Fasciola Hepatica Induced Hepatic Abscess Treated with Triclabendazole.

Fascioliasis is a zoonotic disease caused by Fasciola hepatica that infects mainly cattle, sheep, and goats. Humans can be infected by water or aquatic plants contaminated with metacercariae. The authors encountered two cases of F. hepatica infection. One patient reported abdominal discomfort with marked eosinophilia. The other patient had chest discomfort with marked eosinophilia. The abdominal CT images revealed hypodense lesions in the liver. The ultrasonography-guided liver biopsy findings in both patients were indicative of parasitic infections. Serological tests confirmed the definite diagnoses. Both patients were treated with a single dose of triclabendazole, which is the treatment of choice for fascioliasis. These findings suggest that a diagnosis of fascioliasis, particularly in the acute phase, should be considered in patients with abdominal pain, marked eosinophilia, and hypodense hepatic lesions on CT.

ArfX2 GTPase Regulates Trafficking From the Trans-Golgi to Lysosomes and Is Necessary for Liver Abscess Formation in the Protozoan Parasite Entamoeba histolytica.

Entamoeba histolytica is the causative agent of amoebic dysentery and liver abscess in humans. The parasitic lifestyle and the virulence of the protist require elaborate biological processes, including vesicular traffic and stress management against a variety of reactive oxygen and nitrogen species produced by the host immune response. Although the mechanisms for intracellular traffic of representative virulence factors have been investigated at molecular levels, it remains poorly understood whether and how intracellular traffic is involved in the defense against reactive oxygen and nitrogen species. Here, we demonstrate that EhArfX2, one of the Arf family of GTPases known to be involved in the regulation of vesicular traffic, was identified by comparative transcriptomic analysis of two isogenic strains: an animal-passaged highly virulent HM-1:IMSS Cl6 and in vitro maintained attenuated avirulent strain. EhArfX2 was identified as one of the most highly upregulated genes in the highly virulent strain. EhArfX2 was localized to small vesicle-like structures and largely colocalized with the marker for the trans-Golgi network SNARE, EhYkt6, but neither with the endoplasmic reticulum (ER)-resident chaperon, EhBip, nor the cis-Golgi SNARE, EhSed5, and Golgi-luminal galactosyl transferase, EhGalT. Expression of the dominant-active mutant form of EhArfX2 caused an increase in the number of lysosomes, while expression of the dominant-negative mutant led to a defect in lysosome formation and cysteine protease transport to lysosomes. Expression of the dominant-negative mutant in the virulent E. histolytica strain caused a reduction of the size of liver abscesses in a hamster model. This defect in liver abscess formation was likely at least partially attributed to reduced resistance to nitrosative, but not oxidative stress in vitro. These results showed that the EhArfX2-mediated traffic is necessary for the nitrosative stress response and virulence in the host.

Biliary ascariasis and severe bacterial outcomes: Report of three cases from a paediatric hospital in Brazil.

INTRODUCTION: Biliary ascariasis, although uncommon, can lead to infectious complications and severe outcomes. This study reported three patients with biliary ascariasis and who were admitted to a paediatric hospital in Salvador, Brazil. CASE REPORTS: Case 1: A 1-year-old boy, with HIV, hospitalised with diarrhoea, fever, pain, and abdominal distension. He underwent an exploratory laparotomy, which showed peritonitis secondary to a perforation of the hepatic duct by ascaris. Case 2: A 3-year-old boy admitted with fever, abdominal pain and jaundice. Imaging examination was suggestive of ascaris in the intrahepatic biliary tract and a hepatic abscess. Case 3: A 7-year-old boy who was hospitalised with a history of abdominal colic, jaundice and fever, with a suggestive image of ascaris in the biliary tract and evolution to sepsis. DISCUSSION: Three cases of biliary ascariasis were reported with severe infectious complications involving peritonitis, hepatic abscess and sepsis. CONCLUSION: In endemic regions, biliary ascariasis should be considered in cases with jaundice, abdominal pain and fever, due to its morbidity and risk of complications.

Entamoeba histolytica liver abscess case: could stool PCR avoid it?

Background Liver abscess is the most common extraintestinal manifestation of Entamoeba histolytica. Clinical manifestations could appear after returning from an endemic area or several years after the exposure. The diagnosis usually requires microbiological confirmation. Case presentation We present a case of a 55-year-old woman diagnosed with Crohn's disease treated with immunosuppressive drugs, who was admitted to the Emergency Service with liver parenchyma abscesses. Computed tomography (CT)-guided puncture showed pus, and both Gram staining and fresh parasite visualization were negative. Hepatic pus bacteriological culture was reported as negative and parasite multiplex polymerase chain reaction (PCR) was performed, being positive for E. histolytica. The same PCR was performed on blood, pleural fluid and stool samples, all of them being positive for E. histolytica. Conclusions Reviewing the clinical history of this patient, it was observed that parasite detection in three stool samples was negative 2 months before the current admission. Due to the lack of sensitivity of the microscopy techniques, we propose to routinely perform parasite detection in stools using molecular techniques, especially in immunocompromised patients.

