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Primary Klebsiella pneumoniae liver abscess with metastatic complications is a globally emerging infectious disease and is the leading cause of liver abscess in Taiwan. Host immunity and bacterial virulence, especially of the capsular polysaccharide type, are important in determining clinical manifestations. Investigators retrospectively studied the K pneumoniae genotype and capsular serotype from patients with 37 strains of liver abscess; no correlation was noted with genotype, and many genetically different strains caused liver abscess. Although K pneumoniae is prevalent in patients with diabetes, it can attack healthy or alcoholic people as well. Additional studies are needed to explore the mechanisms of bacterial virulence and to optimize treatment strategies. Physicians should be alert to the illness and its complications. [ABSTRACT FROM AUTHOR]

Esophageal actinomycosis is uncommon and has been reported in immunocompetent and immunocompromised patients. A 41-y-old man with a history of heavy alcohol use presented with progressively worsening odynophagia and dysphagia over a 2-wk period. Upper gastrointestinal endoscopy and esophageal biopsy revealed ulceration with Actinomyces and candidal infection. After therapy with intravenous penicillin G followed by oral amoxicillin that led to clinical improvement, repeat upper gastrointestinal endoscopy revealed healing of esophageal ulceration and no evidence of Actinomyces. From this case and a review of the literature regarding clinical symptoms, diagnosis, and treatment, it is clear that esophageal actinomycosis is a cause of odynophagia and dysphagia. Upper gastrointestinal endoscopy and pathologic examination should be carefully evaluated in patients who present with odynophagia and dysphagia.

Failure to eradicate Helicobacter pylori can lead to peptic ulcer recurrence and gastric malignancy. Therefore, the objective of this study was to develop a noninvasive method for determining whether H. pylori infection was eradicated with antibiotic-based triple therapy. A total of 17 patients with duodenal ulcer (DU) and 17 with gastric ulcer (GU) were evaluated both before and after treatment. Outcomes included serum levels of interleukin-8 (IL-8), pepsinogen I, and gastrin, and the Wilcoxon signed rank test was used to test significance. Changes in these parameters were also correlated with disease status. In those patients where both GU and DU healing occurred as a result of treatment, most showed an increase in serum IL-8 and a decrease in serum pepsinogen. Serum gastrin levels were not significantly changed in either group. Posttreatment increases in serum IL-8 were seen in 15 of 17 (88%) recovered DU patients and 14 of 17 (82%) recovered GU patients (P<.05 for each). Posttreatment decreases in pepsinogen I were found in 15 of 17 DU and 15 of 17 GU patients (P<.05 for each). These preliminary findings suggest that an increase in serum IL-8 and possibly a decrease in pepsinogen I may be useful in identifying the successful eradication of H. pylori infection in patients with peptic ulcer treated with antibiotics. A more systematic analysis of these putative diagnostic markers is now warranted.

The effects of Helicobacter pylori infection are strongly associated with chronic gastritis, gastric and duodenal ulcer, gastric cancer, and MALT lymphoma. The microorganism has been classified as a type I carcinogen by the World Health Organization. Varying clinical results from H. pylori infection are believed due, in part, to differences in virulence among species. The cag pathogenicity island is a complex of virulent genes and a coding region for the type IV phosphorylated secretion system. Through this system, many virulent gene products or proteins are phosphorylated into the host cells. This study demonstrated the positive CagA-phosphorylation effect of H. pylori in patients with chronic gastritis and benign gastric ulcer and revealed significantly different rates of CagA phosphorylation between these two diseases (P<.05).