To study the clinical characteristics and risk factors of pyogenic liver abscess complicated by sepsis in children. METHODS A retrospective analysis was conducted on the clinical data of 120 children with pyogenic liver abscess admitted from May 2004 to January 2024. According to the presence of sepsis, the children were divided into a sepsis group (82 cases) and a non-sepsis group (38 cases). The clinical characteristics of the two groups were compared, and risk factors associated with the occurrence of sepsis were identified. RESULTS Among the 120 children with pyogenic liver abscess, 68.3% (82/120) had sepsis. Multivariate logistic regression analysis showed that fever, elevated white blood cell count, and decreased albumin level were closely associated with the occurrence of sepsis (P<0.05). Receiver operating characteristic curve analysis indicated that white blood cell count and albumin levels had significant predictive value for sepsis (P<0.05), and the combination of white blood cell count and albumin level showed higher predictive value for sepsis than the albumin level alone (P<0.05). CONCLUSIONS The clinical manifestations of children with pyogenic liver abscess complicated by sepsis are non-specific. Fever, elevated white blood cell count, and decreased albumin level are risk factors for sepsis in children with pyogenic liver abscess. Clinically, for children with unexplained fever and imaging suggestive of liver abscess, pyogenic liver abscess should be considered. If laboratory tests show elevated white blood cell count and decreased albumin level simultaneously, there should be a high level of suspicion for the development of sepsis.
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Affiliation(s)
- Xue-Li Wang
- Department of Infection, Children's Hospital Affiliated to Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing 400014, China
| | - Quan-Bo Liu
- Department of Infection, Children's Hospital Affiliated to Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing 400014, China
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3
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Naganuma H, Ishida H. Demonstration of Hepatic Vein Abnormalities Using Contrast-Enhanced Sonography in Liver Diseases. Diagnostics (Basel) 2025; 15:709. [PMID: 40150052 PMCID: PMC11941399 DOI: 10.3390/diagnostics15060709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 03/07/2025] [Accepted: 03/10/2025] [Indexed: 03/29/2025] Open
Abstract
Contrast-enhanced US (CEUS) is now widely used to observe the hemodynamics of the liver. The CEUS diagnosis mainly consists of evaluating hepatic artery and portal vein flow changes in liver diseases, but it has not been widely used for the diagnosis of hepatic venous (HV) abnormalities in the clinical setting. For this background, this review tried to reconsider this problem. In short, observing HV CEUS findings, especially HV transit time, serves to largely narrow the differential diagnosis and increase the diagnostic confidence of the CEUS. However, diagnosing HV CEUS diagnosis in a wide range of liver diseases requires understanding of vascular anatomy of the upper abdomen and vascular structure of each disease. Additionally, interpreting CEUS findings of HCC should be prudent, because its drainage vessels change according to the histological progression, from the HV to the portal vein. Thus, the most important way of making use of the CEUS information is interpreting it in conjunction with the clinical data.
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Affiliation(s)
- Hiroko Naganuma
- Department of Gastroenterology, Yokote Municipal Hospital, Yokote 013-8602, Japan
| | - Hideaki Ishida
- Department of Gastroenterology, Akita Red Cross Hospital, Akita 010-1495, Japan
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Adewole V, Boubaker F, Hossu G, Nguyen DT, Blum A, Gondim Teixeira PA, Rumeau C, Gillet R. Diffusion-Weighted MRI Over Standard MRI for Differential Diagnosis between Mucopyocele and Mucoceles. Laryngoscope 2025; 135:1008-1014. [PMID: 39400344 DOI: 10.1002/lary.31833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 09/18/2024] [Accepted: 09/23/2024] [Indexed: 10/15/2024]
Abstract
OBJECTIVE(S) To determine the accuracy of conventional and diffusion-weighted (DWI) MRI for the differential diagnosis between mucopyocele and mucocele using surgical diagnosis as a reference. METHODS This retrospective study included patients referred to our institution between March 2017 and February 2024 for paranasal sinus MRI to characterize an expansile non-enhanced sinus filling on CT. The T1 and T2 signal intensities were recorded, as well as the presence of restriction diffusion, of the penumbra sign, the double rim sign, and the presence of parietal micro-abscesses. Quantitative apparent diffusion coefficient values were also recorded. RESULTS The study included 74 patients aged 18 to 88 years (mean age: 60.4 ± 17.7 years). Of these, 43 had a mucopyocele and 31 had a mucocele. The T1 high signal intensity was different amongst groups as an hypersignal was present in 35.5% of mucoceles and only 4.7% of mucopyoceles (p = 0.02). The T2 signal did not differ between the two groups (p = 0.59). The double rim sign and the presence of parietal micro-abscesses demonstrated 96.8% and 100% specificities, respectively, but were predominantly located in the maxillary sinus. The penumbra sign exhibited a sensitivity of 60.5% and a specificity of 67.7%. All mucopyoceles exhibited a diffusion restriction with an apparent diffusion coefficient of less than 0.78 × 10-3 mm2/s. CONCLUSION DWI is the most useful MRI tool for the accurate differential diagnosis between mucopyocele and mucocele in non-enhanced sinus fillings. LEVEL OF EVIDENCE 3 (case-control study) Laryngoscope, 135:1008-1014, 2025.
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Affiliation(s)
- Vanessa Adewole
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
| | - Fatma Boubaker
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, Nancy, France
| | - Gabriela Hossu
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Duc T Nguyen
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Pedro A Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
| | - Cécile Rumeau
- ENT and Head and Neck Surgery Department, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, DevAh, Nancy, France
| | - Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, Nancy, France
- Université de Lorraine, INSERM, IADI, Nancy, France
- Université de Lorraine, CIC, Innovation Technologique, University Hospital Center of Nancy, Nancy, France
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Nguyen ED, Wen KW, Kakar S, Balitzer DJ. Clinicopathologic features and outcomes of hepatic inflammatory pseudotumour (IPT) and hepatic IPT-like lesions. Histopathology 2025; 86:525-535. [PMID: 39478419 PMCID: PMC11791728 DOI: 10.1111/his.15357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 09/02/2024] [Accepted: 10/14/2024] [Indexed: 02/05/2025]
Abstract
AIMS Hepatic inflammatory pseudotumours (IPTs) are nonneoplastic hepatic masses characterized by variably fibroblastic stroma and inflammatory infiltrate, hypothesized to arise as part of a response to infection or prior surgery. The aim of this study was to evaluate the clinicopathologic features and outcomes of biopsy-proven hepatic IPT as well as other cases with IPT-like histologic features. METHODS AND RESULTS A database search at our institution identified cases with a pathologic diagnosis of hepatic IPT (n = 80) between 2000 and 2023. Histologic features (stromal quality, inflammatory cell components, granulomas, and necrosis) were evaluated. Past medical and surgical history, microbiologic studies, and outcomes were reviewed retrospectively. Patients frequently had a past medical history of malignancy (34%), biliary disease (15%), or prior intraabdominal surgery (24%), and often presented with multifocal hepatic lesions (36%). Variable inflammatory backgrounds were present, including histiocytic (36%), lymphoplasmacytic (34%), or neutrophilic (24%). Specific organisms were identified in 15% of cases, most commonly Klebsiella and Staphylococcus species. Most patients with available clinical follow-up demonstrated radiologic resolution and/or had repeat negative biopsy; a minority of patients (8%) were subsequently diagnosed with neoplastic hepatic lesions. No significant association was seen between histologic features and the subsequent clinical or pathologic diagnosis of hepatic neoplastic lesions. CONCLUSIONS Hepatic IPT is a heterogeneous entity that can present in a variety of clinical scenarios and show a wide morphologic spectrum. These lesions often regress spontaneously or with antibiotics. A subset of cases with hepatic IPT-like histologic features were subsequently diagnosed with malignancy, emphasizing the need for continued follow-up and repeat biopsy depending on clinical and radiologic features.
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Affiliation(s)
- Eric D Nguyen
- Department of PathologyUniversity of California, San FranciscoSan FranciscoCAUSA
- Cellnetix Pathology & LaboratoriesSeattleWAUSA
| | - Kwun Wah Wen
- Department of PathologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Sanjay Kakar
- Department of PathologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Dana J Balitzer
- Department of PathologyUniversity of California, San FranciscoSan FranciscoCAUSA
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Giorgio A, Ciracì E, De Luca M, Stella G, Giorgio V. Hepatic abscess and hydatid liver cyst: European infectious disease point of view. World J Hepatol 2025; 17:103325. [PMID: 40027570 PMCID: PMC11866163 DOI: 10.4254/wjh.v17.i2.103325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Revised: 12/25/2024] [Accepted: 01/21/2025] [Indexed: 02/20/2025] Open
Abstract
This manuscript is based on a recent study by Pillay et al that was published in recently. Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin. The incidence rate in Europe is lower than in developing countries, but it is a major complication with high morbidity, particularly in immunocompromised patients. They are most frequently caused by Enterobacterales infections, but hypervirulent Klebsiella strains are an emerging problem in Western countries. Amoebiasis has been a public health problem in Europe, primarily imported from other endemic foci. At the same time, this infection is becoming an emerging disease, as the number of infected patients who have not traveled to endemic areas is rising. Treatment options for hydatid liver cyst include chemotherapy, open or laparoscopic surgery, percutaneous treatment (percutaneous aspiration, re-aspiration and injection and its modification) and ''wait and watch'' strategy. Most hydatid liver cyst patients in Pillay et al's study received surgical treatment, but several studies have confirmed the safety and efficacy of percutaneous aspiration, re-aspiration and injection.
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Affiliation(s)
- Antonio Giorgio
- Liver Unit, Athena Clinical Center, Piedimonte 81016, Caserta, Italy.
| | - Emanuela Ciracì
- Ospedale Civile di Ostuni (BR), Medicina Interna, Ostuni 72017, Brindisi, Italy
| | | | - Giuseppe Stella
- Department of Pediatric and Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica Del Sacro Cuore, Rome 00168, Italy
| | - Valentina Giorgio
- Department of Pediatric and Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica Del Sacro Cuore, Rome 00168, Italy
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Saeed A, Nesari C, Evans V, Chandrakumaran K, Cecil TD, Moran BJ, Mohamed F. Predicting and managing intra-abdominal collections by image guided percutaneous drainage after cytoreductive surgery and hyperthermic intra peritoneal chemotherapy: A five-year experience with 1313 patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109495. [PMID: 39626331 DOI: 10.1016/j.ejso.2024.109495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 10/29/2024] [Accepted: 11/23/2024] [Indexed: 02/10/2025]
Abstract
INTRODUCTION Intraabdominal collections (IACs) are common following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Inflammatory biomarkers and nutritional index (NI) may predict IACs. Management of IACs with image guided percutaneous drainage (IGPD) is an alternative to laparotomy. AIM To identify factors that predict IACs following CRS and HIPEC and to review outcomes following IGPD. METHOD A retrospective review of prospectively collected data from a national referral centre including patients undergoing CRS and HIPEC who developed IACs treated with IGPD, between January 2018 and March 2022. Propensity score matched cases were compared to evaluate the prediction of IACs. The outcomes of IGPD were reviewed. RESULTS Intraabdominal collections developed in 106 (8.0 %) of 1313 patients and 101/106 underwent IGPD, under Ultrasound or CT guidance. Laparotomy was required in 5/106. In those undergoing IGPD, pre- and postoperative CRP and neutrophils were significantly elevated while pre- and postoperative albumin and NI were significantly lower than propensity score matched controls. The postoperative CRP and neutrophil count, and pre and postoperative albumin and mGPS were identified as independent predictors in multivariable analysis. IGPD improved clinical condition in 94 %. In 15/106(14.8 %) the aetiology of the IAC was anastomotic leak with left subphrenic collections the most common (24/101, 24 %). There were 4 major complications, 2 perforations of bladder during IGPD insertion and 2 post drain removal bleeds. CONCLUSION Intraabdominal collections following CRS and HIPEC can be predicted by inflammatory markers and nutritional index. Prompt use of IGPD results in good outcomes avoiding the need for laparotomy.
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Affiliation(s)
- Ahmed Saeed
- Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Aldermaston Road, Basingstoke, RG24 9NA, United Kingdom.
| | - Camran Nesari
- Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Aldermaston Road, Basingstoke, RG24 9NA, United Kingdom.
| | - Victoria Evans
- Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Aldermaston Road, Basingstoke, RG24 9NA, United Kingdom.
| | - Kandiah Chandrakumaran
- Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Aldermaston Road, Basingstoke, RG24 9NA, United Kingdom.
| | - Thomas Desmond Cecil
- Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Aldermaston Road, Basingstoke, RG24 9NA, United Kingdom.
| | - Brendan John Moran
- Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Aldermaston Road, Basingstoke, RG24 9NA, United Kingdom.
| | - Faheez Mohamed
- Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Aldermaston Road, Basingstoke, RG24 9NA, United Kingdom.
