The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic ...The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary parasites.In the last century,owing to migration,its global incidence has increased.The main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma.Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment.The management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications.This comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.展开更多
BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecula...BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecular mechanisms have not been elucidated.This study aimed to explore the molecular mechanism of XBJ in treating PLA complicated with sepsis using a network pharmacology approach.METHODS:The active ingredients and targets of XBJ were retrieved from the ETCM database.Potential targets related to PLA and sepsis were retrieved from the GeneCards,PharmGKB,DisGeNet,Online Mendelian Inheritance in Man(OMIM),Therapeutic Targets Database(TTD),and DrugBank databases.The targets of PLA complicated with sepsis were mapped to the targets of XBJ to identify potential treatment targets.Protein-protein interaction networks were analyzed using the STRING database.Potential treatment targets were imported into the Metascape platform for Gene Ontology(GO)functional enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.Molecular docking was performed to validate the interactions between active ingredients and core targets.RESULTS:XBJ was found to have 54 potential treatment targets for PLA complicated with sepsis.Interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor(TNF)were identifi ed as core targets.KEGG enrichment analysis revealed important pathways,including the interleukin-17(IL-17)signaling pathway,the TNF signaling pathway,the nuclear factor-kappa B(NF-κB)signaling pathway,and the Toll-like receptor(TLR)signaling pathway.Molecular docking experiments indicated stable binding between XBJ active ingredients and core targets.CONCLUSION:XBJ may exert therapeutic eff ects on PLA complicated with sepsis by modulating signaling pathways,such as the IL-17,TNF,NF-κB,and TLR pathways,and targeting IL-1β,IL-6,and TNF.展开更多
BACKGROUND Primary hepatic lymphoma(PHL)is a lymphoproliferative disorder confined to the liver without peripheral lymph node involvement and bone marrow invasion.PHL is extremely rare in clinical practice.The etiolog...BACKGROUND Primary hepatic lymphoma(PHL)is a lymphoproliferative disorder confined to the liver without peripheral lymph node involvement and bone marrow invasion.PHL is extremely rare in clinical practice.The etiology and pathogenesis of PHL are largely unknown.There are no common standard protocols or guidelines for the treatment of PHL.CASE SUMMARY We report the case of a 66-year-old man who presented with fever and abdominal pain for three weeks.Computed tomography and magnetic resonance imaging scans showed a pyogenic liver abscess.The patient underwent a right posterior hepatectomy.The surgical pathology revealed aggressive B-cell lymphoma,with a primary consideration of diffuse large B-cell lymphoma of non-germinal center origin.CONCLUSION This article reviews the characteristics,mechanism and treatment of PHL and provides insight into the diagnosis of PHL.展开更多
Background: Liver abscess (LA) is a suppurated collection in the hepatic parenchyma. In Africa, liver abscesses are most often of amoebic origin, but more recently, the rate of pyogenic liver abscesses (PLA) has incre...Background: Liver abscess (LA) is a suppurated collection in the hepatic parenchyma. In Africa, liver abscesses are most often of amoebic origin, but more recently, the rate of pyogenic liver abscesses (PLA) has increased. Objective: to assess the epidemiological characteristics, clinical features, biological radiological findings, and outcomes of patients with PLA and with amebic liver abscess (ALA) in order to determine the potential factors that may help improve diagnosis and treatment for LA in the context of secondary care centers with limited medical supports. Methods: Retrospective review of LA diagnosed and treated at three secondary care centers in Thiès over 11 years. Results: 61 patients, were included, 52.45% had ALA and 47.54% had PLA. Males were predominant (79.31% in PLA vs 65.63% in ALA, p = 0.2). The median age was 38 years for the PLA group vs 39 years for the ALA group (p = 0.4). In both groups, the most common symptom was right upper abdominal pain (81.97%), hepatomegaly (81.97%). The PLA group had a higher prevalence of fever (79.31% vs 46.88%, p = 0,009), chills (51.72% vs 18.75%, p = 0.007), right basi-thoracic pain (55.17% vs 28.13%, p = 0.032), and jaundice (55.17% vs 28%, p = 0.032). There was no difference in radiological features between PLA and ALA. Patients with PLA had a higher level of White blood cell (20.600 vs 15.400, p = 0.014). The most common bacteria identified in PLA were Escherichia coli (58.8%). All patients had received antibiotic therapy, which was combined with aspiration puncture (37.3%), transcutaneous drainage (43.3%), and surgery (9.0%). Seven patients had received antibiotic therapy alone and all had amoebic abscesses. Elsewhere, the occurrence of complications was higher in PLA cases (75.86% vs 37.5%, p = 0.003). The overall hospital mortality rate was 13.11%, higher in cases of PLA (24.14% vs 3.13%, p = 0.022). Conclusion: Clinical and biological features were more severe in PLA. But radiological features cannot be used to distinguish between PLA and ALA.展开更多
BACKGROUND Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion.Less than 100 cases have been reported to date.CASE SUMMARY We re...BACKGROUND Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion.Less than 100 cases have been reported to date.CASE SUMMARY We report a case of a 53-year old female patient with pyogenic liver abscess secondary to ingestion of a toothpick with penetration through the lesser curvature of the stomach.The patient presented with persistent epigastric pain.Abdominal computed tomography demonstrated the presence of a linear radiopaque object associated with abscess formation in the left liver lobe.Inflammatory changes in the lesser curvature of the stomach indicated gastric wall penetration by the object.As the abscess was refractory to antibiotic treatment,laparoscopic liver resection was performed to remove the foreign body and adjacent liver parenchyma.Following surgery,symptoms fully resolved without any sequelae.CONCLUSION This rare case demonstrates the importance of considering foreign body penetration as a cause of pyogenic liver abscess,particularly in abscesses of unknown origin that are resistant to antibiotic therapy.Clinical suspicion,early diagnosis,and prompt removal of the foreign body could lead to improved outcomes in these patients.展开更多
BACKGROUND Pyogenic granuloma(PG)is a localized,reddish and vascularized hyperplastic lesion of the connective tissue which occurs in the oral cavity.In most cases,the presence of this lesion does not show alveolar bo...BACKGROUND Pyogenic granuloma(PG)is a localized,reddish and vascularized hyperplastic lesion of the connective tissue which occurs in the oral cavity.In most cases,the presence of this lesion does not show alveolar bone resorption.The pathology is diagnosed clinically with some caution.However,the diagnosis and treatment are usually corroborated with histopathological evidence.CASE SUMMARY Three clinical cases of PG associated with bone loss were described in this study.The three patients presented tumor-like growth which bled on touch,and were associated with local irritant factors.Radiographs showed bone loss.All cases were treated with conservative surgical excision.The scarring was satisfactory,and there was no case of recurrence.The diagnoses were based on clinical findings,and were confirmed histopathologically.CONCLUSION The occurrence of oral PG with bone loss is unusual.Therefore,clinical and radiographic evaluations are important for the diagnosis.展开更多
