A Unique Case of Empyema Secondary to Amoebic Liver Abscess.
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ABSTRACT:
SUBMITTER: Nasrullah A
PROVIDER: S-EPMC5522014 | biostudies-other | 2017 Jun
REPOSITORIES: biostudies-other
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Project description:BACKGROUND:The aim of this study was to investigate the clinical manifestation and predictive risk factors of pleural empyema developing during treatment of the pyogenic liver abscess. METHODS:Medical records of patients with the liver abscess in our institution were reviewed retrospectively. Enrolled patients were classified into four groups; Group 1: patients without pleural effusion, Group 2: patients with pleural effusion and who were treated noninvasively, Group 3: patient with pleural effusion and who were treated with thoracentesis, and Group 4: patients with pleural effusion that developed into empyema. Patient characteristics, clinical manifestation, and possible risk factors in development of empyema were analyzed. RESULTS:A total of 234 patients was enrolled in this study. The incidence rate of empyema was 4.27% (10 patients). The mean interval for developing pleural effusion was 5.6?±?6.35?days. In multivariate analysis, risk factors for developing pleural effusion included the location of the liver abscess near the right diaphragm (segment 7 and 8, OR?=?2.30, p?=?0.048), and larger diameter of the liver abscess (OR?=?1.02, p?=?0.042). Among patients who developed pleural effusions, presences of mixed microorganisms from culture of liver aspirates (OR?=?10.62, p?=?0.044), bilateral pleural effusion (OR?=?46.72, p?=?0.012) and combined biliary tract inflammation (OR?=?21.05, p?=?0.040) were significantly associated with the need for invasive intervention including surgery on effusion. CONCLUSION:The location of the liver abscess as well as pleural effusion, elevated inflammatory markers, and combined biliary tract inflammation may be important markers of developing pleural complication in patients with pyogenic liver abscess.
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Project description:BACKGROUND:Vertebral osteomyelitis can be attributed to many factors including immunosuppression, diabetes, malignancy, collagen disease, periodontal disease, open fractures, and endoscopic procedures. Anaerobic bacteria, such as Veillonella species, are found in the oral cavity and are rarely implicated in the infection. This report describes vertebral osteomyelitis secondary to a dental abscess with positive Veillonella cultures. CASE DESCRIPTION:A 76-year-old man presented to the hospital due to back pain with a four-day history of fever and chills. CT scans revealed several abscesses in the lumbar region as well as indications of vertebral osteomyelitis. After a psoas drain, the patient began antibiotics with a combination of ampicillin-sulbactam, metronidazole, and levofloxacin, but due to the patient's penicillin allergy, he was initially desensitized to this antibiotic for a significant period of time. Laminectomies, foraminotomies, and facetectomies were performed, but the infection spread to vertebral levels. The patient was then switched to a combination of vancomycin, metronidazole, and levofloxacin which eliminated the infection. Final laminectomy was performed with posterior segmental instrumentation and arthrodesis. Post-operatively, there were no signs of infection. The patient recovered well and regained mobility. Deeper examination of the patient's medical history revealed a severe tooth abscess immediately before the onset of bacteremia. CONCLUSION:We believe that a delay in the onset of antibiotic treatment is what led to the initial bacteremia that ultimately took root in the lower lumbar vertebrae. To the best of our ability, we could identify only one other case that linked vertebral osteomyelitis to the oral cavity.
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Project description:Pleural effusion is an accumulation of fluid in the pleural space that is classified as transudate or exudate according to its composition and underlying pathophysiology. Empyema is defined by purulent fluid collection in the pleural space, which is most commonly caused by pneumonia. A lung abscess, on the other hand, is a parenchymal necrosis with confined cavitation that results from a pulmonary infection. Pleural effusion, empyema, and lung abscess are commonly encountered clinical problems that increase mortality. These conditions have traditionally been managed by antibiotics or surgical placement of a large drainage tube. However, as the efficacy of minimally invasive interventional procedures has been well established, image-guided small percutaneous drainage tubes have been considered as the mainstay of treatment for patients with pleural fluid collections or a lung abscess. In this article, the technical aspects of image-guided interventions, indications, expected benefits, and complications are discussed and the published literature is reviewed.
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Project description:IntroductionCoronavirus disease 2019 (COVID-19) is an acute respiratory tract infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). Recent evidences mentioned the possibility of COVID-19 as a systemic infectious and inflammatory disease. Signs and symptoms of liver and gastrointestinal system are often found in post-acute COVID-19 patients. However, there are only few data found about liver abscess and necrosis in post COVID-19 patients.Case presentationA 49-year-old man admitted to the hospital with dyspnea, nausea, loss of appetite and epigastric pain, post confirmed SARS CoV-2 severe pneumonia 1 month ago in ICU with noninvasive ventilator (NIV), enoxaparin, tocilizumab, azithromycin, levofloxacin, hydroxychloroquine, and no preexisting liver condition. Swab PCR result was negative. The result of abdominal computed tomography (CT) scan with contrast was liver abscess formation with hemorrhages measuring about 16 × 12 × 11 cm & 10 × 9x9 cm occupying most of the right lobe liver. The patient underwent exploratory laparotomy, there were multiple liver abscesses in segment 8 with parenchymal liver necrosis and abscesses in segment 7 of liver. Necrosectomy and liver abscess drainage was performed.Clinical discussionPathophysiology of liver damage in post COVID-19 are direct cytotoxicity of SARS-CoV2, immune-mediated due to severe systemic inflammatory response syndrome (SIRS) in COVID-19, hypoxemia, vascular changes due to coagulopathy, endothelitis or congestion from right heart failure, and drug-induced liver injury (DILI).ConclusionThe possible pathophysiology of liver abscess and necrosis in post COVID-19 should be considered in monitoring and management for both COVID-19 patients and post COVID-19 patients.
