Nature Heals: Spontaneous Resolution of Liver Abscess through Hepato-colic Fistula.

Rupture of a liver abscess is a fairly common phenomenon in surgical practice. It is commoner in developing countries like India. Sites of rupture often predict the clinical course of the patient and affect the natural history of the disease, more common being the pleural and peritoneal cavity. Rupture into the bowel with fistulization is a rare phenomenon in liver abscess. Hepato-colic fistulae are being encountered following radiofrequency ablation for hepato cellular carcinoma. This occurring in the setting of liver abscess is highly uncommon. We report the first ever case in English literature, wherein an amoebic liver abscess was complicated by the occurrence of a hepato-colic fistula. The patient was a 48-year-old male who had a liver abscess in a background of alcoholic liver disease. On further investigation, he was found to have abnormal communication between the abscess cavity and the hepatic flexure of the colon. He was managed conservatively followed by spontaneous closure of the fistula.

Three cases of amoebic liver abscess causing inferior vena cava obstruction, with a review of the literature / 대한간학회지

Amoebic liver abscess is a common disease, especially in endemic areas, but it is a rare cause of inferior vena cava (IVC) obstruction, with only a few cases appearing in the literature. We report three cases of amoebic liver abscess complicated with obstruction of the IVC and which responded to conservative treatment or radiological intervention.

Hepato-pulmonary amebiasis: a case report

Infections with Entamoeba histolytica are seen worldwide and are more prevalent in the tropics. About 90 percent of infections are asymptomatic, and the remaining 10 percent produce a spectrum of clinical syndromes, ranging from dysentery to abscesses of the liver or other organs. Extra-intestinal infection by E. histolytica most often involves liver. Pleuro-pulmonary involvement, seen as the second most common extra-intestinal pattern of infection, is frequently associated with amebic liver abscess. Pulmonary amebiasis occurs in about 2-3 percent of patients with invasive amebiasis. We report herein the case of a 45-year-old male presenting with hepato-pulmonary amebiasis. The diagnosis was established from direct examination of sputum, in which trophozoites of E. histolytica were detected, and by serology. Following treatment with metronidazole and chloroquine, the clinical evolution improved significantly. On regular follow-up visits, the patient was asymptomatic. This case report reiterates the need for collaboration between clinicians and microbiologists for timely diagnosis of such infections.

Absceso hepático amebiano en el embarazo: reporte de un caso / Amebic liver abscess in pregnancy: a case report

La asociación de absceso hepático amebiano y embarazo es poco frecuente y se asocia a un aumento de la morbilidad y mortalidad materna. Presentamos el caso de una paciente de 33 años, cursando un embarazo de 35 semanas, que ingresó a nuestro servicio con el diagnóstico de absceso hepático, cuya etiología fue E. histolytica.

The appearance of amebic liver abscess in pregnancy is uncommon and is associated to increased maternal morbidity and mortality. We report the case of 33 years old woman, with a 35 weeks pregnancy that was admitted in our Hospital with the diagnosis of liver abscess, whose etiology was E. histolytica.

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.

An unusual cause of gastric outlet obstruction: a case report.

We report the case of a 49-year-old male who presented with pain in the upper abdomen and loss of appetite of 1 month's duration. A diagnosis of an unusual amoebic liver abscess was made. The patient recovered well after aspiration of 600 ml of anchovy sauce pus and treatment with metronidazole.

Management of amebic and pyogenic liver abscess.

The management of pyogenic liver abscess differs radically from that of amebic liver abscess. Medical management is the cornerstone of therapy in amebic liver abscess while early intervention in the form of surgical therapy or catheter drainage and parenteral antibiotics is the rule in pyogenic liver abscess. The prognosis of amebic abscess is much better than that of pyogenic abscess and usually a quick response to therapy is seen in amebic abscess.

Ruptured liver abscess with fulminant amoebic colitis: case report with review.

