RESUMO
BACKGROUND: Amebic liver abscess is the most common type of liver abscess on a worldwide basis, with caudate lobe being a relatively uncommon location for its occurrence. Abscess in caudate lobe of liver is often considered a challenging location for image-guided percutaneous drainage due to its difficult-to-access location along with close relationship with major vessels at porta hepatis. PURPOSE: This study aims to demonstrate safety and efficacy of percutaneous drainage for caudate lobe amebic abscess. MATERIALS AND METHODS: In this retrospective study, hospital database was electronically searched for patients having caudate lobe amebic abscess that underwent percutaneous catheter drainage/needle aspiration (PCD/PNA) between January 2016 and January 2021. The etiology, risk factors, microbiology, complications, different approaches for PCD/PNA, and their outcome were studied and reported. RESULTS: Of 30 patients having caudate lobe amebic abscess treated with PCD/PNA, solitary caudate lobe abscess was seen in 29, whereas one patient had more than one abscesses in caudate lobe. Contained and free intraperitoneal rupture of the abscess were seen in 9 (30%) and one patient, respectively. Ten (32%) patients had associated vascular thrombosis, while 2 patients were found to have abscess-biliary communication. Twenty-six (86.7%) patients were treated with PCD, while remaining 4 (13.3%) with PNA. On Univariate analysis, factors such as volume, multilocularity, and contained rupture of the abscess were found to be significantly increasing the duration of percutaneous drainage (PCD), while only multilocularity (p value 0.007) continued to show statistical significance on Multivariate analysis. Venous thrombosis and duration of catheter drainage were the two factors found to have significant influence on the length of hospital stay on Univariate as well as Multivariate analysis (p value 0.05 and 0.001, respectively). The rates of catheter manipulation were also significantly higher in patients with abscess showing complex internal configuration (heteroechoic contents and/or multilocularity). Technical and clinical success rates of 100% and 96.7% were achieved through percutaneous interventions (PCD/PNA), despite the complex location of abscesses and associated complications, with no incidence of vascular injury. CONCLUSION: Liver abscess in caudate lobe can be accessed by different routes for percutaneous drainage, despite being surrounded by large vessels and its deep location, without major complications. Thus, PCD/PNA may be considered as a first-line therapy for the management of caudate lobe amebic abscesses in adjunct to medical therapy.
Assuntos
Drenagem , Abscesso Hepático Amebiano , Humanos , Abscesso Hepático Amebiano/diagnóstico por imagem , Abscesso Hepático Amebiano/terapia , Estudos Retrospectivos , SucçãoRESUMO
INTRODUCTION: Patients with amoebic liver abscess (ALA) may require percutaneous catheter drainage (PCD). Once the PCD output is substantially reduced or has ceased along with clinical recovery, residual collections on radiological evaluation may concern the treating physicians. The prevalence and significance of such collections is unknown, and the subsequent approach how to tackle them is unclear. METHODS: Consecutive patients with one or more uncomplicated ALAs requiring drainage were prospectively enrolled from 3 hospitals and managed based on a standard approach. Catheter removal was attempted after the patients fulfilled all 4 of the following criteria: disappearance of abdominal pain, absence of fever for at least 48 h, an improving trend of TLC (documented on 2 consecutive reports), and catheter drain output of < 10 ml/day for at least 2 consecutive days. RESULTS: A total of 110 patients (mean age 46.6 ± 10.5 years, 93.6% males, 89.1% alcoholics) underwent PCD placement; 69 patients (69/110; 62.7%) met all 4 criteria within 5 days of PCD placement (optimal response) and had an uncomplicated course. Patients with suboptimal responses (41/110; 37.3%) were evaluated for local and systemic complications; the appearance of fresh collections (5/110; 4.5%), abscess rupture (2/110; 1.8%), bile leakage (3/110; 2.7%), cholangitis (2/110; 1.8%), thrombophlebitis (2/110; 1.8%) and hospital-acquired infections (2/110; 1.8%) were diagnosed and treated accordingly. Ultimately, PCD removal (based on the fulfilment of all 4 criteria) was universally successful after a median of 5 days (IQR, 4-9 days). None of the patients had symptom recurrence after PCD removal, although residual collections were still seen in 97.3% of patients at the time of PCD removal and in 92.1% and 84.9% of patients available for follow-up at 1 and 3 months, respectively. CONCLUSION: Based on our clinical protocol, PCD removal in ALA can be successfully expedited even in the presence of residual collections. An inability to fulfill all 4 criteria within 5 days of PCD placement warrants further evaluations for local and systemic complications that require additional therapeutic measures.