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Project description:Patients with penetrating head trauma with retained projectiles develop intracranial abscesses as a common complication. The most common presentation is a suddenly worsening headache. The most common pathogen identified is staphylococcus. Outcomes are related to adherence of Matson's tenets. This case study details the presentation of a 19-year-old patient that presented to the neurological surgery clinic without neurologic deficits. Further questioning revealed complaints of intermittent diffuse headaches with bilateral upper extremity shock-like sensation for two weeks. Eight weeks prior he had undergone right craniotomy, after a gunshot wound, for debridement and watertight dural closure. The patient denied symptoms of fever, chills, nausea, vomiting, diarrhea, or seizure. The patient presented with a noncontrast head computed tomography (CT) which revealed retained projectile fragments without clear evidence of abscess. On physical exam, the patient was without any neurological deficit. Laboratory investigation revealed normal white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and negative blood cultures. Head CT with contrast revealed a large intracerebral abscess adjacent to the thalamus. The patient was taken to the operating room for repeat craniotomy with resection of the abscess and removal of the intracranial projectile fragments. Post-operatively, the patient remained neurology intact. Intraoperative cultures were not significant for the growth of any bacteria. In eight weeks time, the patient returned to his employment and his baseline level of activity. This case underscores the importance of thorough assessment in patients with retained intracranial projectiles as well as the need to routine follow-up. The unique presentation of this patient prompted further investigation which elucidated a lesion which correlated to his symptoms although laboratory assessment was without abnormality.
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Project description:BackgroundBacterial hepatic abscess is a common occurrence in developing countries, which is mostly caused by Klebsiella pneumoniae and Escherichia coli. Pannonibacter phragmitetus is a Gram-negative alkali-tolerant bacillus that exists in the natural environment. Human infection by this bacterium is rare, with only four cases reported.MethodWe presented one of these cases with a bacterial liver abscess by a polymicrobial infection involving P. phragmitetus and Streptococcus oralis, with P. phragmitetus being the predominate isolate.Result and discussionOur strain of P. phragmitetus was resistant to more antibiotics than the other reported two strains. This case further verified the infectivity of P. phragmitetus.
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Project description:BackgroundExposure to hydrocarbon compounds, such as benzene may cause injury to several organ systems. It occurs accidentally or intentionally by ingestion, inhalation, cutaneous exposure and either subcutaneous injection or intravenous injection. We report a patient who injected benzene into the left hemithorax and secondly attempted to commit suicide with paracetamol.Case presentationA 52-year old man was admitted in the hospital because of an attempted suicide with an injection of benzene in the left hemithorax and ingestion of 50 tablets of 500?mg paracetamol. He developed a hydro-tensionpneumothorax due to inflammatory pleural effusion as a reaction to intrathoracic benzene. Therefore a chest-tube was inserted. A few days later he developed an empyema in the left lung and secondly a pectoral abscess, which required surgical debridement. After surgery, recovered fully and after 23 days of hospitalisation he was discharged to a psychiatric care facility.ConclusionHydrocarbon poisoning is either accidentally or intentionally and leads to thoracic pathology in rare cases. The most affected organ system is the respiratory system, and the cytotoxic effects of hydrocarbons can manifest as respiratory failure, pneumonitis and even acute respiratory distress syndrome (ARDS).
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Project description:BackgroundAmoebiasis is a prevalent infection in the tropics. Amoebic liver abscess is the most common extraintestinal manifestation. Cardiac tamponade is an uncommon complication of amoebic liver abscess that may need urgent pericardiocentesis.Case summaryA 25-year-old man presented with abdominal pain and fever for 1 month. Abdominal ultrasound revealed a 4.7 × 4.7 cm abscess in the left lobe of the liver. Percutaneous pigtail drainage was performed to evacuate the abscess. After 2 days, the patient developed signs of cardiac tamponade and bilateral pleural effusion, requiring urgent pericardiocentesis and chest drain insertion. Persistent posterior collection of thick abscess in pericardium needed pericardial window for complete drainage. The patient recovered completely after pericardial window. There was no evidence of chronic constrictive pericarditis after 1 year of follow-up.DiscussionA rare complication of the amoebic liver abscess was observed in this young adult who developed cardiac tamponade, requiring an urgent pericardiocentesis, and later requiring pericardial window. Management includes amoebicidal and luminicidal drugs for complete eradication of Entamoeba histolytica.
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Project description:Pyogenic liver abscess has a variable clinical presentation. Its management requires input from several disciplines and is often coordinated by a gastroenterologist. This review examines demographics, clinical presentation, aetiology, diagnosis and prognosis; a suggested management approach, including antibiotic selection, radiological intervention and indications for surgery, is offered from a physician's perspective.
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