Percutaneous aspiration versus catheter drainage of liver abscess: A retrospective review

Background

A review of the effectiveness and outcomes in liver abscess drainage performed by different operators using percutaneous aspiration (PA) and catheter drainage (PCD), respectively, from 2008–2013 at Sir Charles Gairdner Hospital, a tertiary hospital in Australia.

Methods

Forty-two patients (29 males and 13 females; aged between 28–93 years; median age of 67 years) with liver abscesses underwent either ultrasound or CT-guided PA (n=22) and PCD (n=20) in conjunction with appropriate antimicrobial therapy. A median of 18 Gauge needle and 10 French catheters were utilised.

Results

Nineteen (86.4 per cent) PA cases and 12 (60 per cent) PCD cases were successfully drained on a single attempt (p=0.08). More male patients (69 per cent) than females (31 per cent) were observed. Portal sepsis (42.9 per cent) was the most common cause identified. Fever (47.6 per cent) was the most frequent clinical presentation on admission. Thirty-two patients (76.2 per cent) had solitary abscesses with a right lobe (59.5 per cent) predilection. CRP was significantly raised. The PCD group observed a significantly larger abscess size (p=0.01). Klebsiella pneumoniae was the most common organism isolated in both pus (33.3 per cent) and blood cultures (11.9 per cent). Five procedure-related complications were noted, all in the PCD group. Thirty-day mortality was 2.4 per cent. No difference was observed in clinical and treatment outcomes in both groups.

Conclusion

The null hypothesis that both PA and PCD are equally effective in the drainage of liver abscess cannot be rejected. Apart from PA being simpler and safer to perform, the higher incidence of indwelling catheter-associated complications suggests that a trial of PA should always be attempted first.     

Empyema thoracis and lung abscess

The case histories of 22 patients with lung abscess and empyema presenting to Hospital University Sains Malaysia (HUSM) between 1984 and 1989 are reviewed. The presenting features of both lung abscess and empyema were similar. The commonest predisposing factor was pneumonia, and the commonest organism isolated was Staphylococcus aureus but in the majority of cases, no causal organisms were identified. All the patients were treated with antibiotics and in addition, closed chest tube drainage was performed initially in all patients with empyema. Three patients with empyema required additional surgical drainage procedures. Death occurred in one patient with empyema and in one patient with lung abscess. The features, aetiology, treatment and outcome of thoracic empyema and lung abscess are discussed.     

Tropical liver abscess.

Forty-one consecutive cases of liver abscesses seen at the National University Hospital, Singapore from 1988 to 1994 were reviewed. Twenty-seven cases (65%) were pyogenic, six (15%) amoebic, two (5%) tuberculous and six (15%) indeterminate. The predominance of pyogenic abscesses is in marked contrast to previous studies from the region a decade ago in which amoebic abscesses were the commonest type. The commonest pathogen causing pyogenic abscess was Klebsiella pneumoniae. Two cases were due to Mycobacterium tuberculosis, and this organism needs to be actively looked for in smears and cultures of aspirated material. As the majority of organisms isolated were resistant to ampicillin, empirical antibiotic treatment for suspected pyogenic abscess should include gentamicin or a cephalosporin. Percutaneous needle aspiration of the abscess was performed for 85% of pyogenic abscesses and surgery was necessary in only two cases because of complications. We found that percutaneous aspiration of liver abscess is helpful to confirm the diagnosis, provides a better bacteriological culture yield, gives a good outcome, and may uncover clinically unsuspected conditions like malignancy and tuberculoma which may mimic the presentation of liver abscesses. We recommend routine cytological examination of aspirated abscess material as well as stains and cultures for acid-fast bacilli.     

