A prospective observational study of demographic profile in patients of amoebic and pyogenic liver abscesses in a tertiary care hospital

Background: Liver abscesses, both amoebic and pyogenic, continue to be an important cause of morbidity and mortality in tropical countries. Pyogenic liver abscess is a serious, life-threatening condition with a high mortality rate that represents a diagnostic and therapeutic challenge. In India, due to poor sanitary condition and a lower socioeconomic status, amoebiasis is endemic and amoebic liver abscess accounts for 3-9% of all cases of amoebiasis. Aim and objectives of current study was to study demographic profile in patients of amoebic and pyogenic liver abscesses. Methods: A detailed history was taken from each of these patients and all of them were subjected to a through clinical examination. Results: The highest incidence occurred in the age group 31-50 years; males were more commonly affected than females. Fever and pain abdomen were the most consistently occurring symptoms. All the patients with liver abscess had abdominal tenderness. 17 patients (74%) with liver abscess were alcoholics. 8 patients (80%) with amoebic liver abscess were alcoholic as compared to 9 patients (69%) in pyogenic liver abscess. Conclusions: Pyogenic organisms were most common cause of liver abscess.

Huge pyogenic liver abscess (PLA) in an elderly patient with diabetes following the pancreaticoduodenectomy / 中华内分泌外科杂志

We described an elderly female with type 2 diabetes referred to our hospital with fever,nausea and upper abdominal pain.The patient had got duodenal tumor and received the pancreaticoduodenectomy (PD) 12 years ago.The laboratory examinations revealed white blood cells (WBC) increasing and severe hypocalcemia.Abdominal computed tomography (CT) revealed a huge gas-forming pyogenic liver abscess (PLA) in left lobe of the liver.The patient got cured after correction of calcium metabolism disorders,treatment with antibiotic and receiving percutaneous tube drainage.We concluded that we should remain on high alert of those patients with DM and the history of cancer,when he or she gets fever of unknown origin and abdominal tenderness.PLA should be considered.

Estudio y tratamiento de los abscesos hepáticos / Study and treatment of liver abscesses

Liver abscess is an unusual but potentially lethal disease. We should be especially cautious in patients diagnosed with biliary pathology or immunosuppression, with right upper quadrant pain, fever or jaundice. The study should include images, cultures and serology for Entamoeba histolytica in certain scenarios. The treatment of pyogenic liver abscess is based on prolonged antibiotic therapy and usually in the drainage of the collection, which can be percutaneous, open or endoscopic. In case of amoebic liver abscesses, drug treatment -in two phases- achieve the parasitic removal at tissue and luminal levels, keeping the drain choice for larger abscesses.

El absceso hepático es una patología poco prevalente pero potencialmente letal. Se debe tener una alta sospecha en pacientes con patología de la vía biliar o inmunosupresión, que presenten dolor en hipocondrio derecho, fiebre o ictericia. El estudio debe incluir imágenes, cultivos y eventualmente serología para Entamoeba histolytica en determinados escenarios. El tratamiento de los abscesos hepáticos piógenos se basa en antibioterapia prolongada y habitualmente en el drenaje de la colección, el cuál puede ser percutáneo, abierto o endoscópico. En el caso de los abscesos hepáticos amebianos el tratamiento farmacológico, en dos fases, logra la eliminación parasitaria a nivel tisular y luminal, reservando el drenaje para los de gran tamaño.

Acute schistosomiasis mansoni: revisited and reconsidered

Acute schistosomiasis is a systemic hypersensitivity reaction against the migrating schistosomula and eggs. A variety of clinical manifestations appear during the migration of schistosomes in humans: cercarial dermatitis, fever, pneumonia, diarrhoea, hepatomegaly, splenomegaly, skin lesions, liver abscesses, brain tumours and myeloradiculopathy. Hypereosinophilia is common and aids diagnosis. The disease has been overlooked, misdiagnosed, underestimated and underreported in endemic areas, but risk groups are well known, including military recruits, some religious congregations, rural tourists and people practicing recreational water sports. Serology may help in diagnosis, but the finding of necrotic-exudative granulomata in a liver biopsy specimen is pathognomonic. Differentials include malaria, tuberculosis, typhoid fever, kala-azar, prolonged Salmonella bacteraemia, lymphoma, toxocariasis, liver abscesses and fever of undetermined origin. For symptomatic hospitalised patients, treatment with steroids and schistosomicides is recommended. Treatment is curative in those timely diagnosed.