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Key Clinical Message: This case highlights the importance of early diagnosis of iliopsoas abscess in patients with communication difficulties and appropriate treatment to prevent further complications. We report a case in which the detection of an iliopsoas abscess was delayed due to difficulty in communication but was successfully treated with percutaneous drainage. A 70‐year‐old man with a 38–39°C fever and 5.69 mg/dL C‐reactive protein. Adult‐onset Alexander's illness, affected his swallowing, speech, coordination, and motor function. Abdominal computed tomography revealed a big iliopsoas abscess. Antibacterial treatment followed percutaneous draining. Drainage reduced temperature and inflammation. Four months later, the iliopsoas abscess returned, the second drainage eliminated recurrence. Difficulty in communicating was a contributing factor to the delayed diagnosis of a giant iliopsoas abscess. In the treatment of such patients, percutaneous drainage seems effective as an initial therapy. [ABSTRACT FROM AUTHOR]

Gallbladder perforation is a rare but life-threatening complication of acute cholecystitis. A rapid diagnostic work-up helps in identifying the type of gallbladder perforation. All these measures help in deciding the most effective means of management. We reported a case of an elderly man, who had co-morbidities. He presented an intrahepatic perforation of the gall bladder (GB) and a liver abscess. The patient was managed initially by performing a percutaneous image-guided drainage of the abscess. Then, we performed an endoscopic retrograde cholangiopancreatography and an extraction of the common bile duct stone. The patient underwent a successful open cholecystectomy after stabilization.The GB perforation and a liver abscess were detected in an elderly patient with co-morbidities. Initially, this condition can be managed conservatively by performing a percutaneous drainage of the abscess. Thus, this technique acts as a bridge to surgery. [ABSTRACT FROM AUTHOR]

Background: Neonatal appendicitis is a rare diagnosis. There is increased morbidity with associated complications like perforation, mass formation etc. Cases: We present here 6 cases of acute surgical abdomen, with pre-operative diagnosis of right iliac fossa lump formation in 3 and perforation peritonitis, intussusception, liver abscess each in 1 patient. On exploration, they were found to have complicated appendicitis. 5 of them could be salvaged, with 1 mortality. Conclusion: It is imperative to have high index of suspicion to prevent delayed treatment. Early surgical intervention is recommended to avoid potential morbidity and mortality. [ABSTRACT FROM AUTHOR]

A 58‐year‐old man was referred to our hospital with right abdominal pain. Contrast‐enhanced computed tomography (CECT) showed a rim‐enhanced lesion with a fluid collection in the right hepatic lobe. Upper gastrointestinal endoscopy revealed a Borrmann type 1 tumor on the middle gastric body, identified as an adenocarcinoma on pathology. The patient underwent percutaneous transhepatic abscess drainage and was treated with antibiotics. Two weeks after drainage, CECT revealed shrinkage of the abscess; however, the wall showed contrast enhancement. Needle biopsy was performed for the liver tumor, and it suggested the possibility of highly differentiated hepatocellular carcinoma. The patient first underwent gastrectomy, and the liver tumor was followed with CECT. Two months after surgery, CECT revealed that the liver tumor had vanished. Liver abscesses and infectious tumors can be difficult to differentiate between; therefore, careful scrutiny is essential before treatment. [ABSTRACT FROM AUTHOR]

Background: Malignant obstructive jaundice is associated with a poor prognosis. Patients can undergo percutaneous transhepatic biliary drainage (PTBD), but the impact it has on quality of life is not well understood. Objective: To assess the potential impact of PTBD on quality of life in patients with obstructive jaundice from advanced malignancy using surrogate markers including complications, hospital length of stay, readmission, reintervention, and mortality. Methods: A retrospective analysis of a single-centre cohort of all patients with advanced solid organ malignancy undergoing PTBD between April 2020 and February 2022. Data was collected from electronic medical records. Results: Among the sixteen patients, abdominal pain and cholangitis were observed in 62.5% and 37.5% patients, respectively. Peritonitis, biliary leak, perihepatic abscess, and haemobilia occurred in individual cases. The median hospital length of stay post PTBD was nine days. The 30-day readmission rate for PTBD-related complications was 31.3% with a median of three total readmissions per patient. The 30-day reintervention rate was 62.5%. The 30-day all-cause mortality was 25% (95% CI:8.9-53.3), which included one procedure-related death. Conclusions: Quality of life in patients with obstructive jaundice from advanced solid organ malignancy undergoing PTBD can be adversely impacted due to the high risk of complications, reintervention, hospitalisation, and mortality. Thorough patient assessments are crucial in selecting appropriate candidates for PTBD. [ABSTRACT FROM AUTHOR]

We propose photodynamic therapy (PDT) as an adjunct for recurrent or difficult to treat abscesses, or where placement of a drainage catheter is undesirable. I ClinicalTrials.gov Identifier i NCT02240498 Interventional radiological draining of abscesses has become the standard of care treatment for abscesses unresponsive to conservative management. 1Pre-procedure CT showing tubo-ovarian abscess (horizontal arrow) Therefore, the abscess was percutaneously drained and PDT was performed as part of an ongoing Phase 1 clinical trial. [Extracted from the article]

Biliary tract disease is currently the leading cause of pyogenic liver abscess (PLA) and complications of rupture are associated with high mortality and morbidity even with current medical knowledge advancement. We report a 35‑year‑old female who presented in emergency setting with complaints of jaundice, abdominal pain, fever, and respiratory distress. Patient had prior history of endoscopic management of biliary stones about 6 years back followed by asymptomatic period. Patient was managed by percutaneous drainage of left lobe liver abscess and left pleural empyema after initial resuscitation with further investigations revealing biliary stent with left hepatic abscess with transdiaphragmatic extension into left hemithorax. Neglected biliary stent has been reported to cause severe cholangitis with PLAs and these patients require immediate timely attention to the management of abscess and its complications. [ABSTRACT FROM AUTHOR]

The article "The Raoultella genus" presents information about the Raoultella genus, which belongs to the Enterobacteriaceae family and was named in honor of the French microbiologist Didier Raoult. These bacteria are Gram-negative bacilli, non-motile, encapsulated, and facultative anaerobes. They can degrade pectate and produce pigments on ferric gluconate citrate agar. Although they are considered bacteria with low virulence, in recent years they have gained relevance as causes of important medical infections, such as bacteremia, liver abscesses, biliary tract pathologies, urinary tract infections, and pneumonia. The identification of these bacteria is recommended using MALDI-TOF. They are intrinsically resistant to aminopenicillins and show variable resistance to amoxicillin-clavulanate due to the presence of chromosomal class A beta-lactamases and the acquisition of genes from other bacteria. Empirical treatment usually includes cephalosporins and fluoroquinolones, but it should be adjusted according to the reported sensitivity. [Extracted from the article]

This article discusses a rare case of a fishbone causing an intra-abdominal infection in a 39-year-old man. The patient initially presented with fevers, abdominal pain, and vomiting after consuming barbecued fish, chicken, and pork. Imaging tests revealed a liver abscess with a fishbone foreign body and a fistulous tract. The patient underwent percutaneous drainage and closure of the fistula. Antibiotic treatment was administered, and the abscess resolved with the fishbone remaining in place. The article highlights the challenges in diagnosing and treating hepatic abscesses caused by foreign bodies and emphasizes the importance of early detection and percutaneous drainage. Surgical intervention may be necessary in some cases. [Extracted from the article]

Milligan–Morgan(M-M) hemorrhoidectomy is regarded as the primary treatment option for patients diagnosed with grade III or IV hemorrhoids. Here, we present the case of a 50-year-old male who developed pyogenic liver abscesses as an unusual complication following M-M hemorrhoidectomy. Severe complications subsequent to hemorrhoid surgery are infrequent. A review of the PubMed database spanning the 30-year period between 1994 and 2024 yielded only four publications documenting patients who experienced liver abscesses following open hemorrhoidectomy. Furthermore, the patient exhibited symptoms of a liver abscess as early as the second day post-surgery, despite having no history of diabetes or liver disease, making this occurrence truly uncommon. [ABSTRACT FROM AUTHOR]

