Massive pleural empyema secondary to amoebic liver abscess in a child.

BACKGROUND: Pleural empyema secondary to a ruptured amoebic liver abscess is a rare complication in the pediatric population. CASE REPORT: We report the case of a 13-year-old male with right flank abdominal pain, productive cough with foul-smelling sputum, fever, and respiratory distress. Physical examination revealed breathlessness, decreased vesicular murmur in the right hemithorax, abdominal distension, hepatomegaly, and lower limb edema. Laboratory tests revealed mild anemia, leukocytosis without eosinophilia, elevated alkaline phosphatase, hypoalbuminemia, and positive immunoglobulin G antibodies against Entamoeba histolytica in pleural fluid. He required a chest tube and treatment with metronidazole. After 2 months of follow-up, the abscesses disappeared, and the empyema decreased. CONCLUSIONS: Massive pleural empyema secondary to a ruptured liver abscess is a rare complication. The epidemiological link associated with the symptoms and serological tests can help in the diagnosis.

INTRODUCCIÓN: El empiema pleural secundario a ruptura de absceso amebiano hepático es una complicación poco frecuente en la población pediátrica. CASO CLÍNICO: Se reporta el caso de un paciente de sexo masculino de 13 años que presentó dolor abdominal en flanco derecho, tos productiva con esputo de mal olor, fiebre y dificultad respiratoria. Al examen físico se encontró amplexación y murmullo vesicular disminuido en hemitórax derecho, distensión abdominal, hepatomegalia y edema de miembros inferiores. Los resultados del laboratorio evidenciaron anemia leve, leucocitosis sin eosinofilia, elevación de fosfatasa alcalina, hipoalbuminemia y anticuerpos IgG contra Entamoeba histolytica positivo en líquido pleural. Requirió tubo de drenaje torácico y tratamiento con metronidazol. A los dos meses de seguimiento los abscesos desaparecieron y el empiema disminuyó. CONCLUSIONES: El empiema pleural masivo secundario a ruptura de absceso hepático es una complicación poco frecuente. El nexo epidemiológico asociado con la sintomatología y pruebas serológicas pueden ser de ayuda en el diagnóstico.

Hypocholesterolemia in patients with an amebic liver abscess.

BACKGROUND/AIMS: Many parasites induce changes in the lipid profiles of the host. Cholesterol increases the virulence of Entamoeba histolytica in animal models and in vitro culture. This study aimed to determine, in patients with an amebic liver abscess, the correlation between cholesterol and other features, such as the size and number of abscesses, standard hematological and serum chemistry profiles, liver tests, and duration of hospital stay. METHODS: A total of 108 patients with an amebic liver abscess and 140 clinically healthy volunteers were investigated. Cholesterol and triglycerides were measured in the sera. The data from medical observations and laboratory tests were obtained from the clinical records. RESULTS: A total of 93% of patients with an amebic liver abscess showed hypocholesterolemia not related to any of the studied parameters. Liver function tests correlated with the size of the abscess. The most severe cases of amebic liver disease or death were found in patients whose cholesterol levels continued to decrease despite receiving antiamebic treatment and hospital care. CONCLUSIONS: Our results show that the hypocholesterolemia observed in patients with an amebic liver abscess is not related to any of the clinical and laboratory features analyzed. This is the first study relating hypocholesterolemia to severity of hepatic amebiasis.

Hepato-pulmonary amebiasis: a case report.

Infections with Entamoeba histolytica are seen worldwide and are more prevalent in the tropics. About 90% of infections are asymptomatic, and the remaining 10% 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% 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.

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.

[Probable amebic brain abscess in a homosexual man with an Entamoeba histolytica liver abscess].

A 51-year-old Japanese-Brazilian homosexual man was admitted to a hospital because of fever, headache and right epigastralgia. He had been homosexual for 20 years. An abdominal CT revealed a liver abscess and microscopic examination of the pus of the drainage revealed cystic forms of Entamoeba histolytica. Oral administration of metronidazole 2,250 mg/day was started for amebic liver abscess. He complained of severe throbbing headache, and magnetic resonance imaging (MRI) of the brain showed a brain mass of approximately 2 cm in diameter in the right parietooccipital lobe. An amebic brain abscess was suspected and he was transferred to our hospital. Continuous oral administration of metronidazole for 49 days instead of invasive procedures gradually improved headache, fever and right epigastralgia. On the follow-up MRIs, the brain mass was gradually encapsulated, reduced its size, and finally disappeared. A diagnosis of amebic brain abscess was made on the basis of coexistent amebic liver abscess, MRI findings and a dramatic effectiveness to metronidazole. One should pay attention to E. Histolytica infection in the differential diagnosis of the abscess of the liver and brain since it has been increasing in Japan in recent years.

