Amebic Abscess Research Articles

Open surgical drainage for hepatic amebic abscess.

Of all the complications of amebiasis, amebic liver abscess is the commonest and most serious as regards mortality and morbidity. For many years the consensus has been that amebic abscess of the liver should be treated medically because of the unusually high mortality associated with this condition. Kean,1in 1953, reported on six patients at Halloran General Hospital with amebic liver abscess treated with emetine and chloroquine diphosphate without recourse to surgery. Spellberg,2as recently as 1954, said Surgical drainage is inadvisable because of its higher mortality and morbidity owing to secondary infection. He advised that only those cases with demonstrable secondary infection, with multiple abscesses, and with solitary left-lobed abscesses be considered as suitable candidates for open surgical drainage. After a thorough review and study of the problem, Jordon3suggested that these original ideas regarding open surgical drainage be revised. His paper reviews the most recent

Diagnosis and therapy of amebic hepatitis and amebic abscess; experiences in Sumatra

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Amebic abscess of the liver presenting in the subscapular area.

THE PURPOSE of this report is to present an unusual case of hepatic abscess due to infestation by Endamoeba histolytica. It is unusual in that the abscess spontaneously ruptured and dissected its way extrapleurally up into the region of the inferior angle of the right scapula, where it presented itself as a soft-tissue mass in the subcutaneous level. When a search of the literature failed to reveal any similar cases, even through the past decades when amebic abscess was a far commoner disease, it was elected to present the essential details of this case history to the medical profession. REPORT OF CASE A 24-year-old white man was admitted to the hospital because of a mass in the right subscapular region, which had appeared over a three-week period. Three months prior to admission he had fallen against a truck handle, striking his lower right rib cage. Minimal symptoms of slight pain

Amebic hepatitis; absence of diffuse lesions at autopsy and in biopsies.

The clinical syndrome of amebic hepatitis consists of hepatomegaly, hepatic tenderness, slight to moderate fever, moderate leucocytosis, and laboratory evidence of hepatic dysfunction in a patient with a history of intestinal amebiasis.* An important feature is response to specific antiamebic therapy. The lesion in the liver is assumed to be a diffuse hepatitis caused by Endamoeba histolytica in contrast to the classic localized amebic abscess. The purpose of this paper is to report the absence of specific diffuse hepatic lesions in (I) a large series of autopsies from an area where the incidence of intestinal amebiasis is moderately high; (II) 148 persons who died of amebiasis; (III) 50 patients with the clinical pattern of diffuse amebic hepatitis who were subjected to liver biopsy. DEFINITIONS The following definitions will be employed to distinguish terms which have been used synonymously and which may represent different entities. Amebic Abscess of Liver: A localized

Amebic abscess of the liver in an infant

Summary A case of acute amebic abscess of the liver with associated pneumonitis and intestinal amebiasis is presented in a white male infant, aged 17 months.

The use of hepatic function tests in the diagnosis of amebic abscess of the liver.

The use of hepatic function tests in the diagnosis of amebic abscess of the liver.

Non-traumatic pneumopericardium and pyo-pneumopericardium; report of two cases.

