Liver abscess

肝脓肿
  • 文章类型: Case Reports
    肝细胞癌(HCC)是全球癌症相关死亡率的重要贡献者。虽然局部晚期HCC的急性和通常致命的表现主要存在于腹部内,至关重要的是要认识到,由于肝脏在体内独特的解剖位置,呼吸和循环系统也可能成为受害者。这里,我们介绍了一例63岁男性最近诊断为局部晚期HCC伴血管侵犯的病例.在接受靶向治疗和局灶性放疗后不久,患者出现反复继发感染和持续性膈缺损.坏死组织侵入胸膜腔,随后出现了肿瘤到支气管和肿瘤到心脏的瘘,导致呼吸系统和心血管系统之间的异常连接,导致循环中大量的空气栓塞。本报告强调了HCC患者治疗后继发感染的膈肌并发症的风险,特别是倾向于发展为膈肌缺陷的患者。
    Hepatocellular carcinoma (HCC) stands as a significant contributor to cancer-related mortality globally. While the acute and often fatal manifestations of locally advanced HCC primarily present within the abdomen, it is crucial to recognize that the respiratory and circulatory systems can also fall victim due to the liver\'s unique anatomical position within the body. Here, we present the case of a 63-year-old male recently diagnosed with locally advanced HCC with vascular invasion. Shortly after receiving target therapy and focal radiotherapy, the patient developed repeated secondary infections and a persistent diaphragmatic defect. As the necrotic tissue invaded the pleural space, subsequent tumor-to-bronchial and tumor-to-cardiac fistulas emerged, resulting in an abnormal connection between the respiratory and cardiovascular systems, leading to massive air emboli in circulation. This report highlights the risk of supradiaphragmatic complications in HCC patients with post-treatment secondary infections, particularly in patients predisposed to developing diaphragmatic defects.
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  • 文章类型: Case Reports
    弓形虫病,由犬弓形虫(来自狗)和弓形虫(来自猫)幼虫传播的人畜共患感染,对人类构成罕见但严重的风险。我们介绍了一例由犬弓形虫引起的肝内脏幼虫(VLM)病例,该病例有与宠物狗密切接触的病史。最初的症状和影像学表现模仿化脓性肝脓肿。最初的实验室调查显示嗜中性粒细胞增多和IgE水平升高。尽管有广谱抗生素,持续发烧促使进一步调查。随后对Toxocara抗体进行血清学测试,并对肝组织进行组织病理学分析,证明嗜酸性粒细胞浸润和Charcot-Leyden晶体可明确诊断为犬弓形虫引起的肝脓肿。弓形虫抗体的血清学测试和肝组织的组织病理学分析证实了弓形虫诱发的肝脓肿。阿苯达唑治疗产生了显著的临床改善。该病例强调了在肝脓肿差异中考虑弓形虫病的必要性,特别是在像越南这样的高血清阳性率地区。仅仅依靠血清学检测可能是不够的,强调需要确凿证据,包括肝活检等侵入性手术,用于准确的肝弓形虫病诊断。
    Toxocariasis, a zoonotic infection transmitted by Toxocara canis (from dogs) and Toxocara cati (from cats) larvae, poses rare but severe risks to humans. We present a case of hepatic visceral larva migrans (VLM) caused by Toxocara canis in a 21-year-old male with a history of close contact with a pet dog. Initial symptoms and imaging findings mimicked a pyogenic liver abscess. The initial laboratory investigations revealed neutrophilia and elevated levels of IgE. Despite broad-spectrum antibiotics, persistent fever prompted further investigation. Subsequent serological testing for Toxocara antibodies and histopathological analysis of liver tissue demonstrating eosinophil infiltrates and Charcot-Leyden crystals led to a confirmed diagnosis of a liver abscess caused by Toxocara canis. Serological testing for Toxocara antibodies and histopathological analysis of liver tissue confirmed a Toxocara canis-induced liver abscess. Albendazole treatment yielded significant clinical improvement. This case highlights the necessity of considering toxocariasis in liver abscess differentials, particularly in high-seroprevalence regions like Vietnam. Relying solely on serological tests may be insufficient, emphasizing the need for corroborative evidence, including invasive procedures like liver biopsy, for accurate hepatic toxocariasis diagnosis.