BACKGROUND Pyogenic spondylitis is often manifested as atypical low back pain and fever,which makes it easy to be confused with other diseases.Here we report a case of pyogenic spondylitis and describe the diagnosis a...BACKGROUND Pyogenic spondylitis is often manifested as atypical low back pain and fever,which makes it easy to be confused with other diseases.Here we report a case of pyogenic spondylitis and describe the diagnosis and treatment based on the related literature.CASE SUMMARY The reported case suffered from pyogenic spondylitis caused by Escherichia coli and complicated with bacteremia and psoas abscess.Acute pyelonephritis was initially diagnosed due to atypical symptoms.Symptoms were improved from antibiotic treatment while developing progressive lower limb dysfunction.One month post the admission,the patient underwent anterior lumbar debridement+autogenous iliac bone graft fusion+posterior percutaneous screw-rod internal fixation,and received 6 wk of antibiotic treatment after the operation.Reexamination 4 mo post the operation showed that the patient had no evident pain in the waist,and walked well with no evident dysfunction of lower limbs.CONCLUSION Here we describe the application value of several imaging examinations,such as X-ray,computed tomography and magnetic resonance imaging,and certain tests like erythrocyte sedimentation rate and C-reactive protein in the clinical treatment of pyogenic spondylitis.This disease requires early diagnosis and treatment.Sensitive antibiotics should be used in early stages and surgical intervention should be taken if necessary,which may help for a speedy recovery and prevent the occurrence of severe complications.展开更多
BACKGROUND This case report presents a patient with pyogenic spondylitis(PS)associated with lactation-related osteoporosis during pregnancy.The 34-year-old female patient experienced low back pain for one month,beginn...BACKGROUND This case report presents a patient with pyogenic spondylitis(PS)associated with lactation-related osteoporosis during pregnancy.The 34-year-old female patient experienced low back pain for one month,beginning one month postpartum,with no history of trauma or fever.Dual-energy X-ray absorptiometry of the lumbar spine revealed a Z-score of-2.45,leading to a diagnosis of pregnancy and lactation-associated osteoporosis(PLO).The patient was advised to cease breastfeeding and take oral calcium and active vitamin D.Despite these interventions,her symptoms worsened,and she had difficulty walking one week later,prompting her to revisit our hospital.CASE SUMMARY Lumbar magnetic resonance imaging(MRI)scans showed abnormal signals in the L4 and L5 vertebral bodies and intervertebral space,while an enhancement scan displayed abnormal enhanced high signals around the L4/5 intervertebral disc,suggesting a lumbar infection.A needle biopsy was performed for bacterial culture and pathological examination,culminating in a final diagnosis of pregnancy and lactation-related osteoporosis with PS.Following treatment with antiosteoporotic medications and antibiotics,the patient’s pain gradually subsided,and she returned to normal life within five months.PLO is a rare condition that has garnered increasing attention in recent years.Spinal infections during lactation in pregnancy are also relatively uncommon.CONCLUSION Both conditions primarily manifest as low back pain but require distinct treatments.In clinical practice,when diagnosing patients with pregnancy and lactation-associated osteoporosis,the possibility of spinal infection should be considered.A lumbar MRI should be conducted as needed to prevent delays in diagnosis and treatment.展开更多
Background: Respiratory tract infection (RTI) is a prevalent infection across the world and is a major health concern linked to the crowding that occurs during the Hajj season. Objectives: To identify how prevalent St...Background: Respiratory tract infection (RTI) is a prevalent infection across the world and is a major health concern linked to the crowding that occurs during the Hajj season. Objectives: To identify how prevalent Streptococcus pyogenes is among Umrah visitors and pilgrims by comparing its presence before and after the visitors perform Umrah and hajj. Methods: A cross-sectional study was carried out on Umrah visitors/pilgrims, for which their throat swabs were taken for assessing the upper respiratory tract infection’s carriage rate, particularly of Group A streptococci (GAS), after they arrived in Saudi Arabia for the Hajj and Umrah rituals and befor their leaving. After collecting the swabs, they were inoculated on Columbia agar using 5% sheep blood and then incubated at 37˚C. VITEK 2 systems were used to identify the isolates. Results: Of the 979/613 Umrah visitors/pilgrims involved, before performing Umrah, their Streptococcus pyogenes percentage was 0.2% and it increased to 0.7 after performing Umrah. Further, the Streptococcus pyogenes percentage before and after performing Hajj was 0.3% and 1.1%, respectively. No statistical significance was found in the difference between the positive Streptococcus pyogenes found before and after performing Hajj and Umrah among Umrah visitors/pilgrims (p-value = 0.2). All bacterial isolates were found to be sensitive to Cefotaxime and Ceftriaxone antibiotics (100%). Conclusion: The Streptococcus pyogeneshigh resistance to antibiotics combined with the lack of a vaccine poses a serious risk concerning the resulting infection spread and emphasizes the necessity of ensuring greater global surveillance of such epidemics.展开更多
AIM:To describe our own experience with pyogenic liver abscesses over the past 10 years and investigate the risk factors associated with failure of initial percutaneous therapy.METHODS:A retrospective study of records...AIM:To describe our own experience with pyogenic liver abscesses over the past 10 years and investigate the risk factors associated with failure of initial percutaneous therapy.METHODS:A retrospective study of records of 63 PLA patients presenting between 1998 and 2008 to Australian tertiary referral centre,were reviewed.Amoebic and hydatid abscesses were excluded.Demographic,clinical,radiological,and microbiological characteristics,as well as surgical/radiological interventions,were recorded.RESULTS:Sixty-three patients(42 males,21 females) aged 65(±14) years[mean±(SD) ]had prodromal symptoms for a median(interquartile range;IQR) of 7(5-14) d.Only 59%of patients were febrile at presentation;however,the serum C-reactive protein was elevated in all 47 in whom it was measured.Liver function tests were non-specifically abnormal.67%of patients had a solitary abscess,while 32%had>3 abscesses with a median(IQR) diameter of 6.3(4-9) cm.Causative organisms were:Streptococcus milleri 25%,Klebsiella pneumoniae 21%,and Escherichia coli 16%.A presumptive cryptogenic cause was most common (34%).Four patients died in this series:one from sepsis,two from advanced cancer,and one from acute myocardial infarction.The initial procedure was radiological aspiration±drainage in 54 and surgery in two patients.17%underwent surgical management during their hospitalization.Serum hypoalbuminaemia[mean (95%CI) :32(29-35) g/L vs 28(25-31) g/L,P=0.045] on presentation was found to be the only factor related to failure of initial percutaneous therapy on univariate analysis.CONCLUSION:PLA is a diagnostic challenge,because the presentation of this condition is non-specific.Intravenous antibiotics and radiological drainage in the first instance allows resolution of most PLAs;However,a small proportion of patients still require surgical drainage.展开更多
AIM:To compare the outcomes of concomitant cholangiocarcinoma(C-CCA)and subsequent cholangiocar-cinoma(S-CCA)associated with hepatolithiasis. METHODS:From December 1987 to December 2007, 276 patients underwent hepatic...AIM:To compare the outcomes of concomitant cholangiocarcinoma(C-CCA)and subsequent cholangiocar-cinoma(S-CCA)associated with hepatolithiasis. METHODS:From December 1987 to December 2007, 276 patients underwent hepatic resection for hepa-tolithiasis in Changhua Christian Hospital.Sixty-five patients were excluded due to incomplete medical records and the remaining 211 patients constituted our study population base.Ten patients were diag-nosed with C-CCA based on the preoperative biopsy or postoperative pathology.During the follow-up period, 12 patients developed S-CCA.The diagnosis of S-CCA was made by image-guided biopsy or by pathology if surgical intervention was carried out.Patient charts were reviewed to collect clinical information.Parameters such as CCA incidence,interval from operation to CCA diagnosis,interval from CCA diagnosis to disease-related death,follow-up time,and mortality rate were calculated for both the C-CCA and S-CCA groups.The outcomes of the C-CCA and S-CCA groups were math-ematically compared and analysed. RESULTS:Our study demonstrates the clinical implications and the survival outcomes of C-CCA and S-CCA. Among the patients with unilateral hepatolithiasis,the incidence rates of C-CCA and S-CCA were fairly similar (4.8%vs 