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Rudnick P, Feia K, Laeseke P, Herman J, Geschwind J. Risk Reduction of Intrahepatic Abscess After Locoregional Therapy for Liver Cancer in Patients with Prior Hepatobiliary Intervention. Diagnostics (Basel) 2025; 15:333. [PMID: 39941263 PMCID: PMC11817204 DOI: 10.3390/diagnostics15030333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Revised: 01/28/2025] [Accepted: 01/28/2025] [Indexed: 02/16/2025] Open
Abstract
Intrahepatic abscess is an exceedingly rare complication of locoregional therapy for patients with liver cancer. However, in patients who underwent prior hepatobiliary intervention, the incidence of liver abscess increases significantly, causing morbidity and even mortality in such patients. Here, we will review the relative risk of developing a liver abscess after intraarterial and ablative locoregional therapies in patients with liver cancer depending on whether they underwent any kind of prior hepatobiliary procedures that resulted in violation of the Ampulla of Vater. As a result, patients deemed at high risk of developing a liver abscess were treated prophylactically, with the combination of bowel preparation and antibiotics nearly eliminating the occurrence of a liver abscess after locoregional therapy. Therefore, given the significant risk of developing a liver abscess in patients with prior hepatobiliary procedures, management consisting of prophylactic bowel preparation with antibiotic coverage followed by antibiotics post-locoregional therapy is recommended.
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Affiliation(s)
- Peter Rudnick
- School of Medicine, Creighton University, Omaha, NE 68178, USA;
| | - Kaleb Feia
- Department of Biochemistry and Molecular Biology, University of Iowa, Iowa City, IA 52242, USA;
| | - Paul Laeseke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA;
| | - Joseph Herman
- Department of Radiation Oncology, Northwell Health, New York, NY 11042, USA;
| | - Jeff Geschwind
- Division of Oncology, USA Oncology Centers, Northbrook, IL 60062, USA
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Steffen C, Sägmüller J, Schöneburg D, Göncz E, Möckel M, Ott S, Ungur AL, O 'Brien B. Pyopericardium with cardiac tamponade caused by pyogenic liver abscess: a case report. J Med Case Rep 2025; 19:7. [PMID: 39780178 PMCID: PMC11715506 DOI: 10.1186/s13256-024-05014-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 11/26/2024] [Indexed: 01/11/2025] Open
Abstract
INTRODUCTION Purulent bacterial pericarditis is a potentially fatal disease with mortality rates reaching 100% if left untreated. CASE PRESENTATION We present the case of a 33-year-old Caucasian male patient who developed cardiac tamponade, most likely caused by a pyogenic liver abscess communicating with the pericardium. Treatment with antibiotics, extended sepsis therapy, and drainage of the abscess led to a full recovery. CONCLUSION This report describes a rare but potentially fatal differential diagnosis of aortic dissection and serves as a reminder that lives abscesses can manifest unexpectedly. Clinical signs and symptoms of tamponade can be mistaken as sepsis. In this particular case, the combination of a septic abscess and tamponade caused by pyopericardium posed a diagnostic challenge.
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Affiliation(s)
- Carolin Steffen
- Charité - Universitätsmedizin Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Josef Sägmüller
- Labor Berlin - Charité Vivantes GmbH, Subsidiary company of Charité - Universitätsmedizin Berlin, Sylter Str. 2, 13353, Berlin, Germany
| | - Dominique Schöneburg
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Eva Göncz
- Charité - Universitätsmedizin Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Möckel
- Charité - Universitätsmedizin Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sascha Ott
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Alexander Lavinius Ungur
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Benjamin O 'Brien
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Department of Perioperative Medicine, St Bartholomew's Hospital and Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK
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Chen SC, Wu TT, Yin CH, Chen JS, Chen YS. Widespread Adoption of Microincision Vitrectomy Surgery Improves Visual Outcomes in Endogenous Endophthalmitis with Poor Initial Vision: A 21-Year Experience in Taiwan. Ocul Immunol Inflamm 2025; 33:18-23. [PMID: 38691837 DOI: 10.1080/09273948.2024.2338272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE To review the presentation and visual prognostic factors of patients with endogenous endophthalmitis before and after the introduction of microincision vitrectomy surgery (MIVS), at a tertiary referral hospital in Taiwan, over a 21-year period. METHODS We retrospectively analyzed medical records of patients diagnosed with endogenous endophthalmitis before and after the introduction of MIVS between January 2002 and December 2022. RESULTS Data were collected from 147 patients. Diabetes mellitus was the most common comorbidity (59.9%). Liver abscess (32.7%) was the leading source of infection, followed by urinary tract infection (15.0%), and infective endocarditis (5.4%). Klebsiella pneumoniae (50.4%) was the most common pathogen, followed by Staphylococcus aureus (13.5%), and Candida albicans (8.3%). Poor initial visual acuity worse than counting fingers (CF) (p < 0.001) and diabetes mellitus (p = 0.008) were significantly associated with poor visual outcomes. In the treatment of 98 patients with poor initial visual acuity worse than CF, the proportion of vitrectomy surgeries performed increased from 13/56 (23.2%) to 24/42 (57.1%) (p = 0.001) after the introduction of MIVS. Final visual acuity of CF or better increased from 7/56 (12.5%) to 12/42 (28.6%) after the introduction of MIVS (p = 0.046). Vitrectomy was a better prognostic factor for final visual outcome in patients with poor initial visual acuity of worse than CF (p = 0.011) than other factors. CONCLUSION In endogenous endophthalmitis patients presenting with poor initial visual acuity, vitrectomy was a better visual prognostic factor. MIVS has allowed more patients to undergo vitrectomy and improved visual outcomes.
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Affiliation(s)
- Shih-Chou Chen
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Optometry, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Tsung-Tien Wu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Health Care Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Jin-Shuen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yao-Shen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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11
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Pillay K, Khan ZA, Nweke EE, Omoshoro-Jones J. Clinicopathological presentation of liver abscesses and hydatid liver disease from two South African tertiary hospitals. World J Hepatol 2024; 16:1417-1428. [DOI: 10.4254/wjh.v16.i12.1417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 10/02/2024] [Accepted: 10/29/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND Hepatic abscesses represent infections of the liver parenchyma from bacteria, fungi, and parasitic organisms. Trends in both abscess microbiology and management of abscesses (infective collections) have changed over the past decade. There is a paucity of published data regarding the clinicopathological features of liver abscesses in sub-Saharan Africa and other low-income and middle-income countries.
AIM To evaluate the clinical presentations of liver abscesses and hydatid liver disease at two South African tertiary-level hospitals.
METHODS Information accessed from electronic discharge summaries of patients from two South African referral hospitals in Johannesburg, South Africa from January 2016 to December 2020 were reviewed and analyzed. All patients older than 13 years presenting with infective liver collections (pyogenic, amoebic) and hydatid disease were included. Clinical findings and laboratory, microbiology, and radiology results and outcomes were collated and analyzed.
RESULTS In total, 222 patients were included. There were 123 males (55.41%) and 99 females (44.59%), with a median age of 48 years. Comorbidities included HIV (24.23%), hypertension (20.57%), and diabetes mellitus (16.83%). The majority (74.77%) of abscesses were pyogenic, while amoebic and hydatid abscesses represented 16.22% and 9.01%, respectively. The predominant etiology of the pyogenic liver abscesses (PLA) was biliary-related disease. WBC and C-reactive protein were significantly higher in the pyogenic group (P < 0.0002 and P < 0.007, respectively) when compared to the amoebic and hydatid groups. In patients with PLAs, organisms were cultured on blood in 17.58% and abscess fluid in 56.60%. Klebsiella, Escherichia coli and Streptococci were the most cultured organisms. Sixteen percent of the cultures were polymicrobial. In the overall group, 76.00% (n = 169) of patients requiring drainage had a percutaneous transhepatic catheter drain placed, while 8.76% (n = 19) had open surgery. The median length of hospital stay was 13 days. The mortality rate was 3.02%.
CONCLUSION In this study, the most common type of liver abscess was PLAs of biliary origin in middle-aged males. The microbiology was similar to those described in Asian populations, and non-surgical management via percutaneous drainage was sufficient in the majority of cases with acceptable morbidity and mortality.
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Affiliation(s)
- Krevosha Pillay
- Department of Surgery, University of Witwatersrand, School of Clinical Medicine, Johannesburg 2193, Gauteng, South Africa
| | - Zafar Ahmed Khan
- Department of Surgery, University of Witwatersrand, School of Clinical Medicine, Johannesburg 2193, Gauteng, South Africa
- Department of Hepatobiliary Surgery, Chris Hani Baragwanath Academic Hospital, Soweto 1864, Gauteng, South Africa
| | - Ekene Emmanuel Nweke
- Department of Surgery, University of Witwatersrand, School of Clinical Medicine, Johannesburg 2193, Gauteng, South Africa
| | - Jones Omoshoro-Jones
- Department of Surgery, University of Witwatersrand, School of Clinical Medicine, Johannesburg 2193, Gauteng, South Africa
- Department of Hepatobiliary Surgery, Chris Hani Baragwanath Academic Hospital, Soweto 1864, Gauteng, South Africa
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12
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Huang L, Luo J, Li N, Bao Z, Gu W. Retrospective comparative analysis of human fascioliasis versus bacterial liver abscess. Medicine (Baltimore) 2024; 103:e40914. [PMID: 39686435 DOI: 10.1097/md.0000000000040914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2024] Open
Abstract
This study aimed to compare the clinical characteristics of human fascioliasis and bacterial liver abscesses to provide a reference for the early and effective differentiation of these 2 diseases to avoid misdiagnosis. We retrospectively compared the epidemiological and clinical characteristics of 95 patients with human fascioliasis and 95 with bacterial liver abscess admitted to the First Affiliated Hospital of Dali University between January 2013 and March 30, 2023. The human fascioliasis group exhibited a higher proportion of female patients and a greater frequency of abdominal pain and lesions affecting both lobes of the liver. Additionally, eosinophil count, percentage of eosinophils, red blood cells, hemoglobin, total protein, albumin, carbohydrate antigen-125 (CA-125), CA-199, and CA-724 levels were elevated compared to the bacterial liver abscess group. Conversely, the proportion of patients with diabetes, duration of hospital stay, and the incidence of lesions affecting the right lobe of the liver, cavity formation, ascites, pleural effusion, white blood cells, total bilirubin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase levels were lower in the fascioliasis group compared to the bacterial liver abscess group. Furthermore, higher thrombin time and fibrinogen levels were observed in the fascioliasis group than in the bacterial liver abscess group (P < .05). Human fascioliasis predominantly occurs from August to November, while bacterial liver abscess exhibits a consistent incidence throughout the year. Human fascioliasis predominantly affects young women and demonstrates a seasonal pattern. It is associated with severe abdominal symptoms, widespread lesions, significantly elevated eosinophil levels, and seasonal incidence. Bacterial liver abscess predominantly affects elderly men with diabetes, and it is associated with localized lesions and severe inflammatory manifestations and occurs throughout the year.
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Affiliation(s)
- Lihua Huang
- Department of Infection Disease, The First Affiliated Hospital of Dali University, Dali, Yunnan, PR China
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13
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Veronese P, Cella S, Giacometti A, Lapetina I, Maffini V, Pappalardo M, Rubini M, Ruozi MB, Dodi I. Invasive Streptococcus intermedius Infections in Children: Two Cases from a Pediatric Infectious Diseases Unit in Italy. Pathogens 2024; 13:1099. [PMID: 39770358 PMCID: PMC11728730 DOI: 10.3390/pathogens13121099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 11/26/2024] [Accepted: 12/05/2024] [Indexed: 01/16/2025] Open
Abstract
In recent years, an increasing number of reports have described invasive infections caused by bacteria from Streptococcus anginosus group (SAGs). S. intermedius seems to be more related with pleuropulmonary infections and abscess of the brain and deep soft tissues, and it is more likely to cause suppurative and non-bacteremic infections compared to other members of the same genus. We present two clinical cases of invasive S. intermedius infections in pediatric patients: a liver abscess case and a pansinusitis case associated with bilateral otomastoiditis and parapharyngeal abscess complicated by acute mediastinitis, thrombophlebitis of the cavernous sinus, and thrombosis of the cranial tract of the ipsilateral jugular vein. In both cases, prompt broad-spectrum antibiotic therapy and operative drainage of the collections resulted in a good clinical response with full recovery.
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Affiliation(s)
- Piero Veronese
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
| | - Simone Cella
- Pediatric Radiology Unit, Institute of Radiology, University of Parma, 43126 Parma, Italy;
| | - Alessandra Giacometti
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
| | - Irene Lapetina
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
| | - Valentina Maffini
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
| | - Marco Pappalardo
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
| | - Monica Rubini
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
| | - Maria Beatrice Ruozi
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
| | - Icilio Dodi
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
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14
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Tian Y, Hao D, Du J, Wang H, Wen X. Summary of clinical features of 1800 cases of pyogenic liver abscess. Eur J Gastroenterol Hepatol 2024; 37:00042737-990000000-00451. [PMID: 39652844 PMCID: PMC11867797 DOI: 10.1097/meg.0000000000002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Accepted: 11/25/2024] [Indexed: 03/03/2025]
Abstract
OBJECTIVE This study aimed to summarize the clinical and microbiological characteristics of patients with pyogenic liver abscess (PLA) and to explore the clinical features of PLA with extrahepatic migratory infection (EMI). METHODS A retrospective analysis was conducted on clinical data from 1800 PLA patients at Jilin University First Hospital from January 2019 to December 2023. Patients were divided into two groups based on the presence of EMI: with EMI and without EMI. Clinical features and prognoses of the two groups were compared using rank-sum tests and chi-square tests for continuous and categorical data, respectively. RESULTS PLA patients were predominantly male (65.56%) with an average age of 60. Abscesses were mainly located in the right lobe (64.83%) and were often single (68.17%). Klebsiella pneumoniae was the primary pathogen (68.46%), with 9.50% of strains being multidrug-resistant. The majority of patients improved with effective treatment (96.17%). Compared with the non-EMI group, patients with EMI were younger, had longer hospital stays, smaller abscesses, and a higher incidence of diabetes and cerebrovascular disease, with poorer prognoses. CONCLUSION PLA is most commonly observed in middle-aged and elderly males, often presenting as single abscesses in the right lobe, with diabetes as a frequent underlying condition. Most patients recover with appropriate antibiotic treatment and ultrasound-guided drainage. PLA patients with EMI generally have poorer outcomes and require special attention.