Background: Serum lipids variations are closely related to the sepsis progression; however, their value for patients with pyogenic liver abscesses (PLA) has rarely been studied. We investigated the serum lipid level variations in patients with PLA and its predictive value to the disease. Methods: The study included 328 patients with PLA hospitalized in the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2021; 35 (10.67%) in the severe group (SG) and 293 (89.33%) in the non-severe group (nSG). Their clinical records were analyzed retrospectively, and dynamic curves were drawn to clarify the changes in different indicators during the course of the disease. Results: High-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and lipoprotein(a) (Lp(a)) in the SG were significantly lower than those in nSG (P < 0.001). Total cholesterol (TC) at baseline (OR = 0.184, P < 0.001) was an independent risk factor for severe patients and had the highest predictive value, with an area under the curve of 0.859 and a cut-off value of 2.70 mmol/L (sensitivity = 94.3%, specificity = 63.5%). For patients who met the criteria for drainage surgery, TC, HDL-C and LDL-C levels continued to decrease with antibiotic therapy alone before drainage and began to increase after the surgery. Conclusions: Low TC level on admission is an independent risk factor for the progression of severe illness in PLA patients, with the highest predictive value surpassing other routine clinical indices. Abscess drainage should be performed as soon as possible for patients whose TC continues to decline after medical treatment. [ABSTRACT FROM AUTHOR]

Hypervirulent Klebsiella pneumoniae (hvKp) is an important pathotype with enhanced virulence features compared with classical K. pneumoniae (cKp). hvKp usually causes life-threatening infections in the community, often affecting young and healthy individuals. During the past few decades, hvKp-induced liver abscess has been increasingly reported in Asia and is emerging as a global disease. To better comprehend the molecular characteristics of hvKp-induced liver abscess and recognize the global dissemination of hypervirulent strains with resistance determinants, we sequenced the whole genome of 26 K. pneumoniae strains from patients with liver abscess (KLA) and investigated the clinical factors related to different phenotype groups. The epidemiology, virulence-related factors, and antimicrobial resistance determinants were also discussed. The age, gender, and whether being hospitalized showed no differences among the string-positive and -negative groups were also studied. The assembly and annotation suggested that most of the 26 new liver abscess-causing hvKp strains were ST23-K1 or ST86-K2, and only one of the strains exhibited multidrug resistance. Compared with the existing 36 global liver abscess genome sequences, higher sequence type and virulence gene diversity were found in the new genomes. The clinical characteristics and genomic data of the isolated strains will enrich our knowledge for comparative genomic studies, allowing the better understanding of hvKp characteristics and evolution. [ABSTRACT FROM AUTHOR]

Purpose: Klebsiella pneumoniae (K. pneumoniae) is a Gram-negative bacterium that is predominantly associated with liver abscesses in global diabetic patients. High levels of glucose in the surrounding of K. pneumonia increase its pathogenicity including capsular polysaccharide (CPS) and fimbriae. Other important virulent factors include outer membrane protein A (ompA) and regulator mucoid phenotype A (rmpA). The objective of this investigation was to elucidate the effects of high glucose on rmpA and ompA gene expression and serum resistance of K. pneumoniae causing liver abscess. Patients and Methods: The clinical history of 57 patients suffering from K. pneumoniae-caused liver abscesses (KLA) was acquired and their clinical and laboratory manifestations in the presence or absence of diabetes were analyzed. The antimicrobial susceptibility, serotypes, and virulence genes were tested. Clinical isolates of 3 serotype-K1 hypervirulent K. pneumoniae (hvKP) were used to detect the effect of exogenous high glucose on rmpA, ompA, and clbB genes expression, and bacterial serum resistance. Results: KLA patients with diabetes showed higher C-reactive protein (CRP) compared to non-diabetic KLA patients. Furthermore, the diabetic group showed increased incidences of sepsis and invasive infections, and their length of hospital stay was also prolonged. Pre-incubation of K. pneumoniae in high glucose (0.5%) concentration up-regulated rmpA, ompA, and clbB genes expression. However, cAMP supplementation, which was inhibited by environmental glucose, reversed the increase of rmpA and ompA in a cAMP-dependent manner. Moreover, hvKP strains incubated in high glucose also exhibited enhanced protection from serum killing. Conclusion: High glucose levels reflected by poor glycemic control has increased gene expression of rmpA and ompA in hvKP by the cAMP signaling pathway and enhanced its resistance to serum killing, thus providing a new and reasonable explanation for the high incidences of sepsis and invasive infections in KLA patients with diabetes. [ABSTRACT FROM AUTHOR]

aim was to evaluate differences in clinical characteristics between patients with culture-negative liver abscess (CNLA) and those with culture-positive liver abscess (CPLA), and identify differences in the main causative pathogen. Methods: In this study, we retrospectively collected medical records of PLA patients admitted to a teaching hospital from January 2010 to December 2019. Results: In total, 324 PLA patients were enrolled in this study. Of these, 202 (62.3%) cases were confirmed cultural positive, including 109 patients (54%) and 20 (9.9%) patients infected with Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E.coli), respectively. Patients in the CPLA group were older (p=0.029) and had higher prevalence of abscesses larger than 5 cm in diameter (p = 0.003), gas-forming rate (p = 0.016), and percutaneous drainage (p < 0.001) compared with CNLA group. Patients with CPLA had significantly longer hospitalizations than those with CNLA (p = 0.010). Nevertheless, there was no significant difference in in-hospital mortality between the two groups (p = 0.415). Compared with patients with E. coli, those with K. pneumoniae had higher incidence of diabetes mellitus (p = 0.041), solitary abscess (p < 0.001), localization in the right hepatic lobe (p = 0.033), abscess size larger than 5 cm (p < 0.001) and percutaneous drainage (p = 0.002), but mortality was not significantly different (p = 1.000). Conclusion: No significant difference in in-hospital mortality was found between patients with CNLA and those with CPLA group. However, clinical characteristics and management were different between the main causative pathogens, including K. pneumoniae and E. coli. [ABSTRACT FROM AUTHOR]

Introduction: Hypermucoviscous Klebsiella pneumoniae (HmKp) poses an emerging and highly pathogenic global health threat. This study aimed to investigate the clinical and genomic characteristics of HmKp isolates to better understand the virulence mechanisms of the hypermucoviscous (HMV) phenotype. Methods: From May 2018 to August 2021, 203 non-repeat K. pneumoniae isolates causing invasive infections were collected from a hospital in Beijing, China. Isolates were divided into HmKp (n=90, 44.3%) and non-HmKp (n=113, 55.7%) groups according to string test results. Results: Multivariate regression showed that diabetes mellitus (odds ratio [OR]= 2.20, 95% confidence interval (CI): 1.20-4.05, p=0.010) and liver abscess (OR=2.93, CI 95%:1.29-7.03, p=0.012) were associated with HmKp infections. K. pneumoniae was highly diverse, comprising 87 sequence types (STs) and 54 serotypes. Among HmKp isolates, ST23 was the most frequent ST (25/90, 27.8%), and the most prevalent serotypes were KL2 (31/90, 34.4%) and KL1 (27/90, 30.0%). Thirteen virulence genes were located on the capsular polysaccharide synthesis region of KL1 strains. HmKp isolates were sensitive to multiple antibiotics but carried more SHV-type extended spectrumb-lactamase (ESBL) resistance genes (p<0.05), suggesting that the emergence of ESBL-mediated multidrug resistance in HmKp should be monitored carefully during treatment. Phylogenetic analysis disclosed that HmKp isolates were highly diverse. Comparative genomic analysis confirmed that the HMV phenotype is a plasmid-encoded virulence factor. Seventeen HmKp genes were highly associated with HmKp, and included rmpAC, 7 iron-acquisitionrelated genes, and pagO, which may promote liver abscess formation. Discussion: This investigation provides insight into the mechanisms producing the HMV phenotype. [ABSTRACT FROM AUTHOR]

