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Clinical and Pathological Comparison of Pyogenic and Amoebic Liver Abscesses  [PDF]
Adnan Bashir Bhatti, Farhan Ali, Siddique Akbar Satti, Tariq Mehmood Satti
Advances in Infectious Diseases (AID) , 2014, DOI: 10.4236/aid.2014.43018
Abstract:

BACKGROUND: Pyogenic and amoebic liver abscesses are rare, potentially lethal conditions. In this study, we aimed to examine the clinical and pathological differences between them. METHODS: Patients with confirmed liver abscesses were divided into two groups: the pyogenic (n = 47) and amoebic group (n = 21), which were analyzed for differences in clinical and laboratory findings. RESULTS: Amoebic liver abscesses presented most frequently in young adults (14 - 30 years; 71%), whereas pyogenic liver abscesses were most commonly observed in adults 41 - 50 years (49%). Indirect hemagglutination test revealed a 100% positive response in the amoebic group, whereas 68% of the pyogenic group presented with blood/pus culture. Multiple abscesses were observed in 66% and 24% of patients in the pyogenic and amoebic group, respectively. CONCLUSIONS: Pyogenic abscesses were commonly observed in older patients, and were associated with features such as markedly deranged liver function test, higher prothrombin time, and multiple abscesses, compared to amoebic abscess. Early and improved diagnoses and differentiation between the two conditions, followed by the correct treatment, can help prevent serious complications and lead to an overall improved mortality rate.

Imported Amoebic Liver Abscess in France  [PDF]
Hugues Cordel,Virginie Prendki,Yoann Madec,Sandrine Houze,Luc Paris,Patrice Bourée,Eric Caumes,Sophie Matheron,Olivier Bouchaud ,the ALA Study Group
PLOS Neglected Tropical Diseases , 2013, DOI: 10.1371/journal.pntd.0002333
Abstract: Background Worldwide, amoebic liver abscess (ALA) can be found in individuals in non-endemic areas, especially in foreign-born travelers. Methods We performed a retrospective analysis of ALA in patients admitted to French hospitals between 2002 and 2006. We compared imported ALA cases in European and foreign-born patients and assessed the factors associated with abscess size using a logistic regression model. Results We investigated 90 ALA cases. Patient median age was 41. The male:female ratio was 3.5:1. We were able to determine the origin for 75 patients: 38 were European-born and 37 foreign-born. With respect to clinical characteristics, no significant difference was observed between European and foreign-born patients except a longer lag time between the return to France after traveling abroad and the onset of symptoms for foreign-born. Factors associated with an abscess size of more than 69 mm were being male (OR = 11.25, p<0.01), aged more than 41 years old (OR = 3.63, p = 0.02) and being an immigrant (OR = 11.56, p = 0.03). Percutaneous aspiration was not based on initial abscess size but was carried out significantly more often on patients who were admitted to surgical units (OR = 10, p<0.01). The median time to abscess disappearance for 24 ALA was 7.5 months. Conclusions/Significance In this study on imported ALA was one of the largest worldwide in terms of the number of cases included males, older patients and foreign-born patients presented with larger abscesses, suggesting that hormonal and immunological factors may be involved in ALA physiopathology. The long lag time before developing ALA after returning to a non-endemic area must be highlighted to clinicians so that they will consider Entamoeba histolytica as a possible pathogen of liver abscesses more often.
Amoebic liver abscess: a diagnostic dilemma in the elderly
IB Bosan, TS Baduku
Annals of African Medicine , 2003,
Abstract: A 63-year old man presented with a 2-year history of progressive abdominal swelling with non-specific symptoms and signs. He visited several hospitals, where no diagnosis could be made for about 2 years and all therapeutic options given were ineffective. The appearance of an elevated right hemi diaphragm on chest X-ray, a single well defined area of Sonolucency with a thin edged border on ultrasound and a positive amoebic precipitin led to a diagnosis of amoebic liver abscess. Radiological intervention through ultrasound guided aspiration combined with medical therapy using metronidazole, led to rapid recovery and near complete resolution. This case typifies a not very uncommon but atypical presentation of amoebic liver abscess seen in practice characterized by intra abdominal space occupying lesion with non-specific symptoms and signs. Effective use of imaging techniques should help in the diagnosis. Ultrasound guided aspiration combined with medical therapy is effective treatment.