4.5%,respectively,P=0.906).However,for the patients with bilateral hepatolithiasis,the incidence rate of S-CCA(12.2%)was higher than that of C-CCA (4.7%),although the sample size was limited and the difference between two groups was not statistically sig-nificant(P=0.211).The average follow-up time was 56 mo for the C-CCA group and 71 mo for the S-CCA group.Regard to the average time intervals from operation to CCA diagnosis,S-CCA was diagnosed after 67 mo from the initial hepatectomy.The average time intervals from the diagnoses of CCA to disease-related death was 41 mo for the C-CCA group and 4 mo for the S-CCA group,this difference approached statistical sig-nificance(P=0.075).Regarding the rates of overall and disease-related mortality,the C-CCA group had signifi-cantly lower overall mortality(70%vs 100%,P=0.041) and disease-related mortality(60%vs 100%,P=0.015) than the S-CCA group.For the survival outcomes of two groups,the Kaplan-Meier curves corresponding to each group also demonstrated better survival outcomes for the C-CCA group(log rank P=0.005).In the C-CCA group,three patients were still alive at the time of data analysis,all of them had free surgical margins and did not have pathologically proven lymph node metastasis at the time of the initial hepatectomy.In the S-CCA group,only one patient had chance to undergo a second hepatectomy,and all 12 S-CCA patients had died at the time of data analysis. CONCLUSION:C-CCA has better outcomes than S-CCA.The first hepatectomy is crucial because most patients with recurrent CCA or S-CCA are not eligible for repeated surgical intervention.展开更多
AIM: To elaborate the clinicopathologic features of colorectal cancer-related pyogenic liver abscess (PLA). METHODS: Reported cases of colorectal cancer-related PLAs were collected from the literature published up to ...AIM: To elaborate the clinicopathologic features of colorectal cancer-related pyogenic liver abscess (PLA). METHODS: Reported cases of colorectal cancer-related PLAs were collected from the literature published up to October 2011 and evaluated for their clinicopathologic features. Data of collected cases included demographics, clinical presentation, microbial findings and treatment. Categorical variables were compared by 2 analysis and continuous variables were evaluated using Student's t test. RESULTS: A total 96 cases of colorectal cancer-related PLA were collected from the previous literature. Most patients (60%) were male and 40% cases occurred in the age group of 61-70 years. Apart from some special types of PLA, there were significant differences in the microbiological spectrum between Eastern Asia and non-Eastern Asian countries, which implied different risk factors and courses of the disease. Gram negative bacteria especially Klebsiella pneumoniae (K. pneu- moniae ) PLA was predominant in Eastern Asia (80.0%) in contrast to non-Eastern Asian countries (P < 0.01). Meanwhile, most of the Eastern Asian patients exhibited smaller size of liver abscess and atypical presentation. Sigmoid colon and rectum (72.73%) were the main sites of tumor in Eastern Asian patients, whereas tumor sites were uneven among most of the non-Easter Asian PLA patients. CONCLUSION:K. pneumoniae PLA was strongly associated with colorectal cancer, especially those occurring in sigmoid colon and rectum, in elderly Eastern Asian male patients.展开更多
We present a rare case of invasive liver abscess syndrome due to Klebsiella pneumoniae (K. pneumoniae) with metastatic meningitis and septic shock. A previously healthy, 55-year-old female patient developed fever, liv...We present a rare case of invasive liver abscess syndrome due to Klebsiella pneumoniae (K. pneumoniae) with metastatic meningitis and septic shock. A previously healthy, 55-year-old female patient developed fever, liver abscess, septic shock, purulent meningitis and metastatic hydrocephalus. Upon admission, the clinical manifestations, laboratory and imaging examinations were compatible with a diagnosis of K. pneumoniae primary liver abscess. Her distal metastasis infection involved meningitis and hydrocephalus, which could flare abruptly and be life threatening. Even with early adequate drainage and antibiotic therapy, the patient’s condition deteriorated and she ultimately died. To the best of our knowledge, this is the first case of K. pneumoniae invasive liver abscess syndrome with septic meningitis reported in China's Mainland. Our findings reflect the need for a better understanding of the epidemiology, risk factors, complications, comorbid medical conditions and treatment of this disease.展开更多
Objective To investigate molecular characterization of streptococcus pyogenes isolates involved in an outbreak of scarlet fever in China in 2011. Methods Seventy-four 5treptococcol pyogenes involved in an outbreak of ...Objective To investigate molecular characterization of streptococcus pyogenes isolates involved in an outbreak of scarlet fever in China in 2011. Methods Seventy-four 5treptococcol pyogenes involved in an outbreak of scarlet fever were isolated from pediatric patients in the areas with high incidence in China from May to August of 2011. Emm genotyping, pulsed-field gel electrophoresis （PFGE）, superantigen （SAg） genes and antimicrobial susceptibility profiling were analyzed for these isolates. Results A total of 4 different emm types were identified. Emm12 was the most prevalent type which contained four predominating PFGE patterns corresponding to four different virulence and superantigen profiles. Emm12（79.7%） and emml （14.9%） accounted for approximately 94% of all the isolates. The speA gene was all negative in emm12 isolates and positive in emml isolates. All strains were resistant to erythromycin, and 89.4% of them were resistant to erythromycin, tracycline, and clindamycin simultaneously. Conclusion Several highly diversified clones with a high macrolide resistance rate comprise a predominant proportion of circulating strains, though no new emm type was found in this outbreak. The data provide a baseline for further surveillance of scarlet fever, which may contribute to the explanation of the outbreak and development of a GAS vaccine in China.展开更多
AIM To investigate the association between a recent gastrointestinal(GI) endoscopy and the subsequent risk of pyogenic liver abscess(PLA).METHODS We designed a nested case control study. Using the Taiwan National Heal...AIM To investigate the association between a recent gastrointestinal(GI) endoscopy and the subsequent risk of pyogenic liver abscess(PLA).METHODS We designed a nested case control study. Using the Taiwan National Health Insurance Research Database, 2135 patients with a first diagnosis of PLA were identified from 1998 to 2011. Another 10675 patients without PLA matched by age and sex were selected as reference controls. We identified and compared the possible risk factors for PLA and GI endoscopies performed before the index date(when PLA was diagnosed) between the two cohorts. Multivariate analysis was conducted to examine the risk of PLA within the 90 d after the GI endoscopies.RESULTS Patients with a history of diabetes [adjusted odds ratio(a OR) = 4.92, 95%CI: 1.78-13.61], end-stage renal disease(a OR = 3.98, 95%CI: 1.45-10.91), biliary tract infection(a OR = 2.68, 95%CI: 2.11-3.40), liver cirrhosis(a OR = 2.19, 95%CI: 1.39-3.46), GI malignancies(a OR = 5.68, 95%CI: 4.23-7.64), appendicitis(a OR = 3.16, 95%CI: 2.27-4.41), diverticulitis(a OR = 1.64, 95%CI: 1.01-2.64), and recent endoscopic retrograde cholangiopancreatography(a OR = 27.04, 95%CI: 11.65-62.72) were significantly associated with an increased risk of PLA. After adjusting for the above risk factors and the frequency of outpatient department visits and abdominal ultrasounds during 90 d before the index date, an upper GI panendoscopy(a OR = 2.75, 95%CI: 2.05-3.69) but not a lower GI endoscopy(a OR = 1.07, 95%CI: 0.62-1.86) was significantly associated with PLA.CONCLUSION An upper GI panendoscopy performed before 90 d may increase the risk of PLA.展开更多
The pyogenic liver abscess caused by Clostridium perfringens (C. perfringens ) is a rare, but rapidly fatal infection. It is usually associated with malignancy and immunosuppression. We report the case of 50-year-old ...The pyogenic liver abscess caused by Clostridium perfringens (C. perfringens ) is a rare, but rapidly fatal infection. It is usually associated with malignancy and immunosuppression. We report the case of 50-year-old lady with the secondary liver metastases from rectal cancer presented with fever and epigastric pain. The identification of Grampositive bacilli septicaemia, the presence of gas-forming liver abscess and massive intravascular hemolysis should lead to the suspicion of C. perfringens infection. Here we review twenty cases published since 1990 and their clinical features are discussed. The importance of "an aggressive treatment policy" with multidisciplinary team approach is emphasized.展开更多
