Morphological characteristics of liver abscesses according its etiology / Características morfológicas de los abscesos hepáticos según su etiología

Although infrequent in the diagnostics areas, liver abscesses are of significant relevance, which is related to the high morbidity and mortality figures they can cause if they are not detected and treated in time. Although multiple operational classifications are described, the one most recognized for its usefulness is that related to its causative agent (pyogenic or bacterial infection, hydatid origin or secondary to infected hydatidosis, and amoebic or by invasive amebiasis). The objective of this article was to generate a study report regarding the morphological characteristics of liver abscesses, characterizing them according to their etiology, as well as describing their study and the latest recommended treatments.

Los abscesos hepáticos son entidades nosológicas de baja frecuencia, pero de significativa relevancia, la que se relacionada con las elevadas cifras de morbilidad y mortalidad que pueden causar si no son detectados y tratados a tiempo. Si bien se describen múltiples clasificaciones operacionales, aquella más reconocida por su utilidad es la relacionada a su agente causal (piógenos o bacterianos, hidatídicos o secundarios a hidatidosis infectada, y amebianos o por amebiasis invasora). El objetivo de este artículo fue generar un documento de estudio respecto de las características morfológicas de los abscesos hepáticos, caracterizándolos de acuerdo con su etiología, así como describir su estudio y tratamiento recomendado de acuerdo con el estado del arte.

Morbidity due to Schistosoma mansoni - Entamoeba histolytica coinfection in hamsters (Mesocricetus auratus)

Data on Schistosoma mansoni-Entamoeba histolytica coinfection are scarce in the literature. In the present study, hamsters that had been infected for 70 days with Schistosoma mansoni (LE strain) were inoculated via the portal vein with two strains of trophozoites of Entamoeba histolytica: ICB-EGG (highly virulent) and ICB-RPS (non-virulent). The most evident result of coinfection was increased morbidity and mortality, in comparison with either of the infections alone. Histologically, there were no evident signs of interaction between these two infections. The morphological findings of schistosomal granuloma and amoebic abscesses in the liver were similar to those seen in the respective single-infection controls. However, there was severe wasting of the animals with both infections and greater numbers of amoebic lesions in their livers. The results obtained indicated that schistosomiasis aggravates the course of amoebiasis in hamsters.

Dados sobre a co-infecção Schistosoma mansoni-Entamoeba histolytica são escassos na literatura. No presente estudo, hamsters com 70 dias de infecção por Schistosoma mansoni (cepa LE) foram inoculados com trofozoítos de Entamoeba histolytica, cepa ICB-EGG (virulenta) e cepa ICB-RPS (não virulenta), via veia porta. O mais evidente resultado da co-infecção foi o aumento da morbidade e mortalidade, quando comparado com os animais com somente uma das infecções. Histologicamente, não houve sinais evidentes da interação entre as duas infecções. O aspecto morfológico do granuloma esquistossomótico e do abcesso hepático amebiano são similares aos observados nos controles, com somente uma infecção. Entretanto, foi observado que os animais co-infectados apresentavam-se mais debilitados e com maior número de lesões amebianas no fígado. Os resultados obtidos indicam que a esquistossomose agrava o curso da infecção amebiana em hamsters.

Amebiasis extraintestinal en pacientes psiquiatricos: análisis de un caso / Extrainststinal amebiasis in psychatric patients: case studied

El absceso hepático amebiano constituye un grave problema clínico con una alta tasa de mortalidad, sobre todo con los pacientes psiquiátricos que su condición de psicótico minimiza los síntomas dolorosos, haciendo que pasen inadvertidos afecciones graves o que se detecten en estadío avanzado. Las manifestaciones clínicas fueron: pérdida de peso, fiebre, dolor abdominal, tumoración en hipocondrio derecho. El diagnóstico se realizó mediante econosografía y drenaje pericutáneo dirigido de las lesiones hepáticas, lo que unido al tratamiento médico, permitió la completa curación del paciente