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Affiliation(s)
- Yu Tian
- Department of Hepatic-Biliary-Pancreatic Medicine, the First Hospital of Jilin University, Changchun, Jilin Province
- Department of Cardiovascular Medicine, Dandong Central Hospital, Dandong, Liaoning Province, China
| | - Diandian Hao
- Department of Hepatic-Biliary-Pancreatic Medicine, the First Hospital of Jilin University, Changchun, Jilin Province
| | - Jialin Du
- Department of Hepatic-Biliary-Pancreatic Medicine, the First Hospital of Jilin University, Changchun, Jilin Province
| | - Hui Wang
- Department of Hepatic-Biliary-Pancreatic Medicine, the First Hospital of Jilin University, Changchun, Jilin Province
| | - Xiaoyu Wen
- Department of Hepatic-Biliary-Pancreatic Medicine, the First Hospital of Jilin University, Changchun, Jilin Province
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15
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Dudina M, Søgaard KK, Olesen SS, Nielsen HL. A Validation Study of the Danish ICD-10 Diagnosis Code K75.0 for Pyogenic Liver Abscess. Clin Epidemiol 2024; 16:803-810. [PMID: 39588012 PMCID: PMC11587803 DOI: 10.2147/clep.s485678] [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: 07/09/2024] [Accepted: 10/14/2024] [Indexed: 11/27/2024] Open
Abstract
Purpose Routinely collected clinical data are a valuable resource for epidemiological research in infectious diseases. We examined the validity of the ICD-10 diagnosis code K75.0 for pyogenic liver abscess (PLA) from hospital discharge registries. Patients and Methods This validation study was conducted in the North Denmark Region, using data from Aalborg University Hospital and the North Denmark Regional Hospital, along with their smaller regional satellite hospitals. The study period extended from January 1, 2010, to June 30, 2022, covering a catchment population of approximately 590,000 inhabitants. We identified patients with a first diagnosis (primary or secondary) of PLA (ICD-10 code K75.0) recorded in the Danish National Patient Registry and estimated the positive predictive value (PPV) of the PLA diagnosis using medical records as the reference standard. Subanalyses of PPV were conducted based on the department setting (emergency, medical, or surgical). Results A total of 297 patients received an ICD-10 diagnosis code of K75.0 during the study period. Five (2.0%) patients were excluded due to initial hospitalization outside the North Denmark Region, and 67 (23%) were misclassified. The overall PPV for the K75.0 diagnosis code during the study period was 77% (95% CI: 72-82%). The highest PPV, 88% (95% CI: 81-93%), was observed in patients diagnosed in medical departments, while the lowest PPV, 56% (95% CI: 30-80%), was observed in patients diagnosed in emergency wards. The PPV for surgical departments was 69% (95% CI: 61-77%). Conclusion The overall PPV of the ICD-10 diagnosis code K75.0 for PLA was 77%. Variability in PPVs across departments suggested differences in diagnostic accuracy, with medical departments demonstrating the highest PPV.
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Affiliation(s)
- Margarita Dudina
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, 9000, Denmark
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus N, 8200, Denmark
| | - Kirstine Kobberøe Søgaard
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, 9000, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, 9000, Denmark
| | - Søren Schou Olesen
- Department of Clinical Medicine, Aalborg University, Aalborg, 9000, Denmark
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, 9000, Denmark
| | - Hans Linde Nielsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, 9000, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, 9000, Denmark
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16
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Chen Y, Zhou Y, Xu Z. Concurrent Klebsiella pneumoniae liver abscess and infective endocarditis: A rare case report and literature review. IDCases 2024; 38:e02117. [PMID: 39651042 PMCID: PMC11625305 DOI: 10.1016/j.idcr.2024.e02117] [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: 07/11/2024] [Revised: 11/05/2024] [Accepted: 11/11/2024] [Indexed: 12/11/2024] Open
Abstract
Background Investigating the clinical characteristics and treatment strategies of pyogenic liver abscess (PLA) complicated by infective endocarditis (IE), this study draws on a successfully treated case of PLA caused by Klebsiella pneumoniae, alongside a literature review of similar cases. Case Summary We report a 50-year-old male with type 2 diabetes who presented with acute fever, chills, and a liver abscess. The patient was initially treated with intravenous ceftriaxone (2 g daily). Due to the onset of septic shock, the antibiotic regimen was escalated to piperacillin-tazobactam (4.5 g every 8 h) and levofloxacin (0.5 g daily). Ultrasound-guided percutaneous drainage of the liver abscess was performed, and blood cultures confirmed Klebsiella pneumoniae. Upon the development of infective endocarditis, the treatment was adjusted to a combination of ceftriaxone and amikacin for one week, followed by six weeks of ceftriaxone monotherapy, resulting in full recovery. Conclusion This case report illustrates the rare association of Klebsiella pneumoniae-induced PLA with IE in a diabetic patient. It emphasizes the importance of individualized treatment strategies, with insights drawn from this case contributing to the understanding of managing such complex infections. While the successful outcome of this case provides valuable clinical insights, it highlights the need for careful consideration in treatment approaches. The findings from this single case should guide clinicians in similar scenarios but should not be generalized without further evidence.
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Affiliation(s)
- Yuanwen Chen
- Department of Burn and Plastic Surgery, The People’s Hospital of Baoan Shenzhen, Shenzhen, Guangdong 518101, China
| | - Yisheng Zhou
- Department of Cardiology, Guangzhou Development District Hospital (Guangzhou Huangpu District People's Hospital), Guangdong 510730, China
| | - Zhibin Xu
- Department of Organ Transplantation, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China
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17
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Lee J, Nam SW, Kwon JH, Shim DJ, Baek SH, Lee SK. Development of a nomogram to assess thromboembolic risk in patients with liver abscesses. Sci Rep 2024; 14:26718. [PMID: 39496713 PMCID: PMC11535388 DOI: 10.1038/s41598-024-77799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 10/25/2024] [Indexed: 11/06/2024] Open
Abstract
Thromboembolism, a serious complication in patients with liver abscesses, can lead to organ deterioration if left untreated. However, factors associated with thromboembolism in these patients remain poorly understood. We aimed to identify the factors associated with liver abscess complications, with a focus on thromboembolism and metastatic infection. Data from 325 patients diagnosed with liver abscesses between March 2019 and June 2023 were retrospectively collected. Baseline clinical and laboratory variables associated with thromboembolic events and metastatic infections were analyzed using logistic regression. A nomogram for predicting thromboembolism was constructed using significant predictors. Among the 325 patients, the median age was 68.0 years, and included 129 women. Fifty patients experienced thromboembolic events and 44 had metastatic infections. Significant predictors for thromboembolic events included white blood cell (WBC) ≥ 20,000/µL (odds ratio [OR] 3.401, p = 0.002), platelet count < 100,000/µL (OR 3.291, p = 0.004), and abscess septation (OR 2.704, p = 0.007). Age ≥ 65 years (OR 0.457, p = 0.040), WBC ≥ 20,000/µL (OR 3.340, p = 0.005), and abscess septation (OR 2.909, p = 0.008) were identified as factors associated with metastatic infections. A nomogram was constructed to predict thromboembolism using the following four variables: WBC ≥ 20,000/µL platelet count < 100,000/µL, albumin < 2.8 g/dL, and abscess septation, and demonstrated an AUROC of 0.755. Our study is the first to develop a reliable nomogram for thromboembolism prediction, utilizing easily accessible clinical parameters. This innovative model enables clinicians to efficiently identify high-risk patients, facilitating the implementation of additional studies to mitigate the risk of overlooked thromboembolic events in these at-risk individuals.
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Affiliation(s)
- Jaejun Lee
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soon Woo Nam
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 21431, Republic of Korea
| | - Jung Hyun Kwon
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 21431, Republic of Korea
| | - Dong Jae Shim
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Hwan Baek
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soon Kyu Lee
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Republic of Korea.
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 21431, Republic of Korea.
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18
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Louis M, Grabill N, Mohamed B, Khan F, Williams J, Royall NA. Intrahepatic Rupture of Acute Cholecystitis Complicated by Septic Portal Thrombosis. Cureus 2024; 16:e73865. [PMID: 39697909 PMCID: PMC11652117 DOI: 10.7759/cureus.73865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 11/17/2024] [Indexed: 12/20/2024] Open
Abstract
Gallbladder rupture, though rare, is a serious complication often arising from choledocholithiasis and subsequent interventions such as endoscopic retrograde cholangiopancreatography (ERCP). In this case, the patient presented with acute choledocholithiasis and underwent ERCP with sphincterotomy and stone extraction, followed by placement of a fully covered metal stent in the common bile duct (CBD). While the use of covered stents is appropriate, it is important to note that these stents can obstruct the cystic duct orifice in patients with a gallbladder. This occurs in more than 33% of patients with a low cystic duct junction, leading to obstructive acute cholecystitis, as seen in patients with pancreatic ductal adenocarcinoma (PDAC) or distal cholangiocarcinoma who receive metal biliary stents. In this case, the patient developed a liver abscess following a gallbladder rupture, likely due to the stent obstructing the cystic duct. The liver abscess was managed with percutaneous drainage, and cultures grew Streptococcus anginosus, a common pathogen in hepatobiliary infections. The patient was treated with IV piperacillin-tazobactam, followed by oral amoxicillin-clavulanate for a 4-6 week course. Additionally, portal vein thrombosis, a known complication of severe infection, was identified and treated with anticoagulation. This case highlights the need for careful stent selection and possible prophylactic cholecystectomy in patients with a functioning gallbladder to prevent post-ERCP complications like cholecystitis and abscess formation. Early diagnosis, timely drainage, and appropriate antibiotic therapy are critical to managing such complex hepatobiliary conditions.
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Affiliation(s)
- Mena Louis
- General Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA
| | - Nathaniel Grabill
- Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA
| | - Baraa Mohamed
- Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA
| | - Firdous Khan
- Gastroenterology, Augusta University Medical College of Georgia, Augusta, USA
| | - Joe Williams
- Gastroenterology and Hepatology, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Nelson A Royall
- Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA
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Dobek A, Kobierecki M, Ciesielski W, Grząsiak O, Kosztowny K, Fabisiak A, Białek P, Stefańczyk L. Comparative efficacy of contrast-enhanced ultrasound versus B-mode ultrasound in the diagnosis and monitoring of hepatic abscesses. Pol J Radiol 2024; 89:e470-e479. [PMID: 39507891 PMCID: PMC11538908 DOI: 10.5114/pjr/192184] [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: 05/22/2024] [Accepted: 08/09/2024] [Indexed: 11/08/2024] Open
Abstract
Purpose This study aimed to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in diagnosing and monitoring hepatic abscesses (HA). Material and methods This retrospective study included 29 patients (9 females, 20 males) with 64 HA. Computed tomography (CT) served as the diagnostic benchmark, compared with CEUS and B-mode ultrasound (B-mode). Two radiologists assessed the presence, size, and characteristics of the HA. Results The contrast enhancement pattern on CEUS matched post-contrast CT. Lesion size detected by CEUS ranged from 1.16 cm to 15.33 cm (median 5.74 cm). CT classified lesions into four types: I (tumor-like) - 2, II (honeycomb) - 5, III (lacunar) - 23, IV (cystic-like) - 34. CEUS fully agreed with these classifications. B-mode missed two type I lesions. For type III abscesses, agreement with CEUS was perfect (κ = 1, 100%), and moderate with B-mode (κ = 0.50, 79.7%). For type IV abscesses, agreement with CEUS was perfect (κ = 1, 100%), and high with B-mode (κ = 0.88, 93.75%). Pus enhancement remained stable (± 15 dB), while the abscess pouch background varied (± 11 dB to ± 6 dB). The Mann-Whitney U test confirmed these observations (arterial: p = 1.02e-14, portal: p = 3.79e-12, late venous: p = 4.53e-13). No significant difference in enhancement values was found based on abscess size (> 4 cm vs. < 4 cm). Conclusions CEUS is superior to B-mode for diagnosing and monitoring HA, offering clearer views of the abscess pouch, septa, and liver parenchyma. The purulent part lacks contrast, allowing accurate assessment. CEUS can replace CT for monitoring and aid in patient selection for percutaneous intervention.