Amoebic liver abscess is the commonest extra intestinal manifestation of amoebiasis. Intraperitoneal rupture of liver abscess and fulminant necrotizing amoebic colitis are rare occurrences which complicate a severe form of invasive disease caused by Entamoeba histolytica. These complications are associated with a high morbidity and mortality. Synchronous pathological lesions in colon and liver are rare. Still rare is the occurrence of complicated colonic and hepatic invasive amoebiasis presenting as an acute abdomen. One such presentation of ruptured liver abscess and necrotizing amoebic colitis in a 70 year old male which was successfully managed is being reported.

Amebic liver abscess in an elderly AIDS patient.

An elderly bisexual male AIDS patient, whose CD4 cell count was 128/mm3 and HIV-RNA was 3.0x10(5) copies/ml, was admitted because of amebic liver abscess and poor nutritional condition. He was treated with daily doses of 1,500 mg of metronidazole for 14 days for amebic liver abscess and with anti-HIV drugs; good therapeutic results were observed. Our study indicates that amebic liver abscess is easily treated by appropriate administration of metronidazole even in an old AIDS patient receiving anti-HIV drugs with low CD4 cell counts and high HIV-RNA values.

HBsAg carrier with simultaneous amebic liver abscess and acute hepatitis E.

Hepatitis E virus (HEV) infection and amebiasis are waterborne diseases that are endemic in India. However, their co-occurrence has never been described. We report a patient who presented with fever, jaundice and tender hepatomegaly and on investigation was found to have coexisting acute hepatitis E and amebic liver abscess. Incidentally, he was also an HBsAg carrier.

Amibiasis hepática en el Instituto Nacional de Pediatría de 1971-1994 / Hepatic amibiasis at the National Pediatrics Institute from 1971 to 1994

Se analizaron 217 casos de amibiasis hepática (AH) con la descripción de sus características clínicas de laboratorio y gabinete, así como los posibles factores de riesgo para el desarrollo de complicaciones y mortalidad y las diferentes modalidades terapéuticas. El promedio anual de ingreso disminuyó de 13 casos durante el periodo de 1971 a 1984, a 4.4 en los últimos años. El 56.6 por ciento fueron menores de cinco años; no obstante, sólo 0.02 por ciento (6) eran menores de un año, 83 por ciento tenían absceso único, con franco predominio en el lóbulo hepático derecho en 73 por ciento. El diagnóstico (Dx) se sospechó clínicamente al ingreso en el 82 por ciento de los casos; en tres pacientes el Dx se hizo en autopsia. El ultrasonido (ULTS), la gamagrafía y la hemaglutinación confirmaron el Dx en todos los pacientes. El ULTS como método de diagnóstico no invasivo fue de gran utilidad ya que los hallazgos sugirieron el Dx en la mayoría de los casos, lo que permitió el pronto inicio del tratamiento. Se observaron complicaciones (ruptura a áreas adyacentes) en 30 por ciento, la más frecuente fue la ruptura del absceso a la cavidad torácica. La ruptura del absceso es un signo de gravedad que requiere tratamiento con aspiración o drenaje quirúrgico. El tiempo de evolución fue significativamente mayor en los niños con complicaciones (23.7 ñ 20.3 vs 16.9 ñ 12.4 días, p<0.05). Ciento setenta y cuatro pacientes recibieron tratamiento con dehidroemetina y metronidazol y el resto solo metronidazol sin diferencia significativa. La recuperación clínica fue significativamente más rápida en los pacientes no complicados que tuvieron además del tratamiento médico punción cerrada del absceso, particularmente en abscesos con diámetro igual o mayor a 10 cm. La mortalidad se redujo de 8 por ciento en los primeros 14 años a ningún fallecimiento en el último periodo. El alto índice de sospecha diagnóstica y el inicio temprano de metronidazol con el drenaje oportuno de los abscesos complicados, probablemente han contribuido a una mejor sobrevida en los últimos años

