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Background: The prevalence of pyogenic liver abscess (PLA) is increasing worldwide. However, evaluation on its economic burden is still lack. Methods: A retrospective study that included all patients identified PLA from 2017 to 2020 was conducted. Clinical information and hospital costs were collected through the electronic medical records. We evaluated the economic burden using disability-adjusted life years (DALYs). Differences in socioeconomic burdens between Klebsiella pneumoniae-caused liver abscesses (KPLA) and non-Klebsiella pneumoniae-caused liver abscesses (non-KPLA) were compared. Results: We found 327 patients identified PLA in the study, including 146 with KPLA and 181 with non-KPLA. The demographic characteristics, median hospital stay, severity, and in-hospital mortality were similar between the two groups. The median total in-hospital cost was higher in the non-KPLA than in the KPLA group, although no statistical difference was found ($3607.2 vs $3424.6; P = 0.446). The median DALY loss was significantly higher in the KPLA than in the non-KPLA group [1.49 (0.97– 2.30) vs 1.27 (0.87– 1.89); P = 0.033)], and male patients presented a higher average DALY loss than female patients. KPLA had a substantially greater median indirect economic loss than the non-KPLA group [$1442.8 (915.9– 17,221.5) vs $1232.5 (764.6– 15,473.0); P = 0.028], and indirect economic loss exhibited a significant increase from 2017 to 2020 in patients with PLA. No differences were found in the socioeconomic burden between the two groups [$8019.6 (4200.3– 21,832.1) vs $7436.4 (4023.2– 19,063.9); P = 0.172]. Conclusion: The economic burden of PLA is significant, particularly in patients with KP. Patients with KPLA experienced increased DALY loss and indirect economic loss than non-KPLA. PLA must be prioritized as the indirect economic burden rises annually. [ABSTRACT FROM AUTHOR]

Hypervirulent Klebsiella pneumoniae (hvKP) has emerged as a novel variant of K. pneumoniae, exhibiting distinct phenotypic and genotypic characteristics that confer increased virulence and pathogenicity. It is not only responsible for nosocomial infections but also community-acquired infections, including liver abscesses, endophthalmitis, and meningitis, leading to significant morbidity and mortality. HvKP has been reported all over the world, but it is mainly prevalent in Asia Pacific, especially China. Moreover, hvKP can acquire carbapenemase genes resulting in the emergence of carbapenem-resistant hypervirulent K. pneumoniae (CR-hvKP), which possesses both high virulence and drug resistance capabilities. Consequently, CR-hvKP poses substantial challenges to infection control and presents serious threats to global public health. In this paper, we provide a comprehensive summary of the epidemiological characteristics, virulence factors, and mechanisms underlying carbapenem resistance in hvKP strains with the aim of offering valuable insights for practical prevention strategies as well as future research. [ABSTRACT FROM AUTHOR]

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Background: In recent years, Raoultella ornithinolytica (R. ornithinolytica) have attracted clinical attention as a new type of pathogen. A wide range of infections with these germs is reported, and commonly found in urinary tract infections, respiratory infections, and bacteremia. Case presentation: We report the case of an elderly woman with liver abscess, choledocholithiasis and cholangitis, who developed gastric fistula and abdominal abscess after underwent choledocholithotomy, and R. ornithinolytica were isolated from the abdominal drainage fluid. The patient was treated with meropenem and levofloxacin and had a good outcome. Conclusions: To the best of our knowledge, case of isolating R. ornithinolytica from a patient with non-viscerally abdominal abscess was extremely rare. We share a case of a woman with non-viscerally abdominal abscess secondary to postoperative gastric fistula, R. ornithinolytica was isolated from the patient's pus, and the pathogenic bacteria may originate from the gastrointestinal tract. Based on this case, We should be cautious that invasive treatment may greatly increase the probability of infection with this pathogenic bacterium. [ABSTRACT FROM AUTHOR]

Klebsiella pneumoniae is a Gram-negative bacterium within the Enterobacteriaceae family that can cause multiple systemic infections, such as respiratory, blood, liver abscesses and urinary systems. Antibiotic resistance is a global health threat and K. pneumoniae warrants special attention due to its resistance to most modern day antibiotics. Biofilm formation is a critical obstruction that enhances the antibiotic resistance of K. pneumoniae. However, knowledge on the molecular mechanisms of biofilm formation and its relation with antibiotic resistance in K. pneumoniae is limited. Understanding the molecular mechanisms of biofilm formation and its correlation with antibiotic resistance is crucial for providing insight for the design of new drugs to control and treat biofilm-related infections. In this review, we summarize recent advances in genes contributing to the biofilm formation of K. pneumoniae, new progress on the relationship between biofilm formation and antibiotic resistance, and new therapeutic strategies targeting biofilms. Finally, we discuss future research directions that target biofilm formation and antibiotic resistance of this priority pathogen. [ABSTRACT FROM AUTHOR]

(1) Background: With the increasing demand for repeat hepatectomy, preventing perihepatic adhesion formation following initial hepatectomy is crucial. Adhesion-preventative barriers, like the new spray-type AdSprayTM (Terumo Corporation, Tokyo, Japan), have been proposed to reduce adhesion risk. However, data on their safety in minimally invasive hepatectomy (MIH) remain scarce. This is the first prospective study to evaluate the safety and feasibility of AdSprayTM in MIH. (2) Methods: A total of 124 patients who underwent MIH with AdSprayTM and 20 controls were analyzed. Subgroup analysis according to the AdSpray™ application area was conducted. Major complications were assessed using the Clavien–Dindo classification. Moreover, intraperitoneal pressure during AdSpray™ application was monitored in 20 cases. (3) Results: Major complications occurred in 6.4% of the patients, which was comparable to that in open hepatectomy. Intraperitoneal pressure remained stable below 12 mmHg during AdSpray™ application without any complications. No significant difference in complication rates was observed among subgroups. However, a potential increase in intra-abdominal abscess formation was suspected with AdSpray™ application to the resected liver surfaces. (4) Conclusions: AdSpray™ can be safely used in MIH; however, further research is needed to confirm the appropriacy of using AdSpray™, particularly over resected liver surfaces. Overall, AdSpray™ is a promising tool for enhancing the safety of MIH. [ABSTRACT FROM AUTHOR]

Acupuncture is increasingly being used in Asian countries and is generally considered a relatively safe procedure. However, adverse events have been reported consistently. Therefore, clinicians should be aware of the possibility of acupuncture-related complications and should actively treat serious cases. We report a case of an acupuncture-induced large abscess in the retroperitoneal cavity and thigh muscles treated with percutaneous catheter drainage, surgical incision, and drainage. [ABSTRACT FROM AUTHOR]

This article, published in the British Journal of Surgery, explores the use of portal vein arterialization (PVA) as a method to salvage the arterial supply to the liver in advanced hepatopancreatobiliary (HPB) surgery. The hepatic artery plays a crucial role in supplying blood and oxygen to the biliary tract, and de-arterialization of the liver can lead to liver damage and failure. PVA aims to improve oxygenation of the biliary tree and has shown promising outcomes with low morbidity and no mortality in patients who underwent the procedure. However, the use of PVA as a rescue method remains controversial due to varying results and high complication rates, highlighting the need for further research. [Extracted from the article]

Liver abscess is commonly seen but liver abscess with caecal gangrene or perforation is a very rare condition. The peritonitis due to caecal perforation when associated with liver abscess is commonly misdiagnosed as ruptured liver abscess and during surgical intervention is often overlooked which comes out to be detrimental. Entamoeba histolytica commonly invades the mucosa of caecum which causes flask shaped ulcers leading to fulminant typhilitis to caecal perforation. Here we describe six cases of concomitant liver abscess with cecal gangrene. Caecal perforation with liver abscess is rare but fatal condition which requires high degree of suspicion for diagnosis as the early intervention is prerequisite for better outcome. [ABSTRACT FROM AUTHOR]