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Abscesso Hepático Amebiano , Adulto , Catéteres , Protocolos Clínicos , Drenagem , Feminino , Humanos , Abscesso Hepático Amebiano/diagnóstico por imagem , Abscesso Hepático Amebiano/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
Pyogenic liver abscesses are classified by the bacteria that have caused the abscess because this guides treatment and can point to the underlying cause. The most common cause is biliary disease. The diagnosis is made by imaging. Treatment is a combination of antibiotics and percutaneous drainage. Amebic liver abscess is caused by extraintestinal spread of Entamoeba histolytica. E histolytica is spread by fecal-oral transmission and typically colonizes the gastrointestinal tract. It is diagnosed based on imaging and the mainstay of treatment is metronidazole. Only about 15% of cases require percutaneous drainage. The prognosis is good, with almost universal recovery.
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Antibacterianos/uso terapêutico , Entamoeba histolytica , Abscesso Hepático Amebiano , Abscesso Hepático Piogênico , Metronidazol/uso terapêutico , Drenagem/métodos , Humanos , Abscesso Hepático Amebiano/diagnóstico , Abscesso Hepático Amebiano/epidemiologia , Abscesso Hepático Amebiano/parasitologia , Abscesso Hepático Amebiano/terapia , Abscesso Hepático Piogênico/diagnóstico , Abscesso Hepático Piogênico/epidemiologia , Abscesso Hepático Piogênico/etiologia , Abscesso Hepático Piogênico/terapia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
INTRODUCTION: Liver abscesses are mainly caused by parasitic or bacterial infection and are an important cause of hospitalization in low-middle income countries (LMIC). The pathophysiology of abscesses is different depending on the etiology and requires different strategies for diagnosis and management. This paper discusses pathophysiology and epidemiology, the current diagnostic approach and its limitations and management of liver abscess in low resource settings. SOURCES OF DATA: We searched PubMed for relevant reviews by typing the following keywords: 'amoebic liver abscess' and 'pyogenic liver abscess'. AREAS OF AGREEMENT: Amoebic liver abscess can be treated medically while pyogenic liver abscess usually needs to be percutaneously drained and treated with effective antibiotics. AREAS OF CONTROVERSY: In an LMIC setting, where misuse of antibiotics is a recognized issue, liver abscesses are a therapeutic conundrum, leaving little choices for treatment for physicians in low capacity settings. GROWING POINTS: As antimicrobial resistance awareness and antibiotic stewardship programs are put into place, liver abscess management will likely improve in LMICs provided that systematic adapted guidelines are established and practiced. AREAS TIMELY FOR DEVELOPING RESEARCH: The lack of a quick and reliable diagnostic strategy in the majority of LMIC makes selection of appropriate treatment challenging.
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Abscesso Hepático/diagnóstico , Abscesso Hepático/terapia , Área Carente de Assistência Médica , Antibacterianos/uso terapêutico , Humanos , Abscesso Hepático/microbiologia , Abscesso Hepático/fisiopatologia , Abscesso Hepático Amebiano/diagnóstico , Abscesso Hepático Amebiano/microbiologia , Abscesso Hepático Amebiano/fisiopatologia , Abscesso Hepático Amebiano/terapia , Abscesso Hepático Piogênico/diagnóstico , Abscesso Hepático Piogênico/microbiologia , Abscesso Hepático Piogênico/fisiopatologia , Abscesso Hepático Piogênico/terapia , PrognósticoRESUMO
BACKGROUND: Intestinal amebiasis is endemic in India, with myriad clinical presentations. The liver is the most common extra-intestinal organ to be involved in invasive amoebiasis up to 37% of cases. Synchronous presentation of hepatic and intestinal disease is unusual, and presentation as acute gastrointestinal bleed, or amoeboma even more atypical. GOALS: We aimed to assess the frequency of synchronous hepatic and colonic amebiasis and the efficacy of endoscopic management of colonic bleeding. RESULTS: We screened 52 consecutive patients with amebic liver abscess for synchronous intestinal amoebiasis and report the clinical course of 28 patients (mean age 48.3 years, all male) with amoebic liver abscess (ALA), (mean size, 7.2 ± 2.8 cm) who presented to us with lower gastrointestinal bleed requiring endotherapy. Patients with synchronous infection had higher bilirubin, liver enzymes and prothrombin time. Most needed percutaneous drainage of the liver abscess, and had prolonged hospital stay. They had ileocaecal ulcers with active bleeding; ulcer with adherent clot in 10(50%), and visible vessel in 8(37.5%), or active ooze in 4(12.5%). One patient had an ulcerated rectal mass, which appeared malignant on endoscopy, which was later found to be an amoeboma on microscopy. Hemostasis was achieved with dilute epinephrine injection, one patient required argon plasma coagulation, and 4 subjects required haemoclip placement at the site to control ooze from a visible vessel. CONCLUSION: Synchronous hepatic and intestinal amoebiasis is not uncommon, and often requires endoscopic haemostasis in case of gastrointestinal bleeding due to colonic disease. We report the successful endoscopic control of bleeding amoebic ulcers in all 24 patients.