An experimental mouse model to study the pathogenicity of Prevotella bivia and investigations of possible virulence

Induction of subcutaneous abscesses in mice was used to study the pathogenicity of Prevotella bivia both in mono-infection and in mixed cultures with Escherichia coli and Peptostreptococcus spp. Virulence factors such as coaggregation and aggregate formation of cells, haemagglutination activity and tolerance to serum bactericidal activity were investigated for their possible role in P bivia pathogenicity. Monocultures of P bivia, E coli and Peptostreptococcus spp did not induce subcutaneous abscess at concentrations as high as 10(9) colony forming units/millilitre (cfu/ml). Only E coli persisted at the infection site for up to 7 days post infection but with a marked decline in cell count (8.0 x 10(2) cfu/ml). The anaerobic organisms did not persist at the infection sites beyond the fifth day. In contrast, mixed cultures of P bivia and E coli or all three organisms potentiated for infective abscess two weeks after infection. Viable cells were recovered from abscesses in greater numbers as the infection progressed. Prevotella bivia was the predominant organism in chronic abscesses while E coli predominated in abscesses in the acute stage of the infection. Prevotella bivia lacked haemagglutination activity against human and sheep erythrocytes and showed marked susceptibility to 50 per cent human serum. These may limit its haematogenous spread. Its ability to form aggregates in molar salt solutions and coaggregate with facultative organisms may account for its persistence in pathological sites.     

Acute bacterial meningitis in adults: Analysis of 218 episodes

A retrospective study was conducted to examine the laboratory, clinical features and outcome of 206 adult acute bacterial meningitis patients (218 episodes) during the years 1985–1996. Pneumonia (8.7 per cent), head trauma (7.8 per cent) and chronic otitis media (6.0 per cent) were identified as the main predisposing factors for acute bacterial meningitis. Aetiology was described only in 61 episodes (28.0 per cent). Streptococcus pneumonia was the most commonly identified pathogen overall, causing 33 of the 218 episodes (15.2 per cent). Antibiotic treatment before admission was given to 48.4 per cent of patients. On admission, the following symptoms of meningitis were predominant: 83 per cent had neck stiffness, 81 per cent had a headache and 73 per cent had fever. Case fatality rate was 27.1 per cent (59 patients). The important factors in mortality were as follows: old age, a long duration of symptoms before admission, a lack of neck stiffness, obtunded mental state on admission, low glucose levels in first CSF, low CSF/blood glucose ratio, and abnormality in computerised tomography scanning.     

Microbiology of cerebral abscess at the neurosurgical unit of the National Hospital of Sri Lanka

OBJECTIVES: To determine the microbial pathogens responsible for cerebral abscess, ascertain the most suitable antibiotic for treatment and to determine the predisposing causes of cerebral abscess. DESIGN: Prospective study with microbiological investigation of pus aspirated from cerebral abscesses. SETTING: Neurosurgical Unit, National Hospital of Sri Lanka, Colombo. STUDY GROUP: 41 patients with cerebral abscess. PERIOD OF STUDY: 18 months (May 1997 to December 1998) RESULTS: Of the 41 samples of pus 26 (63.1%) gave a positive microbial culture. The Gram stain of the direct smear was positive in 77% of the 26 positive cultures. The most frequently occurring species were Streptococcus milleri group (35%) followed by Staphylococcus aureus (10%). Anaerobes accounted for 23% of positive cultures. All Streptococcus milleri isolates were penicillin and cefotaxime, and all anaerobic isolates except one were susceptible to sensitive to metronidazole. 75% of Gram negative bacilli isolated were sensitive to cefotaxime. All Staphylococcus aureus isolates were methicillin resistant, but sensitive to vancomycin and chloramphenicol. Common predisposing conditions were congenital heart disease (30%), trauma (25%), middle ear disease (7%), and meningitis (7%). CONCLUSIONS: Organisms of the Streptococcus milleri group were most frequently found in cerebral abscesses. The present empirical therapeutic regime adopted in the unit which consisted of cefotaxime 1 g intravenously three times daily and metronidazole 500 mg intravenously three times daily was found to be satisfactory as a majority of the organisms isolated were sensitive to these antimicrobials. In the case of methicillin resistant Staphylococcus aureus (MRSA), it is recommended that chloramphenicol be added to the current regime in management until the antibiotic sensitivity pattern is available.     