Background: Ascites of obscured etiology (AOU) poses significant diagnostic challenges, especially in differentiating between tubercular ascites and malignant ascites. Diagnostic laparoscopy (DL) has emerged as a pivotal tool for establishing the etiology by allowing direct visualization and biopsy of the peritoneum, omentum, and visceral organs. This study aims to evaluate the correlation between DL findings and histopathological results to improve diagnostic accuracy for patients with AOU. Materials and Methods: A longitudinal observational study was conducted on patients referred for DL at AIIMS Patna from June 2019 to March 2021, presenting with AOU after inconclusive results from ultrasound, computed tomography, and ascitic fluid analysis. Patients underwent DL, with biopsies taken for histopathological examination. Diagnostic accuracy, specifically sensitivity, and specificity, were calculated for DL findings against histopathology. Results: Twenty patients were analyzed, with a mean age distribution showing the highest frequency in the 21-40 years category. Tubercular ascites were diagnosed in 50% of cases, peritoneal carcinomatosis in 30%, liver cirrhosis in 10%, and 10% remained undiagnosed. The correlation between DL and histopathological findings showed high diagnostic accuracy, with significant findings in omental pattern, parietal peritoneal abnormality, and the presence of ascites of varying severity. Conclusion: DL is a highly accurate diagnostic tool for evaluating AOU, with a strong correlation between laparoscopic and histopathological findings. It is especially valuable in cases where non-invasive methods fail to provide a definitive diagnosis, thereby guiding appropriate management and treatment strategies. [ABSTRACT FROM AUTHOR]

A 76‐year‐old man underwent an operation for lung squamous cell carcinoma in the right lower lobe, followed by initial adjuvant therapy with atezolizumab, an antibody against anti‐programmed death‐ligand 1 (PD‐L1). On day 4 after atezolizumab treatment, the patient developed general malaise and fatigue. He was diagnosed with atezolizumab‐induced sclerosing cholangitis. Steroid treatment was started, and patient's condition, including symptoms, laboratory data and imaging findings, improved. Antibiotic treatments were ended on day 40, and the steroid dose was gradually reduced. Multiple liver abscesses were observed on day 106, and another treatment with antibiotics became necessary. The patient eventually recovered from liver abscesses. Sclerosing cholangitis induced by immune checkpoint inhibitor is rare, and the long‐term clinical data about this adverse effect is limited. Hence, we think it is important to raise an alarm over sclerosing cholangitis coupled with liver abscesses after immunosuppressive therapy. [ABSTRACT FROM AUTHOR]

We present a case of bilateral giant bullous emphysema (GBE) with rapidly progressive dyspnea. The dyspnea was thought to be due to tension bullae caused by the check valve mechanism in COVID‐19 bronchitis. Multiple nodules were also detected on both sides of the lung. As the patient had poor pulmonary reserve for surgical bullectomy, we first performed percutaneous intracavitary drainage. Prior to this procedure, we placed a chest tube in the thoracic cavity to avoid tension pneumothorax. As a result, the patient's remaining lung expanded and respiratory status improved, allowing him to undergo surgical bullectomy. Intraoperatively, needle biopsy of the lung nodule was directly performed, which led to a diagnosis of adenocarcinoma. Despite multiple distant metastases, the patient's general condition improved postoperatively, and chemotherapy was successfully initiated. [ABSTRACT FROM AUTHOR]

Amoebic liver abscess is a severe and potentially life-threatening infection requiring prompt diagnosis and early targeted treatment. Diagnosis is challenging because conventional diagnostic methods such as light microscopy and serology are often unreliable. Molecular techniques have emerged as an additional diagnostic tool, suddenly becoming the new diagnostic reference standard. More recently, commercial multiplex PCR panels, including FilmArray, have been introduced, which permit the simultaneous detection of several enteric pathogens including Entamoeba histolytica in stool samples. We report a case of an amoebic liver abscess promptly diagnosed by FilmArray gastrointestinal panel performed on liver drainage fluid. [ABSTRACT FROM AUTHOR]

Two randomized complete block design experiments evaluated the influence that varying degrees of ingredient inclusion accuracy in a finishing diet have on growth performance and carcass traits. Treatments included (1) normal inclusion tolerance with a 0.454 kg tolerance for all ingredients (CON) or (2) variable inclusion tolerance where each ingredient was randomly increased or decreased but the targeted as-fed quantity for the daily delivery was met (VAR). In Experiment. 1, black Angus heifers (n = 60; initial shrunk BW = 460 ± 26.2 kg) were used in a 112 d experiment. Ten pens in total (5 pens/treatment, 6 heifers/pen) were used. The targeted diet (DM basis) consisted of high-moisture ear corn (75%), dried distiller's grains (20%), and a liquid supplement (5%). As-fed inclusion rates for DDGS and LS varied from formulated targets by −20, −15, −10, −5, 0, +5, +10, +15 or +20%. The HMEC inclusion was adjusted so that the targeted as-fed amount of the diet was delivered daily. Treatment did not alter ADG, DMI, G:F, HCW, dressing percentage, rib-eye area, rib fat, USDA marbling score, KPH, yield grade, retail yield, empty body fat, or body weight at 28% estimated EBF, nor liver abscess prevalence or severity (p ≥ 0.15). In Exp. 2, Charolais–Angus cross steers (n = 128; initial shrunk BW = 505 ± 32.1 kg) were used in a 94 d experiment. Steers were assigned to pens (8 pens/treatment; 8 steers/pen) and one of the two management strategies used in Exp. 1 was employed. Ractopamine HCl was fed (300 mg per head daily) during the final 28 d. Diets consisted of (DM basis) dry-rolled corn (63%), dried distiller's grains plus solubles (15%), liquid supplement (5%), grass hay (7%), and corn silage (10%). Ingredient inclusions were randomized in the same manner as Exp. 1, except LS inclusion was held constant. Corn silage inclusion was adjusted so that the targeted as-fed amount of the diet was delivered each day. Steers from VAR had increased (p = 0.01) DMI, but similar (p = 0.75) ADG resulting in reduced (p ≤ 0.02) G:F and growth-performance-predicted Net Energy for maintenance and gain. Treatment did not influence (p ≥ 0.38) HCW, dressing percentage, rib-eye area, rib fat, KPH, yield grade, retail yield, empty body fat, or body weight at 28% estimated EBF. A tendency for an increased USDA marbling score (p = 0.08) was noted in VAR. Under the conditions of this experiment, randomly altering ingredient proportions can impact growth performance and efficiency measures depending upon the type of finishing diet fed. [ABSTRACT FROM AUTHOR]

The use of high-grain diets in feedlots is associated with the development of acidosis and ruminitis, which can lead to the occurrence of liver abscesses (LAs). However, the effect of LA on carcass traits is not well known. This study assessed the effects of LA on the performance and carcass traits of beef cattle. Nine peer-reviewed publications with forty-seven treatment means were included in the data set. The effects of the LA were evaluated by examining the weighted mean difference (WMD) between LA (animal with LA) and control treatment (animal without LA). Heterogeneity was explored by meta-regression, followed by a subgroup analysis of the scores and percentages of liver abscess and concentrate level in the feedlot diet. Animals affected by LA showed a reduction in dry matter intake (−1.03%) and feed efficiency (−1.82%). Animals with an LA score of "A" (one or two small abscesses) exhibited a decrease in carcass weight (WMD = 3.41 kg; p = 0.034) and ribeye area (WMD = −1.37 cm2; p = 0.019). When assessing the impact of LA on carcass traits, the most reliable finding indicates a 1.21% reduction in the ribeye area, with no adverse effects observed on subcutaneous fat thickness or the marbling score in the carcass. [ABSTRACT FROM AUTHOR]