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  • 文章类型: Case Reports
    背景:经动脉化疗栓塞(TACE)是中期肝细胞癌(HCC)的标准治疗方法。TACE的并发症包括胆道感染,肝功能障碍,肿瘤溶解综合征,biloma,部分肠梗阻,脑内碘油栓塞,等。关于TACE致气管瘘的报道较少。
    方法:一名42岁的男子因肝癌TACE术后1个月咳嗽咳痰来到我院。实验室检查结果显示白蛋白异常,血红蛋白,凝血酶原时间,C反应蛋白,D-二聚体,和凝血酶原。痰和肝脓液的培养都显示了苦参柠檬酸杆菌的生长。计算机断层扫描显示右肺下叶感染,右肝低密度病变伴气体。肝脏超声显示有很大的低回声液体病变,无血流信号。超声引导下针穿刺引流术治疗肝脓肿。引流和抗感染治疗1个月后,肝脓肿和肺部感染明显减少,咳痰症状缓解。
    结论:临床医生应警惕肝癌TACE术后肝脓肿和气管瘘并发症的可能性。超声引导下针穿刺引流术可缓解肝脓肿和气管瘘。
    BACKGROUND: Transarterial chemoembolization (TACE) is a standard treatment for intermediate-stage hepatocellular carcinoma (HCC). The complications of TACE include biliary tract infection, liver dysfunction, tumor lysis syndrome, biloma, partial intestinal obstruction, cerebral lipiodol embolism, etc. There are few reports about tracheal fistula induced by TACE.
    METHODS: A 42-year-old man came to our hospital with cough and expectoration for 1 month after TACE for HCC. Laboratory test results showed abnormalities of albumin, hemoglobin, prothrombin time, C-reactive protein, D-dimer, and prothrombin. Culture of both phlegm and liver pus revealed growth of Citrobacter flavescens. Computed tomography showed infection in the inferior lobe of the right lung and a low-density lesion with gas in the right liver. Liver ultrasound showed that there was a big hypoechoic liquid lesion without blood flow signal. Drainage for liver abscess by needle puncture under ultrasonic guidance was performed. After 1 month of drainage and anti-infection therapy, the abscess in the liver and the infection in the lung were reduced obviously, and the symptom of expectoration was relieved.
    CONCLUSIONS: Clinicians should be alert to the possibility of complications of liver abscess and tracheal fistula after TACE for HCC. Drainage for liver abscess by needle puncture under ultrasonic guidance could relieve the liver abscess and tracheal fistula.
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  • 文章类型: Case Reports
    在临床实践中,异物相关并发症很少见,但可能是致命的事件。由于异物引起的胃肠道穿孔引起的肝脓肿更为罕见。我们报告了一例63岁的男子,他因发烧和上腹痛入院。进一步的调查显示,尽管抗生素治疗了数周,但肝脓肿仍未消退。在第二次录取中,增强的计算机断层扫描显示肝脏左叶有多个脓肿,收集中带有线性无线电密集异物。进行开放手术以取出异物。患者术后恢复满意,无并发症,术后第六天出院。
    Foreign body-related complications are rare but possibly fatal events in clinical practice. Liver abscess as a result of gastrointestinal perforation caused by foreign bodies is even more rare. We report a case of a 63-year-old man who was admitted with fever and left epigastric pain. Further investigation revealed a liver abscess without resolution despite antibiotic therapy for several weeks. In the second admission, an enhanced computerized tomography scan revealed multiple abscesses in the left lobe of the liver, with a linear radio-dense foreign body within the collection. Open surgery was performed to extract the foreign body. The patient made a satisfactory postoperative recovery without complications and was discharged on the sixth postoperative day.