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Affiliation(s)
- Adam Dobek
- I Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland
| | - Mateusz Kobierecki
- Department of Diagnostic Imaging, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Wojciech Ciesielski
- Department of General Surgery and Transplantology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland
| | - Oliwia Grząsiak
- Department of General Surgery and Transplantology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland
| | - Konrad Kosztowny
- Department of General Surgery and Transplantology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland
| | - Adam Fabisiak
- Department of Digestive Tract Diseases, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland
| | - Piotr Białek
- I Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland
| | - Ludomir Stefańczyk
- I Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Lodz, Poland
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20
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Sforza A, Bonito A, Tiecco G, Moioli G, Storti S, Lechiara M, Castelli F, Quiros-Roldan E. A Rare Case and Literature Review of Pyelo-Hepatic Abscess in an Immunocompetent Patient: When Effective Source Control and Targeted Antimicrobial Therapy Might Not Be Enough. Microorganisms 2024; 12:1989. [PMID: 39458298 PMCID: PMC11509454 DOI: 10.3390/microorganisms12101989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 09/26/2024] [Accepted: 09/28/2024] [Indexed: 10/28/2024] Open
Abstract
Pyelo-hepatic abscess is a rare complication of upper urinary tract infections (UTIs). We describe a case of polymicrobial pyelo-hepatic abscess in an immunocompetent patient. A 71-year-old male patient with a double-J stent for right ureteral lithiasis was admitted in our Infectious Diseases Department for a pyelo-hepatic abscess. Despite a targeted antibiotic therapy against an extended spectrum betalactamase-negative Escherichia coli, the patient did not improve. Further examinations revealed a possible polymicrobial aetiology, including Candida spp. and E. coli resistant to piperacillin/tazobactam but sensitive to third-generation cephalosporins. To date, a paucity of articles regarding pyelo-hepatic abscess exist, consisting mostly of case reports. Urinary stones and a ureteral stent indwelling time exceeding 90 days are known risk factors for upper UTIs and for bacterial dissemination in contiguous organs. Pyelo-hepatic abscesses usually involve Gram-negative bacilli, but they can be polymicrobial, including fungi. As a range of factors could limit the efficacy of antibiotics inside an encapsulated lesion and might contribute to the selection of resistant species during treatment, clinicians should be aware of this complication and try to prevent this event by acting on the main modifiable risk factor.
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Affiliation(s)
- Anita Sforza
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy; (A.S.); (G.T.); (S.S.); (F.C.)
| | - Andrea Bonito
- Operating Unit of Infectious and Tropical Diseases, ASST Spedali Civili, 25123 Brescia, Italy; (A.B.); (G.M.)
| | - Giorgio Tiecco
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy; (A.S.); (G.T.); (S.S.); (F.C.)
| | - Giovanni Moioli
- Operating Unit of Infectious and Tropical Diseases, ASST Spedali Civili, 25123 Brescia, Italy; (A.B.); (G.M.)
| | - Samuele Storti
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy; (A.S.); (G.T.); (S.S.); (F.C.)
| | - Marco Lechiara
- Unit of Diagnostic Radiology 1, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Francesco Castelli
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy; (A.S.); (G.T.); (S.S.); (F.C.)
| | - Eugenia Quiros-Roldan
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy; (A.S.); (G.T.); (S.S.); (F.C.)
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21
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Yang D, Hu D, Hui J, Liu Z. The clinical significance of pyogenic liver abscess after transarterial chemoembolization or microwave ablation on malignant liver tumors: A retrospective study. Medicine (Baltimore) 2024; 103:e39625. [PMID: 39287315 PMCID: PMC11404977 DOI: 10.1097/md.0000000000039625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
Pyogenic liver abscess (PLA) is a rare but severe complication of interventional therapy that has been little studied. We aimed to find the risk factors for PLA after transarterial chemoembolization (TACE) or microwave ablation (MWA), further explore its clinical significance and summarize our experience with its treatment. Twenty-two patients with PLA and 118 randomly selected patients without PLA after TACE/MWA were enrolled. Logistic regression was used to analyze risk factors, a nonparametric test was used to compare recovery duration, the log-rank test was used to compare progression-free survival, and Spearman correlation coefficient was calculated between the time from fever to drainage and the total duration of fever. The disease process and treatment were summarized. Sphincter of Oddi manipulation increased the risk of PLA by 70.781-fold. The PLA group took longer to recover (36.56 ± 16.42 days) than the control group (5.54 ± 4.33 days), and had a shorter progression-free survival. Escherichia coli was the major pathogenic bacterium, and multidrug resistance was found in 8 patients with E coli or Enterococcus faecium. The time from fever to drainage was 15.89 ± 13.78 days, which was positively correlated with the total duration of fever (24.29 ± 18.24 days). Overall, 18 patients recovered, and 4 patients died of PLA, for a mortality rate of 18.18%. The fever of 10 patients (45.45%) was controlled by cefoperazone sodium and sulbactam sodium or piperacillin sodium and tazobactam sodium; the fever of 7 patients (31.81%) was controlled by imipenem and cilastatin sodium; and the fever of 3 patients (13.63%) was controlled by tigecycline. Sphincter of Oddi manipulation is a high-risk factor for PLA after TACE or MWA. PLA can accelerate cancer progression and even lead to death. E coli was the major pathogenic bacterium, and multidrug resistance was most common in E coli and E faecium. Timely drainage and appropriate antibiotics are the key primary measures for treating PLA. Cefoperazone sodium and sulbactam sodium or piperacillin sodium and tazobactam sodium is a good choice for the first treatment of PLA, especially before pathogenic bacteria are identified. With the emergence of drug resistance, imipenem and cilastatin sodium, and tigecycline can be used for posterior treatment.
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Affiliation(s)
- Dong Yang
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, P. R. China
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong, P. R. China
| | - Dongyu Hu
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, P. R. China
| | - Jing Hui
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, P. R. China
| | - Zifeng Liu
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong, P. R. China
- Oncology Department, Jining NO. 1 People's Hospital, Jining, Shandong, P. R. China
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22
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Lyu Y, Wang B. Prognostic risk factors for pyogenic liver abscess caused by Klebsiella pneumoniae. BMC Gastroenterol 2024; 24:298. [PMID: 39227812 PMCID: PMC11373132 DOI: 10.1186/s12876-024-03391-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 08/29/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Pyogenic liver abscess (PLA) caused by Klebsiella pneumoniae can vary in severity, and several risk factors for the development of organ dysfunction in PLA have been implicated. However, few studies to date have explored the most common risk factors for clinical severity. METHODS We conducted a study on patients with PLA caused by Klebsiella pneumoniae between February 2013 and December 2022.Using logistic regression analysis, we sought to identify factors associated with positive blood culture, septic shock, and intensive care unit (ICU) admission. RESULTS After included 200 patients, we found that an elevated procalcitonin (PCT) level (p = 0.03), higher glucose level (p = 0.03), and lower total cholesterol (TC) level (p = 0.01) were associated with a higher likelihood of positive blood bacteriological culture. Additionally, an increased PCT level (p = 0.02) and lower TC level (p < 0.01) were associated with an elevated risk of septic shock. Furthermore, a higher PCT level (p < 0.01) was associated with a higher probability of ICU admission. CONCLUSION In patients with PLA caused by Klebsiella pneumoniae, the PCT, glucose, and TC levels were found to be associated with positive blood culture, septic shock, and ICU admission.
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Affiliation(s)
- Yunxiao Lyu
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, Affiliated Dongyang Hospital of Wenzhou Medical University, 60 West Wuning Road, Dongyang, Zhejiang, 322100, P.R. China.
| | - Bin Wang
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, Affiliated Dongyang Hospital of Wenzhou Medical University, 60 West Wuning Road, Dongyang, Zhejiang, 322100, P.R. China
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23
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Dobek A, Kobierecki M, Kosztowny K, Grząsiak O, Fabisiak A, Falenta K, Stefańczyk L. Utility of Contrast-Enhanced Ultrasound in Optimizing Hepatic Abscess Treatment and Monitoring. J Clin Med 2024; 13:5046. [PMID: 39274258 PMCID: PMC11396598 DOI: 10.3390/jcm13175046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/12/2024] [Accepted: 08/23/2024] [Indexed: 09/16/2024] Open
Abstract
Background/Objectives: Untreated hepatic abscesses (HAs) have an 80% mortality rate and can be caused by bacteria and fungi. Previously managed with surgery, current treatments now utilize interventional radiology and antibiotics, reducing complications to 2.5%. This study evaluates contrast-enhanced ultrasound (CEUS) for better drainage placement and monitoring, overcoming conventional ultrasound's limitations in detecting the HA liquefied portion. Methods: We conducted a retrospective study of 50 patients with HAs confirmed via computed tomography (CT) scans. Inclusion criteria comprised specific clinical symptoms and laboratory parameters. Both B-mode and CEUS were utilized for initial and follow-up imaging. Results: In the CEUS studies, the mean size of HAs was 6.26 cm, with pus displaying significantly lower echogenicity compared to the HA pouch and liver parenchyma in all phases. Classification by size (>6 cm, <6 cm) and volume (>113 mL, <113 mL) revealed differences in the assessment of fluid volume between CEUS and B-mode. Conclusions: CEUS is valuable for diagnosing, performing therapeutic procedures, and monitoring HA. It provides precise real-time assessment of HA morphology, including dimensions and volume. If the liquefied volume of an HA exceeds 113 mL, it may qualify for drainage placement. CEUS can replace CT as an effective, less harmful, and cheaper method, eliminating the need for multiple radiological departments. While CEUS is a safer, cost-effective alternative to CT for HA evaluation and monitoring, comprehensive clinical evaluation remains essential. Therefore, CEUS should be part of a broader diagnostic and monitoring strategy, not a stand-alone solution.
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Affiliation(s)
- Adam Dobek
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Mateusz Kobierecki
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institite, 90-153 Lodz, Poland
| | - Konrad Kosztowny
- Department of General Surgery and Transplantology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Oliwia Grząsiak
- Department of General Surgery and Transplantology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Adam Fabisiak
- Department of Digestive Tract Diseases, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Krzysztof Falenta
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
| | - Ludomir Stefańczyk
- Department of Radiology and Diagnostic Imaging, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
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24
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Díez-Vidal A, Martínez-Martín P, González-Muñoz B, Tung-Chen Y. Point-of-care Ultrasound in Infectious Diseases: Current Insights and Future Perspectives. Clin Infect Dis 2024; 79:420-429. [PMID: 38769593 DOI: 10.1093/cid/ciae285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/09/2024] [Accepted: 05/18/2024] [Indexed: 05/22/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is a safe, noninvasive technique performed at the patient's bedside, providing immediate results to the operator. It complements physical examination and facilitates clinical decision-making. In infectious diseases, POCUS is particularly valuable, offering an initial assessment in cases of suspected infection. It often leads to an early tentative diagnosis enabling the prompt initiation of antimicrobial treatment without the delay associated with traditional radiology. POCUS provides direct visualization of affected organs, assists in evaluating fluid balance, and facilitates various interventions, all while reducing patient discomfort. For infectious disease specialists, becoming proficient in POCUS is a critical future challenge, requiring dedicated training for effective utilization.
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Affiliation(s)
- Alejandro Díez-Vidal
- Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, Madrid, Spain
- IdiPAZ Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Patricia Martínez-Martín
- Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, Madrid, Spain
- IdiPAZ Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
| | - Borja González-Muñoz
- IdiPAZ Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
- Internal Medicine Department, La Paz University Hospital, Madrid, Spain
| | - Yale Tung-Chen
- IdiPAZ Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
- Internal Medicine Department, La Paz University Hospital, Madrid, Spain
- Department of Medicine, Alfonso X El Sabio University, Madrid, Spain
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25
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Hasalliu E, Rehana R, Hanna M, Barawi M. An Unusual Presentation of Monofocal Methicillin-Resistant Staphylococcus aureus Hepatic Abscess in an Otherwise Healthy Man. Cureus 2024; 16:e65542. [PMID: 39188446 PMCID: PMC11346961 DOI: 10.7759/cureus.65542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2024] [Indexed: 08/28/2024] Open
Abstract
A hepatic abscess is the collection of suppurative matter within the parenchyma of the liver. While most pyogenic liver abscesses (PLAs) are polymicrobial in nature, some rare cases are caused by methicillin-resistant Staphylococcus aureus (MRSA). We present a case of a 43 year-old male without evident exposures who presented with abdominal pain and via CT imaging was found to have monofocal MRSA hepatic abscess. An ultrasonography (US)-guided abscess drainage along with a pigtail catheter placement was performed along with antibiotic initiation. This article emphasizes the clinical manifestations of hepatic abscesses and employs literature reviews to offer a comprehensive approach to managing these patient populations.