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.

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.

Supra infection of amoebic liver abscess consequent to acute appendicitis. Clinical case.

Amoebic liver abscess is the most common extra-intestinal manifestation of amebiasis with approximately 10% of the world's population infected by this parasite. Actually, incidence of this infection is also increasing in industrialized countries, as a consequence of the more frequent immigration or travelling. Only 3-10% of patients with intestinal amebiasis develop liver abscess. A clinical case of suprainfection of amoebic liver abscess consequent on acute appendicitis is presented.

Absceso hepático y VIH: a propósito de un caso / Liver abscess and HIV: apropos of a case

Se describió la asociación de absceso hepático de posible etiología amebiana y el virus de la inmunodeficiencia humana, en un paciente cubano que laboró en la república de Etiopía. La importancia de este reporte radicó en que, durante el tiempo transcurrido desde que se describió la infección por VIH, múltiples han sido las infecciones oportunistas reportadas, algunas capaces de dar lugar a la formación de abscesos hepáticos, pero ninguna de estas infecciones es de etiología amebiana. Por otra parte, este paciente constituyó el primer caso reportado de absceso hepático de posible etiología amebiana, en toda la población de pacientes VIH (+) estudiados en el Instituto de Medicina Tropical ôPedro Kouríö(AU)

Common presentations of amebic liver abscess.

STUDY OBJECTIVE: The most common extraintestinal manifestation of Entamoeba histolytica, the agent of amebiasis, is a hepatic abscess. This infection is common throughout the world and can be associated with life-threatening consequences. Given the often nonspecific nature of the complaints related to an amebic abscess, a retrospective review of patients with confirmed disease was done to recognize the most common patterns of presentation. METHODS: A retrospective case series was conducted of all patients with confirmed amebic liver abscess over a 5-year period. All available emergency department and inpatient records were reviewed. Age, sex, country of origin, chief complaint (including duration), vital signs, and physical and laboratory findings were recorded. The use of ultrasonography, computed tomography scan, chest radiograph, and serum antibodies was noted, as well as the final ED diagnosis. RESULTS: Seventy-five patients were reviewed; mean patient age was 35.5 years, 80% were male, and Mexico was the country of origin for 64%. The most common complaint was fever (77%), followed by abdominal pain (72%), which was most often located in the right upper quadrant. Cough (16%), chest pain (19%), and chest radiographic abnormalities (57%) were also common. The majority of patients (69%) had symptoms for less than 13 days. The WBC count was the most consistent laboratory abnormality (83%), whereas the liver aminotransferase, alkaline phosphatase, and bilirubin levels were often normal. Most patients received their diagnoses on the basis of ultrasonography (85%), followed by a confirmatory serum antibody titer (88%). The diagnosis of amebic liver abscess was correctly made in the ED in 31.5% of the patients, with the most common misdiagnoses being cholecystitis (16.4%), hepatitis (12.3%), and pneumonia (9.6%). CONCLUSION: Patients with amebic liver abscess do present to EDs in the southwestern United States, especially in areas with a high immigrant population from endemic areas. Patients with complaints of fever and right upper quadrant abdominal pain, especially men of Hispanic origin, warrant a high degree of vigilance. Whereas most laboratory studies are unhelpful, the diagnosis can often be made in the ED by means of a bedside ultrasonographic test. Treatment should be initiated with metronidazole with disposition to an inpatient medical service.

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

A liver-lung connection.

A 35-year-old man presented with cough, expectoration of green sputum, and right-sided pleuritic chest pain. Symptoms had begun the previous day and he had vomited the night before. The patient also complained of chronic fatigue, a 12-lb. weight loss, insomnia, right-sided back pain, and lower extremity myalgias. He denied having had fever, chills, diaphoresis, dyspnea, diarrhea, dysuria, abdominal pain, skin lesions, or jaundice.

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