糖尿病合并肝脓肿的临床特点和治疗

目的　探讨糖尿病合并肝脓肿 (diabetichepaticabscess ,DHA)的临床特点和有效治疗方法。方法　对 1994年 5月～ 2 0 0 3年 3月我院收治的 2 9例DHA和 6 4例非糖尿病肝脓肿 (nondiabetiche paticabscess ,NDHA)进行对比总结。结果　 2 9例DHA均为 2型糖尿病患者 ,老年人居多 ,男女发病相似 ,6 4例NDHA以中年人为多 ,男略多于女 ;DHA的诱因主要为肺部感染、胆囊炎胆结石、尿路感染、腹腔肿瘤 ,而NDHA为胆道疾患、腹腔手术等 ;病原菌DHA主要为肺炎克雷伯杆菌、坚实牙胞杆菌、大肠杆菌 ,NDHA为粪肠球菌、模仿葡萄球菌、肺炎克雷伯杆菌等 ;DHA组治愈率较NDHA组低 ( 37.9%和 6 2 .5 % ) ,P <0 .0 5 ;平均住院时间较NDHA组长 ,分别为 ( 32 .4± 10 .2 )d和 ( 2 3.8± 11.1)d ,P <0 .0 5 ;DHA组应用抗生素时间较NDHA组长而量大。结论　DHA是糖尿病感染中严重的感染症之一 ,与长期高血糖有关。及早用胰岛素控制血糖至正常、应用足量抗革兰阴性杆菌抗生素控制感染、及时脓液穿刺手术 ,是DHA的有效治疗方法     

80例细菌性肝脓肿临床诊治分析

目的：总结、探讨近年来肝脓肿的病因、病原菌及治疗方式的变化。方法：回顾性分析1991年－2002年80例肝脓肿患者的临床资料，比较采用不同治疗方法，观察患者的脓肿大小及转归。结果：肝脓肿多见于中、老年人，以右肝叶多见。手术引充29例（36．25％），穿刺引流19例（23．75％），保守治疗31例（38．75％），肝左外叶切除1例。隐源性肝脓肿构成比明显上升（50％），胆道疾患仍为重要致病因素（31．25％）。肝脓肿合并糖尿病患者增加（51．25％）。结论：糖尿病已成为肝脓肿患者（特别是隐源性患者）的一个独立的、重要的易患因素；克雷白杆菌成为引发肝脓肿的主要致病菌之一；治疗方法选择应个体化。     

Perianal abscess and fistula in children in Zaria

Perianal abscess (PAA) and fistula-in-ano (FIA) are not uncommon in children, but reports from tropical Africa are uncommon. In a period of 17 years, 17 children aged 12 years and below were treated for these conditions in Zaria, Nigeria. There were 14 boys and 3 girls, aged 4 months-12 years (median 3 years), Eight had PAA (median age 3 years), 5 ischiorectal abscess (median age 5 years) and 4 FIA (median age 10 months). FIA followed pull through for anorectal malformation in 2 patients and in one it was preceded by PAA. PAA was associated with chronic fissure-in-ano in one patient and uncontrolled diabetes mellitus in one. One 16-month girl with an ischiorectal abscess developed severe perineal necrotising fascitis and separation and retraction of the anorectum. Escherichia coli was cultured in 2 patients with abscesses and staphylococcus aureus in another 2. Culture was sterile in 7 patients with abscesses. Treatment was by adequate incision and drainage for abscesses. Fistulectomy was the treatment for FIA, but in one patient a diversion colostomy was performed in addition as the fistula was a high one. The child who developed necrotising fascitis had debridement and diversion colostomy. FIA recurred in one patient necessitating repeat fistulectomy. Although the number of patients is small, perianal sepsis appears to be less common in our environment compared to developed countries. Some differences are highlighted.     