The objective was to evaluate the replacement of barley-based ingredients with short-season high-moisture corn products on steer growth performance and carcass characteristics. Over 2 years, 320 beef steers (528�±�36.2�kg initial body weight) were assigned to 32 pens (4 pens/treatment/year). Treatments were finishing diets that contained dry-rolled barley grain and barley silage (BGBS; control), barley grain and corn silage (BGCS), high-moisture shelled corn and barley grain with barley silage (HCBS), or snaplage (included as a silage and grain source) with barley grain (SNAP). Steers were fed for 99 days and 72 days in years 1 and 2, respectively. Steers fed BGCS did not differ (P�≥�0.13) from BGBS for dry matter intake, average daily gain, gain:feed, or carcass characteristics. Steers fed HCBS had greater (P�≤�0.05) hot carcass weight and dressing percentage than BGBS. A lesser (P�=�0.02) proportion of steers fed SNAP had severe liver abscesses than BGBS. We concluded that corn silage can replace barley silage, 50% replacement of barley grain with high-moisture shelled corn may improve hot carcass weight, and replacement of barley silage and some barley grain with snaplage decreases the proportion of cattle with severe liver abscesses at slaughter. [ABSTRACT FROM AUTHOR]

Background: Chromobacterium violaceum (C. violaceum) is a Gram-negative bacterium capable of causing severe infections in both humans and specific animals. Despite its infrequency, C. violaceum infections exhibit a notably high mortality rate. The timely and precise detection of this pathogen stands as a critical factor in achieving effective diagnosis and treatment. Traditional diagnostic approaches possess limitations, particularly in terms of their time-consuming nature and the range of pathogens they can identify. Metagenomic next-generation sequencing (mNGS) testing has emerged as a highly promising diagnostic tool for infectious diseases. Methods: Within this case report, we present a patient who developed a C. violaceum infection subsequent to a lower limb infection, leading to the progression of sepsis, a liver abscess, septic shock, multi-organ dysfunction, and altered mental status. Samples of the patient's blood and tissue from the lower limb skin are collected, and the infection is swiftly diagnosed through mNGS, allowing for the immediate initiation of suitable treatment. Results: The mNGS results revealed the patient's infection with C. violaceum. Subsequent conventional bacterial culture results were concordant with the mNGS findings. Following comprehensive management measures, including prompt and effective anti-infective treatment, the patient achieved cure and was successfully discharged. Conclusion: This case underscores the significance of employing advanced diagnostic methodologies like mNGS for the early detection of uncommon pathogens such as C. violaceum. The expedited diagnosis and timely intervention hold the potential to substantially enhance patient outcomes in cases of severe infections instigated by this bacterium. [ABSTRACT FROM AUTHOR]

Liver abscess is endemic in resource-limited countries such as The Gambia where access to advanced imaging techniques or modern treatment modalities is limited. Despite this, mortality in this cohort was low. Therefore antibiotic therapy combined with percutaneous abscess drainage remains a reasonable treatment strategy of liver abscess in resource-poor settings. [ABSTRACT FROM AUTHOR]

The article discusses the multifaceted nature of endophthalmitis, which is inflammation of the intraocular fluids that can lead to vision loss or loss of an eye. The article covers various topics related to endophthalmitis, including prophylactic measures to reduce postoperative infections, the challenges of endogenous endophthalmitis, differences in incidence and microbiological profile across different age groups, and the management of fungal endophthalmitis. The article also includes case reports and case series that highlight different aspects of endophthalmitis. The authors emphasize the need for tailored management strategies, early diagnosis, and personalized therapies to improve patient outcomes. [Extracted from the article]

• Patients with late hepatic artery thrombosis may develop severe biliary complications. • Retransplantation may be required but is associated with significant mortality. • Choledochojejunostomy and reconstruction without the recipient's hepatic artery are often needed. • Recurrent infections may lead to poor clinical and nutritional status. Hepatic artery thrombosis is the most common vascular complication of liver transplantation. When occurring late in the postoperative course, it may have no clinical repercussions, and conservative treatment may be implemented. Some patients, however, will develop severe biliary complications due to ischemic cholangiopathy and require retransplantation. The aim of this study is to report the outcomes of retransplantation in this population. This is a single-center retrospective study involving all adult patients who underwent liver retransplantation due to late hepatic artery thrombosis from January/2010 to December/2022. During the study period, 1378 liver transplants were performed in our center; 147 were retransplantations, with 13 cases of late hepatic artery thrombosis (0.94%). All had symptomatic ischemic cholangiopathy. Twelve of them had already presented previous cholangitis, bilomas, or liver abscesses and had undergone biliary stenting or percutaneous drainage. The median time between the first liver transplant and late hepatic artery thrombosis diagnosis and between this diagnosis and retransplantation were 73 and 50 days, respectively. Arterial reconstruction using splenic artery, celiac trunk, or arterial conduit from the aorta was performed in 7 cases, whereas biliary reconstruction was mostly done with choledochojejunostomy (n = 8). There were 4 perioperative deaths, 2 due to primary non-function and 2 due to refractory shock after exceedingly complex retransplants. Liver retransplantation due to late hepatic artery thrombosis is a rare condition that should be offered to patients who develop severe biliary complications and recurrent infections. It is nonetheless a challenging procedure associated with significant perioperative mortality. [ABSTRACT FROM AUTHOR]

Simple Summary: This study aimed to determine the influence that initial BW has on growth performance responses, efficiency of dietary net energy (NE) utilization, and carcass traits in feedlot steers. Experimental data were analyzed as a randomized complete block design with pen as the experimental unit. Heavy initial weight (HIW) steers had greater growth, but poorer feed efficiency compared to light initial weight (LIW) steers. Steers with HIW produced fatter carcasses with a greater degree of marbling. The objective of the study was to determine the influence that initial BW has on growth performance responses, efficiency of dietary net energy (NE) utilization, and carcass traits in feedlot steers. Charolais×Red Angus steers (n = 70) selected from a larger single-source group were used in a 209-d growing-finishing feedlot experiment. Steers were assigned to two groups based on initial BW (light initial weight, LIW = 273 ± 16.0 kg; heavy initial weight, HIW = 356 ± 14.2 kg) and allotted into 10 pens (n = 7 steers per pen; 5 pens per experimental group) the within pen standard deviation for LIW was from 14.1 kg to 20.9 kg and for HIW was from 13.7 kg to 16.0 kg. Steers were fed a common diet once daily. Experimental data were analyzed as a randomized complete block design with pen as the experimental unit. LIW steers had a greater cumulative HH change (p = 0.04). A treatment × day interaction (p = 0.05) was observed for HH with HIW steers having a greater HH at all time points. Final BW and carcass-adjusted (HCW/0.625) BW were greater for HIW steers by 13.1% and 13.4% respectively (p ≤ 0.01). HIW steers had a greater DMI (p = 0.01) compared to LIW. Cumulative ADG was greater for HIW by 3% (p = 0.04). LIW steers had better feed conversion (p = 0.01). HIW steers had greater (p ≤ 0.05) HCW, marbling scores, and yield grade (YG), with decreased REA/HCW (p = 0.01) compared to LIW. The distribution of USDA Yield Grade was altered by initial BW (p = 0.04). No differences were detected (p ≥ 0.22) for the distribution of Quality grade nor liver abscess prevalence and severity. Regression coefficients did not differ between LIW and HIW for urea space calculations of empty body water, fat, or protein (p ≥ 0.70). A quadratic response was noted for empty body fat (EBF), empty body water (EBH20), and carcass protein (CP). In conclusion, HIW steers had greater growth, but poorer feed efficiency compared to LIW steers. Steers with a HIW produced fatter carcasses with a greater degree of marbling. [ABSTRACT FROM AUTHOR]