Object The management and recommendations for treatment strategies of pyogenic spinal infection are still a highly controversial issue. The purpose of this study was to evaluate patient's quality of life (QoL) after surgical and conservative treatment of spinal infection. Materials and Methods We conducted a retrospective, single-center study. All patients treated between 2009 and 2016 were included in this study. For evaluation of QoL, we recorded each patient's satisfaction according to the 36-Item Short Form Health Survey (SF-36) questionnaire. Scores were compared with a U.S. standard population. Results Two hundred and ten adult patients with spondylodiskitis were identified. Of these, 155 (74%) underwent surgery and 55 (26%) were treated conservatively. The mean overall age was 68.6 (23–98) years. Seventy-two patients were females and 138 patients were males. The mean outcome values in the surgical group did not reach the level of the normative sample in one of eight items, whereas the conservative group revealed a reduced QoL in all items. Intergroup comparison revealed significant differences in all items (p < 0.05). Conclusion In the patient population we investigated, QoL in surgically treated patients was better than that in conservatively managed patients. [ABSTRACT FROM AUTHOR]

The prevalence of nonspecific pyogenic spondylodiskitis, associated with both a high morbidity and a high mortality, has increased in the last few decades. The diagnosis is often delayed because of the nonspecific clinical manifestation at the early stage. The reliability of radiographs is limited, particularly in early stage after the onset of infection. Computed tomography (CT) can reliably assess the bony condition with the possibility of spatial visualization. Contrast enhancement supports the detection of affected soft tissue. Magnetic resonance imaging (MRI) continues to be the gold standard in the diagnosis of spondylodiskitis. Sophisticated investigation protocols supported by gadolinium enhancement secure the diagnosis. MRI has a high resolution without radiation exposure. Different nuclear investigation techniques extend the diagnostic options. Reports of 18F-fluorodeoxyglucose-positron emission tomography (18-FDG-PET) are particularly promising to confirm the diagnosis. The drawback of the reduced image quality with respect to detailed anatomical information can be overcome by a combined simultaneous acquisition of CT or MRI. With respect to one of the greatest challenges, the differentiation between degenerative changes (Modic type 1) and infection at an early stage using differentiated MRI protocols and FDG-PET is promising. This overview presents a concise state-of-the-art look at radiologic investigations in case of suspected nonspecific pyogenic spondylodiskitis with the focus on a pragmatic approach. [ABSTRACT FROM AUTHOR]

Liver abscesses in feedlot cattle are a polymicrobial infection with Fusobacterium necrophorum and Trueperella pyogenes as the primary and secondary etiologic agents, respectively. Cattle with liver abscesses do not exhibit clinical signs and the abscesses are detected only at slaughter. The objective was to conduct metabolomics analysis of purulent materials of liver abscesses to identify biochemicals. Liver abscesses from crossbred cattle (n = 24) and Holstein steers (n = 24), each fed high-grain finishing diet with tylosin (n = 12) or no tylosin (n = 12), were included in the study. Abscess purulent materials were analyzed by ultrahigh-performance liquid chromatography-tandem mass spectroscopy. A total of 759 biochemicals were identified and were broadly categorized into carbohydrates, energy metabolism pathways intermediates, peptides, amino acids and their metabolites, lipids and their metabolites, nucleotides, vitamins and cofactors, xenobiotics, and partially characterized molecules. The top 50 biochemicals identified included amino acids, lipids, nucleotides, xenobiotics, peptides, and carbohydrates and their metabolites. Among the 15 amino acid metabolites in the top 50 biochemicals, four were tryptophan metabolites, indoleacrylate, indolepropionate, tryptamine, and anthranilate. The 3-phenylpropionate, a product of phenylalanine metabolism, was the predominant metabolite in purulent materials. Between the four treatment groups, a two-way ANOVA analysis identified biochemicals that exhibited significant main effects for cattle type and in-feed tylosin use and their interactions. A total of 59 and 85 biochemicals were different (P < 0.05) between the cattle type (crossbred vs. Holstein steers) and in-feed tylosin use (tylosin vs. no tylosin), respectively. Succinate, an intermediate of lactate fermentation by some bacterial species, was one of the top 30 biochemicals that differentiated the four treatment groups. A number of lysophospholipids, indicative of bacterial and host cell membrane lyses, were identified in the purulent materials. In conclusion, to our knowledge this is the first report on the metabolome of liver abscess purulent materials and several biochemicals identified were related to metabolic activities of the bacterial community, particularly F. necrophorum and T. pyogenes. Biochemicals unique to liver abscesses that appear in the blood may serve as biomarkers and be of diagnostic value to detect liver abscesses of cattle before slaughter. [ABSTRACT FROM AUTHOR]

A pooled analysis was performed to evaluate whether corn silage fed at 15% or 45% of diet DM impacted liver abscesses prevalence at slaughter in five previous experiments. Cattle fed 15% corn silage had 7.8% abscessed livers compared to 4.1% for cattle fed 45% corn silage when all diets contained tylosin. While improved due to increased corn silage inclusion, the objective of the current finishing study was to determine the impact of silage inclusion in finishing diets with and without tylosin on performance and incidence of abscessed livers in beef cattle. A total of 640 (BW = 334 ± 25 kg) steers were used in a generalized randomized block design with a 2 × 2 factorial treatment design. Treatments included two concentrations of corn silage (15% and 45% of diet DM), with or without tylosin for liver abscesses. This study used 32 pens of cattle with 20 steers per pen and 8 pens per treatment. There was a tendency for an interaction for feed efficiency (G:F; P = 0.10) where cattle fed 15% corn silage had a 2% increase in G:F when tylosin was added to the diet, but no improvements in G:F were observed when tylosin was added to diets containing 45% silage. There was an interaction between silage and tylosin inclusion for abscessed livers (P = 0.05). Cattle fed 15% corn silage without tylosin had the greatest incidence of abscessed livers (34.5%) compared to other treatments (P = 0.05), and the incidence of abscessed livers was decreased to 19% if tylosin was fed with 15% corn silage. Feeding 45% silage was effective at lowering the incidence of abscessed livers (P = 0.05) which was 12.4%, regardless of whether tylosin was fed. Feeding corn silage at 45% of diet DM (77.5% concentrate) was as effective as feeding tylosin to cattle on a 92.5% concentrate diet. Feeding corn silage at greater inclusions decreased daily gain (P ≤ 0.01) but increased final body weight when fed to an equal fatness (cattle fed 45% CS were fed 28 d longer). Feeding corn silage at 45% was more economical compared to feeding 15% corn silage, especially as corn prices increase, provided shrink is well managed. Feeding elevated concentrations of corn silage may be an economically viable method to reduce incidence of liver abscesses without antibiotic use for smaller operations that can manage more corn silage in finishing diets. [ABSTRACT FROM AUTHOR]

(1) Background: Although invasive fungal infections are a major cause of neonatal morbidity and mortality, data on the incidence and outcomes of localized abscesses in solid organs due to fungal infections are scarce. The aim of this study was to consolidate evidence and enhance our understanding on neonatal liver abscesses due to invasive fungal infections. (2) Methods: An electronic search of the PubMed and Scopus databases was conducted, considering studies that evaluated fungal liver abscesses in the neonatal population. Data on the epidemiology, clinical course, treatment, and outcome of these infections were integrated in our study. (3) Results: Overall, 10 studies were included presenting data on 19 cases of neonatal fungal liver abscesses. Candida spp. were the most common causative pathogens (94.7%). Premature neonates constituted the majority of cases (93%), while umbilical venous catheter placement, broad spectrum antibiotics, and prolonged parenteral nutrition administration were identified as other common predisposing factors. Diagnosis was established primarily by abdominal ultrasonography. Medical therapy with antifungal agents was the mainstay of treatment, with Amphotericin B being the most common agent (47%). Abscess drainage was required in four cases (21%). Eradication of the infection was achieved in the majority of cases (80%). (4) Conclusions: Even though fungal liver abscess is a rare entity in the neonatal population, clinicians should keep it in mind in small, premature infants who fail to respond to conventional treatment for sepsis, particularly if an indwelling catheter is in situ. A high index of suspicion is necessary in order to achieve a timely diagnosis and the initiation of the appropriate treatment. [ABSTRACT FROM AUTHOR]