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Affiliation(s)
- Ermal Hasalliu
- Internal Medicine, Ascension Macomb Oakland Hospital, Warren, USA
| | - Rita Rehana
- Gastroenterology, Ascension Macomb Oakland Hospital, Warren, USA
| | - Majid Hanna
- Internal Medicine, Ascension Macomb Oakland Hospital, Warren, USA
| | - Mohammed Barawi
- Gastroenterology, Ascension Saint John Hospital, Detroit, USA
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26
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Kidess GG, Abou Chaer K, Almawazreh A, Weinberger JJ. A Rare Case of Pseudo-Mirizzi Syndrome Presenting With Acute-on-Chronic Cholecystitis and Hepatic Abscesses. Cureus 2024; 16:e65031. [PMID: 39165467 PMCID: PMC11334691 DOI: 10.7759/cureus.65031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2024] [Indexed: 08/22/2024] Open
Abstract
Mirizzi syndrome (MS) is an uncommon cause of gallstone disease caused by calculous cholecystitis resulting in extrinsic obstruction of the common bile duct, causing concurrent obstructive jaundice. An acalculous variant of MS, at times referred to as pseudo-MS, occurs even more rarely. We present the case of a patient who was found to have pseudo-MS complicated by several hepatic microabscesses. The patient was managed with an endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and eventual cholecystectomy, with histopathology of the gallbladder confirming chronic cholecystitis. To our knowledge, the case presented here is the first in literature that identified pseudo-MS in a patient with pathology-confirmed chronic cholecystitis, and the first to be associated with hepatic abscesses; which usually occur with calculous rather than acalculous biliary disease.
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Affiliation(s)
- George G Kidess
- Department of Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Kenan Abou Chaer
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
| | - Abdallah Almawazreh
- Internal Medicine, Wayne State University Detroit Medical Center, Detroit, USA
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27
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Wendt S, Bačák M, Petroff D, Lippmann N, Blank V, Seehofer D, Zimmermann L, Lübbert C, Karlas T. Clinical management, pathogen spectrum and outcomes in patients with pyogenic liver abscess in a German tertiary-care hospital. Sci Rep 2024; 14:12972. [PMID: 38839980 PMCID: PMC11153614 DOI: 10.1038/s41598-024-63819-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/03/2024] [Indexed: 06/07/2024] Open
Abstract
Pyogenic liver abscesses (PLA) are life-threatening disorders and require immediate treatment, but structured evidence is sparse and treatment guidelines are not established. In a retrospective observational study of 221 adult PLA patients (mean age 63 years, 63% men) treated between 2013 and 2019 at the Leipzig University Medical Center, we characterized pathogen spectrum, clinical management and outcomes. Biliary malignancies (33%), cholelithiasis (23%) and ischemic biliary tract disease (16%) were most common causes of PLA. Comorbidities included malignancies (40%) and diabetes mellitus (35%). Abdominal ultrasound was the preferred initial imaging modality (58%). Enterobacterales (58%), enterococci (42%) and streptococci (18%) were identified as most frequent pathogens. 97% of patients were treated with antibiotics and 75% of patients underwent an invasive treatment procedure. The 30-day mortality was almost identical in patients with and without underlying malignancy (14.6% vs. 14.4%, p = 0.96), while the one-year outcome differed significantly (58.4% vs. 29.6%, p < 0.001). Positive blood cultures (OR 4.78, 95% CI 1.39 to 22.5, p = 0.023) and detection of Enterobacterales (OR 3.55, 95% CI 1.40 to 9.97, p = 0.010) were associated with increased 30-day-mortality. We conclude that ultrasound, extensive microbiologic diagnosis, adequate anti-infective therapy and early intervention are crucial for the management of PLA.
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Affiliation(s)
- Sebastian Wendt
- Hospital Hygiene Staff Unit, University Hospital Halle (Saale), Halle (Saale), Germany
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Leipzig University Medical Center, Leipzig, Germany
| | - Miroslav Bačák
- Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - David Petroff
- Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Norman Lippmann
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Medical Center, Leipzig, Germany
- Institute for Medical Microbiology and Virology, Leipzig University Medical Center, Leipzig, Germany
| | - Valentin Blank
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany
- Division of Interdisciplinary Ultrasound, Department of Medicine I, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Leipzig University Medical Center, Leipzig, Germany
| | - Lisa Zimmermann
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Leipzig University Medical Center, Leipzig, Germany
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Leipzig University Medical Center, Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Medical Center, Leipzig, Germany
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Liebigstraße 20, 04103, Leipzig, Germany.
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Alias NSAQ, Abu-Bakar MF, Rosli AH, Jabbari AJ. A Retrospective Review of Endogenous Endophthalmitis: Three Years of Experience at Sultan Ahmad Shah Medical Centre at International Islamic University Malaysia. Cureus 2024; 16:e63175. [PMID: 39070347 PMCID: PMC11273178 DOI: 10.7759/cureus.63175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Introduction Endogenous endophthalmitis is characterized by severe intraocular inflammation caused by the invasion of microorganisms into the anterior and posterior chambers of the eye. It results from hematogenous spread from distant foci of infection. This, in turn, leads to potential vision loss and blindness due to reduced anatomical and functional outcomes. The latest reported prevalence of endogenous endophthalmitis accounts for at least 2-8% of cases of general endophthalmitis which is fairly significant. Purpose This study aimed to analyze the clinical profile of endogenous endophthalmitis presented in the Ophthalmology Clinic, Sultan Ahmad Shah Medical Centre at International Islamic University Malaysia (SASMEC@IIUM). This study includes the patients' demographics, clinical manifestations, causative organism, treatment, and final visual outcome. Methods This is a retrospective case series of endogenous endophthalmitis patients from January 2020 to June 2023. The data were obtained from the patients' medical records in SASMEC@IIUM. Results A total of six patients (six eyes) were diagnosed with endogenous endophthalmitis from January 2020 to June 2023. Four patients (66.6%) were female, with a mean age of 51.6 ± 17.5 years. Presenting visual acuity ranged between 6/21 to hand movement (HM). Five patients (83.3%) presented with reduced vision, while one presented with eye redness (16.6%). Ocular signs included vitritis and retinitis (five eyes, 83.3%), hypopyon (five eyes, 83.3%), injected conjunctiva (five eyes, 83.3%), and eyelid swelling (one eye, 16.6%). The most common primary infection seen was intraabdominal sepsis (three patients, 50%), septic arthritis, hospital-acquired pneumonia (HAP), and urinary tract infection (UTI). Vitreous biopsy was only positive in two patients (33.3%) However, five out of the six patients (83.3%) had positive blood cultures (two Staphylococcus aureus, two Klebsiella pneumoniae and one Pseudomonas aeruginosa). All patients received intravitreal injections and intravenous antibiotics. Only one patient underwent subsequent trans pars plana vitrectomy (TPPV). Final visual acuity ranged from 6/6 to no light perception (NPL). Conclusion In this case series of six patients, we observed a variety of outcomes with similar presentations despite standardized treatment in all patients. Five out of six patients showed poorer visual outcomes and only one patient showed a final visual acuity of 6/6. Therefore, further study with a larger sample size is needed to evaluate the factors associated with the final visual outcome in endogenous endophthalmitis.
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Affiliation(s)
| | - Mohd-Fadzil Abu-Bakar
- Ophthalmology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, MYS
| | - Abdul-Hadi Rosli
- Ophthalmology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, MYS
| | - Aidila Jesmin Jabbari
- Ophthalmology, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, MYS
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Sohrabi M, Pirbonyeh N, Alizade Naini M, Rasekhi A, Ayoub A, Hashemizadeh Z, Shahcheraghi F. A challenging case of carbapenem resistant Klebsiella pneumoniae-related pyogenic liver abscess with capsular polysaccharide hyperproduction: a case report. BMC Infect Dis 2024; 24:433. [PMID: 38654215 PMCID: PMC11040961 DOI: 10.1186/s12879-024-09314-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections are a major public health problem, necessitating the administration of polymyxin E (colistin) as a last-line antibiotic. Meanwhile, the mortality rate associated with colistin-resistant K. pneumoniae infections is seriously increasing. On the other hand, importance of administration of carbapenems in promoting colistin resistance in K. pneumoniae is unknown. CASE PRESENTATION We report a case of K. pneumoniae-related pyogenic liver abscess in which susceptible K. pneumoniae transformed into carbapenem- and colistin-resistant K. pneumoniae during treatment with imipenem. The case of pyogenic liver abscess was a 50-year-old man with diabetes and liver transplant who was admitted to Abu Ali Sina Hospital in Shiraz. The K. pneumoniae isolate responsible for community-acquired pyogenic liver abscess was isolated and identified. The K. pneumoniae isolate was sensitive to all tested antibiotics except ampicillin in the antimicrobial susceptibility test and was identified as a non-K1/K2 classical K. pneumoniae (cKp) strain. Multilocus sequence typing (MLST) identified the isolate as sequence type 54 (ST54). Based on the patient's request, he was discharged to continue treatment at another center. After two months, he was readmitted due to fever and progressive constitutional symptoms. During treatment with imipenem, the strain acquired blaOXA-48 and showed resistance to carbapenems and was identified as a multidrug resistant (MDR) strain. The minimum inhibitory concentration (MIC) test for colistin was performed by broth microdilution method and the strain was sensitive to colistin (MIC < 2 µg/mL). Meanwhile, on blood agar, the colonies had a sticky consistency and adhered to the culture medium (sticky mucoviscous colonies). Quantitative real-time PCR and biofilm formation assay revealed that the CRKP strain increased capsule wzi gene expression and produced slime in response to imipenem. Finally, K. pneumoniae-related pyogenic liver abscess with resistance to a wide range of antibiotics, including the last-line antibiotics colistin and tigecycline, led to sepsis and death. CONCLUSIONS Based on this information, can we have a theoretical hypothesis that imipenem is a promoter of resistance to carbapenems and colistin in K. pneumoniae? This needs more attention.
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Affiliation(s)
- Maryam Sohrabi
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Neda Pirbonyeh
- Department of Microbiology, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahvash Alizade Naini
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rasekhi
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Ayoub
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Hashemizadeh
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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30
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Ness T. [Bacterial endogenous endophthalmitis : Spectrum of pathogens and drug therapy]. DIE OPHTHALMOLOGIE 2024; 121:264-271. [PMID: 38438813 DOI: 10.1007/s00347-024-01995-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 03/06/2024]
Abstract
Endogenous endophthalmitis represents an ophthalmological emergency requiring immediate diagnostics and treatment. Pathogens should be detected using appropriate methods, such as the Freiburg endophthalmitis set. In bacterial endophthalmitis both Gram-positive and Gram-negative bacteria can be detected. Frequent underlying sources include endocarditis, gastrointestinal or urogenital surgery, indwelling venous catheters, liver abscesses, skin or soft tissue infections, meningitis or less commonly, intravenous drug abuse. The treatment consists of systemic and intraocular administration of antibiotics and vitrectomy. Systemic or intraocular corticosteroids can additionally be considered.
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Affiliation(s)
- Thomas Ness
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
- Albert-Ludwigs Universität Freiburg, Medizinische Fakultät, Freiburg, Deutschland.
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31
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Verdyguer MR, Muñoz BM, Gómez FM, Cardona JL. Quistes hepáticos. MEDICINE - PROGRAMA DE FORMACIÓN MÉDICA CONTINUADA ACREDITADO 2024; 14:506-515. [DOI: 10.1016/j.med.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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32
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Wang LJ, Yin L, Liu KC, Lv WF, Lu D. Liver abscess after drug-eluting bead transarterial chemoembolization for hepatic malignant tumors: Clinical features, pathogenesis, and management. Hepatol Res 2024; 54:358-367. [PMID: 37924506 DOI: 10.1111/hepr.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/19/2023] [Accepted: 10/28/2023] [Indexed: 11/06/2023]
Abstract
AIM The study aimed to investigate the clinical features, incidence, pathogenesis, and management of liver abscess after drug-eluting bead transarterial chemoembolization (DEB-TACE) for primary and metastatic hepatic malignant tumors. METHODS From June 2019 to June 2021, patients with liver abscess after DEB-TACE for primary and metastatic hepatic malignant tumors were reviewed and evaluated at our hospital. Demographic and clinical data, radiological findings, management approaches, and prognosis were retrospectively analyzed. RESULTS In total, 419 DEB-TACE procedures were carried out in 314 patients with primary and metastatic liver tumors at our medical center. Twelve patients were confirmed to have liver abscesses after DEB-TACE through clinical manifestations, laboratory investigations, and imaging. In this study, the incidence of liver abscess was 3.82% per patient and 2.86% per DEB-TACE procedure. After percutaneous drainage and anti-inflammatory treatments, 10 patients recovered, and the remaining 2 patients died due to direct complications of liver abscess, such as sepsis and multiple organ failure. The mortality rate of liver abscesses after DEB-TACE was 16.7% (2/12). CONCLUSION The incidence of liver abscess after DEB-TACE is relatively high and can have serious consequences, including death. Potential risk factors could include large tumor size, history of bile duct or tumor resection, history of diabetes, small DEB size (100-300 μm). Sensitive antibiotics therapy and percutaneous abscess aspiration/drainage are effective treatments for liver abscess after DEB-TACE.
