Transfer of CMY-2 Cephalosporinase from Escherichia coli to Virulent Klebsiella pneumoniae Causing a Recurrent Liver Abscess.

A CMY-2-producing capsular type K2 Klebsiella pneumoniae strain (TVGHKP93) with multidrug resistance was isolated from a recurrent liver abscess in a patient who also carried a CMY-2-producing Escherichia coli strain (TVGHEC01) in the stool. TVGHKP93 retained its high virulence compared with that of the isogenic strain (TVGHKP60) with wild-type resistance from the first liver abscess. Our conjugation experiment showed the successful transfer of the blaCMY-2-carrying plasmid from TVGHEC01 into TVGHKP60. The transconjugant showed both high virulence and the multidrug-resistant phenotype, as did TVGHKP93.

The pathogenesis of raised serum alpha-fetoprotein levels in amoebic and pyogenic hepatic abscesses.

Serum alpha-fetoprotein (AFP) concentrations may be slightly raised in patients with amoebic hepatic abscesses. In an attempt to learn more about the pathogenesis of the raised levels, we studied 74 patients with amoebic and six with pyogenic hepatic abscesses. Serum (AFP) levels were slightly elevated (24-72 ng/ml) on admission in four patients and markedly raised (2000 ng/ml) in one, who had hepatocellular carcinoma in addition to a pyogenic hepatic abscess. The pattern of the early rise in AFP levels could not be determined because these four patients were lost to follow-up. However, serial serum AFP estimations were obtained in 29 patients with a normal value on admission and in none of these did the concentration rise during recovery. Our findings do not support the prevailing hypothesis that regenerating hepatocytes are responsible for the raised serum AFP levels in non-neoplastic hepatic disorders, including hepatic abscesses.

Ultrasonography and determination of proteins and enzymes in blood for the diagnosis of liver abscesses in intensively fed beef cattle.

The concentrations of plasma proteins and the activities of liver enzymes were measured every 2 weeks from weaning to slaughter in 21 beef cattle, and their livers were examined ultrasonographically every 4 weeks. Eight of the 9 cases of single or multiple liver abscesses were detected by ultrasonography but some individual abscesses, particularly those in the left side of the liver, remained undetected. The time at which the abscesses were first detected ranged from 4 to 20 (mean 12.5) weeks. There were only slight variations in the blood constituents and they were of no significant value in the diagnosis of the liver abscesses.

[New views referred to gamma-glutamyl-transpeptidase (author's transl]. / Nuove acquisizioni sulla gamma-glutamil-transpeptidasi

The AA. have observed some patients suffering from persistent chronic hepatitis, aggressive chronic hepatitis, severe virus hepatitis, hepatic cirrhosis, hepatic metastasis, cholecystolithiasis, hepatic abscess, congestic heart disorder, alcoholism also patients treated with barbiturics and benzodiazepine, comparising in the meanwhile gamma-glutamyl-transaminase. They would suggest a new interpretation: the observed enzyme was higher in the obstructive diseases, gamma-GT also notable higher in the cellular hepatic diseases (hepatitis, cirrhosis and so on). In their opinion gamma-GT should be a regular enzymatic screening for liver diseases, but should not anyway eliminate the till now used enzymes.

Plasma prolidase activity as a possible diagnostic index of chronic hepatic abscess in cattle.

The usefulness of prolidase as a biochemical parameter to represent the chronic state of hepatic abscess was discussed in eight cattle experimentally inoculated with Fusobacterium necrophorum and 18 spontaneously affected cattle. Blood was daily collected to measure the plasma prolidase activity and sialic acid level from the experimental cattle for 90 days after inoculation. In three out of four cattle affected with hepatic abscess, prolidase activity began to rise about 40 days after inoculation, and maintained high activity till 90 days. In the same cattle the sialic acid concentration increased from 7 to 10 days after inoculation, and gradually returned to the normal value 50 days after it. Another cow showed a similar change in early stage of experiment, but prolidase activity decreased after 70 days and sialic acid concentration maintained high level till 90 days. In two cattle, which showed scars but no abscess on autopsy, the prolidase activity increased temporarily from 40 to 55 days after inoculation. In the control cattle inoculated with an inactivated bacterial suspension, neither the sialic acid level nor the prolidase activity showed any large variation in the experimental period. Among the spontaneously affected cattle, those with a high sialic acid level revealed normal prolidase activity and those with a normal sialic acid level had high prolidase activity.

[Pyogenic liver abscess in chronic alcoholic pancreatitis]. / Pyogener Leberabszess bei chronischer äthyltoxischer Pankreatitis.

HISTORY AND ADMISSION FINDINGS: A 44-year-old patient was transferred for further treatment of pyogenic liver abscess and a severe attack of a chronic pancreatitis for strong upper right quadrant abdominal pain and recurring fever. INVESTIGATIONS: Laboratory results revealed a significant inflammatory constellation. Abdominal ultrasound was performed which showed a big pyogenic abscess in the right lobe of the liver. Escherichia coli and Enterococcus faecalis could be isolated from abscess aspirates. Endoscopic retrograde cholangiography (ERC) without access of the pancreatic duct showed stenosis of the Ductus hepatocholedochus which was treated with a biliary endoprothesis. DIAGNOSIS, TREATMENT AND COURSE: Antibiotic treatment and percutaneous drainage led to complete remission of the abscess. A few days after discharge the patient returned with identical clinical symptoms. Abdominal ultrasound showed recurrence of the abscess. Because of excessively high pancreatic amylase in aspirated abscess material the patient underwent endoscopic retrograde cholangiopancreaticography (ERCP). There, a pancreatico-hepatic fistula was seen, probably the result of necrosis caused by a severe acute attack of the chronic pancreatitis. After insertion of a naso-fistular drainage, continous rinse and appropriate antibiotic therapy both abscess and fistula completely disappeared without recurrence. CONCLUSION: The rare case of a pancreatic fistula should be considered when a pyogenic liver abscess follows an episode of acute pancreatitis or attack of chronic pancreatitis. Determination of pancreatic amylase in aspired abscess material can be an important step towards correct diagnosis.