Though non-traumatic pneumopericardium is an unusual finding on roentgen examination of the chest, the diagnostic features are specific. In a review of the Hines Hospital records, only 2 cases were found. In one of these a gastric ulcer perforated into the subdiaphragmatic space and formed a fistulous tract, with extension into the pericardium. A peptic ulcer of the myocardium and pyo-pneumopericardium developed. In the second case an esophageal carcinoma, with necrosis, extended to the pericardium, producing pneumopericardium. Etiology Various mechanisms have been described for the production of pneumopericardium. Regardless of the underlying cause, infection commonly occurs, so that eventually pyo-pneumopericardium is present. Ludwig Pick (1), in 1894, published a monograph on perforation of the diaphragm by gastric ulcer as observed in 28 cases. In 10 of these, the pericardium was involved, and in 4 the myocardium was perforated. In some cases ulcerations of the posterior gastric wall had perforated into the left pleura. Most of the pericardial perforations were due to ulcers on the lesser curvature. In 1904, James (2) reviewed 38 cases of pneumopericardium and added 1 of his own. In 16 of the cases, trauma was responsible for the entrance of air into the pericardium. Other less common causes of pneumopericardium were perforations secondary to esophageal ulcer (3 cases), pulmonary tuberculosis (3 cases), esophageal carcinoma (2 cases), and gastric ulcer (2 cases). In single instances, pericardial perforation was attributable, respectively, to liver abscess, pneumothorax, lung abscess, communication with a bronchus in suppurative pericarditis, and direct pericardial paracentesis. Single cases were also included of pneumopericardium (or pyo-pneumopericardium) due to pericarditis without demonstrable connection with any outside air-containing structure, presumably caused by a gas-forming organism, and of ulceration of a necrotic hilar lymph node, possibly by the same mechanism, although this is not accurately described. James' case was one of esophageal perforation by a swallowed piece of bone. Tylecote (3) reported a case of gastric ulcer perforating into the heart. The patient was found dead, and autopsy showed an ulcer on the posterior part of the left ventricle communicating with the stomach. Monroe (4) cited 2 cases (reported by others) of rupture of the heart by gastric ulcer; Johannessen (5) and Rappert (6) each described a single similar case. Perforation of an amebic abscess of the left lobe of the liver into the pericardium was reported by Hartz (7). Outerbridge (8) published a case of pyogenic abscess of the left lobe of the liver perforating into the pericardium. In Gottesman's (9) case, pneumopericardium was secondary to radiation necrosis. A carcinoma of the fundus of the stomach was treated by the implantation of radium needles and pneumopericardium occurred two months later.

Aspiration and air replacement in diagnosis and management of amebic liver abscess.

CONSIDERABLE and treatment of amebiasis and its most important complications, hepatitis and liver abscess. For the delineation of an amebic abscess roentgenologic aids, such as hepatography with thorium dioxide, injection of iodized oil into the abscess cavity, and pneumoperitoneum, have for the most part fallen into disrepute. The injection of air into an amebic abscess cavity following aspiration, however, has a number of proponents, since it is an innocuous procedure and serves as an aid in diagnosis and in evaluating the efficacy of therapy. We feel that this procedure, which has not received sufficient recognition, is worthy of further clinical consideration. Its value is demonstrated in the following illustrative case. REPORT OF A CASE S. L., a 26-year-old airman, was admitted to the United States Air Force Hospital, Norton Air Force Base, Calif., on Oct. 15, 1951, with the complaints of fatigue, lassitude, nocturnal sweating, and recurrent chilliness of two

AMEBIC ABSCESS OF THE FOOT

To the Editor: —Amebic infections of the skin have been described by some authors following the surgical treatment of amebic abscess of the liver (Heimburger, L. F.:Arch. Dermat. & Syph.11:49, 1925, and Van Hoof, L.:Ann. Soc. belge de med. trop.6:45, 1926), the drainage after appendectomy (Cole, W. H., and Heideman, M. L.:J. A. M. A.92:537 [Feb. 16] 1929), or as anal amebiasis (Kouri, P.; Iriondo, M., and Peraza, J. A.:Rev. Kuba5:93, 1949). I have seen two patients with amebic infection of the foot, without any relation to intestinal amebiasis. The special conditions of the country must be mentioned: a very high percentage of the population are amebic cystpassers and deposit the stools in the yards between the houses. The result is that in the dry season the dust contains the amebic cyst. One patient, a 32-year-old Italian welder,

Rationale of therapeutic use of streptokinase-streptodornase in amebic abscess of liver.

IT HAS been previously pointed out 1 that the therapeutic effectiveness associated with the local instillation or application of the streptococcal enzymatic solutions of streptokinase-streptodornase 2 is closely proportional to the fulfilment of the following principles: The exudative substances present in areas of disease must be composed of materials that are wholly or in part subject to the liquefying action of streptokinase and/or streptodornase. Direct and sustained contact must be made between the enzymatic solution and the total area of disease, followed by thorough evacuation of the thinned exudate and repetitions of the process if indicated. It is the purpose of this presentation to describe the results obtained on a patient with an amebic abscess of the liver who was treated locally by repeated instillations of streptokinase-streptodornase, associated with appropriate drainage, and to demonstrate particularly the applicability of the principles indicated above. REPORT OF A CASE Patient B.