Amoebic liver abscess

The term amoebiasis denotes the condition of harbouring Entamoeba histolytica with or without clinical manifestations [WHO 1969]. Amoebiasis occurs throughout Tropics, Sub Tropics and Temperate climates for instance in U.S.A. Northern Europe and Britain Prevalence of Amoebic infection depends on cultural habits, sanitation, crowding and socio-ecoaomic status. The trophozoites of E. Histolylica are carried as emboli into the portal vein from the base of an amoebic ulcer in the large intestine. Once established in the liver they multiply and carry on their cytolytic action. Liver abscesses are usually found in the right lobe. Extensive evidence indicates that cure of amoebic colitis or liver abscess is followed by resistance to subsequent colitis or liver abscess and resistance to subsequent invasive amoebiasis. The Humoral immunity, complement mediated immunity and cell-mediated immunity play their role. Liver abscess of acute onset may present with abdominal pain and fever or sub-acutely with weight loss. Concomitant diarrhoea occurs. Abdominal pain can be referred to the shoulder and accompanied by a non-productive cough. There is usually point tenderness over the liver Hepatomegaly is present. Pleuropulmonary amoebiasis is the most common complication of amoebic abscess and Interaperit oneal rupture, pericardial amoebiasis, obstructive jaundice, splenomegaly, splenic abscess, gastric perforation, glomerular nephritis, hepato duodenal fistula, abdominal vein distention and hepato biliary communication can occur. The complement fixation test simple latex agglutination test haemagglutination inhibition test, counter immunoelectrophoresis using cellulose acetate, ELISA, preciptin test and test of goldman all are used in diagnosis to some extent. Methods available to establish the presence of cystic liver lesions include ultrasound, TC liver scan, CT scan, magnetic resonance imaging scan and GA scan. no of these methods are absolutely specific in differentiating an amoebic liver abscess from a pyogenic obscess or tumour. Extraintestinal amoebiasis should be treated with metronidazole and to prevent continued intraluminal infection, paromycin or diloxanide furoate. Needle aspiration should be used if there is a lack of response to five days of metronidazole treatment, if abscess is very large and patients is very toxic. Surgical treatment is reserved for when medical treatment has failed to produce complete resolution and for certain specific indications

Efecto de la metilprednisolona en la amibiasis hepática experimental / Effect of methylprednisolone in experimental amebic liver abscess

Para examinar si la extensión de la necrosis tisular en la amibiasis hepática experimental en hamsters es proporcional a la magnitud de la respuesta inflamatoria inicial se comparó la evolución morfológica de las lesiones en presencia y en ausencia de dosis altas de metilprednisolona a las 10 hrs, 24 hrs, 72 hrs y 7 días. Se observó en los animales con metilprednisolona una respuesta inflamatoria inicial menor que en los controles y una extensión de las lesiones menor a los 7 días de evolución. La metilprednisolona no altera ni la actividad proteolítica ni la eritrofagocitosis de Entamoeba histolytica in vitro.

Effect of silica treatment on histopathology of intestinal & hepatic amoebiasis in murine model.

Histopathological changes in intestinal and hepatic amoebiasis were studied in Swiss albine mice with and without silica pretreatment. The intestinal infection rate was higher in silica treated mice (83%) as compared to non-silica treated mice (33%). Histologically all the silica treated mice had caecal ulceration which tended to spread across the muscularis propria into the serosal layer. The hepatic lesions were observed grossly in 100 and 60 per cent mice with and without silica treatment, respectively. However, the liver lesions in the silica treated mice were more severe, leading to satellite abscesses and in some cases the capsule ruptured leading to adhesions to the diaphragm and peritoneum. Histologically, the blockade of histiocytes with silica resulted in mainly a neutrophilic damage which was extensive and widespread. It also destroyed the amoeba and led to abundant fibrosis. In the non-silica group the damage was slow and devoid of neutrophils with quicker healing and lack of fibrosis resembling human hepatic lesions.

Tratamiento quirúrgico del absceso hepático amibiano: experiencia durante los últimos años en el Instituto Nacional de la Nutrición Salvador Zubirán / Surgical treatment of hepatic amebic abscess: 10 years' experience

A pesar del advenimiento de efectivos fármacos antiamibianos, el absceso hepático amibiano (AHA) continúa siendo una entidad común en nuestro medio. Se revisaron retrospectivamente 38 pacientes que fueron sometidos a tratamiento quirúrgico para AHA de 1976 a 1985 en el Instituto Nacional de la Nutrición Salvador Zubirán. Las principales manifestaciones clínicas fueron fiebre, dolor abdominal, hepatomegalia e icterica. Las principales indicaciones quirúrgicas fueron falta de respuesta al tratamiento médico, sindrome abdominal agudo y sospecha de perforación. La mortalidad y morbilidad operatoria fueron 29 y 13%, respectivamente. Lo alto de estas cifras refleja que el AHA es una enfermedad severa que debe ser tempranamente diagnosticada y manejada. Las indicaciones principales para cirugía son la falta de respuesta al tratamiento médico o la existencia de complicaciones