Case Report: First Molecular Diagnosis of Liver Abscesses Due to Fasciola hepatica Acute Infection Imported from Vietnam.

We report a case of Fasciola hepatica liver abscesses in a 67-year-old female returning from a trip to Vietnam. She has been suffering from a fever, right abdominal pain for 4 days, and major eosinophilia. Radiologic investigations showed multiple hypodense confluent abscesses in the right lobe of the liver, complicated by occlusive thrombosis of the right branch of the portal vein. The serological investigation of helminth-elicited eosinophilia showed only a positive serology for F. hepatica. Despite repeated negative stool examinations for any intestinal pathogen, the diagnosis was established by the detection of F. hepatica DNA in stool and pus aspirate samples.

Absceso hepático gigante por Fasciola hepatica / A giant liver abscess due to Fasciola hepatica infection

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A giant liver abscess due to Fasciola hepatica infection.

A 60-year-old female patient with a 3-month history of upper right quadrant pain, nausea, fluid evacuation, yellowing, weight loss, intolerance to the oral route, liver disease and hepatomegaly without impaired liver function tests Performs diagnosis by CT scan of giant hepatic abscess, which is managed by means of percutaneous drainage and antibiotic, is determined as etiology, infection by hepatic fasciola.

Síndrome de larva migrans visceral y absceso hepático: Reporte de un caso / Visceral larva migrans syndrome and hepatic abscess: A case report

La infección por T oxocara canis o catis es una zoonosis diseminada en el ser humano. La toxocariasis puede coexistir con otras parasitosis endémicas. El hombre actúa como huésped no natural y adquiere la infección a través de la ingesta de huevos del geohelminto. Estos pueden localizarse en la tierra, los patios y los juegos de los niños, y son eliminados, principalmente, por perros o gatos. Existen distintos espectros en la presentación clínica; algunos de ellos son toxocariasis ocular, larva migrans visceral, toxocariasis encubierta y neurotoxocariasis. Se presenta el caso de un paciente de 2 años y 3 meses de edad, con antecedente de síntomas respiratorios, fiebre prolongada y hepatomegalia, con resultados de laboratorio que informa hipereosinofilia, hipergammaglobulinemia y serología positiva para toxocariasis (ensayo por inmunoabsorción ligado a enzimas). Se plantea el diagnóstico de síndrome de larva migrans visceral.

Toxocariasis canis or catis is a zoonotic infection disseminated in humans. Human beings can act as non-natural hosts in which the parasite can survive for long periods of time and they become infected by the ingestion of geohelminth eggs. These can be located on the ground, playgrounds and children's games, and are mostly eliminated by dogs or cats. There are different spectra in the clinical presentation of this infection, which can vary from an asymptomatic host to the production of serious organic lesions; some of them are ocular toxocariasis, visceral larva migrans, covert toxocariasis and neurotoxocariasis. In this case report a patient who presents with a history of respiratory problems, prolonged fever, and hepatomegaly. Laboratory analyses show hypereosinophilia, hypergammaglobulinemia and serodiagnosis is positive for toxocariasis. Preliminary diagnosis: Visceral Larva Migrans Syndrome.

[Visceral larva migrans syndrome and hepatic abscess: A case report]. / Síndrome de larva migrans visceral y absceso hepático: Reporte de un caso.

Toxocariasis canis or catis is a zoonotic infection disseminated in humans. Human beings can act as non-natural hosts in which the parasite can survive for long periods of time and they become infected by the ingestion of geohelminth eggs. These can be located on the ground, playgrounds and children's games, and are mostly eliminated by dogs or cats. There are different spectra in the clinical presentation of this infection, which can vary from an asymptomatic host to the production of serious organic lesions; some of them are ocular toxocariasis, visceral larva migrans, covert toxocariasis and neurotoxocariasis. In this case report a patient who presents with a history of respiratory problems, prolonged fever, and hepatomegaly. Laboratory analyses show hypereosinophilia, hypergammaglobulinemia and serodiagnosis is positive for toxocariasis. Preliminary diagnosis: Visceral Larva Migrans Syndrome.

La infección por T oxocara canis o catis es una zoonosis diseminada en el ser humano. La toxocariasis puede coexistir con otras parasitosis endémicas. El hombre actúa como huésped no natural y adquiere la infección a través de la ingesta de huevos del geohelminto. Estos pueden localizarse en la tierra, los patios y los juegos de los niños, y son eliminados, principalmente, por perros o gatos. Existen distintos espectros en la presentación clínica; algunos de ellos son toxocariasis ocular, larva migrans visceral, toxocariasis encubierta y neurotoxocariasis. Se presenta el caso de un paciente de 2 años y 3 meses de edad, con antecedente de síntomas respiratorios, fiebre prolongada y hepatomegalia, con resultados de laboratorio que informa hipereosinofilia, hipergammaglobulinemia y serología positiva para toxocariasis (ensayo por inmunoabsorción ligado a enzimas). Se plantea el diagnóstico de síndrome de larva migrans visceral.