A survey of intestinal parasitic infections in the Dominican Republic.

Summary 1. A group of 1139 individuals on two sugar properties on the south coast of the Dominican Republic have been surveyed to determine the prevalence of intestinal parasitic infections. 2. The percentage prevalence of the most common pathogenic parasites are: Hookworm 59.2%; Trichuris trichiura 58.9%; Endamoeba histolytica 34.2%; and Ascaris lumbricoides 20.1%. 3. Clinical amebiasis is not common among the indigenous population and no instance of hepatitis or amebic abscess of the liver has been encountered. 4. Clinical hookworm disease is not common in this portion of the Dominican Republic despite widespread infection of the population investigated. 5. Differences in prevalence of the most common parasites observed between the two Bateys and the cane field villages are probably to be attributed to local population densities, local rainfall and soil conditions, and varying availability and use of latrines.

Treatment of unusual pulmonary amebic abscess with chloroquine.

To investigate the factor structure, reliability, and validity of the German version of the Perceived Stigmatization Questionnaire/Social Comfort Questionnaire (PSQ/SCQ) in burn victims.The PSQ/SCQ was answered by 139 adult burn survivors (age M = 49.69, SD = 15.16 years). Factor structure was examined using a confirmatory factor analysis (CFA). Validity was investigated through correlations between the PSQ/SCQ scales and questionnaires assessing perceived social support, burn-specific health-related quality of life, symptoms of anxiety/depression, and percent of total body surface area (TBSA) burned. Additionally, the link between perceived stigmatization/social comfort and current partnership status was investigated.The four-factor model showed the best fit to the data with three PSQ factors (Absence of Friendly Behavior, Confused/Staring Behavior, and Hostile Behavior) and one single SCQ factor. All PSQ/SCQ scales showed good internal consistency. Higher PSQ/lower SCQ means were related to less perceived social support, less burn-specific quality of life, and more symptoms of anxiety/depression. With the exception of a positive correlation with the PSQ subscale Confused Behavior and Staring, no other significant correlations were found between the PSQ/SCQ subscales and TBSA burned. While PSQ/SCQ scores were not linked to age or gender, less perceived social stigmatization/more social comfort was reported by participants who were currently living with a partner.The results indicate a four-factor structure and a good validity of the PSQ/SCQ which is in line with prior research. Further studies should investigate the application of the PSQ/SCQ in individuals with appearance distinctions that are not related to burns.

Pain in acute and chronic diseases of the liver.

Excerpt The symptoms and signs of liver disease have suffered from under-emphasis in recent years as sharper focus has been brought to bear on the greatly expanded knowledge of the physiology and l...

Bronchobiliary fistula in Hodgkin's disease.

THE SUDDEN appearance of deeply bile-stained sputum in the course of a disease process is indeed a striking and dramatic event. The essential dynamics for such a complication seem to be the formation of a cavity either in the substance of the liver or in a walled-off subphrenic space, but in continuity with the biliary tree, and concomitantly a mechanism maintaining an increased pressure within the bile duct to allow for a continued flow of bile through the channel between the liver and the lung. These conditions are met most frequently in the parasitic diseases of the liver, and it is especially in amebic abscesses and Echinococcus cysts of the liver that bronchobiliary fistulas may be encountered. In the nonparasitic diseases of the liver the formation of a bronchobiliary fistula is quite uncommon. This rare and, as far as I have been able to ascertain, unreported complication of Hodgkin's involvement

Aureomycin in the treatment of intestinal amebiasis; report on 44 cases.

SummaryForty-four cases of intestinal amebiasis treated with aureomycin are reported. Nineteen of them had asymptomatic amebic colitis, while twenty-five presented typical symptoms of amebic colitis, of which seven cases had secondary hepatic congestion and one, amebic abscess of the liver.The dosage per day per kilogram of bodyweight was about 30 mg. The total amount administered was 15 grams in one case; 12 grams in 5 cases; 8 grams in 36 cases. In 2 children, the total was 3 grams.The percentage of cures was 86.