To investigate the clinical and CT features of invasive and non-invasive Klebsiella pneumoniae liver abscesses (KPLA). Fifty-one patients with KPLA diagnosis including 26 invasive and 25 non-invasive KPLA cases were analysed retrospectively. All patients underwent routine abdominal unenhanced and three-phase enhanced CT examinations. The CT images were assessed by two experienced radiologists by examining location, number, size, septa, texture, gas in the pus cavity, portal phlebitis, thrombophlebitis, and abnormal perfusion during the arterial phase. Statistical differences for continuous characteristics were analysed with independent samples t -test or Wilcoxon's test, while the chi-square test or Fisher's exact test was used for categorical variables. A logistic regression analysis was performed to determine the independent related factors of invasive KPLA and receiver operating characteristic (ROC) curves were used for assessment. Age and type 2 diabetes were significantly different between the patients with invasive and non-invasive KPLA. In addition, patients with invasive KPLA had lower levels of platelet and total protein (p< 0.05) and higher total bilirubin compared to patients with non-invasive KPLA. Throughout the regression analysis, total bilirubin, platelets, and total protein demonstrated an area under the ROC curves of 0.717, 0.745, and 0.728, respectively. Invasive KPLA occurs predominantly in younger patients with type 2 diabetes. Laboratory tests revealed low platelet and total protein levels and high total bilirubin levels. If the patient with KPLA exhibits hepatic venous thrombophlebitis with no abnormal enhancement around the abscess in the arterial phase of enhanced CT, it indicates that the abscess has invaded. • This study is helpful for early clinical diagnosis and treatment. • IKPLA occurs predominantly in younger patients with type 2 diabetes. • Low total protein level, and high serum TBIL level are suggestive of IKPLA. [ABSTRACT FROM AUTHOR]

Klebsiella pneumoniae is a major pathogen of bacterial liver abscess in Asia. Particularly, patients with community-acquired Klebsiella pneumoniae liver abscess (CA-KPLA) tend to have a higher risk of invasive infection and pulmonary is a common invasive infectious site, making it a global clinical crisis. Therefore, considerable attention should be focused on the early prediction and active treatment strategies of such patients. The clinical data of 127 CA-KPLA cases hospitalized from January 2017 to February 2022 were collected from a single center. Risk factors were analyzed by the use of univariable and multivariable analysis. Furthermore, independent risk factors of pulmonary affection were utilized to construct a predictive nomogram. The incidence of pulmonary affection in KPLA patients was 57.5% (73/127) and the majority manifested as nodular lesions with cavities and pleural effusion in chest CT images. Based on the predictive nomogram, the SOFA score (>2) was defined as the most dominant independent risk factor for the occurrence of pulmonary affection, followed by the maximum diameter of liver abscess (>3 cm), multiple liver abscesses, bacteremia, and badly-controlled diabetes sequentially. The validation of this nomogram also demonstrated good discriminative ability and satisfactory consistency. Finally, early drainage of liver abscess, initial combinational antibiotics, and early Carbapenem-including antibiotic usage were established as favorable factors for therapy in pulmonary affected CA-KPLA patients. This study provided an effective model for the early prediction of pulmonary affection in patients with CA-KPLA and some rational strategies for their early therapeutic remission. [ABSTRACT FROM AUTHOR]

The optimal timing of antibiotic administration in patients with a liver abscess undergoing liver aspiration or drainage is unknown. This was a retrospective cohort study using the Diagnosis Procedure Combination database, a national inpatient database in Japan. A total of 34,424 patients who were emergently hospitalized due to liver abscess between July 2010 and March 2020 were included. Of these, 31,248 (90.8%) received antibiotics on the day of admission (early antibiotics group), and 3176 (9.2%) did not (delayed antibiotics group). Multivariable logistic regression analyses showed that in-hospital mortality of patients in the early antibiotics group was significantly lower than that in the delayed antibiotics group (odds ratio, 0.61; 95% confidence interval, 0.52–0.72; p <0.001). Patients in the early antibiotics group had a significantly lower proportion of clinical deterioration (odds ratio, 0.73; 95% confidence interval, 0.63–0.84; p <0.001) and shorter length of stay (adjusted difference, −5.2 days; 95% confidence interval, −6.2 to −4.1 days; p <0.001) than those in the delayed antibiotics group. Starting antibiotic treatment on the day of admission was associated with lower mortality, a lower proportion of clinical deterioration, and a shorter length of hospital stay. [ABSTRACT FROM AUTHOR]

The beef liver has important nutritional properties in food, but can transmit zoonoses important to humans. Service inspection of products of animal origin used to give food security in the consumption of these products. Liver abscesses occur by different etiologies in bovine liver. From the record of liver condemnations of cattle slaughter in abatoir under state inspection, 2,256 cattle slaughtered between August 2011 and March 2014, in Rolandia county from 14 counties of north central mesorregion Parana were detected 8,37% of liver abscesses. All 189 livers containing single or multiple abscesses were condemned by the standard inspection service, causing economic losses resulting decreased feed efficiency, and decreased carcass yield beyond the value of the viscera which is no longer marketed. [ABSTRACT FROM AUTHOR]

We present a patient with multiple bee stings who developed lung and liver injuries and subsequently tested positive for coronavirus disease 2019 (COVID-19). A 65-year-old male patient presented to the emergency department after being stung by more than 100 honeybees. His physical examination revealed pustular lesions distributed across his chest, arms, back, legs, and head, marking the sting zones. While the patient had no history of liver disease, initial laboratory test results showed elevated liver enzyme levels. A chest computer tomography scan was ordered, revealing bilateral ground-glass opacities suggesting COVID-19. His condition worsened over the course of the following day, and when he was admitted to the intensive care unit (ICU), his SpO2 decreased to 83% despite oxygen support with a mask. The second polymerase chain reaction test taken in the ICU was positive for COVID-19 infection. After stung with multiple bees, the patient developed acute liver injury and suffered from concomitant COVID-19-related respiratory insufficency, and he was treated accordingly. Starting on the 5th day, the patient's liver markers began to improve, and on the 13th day, he was discharged with normal vital signs and liver enzyme values. There seem to be varying outcomes across different studies with regard to the relationship between bee stings and COVID-19. Further research is needed to explore the possibility of this complementary treatment with bee venom in the prevention of severe acute respiratory syndrome coronavirus-2 infection. [ABSTRACT FROM AUTHOR]

The administration of chemotherapy to cancer patients with organ dysfunction raises concerns regarding its safety. The safety profile of patients with organ dysfunction due to rare diseases treated with chemotherapy plus immune checkpoint inhibitor is limited. Fibrinogen storage disease (FSD) is a rare disease that causes liver dysfunction through endoplasmic reticulum stress response due to abnormal accumulation of fibrinogen in the endoplasmic reticulum of hepatocytes. Although chemotherapy plus nivolumab is recommended as a standard first-line treatment for patients with advanced gastric cancer (AGC), its safety profile for patients with FSD is rarely available. In this study, an 80-year-old male with gastric cancer with positive lavage cytology was scheduled to receive palliative chemotherapy. This case had liver dysfunction of unknown cause, and a liver biopsy was performed. Histopathological findings revealed a diagnosis of type II/III fibrinogen inclusion based on morphology and immunohistochemistry. Liver function was recovered by administering ursodeoxycholic acid. Therefore, the combination chemotherapy of S-1, oxaliplatin, with nivolumab as palliative chemotherapy was initiated. The case responded well to chemotherapy and achieved conversion surgery without worsening of liver function. We report a case of AGC with fibrinogen inclusion complication where chemotherapy was safely administered with a good outcome. The combination therapy of cytotoxic drugs and immune checkpoint inhibitors may be safely and effectively administered to such patients. [ABSTRACT FROM AUTHOR]

Streptococcus intermedius is a beta‐hemolytic, non‐motile, catalase‐negative, gram‐positive member of the Streptococcus anginosus group. When compared to other members of this group like S. anginosus and Streptococcus constellatus, S. intermedius infections are more substantial. In this case, we present a 47‐year‐old male patient who was found to have S. intermedius abscesses in his lungs, liver, and brain. The treatment of choice for these abscesses is a combination of drainage, surgery, and antibiotic therapy. Streptococcus intermedius has a unique tropism in the brain, liver, and lungs leading to abscess formation. When compared to other members of this group like Streptococcus anginosus and Streptococcus constellatus, S. intermedius infections are more substantial. S. intermedius is unique to the other bacteria in SAG due to the expression of intermedilysin (ILY), allowing it to cause cell necrosis with membrane bleb formation. The mortality rate for SAG‐associated bacteremia is 10%–16%. Early recognition and timely intervention are important for successful treatment and improved outcomes. There are currently no screening guidelines when S. intermedius is found in culture data; however, clinicians should have a low threshold to consider imaging for indolent infections. [ABSTRACT FROM AUTHOR]