Dynamic CT features of hepatic abscesses

Abstract Objective:To investigate the features of hepatic abscess by dynamic contrast-enhanced CT.Methods:CT films of 62 cases of hepatic abscesses were reviewed retrospectively.All the patients underwent both plain and enhanced CT scanning,and 23 of them received dynamic CT examination.Results:The dynamic CT appearance of hepatic abscesses was characterized by :①In the early phase(30s),abscess membrane en-hanced obviously and the liver parenchyma surrounding the abscesses enhanced transiently;②In the late phase(60-90s),the enhancement patternms of the abscesses varied from the ring enhancement of the abscess membrane to the irregular enhancement of the abscess;③In the delayed phase,the enhancement of abscess diminished in which the hypodense ring enhanced and became isodense,or the abscess enhanced diffusely and became smaller,the colliquative necrosis area more obvious.Conclusion:Contrast enhanced CT should be used routinely in the evaluation of hepatic abscesses.The dynamic and delayed scan is necessary to diagnose atypical hepatic abscesses.     

儿童惠普尔养障体肺炎的临床特征分析

目的：探讨儿童惠普尔养障体（TW）肺炎的临床表现、诊断及治疗,提高儿科医师对该病的认识。方法：回顾性分析2020年8月至2022年1月收治于温州医科大学附属第二医院育英儿童医院儿童呼吸科的3例TW肺炎患儿的临床资料。以“惠普尔养障体”和“肺部感染”或“肺炎”为关键词在中国知网、万方数据库“Tropherywhipplei”和“pneumonia”为关键词在PubMed数据库检索自建库至2022年7月的相关文献。总结TW肺炎的临床特点、辅助检查、诊疗经过及预后。结果：本组3例患儿中,男2例,女1例,平均年龄（7.3±2.3）岁。肺泡灌洗液宏基因组二代测序（BALF mNGS）除例3合并检出流感嗜血杆菌,余2例仅检出TW,3例均应用头孢曲松针抗感染,联合或续用TMP-SMZ,除例2 预后不佳（出现较严重的间质性肺病,运动耐量下降）,余2例预后良好。检索符合条件的中文文献3篇,英文文献15篇,共23例,加上本组3例共26例,该病临床特征无特异性,主要表现为咳嗽（14例）、呼吸困难/气促（12例）、胸痛（6例）等。结论：TW肺炎多为慢性肺部感染,临床特征及影像学表现均不典型,临床上极易误诊,早期行BALF mNGS有助于明确病原体,协助诊断,合理抗感染治疗可迅速缓解症状,但易复发,预后大多良好。     

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.     

小儿急性咽后脓肿的诊断与治疗

目的总结小儿急性咽后脓肿的诊治体会。方法回顾性分析8例小儿急性咽后脓肿患者的临床表现及治疗经过。结果5例首诊儿科并延误诊断。5例进行了颈部影像学检查，诊断准确率为100％。8例中6例经口内脓肿切开引流治愈；2例脓肿突然破裂，1例抢救后治愈，1例因全身感染中毒症状重而死亡。结论小儿急性咽后脓肿易被误诊，影像学检查有助提高诊断准确率，脓肿切开引流是最直接有效的治疗手段，倒提患儿是脓肿突然破裂时实用有效的急救措施。对于全身感染中毒症状较重的患儿，应及早行对症治疗。     

A case series of brain abscesses in Malawian children

We report three cases of brain abscess in children admitted to QECH in 2006. All children were HIV-uninfected. One case was associated with staphylococcal empyema, another with chronic suppurative otitis media and mastoiditis, and the third case had no identified extracranial focus of infection. These cases illustrate the difficulties of diagnosis and management of brain abscesses in the resource-poor setting where other causes of infection of the central nervous system are common. The typical clinical presentation of brain abscess of altered mental state and seizures is also characteristic of cerebral malaria and meningitis and it is likely that many cases of brain abscess in Malawian children are not diagnosed. The value of cranial CT scan, ideally with contrast, for diagnosis and management of brain abscess is highlighted by these cases.     