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Affiliation(s)
- Li-Jun Wang
- School of Graduate, Wannan Medical College, Wuhu, China
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Liang Yin
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Kai-Cai Liu
- Department of Infection, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wei-Fu Lv
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Sorlin A, López-Álvarez M, Biboy J, Gray J, Rabbitt SJ, Rahim JU, Lee SH, Bobba KN, Blecha J, Parker MF, Flavell RR, Engel J, Ohliger M, Vollmer W, Wilson DM. Peptidoglycan-Targeted [ 18F]3,3,3-Trifluoro-d-alanine Tracer for Imaging Bacterial Infection. JACS AU 2024; 4:1039-1047. [PMID: 38559735 PMCID: PMC10976610 DOI: 10.1021/jacsau.3c00776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 04/04/2024]
Abstract
Imaging is increasingly used to detect and monitor bacterial infection. Both anatomic (X-rays, computed tomography, ultrasound, and MRI) and nuclear medicine ([111In]-WBC SPECT, [18F]FDG PET) techniques are used in clinical practice but lack specificity for the causative microorganisms themselves. To meet this challenge, many groups have developed imaging methods that target pathogen-specific metabolism, including PET tracers integrated into the bacterial cell wall. We have previously reported the d-amino acid derived PET radiotracers d-methyl-[11C]-methionine, d-[3-11C]-alanine, and d-[3-11C]-alanine-d-alanine, which showed robust bacterial accumulation in vitro and in vivo. Given the clinical importance of radionuclide half-life, in the current study, we developed [18F]3,3,3-trifluoro-d-alanine (d-[18F]-CF3-ala), a fluorine-18 labeled tracer. We tested the hypothesis that d-[18F]-CF3-ala would be incorporated into bacterial peptidoglycan given its structural similarity to d-alanine itself. NMR analysis showed that the fluorine-19 parent amino acid d-[19F]-CF3-ala was stable in human and mouse serum. d-[19F]-CF3-ala was also a poor substrate for d-amino acid oxidase, the enzyme largely responsible for mammalian d-amino acid metabolism and a likely contributor to background signals using d-amino acid derived PET tracers. In addition, d-[19F]-CF3-ala showed robust incorporation into Escherichia coli peptidoglycan, as detected by HPLC/mass spectrometry. Based on these promising results, we developed a radiosynthesis of d-[18F]-CF3-ala via displacement of a bromo-precursor with [18F]fluoride followed by chiral stationary phase HPLC. Unexpectedly, the accumulation of d-[18F]-CF3-ala by bacteria in vitro was highest for Gram-negative pathogens in particular E. coli. In a murine model of acute bacterial infection, d-[18F]-CF3-ala could distinguish live from heat-killed E. coli, with low background signals. These results indicate the viability of [18F]-modified d-amino acids for infection imaging and indicate that improved specificity for bacterial metabolism can improve tracer performance.
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Affiliation(s)
- Alexandre
M. Sorlin
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| | - Marina López-Álvarez
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| | - Jacob Biboy
- The
Centre for Bacterial Cell Biology, Newcastle
University Newcastle, Newcastle
upon Tyne NE2 4AX, United Kingdom
| | - Joe Gray
- The
Centre for Bacterial Cell Biology, Newcastle
University Newcastle, Newcastle
upon Tyne NE2 4AX, United Kingdom
| | - Sarah J. Rabbitt
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| | - Junaid Ur Rahim
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| | - Sang Hee Lee
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| | - Kondapa Naidu Bobba
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| | - Joseph Blecha
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
| | - Mathew F.L. Parker
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
- Department
of Psychiatry, Renaissance School of Medicine
at Stony Brook University, Stony Brook, New York 11794, United States
| | - Robert R. Flavell
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
- UCSF
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California 94158, United States
- Department
of Pharmaceutical Chemistry, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Joanne Engel
- Department
of Medicine, University of California, San
Francisco, San Francisco, California 94158, United States
- Department
of Microbiology and Immunology, University
of California, San Francisco, San
Francisco, California 94158, United States
| | - Michael Ohliger
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
- Department
of Radiology, Zuckerberg San Francisco General
Hospital, San Francisco, California 94110, United States
| | - Waldemar Vollmer
- The
Centre for Bacterial Cell Biology, Newcastle
University Newcastle, Newcastle
upon Tyne NE2 4AX, United Kingdom
- Institute
for Molecular Bioscience, The University
of Queensland, Brisbane 4072, Australia
| | - David M. Wilson
- Department
of Radiology, Biomedical Imaging University
of California, San Francisco, San Francisco, California 94158, United States
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Dumic I, Caetano EM, Domingues SM, Pantic I, Radovanovic M, Prada LR, Nordstrom CW, Antic M, Milovanovic T, Kotseva M, Singh A, Fnu S. Clinical characteristics, diagnosis, treatment, and outcome of patients with liver abscess due to Aspergillus spp: a systematic review of published cases. BMC Infect Dis 2024; 24:345. [PMID: 38519916 PMCID: PMC10960385 DOI: 10.1186/s12879-024-09226-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/14/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Aspergillus spp liver abscess is a relatively rare entity and thus far no systematic review has been performed examining patients' demographics, clinical manifestations, diagnosis, management, and outcome. METHODS We performed a systematic review of the literature using MEDLINE and LILACS databases. We searched for articles published in the period from January 1990 to December 24, 2022, to identify patients who developed liver abscesses due to Aspergillus spp. RESULTS Our search yielded 21 patients all of whom had invasive aspergillosis confirmed on liver biopsy. Of these patients 81% were adults, and 60% were males. The majority (86%) of patients were immunocompromised and 95% had symptomatic disease at the time of diagnosis. The most common symptoms were fever (79%), abdominal pain (47%), and constitutional symptoms (weight loss, chills, night sweats, fatigue) (38%). Liver enzymes were elevated in 50%, serum galactomannan was positive in 57%, and fungal blood cultures were positive in only 11%. Co-infection with other pathogens preceded development of apsergillosis in one-third of patients, and the majority of the abscesses (43%) were cryptogenic. In the remaining patients with known source, 28% of patients developed liver abscess through dissemination from the lungs, 19% through the portal vein system, and in 10% liver abscess developed through contiguous spread. The most common imaging modality was abdominal computerized tomography done in 86% of patients. Solitary abscess was present in 52% of patients while 48% had multiple abscesses. Inadequate initial empiric therapy was prescribed in 60% of patients and in 44% of patients definite treatment included combination therapy with two or more antifungal agents. Percutaneous drainage of the abscesses was done in 40% of patients, while 20% required liver resection for the treatment of the abscess. Overall mortality was very high at 38%. CONCLUSION Further studies are urgently needed for a better understanding of pathophysiology of liver aspergillosis and for developement of newer blood markers in order to expedite diagnosis and decrease mortality.
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Affiliation(s)
- Igor Dumic
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.
| | | | | | - Ivana Pantic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Radovanovic
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Libardo Rueda Prada
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Jacksonville, Florida, USA
| | - Charles W Nordstrom
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Marina Antic
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Tamara Milovanovic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Magdalena Kotseva
- Internal Medicine Residency Program, Franciscan Health, Olympia Fields, IL, USA
| | - Amteshwar Singh
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Shweta Fnu
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Infectious Diseases, Mayo Clinic Health System, Eau Claire, WI, USA
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Parihar SS, Shah AS, Bassi N, Mittal I, Yadav D, Dixit VK, Tiwari AK. Observational Study of Clinical Profiles and Management of Liver Abscess in Hospitalized Patients: A North Indian Tertiary Care Perspective. Cureus 2024; 16:e54401. [PMID: 38505450 PMCID: PMC10950039 DOI: 10.7759/cureus.54401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/21/2024] Open
Abstract
Background Liver abscesses are a significant health concern, necessitating prompt diagnosis and appropriate management. Spontaneous liver abscesses are a frequent reason for hospitalizations in India, particularly in the northern part. By analyzing demographics, symptoms, radiological findings, laboratory parameters, and treatment outcomes, this study will contribute valuable insights to enhance the understanding and management of liver abscesses. Aims and objective To evaluate demographic, clinical, laboratory, and radiological parameters and management options in hospitalized patients with liver abscesses at a tertiary care center. Methods This study retrospectively analyzed prospectively collected data from 150 patients diagnosed with liver abscesses who were admitted to our ward for one year. Data on demographic characteristics, clinical presentation, etiology, radiological findings, laboratory investigations, management strategies, and treatment outcomes were collected. Descriptive statistics and relevant statistical tests were employed for data analysis. Results The study population had a mean age of 40.28±12.72 years, with a male preponderance (136 (90.7%)). Amoebic abscesses (94 (62.7%)) were the most common. Hepatomegaly (144 (96%)), fever (140 (93.3%)), abdominal pain (136 (90.7%)), and anorexia (118 (78.7%)) were the most common symptoms. Ultrasonography revealed solitary abscesses (99 (66%)) to be more common than multiple abscesses (24 (16%)), with a predominant location in the right lobe (128 (85.3%)). Laboratory investigations showed leukocytosis in 121 (80.7%), elevated liver enzymes (95 (63.3%) aspartate aminotransferase (AST) and 80 (53.3%) alanine transaminase (ALT)), elevated alkaline phosphatase (ALP) in 133 (88.7%), and low albumin levels (138 (92%)) in a significant proportion of patients. Single-time needle aspiration (95 (63.3%)), percutaneous drain (36 (24%)), and surgical intervention (4 (2.7%)) were the primary treatment modalities. Serum albumin level (p<0.001) and ALP (p<0.001) were significantly low and high, respectively, in patients with hospital stays ≥10 days. Conclusions This study provides insights into patients with liver abscesses' clinical and laboratory parameters and management strategies. The findings highlight the diverse clinical presentation, varied etiologies, and the importance of radiological imaging and laboratory investigations in diagnosis and management. Tailored treatment strategies based on the patient's condition are crucial for optimizing outcomes.
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Affiliation(s)
- Shishirendu S Parihar
- Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Aakash S Shah
- Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Nitesh Bassi
- Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Ishan Mittal
- Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Dawesh Yadav
- Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Vinod K Dixit
- Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Anurag K Tiwari
- Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
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Ismail M, Elaskandrany MA, Singh S, Chmielewska N, Wang W. A Novel Case of a Massive Amebic Liver Abscess in the Setting of Uncontrolled Diabetes Mellitus and Concurrent Pulmonary Embolism. Cureus 2024; 16:e52533. [PMID: 38371135 PMCID: PMC10874467 DOI: 10.7759/cureus.52533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Amebic liver abscesses (ALAs), one of the most common extraintestinal manifestations of invasive amebiasis, pose diagnostic challenges due to their various clinical presentations and difficulty in distinguishing them from pyogenic abscesses. This case presentation highlights the intricacy of determining the source of an unusually large liver abscess that had an even rare occurrence of a coinciding pulmonary embolus without any evidence of a deep vein thrombosis. This unusual combination underscores the challenges in identifying and managing atypical cases of ALA and emphasizes the need for more comprehensive data to enhance our understanding of such occurrences.
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Affiliation(s)
- Mohamed Ismail
- Department of Internal Medicine, New Jersey Medical School, Rutgers University, Newark, USA
| | | | - Sahiba Singh
- College of Osteopathic Medicine, Michigan State University, East Lansing, USA
| | - Natalia Chmielewska
- Department of Internal Medicine, New Jersey Medical School, Rutgers University, Newark, USA
| | - Weizheng Wang
- Department of Gastroenterology and Hepatology, New Jersey Medical School, Rutgers University, Newark, USA
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Canouï E, Rossi G, Nguyen Y, Lafont E, Rossi B, Roux O, Dokmak S, Bert F, Leflon-Guibout V, Fantin B, Lefort A. Analysis of 15 cases from a monocentric cohort of 307 liver abscesses. Mycoses 2023; 66:984-991. [PMID: 37534436 DOI: 10.1111/myc.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/06/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Out of the context of haematological patients, Candida sp. is rarely retrieved from pyogenic liver abscesses (PLA). OBJECTIVES Our objective was to assess the risk factors for occurrence, and clinical, microbiological characteristics, management and outcome of Candida pyogenic liver abscesses (C-PLA). PATIENTS/METHODS We retrospectively analysed C-PLA cases and compared them to pyogenic liver abscesses exclusively due to bacteria (B-PLA) included in our monocentric database on liver abscesses. Unfavourable course was defined as the occurrence of a primary treatment failure (PTF), recurrence after an initial cure, or death within 3 months after diagnosis. RESULTS Between 2010 and 2018, 15 C-PLA and 292 B-PLA were included. All C-PLA had a biliary origin and were polymicrobial. All patients with C-PLA had at least one comorbidity at risk for Candida infection and 7 (53.3%) presented with sepsis requiring an admission in intensive care unit. Median duration of antifungal treatment was 42 days [24-55]. In multivariate analysis, compared with B-PLA, a medical history of malignancy (OR 4.16; 95%CI 1.15-18.72) or liver abscess (OR 7.39; 95%CI 2.10-26.62), and sepsis with severity criteria (OR 3.52; 95%CI 1.07-11.90) were independently associated with the occurrence of C-PLA. In multivariate analysis, C-PLA was associated with a higher risk of recurrence (HR 3.08; 95%CI 1.38-11.22). CONCLUSION Candida liver abscesses in non-neutropenic is a rare and severe disease. The high rate of recurrence should lead to discuss a more intensive treatment.