Observations on the cystic stage of E. histolytica in abscesses of the human bowel.

The exact place and formation of cysts of E. histolytica in human infections has not been decided. Most text books venture the opinion that the cystic stage is formed in the fecal stream and not in the bowel wall, where this ameba species causes abscess formations followed by ulcerations. Warthin (1) described the presence of cysts and pre-cysts of E. histolytica in amebic lesions of the testis and of lthe epididymis. No ather references to such observations were found by this worker in the medical literature. Using a technic consisting of careful cleansing of the fecal stream overlying amebic abscesses, by means of aspiration employing a woven catheter and ear, nose and throat suction machine, followed by additional cleansing by aspiration with 1 cc bacteriologic pipette, the wrTiter aspirated material containing cysts of E. histolytica from abscesses in the bowel wall of 25 patients with intestinal amebiasis.

Amebic abscess of the liver--therapeutic approaches.

WHEN one searches for a plan of therapy for amebic abscess of the liver in 1950, the adjunctive use of antibiotics is expected to be in that plan. Leonard Rogers 1 (1922) actually formulated the basis of modern therapy by proving that Endamoeba histolytica was the etiological agent and that emetine was specific for the disease. He reduced the mortality rate from 57 to 14 per cent by the introduction of emetine as the antiamebic and of the more conservative closed aspiration drainage instead of open drainage, which prior to this time had been associated with dangerous sequelae. The excellent 1943 monograph by Ochsner and DeBakey 2 remains the actual guide, although their plans were largely concerned with surgery and antiamebics and not with antibiotics. Sporadic reports concerning the adjunctive role of the use of antibiotics with promising results have recently appeared. 3 It may be superfluous to add that antibiotics should accompany any plan of therapy

Amebic Pericarditis

AMEBIC pericarditis is a rare complication of infection with Endamoeba histolytica. A review of the literature from 1885 to the present revealed 44 proved cases of suppurative amebic pericarditis. Pericarditis was reported to have developed in 14 additional patients with known amebiasis. In these, however, the diagnosis was established either by the finding of serous fluid in the pericardial sac at post-mortem examination or by the appearance, during life, of a pericardial friction rub that disappeared after treatment with emetine hydrochloride. In all cases the pericardial involvement was secondary to an amebic abscess adjacent to the pericardial sac in either . . .

Chronic amebic abscess of liver and aspiration liver biopsy.

Summary Occasionally single large chronic amebic abscesses of the liver do not present classic diagnostic symptoms. In two such cases a diagnostic liver aspirationbiopsy disclosed the abscesses, which were further treated by a single aspiration, instillation of emetine and penicillin in the abscess cavity and subsequent routine anti-amebic treatment with emetine, chiniofon and carbarsone with penicillin intramuscular injections as an adjunct. Both patients recovered completely. Puncture through the sinus pleurae and diaphragm in the posterior axillary line is recommended.

REFRACTORY AMEBIC ABSCESS OF THE LIVER TREATED WITH CHLOROQUINE

In 1948 Conan 1 reported 6 cases of hepatic amebiasis (without abscess of the liver) successfully treated with chloroquine. In the same year Murgatroyd and Kent 2 reported the cure of a case of refractory amebic abscess of the liver treated with chloroquine. The success of this treatment, after the failure of emetine, diiodo-hydroxyquinoline (diodoquine®) and penicillin given systemically and proflavine sulfate used locally, was striking. In 1949 Conan confirmed the efficacy of chloroquine against hepatic amebiasis (without abscess) with the report of several more cases in which it was used with success.3 The purpose of this article is to report a second case of refractory amebic abscess of the liver, which has been successfully treated by chloroquine, confirming the result reported by Murgatroyd and Kent. REPORT OF CASE H. S., a white man aged 53, was admitted on Feb. 1, 1949 after transfer from another institution, where he had