Choledochal cysts (CCs) are rare cystic dilatations of the intrahepatic and/or extrahepatic bile ducts. We review the pathophysiology, diagnosis, and management of CCs. MEDLINE/PubMed and Web of Science databases were queried for "choledochal cyst", "bile duct cyst", "choledochocele", and "Caroli disease". Data were synthesized and systematically reviewed. Classified according to the Todani Classification, CCs are generally believed to arise secondary to reflux of pancreatic enzymes into the biliary tree due to anomalous pancreaticobiliary duct union. Complications of CCs include abdominal pain, jaundice, cystolithiasis, cholecystitis, pancreatitis, liver abscess, liver cirrhosis and malignant transformation (3–7.5%). Radiological and endoscopic imaging is the cornerstone of CC diagnosis and full delineation of cyst anatomy is imperative for proper management. Management is generally guided by cyst classification with complete cyst excision necessary for CCs with high potential of malignant transformation such as types I and IV. 5-year overall survival after choledochal cyst excision is 95.5%. Most CCs should undergo surgical intervention to mitigate the risk of cyst related complications such as cholangitis and malignant transformation. [ABSTRACT FROM AUTHOR]

Surgical emergencies are common in the critical care setting and require prompt diagnosis and management. Here, we discuss some of the surgical emergencies involving the gastrointestinal, hepatobiliary, and genitourinary sites. In addition, foreign body aspiration and necrotizing soft-tissue infections have been elaborated. Clinicians should be aware of the risk factors, keys examination findings, diagnostic modalities, and medical as well as surgical treatment options for these potentially fatal illnesses. [ABSTRACT FROM AUTHOR]

Background: Gram-negative bacteria are causative agents of endogenous endophthalmitis (EBE). We aim to systematically review the current literature to assess the aetiologies, risk factors, and early ocular lesions in cases of Gram-negative EBE. Methods: All peer-reviewed articles between January 2002 and August 2022 regarding Gram-negative EBE were included. We conducted a literature search on PubMed and Cochrane Controlled Trials. Results: A total of 115 studies and 591 patients were included, prevalently Asian (98; 81.7%) and male (302; 62.9%). The most common comorbidity was diabetes (231; 55%). The main aetiologies were Klebsiella pneumoniae (510; 66.1%), Pseudomonas aeruginosa (111; 14.4%), and Escherichia coli (60; 7.8%). Liver abscesses (266; 54.5%) were the predominant source of infection. The most frequent ocular lesions were vitreal opacity (134; 49.6%) and hypopyon (95; 35.2%). Ceftriaxone (76; 30.9%), fluoroquinolones (14; 14.4%), and ceftazidime (213; 78.0%) were the most widely used as systemic, topical, and intravitreal anti-Gram-negative agents, respectively. The most reported surgical approaches were vitrectomy (130; 24.1%) and evisceration/exenteration (60; 11.1%). Frequently, visual acuity at discharge was no light perception (301; 55.2%). Conclusions: Gram-negative EBEs are associated with poor outcomes. Our systematic review is mainly based on case reports and case series with significant heterogeneity. The main strength is the large sample spanning over 20 years. Our findings underscore the importance of considering ocular involvement in Gram-negative infections. [ABSTRACT FROM AUTHOR]

Clinical, laboratory, and microbiological features, clinical outcomes, and pyogenic liver abscess (PLA) prognosis evaluation in non‐liver cancer (Non‐LC) and liver cancer patients treated with transarterial chemoembolization (TACE, LC‐TACE). Clinical data of 48 consecutive PLA patients from January 2016 to December 2020 were retrospectively analyzed. Mortality between two PLA patient groups were compared, and mortality risk factors were evaluated. A total of 48 PLA patients (31 males and 17 females) from January 2016 to December 2020 met the study's inclusion criteria. There were 32 and 16 patients in the Non‐LC and LC‐TACE groups, respectively. Positive pus culture rate in the Non‐LC group was 87.5% and positive pus culture rate in LC‐TACE group was 81.3%. In the Non‐LC group, 28 patients improved after treatment, 1 patient did not improve, and 3 patients died during hospitalization, with a 9.4% mortality rate. In the LC‐TACE group, nine patients improved after treatment, three patients did not improve, and four patients died during hospitalization, with a 25% mortality rate. The Non‐LC group cure time was 37.4 ± 23.1 days, while the LC‐TACE group was 91.5 ± 49.7 days. PLA of the Non‐LC group and the LC‐TACE group were different in terms of pathogenic bacteria and cure time, and so on. A more comprehensive treatment should be considered for PLA after TACE. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the influence that a ruminally-protected B-vitamin (RPBV) blend (containing vitamin B5, B6, B7, B9, and B12) had on growth performance, efficiency of dietary net energy utilization, carcass trait responses, and liver abscess severity and prevalence in beef steers fed a finishing diet. Steers (n  = 246; initial shrunk body weight [BW] = 411 ± 25.8 kg) from two different sources, were used in a 126-d RCBD experiment. Within 48 h after arrival, steers were individually weighed and allotted to 1 of 24 pens (n  = 8 to 12 steers; 8 pens per treatment) and randomly assigned to 1 of 3 treatments: (1) No RPBV; (2) RPBV1 at 1 g/steer d−1; 3) RPBV2 at 2 g/steer d−1. During the first 14 d, cattle received two transition diets with increasing concentrate. From days 15 to 126, cattle were fed the final diet containing 53% dry-rolled corn; 23% corn silage; 20% MDGS; and 4% suspended supplement. On the first 28 d, steers of RPBV1 had a greater average daily gain (ADG) and better feed conversion (G:F), both by 9% (quadratic effect, P  ≤ 0.02). However, cumulatively, no differences (P  ≥ 0.13) among treatments were found for dry-matter intake (DMI), live final BW, ADG, or G:F. Carcass-adjusted final BW, ADG, and G:F were not influenced by treatment (P  ≥ 0.59). Additionally, carcass weight, dressing percentage, marbling score, kidney–pelvic–heart fat, or BW at 28% empty body fat did not differ among treatments (P  ≥ 0.11). Ribeye area (REA) was altered (quadratic effect, P  = 0.02) by treatment; steers from RPBV1 had decreased REA compared to others. Additionally, calculated yield grade (YG) and calculated retail yield (RY) were altered (quadratic effect, P  ≤ 0.01) by treatment; steers from RPBV1 had increased YG and decreased RY compared to others. Estimated empty body fatness tended (P  = 0.06) to be greater from steers-fed RPBV compared to control. Overall USDA YG distribution was altered by dietary treatment (P  = 0.01). The proportions of YG1 and YG5 carcasses were unaffected by treatment, but there was a shift in the proportion of carcasses that graded YG2, YG3, and YG4 among treatments. Distribution of USDA Quality Grade was not altered by treatment (P  = 0.53). No treatment differences in liver abscess incidence or severity were observed (P  = 0.13). The use of RPBV altered carcass muscularity and rib fat accumulation affecting the overall YG distribution. However, RPBV did not appreciably influence any cumulative growth performance measures or liver abscess outcome. [ABSTRACT FROM AUTHOR]

