Hepatic Abscess in a Returning Traveler with Crohn’s Disease: Differentiating Amebic from Pyogenic Liver Abscess

Gaut, Daria; Shull, Hannah; Bejjani, Anthony; Kahn, Daniel

doi:10.1155/2018/9593865

Cited by 6 publications

(6 citation statements)

References 16 publications

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“…Based on the causative organism, hepatic abscess can be broadly classified into pyogenic and amebic entities. Although the 2 categories have some overlapping features, it is crucial to differentiate between them as the management and prognosis markedly differ [ 8 ]. Pyogenic forms, for example, tend to present as multiple lesions and have a polymicrobial origin [ 2 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although the 2 categories have some overlapping features, it is crucial to differentiate between them as the management and prognosis markedly differ [ 8 ]. Pyogenic forms, for example, tend to present as multiple lesions and have a polymicrobial origin [ 2 , 8 ]. Escherichia coli , Streptococcus species and Klebsiella pneumoniae are among the predominant causative pathogens of PLA, with the latter being the most aggressive agent [ 5 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Escherichia coli , Streptococcus species and Klebsiella pneumoniae are among the predominant causative pathogens of PLA, with the latter being the most aggressive agent [ 5 , 9 ]. Amebic liver abscess, on the other hand, can be suspected when a solitary cyst presents, especially among residents of endemic areas [ 8 , 10 ]. In fact, the clinical manifestations of PLA are usually a combination of non-specific systemic and local symptoms that often include fever, anorexia, RUQ abdominal pain, nausea and vomiting.…”

Section: Discussionmentioning

confidence: 99%

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Pleural Empyema as a Complication of Pyogenic Liver Abscess: Can the Minimum Achieve the Optimal? A Comparison of 3 Approaches

et al. 2021

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Case series Patients: Male, 29-year-old • Male, 42-year-old • Male, 26-year-old Final Diagnosis: Empyema Symptoms: Abdominal pain • dyspnea Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare coexistence of disease or pathology Background: Pyogenic liver abscess is an uncommon entity that is potentially lethal. Pleural empyema and mediastinal collection are 2 rare complications of hepatic abscess that negatively impact the prognosis. Case Reports: Herein, we report 3 cases of pyogenic liver abscesses complicated by pleural empyema, each approached differently, along with a succinct review of the literature. Case 1: A 29-year-old man diagnosed with Crohn’s disease presented with Crohn’s disease-associated hepatic abscess complicated by pleural empyema and concurrent mediastinal collection. The patient demonstrated significant improvement after administration of intrapleural fibrinolytic therapy. Case 2: A 42-year-old man with unremarkable past medical history presented with abdominal pain and dyspnea. Upon investigation, he was found to have massive pleural empyema secondary to liver abscess. In contrast to case 1, case 2 required pleural debridement via video-assisted thoracoscopic surgery followed by formal decortication through a posterolateral thoracotomy. Thereafter, a dramatic clinical improvement was observed. Case 3: A 26-year-old man with history of brucellosis 6 months before was transferred to our facility as a case of pleural empyema secondary to transdiaphragmatic extension of liver abscess. Unlike case 1 and 2, this patient was managed by drainage of hepatic and pleural collections under radiological guidance only, without the need for intrapleural fibrinolytic therapy or surgical intervention. Conclusions: The current paper sheds light on one of the uncommon complications of hepatic abscess and contributes to this scant literature by summarizing pertinent publications. Adequate drainage remains the cornerstone of any pus collection management despite the complexity of some encountered cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pleural Empyema as a Complication of Pyogenic Liver Abscess: Can the Minimum Achieve the Optimal? A Comparison of 3 Approaches

et al. 2021

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“…The hepatic abscess (HA) is an infectious disease characterized by a capsule collection with a suppurative content in the context of the hepatic parenchyma, whose nature may be of bacterial, fungal and/or parasitic origin [1,2]. It represents an extremely severe and potentially fatal condition with an incidence rate ranging from 6 to 15% [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

The Pyogenic Hepatic Abscess: To Drain or not to Drain, that is the Question. Clinical Presentation and Outcome Evaluation after Conservative and Invasive Treatment