Klebsiella pneumoniae (Kpn) is an opportunistic pathogen that causes intrahospital complications such as pneumonia, liver abscesses, soft tissue infections, urinary infections, bacteraemia, and, in some cases, death. Since this bacterium has a higher frequency than other Gram-negative pathogens, it has become an important pathogen to the health sector. The adaptative genome of Kpn likely facilitates increased survival of the pathogen in diverse situations. Therefore, several studies have been focused on developing new molecules, synergistic formulations, and biomaterials that make it possible to combat and control infections with and dispersion of this pathogen. Note that the uncontrolled antibiotic administration that occurred during the pandemic led to the emergence of new multidrug-resistant strains, and scientists were challenged to overcome them. This review aims to compile the latest information on Kpn that generates intrahospital infections, specifically their pathogenicity-associated factors. Furthermore, it explains the natural-product-based treatments (extracts and essential oils) developed for Kpn infection and dispersion control. [ABSTRACT FROM AUTHOR]

We report a case of Klebsiella pneumoniae invasive liver abscess syndrome (KPILAS) with endophthalmitis-caused blindness as the first symptom after enema. The patient had diabetes, and his blood glucose was poorly controlled. She developed hematuria after four enemas for cosmetic purposes and later became blind. The eye discharge was cultured, which revealed a Klebsiella pneumoniae infection. B ultrasound did not show liver lesions, but computed tomography exhibited abscesses in the right lobe of the liver. Magnetic resonance imaging of the head indicated abscesses. These confirmed the diagnosis of invasive liver abscess syndrome. The patient was given ophthalmic and systemic anti-infection treatments, and her condition was effectively controlled. Unfortunately, the diseased eye still needed to be removed. This case underlines the necessity of avoiding unnecessary risky procedures (such as enemas) in vulnerable populations, the importance of early detection of invasive liver abscess syndrome, and the advantage of computed tomography in detecting liver abscesses. [ABSTRACT FROM AUTHOR]

Simple Summary: Numerous diseases, such as liver abscesses, bacteremias, pneumonia, and urinary tract infections, are caused by Klebsiella pneumonia (K. pneumonia). Historically, immunocompromised patients have been the main target of serious infections induced by K. pneumoniae. However, with the recent appearance and dissemination of hypervirulent strains, healthy individuals have also become susceptible to infection. Moreover, treating K. pneumoniae infections is extremely difficult due to the strains' increased antibiotic resistance. This review summarizes the various virulence factors of this bacterium, especially metallophores. The bacteriology, pathology, and epidemiology of K. pneumonia are also included in this review. The opportunistic pathogen Klebsiella pneumoniae (K. pneumoniae) can colonize mucosal surfaces and spread from mucosae to other tissues, causing fatal infections. Medical equipment and the healthcare setting can become colonized by Klebsiella species, which are widely distributed in nature and can be found in water, soil, and animals. Moreover, a substantial number of community-acquired illnesses are also caused by this organism worldwide. These infections are characterized by a high rate of morbidity and mortality as well as the capacity to spread metastatically. Hypervirulent Klebsiella strains are thought to be connected to these infections. Four components are critical to this bacterium's pathogenicity—the capsule, lipopolysaccharide, fimbriae, and siderophores. Siderophores are secondary metabolites that allow iron to sequester from the surrounding medium and transport it to the intracellular compartment of the bacteria. A number of variables may lead to K. pneumoniae colonization in a specific area. Risk factors for infection include local healthcare practices, antibiotic use and misuse, infection control procedures, nutrition, gender, and age. [ABSTRACT FROM AUTHOR]

Among the parasitic diseases, amoebic liver abscess (ALA) ranks second to malaria in terms of mortality. Due to the poor sensitivity of conventional diagnostic methods, there is a need for the development of effective and rapid diagnostic methods for ALA. Thus, the purpose of this work was to develop a real‐time loop‐mediated isothermal amplification (RT‐LAMP) assay specific to Entamoeba histolytica. Further, we compared the performance of real‐time LAMP with conventional and real‐time PCR (RT‐PCR) targeting 18S small subunit ribosomal RNA (18S SSU rRNA) gene of E. histolytica in patients with ALA. A total of 126 liver samples were obtained for the study. Of these, 96 aspirated pus samples were obtained from patients suffering from an ALA (serology confirmed, anti‐amoebic immunoglobulin IgG positive), 19 aspirated pus samples from patients with pyogenic liver abscess (PLA, 16S RNA gene positive) and 11 autopsy liver tissues. The results showed that the DNA of E. histolytica was detected in 81 samples by conventional PCR, 93 by RT‐PCR and 95 by RT‐LAMP. The analytical sensitivity of the RT‐LAMP assay was much higher than the other two techniques. RT‐LAMP assay was able to amplify up to one copy of the targeted gene of E. histolytica while conventional PCR and RT‐PCR could amplify up to 103 and 102 copies of the targeted gene of E. histolytica, respectively. In conclusion, RT‐LAMP proved to be a sensitive, specific and rapid test which can be utilised as an effective tool for the diagnosis of ALA. [ABSTRACT FROM AUTHOR]

The presence of bacteria in the bloodstream is associated with severe clinical outcomes. In mice, intravenous inoculation of Escherichia coli can lead to the formation of macroscopic abscesses in the liver. Abscesses are regions of severe necrosis and consist of millions of bacteria surrounded by inflammatory immune cells. Liver abscess susceptibility varies widely across strains of mice, but the host factors governing this variation are unknown. Here, we profiled hepatic transcriptomes in mice with varying susceptibility to liver abscess formation. We found that transcripts from endogenous retroviruses (ERVs) are robustly induced in the liver by E. coli infection and ERV expression positively correlates with the frequency of abscess formation. Hypothesizing that ERV-encoded reverse transcriptase may generate cytoplasmic DNA and heighten inflammatory responses, we tested whether nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) influence abscess formation. Strikingly, a single NRTI dose administered immediately following E. coli inoculation prevented abscess formation, leading to a concomitant 100,000-fold reduction in bacterial burden. We provide evidence that NRTIs inhibit abscess formation by preventing the tissue necrosis that facilitates bacterial replication. Together, our findings suggest that endogenous reverse transcriptases drive inflammatory responses during bacterial bloodstream infection to drive abscess formation. The high efficacy of NRTIs in preventing abscess formation suggests that the consequences of reverse transcription on inflammation should be further examined, particularly in infectious diseases where inflammation drives negative clinical outcomes, such as sepsis. [ABSTRACT FROM AUTHOR]

A liver cyst is hepatic fluid-filled cavities often detected in clinical surveillances such as a health examination. Although the liver cyst is usually asymptomatic and observed without any therapeutic intervention, it can be symptomatic and needs treatment due to its enlargement, hemorrhage, and infection. A 74-year-old woman presented with upper abdominal pain and a huge liver cyst in the left lobe. Several examinations including image findings revealed that the symptom could be derived from the liver cyst. Although there is no definite guideline of treatment for symptomatic liver cysts, percutaneous ultrasound-guided drainage with sclerotherapy or surgery is often selected. Because of anatomical accessibility to the liver cyst and the patient's wish, we performed endoscopic transgastric drainage with insertion of both an internal stent and an external nasocystic tube. Sclerotherapy with minocycline hydrochloride was performed through the nasocystic tube, and the liver cyst shrunk completely without any complications. This is the first reported method of administering minocycline hydrochloride through a nasocystic tube, which can be a therapeutic option for patients with symptomatic liver cysts. [ABSTRACT FROM AUTHOR]