The study's aim was to evaluate the effect of dietary Zn supplementation on steer performance, biomarkers of inflammation and metabolism, and liver abscess formation in response to a mild acidosis challenge. Forty-two steers (417 ± 3.99 kg; n = 6/pen) were housed in pens with bunks designed to measure individual dry matter intake (DMI) and fed one of two diets containing either 0 (CON; n = 18) or 90 mg Zn/kg from a Zn-amino acid complex (Zn-AA ; n = 18; AvailaZn; Zinpro) for 109 d. Six additional steers were fed the CON diet and did not undergo the acidosis challenge (NON ; n = 6). The acidosis challenge included restricting steers to 50% of the previous 7 d daily DMI on days 46 and 47, steers were individually provided 10% of DMI as cracked corn (as-fed) at 0800 h followed by ad libitum feed access 2 h post-grain consumption. Steer was the experimental unit, and two contrasts were constructed: NON vs. CON and CON vs. Zn-AA. Blood samples were collected on days 40, 48, 53, 69, 80, and 108 and analyzed as repeated measures. Final body weight and overall average daily gain (2.29, 2.30, and 2.31 ± 0.920 kg/d for CON, Zn-AA, and NON, respectively) were not different (P ≥ 0.74) between treatments. By design, DMI was greater (P < 0.01) for NON compared to CON on day 46 but was not different (P ≥ 0.41) for the rest of the experiment. While hot carcass weight (423, 428, and 424 ± 7.9 kg for CON, Zn-AA, and NON, respectively) and ribeye area were not different (P ≥ 0.53) due to treatment, marbling score tended (P = 0.06) to be greater in CON compared to Zn-AA. The 12th rib backfat thickness was greater (P = 0.05) in NON vs. CON steers. Liver abscess incidence tended to be greater (P = 0.12) in CON (24% abscesses) vs. Zn-AA (6% abscesses). NON had a greater incidence (P = 0.05; 50% abscesses) compared to CON. Overall, blood fibrinogen and leukocyte counts were not different between treatments (P ≥ 0.67); however, neutrophil-to-lymphocyte ratio tended to be greater in NON vs. CON (P = 0.08). Serum aspartate aminotransferase and gamma-glutamyl transferase concentrations were greater in NON vs. CON (P ≤ 0.02), and serum alkaline phosphatase concentration was lesser in CON vs. Zn-AA (P < 0.01). Overall, dietary Zn supplementation tended to lessen incidence of liver abscesses with limited impacts on overall cattle performance. Shifts in liver enzymes may represent opportunities to identify cattle with liver abscesses earlier in the feeding period. [ABSTRACT FROM AUTHOR]

The objective of this research was to determine the influence of long-term supplementation (258 d) of a direct-fed microbial (DFM) and yeast cell wall (YCW) product used alone or in combination on growth performance, dietary net energy utilization, and carcass characteristics in beef steers finished under climatic conditions in the Northern Plains (NP). Single-sourced Charolais × Red Angus steers [ n = 256; body weight = 246 ± 1.68 kg] were blocked by pen location in a 2 × 2 factorial arrangement of DFM and YCW. Steers were administered a series of diets common to the NP and administered ractopamine hydrochloride (RH; 300 mg/kg) during the last 28 d of the finishing phase. Steers were vaccinated and poured at processing and individually weighed on days 1, 14, 42, 77, 105, 133, 161, 182, 230, and 258. Temperature–humidity index (THI) was calculated during RH supplementation. For 98% of the experiment, the THI was lower than 72 and thus cattle were not under high-ambient temperature. On days 1, 2, 21, and 22 of RH supplementation, respiration rates (RR), and panting scores (PS) were determined before and after AM and PM feedings (0700 h, 1100 h, 1400 h, and 1700 h). A DFM + YCW interaction was noted for the proportion of steers categorized as PS 2.0 at 1100 h on day 21 (P = 0.03) and RR on day 21 at 1400 h (P = 0.02). Control steers had a greater proportion of PS 2.0 compared to DFM or YCW steers (P ≤ 0.05), while DFM + YCW steers did not differ from others (P ≥ 0.05); DFM + YCW steers had greater (P < 0.05) RR compared to DFM steers, while control and YCW steers did not differ from others (P ≥ 0.05). No DFM + YCW interactions or main effects (P ≥ 0.05) were observed for cumulative growth performance measures. However, YCW steers had 2% lower (P = 0.04) dry matter intakes compared to steers not fed YCW. No DFM + YCW interactions or main effects (P ≥ 0.05) were observed for carcass traits or liver abscess severity. However, a DFM + YCW interaction (P < 0.05) was noted for the distribution of USDA yield grade (YG) 1 and Prime carcasses. Control steers had a greater proportion (P < 0.05) of YG 1 carcasses compared to other treatments. DFM+YCW steers had a greater proportion (P < 0.05) of USDA Prime carcasses compared to DFM or YCW but were similar to control steers, which were also similar to DFM or YCW. Overall, the use of DFM and YCW alone or in combination had minimal effects on growth performance, carcass traits, and heat stress measures in steers finished in NP climatic conditions. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the influence of supplemental flavomycin on cattle growth performance, carcass characteristics, diet digestibility, and ruminal fermentation characteristics of calf-fed Holstein steers. One hundred Holstein steers (123 ± 7 kg) were balanced by weight and assigned to 20 pens. Dietary treatments consisted of a steam flaked corn-based diet supplemented with (dry matter basis): 1) control, no feed additive; 2) 6.6 mg/kg flavomycin; 3) 13.2 mg/kg flavomycin, and 4) 30 mg/kg monensin (MON). There were no treatment effects (P ≥ 0.17) on live weight, average daily gain (ADG), and gain efficiency. Flavomycin did not affect dry matter intake (DMI; P ≥ 0.24). Flavomycin supplementation did not affect (P ≥ 0.37) the ratio of observed vs. expected DMI. However, MON decreased (P = 0.02) observed vs. expected DMI by 3.7%. There were no treatment effects (P ≥ 0.44) on ruminal pH or temperature. Flavomycin did not affect (P ≥ 0.13) carcass characteristics and liver abscess among steers. Four Holstein steers (463 ± 20 kg) with ruminal cannulas were used in 4 × 4 Latin square experiment to study treatment effects on site and extent of digestion, ruminal pH, and volatile fatty acid (VFA) molar proportions. Dietary treatments were the same as experiment 1. Flavomycin tended to increase (linear effect, P = 0.07) ruminal organic matter (OM) digestion, associated with increased (linear effect, P < 0.01) ruminal starch digestion. Supplementing flavomycin at 13.2 mg/kg decreased net microbial N synthesis (quadratic effect, P = 0.03). Compared with control, MON tended to increase (P = 0.10) ruminal neutral detergent fiber (NDF) digestion and increased (P < 0.01) ruminal starch digestion. Monensin did not affect (P = 0.39) net microbial N synthesis, but decreased (P = 0.01) ruminal degradation of feed nitrogen (N). There were no treatment effects (P > 0.10) on total tract apparent digestion of DM, OM, NDF, and starch. Flavomycin decreased ruminal pH (quadratic effect, P < 0.01) measured 4 h postprandial. Compared with control, MON increased ruminal pH (P = 0.03). Flavomycin increased (linear effect, P = 0.03) ruminal propionate molar proportion and decreased (linear effect, P ≤ 0.04) ruminal molar proportions of acetate and butyrate, and decreased (linear effect, P = 0.02) acetate:propionate molar ratio and estimated methane production. We conclude that supplementing flavomycin at 6.6 or 13.2 mg/kg had no major effects on cattle growth performance, carcass characteristics, diet digestibility, and ruminal fermentation characteristics. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 31-year-old female patient that presented postpartum abdominal pain with fever and was diagnosed with hepatic adenoma. Topics discussed include brief details about the medical history and pregnancy of the patient prior to hospital admission, the results of the physical and laboratory examinations performed such as blood tests and urinalysis, and the patient outcomes recorded following treatment.