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Doenças do Colo , Abscesso Hepático Amebiano/terapia , Endoscopia , Humanos , Índia , Masculino , Pessoa de Meia-Idade , ÚlceraRESUMO
BACKGROUND: We describe the clinical features of a cohort of patients with liver abscesses and investigate relationships between clinical, radiological and microbiological findings and mortality. METHODS: Retrospective review of pyogenic (PLA) or amoebic liver abscesses (ALA) diagnosed and treated at a major infectious diseases department in London over 9 years. RESULTS: One hundred forty-one patient records were identified; 132 (93.6%) had PLA and 9 (6.4%) ALA. No organism was identified in 38.6% (51/132); a single bacterial species was isolated in 47.0% (62/132) of PLA, ≥ 2 in 14.4% (19/132). There was weak evidence of variation in abscess size by type of microorganism, with streptococcal PLA typically larger (p = 0.03 for Streptococcus milleri group, p = 0.05 for non-milleri streptococci). Patients with ALA were younger (median 41, IQR 37-51 years) than those with PLA (median 68, IQR 50.5-78 years) (p = 0.003) and all were male (9/9, 100%, (p = 0.03)), with a history of recent travel in the majority (6/9, 66.7% (p = 0.003)). C-reactive protein was higher in ALA than in PLA (p = 0.06). In the entire cohort, loculation (HR = 2.51 (95% CI 1.00-6.32), p = 0.04) and baseline ALP (HR = 4.78 (95% CI 1.19-19.2) per log10 increase, p = 0.03) were associated with mortality. 16S ribosomal RNA (rRNA) analysis was used in a subset of culture-negative cases and increased the diagnostic yield by 13%. CONCLUSIONS: Clinical or radiological features cannot be used to distinguish between PLA and ALA, or help identify the bacterial cause of PLA. However, ALA is more common in young, male patients with a history of travel. 16S rRNA analysis of abscess fluid has a role in improving microbiological diagnosis in culture-negative cases.
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Abscesso Hepático Amebiano/epidemiologia , Abscesso Hepático Amebiano/microbiologia , Abscesso Hepático Amebiano/terapia , Abscesso Hepático Piogênico/epidemiologia , Abscesso Hepático Piogênico/microbiologia , Abscesso Hepático Piogênico/terapia , Adulto , Idoso , Técnicas de Tipagem Bacteriana , Estudos de Coortes , Feminino , Humanos , Abscesso Hepático Amebiano/diagnóstico , Abscesso Hepático Piogênico/diagnóstico , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , RNA Ribossômico 16S/análise , RNA Ribossômico 16S/genética , Estudos Retrospectivos , Streptococcus/classificação , Streptococcus/genética , Streptococcus milleri (Grupo)/genética , Resultado do TratamentoRESUMO
Intrahepatic pseudoaneurysm (IHPA) is generally iatrogenic, and it warrants urgent management because of its reportedly significant risk of rupture leading to considerable mortality. Intrahepatic pseudoaneurysm caused by amebic liver abscess (ALA) is exceedingly rare with fewer than seven published reports. All reported symptomatic cases have been treated with hepatic artery embolization; therefore, little is known about its natural course and effect of abscess drainage on its outcome. We report the first case of symptomatic intracavitary IHPA caused by ALA in which ultrasound-guided percutaneous catheter drainage of the abscess resulted in the spontaneous resolution of the IHPA.