Brain abscess in children, experience Of Mashad University

Objective： Brain abscesses continue to pose a problem in neurosurgery, and it is a serious life-threatening complication for several diseases. The objective of this research was to lock at the clinical profile of children suffering from brain abscess, predisposing conditions, microbiology and outcome of these patients. Methods： Ninety children aged less than 15 years were reviewed. The clinical presentation, predisposing factors, diagnosis, management and outcome were noted. There were 56（ 62.2% ） males and 34 （ 37.7% ） females. The mean age of presentation was 5.7 ± 4.2 years. Results： The mean duration of illness at the time of presentation was 10.6 ± 12.4 days. Typically patients presented with fever, vomiting, headache, neurological deficit, and seizures. The predisposing conditions found were cyanotic congenital heart disease in 18 （20 % ） of children, meningitis in 6 （6.7 % ）, Otitis or mastoiditis in 32 （35.5 % ）, Head trauma in 6 （ 6.7 % ）, previous intraeranial surgery in 8 （8.8 % ） and no underlying cause was found in 22 （24.4 % ） children. The most common microbe in children with cyanotic congenital heart disease was of the Streptococcus group （54 % ）. Computerized tomography confirmed the diagnosis and the most common location of the abscess was the parietal lobe of the cerebral hemisphere. That abscesses were larger than 2 cm in diameter where aspirated surgically. Excision was performed for eight children. Six children expired, two due to intracranial bleeding and the others due to severe cerebral edema and tentorial herniation. Complications were observed in 11 children out of which six had squeal and five had bemiparesis. Conclusion： Attention to hygiene of mouth and teeth in infant and child patients with cyanotic heart disease is very important in prevention of infectious brain diseases. We must also pay attention to ear-nose-throat diseases of children. That is very important the patients be examined again after treatment because of finding and trea     

Radiological changes in left lobe amoebic liver abscesses

Elevation of the left dome of the diaphragm occurred in 43% of cases with left lobe amoebic liver abscesses. It was rarely seen in patients with an abscess in the right hepatic lobe. Elevation of the right dome of the diaphragm, which occurred in 36% of cases, is also compatible with a diagnosis of left lobe abscess. This radiological sign was present in 75% of cases with right lobe abscesses. Pleuro-pulmonary changes in the left chest, when associated with an elevation of the left dome of the diaphragm, favours the diagnosis of an amoebic abscess of the left lobe of the liver. Radiological changes in barium studies are usually confined to patients with large hepatic abscesses. In clinical practice the information obtained from simple radiology can provide adequate diagnostic confirmation of the presence of a left lobe liver abscess.     

类鼻疽伯克霍尔德杆菌致脾脓肿病例报告的系统评价

目的 总结既往病例诊断治疗情况,结合实际收治病例经验,为类鼻疽伯克霍尔德杆菌（Bulkholderia pseudomallei）感染所致脾脓肿的科学治疗提供依据和参考。方法 以海南医学院第二附属医院为中心,收集类鼻疽伯克霍尔德杆菌感染导致脾脓肿的患者基本资料、临床表现和药物敏感性等病例资料。同时系统检索中文数据库（万方数据库、中国生物医学文献数据库、维普数据库和中国知网）及英文数据库（PubMed、CochraneLibrary、Embase、Web of Science和Ovid）中关于类鼻疽伯克霍尔德杆菌感染致脾脓肿的病例报告。检索时间为建库至2021年1月1日,采用病例报告偏倚评价工具对纳入文献进行质量评估,对全部病例临床表现及治疗预后进行定性分析。结果 收集在海南医学院第二附属医院进行诊断和治疗的病例3例,筛选到符合标准的文献8篇（9个病例）,共纳入符合标准的类鼻疽脾脓肿病例12例。类鼻疽脾脓肿患者临床表现大多为发热伴随寒战、左上腹痛等症状,影像学提示脾脓肿通常表现为多发脓肿灶。实验室检查结果提示患者白细胞计数常有不同程度的升高。最常见的并发类鼻疽感染所致脾脓肿的基础疾病为糖...     