Absceso hepático

Aunque su frecuencia ha disminuído, el absceso hepático es una posibilidad de diagnóstico que debe tenerse en cuenta. En las naciones menos desarrolladas, su causa más frecuente es la amebiasis

Absceso hepático en pediatría: experiencia en un hospital de infectología / Amebic liver abscess in children. experience in infectology hospital

Objetivo: Revisar la experiencia obtenida con el manejo de los niños con absceso hepático. Material y métodos: Se revisaron 17 expedientes clínicos de niños con diagnóstico de absceso hepático, atendidos en nueve años. Resultados: En 15 casos la etiología fue amibiana; nueve tenían títulos elevados de hemoaglutininas para la amiba. Once pacientes presentaron complicaciones (seis derrame pleural, cuatro neumonía y uno compresión de la vena cava); seis requirieron drenaje quirúrgico y uno punción percutánea. El promedio de días de hospitalización fue de 18.4 días; todos los niños evolucionaron satisfactoriamente. Comentarios: Se comentan los hallazgos con respecto a las experiencias obtenidas por otros autores

Amibiasis del hígado complicada con drenaje espontáneo al pericardio / Amebiasis of the liver complicated with spontaneous drainage to pericrdic space

El objetivo del presente informe es comunicar cuatro casos de amibiasis invasora del hígado que ingresaron al Servicio de Infectología del Hospital General de México durante los años de 1985 a 1987 y que se complicaron con drenaje espontáneo al espacio pericárdico, lo cual fue corroborado con estudios clínicos, serológicos y de imagen que nos dieron la pauta para establecer el tratamiento adecuado tanto médico como quirúrgico. Los datos clínicos de los pacientes fueron, además de los relacionados a la patología hepática, dolor en epigastrio, aparición súbita de disnea, datos de falla cardiaca aguda con disminución de la intensidad de los ruidos cardiacos, así como frote pericárdico. Se presentan los resultados de laboratorio y gabinete y se realiza una comparación con lo consignado en la literatura

Amibiasis extraintestinal

Una vez Entamoeba histolytica penetra a la microcirculación de la pared del tubo digestivo, e independientemente de si el proceso invasor que la llevó hasta allí ha generado o no manifestaciones clínicas, los trofozoitos viables alcanzan la circulación portal y por vía hamatógena, pueden diseminarse a otros órganos, especialmente al hígado que es la primera estructura que se interpone en su camino. De la misma manera, pueden también alcanzar el cerebro. Por diseminación local a partir de un absceso hepático, pueden comprometer la pleura, el pulmón, los bronquios, el pericardio, el peritoneo o la piel de la pared abdominal. En conjunto, estas formas de amibiasis invasora se conocen como amibiasis extraintestinal para diferenciarlas de las formas intestinales de amibiasis invasora cuyo cuadro clínico y tratamiento publicamos en la pasada edición de Tribuna Médica. En la edición de julio se publicó la patogenia de la invasión amibiana y en la de junio el diagnóstico y tratamiento de la amibiasis asintomática.

Liver abscess in polycystic liver disease.

A case of an elderly female whose clinical manifestations were atypical in view of physiologic aging changes and multiple pathology commonly found in the geriatric group. The liver abscess had presented clinically and radiologically like a hepatic malignancy and pus was obtained during the process of liver biopsy. Even though anchovy-like pus suggested amebic in origin, the microscopic exam showed numerous polymorphonuclear leucocyte and the culture both from the blood and pus grew Klebsiella spp. as well as the study for E. histolytica antibody was also negative. Pyogenic liver abscess was the working diagnosis and indicated for surgical drainage. Adult polycystic liver disease was found intraoperatively and the liver pathology did reveal the presence of many amebae in the cavity of the right lobe of the liver. After the administration of ceftriaxone and metronidazole as well as the surgical drainage, the patient recovered uneventfully within sixteen days of admission.