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Falso Aneurisma/etiologia , Drenagem , Artéria Hepática/patologia , Abscesso Hepático Amebiano/complicações , Abscesso Hepático Amebiano/terapia , Falso Aneurisma/diagnóstico , Falso Aneurisma/patologia , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Doença de Crohn/diagnóstico , Enteropatias Parasitárias/diagnóstico , Abscesso Hepático Amebiano/diagnóstico , Adulto , Antiprotozoários/uso terapêutico , Colonoscopia , Doença de Crohn/tratamento farmacológico , Diagnóstico Diferencial , Erros de Diagnóstico , Drenagem/métodos , Entamoeba/isolamento & purificação , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Enteropatias Parasitárias/terapia , Abscesso Hepático Amebiano/terapia , Masculino , Metronidazol/uso terapêutico , Tomografia Computadorizada por Raios X , Ultrassonografia de IntervençãoRESUMO
OBJECTIVE: To determine the efficacy and safety ultrasound-guided percutaneous catheter drainage (US-PCD) in management of various types of ruptured amebic liver abscess including free rupture (FR) with diffuse intraperitoneal fluid collections (DIFC). METHODS: This study analyzed 117 patients with ruptured ALA who underwent US-PCD. The indication for US-PCD was failure to respond to conservative treatment and/or percutaneous needle aspiration. RESULTS: Majority of patients were locally fermented alcohol abusers (95%), and malnourished (75%). Ninety-eight patients had intraperitoneal rupture including 66 contained rupture (CR) with localized intraperitoneal fluid collection (LIFC) and 32 FR with DIFC. Pleuropulmonary complication was found in 19 patients including 13 pleural and 6 pulmonary. A total of 333 catheters were used to drain 202 abscess cavities and associated fluid collections. US-PCD was technically and clinically successful in all cases. Multiple sessions (median 2; range 2-5) of PCD required with upsizing the catheter (median 14 F; range 14-20 F) and placement of additional catheter in 26 (22%) patients. The patients with FR with DIFC required more number of catheters (p = 0.01) and had longer hospital stay (p = 0.01). No major procedure related complication was observed. Six patients developed secondary bacterial infection; two of them presented with cavito-cutaneous fistula at catheter insertion site, and one with cholangitis due to biliary stricture formation necessitating subsequent endoscopic treatment. Post-procedural death occurred from sepsis in a patient with FR. CONCLUSION: US-PCD is a safe and effective mode of treatment for ruptured ALA including FR with DIFCs. We recommend PCD as a first-line therapy for ruptured ALA.
Assuntos
Drenagem/métodos , Abscesso Hepático Amebiano/terapia , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Catéteres , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The role of metronidazole alone, percutaneous aspiration (PA), and percutaneous catheter drainage (PCD) in the treatment of uncomplicated amebic liver abscess (ALA) is still unclear. This systematic review and meta-analysis evaluated the available evidences with regard to treatment modalities in such patients. METHODS: The database was searched for relevant randomized controlled trials (RCTs) published until May 2019. All studies were assessed for risk of bias. The relevant data were pooled in a random or fixed-effect model to calculate the mean difference (MD) or relative risks. RESULTS: After the detailed screening, 570 patients from 10 RCTs comparing metronidazole alone with metronidazole + PA were included. Most studies had uncertain risk of biases. Days to resolution of abdominal pain (MD - 1.59, 95% confidence interval [CI] - 2.77, - 0.42, I2 = 89%) and tenderness (MD - 1.76, 95% CI - 2.93, - 0.58, I2 = 72%) were significantly shorter in the metronidazole + PA group. There was no significant difference in relation to the resolution of fever, abscess size, and hospital stay. The beneficial effects of PA were seen with medium-to-large (> 5 cm) ALA and not with small (< 5 cm) ALA. Addition of PCD to metronidazole therapy was better than metronidazole alone in one low-quality RCT. Two RCTs found PCD to be better than PA for large ALA. CONCLUSIONS: Percutaneous aspiration as compared with metronidazole alone results in the early resolution of pain and tenderness in patients with medium-to-large ALA. Percutaneous catheter drainage is better for larger ALA. However, discrepancies in RCTs create therapeutic dilemmas necessitating further efforts to generate more reliable data.