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  • 文章类型: Case Reports
    化脓性肝脓肿(PLA)和甲型肝炎在发展中国家很常见。由于临床特征重叠,双重感染的诊断可能会错过。这里,我们介绍了一个5岁男性腹痛的病例,发烧,黄疸被诊断为并发甲型肝炎的复杂肝脓肿,这是第一个PLA与甲型肝炎共存的病例。当肝脓肿患者出现黄疸时,应考虑同时感染,尤其是在这两种疾病都流行的地区。两者的早期诊断至关重要,因为PLA是一种潜在的致命疾病,甲型肝炎合并感染可能会恶化临床结果。
    Pyogenic liver abscess (PLA) and hepatitis A are common in developing countries. As there is an overlap of clinical features, a diagnosis of dual infection can be missed. Here, we present the case of a five-year-old male who presented with abdominal pain, fever, and jaundice diagnosed as a complicated liver abscess with concurrent hepatitis A. To our knowledge, this is the first case where a PLA co-existed with hepatitis A. Simultaneous infection should be considered when a patient with liver abscess presents with jaundice, especially in areas where both diseases are endemic. Early diagnosis of both is crucial as PLA is a potentially fatal disease and co-infection with hepatitis A may worsen clinical outcomes.
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  • 文章类型: Journal Article
    目的我们的研究旨在描述内源性眼内炎的临床特征,关注患者的人口统计学,感染源,微生物概况,临床结果,以及影响最终视觉结果的因素。方法回顾性分析2011年1月至2020年12月在马来西亚半岛东海岸的两家三级医院住院的60例内源性眼内炎患者的68只眼资料。分析包括评估患者年龄,性别,偏侧性,危险因素,感染起源,呈现和最终的视力,微生物结果,治疗反应,以及影响最终视觉结果的因素。结果患者队列的平均年龄为54.9±13.3岁。女性比男性更容易患内源性眼内炎(33,55.0%vs.27、45.0%)。27例患者(45.0%)出现左眼内源性眼内炎,而25名患者(41.7%)的右眼有这种病,8例患者(13.3%)有双侧受累.大多数患者有潜在的易感条件,以糖尿病为主(53,88.3%)。42例患者(70.0%)确定感染源,其中尿路感染占大多数(11,18.3%)。克雷伯菌属(14,22.7%)是主要病原体,与肝脓肿病例显著相关。在这个系列中,大多数患者的表现较差,最终视力低于3/60(56,82.4%和53,77.9%,分别)。36眼(52.9%)行玻璃体切除术,导致只有四只眼睛(11.11%)达到优于6/12的最终视力。呈现视敏度被确定为促成盲最终视觉结果的因素(r=0.707,p<0.001)。结论女性比男性更常受到内源性眼内炎的影响。克雷伯菌属是最常见的分离微生物,通常与肝脓肿有关。尿路感染是最常见的诱发因素。大多数患者的视力和最终视力都很差,其中视力不佳是失明视力结果的重要指标。
    Purpose Our study aimed to describe the clinical profile of endogenous endophthalmitis, focusing on patient demographics, infection sources, microbial profiles, clinical outcomes, and factors affecting the final visual outcome. Methods A retrospective review was performed on data from 68 eyes of 60 patients diagnosed with endogenous endophthalmitis and hospitalized in two tertiary hospitals on the East Coast of Peninsular Malaysia from January 2011 to December 2020. The analysis encompassed evaluating patient age, gender, laterality, risk factors, infection origins, presenting and final visual acuity, microbial results, treatment responses, and factors affecting final visual outcomes. Results The average age of the patient cohort was 54.9 ± 13.3 years. Females were more likely to have endogenous endophthalmitis than males (33, 55.0% vs. 27, 45.0%). Twenty-seven patients (45.0%) presented with endogenous endophthalmitis in the left eye, while 25 patients (41.7%) had it in the right eye, and eight patients (13.3%) had bilateral involvement. Most patients had underlying predisposing conditions, predominantly diabetes mellitus (53, 88.3%). Infection sources were identified in 42 patients (70.0%), out of which urinary tract infections account for the majority (11, 18.3%). Klebsiella species(14, 22.7%) were the leading pathogens and were significantly associated with liver abscess cases. In this series, the majority of patients had poor presenting and final visual acuity of worse than 3/60 (56, 82.4% and 53, 77.9%, respectively). Thirty-six eyes (52.9%) underwent vitrectomy, resulting in only four eyes (11.11%) achieving final visual acuity better than 6/12. Presenting visual acuity was identified as the factor contributing to the blind final visual outcome (r = 0.707, p < 0.001). Conclusion Females were found to be more commonly affected by endogenous endophthalmitis than males. Klebsiella species were the most commonly isolated microorganisms and were typically associated with liver abscesses. Urinary tract infection was the most common predisposing factor. A majority of the patients had poor presenting and final visual acuity, in which poor visual acuity is a significant indicator of blind visual outcomes.