Changing prevalence of diabetes mellitus amongst rural Malays in Kuala Selangor over a 10-year period

A cross-sectional study was carried out to determine the prevalence of diabetes mellitus and its relationship with age, physical activity, nutritional status and diet amongst rural Malays in Kuala Selangor. By simple random sampling 360 subjects were selected for the study. Besides guided questionnaires, subjects also underwent a 2 hours post prandial (2HPP) test to determine the diabetic status as recommended by WHO. The crude prevalence of diabetes mellitus was 14.6% which increases with age. The prevalence of diabetes adjusted for age was 12.2%. Physical activity status seemed to be a significant risk factor for diabetes. A greater proportion of diabetics was obese and their mean fat intake was higher than normal subjects (p < 0.05). The prevalence of diabetes mellitus in this study was significantly higher compared with data from 1984 (3.9%), representing a marked increment of 212.8 per cent over a 10-year period.     

Successful antimicrobial therapy of hepatic, intra-abdominal and intrapelvic abscesses.

Antimicrobial therapy without surgical drainage or therapeutic aspiration was effective in the management of four patients with deep abscesses ranging in diameter from 1.3 to 10.0 cm. Two of the patients had multiple hepatic abscesses, one had hepatic, intra-abdominal and intrapelvic abscesses, and one had an intrapelvic abscess alone. Anaerobic bacteria were isolated from the blood or abscesses in all four patients, and an aerobic-anaerobic infection was present in one patient. The patients were treated with metronidazole, alone or in combination with other antibiotics, for 3 to 6 weeks. Therefore, in selected patients with deep abscesses, a therapeutic trial of antimicrobial agents instead of surgery may be justified.     

经皮肝穿置管连续灌注引流治疗糖尿病合并细菌性肝脓肿的疗效及影响因素分析

目的：对比研究超声介入治疗糖尿病合并细菌性肝脓肿（DBLA）的2种置管引流方法（连续灌注和单纯引流）的临床疗效,并进一步分析连续灌注引流术后拔管时间和住院时间的影响因素。方法：将170例DBLA的患者随机分为2组,分别采取超声引导下经皮肝穿刺置管连续灌注（连续灌注组,85例）和单纯引流（单纯引流组,85例）2种方法进行治疗,统计分析2组患者的术后并发症、术后体温恢复正常的时间、术后外周血白细胞计数恢复正常的时间、术后拔管时间以及术后住院时间。探讨连续灌注组介入术后拔管时间和住院时间的影响因素。运用LASSO回归分析筛选变量及计算系数,并由此构建术后拔管时间和住院时间的预测模型。结果：2组患者术后并发症发生率、术后体温恢复正常时间、术后外周血白细胞计数恢复正常时间差异均无统计学意义（P＞0.05）。连续灌注组平均术后拔管时间为（21.1±12.4）d,明显短于单纯引流组的（29.1±14.9）d（P＜0.05）;连续灌注组平均术后住院时间为（16.2±6.6）d,明显短于单纯引流组的（27.8±8.0）d（P＜0.05）。连续灌注组术后拔管时间的影响因素为：脓肿含气、脓肿多房、合并胆道结石、血浆白蛋白和体质量指数（BMI）（P＜0.05）;术后住院时间的唯一影响因素为：合并感染性休克（P＜0.05）。LASSO回归构建预测模型：术后拔管时间=0.06×白细胞-0.72×血浆白蛋白+1.99×多房+6.86×胆道结石+ 0.94×BMI;术后住院时间=0.21×甘油三酯+1.79×感染性休克。结论：对于DBLA,超声引导下经皮肝穿置管连续灌注引流的临床疗效优于单纯引流术;超声图像特征为脓肿含气、脓肿多房,患者合并胆道结石、低蛋白血症或高BMI均将延长术后拔管时间;患者合并感染性休克将延长术后住院时间。