Assuntos
Anti-Infecciosos/administração & dosagem , Drenagem/métodos , Abscesso Hepático Amebiano/terapia , Metronidazol/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto , Sucção , Resultado do Tratamento , Adulto JovemRESUMO
AIM: Our aim was to evaluate the diagnosis and therapeutic aspects of the amoebic liver abscesses in the surgery «A¼ department of the University hospital Point "G". PATIENTS AND METHODS: Were included in this study, patients admitted to the surgery «A¼ department for amoebic liver abscess confirmed by a positive amoebic serology and the chocolate appearance of bacteria-free pus. Bacterial liver abscesses were not included into this study. RESULTS: Over a 10-year period, 52 cases of patients diagnosed with amoebic liver abscess were collected in the department. There were 41 men and 11 women, with a sex ratio of 3.7. The mean age was 37.8 years old with extremes of 15 and 66 years. The most represented professions were farmers (36.5%) followed by salesmen (26.7%) and students (11.5%). The average outpatient visit delay time was 18.5 days with the extremes of 5 and 34 days. The most frequent clinical signs were pain in the right hypochondrium (86.5%), fever (78.8%) and hepatomegaly (61.5%). Abdominal ultrasound showed a single located abscess in 44 patients (84.6%) and these abscesses were localized in the right hepatic lobe in 34 patients(65.4%). The average volume of the abscess was 366.5 cm3 with the extremes of 36 cm3 and 1580 cm3. Amoebic serology was positive in 38 patients (80.9%). Cytobacteriological analysis of pus in 37 patients (71%) was negative. Patients underwent an ultrasound assisted needle aspiration of pus in 65.4% he. Laparotomy and a laparoscopic approach were performed in 7.7% and in 5.8%, respectively. The clinical course was uneventfulin 94.2%. The mean hospital stay duration was 16.5 days with the extremes of 4 and 29 days. No death was recorded during hospitalization. CONCLUSION: Amoebic liver abscess is an uncommon pathology in a surgical setting. Abdominal ultrasound andechography guided liver puncture allowed the diagnosis. Laparoscopic approach minimizes the burden of the laparotomy.
BUT: Le but de cette étude était d'évaluer les aspects diagnostiques et thérapeutiques des abcès amibiens du foie dans le service de chirurgie " A " du CHU du Point G. PATIENTS ET MÉTHODES: Ont été inclus dans cette étude, les patients admis dans le service de chirurgie "A" pour abcès amibien du foie sur la base de la positivité de la sérologie amibienne, de l'aspect chocolat du pus et de l'absence de bactéries dans le pus. Les abcès bactériens ont été exclus de cette étude. RÉSULTATS: En 10 ans, 52 dossiers de patients diagnostiqués pour abcès amibiens du foie ont été colligés dans le service. Il s'est agi de 41 hommes et de 11 femmes soit un sex-ratio de 3,7. L'âge moyen des patients a été de 37,8 ans avec des extrêmes de 15ans et 66 ans. Les professions les plus représentées ont été les cultivateurs (36,5%), les commerçants (26,7%) et les élèves et étudiants (11,5%).Le délai moyen de consultation a été de 18,5 jours avec des extrêmes de 5 jours et 34 jours. Les signes cliniques les plus fréquents ont été la douleur de l'hypochondre droit (86,5%), la fièvre (78,8%) et l'hépatomégalie (61,5%). L'échographie abdominale a objectivé un abcès unique dans 44 cas (84,6%) et l'abcès a été localisé dans le lobe hépatique droit dans 34 cas (65,4%). Le volume moyen de l'abcès était de 366,5cm3 avec des extrêmes de 36 cm3 et 1580cm3. La sérologie amibienne a été positive dans 80,9% (n = 38). La culture a été stérile à l'analyse cytobactériologique du pus dans 37 cas (71%). Une ponction évacuatrice écho-guidée a été réalisée dans 65,4% des cas. La procédure chirurgicale a consisté à réaliser une laparotomie dans 7,7% des cas et un abord coelioscopique dans 5,8%. Les antibiotiques utilisés ont été le métronidazole par voie intraveineuse chez tous les patients, associés à la céftriaxone dans 78,8% (n=41). L'évolution clinique a été favorable dans 94,2%. La durée moyenne d'hospitalisation a été de 16,5 jours avec des extrêmes de 4 jours et 29 jours. Aucun décès n'a été constaté pendant l'hospitalisation. CONCLUSION: L'abcès amibien du foie est une pathologie peu fréquente en milieu chirurgical. L'échographie abdominale et la ponction écho-guidée ont permis de poser le diagnostic. Le traitement par abord coelioscopique minimise les inconvénients de la laparotomie.