Purpose: The clinical aspects and prognosis of eyes with endogenous endophthalmitis were compared over the last ten years. The occurrence and progression of endophthalmitis are linked to the systemic immune inflammation index (SII) and clinical features. Methods: The study comprised patients with endogenous endophthalmitis and 64 patients without endophthalmitis who were treated at Hebei Province Eye Hospital in the last ten years. According to the prognostic visual acuity, patients with endophthalmitis were split into two groups: Group A and Group B. Underlying disease (hypertension, diabetes, tuberculosis), infection risk (liver abscess, urinary tract infection, and recent abdominal surgery), signs and symptoms, and complete blood count were among the evaluation parameters (neutrophil count, lymphocyte count, monocyte count, platelet count, red blood cell distribution width). The NLR, PLR, MLR, and SII values were calculated. A nonparametric test was used to examine the clinical features and complete blood count results of patients in each group. To determine the parameters linked to endophthalmitis progression, researchers used principal component and ordinal logistic regression analyses. Results: The study comprised a total of 25 eyes and 22 individuals with endogenous endophthalmitis. Infectious bacteria included Staphylococcus aureus, Micrococcus luteus, Staphylococcus hemolyticus, and so on. The visual acuity of the affected eye ranged from 2.7 (1.55, 2.7) LogMAR to 1.22 (0.6, 2.7) LogMAR during the 6-month to 8-year follow-up period. The neutrophil, monocyte, and PLT counts, NLR, PLR, and SII values and other markers were considerably higher in Groups A and B than in the control group. The likelihood model of the SII and sex, age, onset time, diabetes, hypertension, monocyte count, and red blood cell distribution was the best, and its increase was strongly connected with the occurrence and progression of endophthalmitis, according to ordinal regression analysis. Conclusion: Patients with endophthalmitis had significantly higher blood neutrophil, monocyte, and PLT counts and SII, NLR, PLR, and MLR values. The SII can be employed as a biomarker for predicting endophthalmitis severity and prognosis. [ABSTRACT FROM AUTHOR]

This article, published in the Arab Journal of Interventional Radiology, presents a case study of a patient who developed liver abscesses after undergoing multiple sessions of transarterial chemoembolization (TACE) and Microwave Ablation (MWA) for hepatocellular carcinoma (HCC). The patient showed clinical improvement with intravenous antibiotic therapy. The case highlights the importance of postprocedural vigilance and a multidisciplinary approach in managing HCC patients. It also emphasizes the need for further research to refine clinical protocols for optimal outcomes in HCC management. [Extracted from the article]

This article, published in the Arab Journal of Interventional Radiology, examines the outcomes of percutaneous image-guided liver biopsy in pediatric patients at King Abdulaziz Medical City (KAMC) in Jeddah. The study analyzes the technical success and incidence of complications of 63 liver biopsies performed between February 2016 and December 2022. The results show that complications are rare, and the procedure can be safely performed in patients as young as one month old by interventional radiologists. The study provides valuable insights for medical professionals and researchers interested in pediatric liver biopsies. [Extracted from the article]

Introduction: Pyogenic liver abscess is a noteworthy health concern in North America, characterized by a mortality rate ranging from 2 to 12%. This condition is often polymicrobial, with Streptococcus species and Escherichia coli as the predominant causal pathogens in Western countries. Fusobacterium species, typically commensals of gastrointestinal, genital, and oral flora, have been implicated in the rare formation of tonsillar abscesses and Lemierre syndrome, including its gastrointestinal variant known as pylephlebitis. Case Presentation: We present the case of an immunocompetent male with a 2-week history of abdominal distention and pain. Abdominal magnetic resonance imaging revealed multiseptated cystic hepatic masses and portal vein thrombosis. A subsequent liver biopsy confirmed Fusobacterium nucleatum etiology. The patient was initiated on intravenous cefepime and oral metronidazole antibiotics. Unfortunately, the patient succumbed to cardiac arrest before a final diagnosis could be established. Conclusion:Fusobacterium species-associated liver abscess, coupled with the rare gastrointestinal variant of Lemierre syndrome (pylephlebitis), poses a significant mortality risk. This case underscores the rarity and clinical challenges associated with these conditions. Increased awareness among clinicians is crucial for early diagnosis and prompt intervention, potentially improving outcomes in such cases. [ABSTRACT FROM AUTHOR]

BACKGROUND: Liver abscess is a common clinical problem in tropical countries and is most commonly caused by pyogenic, amoebic or mixed infections. Abscess is usually suspected clinically in cases having fever, tender hepatomegaly and the diagnosis is usually confirmed on the basis of imaging such as ultrasound and computerized tomography. Management includes antimicrobial agents and drainage of abscess. Percutaneous drainage (PD) of abscess is done using needle aspiration or by pigtail catheter drainage. AIMS AND OBJECTIVE: To evaluate the role of ultrasound guided pigtail catheterization drainage procedure as a treatment option in cases of liver abscess. MATERIALS AND METHODS: It was a prospective study conducted at the Radiology department of Bolan Medical Complex Hospital, Quetta, Pakistan from August 2021 to September 2022. Forty eight patients diagnosed as hepatic abscess were included in this study on the basis of predefined inclusion and exclusion criteria. These patients underwent pigtail catheterization of liver abscess as a part of their treatment. The patients included in the study were diagnosed with liver abscess by ultrasound and CT and were treated in coordination with surgery department. The effectiveness of pigtail drainage was evaluated by doing serial ultrasound scans. The demographic characteristics, hepatic lobe involvement, amount of pus drained and complications were studied in these patients. RESULTS: Out of 48 patients, 32 were male and 16 were female with a M: F ratio of 2:1. The age ranged from 10 years to 70 years. The mean age of the study cases was found to be 35-40 years. Right lobe was involved in predominant cases. Eight patients developed procedure related complications out of which 3 had catheter blockage, 2 patients had catheter dislodgment requiring repositioning, 2 patient developed pus discharge from catheter site and remaining 1 patient developed subcapsular hematoma. Average hospital stay varied from 2 5 days. No major complications reported during the procedure. CONCLUSION: Percutaneous ultrasound guided pigtail catheter is an effective minor invasive procedure as a treatment option for liver abscess with high success rate and no procedure related mortality. [ABSTRACT FROM AUTHOR]

Introduction: Myeloid sarcoma (MS) is also known as chloroma, extramedullary acute myeloid leukemia (AML), or granulocytic sarcoma. MS is a rare extramedullary infiltration of myeloid cells, most commonly collecting in the skin and causing a small number of localized lesions. It is strongly associated with AML; however, MS more commonly occurs after diagnosis of AML is previously established or after previous treatment of AML. Case Presentation: This case describes a patient with an atypical presentation of MS with no known history of AML and up to 18 lesions identified on CT scan that were previously being monitored for months by her primary care physician. She presented with sepsis attributed to choledocholithiasis versus bacteremia from scattered abscesses versus osteomyelitis of her left knee; nonetheless, lactic acid failed to improve after common bile duct stent with biliary sphincterotomy/dilation or with incision and drainage and empiric antibiotics. Core needle biopsy of her left abdominal sidewall was eventually positive for MS, but she unfortunately developed multiorgan failure with symptomatic hypercalcemia refractory to treatment and ultimately decided to go to comfort care rather than pursue further workup and treatment. Although bone marrow biopsy was ultimately not performed to rule out synchronous AML, this is likely a case of isolated MS due to her scattered skin lesions being present for months prior to hospitalization and acute illness. Conclusion: This case highlights the importance of maintaining MS in the differential diagnosis and the importance of early diagnostic core needle biopsy for patients with persistent skin lesions of unknown origin. [ABSTRACT FROM AUTHOR]