AIM:To evaluate the role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy. METHODS:The medical records of thirteen patients with pyogenic l...AIM:To evaluate the role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy. METHODS:The medical records of thirteen patients with pyogenic liver abscess who underwent surgical treatment between January 1995 and December 2002 were retrospectively reviewed to determine the clinical presentation, indication and nature of surgery, and out-come of surgery. RESULTS:The patients were predominantly women (10/13) with a mean age of 65 ± 17 years. Their main presenting symptoms were abdominal pain (100%) and fever (77%). The aetiologies included biliary (n = 6), cryptogenic (n = 3), portal (n = 2), and trauma (n = 2). Seven patients underwent percutaneous drainage as the initial treatment. Of these, three patients developed peritonitis secondary to peritoneal spillage. Another four patients failed to respond because of multilocula-tion. Salvage surgery was required in these patients. Six patients proceeded to straight laparotomy:two had marked sepsis and multiloculated abscess that precluded percutaneous drainage, and four presented with perito-nitis of uncertain pathology. Surgical procedures included deroofment and drainage (n = 9), liver resection (n = 3), peritoneal lavage (n = 2), cholecystectomy (n = 4), and exploration of common bile duct (n = 2). One patient required reoperation because of bleeding. Three patients required further percutaneous drainage after surgery. The overall mortality was 46%. Four patients died of multiorgan failure and two patients died of pulmonary embolism. CONCLUSION:Surgical treatment of pyogenic liver ab-scess is occasionally needed when percutaneous drainage has failed due to various reasons. Mortality rate in this group of patients has remained high.展开更多
Hepatobiliary and pancreatic ascariasis(HPA) was described as a clinical entity from Kashmir,India in 1985. HPA is caused by invasion and migration of nematode,Ascaris lumbricoides,in to the biliary tract and pancreat...Hepatobiliary and pancreatic ascariasis(HPA) was described as a clinical entity from Kashmir,India in 1985. HPA is caused by invasion and migration of nematode,Ascaris lumbricoides,in to the biliary tract and pancreatic duct. Patients present with biliary colic,cholangitis,cholecystitis,hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly,get trapped and die,leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir,one such region,HPA is the etiological factor for 36.7%,23%,14.5% and 12.5% of all biliary diseases,acute pancreatitis,liver abscesses and biliary lithiasis respectively. Ultrasonography is an excellent diagnostic tool in visualizing worms in gut lumen and ductal system. The rational treatment for HPA is to give appropriate treatment for clinical syndromes along with effective anthelmintic therapy. Endotherapy in HPA is indicated if patients continue to have symptoms on medical therapy or when worms do not move out of ductal lumen by 3 wk or die within the ducts. The worms can be removed from the ductal system in most of the patients and such patients get regression of symptoms of hepatobiliary and pancreatic disease.展开更多
BACKGROUND Serum amyloid A(SAA)is an acute phase protein mainly synthesized by the liver.SAA induces inflammatory phenotype and promotes cell proliferation in activated hepatic stellate cells,the major scar forming ce...BACKGROUND Serum amyloid A(SAA)is an acute phase protein mainly synthesized by the liver.SAA induces inflammatory phenotype and promotes cell proliferation in activated hepatic stellate cells,the major scar forming cells in the liver.However,few studies have reported on the serum levels of SAA in human liver disease and its clinical significance in various liver diseases.AIM To investigate the serum levels of SAA in patients with different liver diseases and analyze the factors associated with the alteration of SAA levels in chronic hepatitis B(CHB)patients.METHODS Two hundred and seventy-eight patients with different liver diseases and 117 healthy controls were included in this study.The patients included 205 with CHB,22 with active autoimmune liver disease(AILD),21 with nonalcoholic steatohepatitis(NASH),14 with drug-induced liver injury(DILI),and 16 with pyogenic liver abscess.Serum levels of SAA and other clinical parameters were collected for the analysis of the factors associated with SAA level.Mann-Whitney U test was used to compare the serum SAA levels of patients with various liver diseases with those of healthy controls.Bonferroni test was applied for post hoc comparisons to control the probability of type 1 error(alpha=0.05/6=0.008).For statistical tests of other variables,P<0.05 was considered statistically significant.Statistically significant factors determined by single factor analysis were further analyzed by binary multivariate logistic regression analysis.RESULTS All patients with active liver diseases had higher serum SAA levels than healthy controls and the inactive CHB patients,with the highest SAA level found in patients with pyogenic liver abscess(398.4±246.8 mg/L).Patients with active AILD(19.73±24.81 mg/L)or DILI(8.036±5.685 mg/L)showed higher SAA levels than those with active CHB(6.621±6.776 mg/L)and NASH(6.624±4.891 mg/L).Single(P<0.001)and multivariate logistic regression analyses(P=0.039)for the CHB patients suggested that patients with active CHB were associated with an SAA serum level higher than 6.4 mg/L.Serum levels of SAA and CRP(C-reactive protein)were positively correlated in patients with CHB(P<0.001),pyogenic liver abscess(P=0.045),and active AILD(P=0.02).Serum levels of SAA(0.80-871.0 mg/L)had a broader fluctuation range than CRP(0.30-271.3 mg/L).CONCLUSION Serum level of SAA is a sensitive biomarker for inflammatory activity of pyogenic liver abscess.It may also be a weak marker reflecting milder inflammatory status in the liver of patients with CHB and other active liver diseases.展开更多
A 21-year-old male with no significant past medical history, presented with right upper quadrant(RUQ) abdominal pain along with fevers and chills. Lab work revealed leukocytosis, anemia, and slightly elevated alkaline...A 21-year-old male with no significant past medical history, presented with right upper quadrant(RUQ) abdominal pain along with fevers and chills. Lab work revealed leukocytosis, anemia, and slightly elevated alkaline phosphatase. Viral serology for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus were negative and he was immunocompetent.Computed tomography imaging revealed hepatic abscesses, the largest measuring 9.5 cm. Empiric antibiotics were started and percutaneous drains were placed in the abscesses. Anaerobic cultures from the abscesses grew Fusobacterium nucleatum. This is a gram negative anaerobic bacteria; a normal flora of the oral cavity. Fusobacterium is most commonly seen in Lemiere's disease, which is translocation of oral bacteria to the internal jugular vein causing a thrombophlebitis and subsequent spread of abscesses. Our patient did not have Lemiere's, and is the first case described of fusobacterium pyogenic liver abscess in a young immunocompetent male with good oral hygiene. This case was complicated by sepsis, empyema, and subsequent abscesses located outside the liver. These abscesses' have the propensity to flare abruptly and can be fatal. This case not only illustrates fusobacterium as a rare entity for pyogenic liver abscess, but also the need for urgent diagnosis and treatment. It is incumbent on physicians to diagnose and drain any suspicious hepatic lesions. While uncommon, such infections may develop without any overt source and can progress rapidly. Prompt drainage with antibiotic therapy remains the cornerstone of therapy.展开更多
文摘The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary parasites.In the last century,owing to migration,its global incidence has increased.The main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma.Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment.The management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications.This comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.