Assuntos
Abscesso Hepático Amebiano/diagnóstico , Abscesso Hepático Amebiano/terapia , Adolescente , Adulto , Idoso , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centro Cirúrgico Hospitalar , Adulto JovemAssuntos
Entamebíase/sangue , Abscesso Hepático Amebiano/diagnóstico por imagem , Dor Abdominal/etiologia , Adulto , Antiprotozoários/administração & dosagem , Drenagem , Disenteria Amebiana/etiologia , Entamoeba histolytica/isolamento & purificação , Entamebíase/complicações , Febre de Causa Desconhecida/etiologia , Humanos , Abscesso Hepático Amebiano/etiologia , Abscesso Hepático Amebiano/terapia , Masculino , Metronidazol/administração & dosagemRESUMO
CONTEXT: Unfortunately, there is confusion among the medical community regarding the management of amoebic liver abscess (ALA). Therapeutic options range from simple pharmacotherapy to use of interventions like a needle or catheter aspiration under ultrasound guidance to surgical intervention. There is a plethora of thresholds for parameters such as the maximum diameter of the abscess and volume on ultrasound examination suggested by various authors to serve as a criterion to help to decide when to use which modality in these cases. AIMS: To assess the outcome of patients with uncomplicated ALA treated using a conservative approach. Moreover, to identify factors associated with its failure. SETTINGS AND DESIGN: A prospective, observational study was carried out at a large municipal urban health care center over a period of 3-year (2011-2014) in India. MATERIALS AND METHODS: Patients with uncomplicated ALA were recruited. All patients were managed with pharmacotherapy initially for a period of 72 h. Response to treatment was assessed by resolution of symptoms within the given time frame. Failure to respond was considered an indication for intervention. Needle aspiration was offered to these patients and response assessed within 72 h. Failure to respond to aspiration was considered an indication for catheter drainage. STATISTICAL ANALYSIS USED: Data recorded were entered in a Microsoft Office Excel Sheet and analyzed using the SPSS version 16.0 (IBM). RESULTS: Sixty patients with ALA were included in the study over its duration. Forty-nine (81.67%) patients were managed conservatively, while 11 (18.33%) patients needed an intervention for relief. Patients who required intervention had deranged liver function at presentation, a larger abscess diameter (10.09 ± 2.23 vs. 6.33 ± 1.69 cm P < 0.001) and volume (399.73 ± 244.46 vs. 138.34 ± 117.85 ml, P < 0.001) compared to those who did not need it. Patients that required intervention had a longer length of hospital stay (7.1 ± 2.4 vs. 4.8 ± 0.9 days, P < 0.001). On post hoc analysis, a maximum diameter of >7.7 cm was found to be the optimal criterion to predict the need of intervention in cases of ALA. CONCLUSIONS: A conservative approach is effective in the management of ALA for a majority of patients. Failure of conservative management was predicted by the size of the abscess (maximum diameter >7.7 cm). Even in the cases of failure, a gradual step-up with interventions was found to be safe and effective.
Assuntos
Anti-Infecciosos/uso terapêutico , Drenagem/métodos , Abscesso Hepático Amebiano/diagnóstico por imagem , Abscesso Hepático Amebiano/terapia , Metronidazol/uso terapêutico , Ultrassonografia , Dor Abdominal/etiologia , Adulto , Ensaio de Imunoadsorção Enzimática , Humanos , Imunoglobulina G/sangue , Índia , Tempo de Internação , Abscesso Hepático Amebiano/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Solitary small (<5 cm) amoebic liver abscesses in the right lobe are generally treated using medication alone, while large abscesses are typically treated via a combination of medication and drainage. However, the therapeutic indications for multiple medium (5-10 cm) amoebic liver abscesses remain unclear. We herein report the findings of a 53-year-old woman who was receiving lenalidomide for multiple myeloma and subsequently developed multiple amoebic abscesses. Metronidazole alone was unsuccessful, although metronidazole and repeated percutaneous catheter drainage of the right lobe, left lobe, and thorax proved to ultimately be successful. Therefore, the successful use of medication alone may be associated with the total combined abscess volume.
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Drenagem/métodos , Fatores Imunológicos/efeitos adversos , Abscesso Hepático Amebiano/induzido quimicamente , Metronidazol/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Talidomida/análogos & derivados , Cateterismo/métodos , Feminino , Humanos , Lenalidomida , Abscesso Hepático Amebiano/tratamento farmacológico , Abscesso Hepático Amebiano/patologia , Abscesso Hepático Amebiano/terapia , Pessoa de Meia-Idade , Mieloma Múltiplo/patologia , Talidomida/efeitos adversosAssuntos
Abscesso Hepático Amebiano , Administração Oral , Adolescente , Animais , Antiprotozoários/administração & dosagem , Criança , Pré-Escolar , Drenagem/métodos , Entamoeba histolytica , Feminino , Seguimentos , Humanos , Índia/epidemiologia , Infusões Intravenosas , Abscesso Hepático Amebiano/diagnóstico , Abscesso Hepático Amebiano/epidemiologia , Abscesso Hepático Amebiano/parasitologia , Abscesso Hepático Amebiano/terapia , Masculino , Metronidazol/administração & dosagem , Prevalência , Estudos Retrospectivos , Resultado do TratamentoRESUMO