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Affiliation(s)
- Etienne Canouï
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Geoffrey Rossi
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Yann Nguyen
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Emmanuel Lafont
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Benjamin Rossi
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Olivier Roux
- Department of Hepatology, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Safi Dokmak
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Beaujon Hospital, GHU AP-HP.Nord-Université Paris Cité, Paris, France
| | - Frédéric Bert
- Department of microbiology, Beaujon Hospital, GHU AP-HP.Nord-Université Paris Cité, Paris, France
| | - Véronique Leflon-Guibout
- Department of microbiology, Beaujon Hospital, GHU AP-HP.Nord-Université Paris Cité, Paris, France
| | - Bruno Fantin
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
- IAME, UMR1137, Université Paris-Cité, Paris, France
| | - Agnès Lefort
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
- IAME, UMR1137, Université Paris-Cité, Paris, France
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Shahid H, Tyberg A, Sarkar A, Gaidhane M, Mahpour NY, Patel R, Flumignan VK, Vazquez-Sequeiros E, Martínez GM, Artifon EL, Kahaleh M. EUS-guided versus percutaneous liver abscess drainage: A multicenter collaborative study. Endosc Ultrasound 2023; 12:472-476. [PMID: 38948125 PMCID: PMC11213585 DOI: 10.1097/eus.0000000000000033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Background and Objectives Management of hepatic abscesses has traditionally been performed by image-guided percutaneous techniques. More recently, EUS drainage has been shown to be efficacious and safe. The aim of this study is to compare EUS-guided versus percutaneous catheter drainage (PCD) of hepatic abscesses. Methods Patients who underwent EUS-guided drainage or PCD of hepatic abscesses from January 2018 through November 2021 from 4 international academic centers were included in a dedicated registry. Demographics, clinical data preprocedure and postprocedure, abscess characteristics, procedural data, adverse events, and postprocedure care were collected. Results Seventy-four patients were included (mean age, 63.9 years; 45% male): EUS-guided (n = 30), PCD (n = 44). Preprocedure Charlson Comorbidity Index scores were 4.3 for the EUS group and 4.3 for the PCD group. The median abscess size was 8.45 × 6 cm (length × width) in the EUS group versus 7.3 × 5.5 cm in the PCD group. All of the abscesses in the EUS group were left-sided, whereas the PCD group contained both left- and right-sided abscesses (29 and 15, respectively). Technical success was 100% in both groups. Ten-millimeter-diameter stents were used in most cases in the EUS group, and 10F catheters were used in the PCD group. The duration to resolution of symptoms from the initial procedure was 10.9 days less in the EUS group compared with the PCD group (P < 0.00001). Hospital length of stay was shorter in the EUS group by 5.2 days (P = 0.000126). The EUS group had significantly fewer number of repeat sessions: mean of 2 versus 7.7 (P < 0.00001) and trended toward fewer number of procedure-related readmissions: 10% versus 34%. The PCD group had a significantly higher number of adverse events (n = 27 [61%]) when compared with the EUS group (n = 5 [17%]; P = 0.0001). Conclusions EUS-guided drainage is an efficacious and safe intervention for the management of hepatic abscesses. EUS-guided drainage allows for quicker resolution of symptoms, shorter length of hospital stay, fewer adverse events, and fewer procedural sessions needed when compared with the PCD technique. However, EUS-guided drainage may not be feasible in right-sided lesions.
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Affiliation(s)
- Haroon Shahid
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Amy Tyberg
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Monica Gaidhane
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Noah Y. Mahpour
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Roohi Patel
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | | | | | | | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
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Cirimele V, D'Amone G, Vertulli D, Spagnolo G, Pileri M, Montanari E, Faiella E, Zobel BB. Liver abscess after endoscopic sleeve gastroplasty: A case report. Radiol Case Rep 2023; 18:4187-4190. [PMID: 37753500 PMCID: PMC10518679 DOI: 10.1016/j.radcr.2023.08.113] [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: 08/19/2023] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
Endoscopic sleeve gastroplasty is a minimally invasive procedure for the treatment of obesity. The procedure is generally safe and well-tolerated, but major adverse events occur in up to 3% of patients. Perigastric abscess is a potential complication caused by postprocedural gastric leak. To the best of our knowledge, no cases of hepatic abscess (HA) following endoscopic sleeve gastroplasty have been reported, while HA is a well-known complication of laparoscopic sleeve gastrectomy. We report the case of a patient who developed a liver abscess 2 weeks after endoscopic sleeve gastroplasty. The patient improved with administration of intravenous antibiotics and endoscopic drainage.
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Affiliation(s)
- Vincenzo Cirimele
- Diagnostic Imaging Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Giulia D'Amone
- Diagnostic Imaging Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Daniele Vertulli
- Diagnostic Imaging Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Giuseppe Spagnolo
- Bariatric Surgery Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Matteo Pileri
- Diagnostic Imaging Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Edoardo Montanari
- Diagnostic Imaging Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Eliodoro Faiella
- Diagnostic Imaging Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Bruno Beomonte Zobel
- Diagnostic Imaging Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
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Alshammary SA, Boumarah DN. Hepatic Abscess in Inflammatory Bowel Disease: A Systematic Scoping Review of an Overlooked Entity. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:267-274. [PMID: 37970456 PMCID: PMC10634461 DOI: 10.4103/sjmms.sjmms_545_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/24/2023] [Accepted: 07/05/2023] [Indexed: 11/17/2023]
Abstract
Background Liver abscess is one of the hepatobiliary manifestations of inflammatory bowel disease (IBD) that has been scarcely described in the literature. Objectives To conduct a scoping review to provide a detailed description of the occurrence of hepatic abscess in patients with IBD and summarize the observed clinical features. Methodology Searches were carried out using relevant keywords in Medline (via PubMed) and Web of Science from inception until June 13, 2022. Only articles that reported the occurrence of hepatic abscess in patients with IBD were included. Results Forty-eight publications (40 case reports and 8 case series) were included, representing 73 patients with IBD who were radiologically or intraoperatively diagnosed with hepatic abscess. Patients with Crohn's disease were more predisposed to developing hepatic abscess than patients with ulcerative colitis (79.5% vs. 20.5%, respectively). Furthermore, pyogenic liver abscess was found to be more prevalent (57.9%) compared with aseptic (38.7%) and amebic (3.2%) abscesses. No clear relation was found between death or prolonged hospital stay in terms of the clinical presentation or management plan, as mortality was reported in different age groups with different managements. Conclusion To date, there is no consensus regarding the appropriate management of hepatic abscess as an extraintestinal manifestation of IBD. However, the condition shares several features with liver abscess diagnosed among the general population.
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Affiliation(s)
- Shadi Abdullah Alshammary
- Department of Surgery, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Dhuha Nahar Boumarah
- Department of Surgery, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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41
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Dauny V, Dioguardi-Burgio M, Leflon-Guibout V, Bert F, Roux O, Houzé S, Lefort A, Rossi G. [Clinical and radiological differences between amoebic and pyogenic liver abscess: A case-control study]. Rev Med Interne 2023; 44:472-478. [PMID: 37105864 DOI: 10.1016/j.revmed.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/06/2023] [Accepted: 03/29/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Amoebic liver abscess (ALA) is the fourth cause of mortality by parasitic infection. This study aimed to assess clinical, radiological and therapeutic characteristics of patients admitted for amoebic liver abscess compared to pyogenic abscess in a French digestive tertiary care-centre. MATERIAL AND METHOD The charts of patients hospitalized for a liver abscess between 2010 and 2020 were retrospectively assessed then separated in two groups: amoebic liver abscess and pyogenic liver abscess from portal underlying cause. Clinical and radiological data were collected for univariate comparison. RESULTS Twenty-one patients were hospitalized during the time of the study for ALA, and 21 patients for pyogenic liver abscess with a portal mechanism. All patients hospitalized for ALA lived in and/or had travelled recently in an endemic area. In comparison with patients hospitalized for pyogenic abscess, patients admitted for ALA were younger (44years old vs. 63years old, P<0.001), had less comorbidities (5% vs. 43% of patients with at least one comorbidity, P<0.01), a longer median duration of symptoms (10days vs. 3days, P=0.015), abdominal pain (86% vs. 52%, P=0.019), and a slighter leucocytosis (9600G/L vs. 15,500G/L, P=0.041) were more frequent. On the abdominal tomodensitometry, density of ALA was higher (34 vs. 25 UH, P<0.01), associated with a focal intra-hepatic biliary dilatation and less often multiloculated. CONCLUSION While rare in western countries, amoebic liver abscess care should not be underestimated. The presence of a solitary liver abscess of intermediate density on computed tomography, occurring on a patient returning from an endemic zone should lead the physician to a possible diagnosis of ALA.
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Affiliation(s)
- Vincent Dauny
- Service de médecine interne, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France.
| | - Marco Dioguardi-Burgio
- Service de radiologie, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France; Inserm U1149, « centre de recherche sur l'inflammation » (CRI), université Paris Cité, 75018 Paris, France
| | - Véronique Leflon-Guibout
- Laboratoire de microbiologie, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France
| | - Frédéric Bert
- Laboratoire de microbiologie, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France
| | - Olivier Roux
- Service d'hépatologie, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France
| | - Sandrine Houzé
- Service de parasitologie, hôpital Bichat, AP-HP, 75018 Paris, France; IRD, MERIT, université Paris Cité, 75006 Paris, France
| | - Agnès Lefort
- Service de médecine interne, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France; Inserm, IAME, UMR1137, université Paris Cité, Paris, France
| | - Geoffrey Rossi
- Service de médecine interne, hôpital Beaujon, groupe hospitalier AP-HP Nord, université Paris Cité, Clichy, France
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Percival A, Lopez DJ, Miller A, Scrivani PV. Computed tomography of suppurative and neoplastic diseases involving the canine omenta and omental bursa. Vet Radiol Ultrasound 2023; 64:851-863. [PMID: 37496369 DOI: 10.1111/vru.13283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/12/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023] Open
Abstract
The greater and lesser omenta are fused peritoneal folds that largely delimit the omental bursa (lesser peritoneal cavity). The omental bursa is a potential space within the abdominal cavity that communicates with the greater peritoneal cavity via the omental (epiploic) foramen: it is subdivided into the omental vestibule, caudal omental recess, and splenic recess. Aims of this retrospective case series study were to describe the frequencies of CT findings of dogs with confirmed inflammatory or neoplastic disease of the omenta, omental bursa, or both. The sample included seven adult, medium-to-large breed dogs. All had fluid in the greater peritoneal cavity and 5/7 (71%) dogs also had fluid in the omental bursa. Primary suppurative inflammatory disease was present in three dogs, each dog had a large abscess with central gas in either the omental vestibule (two dogs) or caudal omental recess (one dog). Both abscesses in the omental vestibule arose from the papillary process of the caudate liver lobe and were surgically removed without complication. Neoplasia was present in four dogs and either arose from omentum (hemangiosarcoma, carcinoma) or infiltrated the omentum from an adjacent organ (splenic leiomyosarcoma, gastric adenocarcinoma). Neoplasms created mass-like tumors, infiltrative tumors, or both and had variable distribution (focal, multifocal, or locally extensive). All dogs with neoplasia were euthanized. CT signs of inflammatory and neoplastic disease overlapped, but the presence of gas might prioritize abscessation. CT signs helped decide feasibility of surgery based on extent of local invasion, especially involvement of structures passing through the porta hepatis.
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Affiliation(s)
- Aaron Percival
- Department of Clinical Sciences, Cornell University, Ithaca, New York, USA
| | - Daniel J Lopez
- Department of Clinical Sciences, Cornell University, Ithaca, New York, USA
| | - Allison Miller
- Department of Clinical Sciences, Cornell University, Ithaca, New York, USA
| | - Peter V Scrivani
- Department of Clinical Sciences, Cornell University, Ithaca, New York, USA
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Goessmann H, Schleder S, Stroszczynski C, Schreyer AG. Significance of Postprocedural Contrast Medium Injection after CT-Guided Abscess Drainage. Tomography 2023; 9:1434-1442. [PMID: 37624107 PMCID: PMC10458545 DOI: 10.3390/tomography9040114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
The aim was to evaluate the additive clinical value of an additional post-procedural control-scan after CT-guided percutaneous abscess drainage (PAD) placement with contrast medium (CM) via the newly placed drain. All CT-guided PADs during a 33-month period were retrospectively analyzed. We analyzed two subgroups, containing patients with and without surgery before intervention. Additionally, radiological records were reevaluated, concerning severe inflammatory response syndrome (SIRS) during the intervention. A total of 499 drainages were placed under CT-guidance in 352 patients. A total of 197 drainages were flushed with CM directly after the intervention, and 51 (26%) showed an additional significant finding. An immediate change of therapy was found in 19 cases (9%). The subgroup that underwent surgery (120 CM-drainages; 32 (27%) additional findings; 13 (11%) immediate changes of therapy) showed no statistically significant difference compared to the subgroup without surgery (77 CM-drainages; 19 (25%) additional findings; 5 (6%) immediate changes of therapy). SIRS occurred in 2 of the 197 flushed drainages (1%) after CM application. An additional scan with CM injection via the newly placed drain revealed clinically significant additional information in almost 26% of the drainages reviewed in this study. In 9% of the cases this information led to an immediate change of therapy. Risks for SIRS are low.