基金supported by Hunan Province Key Research and Development Program(2020SKC2004).
文摘BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecular mechanisms have not been elucidated.This study aimed to explore the molecular mechanism of XBJ in treating PLA complicated with sepsis using a network pharmacology approach.METHODS:The active ingredients and targets of XBJ were retrieved from the ETCM database.Potential targets related to PLA and sepsis were retrieved from the GeneCards,PharmGKB,DisGeNet,Online Mendelian Inheritance in Man(OMIM),Therapeutic Targets Database(TTD),and DrugBank databases.The targets of PLA complicated with sepsis were mapped to the targets of XBJ to identify potential treatment targets.Protein-protein interaction networks were analyzed using the STRING database.Potential treatment targets were imported into the Metascape platform for Gene Ontology(GO)functional enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.Molecular docking was performed to validate the interactions between active ingredients and core targets.RESULTS:XBJ was found to have 54 potential treatment targets for PLA complicated with sepsis.Interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor(TNF)were identifi ed as core targets.KEGG enrichment analysis revealed important pathways,including the interleukin-17(IL-17)signaling pathway,the TNF signaling pathway,the nuclear factor-kappa B(NF-κB)signaling pathway,and the Toll-like receptor(TLR)signaling pathway.Molecular docking experiments indicated stable binding between XBJ active ingredients and core targets.CONCLUSION:XBJ may exert therapeutic eff ects on PLA complicated with sepsis by modulating signaling pathways,such as the IL-17,TNF,NF-κB,and TLR pathways,and targeting IL-1β,IL-6,and TNF.
文摘BACKGROUND Primary hepatic lymphoma(PHL)is a lymphoproliferative disorder confined to the liver without peripheral lymph node involvement and bone marrow invasion.PHL is extremely rare in clinical practice.The etiology and pathogenesis of PHL are largely unknown.There are no common standard protocols or guidelines for the treatment of PHL.CASE SUMMARY We report the case of a 66-year-old man who presented with fever and abdominal pain for three weeks.Computed tomography and magnetic resonance imaging scans showed a pyogenic liver abscess.The patient underwent a right posterior hepatectomy.The surgical pathology revealed aggressive B-cell lymphoma,with a primary consideration of diffuse large B-cell lymphoma of non-germinal center origin.CONCLUSION This article reviews the characteristics,mechanism and treatment of PHL and provides insight into the diagnosis of PHL.
文摘Background: Liver abscess (LA) is a suppurated collection in the hepatic parenchyma. In Africa, liver abscesses are most often of amoebic origin, but more recently, the rate of pyogenic liver abscesses (PLA) has increased. Objective: to assess the epidemiological characteristics, clinical features, biological radiological findings, and outcomes of patients with PLA and with amebic liver abscess (ALA) in order to determine the potential factors that may help improve diagnosis and treatment for LA in the context of secondary care centers with limited medical supports. Methods: Retrospective review of LA diagnosed and treated at three secondary care centers in Thiès over 11 years. Results: 61 patients, were included, 52.45% had ALA and 47.54% had PLA. Males were predominant (79.31% in PLA vs 65.63% in ALA, p = 0.2). The median age was 38 years for the PLA group vs 39 years for the ALA group (p = 0.4). In both groups, the most common symptom was right upper abdominal pain (81.97%), hepatomegaly (81.97%). The PLA group had a higher prevalence of fever (79.31% vs 46.88%, p = 0,009), chills (51.72% vs 18.75%, p = 0.007), right basi-thoracic pain (55.17% vs 28.13%, p = 0.032), and jaundice (55.17% vs 28%, p = 0.032). There was no difference in radiological features between PLA and ALA. Patients with PLA had a higher level of White blood cell (20.600 vs 15.400, p = 0.014). The most common bacteria identified in PLA were Escherichia coli (58.8%). All patients had received antibiotic therapy, which was combined with aspiration puncture (37.3%), transcutaneous drainage (43.3%), and surgery (9.0%). Seven patients had received antibiotic therapy alone and all had amoebic abscesses. Elsewhere, the occurrence of complications was higher in PLA cases (75.86% vs 37.5%, p = 0.003). The overall hospital mortality rate was 13.11%, higher in cases of PLA (24.14% vs 3.13%, p = 0.022). Conclusion: Clinical and biological features were more severe in PLA. But radiological features cannot be used to distinguish between PLA and ALA.
文摘BACKGROUND Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion.Less than 100 cases have been reported to date.CASE SUMMARY We report a case of a 53-year old female patient with pyogenic liver abscess secondary to ingestion of a toothpick with penetration through the lesser curvature of the stomach.The patient presented with persistent epigastric pain.Abdominal computed tomography demonstrated the presence of a linear radiopaque object associated with abscess formation in the left liver lobe.Inflammatory changes in the lesser curvature of the stomach indicated gastric wall penetration by the object.As the abscess was refractory to antibiotic treatment,laparoscopic liver resection was performed to remove the foreign body and adjacent liver parenchyma.Following surgery,symptoms fully resolved without any sequelae.CONCLUSION This rare case demonstrates the importance of considering foreign body penetration as a cause of pyogenic liver abscess,particularly in abscesses of unknown origin that are resistant to antibiotic therapy.Clinical suspicion,early diagnosis,and prompt removal of the foreign body could lead to improved outcomes in these patients.
文摘BACKGROUND Pyogenic granuloma(PG)is a localized,reddish and vascularized hyperplastic lesion of the connective tissue which occurs in the oral cavity.In most cases,the presence of this lesion does not show alveolar bone resorption.The pathology is diagnosed clinically with some caution.However,the diagnosis and treatment are usually corroborated with histopathological evidence.CASE SUMMARY Three clinical cases of PG associated with bone loss were described in this study.The three patients presented tumor-like growth which bled on touch,and were associated with local irritant factors.Radiographs showed bone loss.All cases were treated with conservative surgical excision.The scarring was satisfactory,and there was no case of recurrence.The diagnoses were based on clinical findings,and were confirmed histopathologically.CONCLUSION The occurrence of oral PG with bone loss is unusual.Therefore,clinical and radiographic evaluations are important for the diagnosis.
