Ampicillin and amoxicillin use and the risk of Klebsiella pneumoniae liver abscess in Taiwan.

BACKGROUND: Klebsiella pneumoniae liver abscess (KPLA) is prevalent in East Asia. Use of amoxicillin/ampicillin may lead to overgrowth of K. pneumoniae in the intestine and predispose to KPLA. We used an animal study and nationwide population-based database to investigate the association between ampicillin/amoxicillin use and KPLA in Taiwan. METHODS: In an animal study, ampicillin or sterile water was administered orogastrically in serotype K1 K. pneumoniae-colonized mice and the outcome was compared. We identified 855 cases with liver abscess and selected 3420 age- and sex-matched control subjects from the National Health Insurance Research Database. Conditional logistic regression was used to estimate the adjusted odds ratios (ORs) for the association between recent use of ampicillin/amoxicillin and KPLA. RESULTS: Ampicillin administration predisposed K. pneumoniae-colonized mice to increased bacterial burden, liver abscess and necrosis, and lethality. The population-based study showed that the adjusted OR associating the use of ampicillin/amoxicillin within the past 30 days with KPLA was 3.5 (95% confidence interval, 2.5-5.1). No association was found with use in the past 31-90 days. CONCLUSIONS: Ampicillin/amoxicillin therapy started within the past 30 days was associated with increased risk for KPLA. We should avoid the overuse of these antibiotics to prevent undesired disease in the endemic area.

Liver abscess following transarterial chemoembolization for the treatment of hepatocellular carcinoma: A retrospective analysis of 23 cases.

OBJECTIVE: To investigate the incidence, management, and outcome of a liver abscess after transarterial embolization/chemoembolization (TAE/TACE) therapy for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: From May 2007 to May 2014, all patients complicated with liver abscess following TAE/TACE for HCC were identified and analyzed at four medical centers. RESULTS: During the study period, a total of 6984 TAE/TACE procedures were performed among 3129 patients, and a total of 23 patients developed liver abscess with the incidence of 0.33% (23/6984) per procedure. There were 21 males and 2 females, and mean age of 52.1 ± 12.1 years. The mean interval from last TAE/TACE procedure to the diagnosis of liver abscess was 12.9 ± 6.6 days. All the patients received intravenous antibiotics, with ten patients had a percutaneous drain, one each for percutaneous aspiration and surgery. Complications related to the liver abscess were hepatorrhexis and pleural effusion (n = 1), pleural effusion (n = 1), and obstructive jaundice (n = 1), all of which were resolved after conservative treatments. The serum alpha-fetoprotein (AFP) levels were significantly reduced at 6 months after treatment (P < 0.01) in 15 patients whose AFP > 400 ng/mL preprocedure. Complete or partial tumor response at 6 months after TAE/TACE was achieved in three and twenty patients, respectively; and 6 months survival was 100%. CONCLUSIONS: The incidence of a liver abscess after TAE/TACE is low; antibiotics therapy along was successful in about half patients, and percutaneous abscess aspiration/drainage were necessary in large size abscess and severely symptomatic patients; the outcomes are benign without worsening of the progression of underlying HCC.

Macrophage-activation inhibitor factor from L5178Y murine lymphoma and formation of hepatic abscesses in BALB/c mice.

BACKGROUND: Normal mice are naturally resistant to hepatic abscesses produced by Listeria monocytogenes. A macrophage-activation inhibitor factor (MAIF) isolated from the cell-free ascitic fluid of L5178Y lymphoma-bearing mice inhibited the lipopolysaccharide-induced production of nitric oxide (NO) by the macrophages. Because macrophages are also involved in the immune response towards L. monocytogenes, the present study had the objective of investigating whether MAIF was also capable of allowing L. monocytogenes to form hepatic abscesses. METHODS: BALC/c mice were inoculated intrahepatically with 5 x 10(5) bacteria. Experimental groups were treated daily with subcutaneous or intraperitoneal doses of 0, 1, 5 or 10 microg of MAIF/g of body weight. One dose was applied before inoculating bacteria and the remaining three doses 24, 48, and 72 h after inoculating bacteria. The development of hepatic abscess was analyzed 24 h after the last administration of MAIF. RESULTS: All treated mice (but not controls) developed hepatic abscess showing no differences regarding MAIF administration route. CONCLUSIONS: These results suggest a possible MAIF in vivo inhibition of NO macrophage production that allows L. monocytogenes hepatic abscess development in mice.

Enterococcal liver abscess associated with moxalactam therapy. Review of literature on enterococcal superinfections in association with moxalactam therapy.

Moxalactam, a third-generation cephalosporin, has been demonstrated to have an ultrawide spectrum of antibacterial activity. One important gap in this impressive spectrum is the enterococcus. Superinfections and colonization with enterococci have been reported following moxalactam therapy. Sites involved have included the urinary tract, wounds, middle ear, and blood stream. To our knowledge, we report the first case of enterococcal liver abscess following moxalactam therapy. The abscess was localized by ultrasound examination and microbiologic diagnosis made by aspiration using a skinny needle. Without surgical drainage or therapeutic aspiration, institution of appropriate antibiotic therapy in optimum dosage resulted in complete resolution. The literature on enterococcal superinfections in association with moxalactam therapy and nonsurgical management of liver abscesses is reviewed.

Hepatic abscess as a paradoxical response to antituberculous chemotherapy for tubercular lymphadenitis.