Influence of inflammation on parasitism and area of experimental amoebic liver abscess: an immunohistochemical and morphometric study
Cássia Costa, Thaisa Fonseca, Fabrício Oliveira, Joseph Santos, Maria Gomes, Marcelo Caliari
Parasites & Vectors , 2011, DOI: 10.1186/1756-3305-4-27
Abstract: Amoebiasis is a disease caused by the protozoan Entamoeba histolytica through oral infection by cysts followed by colonization or tissue invasion by trophozoites in the large intestine. Annually, about 50 million people are infected, causing approximately 100,000 deaths [1]. After the colonic mucosa is damaged, the trophozoites may reach the bloodstream and liver, producing the amoebic hepatic abscess, which is the most common extra-intestinal form of amoebiasis [2]. The typical amoebic lesion is characterized by a liquefactive necrosis zone with edges consisting of cellular debris and polymorph-histiocitary inflammatory infiltrate. Such necrosis is produced by trophozoite derivatives, such as amoebapores (polypeptides capable of forming pores in the hosts' cells), cysteine proteinases (enzymes that cleave collagen, elastin, fibrinogen, and laminin), and galactose/N-acetylgalactosamine lectin (Gal/GalNac) (a CD59 like molecule capable of inhibiting the C5b-9 complex of the complement, inducing apoptosis and stimulating the production of IL-1α, IL-1β, and IL-8).Controversial results have been published about the role of inflammation on the pathogenesis of amoebic necrosis. The inflammatory infiltrate in amoebiasis is very discrete when compared to intense necrosis, suggesting that the inflammatory cells are destroyed, releasing their enzymatic content into the hepatic parenchyma [2]. Radiation-induced leucopenia in hamsters followed by trophozoites inoculation led to the reduction of inflammatory processes, hepatic necrosis, and parasitism [3]. On the other hand, mice infected with E. histolytica and previously treated with anti-neutrophil monoclonal antibodies developed liver necrosis with the same dimensions as those of the control group, and those lesions were probably produced by products secreted by the amoeba itself [4].Considering the doubts that still persist about amoebic pathogenesis, we assessed the influence of inflammation in necrosis and in hepatic para
Standardization and evaluation of ELISA for the serodiagnosis of amoebic liver abscess
Nicholls, R. Santiago;Restrepo, Marcos I.;Duque, Sofia;Lopez, M. Consuelo;Corredor, Augusto;
Memórias do Instituto Oswaldo Cruz , 1994, DOI: 10.1590/S0074-02761994000100010
Abstract: an elisa test for the serological diagnosisof amoebic liver abscess (ala) was standardized and evaluated in sera from three groups of patients: (1) three patients with diagnosis confirmed by isolation of the parasite,(2) thirty seven patients with diagnosis established by clinical findings and ultrasound studies and (3) seven patients whose diagnosis were established by clinical findings and a positive double immunodifusion test. ninety one serum samples from healthy subjects and 22 from patients with other liver or parasitic diseases were also included in the study. the optimum concentration of entamoeba histolytica antigen was 1.25 μg/ml and optimum dilutions of serum and anti-human igg-alkaline phosphatase conjugate were 1:400 and 1:4000 respectively. the cut-off point of the elisa test in this study was an absorbance value of 0.34. the test parameters were: sensitivity = 95.7 per cent, specificty = 100 per cent, positive predictive value = 100 per cent and negative predictive value = 98.2 per cent.the elisa test was found to be of great use as a diagnostic tool for the establishment of amoebic etiology in patients with clinical supposition of ala. the test could also be used for seroepidemiological surveys of the prevalence of invasive amoebiasis in a given population, since it allows the processing of a greater number of samples at a lower cost tahn other serological tests.