基金Supported by Medicine and Health Foundation of Zhejiang Province,No.2021KY864.
文摘BACKGROUND Pyogenic spondylitis is often manifested as atypical low back pain and fever,which makes it easy to be confused with other diseases.Here we report a case of pyogenic spondylitis and describe the diagnosis and treatment based on the related literature.CASE SUMMARY The reported case suffered from pyogenic spondylitis caused by Escherichia coli and complicated with bacteremia and psoas abscess.Acute pyelonephritis was initially diagnosed due to atypical symptoms.Symptoms were improved from antibiotic treatment while developing progressive lower limb dysfunction.One month post the admission,the patient underwent anterior lumbar debridement+autogenous iliac bone graft fusion+posterior percutaneous screw-rod internal fixation,and received 6 wk of antibiotic treatment after the operation.Reexamination 4 mo post the operation showed that the patient had no evident pain in the waist,and walked well with no evident dysfunction of lower limbs.CONCLUSION Here we describe the application value of several imaging examinations,such as X-ray,computed tomography and magnetic resonance imaging,and certain tests like erythrocyte sedimentation rate and C-reactive protein in the clinical treatment of pyogenic spondylitis.This disease requires early diagnosis and treatment.Sensitive antibiotics should be used in early stages and surgical intervention should be taken if necessary,which may help for a speedy recovery and prevent the occurrence of severe complications.
文摘BACKGROUND This case report presents a patient with pyogenic spondylitis(PS)associated with lactation-related osteoporosis during pregnancy.The 34-year-old female patient experienced low back pain for one month,beginning one month postpartum,with no history of trauma or fever.Dual-energy X-ray absorptiometry of the lumbar spine revealed a Z-score of-2.45,leading to a diagnosis of pregnancy and lactation-associated osteoporosis(PLO).The patient was advised to cease breastfeeding and take oral calcium and active vitamin D.Despite these interventions,her symptoms worsened,and she had difficulty walking one week later,prompting her to revisit our hospital.CASE SUMMARY Lumbar magnetic resonance imaging(MRI)scans showed abnormal signals in the L4 and L5 vertebral bodies and intervertebral space,while an enhancement scan displayed abnormal enhanced high signals around the L4/5 intervertebral disc,suggesting a lumbar infection.A needle biopsy was performed for bacterial culture and pathological examination,culminating in a final diagnosis of pregnancy and lactation-related osteoporosis with PS.Following treatment with antiosteoporotic medications and antibiotics,the patient’s pain gradually subsided,and she returned to normal life within five months.PLO is a rare condition that has garnered increasing attention in recent years.Spinal infections during lactation in pregnancy are also relatively uncommon.CONCLUSION Both conditions primarily manifest as low back pain but require distinct treatments.In clinical practice,when diagnosing patients with pregnancy and lactation-associated osteoporosis,the possibility of spinal infection should be considered.A lumbar MRI should be conducted as needed to prevent delays in diagnosis and treatment.
文摘Background: Respiratory tract infection (RTI) is a prevalent infection across the world and is a major health concern linked to the crowding that occurs during the Hajj season. Objectives: To identify how prevalent Streptococcus pyogenes is among Umrah visitors and pilgrims by comparing its presence before and after the visitors perform Umrah and hajj. Methods: A cross-sectional study was carried out on Umrah visitors/pilgrims, for which their throat swabs were taken for assessing the upper respiratory tract infection’s carriage rate, particularly of Group A streptococci (GAS), after they arrived in Saudi Arabia for the Hajj and Umrah rituals and befor their leaving. After collecting the swabs, they were inoculated on Columbia agar using 5% sheep blood and then incubated at 37˚C. VITEK 2 systems were used to identify the isolates. Results: Of the 979/613 Umrah visitors/pilgrims involved, before performing Umrah, their Streptococcus pyogenes percentage was 0.2% and it increased to 0.7 after performing Umrah. Further, the Streptococcus pyogenes percentage before and after performing Hajj was 0.3% and 1.1%, respectively. No statistical significance was found in the difference between the positive Streptococcus pyogenes found before and after performing Hajj and Umrah among Umrah visitors/pilgrims (p-value = 0.2). All bacterial isolates were found to be sensitive to Cefotaxime and Ceftriaxone antibiotics (100%). Conclusion: The Streptococcus pyogeneshigh resistance to antibiotics combined with the lack of a vaccine poses a serious risk concerning the resulting infection spread and emphasizes the necessity of ensuring greater global surveillance of such epidemics.
文摘AIM:To describe our own experience with pyogenic liver abscesses over the past 10 years and investigate the risk factors associated with failure of initial percutaneous therapy.METHODS:A retrospective study of records of 63 PLA patients presenting between 1998 and 2008 to Australian tertiary referral centre,were reviewed.Amoebic and hydatid abscesses were excluded.Demographic,clinical,radiological,and microbiological characteristics,as well as surgical/radiological interventions,were recorded.RESULTS:Sixty-three patients(42 males,21 females) aged 65(±14) years[mean±(SD) ]had prodromal symptoms for a median(interquartile range;IQR) of 7(5-14) d.Only 59%of patients were febrile at presentation;however,the serum C-reactive protein was elevated in all 47 in whom it was measured.Liver function tests were non-specifically abnormal.67%of patients had a solitary abscess,while 32%had>3 abscesses with a median(IQR) diameter of 6.3(4-9) cm.Causative organisms were:Streptococcus milleri 25%,Klebsiella pneumoniae 21%,and Escherichia coli 16%.A presumptive cryptogenic cause was most common (34%).Four patients died in this series:one from sepsis,two from advanced cancer,and one from acute myocardial infarction.The initial procedure was radiological aspiration±drainage in 54 and surgery in two patients.17%underwent surgical management during their hospitalization.Serum hypoalbuminaemia[mean (95%CI) :32(29-35) g/L vs 28(25-31) g/L,P=0.045] on presentation was found to be the only factor related to failure of initial percutaneous therapy on univariate analysis.CONCLUSION:PLA is a diagnostic challenge,because the presentation of this condition is non-specific.Intravenous antibiotics and radiological drainage in the first instance allows resolution of most PLAs;However,a small proportion of patients still require surgical drainage.