MP,

et al. 2023

J Clin Med Surgery

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Background: Pyogenic hepatic abscess (PHA) is an uncommon infectious disease of the liver that should represents a life-threatening condition if not correctly diagnosed and managed. Nowadays there are not precise indications and clear evidences on the best therapeutic approach and on the superiority of a treatment. Methods: Patients with diagnosis of PHA admitted at the Policlinico “Paolo Giaccone” at Palermo University Hospital between January 2010 and December 2022 were identified in a prospective database. Among the demographic, epidemiological and clinical data collected we included the therapeutic choices – antibiotic treatment, image guided percutaneous drainage and surgical operation – and their effect in terms of healing time, treatment failure and time of hospitalization. Results: Patients with single abscesses treated with antibiotics have significant high healing time (p=0.0001) and in-hospital time (p=0.0001) and no differences in treatment failure than patients treated with invasive techniques. Patients that underwent surgical operation have significant higher healing time than percutaneous group (p=0.002) such as higher mean hospital stay (p=0.03 for abscesses <5 cm and p=0.02 for abscesses larger than 5 cm). The last, the percutaneous approach shows a failure rate significantly higher than the surgical procedure (p=0.009 for abscesses <5 cm and p=0.001 for abscesses larger than 5 cm). Conclusions: The study proposed showed the antibiotic therapy is the first line treatment and should first empirically and then directly modified on specimen culture results. Image guided percutaneous drainage should be considered when the antibiotic therapy alone is not sufficient or as bridge to surgery if surgical indications are proven.

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“…[ 1 ] Majority of the cases in developing countries are of amebic etiology, whereas more people suffer from pyogenic liver abscess (PLA) in developed parts of the world. [ 2 ] Entamoeba histolytica , the causative agent of amebiasis, is a protozoan parasite of humans that is estimated to cause amebic liver abscess (ALA) in around 50 million people across the globe. [ 3 ] It is the third leading parasitic cause of death after malaria and schistosomiasis, with an estimated mortality of 100,000 people per year.…”

Section: Introductionmentioning

confidence: 99%

Clinical and laboratory profile of patients with amoebic liver abscess

Tak

Bansal

Maurya

et al. 2022

Tropical Parasitology

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Context: Amebic liver abscess (ALA) occurs in 3%–9% of the amebiasis cases, with complications seen in 20%–40% of the cases and 2%–18% mortality rate. Successful treatment thus requires the accurate identification of these cases. Aims and Objectives: We aimed to assess the seropositivity and profile of ALA patients in western Rajasthan. Materials and Methods: This retrospective study was conducted at a tertiary care center in western Rajasthan from November 2017 to May 2019. Serological diagnosis of ALA was done by detecting immunoglobulin G (IgG) antibodies in the serum of the patients by ELISA. The derangements in laboratory profile (hematological and biochemical parameters) and ultrasonography findings were assessed from the hospital records. Statistical analysis was performed using Mann–Whitney U-test. Results: Among the total cases ( n = 34), 20 were diagnosed as ALA. Twenty-one (61.8%) were positive for anti-amebic IgG antibodies. Among ALA patients, 14 (70%) were >40 years old and only 6 (30%) patients were of age ≤40 years. Male: female ratio was 5.7:1, and ultrasonography records of 15 ALA patients revealed the presence of hepatomegaly ( n = 7, 46.7%), pleural effusion ( n = 3, 20%), lung collapse ( n = 2, 13.3%), and vascular involvement ( n = 1, 6.7%). The right lobe of the liver was involved in majority of the patients ( n = 12, 80%). Total white blood cell count ( P < 0.001), absolute neutrophil count ( P = 0.001), total serum bilirubin ( P = 0.019), and serum alkaline phosphatase ( P = 0.018) were significantly elevated in ALA patients. Conclusions: Seroprevalence shows that ALA still remains the dominant etiology in liver abscess patients in this region. There are significant derangements in the laboratory profile that require a larger study for corroboration.

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Hepatic Abscess in a Returning Traveler with Crohn’s Disease: Differentiating Amebic from Pyogenic Liver Abscess

Cited by 6 publications

References 16 publications

Pleural Empyema as a Complication of Pyogenic Liver Abscess: Can the Minimum Achieve the Optimal? A Comparison of 3 Approaches

Pleural Empyema as a Complication of Pyogenic Liver Abscess: Can the Minimum Achieve the Optimal? A Comparison of 3 Approaches

The Pyogenic Hepatic Abscess: To Drain or not to Drain, that is the Question. Clinical Presentation and Outcome Evaluation after Conservative and Invasive Treatment

Clinical and laboratory profile of patients with amoebic liver abscess

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