Burden of Liver Abscess and Survival Risk Score in Thailand: A Population-Based Study.

In Thailand, the burden of liver abscess, a life-threatening infectious disease, has not been thoroughly evaluated. We developed a predictive scoring system to estimate survival of patients with liver abscess using information from the 2008-2013 Nationwide Hospital Admission Data to evaluate the burden of liver abscess in Thailand. All patients with primary diagnosis of pyogenic liver abscess (PLA) and amoebic liver abscess (ALA) were included. Epidemiological data, baseline characteristics, hospital course, and survival were analyzed. Overall, 11,296 admissions comprising 8,423 patients from 844 hospitals across Thailand were eligible for analysis. The mean age was 52 ± 17 years and 66.1% of patients were male. ALA was significantly prevalent in southern and western border regions of Thailand, and PLA occurred nationwide. The highest incidence of liver abscess occurred in the rainy season (June-November, P < 0.01). The median length of hospital stay was 8 days (interquartile range = 4-13 days), and mean direct cost of hospitalization was 846 ± 1,574 USD. The overall inhospital mortality rate was 2.8%. Incidence of ALA decreased over the 5-year study period, whereas PLA incidence increased (P < 0.01). Using multivariable Cox regression methods with stepwise variable selection, we developed a final model with five highly significant baseline parameters associated with increased 60-day mortality: older age, PLA, underlying chronic kidney disease, cirrhosis, and human immunodeficiency virus infection. Range of estimated probability of 60-day survival was 95-16% at cumulative risk score 0-13. This simplified score is practical, and may help clinicians prioritize patients requiring more intensive care.

Ascariasis as a cause of hepatic abscess: A report of 3 cases.

We receive around 60 cases of hepatic abscess in a year. The commonest diagnosis reached at the time of discharge is amoebic liver abscess. The diagnosis of amoebic liver abscess is mostly presumptive and thus the patients are usually given a mixed treatment with injection ceftriaxone and tablet metronidazole. Here we report three cases of hepatic abscess diagnosed recently, where ascariasis was the probable etiology. Ascariasis may be a much commoner cause of hepatic abscesses in this region than we think.

[Extraenteric infection caused by Blastocystis spp. in a female patient with liver abscess].

The cases associated with the development of liver abscesses in a 64-year-old female patient after elective surgery for colon polyposis could form an opinion that extraenteric infection caused by Blastocystis spp. might develop in the immunocompromised host. The development of Blastocystis spp. in the presence of disintegrated liver tissue and inflammatory cells was verified by microscopic examination of liver abscess aspirates. The Romanovsky-Giemsa stained specimens exhibited typical amoeboid, vacuolar and, what is particularly important, dividing forms of Blastocystis spp. The patients full recovery after timely combination therapy with broad-spectrum antibiotics and imidazole group preparations also indirectly argues for the etiological role of Blastocystis spp. in the development of liver abscess with the signs of changes in both lungs (the signs of right lung compression and bilateral hydrothorax). Physicians' awareness of the potential clinical significance of Blastocystis spp. in immunodeficient patients is sure to expand the range of differential diagnostic studies of patients infected with Blastocystis spp.. particularly in case of gastrointestinal tract diseases of unknown etiology.

Single and multiple liver abscesses in adults in Delhi are amoebic in origin: a clinical and microbiological study.

Single and multiple liver abscesses in Delhi are predominantly amoebic and must be distinguished from pyogenic abscesses which frequently require drainage. Mixed abscesses are larger, harbouring Gram negative rods. Multiple abscesses are not always pyogenic and presence of bacteria does not imply a primary pyogenic source.

Hepatobiliary fascioliasis in non-endemic zones: a surprise diagnosis.

Fascioliasis is a zoonotic infection caused by Fasciola hepatica. Because of population migration and international food trade, human fascioliasis is being an increasingly recognised entity in nonendemic zones. In most parts of Asia, hepatobiliary fascioliasis is sporadic. Human hepatobiliary infection by this trematode has two distinct phases: an acute hepatic phase and a chronic biliary phase. Hepatobiliary infection is mostly associated with intense peripheral eosinophilia. In addition to classically defined hepatic phase and biliary phase fascioliasis, some cases may have an overlap of these two phases. Chronic liver abscess formation is a rare presentation. We describe a surprise case of hepatobiliary fascioliasis who presented to us with liver abscess without intense peripheral eosinophilia, a rare presentation of human fascioliasis especially in non-endemic zones.