Introduction: In tropical countries like India, two-thirds of liver abscess cases are amoebic. Along with abdominal pain, fever, and other non-specific clinical features, jaundice is commonly observed in Amoebic Liver Abscess (ALA) cases. However, the understanding of jaundice in a patients with ALA is limited, and it is associated with a poor prognosis. Aim: To compare the morbidity and mortality of ALA patients with and without hyperbilirubinemia, as well as their clinical outcomes. Materials and Methods: The present prospective cohort study was conducted at a tertiary teaching institute in northern India. It included 150 patients aged between 20 and 60 years with a confirmed diagnosis of ALA. The patients were divided into two groups based on the presence or absence of hyperbilirubinemia. Those with jaundice resulting from other causes or a history of hepatitis were excluded. Variables examined in the study included age, sex, alcohol intake, basic laboratory parameters, ultrasound-assessed abscess size and number, and duration of hospital stay. Results: Among the 150 cases, 22 (14.6%) had elevated serum bilirubin levels (>1 mg/dL). Additionally, 122 (81.33%) had a history of alcohol intake, and 117 (78%) had a single abscess cavity. In ALA patients with hyperbilirubinemia, 12 (54.55%) had abnormal creatinine values, and 6 (27.26%) experienced complications such as rupture and peritonitis. One mortality occurred in a patient with ALA and jaundice. Conclusion: ALA patients with jaundice exhibited larger abscess cavities, a higher complication rates, a longer hospital stays, and a poor prognoses. [ABSTRACT FROM AUTHOR]

Aspirates of liver abscess are frequently encountered in routine practice and are often of a low index of suspicion. However, necrotic liver metastasis clinically and radiologically mimics liver abscesses, and malignant cells can be obscured in an inflammation‐rich background on cytology. It is important to recognise malignant neoplasms in this scenario, in particular uncommon conditions such as metastatic mucosal melanoma. [ABSTRACT FROM AUTHOR]

Background & Methods: The aim of the study is to assess the role of DCE-MRI in characterizing the liver lesions into the various types. The patient was then placed on the gantry table in supine position with arms placed above the head. Patient was explained to hold his/her breath on verbal instruction and to resume breathing on reinstruction. In case patient was dyspneic or was unable to hold breath for reasonably long time, he/she was advised to maintain shallow breathing. Results: The most common age group among our study was between 40-49 years. Pain was the most common presenting complaint, and 36 % patients had a previous history of malignancy. 50 lesions were diagnosed as benign on MRI, while 44 being malignant. Peripheral nodular enhancement with delayed filling in was the most common enhancement characteristic seen in Hemangiomas, while rapid arterial phase enhancement with rapid washout was most commonly seen in HCC's, heterogeneous enhancement was most common for metastatic lesions. Conclusion: Liver lesions are very common, ranging from benign solitary lesion to multiple liver metastases. Histopathological examination makes the definitive diagnosis but DCE-MRI is highly effective tool in making the diagnosis non-invasively and help in planning the treatment of patient. It helps in differentiating between pseudo tumors lesions like focal fatty infiltration, infection (abscess, hydatid cyst etc.) & inflammatory disorders of liver and tumors. It can characterize tumors into benign and malignant lesions and can be also utilized for differential diagnosis in complicated cases. [ABSTRACT FROM AUTHOR]

Background and objective: To research the prevalence of hepatic abscesses at our facility. To examine the Age and Sex distribution. to examine the clinical characteristics based on variations in symptoms and symptomatology. To determine the disease's microbiology. To shed light on the role that radiological imaging plays in making a diagnosis and organising treatment appropriately. to classify the disease's mode of therapy. Method: On 100 patients who were enrolled in the trial throughout the time, a study was conducted at Department of General Surgery, Deccan College of Medical Sciences, Hyderabad, Telangana, India from to December 2022 to October 2023. Ultrasonography was used to confirm the clinical diagnosis of hepatic abscess in these patients. Result: Men are more common than women. 6:1 ratio; 5 th decade is peak incidence. Eighty four percent of cases had alcohol as the cause. The most prevalent clinical features are abdominal pain (96%) and soreness (72%), with the typical mode of presentation being observed in 81% of patients. Sixty five percent of cases had a right lobe abscess. Aspiration is the most often used therapeutic method (45%). Conclusion: According to an ultrasound, the abscess in the current study had completely disappeared after three to four months; in our series, individuals with lower socioeconomic status account for roughly 70% of all abscesses examined. [ABSTRACT FROM AUTHOR]

Background: The emergence and global spread of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) are of great concern to health services worldwide. These β-lactamases hydrolyze almost all β-lactams, are plasmid-encoded, and are easily transferable among bacterial species. They are mostly of the KPC types in CR-hvKp. OXA-48-producing hvKP strains have been rarely reported in the literature. Methods: OXA-48-producing hvKP strains were collected from clinical specimens at the First Affiliated Hospital of Hainan Medical University from January 2022 to March 2023. Hypervirulent strains were tested for virulence in a mouse lethality study and underwent whole genome sequencing to identify genomic features. Results: A total of 42 unique OXA-48-bearing K. pneumoniae strains were identified, including three CR-hvKP strains (KP2683-1, NCRE61, and KP2185), which were isolated from bacteremia, pulmonary abscess, and liver abscess separately. The three CR-hvKP strains belonged to two different clones of ST11 KL64 (KP2185 and NCRE61) and ST23 K1 (KP2683-1). The KP2683-1 strain had the highest virulence. Whole genome sequencing analysis indicated that NCRE61 and KP2185 acquired IncFIB-type plasmids with a set of virulence genes (iroBCDN, iucABCD, iutA, rmpA, and rmpA2), while KP2683-1 acquired an IncL-type blaOXA-48-harboring plasmid. Consecutive cultures showed that the blaOXA-48-harboring plasmids were highly stable in the three hvKP strains and could be transmitted to Escherichia coli J53 by conjugation. The drug susceptibility testing results show that Ceftazidime/avibactam is sensitive for OXA-48-producing hvKP. Conclusions: Our study highlighted the two evolutionary pathways of OXA-48-producing hvKP strains and confirmed their virulence through in vivo testing. Ceftazidime/avibactam may be a viable option for treating OXA-48-producing hvKP strains. [ABSTRACT FROM AUTHOR]

The article presents the discussion on case study of 23-year-old female patient in Luhansk, Ukraine with thrombocytopenia, having experienced a deteriorating general condition, weakness, increased fatigue, and periodic bleeding from the gums. Topics include patient underwent the first consolidation remission treatment and received posaconazole; and pharmacological coma was induced, after which no more cardiac rhythm disturbances were observed.