Tubercular liver abscess developing as a paradoxical reaction (PR) to antitubercular therapy (ATT) is relatively uncommon in the absence of disseminated disease and immunocompromised status of the host even in countries such as India where the disease is rampant. We report a rare case of hepatic abscess that developed paradoxically during antituberculous therapy for tubercular lymphadenitis in a 30-year-old woman who tested negative for HIV. Diagnosis was performed with the help of ultrasonography (USG)-guided aspiration of the abscess followed by cytopathological examination and PCR confirmation of the disease from the USG-guided aspirate. The patient responded well to oral corticosteroid therapy without any alteration of the ongoing ATT regimen. Details of the case and other relevant literature regarding the pathogenesis of this event are discussed in detail.

[Liver abscess caused by hepatic artery infusion chemotherapy].

A 48-year-old man underwent left hemicolectomy and right extended hepatectomy for colon cancer and its synchronous multiple liver metastasis. Sixteen months after, multiple metastases in the remnant liver were found, so he was given bolus hepatic infusion of 5-FU 1,000 mg/week, total amount, 25 g. The response was CR, but he developed a liver abscess in segment 4.

[A case of tuberculous liver abscess developed during chemotherapy for tuberculous peritonitis as paradoxical response].

Tuberculous liver abscesses are rare. Paradoxical response in tuberculosis is common and occurred between 2 weeks and 12 weeks after anti-tuberculous medication. We report here a case of tuberculous liver abscess that developed in a paradoxical response during chemotherapy for tuberculous peritonitis in a 23-year-old male. He was hospitalized, complaining of ascites, epigastric pain. He was diagnosed tuberculous peritonitis by expiratory laparoscopic biopsy and took medication for tuberculosis. After 2 months, a hepatic lesion was detected with CT scan incidentally. Chronic granulomatous inflammation was seen in ultrasound-guided liver biopsy, and tuberculous liver abscess was diagnosed. It was considered as paradoxical response, rather than treatment failure or other else because clinical symptoms of peritoneal tuberculosis and CT scan improved. After continuing initial anti-tuberculous medication, he was successfully treated. Herein, we report a case of tuberculous liver abscess as paradoxical response while treating peritoneal tuberculosis without changing anti-tuberculous treatment regimen.

Severe complication after a doxorubicin-eluting-bead embolization: surgical management and pathological findings.

Doxorubicin-eluting-bead embolization (DEB) is considered a safe and efficient treatment of hepatocellular carcinoma (HCC) with a low complication rate and an increased tumor response compared with conventional transarterial chemoembolization. We describe a case of a 69-year-old patient who underwent DEB for HCC and who developed a liver abscess requiring urgent left liver lobectomy. Despite this severe complication, efficacy of DEB embolization was histologically proved as a large ischemic zone with complete tumor necrosis.

Iron metabolism in the erythrophagocytosing Kupffer cell.

Like the peritoneal macrophage, the isolated Kupffer cell is capable of processing and releasing iron acquired by phagocytosis of immunosensitized homologous red blood cells. When erythrophagocytosis is restrained to levels which do not affect cell viability, or less than 1.5 red cells/macrophage (phagocytic index of 150%), over 40% of iron acquired from red cells is released within 24 hr. More active erythrophagocytosis results in greater release of iron but progressive deterioration in cell viability. Iron release is temperature-dependent, the rate at 37 degrees C being nearly 5-fold greater than at 4 degrees C. Inclusion of either desferrioxamine or apotransferrin in the culture medium augments iron release by 25 to 30%, with both agents together having an almost additive effect. Despite its effect on iron release, apotransferrin is not found in sonicates of Kupffer cells, while desferrioxamine appears to chelate iron within the cells. Ascorbate also enhances iron release, but at the expense of cell viability. Neither chloroquine nor colchicine at concentrations which do not affect cell viability influence iron release. The inflammatory state, characterized by hypoferremia due to impaired processing or release of iron by the reticuloendothelial system, may be modeled in vitro when serum from rats bearing turpentine-induced abscesses is included in the culture medium. Attempts to delineate the humoral agent responsible for this effect have not been successful, iron release being insensitive to the presence of interleukin-1, gamma-interferon and tumor necrosis factor.

Hepatic and splenic abscesses--a common complication of intensive chemotherapy of acute myeloid leukemia (AML). A prospective study.

In order to determine the frequency of hepatosplenic abscesses in AML patients during chemotherapy and to evaluate the clinical and laboratory characteristics of this complication we performed a prospective study over a 28-month period. Fifty-five consecutive patients with de novo AML or relapse who received intensive chemotherapy underwent regular ultrasound examinations. In 16 patients (29.1%) hepatic and/or splenic abscesses were detected sonographically. Histopathological evidence for abscess formation was obtained in five of these 16 patients. In three patients granulation tissue and in one patient necrotizing granulomas were found. Causative micro-organisms were proven in only three patients: Candida hyphae were demonstrated in one patient, gram-positive cocci in another. Bacteria and fungi were seen in the tissue specimen of the third patient. Patients with hepatosplenic abscesses had significantly prolonged fever after neutrophil recovery but did not differ from patients without abscesses in any other laboratory or clinical features. Due to the absence of specific alerting clinical and laboratory signs and symptoms of hepatosplenic abscesses, routine ultrasound examination is required for detection of this complication. The presence of hepatic and/or splenic abscesses does not necessarily worsen the prognosis, but it may influence the decision on further chemotherapy and antimicrobial treatment.