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Affiliation(s)
- Holger Goessmann
- Department of Radiology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Stephan Schleder
- Department of Diagnostic and Interventional Radiology, Merciful Brothers Hospital St. Elisabeth, 94315 Straubing, Germany;
| | | | - Andreas G. Schreyer
- Department of Diagnostic and Interventional Radiology, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg, Germany
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Hu W, Lin X, Qian M, Du TM, Lan X. Treatment of Candida albicans liver abscess complicated with COVID-19 after liver metastasis ablation: A case report. World J Gastrointest Oncol 2023; 15:1311-1316. [PMID: 37546559 PMCID: PMC10401469 DOI: 10.4251/wjgo.v15.i7.1311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Liver interventional surgery is a relatively safe and minimally invasive surgery. However, for patients who have undergone Whipple surgery, the probability of developing a liver abscess after liver interventional surgery is very high. Fungal liver abscess has a high mortality rate, especially when complicated with malignant tumors, diabetes, coronavirus disease 2019 (COVID-19) and other complications. Fungal liver abscess is rare, and there are no guidelines or expert consensus on the course of antifungal therapy.
CASE SUMMARY A 54-year-old woman with pancreatic head cancer received albumin-bound paclitaxel in combination with gemcitabine chemotherapy after laparoscopic pancreaticoduodenectomy. Liver metastasis was found 1 mo after completion of 8 cycles of chemotherapy, followed by ablation of the liver metastasis. After half a month of liver metastasis ablation, the patient experienced fever after chemotherapy and was diagnosed with liver abscess complicated with COVID-19 by contrast-enhanced abdominal computed tomography and real-time polymerase chain reaction detection. The results of pus culture showed Candida albicans, which was sensitive to fluconazole. The patient underwent percutaneous catheter drainage, antifungal therapy with fluconazole, and antiviral therapy with azvudine. During antifungal therapy, the patient showed a significant increase in liver enzyme levels and was discharged after liver protection therapy. Oral fluconazole was continued for 1 wk outside the hospital, and fluconazole was used for a total of 5 wk. The patient recovered well and received 4 cycles of fluorouracil, leucovorin, oxaliplatin, and irinotecan after 2 mo of antifungal therapy.
CONCLUSION Effective treatment of Candida albicans liver abscess requires early detection, percutaneous catheter drainage, and 5 wk of antifungal therapy. Meanwhile, complications such as COVID-19 should be actively managed and nutritional support should be provided.
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Affiliation(s)
- Wen Hu
- Department of Oncology, Chengdu Seventh People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Xi Lin
- Department of Oncology, Yanting County People’s Hospital, Mianyang 621600, Sichuan Province, China
| | - Meng Qian
- Department of Oncology, Chengdu Seventh People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Tao-Ming Du
- Department of Radiology, Chengdu Seventh People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Xi Lan
- Department of Oncology, Chengdu Seventh People’s Hospital, Chengdu 610000, Sichuan Province, China
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White M, Miller R, Locquet L. Bacterial pericarditis associated with a hepatic abscess in a cat. JFMS Open Rep 2023; 9:20551169231208896. [PMID: 38035151 PMCID: PMC10685782 DOI: 10.1177/20551169231208896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Case summary An 8-year-old male neutered domestic shorthair cat presented collapsed and was subsequently diagnosed with a pericardial effusion based on ultrasound imaging. A laboratory analysis of pericardial fluid revealed a septic pericardial effusion and further diagnostics, including abdominal ultrasound and fluid analysis, revealed a concurrent hepatic abscess. Bacterial isolation and identification from both septic foci revealed Escherichia coli. Therapeutic measures included a combination of medical and surgical intervention, the latter including a pericardiectomy, cholecystectomy, liver lobectomy and splenectomy. Relevance and novel information Septic pericarditis is one of the least reported causes of feline pericardial effusion. This case report describes bacterial pericarditis in a cat, suspected to be derived from a hepatic abscess via haematological spread. In this case, a favourable response was achieved with both surgical and medical management.
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Affiliation(s)
- Melissa White
- Dick White Referrals, part of Linnaeus Veterinary Limited, Six Mile Bottom, Cambridgeshire, UK
| | - Rachel Miller
- Vet Oracle Medicine, CVS Referrals, Diss, Norfolk, UK
| | - Laurent Locquet
- Dick White Referrals, part of Linnaeus Veterinary Limited, Six Mile Bottom, Cambridgeshire, UK
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Guo Y, Wang H, Liu Z, Chang Z. Comprehensive analysis of the microbiome and metabolome in pus from pyogenic liver abscess patients with and without diabetes mellitus. Front Microbiol 2023; 14:1211835. [PMID: 37426007 PMCID: PMC10328747 DOI: 10.3389/fmicb.2023.1211835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Pyogenic liver abscess (PLA) patients combined with diabetes mellitus (DM) tend to have more severe clinical manifestations than without DM. The mechanism responsible for this phenomenon is not entirely clear. The current study therefore aimed to comprehensively analyze the microbiome composition and metabolome in pus from PLA patients with and without DM, to determine the potential reasons for these differences. Methods Clinical data from 290 PLA patients were collected retrospectively. We analyzed the pus microbiota using 16S rDNA sequencing in 62 PLA patients. In addition, the pus metabolomes of 38 pus samples were characterized by untargeted metabolomics analysis. Correlation analyses of microbiota, metabolites and laboratory findings were performed to identify significant associations. Results PLA patients with DM had more severe clinical manifestations than PLA patients without DM. There were 17 discriminating genera between the two groups at the genus level, among which Klebsiella was the most discriminating taxa. The ABC transporters was the most significant differential metabolic pathway predicted by PICRUSt2. Untargeted metabolomics analysis showed that concentrations of various metabolites were significantly different between the two groups and seven metabolites were enriched in the ABC transporters pathway. Phosphoric acid, taurine, and orthophosphate in the ABC transporters pathway were negatively correlated with the relative abundance of Klebsiella and the blood glucose level. Discussion The results showed that the relative abundance of Klebsiella in the pus cavity of PLA patients with DM was higher than those without DM, accompanied by changes of various metabolites and metabolic pathways, which may be associated with more severe clinical manifestations.
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Ahmad H, Khan U, Jannat H, Ahmad N. Rare Sequelae of Endoscopic Retrograde Cholangiopancreatography: Polymicrobial Bloodstream Infection and Hepatic Abscess in an Elderly Individual. Cureus 2023; 15:e40517. [PMID: 37461774 PMCID: PMC10350305 DOI: 10.7759/cureus.40517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced technique using a side-viewing upper endoscope to diagnose and treat pancreaticobiliary diseases. ERCP is generally considered a safe procedure; however, it is associated with risks of certain complications such as pancreatitis, bowel perforation, bleeding, and infections. Very rarely, ERCP can result in abscess formation in different organs, such as the pancreas, liver, and intestines. Physicians should be vigilant for rare post-ERCP complications such as clinically significant bacteremia and hepatic abscess, especially in high-risk populations, as if left untreated, they can result in significant morbidity and mortality. We present an interesting and rare case of an 80-year-old patient who presented with nausea, vomiting, and abdominal pain post-ERCP and was found to have a polymicrobial bloodstream infection and a hepatic abscess. The patient was treated with medical therapy alone, with an appropriate clinical response.
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Affiliation(s)
- Hamad Ahmad
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | - Urooj Khan
- Internal Medicine, Khyber Medical University, Peshawar, PAK
| | - Hoore Jannat
- Internal Medicine, Khyber Medical College, Peshawar, PAK
| | - Noaman Ahmad
- Internal Medicine, Huntsville Hospital, Huntsville, USA
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Del Rio T, Fermin B, Sury K. How a Simple Diabetic Ketoacidosis Was Actually a Deadly Liver Abscess. Cureus 2023; 15:e40891. [PMID: 37492821 PMCID: PMC10365395 DOI: 10.7759/cureus.40891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
Pyogenic liver abscesses (PLA) are rare causes of infection in immunocompetent individuals in developed countries. In this report, we discuss a rare presentation and the risk factors associated with developing PLA. Our aim is to raise awareness about PLA developing in patients with uncommon risk factors, enabling early identification and appropriate treatment. The case involves a male patient who presented to the hospital with generalized weakness, was admitted for diabetic ketoacidosis (DKA), and incidentally had elevated liver enzymes that required further investigation. It is important to note that risk factors such as diabetes mellitus, proton pump inhibitors, and colon malignancies are very rare but have been reported in isolated cases as potential risks for developing PLA. Early diagnosis of PLA is crucial due to its high mortality rate, even with intervention.
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Affiliation(s)
- Teresa Del Rio
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
| | - Basilides Fermin
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
| | - Kala Sury
- Pulmonary Critical Care, Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, USA
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García-Casallas J, Patiño-Salazar K, Tuta-Quintero E, Molina-Ardila M. Liver abscess due to Granulicatella adiacens in an immunocompetent patient: Case report. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:22-26. [PMID: 37167469 PMCID: PMC10468023 DOI: 10.7705/biomedica.6504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/04/2023] [Indexed: 05/13/2023]
Abstract
Pyogenic liver abscesses due to Granulicatella adiacens are infections associated with high mortality, mainly in immunocompromised patients. The main microorganisms associated with liver abscesses are Klebsiella pneumoniae, and Escherichia coli, though it may also be polymicrobial. However, case reports describing liver infection by Granulicatella adiacens are scarce. We present the case of an immunocompetent adult patient who presented 15 days of evolution consisting of quantified fever peaks associated with asthenia, adynamia, chills, jaundice and coluria. The initial clinical examination revealed a generalized icteric tint without abdominal pain, and blood pressure with a tendency to hypotension. Biliopancreatic confluent neoplasia, secondary cholangitis and sepsis of biliary origin were suspected, initiating fluid resuscitation and antibiotic therapy; blood cultures and complementary diagnostic studies were taken. Hepatobiliary ultrasound with evidence of an abscess of 73 x 62 mm in segment IV; the bile duct and pancreas were within normal limits. To better characterize the lesion evidenced in the liver, a contrast-enhanced computed tomography of the abdomen was performed. The patient completed antibiotic management with ciprofloxacin, vancomycin, and metronidazole in good condition and was successfully discharged. This is the first pyogenic liver abscess reported caused by Granulicatella adiacens in an immunocompetent patient, in whom early microbiological diagnosis in conjunction with targeted antibiotic treatment and percutaneous drainage of the lesion was decisive in the clinical outcome.
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Affiliation(s)
- Julio García-Casallas
- Facultad de Medicina, Universidad de La Sabana, Chía, Colombia; Clínica Universidad de La Sabana, Chía, Colombia.
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Jiménez-Romero C, Marcacuzco A, Caso Ó, Lechuga I, Manrique A, García-Sesma Á, Calvo J, Aguado JM, López-Medrano F, Juan RS, Justo I. Pyogenic liver abscesses in liver transplant recipients versus non-transplant population. Outcome and risk factors of patient survival. Clin Transplant 2023:e14966. [PMID: 36943872 DOI: 10.1111/ctr.14966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/10/2023] [Accepted: 03/05/2023] [Indexed: 03/23/2023]
Abstract
Pyogenic liver abscess (PLA) is a life-threatening infection in both liver transplant (LT) and non-LT patients. Several risk factors, such as benign and malignant hepatopancreatobiliary diseases and colorectal tumors have been associated with PLA in the non-LT population, and hepatic artery stricture/thrombosis, biliary stricture, and hepaticojejunostomy in the LT patients. The objective of this study is to compare the outcomes of patients with PLA in LT and non-LT patients and to determine the risk factors associated with patient survival. From January 2000 to November 2020, a total of 296 adult patients were diagnosed of PLA in our institution, of whom 26 patients had previously undergone liver transplantation (LTA group), whereas 263 patients corresponded to the non-LTA population. Seven patients with PLA who had undergone previous kidney transplantation were excluded from this retrospective study. Twenty-six patients out of 1503 LT developed PLA (incidence of 1.7%). Median age was significantly higher in non-LTA patients (p = .001). No significant differences were observed in therapy. PLA recurrence was significantly higher in LTA than in non-LTA (34.6% vs. 14.8%; p = .008). In-hospital mortality was greater in the LT group than in the non-LT group (19.2% vs. 9.1% p = .10) and was identified in multivariable analysis as a risk factor for mortality (p = .027). Mortality rate during follow-up did not show significant differences between the groups: 34.6% in LTA patients versus 26.2% in non-LTA patients (p = .10). The most common causes of mortality during follow-up were malignancies, Covid-19 infection, and neurologic disease. 1-, 3-, and 5-year actuarial patient survival rates were 87.0%, 64.1%, and 50.4%, respectively, in patients of LTA group, and 84.5%, 66.5%, and 51.0%, respectively, in patients with liver abscesses in non-LTA population (p = .53). In conclusion, LT was a risk factor for in hospital mortality, but not during long-term follow-up.
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Affiliation(s)
- Carlos Jiménez-Romero
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Alberto Marcacuzco
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Óscar Caso
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Isabel Lechuga
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Alejandro Manrique
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Álvaro García-Sesma
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Jorge Calvo
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, "Doce de Octubre" Hospital, Research Institute (imas12), Faculty of Medicine, Complutense University, Complutense University, Madrid, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, "Doce de Octubre" Hospital, Research Institute (imas12), Faculty of Medicine, Complutense University, Complutense University, Madrid, Spain
| | - Rafael San Juan
- Unit of Infectious Diseases, "Doce de Octubre" Hospital, Research Institute (imas12), Faculty of Medicine, Complutense University, Complutense University, Madrid, Spain
| | - Iago Justo
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
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