Background: Pyogenic liver abscess is a life-threatening disease with high morbidity and mortality. The aim was to investigate the common pathogens and discern the clinical features and microbiological characteristics of PLA more broadly, as well as to identify the most suitable antibiotics for the prevention and treatment of PLA. Materials and Methods: The present retrospective observational study consisted of 80 male patients diagnosed with pyogenic liver abscesses. The study was evaluated based on history-taking and clinical examination. The medical and microbiological records of all the PLA patients who were hospitalized and treated at NMCH, Patna, were retrospectively reviewed. Demographic data and medical information were also retrospectively collected. Results: Males were more commonly affected than females. The mean age of the study patient was 46±16.50 years, and the P value was 0.02 (significant). The mean length of hospital stay was 14.27 ± 4.61 days, and the P value was <0.001 (significant). In our current study, K. pneumoniae and E. coli were the most common pathogens causing pyogenic liver abscess, affecting 65% and 15% of patients, respectively. The most common lobe affected in liver abscesses was the right hepatic lobe (76.25%). Both gender and size of liver abscess between 5 and 10 cm were common. Conclusion: Needle aspiration under USG is done for small abscesses (=200 ml), whereas percutaneous drainage with pigtail catheter placement was done for large abscesses (>200 ml) under USG guidance were most effective interventions. [ABSTRACT FROM AUTHOR]

Background: liver abscess as an inflammatory lesion predominantly caused by ALA and PLA, with ALA being more prevalent in India. It discusses the transmission of Entamoeba histolytica and emphasizes the importance of recognizing unusual variants of ALA due to their association with complications. The section also mentions the occurrence of liver abscess in different lobes of the liver and the benign nature of ALA in the absence of poor prognostic markers. Figure 1 Description: A suggested algorithm for the management of liver abscess is presented in Figure 1, although specific details are not provided in the text. Methodology: The study is designed as a case report and conducted in the Department of OBGY at Rohilkhand Medical College And Hospital, Bareilly. Case Report: This section details a case of a 32-year-old pregnant patient presenting with fever, fatigue, and right upper quadrant pain. The patient's clinical examination, laboratory findings (including blood tests and ultrasound), and the development of tachycardia and tachypnea during hospitalization are described. The ultrasound findings suggest a liver abscess. The patient's subsequent treatment in the ICU and the birth of a healthy neonate are also reported. Figure 2 Description: An abdominal ultrasound image shows the calcified wall of the abscess in a 32-week pregnant woman, as depicted in Figure 2. Conclusion: The conclusion highlights the rarity but critical importance of considering liver abscess as a potential cause of sepsis or septic shock in pregnant patients. It recommends ultrasonographic evaluation of the liver in such cases. [ABSTRACT FROM AUTHOR]

Background: Liver abscess is a well-known condition that is often caused by parasite origin (amoebic) in underdeveloped nations and pyogenic in affluent ones. The goal of this research was to assess the microbiological spectrum of liver abscess, its etiological reasons, the medication susceptibility pattern of the isolates from the liver abscess, and the illness outcome. Materials and Procedures: From January 2021 to June 2022, prospective cross-sectional research was done at the Department of Microbiology on 90 patients diagnosed with a liver abscess in the Department of Surgery of a tertiary care hospital. Results: The most common etiological aetiology of the liver abscess (71%) was amoebic liver abscess. The most prevalent causal organism of pyogenic liver abscess (11%) was E. coli. The bulk of the patients were middle-aged guys with low socioeconomic position and were chronic drinkers. Fever (89%) and stomach discomfort (62%) were the most prevalent symptoms, with hepatomegaly (58%) being a common indicator. The research found complications such as abscess rupture (four instances), sepsis (four cases), chronic liver disease (two cases), and liver failure (two cases). The treatment approach in this research includes beginning patients on a first empirical antibiotic regimen. In addition, in the majority of instances, abscess drainage was performed using fine-needle aspiration (42%), or pigtail drainage (27%). Only 11% of the cases were complex enough to need open surgery. Conclusion: Amoebic liver abscess is the most frequent kind of liver abscess in India, followed by pyogenic liver abscess. The most prevalent bacterium recovered from pyogenic abscesses is E.coli. The most prevalent pattern in our investigation was a solitary right lobe abscess. Early and adequate antibiotic therapy, as well as abscess drainage, have resulted in a better clinical outcome. [ABSTRACT FROM AUTHOR]

Background: Klebsiella pneumoniae invasion syndrome (KPIS) is a severe multi-site infection that is usually caused by hypervirulent Klebsiella pneumoniae. The bacteria are relatively common in Asian diabetics and can cause organ abscesses or sepsis. When patients develop intracranial infection, the prognosis is poor. After anti-infective treatment, the Klebsiella pneumoniae-induced liver and lung abscesses and pulmonary fungal infection were relieved, but the brain abscesses worsened. Such complex and severe infection cases are rarely reported. Early identification of intracranial infection, selection of antibiotics with high concentrations in cerebrospinal fluid, and active treatment of complications such as diabetes and fungal infection are of great significance for the prognosis of patients. Case presentation: A 71-year-old patient diagnosed with liver abscess in another hospital was transferred to our hospital due to a worsening condition. On day 1 (day of admission), the patient was given invasive mechanical ventilation, continuous renal replacement therapy combined with endotoxin adsorption, antimicrobial treatment with imipenem-cilastatin, and percutaneous catheter drainage for liver abscess. Metagenomic next-generation sequencing in bronchoalveolar lavage fluid indicated Klebsiella pneumoniae (K. pneumoniae), Candida albicans, and Aspergillus flavus complex, and no viruses were detected. Blood and pus cultures revealed K. pneumoniae that was sensitive to piperacillin/tazobactam. The anti-infection therapy was adjusted to piperacillin/tazobactam combined with voriconazole. On day 14, a head computed tomography (CT) scan showed no significant changes, and a chest CT scan showed absorption of multiple abscesses in both lungs. The patient was still unconscious. After the endotracheal tube was removed, cranial magnetic resonance imaging (MRI) showed multiple brain abscesses. Finally, his family gave up, and the patient was discharged and died in a local hospital. Conclusion: In cases of K. pneumoniae infection, the possibility of intracranial, liver, lung, or other site infections should be considered, and physicians should be vigilant for the occurrence of KPIS. For patients suspected of developing an intracranial infection, cerebrospinal fluid should be tested and cultured as soon as possible, a head MRI should be performed, and antibiotics with high distribution in cerebrospinal fluid should be used early. When patients are complicated with diabetes, in addition to glycemic control, vigilance for concurrent fungal infections is also needed. [ABSTRACT FROM AUTHOR]

Systemic infections can yield distinct outcomes in different tissues. In mice, intravenous inoculation of Escherichia coli leads to bacterial replication within liver abscesses, while other organs such as the spleen clear the pathogen. Abscesses are macroscopic necrotic regions that comprise the vast majority of the bacterial burden in the animal, yet little is known about the processes underlying their formation. Here, we characterize E. coli liver abscesses and identify host determinants of abscess susceptibility. Spatial transcriptomics revealed that liver abscesses are associated with heterogenous immune cell clusters comprised of macrophages, neutrophils, dendritic cells, innate lymphoid cells, and T-cells that surround necrotic regions of the liver. Abscess susceptibility is heightened in the C57BL lineage, particularly in C57BL/6N females. Backcross analyses demonstrated that abscess susceptibility is a polygenic trait inherited in a sex-dependent manner without direct linkage to sex chromosomes. As early as 1 d post infection, the magnitude of E. coli replication in the liver distinguishes abscess-susceptible and abscess-resistant strains of mice, suggesting that the immune pathways that regulate abscess formation are induced within hours. We characterized the early hepatic response with single-cell RNA sequencing and found that mice with reduced activation of early inflammatory responses, such as those lacking the LPS receptor TLR4 (Toll-like receptor 4), are resistant to abscess formation. Experiments with barcoded E. coli revealed that TLR4 mediates a tradeoff between abscess formation and bacterial clearance. Together, our findings define hallmarks of E. coli liver abscess formation and suggest that hyperactivation of the hepatic innate immune response drives liver abscess susceptibility. [ABSTRACT FROM AUTHOR]