UNLABELLED: Liver abscess is a serious infection that can cause life-threatening complications. OBJECTIVE: To describe the epidemiology, diagnosis, and progression of liver abscess at the Dakar National Albert-Royer Children's Hospital. METHOD: A retrospective study was conducted from over a period of 5 years (1st January 2010 to 31st December 2014). All children aged 0-15 years hospitalized for liver abscess with ultrasound confirmation were included. We collected demographic data (age, gender, socioeconomic status, origin), clinical data (general and hepatic symptoms), diagnostic data (ultrasound, bacteriology) and progression (death, complications, sequelae). The data were analyzed with Epi-info (P<0.05 was considered significant). RESULTS: We collected 26 cases of liver abscesses, representing a hospital prevalence of 100 cases per 100,000 admissions. Males predominated (sex ratio: 1.36). The children's average age was 7.2 years. Most of the children came from urban areas of Dakar. Low socioeconomic status and precarious lifestyle were the contributing factors. Anemia (69.2%), malnutrition (42.3%), and abdominal trauma (15.3%) were the main causes found. The Fontan triad characteristic of the liver abscess was found in 57.7% of cases. At ultrasound, a single abscess was found in 21 cases. The abscess was located in the right lobe in 18 cases, the left lobe in three cases, and in both lobes in three cases. Segment VI (four cases) was the most frequently involved. Bacteriologically, the abscess was pyogenic in 17 cases and an amoebic abscess in nine cases. The main pyogenic sources found were Klebsiella pneumoniae in two cases, Pseudomonas aeruginosa in one case, Streptococcus pneumoniae in one case, and Staphylococcus aureus in one case. The average duration of antibiotic treatment was 14.5 days. Liver drainage was carried out in 24 cases. The outcome was favorable in all children. CONCLUSION: The prevalence of liver abscesses at the Albert-Royer Children's Hospital is relatively high, compared to the literature data. Percutaneous drainage combined with antibiotics remains the treatment of choice. The prognosis is favorable.
Assuntos
Infecções Bacterianas/complicações , Infecções Bacterianas/epidemiologia , Abscesso Hepático Amebiano/epidemiologia , Abscesso Hepático Piogênico/epidemiologia , Abscesso Hepático Piogênico/microbiologia , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , Criança , Pré-Escolar , Entamoeba histolytica/parasitologia , Feminino , Hospitais Pediátricos , Humanos , Lactente , Klebsiella pneumoniae/isolamento & purificação , Estilo de Vida , Abscesso Hepático Amebiano/complicações , Abscesso Hepático Amebiano/diagnóstico , Abscesso Hepático Amebiano/terapia , Abscesso Hepático Piogênico/diagnóstico , Abscesso Hepático Piogênico/terapia , Masculino , Pobreza , Prevalência , Pseudomonas aeruginosa/isolamento & purificação , Estudos Retrospectivos , Fatores de Risco , Senegal/epidemiologia , Staphylococcus aureus/isolamento & purificação , Streptococcus pneumoniae/isolamento & purificação , Sucção , Resultado do TratamentoRESUMO
Amoebic liver abscess is a common condition in Bangladesh. Though conservative treatment plays a major role, refractory patients can be successfully treated with minimally invasive approach. This prospective study was carried out to evaluate the prospect of sono-guided percutaneous catheter drainage for liver abscess patients not responding to conservative treatment. This study was done at Dhaka Medical College Hospital from January 2005 to June 2006 among patients with liver abscess that were treated conservatively outside and got admitted in different surgery and medicine units. Included 35 patients were evaluated clinically and through relevant investigations. Sono-guided percutaneous pigtail catheter was introduced for drainage and patients were followed up for two weeks on average at hospital indoor by amount of drainage, clinical improvement and serial follow up USG. After discharge from the hospital, all patients were followed up monthly and assessed clinically and ultrasonographically up to two months on outdoor basis. Thirty five patients underwent pigtail catheter drainage that was refractory to conservative treatment or needle aspiration. Following insertion of catheter patients who were pyrexic, fever subsided in two to three days and never back during the postoperative period and follow up. Antimicrobials were changed according to the report of the culture and sensitivity of the aspirate that was done routinely. Maximum total (4300 ml) amount of pus was drained in a patient. Average duration of catheter drainage in this study was 8 days. With a very low morbidity and zero mortality rates, minimum treatment costs and early return to regular life style proved this minimally invasive procedure to be a rational treatment option for amoebic liver abscess in selective cases.