文摘AIM:To compare the outcomes of concomitant cholangiocarcinoma(C-CCA)and subsequent cholangiocar-cinoma(S-CCA)associated with hepatolithiasis. METHODS:From December 1987 to December 2007, 276 patients underwent hepatic resection for hepa-tolithiasis in Changhua Christian Hospital.Sixty-five patients were excluded due to incomplete medical records and the remaining 211 patients constituted our study population base.Ten patients were diag-nosed with C-CCA based on the preoperative biopsy or postoperative pathology.During the follow-up period, 12 patients developed S-CCA.The diagnosis of S-CCA was made by image-guided biopsy or by pathology if surgical intervention was carried out.Patient charts were reviewed to collect clinical information.Parameters such as CCA incidence,interval from operation to CCA diagnosis,interval from CCA diagnosis to disease-related death,follow-up time,and mortality rate were calculated for both the C-CCA and S-CCA groups.The outcomes of the C-CCA and S-CCA groups were math-ematically compared and analysed. RESULTS:Our study demonstrates the clinical implications and the survival outcomes of C-CCA and S-CCA. Among the patients with unilateral hepatolithiasis,the incidence rates of C-CCA and S-CCA were fairly similar (4.8%vs 4.5%,respectively,P=0.906).However,for the patients with bilateral hepatolithiasis,the incidence rate of S-CCA(12.2%)was higher than that of C-CCA (4.7%),although the sample size was limited and the difference between two groups was not statistically sig-nificant(P=0.211).The average follow-up time was 56 mo for the C-CCA group and 71 mo for the S-CCA group.Regard to the average time intervals from operation to CCA diagnosis,S-CCA was diagnosed after 67 mo from the initial hepatectomy.The average time intervals from the diagnoses of CCA to disease-related death was 41 mo for the C-CCA group and 4 mo for the S-CCA group,this difference approached statistical sig-nificance(P=0.075).Regarding the rates of overall and disease-related mortality,the C-CCA group had signifi-cantly lower overall mortality(70%vs 100%,P=0.041) and disease-related mortality(60%vs 100%,P=0.015) than the S-CCA group.For the survival outcomes of two groups,the Kaplan-Meier curves corresponding to each group also demonstrated better survival outcomes for the C-CCA group(log rank P=0.005).In the C-CCA group,three patients were still alive at the time of data analysis,all of them had free surgical margins and did not have pathologically proven lymph node metastasis at the time of the initial hepatectomy.In the S-CCA group,only one patient had chance to undergo a second hepatectomy,and all 12 S-CCA patients had died at the time of data analysis. CONCLUSION:C-CCA has better outcomes than S-CCA.The first hepatectomy is crucial because most patients with recurrent CCA or S-CCA are not eligible for repeated surgical intervention.
基金Supported by The National Natural Science Foundation of China, No. 30872482 and No. 81072051
文摘AIM: To elaborate the clinicopathologic features of colorectal cancer-related pyogenic liver abscess (PLA). METHODS: Reported cases of colorectal cancer-related PLAs were collected from the literature published up to October 2011 and evaluated for their clinicopathologic features. Data of collected cases included demographics, clinical presentation, microbial findings and treatment. Categorical variables were compared by 2 analysis and continuous variables were evaluated using Student's t test. RESULTS: A total 96 cases of colorectal cancer-related PLA were collected from the previous literature. Most patients (60%) were male and 40% cases occurred in the age group of 61-70 years. Apart from some special types of PLA, there were significant differences in the microbiological spectrum between Eastern Asia and non-Eastern Asian countries, which implied different risk factors and courses of the disease. Gram negative bacteria especially Klebsiella pneumoniae (K. pneu- moniae ) PLA was predominant in Eastern Asia (80.0%) in contrast to non-Eastern Asian countries (P < 0.01). Meanwhile, most of the Eastern Asian patients exhibited smaller size of liver abscess and atypical presentation. Sigmoid colon and rectum (72.73%) were the main sites of tumor in Eastern Asian patients, whereas tumor sites were uneven among most of the non-Easter Asian PLA patients. CONCLUSION:K. pneumoniae PLA was strongly associated with colorectal cancer, especially those occurring in sigmoid colon and rectum, in elderly Eastern Asian male patients.
基金Supported by the National Natural Science Foundation of China,No.81372623the Zhejiang Province Key Science and Technology Innovation Team,No.2013TD13
文摘We present a rare case of invasive liver abscess syndrome due to Klebsiella pneumoniae (K. pneumoniae) with metastatic meningitis and septic shock. A previously healthy, 55-year-old female patient developed fever, liver abscess, septic shock, purulent meningitis and metastatic hydrocephalus. Upon admission, the clinical manifestations, laboratory and imaging examinations were compatible with a diagnosis of K. pneumoniae primary liver abscess. Her distal metastasis infection involved meningitis and hydrocephalus, which could flare abruptly and be life threatening. Even with early adequate drainage and antibiotic therapy, the patient’s condition deteriorated and she ultimately died. To the best of our knowledge, this is the first case of K. pneumoniae invasive liver abscess syndrome with septic meningitis reported in China's Mainland. Our findings reflect the need for a better understanding of the epidemiology, risk factors, complications, comorbid medical conditions and treatment of this disease.
基金supported by a fund for China Mega-Project for Infectious Disease(2011ZX10004-001)
文摘Objective To investigate molecular characterization of streptococcus pyogenes isolates involved in an outbreak of scarlet fever in China in 2011. Methods Seventy-four 5treptococcol pyogenes involved in an outbreak of scarlet fever were isolated from pediatric patients in the areas with high incidence in China from May to August of 2011. Emm genotyping, pulsed-field gel electrophoresis （PFGE）, superantigen （SAg） genes and antimicrobial susceptibility profiling were analyzed for these isolates. Results A total of 4 different emm types were identified. Emm12 was the most prevalent type which contained four predominating PFGE patterns corresponding to four different virulence and superantigen profiles. Emm12（79.7%） and emml （14.9%） accounted for approximately 94% of all the isolates. The speA gene was all negative in emm12 isolates and positive in emml isolates. All strains were resistant to erythromycin, and 89.4% of them were resistant to erythromycin, tracycline, and clindamycin simultaneously. Conclusion Several highly diversified clones with a high macrolide resistance rate comprise a predominant proportion of circulating strains, though no new emm type was found in this outbreak. The data provide a baseline for further surveillance of scarlet fever, which may contribute to the explanation of the outbreak and development of a GAS vaccine in China.
文摘AIM To investigate the association between a recent gastrointestinal(GI) endoscopy and the subsequent risk of pyogenic liver abscess(PLA).METHODS We designed a nested case control study. Using the Taiwan National Health Insurance Research Database, 2135 patients with a first diagnosis of PLA were identified from 1998 to 2011. Another 10675 patients without PLA matched by age and sex were selected as reference controls. We identified and compared the possible risk factors for PLA and GI endoscopies performed before the index date(when PLA was diagnosed) between the two cohorts. Multivariate analysis was conducted to examine the risk of PLA within the 90 d after the GI endoscopies.RESULTS Patients with a history of diabetes [adjusted odds ratio(a OR) = 4.92, 95%CI: 1.78-13.61], end-stage renal disease(a OR = 3.98, 95%CI: 1.45-10.91), biliary tract infection(a OR = 2.68, 95%CI: 2.11-3.40), liver cirrhosis(a OR = 2.19, 95%CI: 1.39-3.46), GI malignancies(a OR = 5.68, 95%CI: 4.23-7.64), appendicitis(a OR = 3.16, 95%CI: 2.27-4.41), diverticulitis(a OR = 1.64, 95%CI: 1.01-2.64), and recent endoscopic retrograde cholangiopancreatography(a OR = 27.04, 95%CI: 11.65-62.72) were significantly associated with an increased risk of PLA. After adjusting for the above risk factors and the frequency of outpatient department visits and abdominal ultrasounds during 90 d before the index date, an upper GI panendoscopy(a OR = 2.75, 95%CI: 2.05-3.69) but not a lower GI endoscopy(a OR = 1.07, 95%CI: 0.62-1.86) was significantly associated with PLA.CONCLUSION An upper GI panendoscopy performed before 90 d may increase the risk of PLA.