Purpose: To explore the feasibility and efficacy of interstitial brachytherapy application for nonresectable and chemo-resistant malignant liver and lung lesions. Materials and Methods: Percutaneous high-dose-rate interstitial brachytherapy (HDR ISBT) was applied in nine lesions of seven middle-aged patients with advanced carcinoma (five patients with liver lesion and two patients with lung lesion). All patients were surgically ineligible. All patients had already received systemic chemotherapy. Under computed tomography (CT) guidance (for lung lesion) or ultrasonography (USG) guidance (for liver lesion), a single stainless steel brachytherapy needle was inserted percutaneously in patients with lesion size ≤4 centimeter (cm) and multiple needles were inserted in patients of lesion size >4cm. A single dose of 15 Gy to 20 Gy with HDR ISBT was prescribed at the periphery of the lesion. The needles were removed just after treatment. Patients were kept under observation for 24 h after treatment. Results: The median size of the lesion was 6.5 cm. In all the cases of liver lesion, more than 75% shrinkage of tumor volume in follow-up at 6 mo was observed. It was more than 50% for lung lesion. None of the patients had developed significant complications as on the median follow up period of 15 mo (ranges 3–27 mo). Conclusions: Percutaneous CT-guided high-dose-rate interstitial brachytherapy is a minimally invasive, safe, and feasible treatment option with minimal complication for inoperable, chemo resistant, advanced cancers with encouraging treatment outcomes. [ABSTRACT FROM AUTHOR]

Background and Aim: The criteria for aspiration for pediatric liver abscess are unclear. In this randomized controlled trial, we evaluated the efficacy of ultrasound‐guided needle aspiration in addition to antibiotics in children with uncomplicated liver abscess. Methods: We enrolled 110 children aged 1–18 years (mean [SD] = 7.7 [3.7] years) with uncomplicated liver abscess. The primary outcome was clinical cure at 6 weeks (absence of fever and abdominal pain in the preceding 14 days with reduction in abscess size on ultrasonography). The secondary outcomes were clinical response at 4 weeks, fever resolution time, time to abdominal pain reduction and abdominal tenderness, duration of hospitalization, and treatment failure. Results: Clinical cure at 6 weeks was not significantly different (48/50 [96%] vs 39/46 [85%]; P = 0.082) between aspiration plus antibiotics group and antibiotics only group. The clinical response at 4 weeks was also comparable (49/50 [98%] vs 43/46 [93.5%]; P = 0.347). The mean (SD) of fever resolution time was significantly less in the aspiration plus antibiotics group (198 [90.8] h vs 248.2 [104.6] h; P = 0.014). Time to achieve reduction in abdominal pain (8.32 [3.1] vs 9.46 [3.1] days; P = 0.077) and abdominal tenderness (5.7 [2.4] vs 6.3 [2.3] days; P = 0.242), duration of hospitalization (16.6 [3.9] vs 18.2 [4.4] days; P = 0.07), and adverse event profile (9/50 [18%] vs 14/46 [30%]; P = 0.217) were comparable between the two groups. Conclusion: Majority of children with uncomplicated liver abscess achieved clinical cure at 6 weeks with intravenous antibiotics, irrespective of aspiration. However, needle aspiration may slightly reduce the duration of fever and abdominal pain/abdominal tenderness. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis is a leading cause of mortality and morbidity in many countries across the world, including Pakistan. While systemic tuberculosis can involve any organ of the body, tubercular liver abscess is a rare presentation. Case Report: We report the case of an 8-year-old female from a developing country where tuberculosis poses a significant burden on the health care system. The patient presented with fever and weight loss for 6 months and abdominal pain for 14 days. On examination, she had tenderness and guarding over the right hypochondrium. Investigations revealed neutrophilic predominance in the complete blood count and elevated C-reactive protein. Imaging of the abdomen revealed ruptured liver abscess, extensive abdominal lymphadenopathy, and thrombus in the inferior vena cava. Gastric secretions were positive for Mycobacterium tuberculosis. Treatment included antitubercular and antithrombotic therapy. The patient was closely followed until she had completed the 1-year course of antitubercular therapy and was symptom-free. Conclusion: In tuberculosis-endemic countries, physicians should keep a high index of suspicion for tuberculosis in children who present with liver abscess and multisystem involvement. [ABSTRACT FROM AUTHOR]

Abstract Background Liver abscesses (LAs) are one of the most common and important problems faced by the beef industry. The most efficacious method for the prevention of LAs in North America is through dietary inclusion of low doses of antimicrobial drugs such as tylosin, but the mechanisms by which this treatment prevents LAs are not fully understood. LAs are believed to result from mucosal barrier dysfunction in the gastrointestinal tract (GIT) allowing bacterial translocation to the liver via the portal vein, yet differences in the GIT microbiome of cattle with and without LAs have not been explored. Here, we characterized microbial communities from LAs, rumen, ileum, and colon from the same cattle for the first time. Results Results demonstrate that tylosin supplementation was associated with differences in microbial community structure in the rumen and small intestine, largely because of differences in the predominance of Clostridia. Importantly, we show for the first time that microbial communities from multiple LAs in one animal’s liver are highly similar, suggesting that abscesses found at different locations in the liver may originate from a localized source in the GIT (rather than disparate locations). A large portion of abscesses were dominated by microbial taxa that were most abundant in the hindgut. Further, we identified taxa throughout the GIT that were differentially abundant between animals with and without liver abscesses. Bifidobacterium spp.—a bacteria commonly associated with a healthy GIT in several species—were more abundant in the rumen and ileum of animals without LAs compared to those with LAs. Conclusions Together these results provide the first direct comparison of GIT and LA microbial communities within the same animal, add considerable evidence to the hypothesis that some LA microbial communities arise from the hindgut, and suggest that barrier dysfunction throughout the GIT may be the underlying cause of LA formation in cattle.

Dubayla al-Kabid (Liver abscess) is a condition in which collection of pus occurs in the liver commonly involving the right lobe. Traditional Unani medicine offers a detailed description of liver disorders alongwith their management. Causative factors of Dubayla al-Kabid include- infection, chronic dysentery, liver injury, cholelithiasis, irregular diets etc. The symptoms are fever with chills, abdominal pain, loss of appetite and difficulty in breathing. The line of treatment under Usool-e-Ilaj of the disease is based on evacuation of pus, use of medicines with Dāfi‘-i-Ḥummā (Antipyretic), Daf‘-i-Ta‘affun (Antiseptic), Muḥāfiẓ-i-Jigar (Hepatoprotective) and Muqawwī-i-Jigar(Liver tonic) properties. In contemporary medicine liver abscess is an encapsulated collection of suppurated material within the liver resulting from either fungal, bacterial, or parasitic infection. Although Klebsiella pneumoniae accounts for 50–70% of cases in the Asian subcontinent, Entamoeba histolytica is also frequently seen in routine clinical practice causing liver abscesses. Escherichia coli is the most common bacterium causing liver abscesses. Thus, infection that spreads throughout the biliary system is one of the most frequent causes of liver abscess requiring antibiotics. The drainage of pus is the treatment of choice in cases of large abscess while small liver abscess of 2-3 cm is conventionally treated with antibiotics. Antimicrobial resistance and persistence are associated with an elevated risk of treatment failure and relapsing infections. Hence there is a need to explore the ages old treatment strategies for the management of small liver abscess laid down in traditional Unani medicine. This paper will further pave the way of developing novel therapies for the effective management of liver abscess. [ABSTRACT FROM AUTHOR]

This article discusses a case of hypervirulent Klebsiella pneumoniae infection in a 65-year-old man of Indonesian ethnicity with type 2 diabetes mellitus and hypertension. The patient initially presented with fevers and diabetic ketoacidosis and was treated for urosepsis. However, he later developed severe emphysematous cystitis, left-sided pyelonephritis, and prostatic abscess. The article highlights the devastating consequences of hypervirulent K. pneumoniae infection and emphasizes the importance of early identification and appropriate antimicrobial treatment. It also notes that while the infection is primarily endemic in Asia, its global prevalence is increasing, and clinicians should be aware of this life-threatening infection, particularly in multi-ethnic populations like Australia. [Extracted from the article]