Evaluation of antigen detection and polymerase chain reaction for diagnosis of amoebic liver abscess in patients on anti-amoebic treatment
Virendra Jaiswal, Ujjala Ghoshal, Sanjay S Baijal, Balraj Mittal, Tapan N Dhole, Uday C Ghoshal
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-416
Abstract: Using anti-amoebic IgG antibody and bacterial culture, 136/200 (68.0%) were classified as ALA, 12/200 (6.0%) as pyogenic liver abscess (PLA), 29/200 (14.5%) as mixed infection, and 23/200 (11.5%) remained unclassified. Using amoebic PCR and bacterial culture 151/200 (75.5%) were classified as ALA, 25/200 (12.5%) as PLA, 16/200 (8.0%) as mixed infection, and 8/200 (4.0%) remained unclassified. With E. histolytica lectin antigen and bacterial culture, 22/200 (11.0%) patients were classified as ALA, 39/200 (19.5%) as PLA, 2/200 (1.0%) as mixed infection, and 137/200 (68.5%) remained unclassified.E. histolytica lectin antigen was not suitable for classification of ALA patients who had prior anti-amoebic treatment. However, PCR may be used as alternative test to anti-amoebic antibody in diagnosis of ALA.Amoebic liver abscess (ALA) is caused by protozoan parasite Entamoeba histolytica (E. histolytica), a common parasitic infection in tropical countries [1-3]. Approximately 50 million people are infected with E. histolytica annually world-wide, with mortality ranging from 40,000 to 1,000,00 [4]. Most of the mortality due to amoebiasis results from hepatic rather than intestinal infection. Clinical and radiological features of ALA are often somewhat similar with pyogenic liver abscess (PLA). Hence, necessitating laboratory investigation for differentiation between ALA and PLA are required [5]. Currently ALA is distinguished from PLA by microscopic examination, anti-amoebic IgG serology, and culture of aspirate for pyogenic organisms.Detection of trophozoites on microscopic examination in liver aspirate, though confirmatory of ALA, is quite insensitive [6,7]. Diagnosis of ALA is most frequently made using serum anti-amoebic IgG antibody [8,9]. However, this assay may not distinguish past from current infection, especially in endemic regions [10]. Thus, anti-amoebic IgG antibody may also be detected in a proportion of healthy people [10,11].Sensitivity and specificity of E. h
Acute Pancreatitis Associated with Amoebic Liver Abscess  [PDF]
Jayant Kumar Ghosh,Vinod Kumar Dixit,Sangey Chopel Lamtha,Sundeep Kumar Goyal,Pankaj Kaushik
Case Reports in Gastrointestinal Medicine , 2013, DOI: 10.1155/2013/717393
Abstract: We present a rare case of acute pancreatitis in a 50-year-old man with amoebic liver abscess. He had a right lobe liver abscess along with markedly elevated serum lipase and amylase levels and edematous pancreas. Liver abscess was aspirated. The patient was managed conservatively with antibiotics and improved without any complications. Acute pancreatitis associated with ALA is not reported in the literature till date. 1. Case Report A 50-year-old male, nonalcoholic, presented with pain in right upper abdomen for the last 7 days which had increased in severity in the last 24 hours. He had not passed flatus for the last 12 hours. The patient had a history of acute diarrhea 1 month back. At admission patient was conscious, febrile and had diffuse upper abdominal pain which was severe in intensity. Abdomen was distended and bowel sounds were absent. There was tender hepatomegaly. Spleen was not palpable. No free fluid was detected clinically. There was no past history of diabetes, hypertension, and abdominal/biliary surgery. His investigations showed leukocytosis (total leukocyte count = 18,000/mm3). Serum lipase and amylase were markedly elevated (1788?mg/dL and 1365?mg/dL, resp.). X-ray abdomen showed distended bowel loops. Ultrasonography (USG) of abdomen was done which revealed an abscess cavity of 8 × 8 × 7?cm3 in the right lobe of liver situated near the surface of the liver. Serum IgG Entamoeba histolytica was positive. No gall bladder or common bile duct stones were seen in the USG. He had mild hypocalcaemia (serum calcium level = 8.2?mg/dL). Serum lipid profile, glucose, liver function tests, renal function tests, and thyroid profile were within normal limit. X-ray chest was unremarkable except for prominent bronchovascular markings. Arterial blood gas analysis was almost normal except for low calcium level. On day 2 of hospital admission, contrast enhanced CT (CECT) scan of abdomen was done which showed a large right lobe liver abscess associated with edematous pancreas without any necrosis or acute fluid collections (Figure 1). The modified CT severity index (CTSI) was 4/10. No fistulous communication between liver and pancreas or other organs could be demonstrated in the CECT abdomen. Patient was managed with intravenous fluid, intravenous antibiotics, that is, metronidazole and meropenem. Liver abscess was aspirated under USG guidance and about 250?mL of anchovy sauce pus was aspirated. Gram stain and culture of the pus were negative. The pus was also examined for pancreatic enzymes which were within normal limits. On day 2 of hospitalization
Mucosal Delivery of ACNPV Baculovirus Driving Expression of the Gal-Lectin LC3 Fragment Confers Protection against Amoebic Liver Abscess in Hamster
DM Meneses-Ruiz, JP Laclette, H Aguilar-Díaz, J Hernández-Ruiz, A Luz-Madrigal, A Sampieri, L Vaca, JC Carrero
International Journal of Biological Sciences , 2011,
Abstract: Mucosal vaccination against amoebiasis using the Gal-lectin of E. histolytica has been proposed as one of the leading strategies for controlling this human disease. However, most mucosal adjuvants used are toxic and the identification of safe delivery systems is necessary. Here, we evaluate the potential of a recombinant Autographa californica baculovirus driving the expression of the LC3 fragment of the Gal-lectin to confer protection against amoebic liver abscess (ALA) in hamsters following oral or nasal immunization. Hamsters immunized by oral route showed complete absence (57.9%) or partial development (21%) of ALA, resulting in some protection in 78.9% of animals when compared with the wild type baculovirus and sham control groups. In contrast, nasal immunization conferred only 21% of protection efficacy. Levels of ALA protection showed lineal correlation with the development of an anti-amoebic cellular immune response evaluated in spleens, but not with the induction of seric IgG anti-amoeba antibodies. These results suggest that baculovirus driving the expression of E. histolytica vaccine candidate antigens is useful for inducing protective cellular and humoral immune responses following oral immunization, and therefore it could be used as a system for mucosal delivery of an anti-amoebic vaccine.