Assuntos
Catéteres , Drenagem/instrumentação , Abscesso Hepático Amebiano/terapia , Adulto , Anti-Infecciosos/uso terapêutico , Bangladesh , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Here, we report a case of an amoebic liver abscess (ALA) successfully treated with endoscopic ultrasound (EUS)-guided liver abscess drainage (EUS-LAD). A 37-year-old male with a liver abscess was referred to our hospital due to disease progression despite receiving antibiotic therapy. Computed tomography showed an intrahepatic abscess extending into the hepatic subcapsular space. The abscess could not be punctured through the hepatic parenchyma percutaneously due to the presence of hepatic subcapsular lesions. Hence, EUS-LAD was performed via the transhepatic approach through the stomach. A 5-Fr pigtail-type nasocystic tube was inserted into the abscess through the hepatic parenchyma, with no procedure-related complications. The contents of the abscess had the appearance of anchovy paste which made us suspect an amoebic abscess; therefore, we started antibiotic therapy with metronidazole. Afterwards, serum anti-amoebic antibodies were found to be positive and the diagnosis of ALA was confirmed. Two weeks later, the size of the abscess decreased, and the patient's clinical symptoms disappeared. Hence, the tube was removed. There were no signs of recurrence during the follow-up period. The use of EUS-LAD for pyogenic or tuberculous abscesses has been reported previously. EUS-LAD for an ALA, similar to that for other liver abscesses, is an effective alternative to percutaneous transhepatic abscess drainage or surgical treatment.
Assuntos
Drenagem/métodos , Endossonografia/métodos , Abscesso Hepático Amebiano/terapia , Adulto , Antiparasitários/uso terapêutico , Progressão da Doença , Humanos , Fígado/patologia , Abscesso Hepático Amebiano/patologia , Masculino , Metronidazol/uso terapêuticoRESUMO
In one-third of the patients with amoebiasis, amoebic liver abscess (ALA) may occur after the penetration of amoebic trophozoites through the intestinal wall. ALA is seen mostly among men aged 20-45 years with a serious clinical outcome, with fever and abdominal pain on the right upper quadrant. Most patients have no recent history of amoebic colitis; indeed, they have neither gastrointestinal complaints nor Entamoeba histolytica (E. histolytica) cysts/trophozoites in their stools. Therefore, ultrasonography and serology are primary in ALA diagnosis, while searching for E. histolytica DNA in abscess fluid using PCR has been preferred as an effective and reliable method, lately. Early antimicrobial therapy is effective; however, for cases irresponsive to therapy after 72 hours and with large abscess, drainage or surgical intervention is indicated. If left untreated, ALA may disseminate to other organs and cause death. The data concerning the extra-intestinal manifestations of amebiasis in Turkey are limited. Here, a rare case of a young man with an initial diagnosis of pneumonia followed by the identification of ALA after radiological interventions and laboratory tests is presented and the relevant literature is discussed.
Assuntos
Abscesso Hepático Amebiano/diagnóstico , Pneumonia/diagnóstico , Anti-Infecciosos/uso terapêutico , DNA de Protozoário/análise , Diagnóstico Diferencial , Drenagem , Disenteria Amebiana/complicações , Entamoeba histolytica/genética , Entamoeba histolytica/isolamento & purificação , Fezes/parasitologia , Humanos , Abscesso Hepático Amebiano/parasitologia , Abscesso Hepático Amebiano/terapia , Masculino , Reação em Cadeia da Polimerase , Tomografia Computadorizada por Raios X , Turquia , Adulto JovemRESUMO
BACKGROUND: Amebic liver abscess (ALA) is a common and serious problem in our country. There are only a few controlled trials on the efficacy and advantages of combination therapy with percutaneous needle aspiration and pharmacotherapy, over pharmacotherapy alone for amebic liver abscess. MATERIAL AND METHODS: This study was conducted to compare the efficacy of two different treatment modalities i.e. drug treatment alone vs. drug treatment and aspiration of abscess cavity in patients with small (up to 5 cm) and large (5 cm to 10 cm) size ALA. This is one of the largest single center, prospective, randomized studies comparing the efficacy of aspiration in ALA. RESULTS: (i) Mean body temperature, liver tenderness, total leukocyte count (TLC), serum alanine aminotransferase (ALT) and liver span were significantly decreased in the aspiration group on days 8 and 15 as compared to non-aspiration group especially in large abscess (5 cm to 10 cm). (ii) Abscess cavity maximum diameter decreased significantly in aspiration group on days 8 and 15, and 1 month & 3 months in large abscess (5cm to 10 cm). CONCLUSIONS: (i) Needle aspiration along with metronidazole hastens clinical improvement especially in large (5 cm up to 10 cm) cavities in patients with ALA. (ii) Aspiration is safe and no major complications occurred. (iii) Hence, combination therapy should be the first choice especially in large ALA (5 cm to 10 cm).