文摘The pyogenic liver abscess caused by Clostridium perfringens (C. perfringens ) is a rare, but rapidly fatal infection. It is usually associated with malignancy and immunosuppression. We report the case of 50-year-old lady with the secondary liver metastases from rectal cancer presented with fever and epigastric pain. The identification of Grampositive bacilli septicaemia, the presence of gas-forming liver abscess and massive intravascular hemolysis should lead to the suspicion of C. perfringens infection. Here we review twenty cases published since 1990 and their clinical features are discussed. The importance of "an aggressive treatment policy" with multidisciplinary team approach is emphasized.
文摘AIM:To evaluate the role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy. METHODS:The medical records of thirteen patients with pyogenic liver abscess who underwent surgical treatment between January 1995 and December 2002 were retrospectively reviewed to determine the clinical presentation, indication and nature of surgery, and out-come of surgery. RESULTS:The patients were predominantly women (10/13) with a mean age of 65 ± 17 years. Their main presenting symptoms were abdominal pain (100%) and fever (77%). The aetiologies included biliary (n = 6), cryptogenic (n = 3), portal (n = 2), and trauma (n = 2). Seven patients underwent percutaneous drainage as the initial treatment. Of these, three patients developed peritonitis secondary to peritoneal spillage. Another four patients failed to respond because of multilocula-tion. Salvage surgery was required in these patients. Six patients proceeded to straight laparotomy:two had marked sepsis and multiloculated abscess that precluded percutaneous drainage, and four presented with perito-nitis of uncertain pathology. Surgical procedures included deroofment and drainage (n = 9), liver resection (n = 3), peritoneal lavage (n = 2), cholecystectomy (n = 4), and exploration of common bile duct (n = 2). One patient required reoperation because of bleeding. Three patients required further percutaneous drainage after surgery. The overall mortality was 46%. Four patients died of multiorgan failure and two patients died of pulmonary embolism. CONCLUSION:Surgical treatment of pyogenic liver ab-scess is occasionally needed when percutaneous drainage has failed due to various reasons. Mortality rate in this group of patients has remained high.
基金Supported by Dr.Khuroo’s Medical Trust,a nonprofit organization which supports academic activities,disseminates medical education and helps poor patients for medical treatment
文摘Hepatobiliary and pancreatic ascariasis(HPA) was described as a clinical entity from Kashmir,India in 1985. HPA is caused by invasion and migration of nematode,Ascaris lumbricoides,in to the biliary tract and pancreatic duct. Patients present with biliary colic,cholangitis,cholecystitis,hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly,get trapped and die,leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir,one such region,HPA is the etiological factor for 36.7%,23%,14.5% and 12.5% of all biliary diseases,acute pancreatitis,liver abscesses and biliary lithiasis respectively. Ultrasonography is an excellent diagnostic tool in visualizing worms in gut lumen and ductal system. The rational treatment for HPA is to give appropriate treatment for clinical syndromes along with effective anthelmintic therapy. Endotherapy in HPA is indicated if patients continue to have symptoms on medical therapy or when worms do not move out of ductal lumen by 3 wk or die within the ducts. The worms can be removed from the ductal system in most of the patients and such patients get regression of symptoms of hepatobiliary and pancreatic disease.
基金the National Natural Science Foundation of China,No.91129705,No.81070340,and No.30570825Science and Technology Commission of Shanghai Municipality,Shanghai Pujiang Talent Program,No.09PJ1402600
文摘BACKGROUND Serum amyloid A(SAA)is an acute phase protein mainly synthesized by the liver.SAA induces inflammatory phenotype and promotes cell proliferation in activated hepatic stellate cells,the major scar forming cells in the liver.However,few studies have reported on the serum levels of SAA in human liver disease and its clinical significance in various liver diseases.AIM To investigate the serum levels of SAA in patients with different liver diseases and analyze the factors associated with the alteration of SAA levels in chronic hepatitis B(CHB)patients.METHODS Two hundred and seventy-eight patients with different liver diseases and 117 healthy controls were included in this study.The patients included 205 with CHB,22 with active autoimmune liver disease(AILD),21 with nonalcoholic steatohepatitis(NASH),14 with drug-induced liver injury(DILI),and 16 with pyogenic liver abscess.Serum levels of SAA and other clinical parameters were collected for the analysis of the factors associated with SAA level.Mann-Whitney U test was used to compare the serum SAA levels of patients with various liver diseases with those of healthy controls.Bonferroni test was applied for post hoc comparisons to control the probability of type 1 error(alpha=0.05/6=0.008).For statistical tests of other variables,P<0.05 was considered statistically significant.Statistically significant factors determined by single factor analysis were further analyzed by binary multivariate logistic regression analysis.RESULTS All patients with active liver diseases had higher serum SAA levels than healthy controls and the inactive CHB patients,with the highest SAA level found in patients with pyogenic liver abscess(398.4±246.8 mg/L).Patients with active AILD(19.73±24.81 mg/L)or DILI(8.036±5.685 mg/L)showed higher SAA levels than those with active CHB(6.621±6.776 mg/L)and NASH(6.624±4.891 mg/L).Single(P<0.001)and multivariate logistic regression analyses(P=0.039)for the CHB patients suggested that patients with active CHB were associated with an SAA serum level higher than 6.4 mg/L.Serum levels of SAA and CRP(C-reactive protein)were positively correlated in patients with CHB(P<0.001),pyogenic liver abscess(P=0.045),and active AILD(P=0.02).Serum levels of SAA(0.80-871.0 mg/L)had a broader fluctuation range than CRP(0.30-271.3 mg/L).CONCLUSION Serum level of SAA is a sensitive biomarker for inflammatory activity of pyogenic liver abscess.It may also be a weak marker reflecting milder inflammatory status in the liver of patients with CHB and other active liver diseases.
文摘A 21-year-old male with no significant past medical history, presented with right upper quadrant(RUQ) abdominal pain along with fevers and chills. Lab work revealed leukocytosis, anemia, and slightly elevated alkaline phosphatase. Viral serology for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus were negative and he was immunocompetent.Computed tomography imaging revealed hepatic abscesses, the largest measuring 9.5 cm. Empiric antibiotics were started and percutaneous drains were placed in the abscesses. Anaerobic cultures from the abscesses grew Fusobacterium nucleatum. This is a gram negative anaerobic bacteria; a normal flora of the oral cavity. Fusobacterium is most commonly seen in Lemiere's disease, which is translocation of oral bacteria to the internal jugular vein causing a thrombophlebitis and subsequent spread of abscesses. Our patient did not have Lemiere's, and is the first case described of fusobacterium pyogenic liver abscess in a young immunocompetent male with good oral hygiene. This case was complicated by sepsis, empyema, and subsequent abscesses located outside the liver. These abscesses' have the propensity to flare abruptly and can be fatal. This case not only illustrates fusobacterium as a rare entity for pyogenic liver abscess, but also the need for urgent diagnosis and treatment. It is incumbent on physicians to diagnose and drain any suspicious hepatic lesions. While uncommon, such infections may develop without any overt source and can progress rapidly. Prompt drainage with antibiotic therapy remains the cornerstone of therapy.