Background: Neurological symptoms and radiographic abnormalities may remain in a small proportion of patients with metronidazole-induced encephalopathy (MIE). Although experimental animal models of MIE have suggested a Wernicke's encephalopathy-like pathology, little is known about the histopathological features of MIE. Here we report the first autopsy case of irreversible MIE. Case presentation: A 72-year-old Japanese woman with pancreatic neuroendocrine tumour and metastatic tumours in the liver developed intraabdominal bleeding from a hepatic abscess. She was administered metronidazole for 79 days (1.5 g/day), which caused dysarthria followed by hand tremor and altered mental status. Brain magnetic resonance imaging at the time of onset revealed hyperintensities in the deep white matter of the bilateral parietal lobes and splenium of the corpus callosum on diffusion-weighted imaging (DWI) with reduced apparent diffusion coefficient (ADC) values. Despite the improvement of dysarthria and hand tremor, her cognition remained affected even after the withdrawal of metronidazole. She died of pancreatic neuroendocrine tumour at the age of 74 years. Histopathological examinations of the brain confirmed a combination of severe demyelination and moderate axonal degeneration, which corresponded to the regions showing abnormal signal intensities on DWI with reduced ADC values. There were no pathological findings suggestive of Wernicke's encephalopathy in the brain. Conclusion: We have demonstrated the clinical, radiographic and histopathological aspects of irreversible MIE. Hyperintensities on DWI with reduced ADC values in affected regions may indicate a poor clinical prognosis due to irreversible pathological damage. [ABSTRACT FROM AUTHOR]

BACKGROUND: As India is a one of the tropical country and home to 400 million people harbouring E. histolytica, the causative organism of amoebic liver abscess, it is important to thoroughly understanding of the liver abscess. Due to the rising incidence in alcoholism, diabetics & immune-compromised status, liver abscess becomes a matter of grave concern as complications rate are high especially in this sub-group, leading to increased morbidity and mortality. Due to the advancement in imaging modalities, a more concrete picture to treat liver abscesses is slowly evolving. However, much work remains to be done. The story has not ended: it has just begun. As in this country where rural population constitutes approximately 70% and therefore it is mandatory to develop appropriate & realistic guidelines for early diagnosis and management strategies for liver abscesses in order to reduce the morbidity and mortality associated with it. AIM AND OBJECTIVE: 1. To study clinical presentation of liver abscess (Distribution with respect to age and sex, mode of presentations in this area). 2. To study risk factors associated with liver abscesses. 3. To study effectiveness of different modes of management. PATIENTS AND METHODS: All patients attending MKCG Medical College & Hospital, Berhampur in General Surgery OPD, Casualty and Inpatient department, irrespective of their gender/background/socio economic status of age above 14 years were included in the study. 50 number of patients who attended during the study period from July 2017 to June 2019 were included in this study. Detailed history of patient entered in preformed proforma. Ultrasound of Abdomen and Pelvis was done routinely on the same day of presentation. CT scan was done in patients with multiple liver abscesses, caudate lobe abscess, left lobe liver abscess and ruptured liver abscesses. After investigations, they underwent different modalities of treatment as per the protocol. The results were recorded and analysed. RESULTS: Parenteral antibiotics alone without any drainage procedure has shown poor results in this series of studies. Only 17 patients were subjected to this mode of treatment and 6 of them needed aspiration, because of poor response to antibiotic alone. (Failure rate of 36%). Percutaneous aspiration mode of treatment has better results than I.V. Antibiotics alone treatment, with success rate of 54% after single aspiration with antibiotics in large cavity abscesses and failure cases of parenteral antibiotics alone mode of therapy, with success rate of 72% after two aspirations with antibiotics, with success rate of 96% after three aspirations with antibiotics. Tube drainage with antibiotics mode of management was tried in failure of percutaneous aspiration with antibiotics cases and success rate of 100%. Laparotomy and drainage with antibiotics mode of management was done only in cases, brought to the hospital with ruptured liver abscess with signs of peritonitis. The outcome of this mode was 33% of success rate. CONCLUSION: Chronic Alcohol intake is a definitive risk factor for development of liver abscess. Diabetes Mellitus is the prevalent comorbid factor, seen especially in the elderly. Other comorbid factors include hypertension, bronchial asthma etc. None of these seemed to have a significant correlation with the disease process. Pig tail drainage is preferred in patients with single abscess of size less than 5 cm situated in superficial segments. Laparotomy and drainage was done in patients with ruptured or impeding rupture abscess. Conservative management with antibiotics was also useful in very small single cavity abscess. The incidence of complications was predominantly seen in patients with ruptured liver abscess who underwent laparotomy, in form of sepsis followed by MODS and death. Residual abscess cavity was seen in small number of patients following pig tail drainage but it was not Significant. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus is a common bacterial etiology for infections in the neonatal intensive care unit (NICU). Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) can be difficult to treat, even when good source control is obtained. There are few data on treatment of MRSA abscess in the neonatal population. Vancomycin, clindamycin, daptomycin, ceftaroline, and linezolid are often used to treat MRSA infections in pediatric patients. Daptomycin and ceftaroline have been studied in adults as a salvage therapy for refractory MRSA infections. Few data exist on combination therapy for treatment of MRSA infection in neonatal or premature infant patients. This case report describes the successful use of intravenous (IV) daptomycin (6 mg/kg IV every 12 hours) plus ceftaroline (8 mg/kg IV every 8 hours) for 18 days after failure of daptomycin monotherapy to treat multiple hepatic abscesses and an infected thrombus caused by MRSA in a premature female born at 30 weeks of gestation. The patient had increased abscess size after daptomycin monotherapy and treatment was changed to combination therapy. With addition of the ceftaroline, the abscesses resolved entirely on ultrasonography within 3 weeks. While combination therapy was effective in this patient, additional research is needed to determine the most appropriate use for combination therapy for treatment of MRSA infections in the premature infant and neonatal population. [ABSTRACT FROM AUTHOR]

Cytomegalovirus (CMV) causes severe infection in immunocompromised patients, especially those with acquired immunodeficiency syndrome (AIDS), those who have undergone organ transplantation, and/or those who are being treated with steroids. In patients with AIDS, CMV is the most common pathogen that causes opportunistic infections. Here, we present a case of liver abscess due to CMV in a 58-year-old man diagnosed with AIDS. At the time of the study, his CD4 T lymphocyte count was 39 cells/mm3, and his human immunodeficiency virus (HIV) ribonucleic acid (RNA) level was 411,000 copies/mL. Upon presentation, he complained of upper abdominal pain. Ultrasonography-guided percutaneous drainage of the liver abscess was performed, and polymerase chain reaction analysis of the drained pus was positive for CMV. He was treated with intravenous ganciclovir, after which he recovered fully. In conclusion, our patient represents, to our knowledge, the first described case of liver abscess caused by CMV in an AIDS patient, which was probably facilitated by severe immunodeficiency. [ABSTRACT FROM AUTHOR]

Deep neck space infection (DNSI) is the infection of the potential space in the Neck; in this study our aim is to identify various aetiological causes, common site, bacteriology, and complications arising from it. DNSI is traditionally managed by prompt surgical drainage of the abscess followed by culture specific antibiotics. It is a prospective cross sectional type of study done conducted on 150 patients suffering from DNSI, it was conducted from March 2019 to March 2020 (1 year duration) at Department of ENT and Head & Neck Surgery, A.B.V Govt Medical College, Vidisha, MP, India. In our study, the majority of patients were in the 31–40 year age group. 53.33% were male 44.66% were female. Pain in the swelling was the most common symptom identified in 46.66% patients. Odontogenic infection 42.66% was the most common etiological factor, Ludwig angina 24.66% was the common site of presentation. Streptococcus species was found on pus culture 31.33%. Surgical intervention incision & drainage was carried out in 38% patients and emergency tracheostomy was required in 12% cases. DNSI is a potential life threatening condition; patients should be treated with Incision and drainage along with intravenous antibiotics which is subsequently updated to culture & sensitivity report. Due to poor oral hygiene, chronic irritation by caries tooth, chewing beetle nut and tobacco, odontogenic cause has became major etiological factor for DNSI. Regular dental checkups, general awareness about oral hygiene are a must to prevent dental infections as odontogenic is leading cause of DNSI in our study. [ABSTRACT FROM AUTHOR]

Alagille Syndrome (ALGS) is a rare, autosomal dominant inherited disorder that causes abnormalities of liver, eye, heart, skeleton and distinctive facial appearance. ALGS is caused by mutation in one of two genes: JAG1 and NOTCH2. There are some reports of Hearing Loss in patients with ALGS raising the possibility of involvement of both structural components of middle ear and sensorineural components of the inner ear. The present case study was to emphasize audiological perspectives of Alagille Syndrome in a nine year old female child. Audiologists must be well aware of the typical features and clinical perspectives of ALGS and should be an expert in selecting appropriate tests and in interpreting findings. [ABSTRACT FROM AUTHOR]