Amoebic liver abscess in the medical emergency of a North Indian hospital
Navneet Sharma, Aman Sharma, Subhash Varma, Anupam Lal, Virendra Singh
BMC Research Notes , 2010, DOI: 10.1186/1756-0500-3-21
Abstract: The mean age of patients was 40.5 ± 2.1 years (male-female ratio = 7:1). Fever, pain abdomen and diarrhea were seen in 94%, 90% and 10.5% respectively. Duration of symptoms less than 2 weeks was seen in 48% cases. Hepatomegaly was present in 16% cases only, a right sided pleural effusion in 14% cases and ascites in 5.7%. On ultrasound, a right lobe abscess was seen in 65%, a left lobe abscess in 13% and multiple abscesses in both the lobes in 22% cases. Seventy one cases underwent per-cutaneous pigtail catheter drainage for a mean period of 13.4 ± 0.8 days. The mortality rate was 5.8%. On multivariate regression and correlation analysis, a higher number of inserted pigtail catheters correlated to mortality.Amoebic liver abscess presents commonly to the emergency department and should be suspected in persons with prolonged fever and pain abdomen. Conservative management for uncomplicated amoebic liver abscess and insertion of single per-cutaneous pigtail catheter drainage for complicated amoebic liver abscess are efficacious as treatment modalities.Diseases caused by Entamoeba histolytica manifest as acute infectious diarrhea clinically and pathologically as ulcerative and inflammatory lesion in the caecum and the entire colon [1]. The organism during the invasive stage gains access to the liver via the portal vein where marked tissue destruction occurs resulting in a liver abscess [2-7]. In India, due to poor sanitary condition and a lower socioeconomic status, amoebiasis is endemic and amoebic liver abscess accounts for 3-9% of all cases of amoebiasis [8].Patients with amoebic liver abscess manifest early with abdominal pain and fever or as fever of unknown origin, weight loss and abdominal pain [7]. Coexisting diarrhea occurs in 30% and it is extremely rare to find amoebic trophozoites in the stool examination [7]. Although, amebic liver abscess occurs mostly in the right lobe, yet, considerable variations exist. In an ultrasonographic analysis of 212 patients of
Amoebic liver abscess — results of a conservative management policy
PI McGarr, TE Madiba, SR Thomson, P Corr
South African Medical Journal , 2003,
Abstract: Objective. To evaluate the safety and efficacy of conservative management of amoebic liver abscesses. Design. A prospective study carried out over a 1-year period. Setting. Inpatients and outpatients in a tertiary referral institution. Subjects. Amoebic liver abscess was diagnosed on clinical, ultrasonographic, and serological features. All patients were treated with metronidazole. The indication for ultrasoundguided aspiration of the abscess was failure to improve clinically within 48 - 72 hours. Main outcome measures. Clinical improvement, clinical deterioration and failure of clinical improvement (persistent pain). Results. In total 178 patients (male-to-female ratio 5:1) with 203 abscesses were treated during this period. Of these, 23 patients required percutaneous aspiration and 150 patients were managed without intervention and clinically resolved spontaneously. Abscesses requiring aspiration tended to be larger than those managed without aspiration (10.7 cm v. 8.2 cm) (p = 0.003). There were no complications following aspiration. Mean hospital stay was longer (12.3 days) for patients who underwent aspiration compared with those who did not (6. 7 days) (p = 0.031). Only 5 patients presented with ruptured abscesses, 1 cutaneously and 4 intraperitoneally, with the only death in this latter category. Conclusion Conservative medical management of amoebic liver abscess is safe. Percutaneous ultrasound-guided aspiration is indicated only in patients who fail to improve clinically after 48 - 72 hours rather than on rigid criteria.
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