Despite the Entamoeba histolytica was first discovered more than 160 years ago, it remains a major health problem in developing countries, including Egypt. Discriminating the morphologically similar pathogenic species from the non-pathogenic one is a challenging task, specifically when relying on the traditional diagnostic tools as microscopy. The objective of the current study was to assess the usefulness of detecting E. histolytica coproantigen and specific salivary IgA for proper identification of intestinal infection with E. histolytica, using ELISA, in relation to the gold standard realtime PCR technique. 38 stool samples were proved positive for E. histolyticalike stages by microscopy and subsequently exposed to molecular analysis, using specific primers and probes related to E. histolytica which excluded 8 out of these 38 samples, indicating their relation to non-pathogenic species. All diagnostic tests achieved 100% specificity and relatively good sensitivity of 93.3 and 86.6% for specific coproantigen and salivary IgA respectively. Conclusively, ELISA-specific coproantigen or secretory salivary IgA are rapid reliable cost-effective and relatively sensitive diagnostic tools that can discriminate between pathogenic E. histolytica from those of non-pathogenic E. dispar, thus helpful in epidemiological surveys. The short duration of the secretory IgA may pose additional advantages as it can diagnose active infection, besides its ability to diagnose amoebic liver abscess. [ABSTRACT FROM AUTHOR]

Characterize the impact of frailty on endogenous endophthalmitis (EE) development and clinical outcomes among septicemic patients. Population-level, retrospective cohort study. Adult inpatients within the National Inpatient Sample (years 2002–2014) diagnosed with bacterial septicemia. Septicemic patients were classified as frail or nonfrail using the previously validated Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator, and diagnosis of EE was abstracted from International Classification of Diseases 9 codes. We used multivariable logistic regression to generate odds ratios (ORs) for rates of EE development and in-hospital mortality based on frailty status. We also examined the association between frailty and blood culture–proven organism class, inpatient length of stay, and total charges billed to insurance. Incidence of EE among septicemic patients; rates of EE development among frail and nonfrail patients; blood culture–proven microbe type, length of stay, and total charges billed to insurance. 9294 of 18 470 658 (0.05%) inpatients with bacteremia developed EE, 2102 (22.6%) of whom had at least 1 frailty-defining feature (predominantly malnutrition [68%]). Odds of developing EE were 16.7% higher for frail patients (OR, 1.167; 95% confidence interval, 1.108–1.229) when controlling for age, sex, race, concomitant human immunodeficiency virus/AIDS, pyogenic liver abscess, infectious endocarditis, cirrhosis, and diabetes with chronic complications. Frail EE patients had a 27.9% increased odds of in-hospital death, independent of age, sex, race, and Elixhauser comorbidity score (OR, 1.279; 95% confidence interval, 1.056–1.549). Higher rates of methicillin-resistant Staphylococcus aureus bacteremia (14.3% vs. 10.9%, P = 0.000016), gram-negative bacteremia (7.6% vs. 4.9%, P = 0.000003), and concomitant candidemia (10.4% vs. 7.0%, P = 0.0000004) were associated with frailty. Hospital stays were significantly longer (median, 14 days; interquartile range, 19 days; P < 0.00001) and total charges billed to insurance were significantly greater (median, $96 398; interquartile range, $154,682; P < 0.00001) among frail EE patients. Frailty syndrome is independently associated with development of EE in the setting of bacterial septicemia; frailty-associated EE may occur in patients with malnutrition and particular bacterial subtypes, and it predisposes to higher rates of in-hospital death and health care resource usage. [ABSTRACT FROM AUTHOR]

Central nervous system (CNS) infection with Klebsiella pneumoniae can be a complication of invasive liver abscess syndrome; however, CNS infections due to K. pneumoniae without liver abscesses are rare. We report three fatal cases of CNS infection due to K. pneumoniae that lacked liver abscesses during the initial investigation. [ABSTRACT FROM AUTHOR]

Hypervirulent Klebsiella pneumoniae (hvKP) is recognized as a lifethreatening community‐acquired infection associated with pyogenic liver abscess. However, rhabdomyolysis secondary to hvKP infection is rare. To the best of our knowledge, we report the first case of rhabdomyolysis due to hvKP infection in a patient who survived septic shock syndrome. Longer duration of PMX‐DHP improves hemodynamics and decreases vasopressors rapidly compared to the conventional duration. Additionally, it encourages clinicians to suspect other causes of rhabdomyolysis. [ABSTRACT FROM AUTHOR]

Percutaneous catheter drainage (PCD) has been viewed as first-line treatment for pyogenic liver abscess (PLA), yet detailed guidance is lacking for best practice of PCD. This study investigated characteristics of patients with PLA who had received PCD, identified factors associated with prolonged fever, and aimed to evaluate the relationship between timing of PCD and clinical improvement. This was a retrospective study of patients with PLA who had undergone PCD over a 7-year period. PCD performed when the liquefaction degree of abscesses was less than 30% and/or within 1 week after fever onset was defined as early PCD. Patients were grouped and analysed based on the timing of PCD (early vs. delayed). Factors associated with prolonged fever were also analysed using univariate and multivariate logistic regression. Among 231 patients with PLA, 81 treated with PCD were included in the study after exclusion. The size of abscesses ranged from 3.4 to 16 cm in diameter. Interestingly, the abscesses were predominantly multiloculated in this cohort (82.7%). The most common pathogen isolated from pus was Klebsiella pneumoniae (60.5%), followed by Escherichia coli (8.6%). The duration of fever was significantly shortened with early PCD as compared to delayed PCD intervention (p =.042). No statistical differences were found between the two groups with regard to catheter adjustment and salvage drainage. Maximum body temperature and diameter of abscess > 7.5 cm were found to be associated with prolonged fever while early PCD was inversely related to prolonged fever. Multivariate analysis suggested that early PCD treatment was an independent protective factor of prolonged fever (p =.030). Large abscesses with loculation could be successfully treated with PCD, and early PCD protected patients with PLA from prolonged fever. Our findings suggest that early intervention should be provided if PCD is indicated in clinical practice. Large abscesses and multiloculated abscesses can be treated with percutaneous catheter drainage. Early percutaneous catheter drainage is identified as a protective factor of prolonged fever among patients with pyogenic liver abscesses. Early intervention should be provided if percutaneous catheter drainage is indicated for pyogenic liver abscesses. [ABSTRACT FROM AUTHOR]

Background: Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) causes fewer infections, and it causes invasive Klebsiella pneumoniae liver abscess syndrome (IKLAS) that can lead to a poor prognosis for patients. Methods: Next-generation sequencing (NGS), sputum culture, drug sensitivity test, and other examination methods can detect the specific situation of pathogens in advance. Results: The patient was determined to have CR-hvKP infection after NGS, sputum culture, and drug sensitivity test, and improved after treatment. Conclusions: When antibiotics are applied in the presence of infection but symptoms do not improve, relevant laboratory or other tests should be performed promptly, and the selection of appropriate antibiotics may improve the survival rate of patients. [ABSTRACT FROM AUTHOR]

Entamoeba nuttalli is genetically the closest to Entamoeba histolytica , the causative agent of human amebiasis, and its natural host is Macaca species. A unique E. nuttalli specific surface protein (PTORS) containing 42 repeats of octapeptide was identified by comparative genomic analysis of Entamoeba species. We aimed to elucidate the function of this protein. When trophozoites from various E. nuttalli strains were examined by immunofluorescence microscopy and flow cytometry using a PTORS-specific monoclonal antibody, only a limited proportion of trophozoites were stained, indicating that the protein was not commonly expressed in all E. nuttalli trophozoite. The proportion of trophozoites expressing PTORS increased after passage in hamster livers, suggesting that the protein functions in the virulence of trophozoites in the liver tissue. Single-cell analysis revealed that in the cluster including trophozoites with PTORS gene expression, genes of virulence-related proteins were also upregulated. Trophozoites of E. histolytica transfected with PTORS showed enhanced adherence and subsequent phagocytic activity towards human Jurkat cells, independent of the lectin. E. histolytica trophozoites expressing PTORS formed larger liver abscesses in hamsters. These results demonstrate that PTORS is a novel virulence factor in Entamoeba species. • A limited number of Entamoeba nuttalli expresses octapeptide repeat protein (PTORS). • Number of E. nuttalli with PTORS expression increases after hamster liver passages. • PTORS expression correlates with those of other virulence factors in single cells. • PTORS induces increased adherence and phagocytic activity to Jurkat cells in vitro. • PTORS seems to be a novel virulence factor in Entamoeba spp. [ABSTRACT FROM AUTHOR]