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  • 文章类型: Journal Article
    病原微生物是共生的肠道微生物群,能够在特定条件下引起全身感染,如环境变化或老化。然而,目前尚不清楚在生理条件下,肠道粘膜免疫系统如何识别病原体。这项研究表明,在用消耗巨噬细胞的氯膦酸盐脂质体处理的无特定病原体的小鼠中,肠道致病性肺炎克雷伯菌对上皮造成损伤,并易位到肝脏。在氯膦酸盐脂质体治疗的小鼠中,从肝脏中分离出具有非K1/K2荚膜血清型的本地经典肺炎克雷伯菌(cKp),表明由于肠巨噬细胞的消耗,肠共生cKp从胃肠道转移到肝脏。与未治疗的小鼠相比,将分离的cKp口服接种到氯膦酸盐脂质体治疗的小鼠中显着降低了存活率。我们的发现表明,肠粘膜巨噬细胞在感知共生cKp和抑制其向肝脏的易位中起着关键作用。这项研究表明,氯膦酸盐-脂质体处理的小鼠模型对于筛选和评估防止cKp易位到肝脏的药物是有效的,为预防肺炎克雷伯菌感染的预防方案的发展提供新的见解。
    Pathobionts are commensal intestinal microbiota capable of causing systemic infections under specific conditions, such as environmental changes or aging. However, it is unclear how pathobionts are recognized by the intestinal mucosal immune system under physiological conditions. This study demonstrates that the gut pathobiont Klebsiella pneumoniae causes injury to the epithelium and translocates to the liver in specific pathogen-free mice treated with clodronate-liposomes that depleted macrophages. In the clodronate-liposome-treated mice, indigenous classical K. pneumoniae (cKp) with non-K1/K2 capsular serotypes were isolated from the liver, indicating that gut commensal cKp translocated from the gastrointestinal tract to the liver due to the depletion of intestinal macrophages. Oral inoculation of isolated cKp to clodronate-liposome-treated mice significantly reduced the survival rates compared to that of non-treated mice. Our findings demonstrate that intestinal mucosal macrophages play a pivotal role in sensing commensal cKp and suppressing their translocation to the liver. This study demonstrates that clodronate-liposome-treated mouse models are effective for screening and evaluating drugs that prevent the translocation of cKp to the liver, providing new insights into the development of preventive protocols against K. pneumoniae infection.
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  • 文章类型: Case Reports
    产气荚膜梭菌因引起皮肤和软组织感染和食物中毒而臭名昭著。很少,产气荚膜梭菌感染与严重溶血有关,死亡率>80%。一名70多岁的健康男子以发烧为主要症状,被迅速送往地区核心医院。在接下来的三个小时里,休克和多器官衰竭随之而来,导致转诊到我们医院接受重症监护。我们怀疑产气荚膜梭菌感染引起的肝脓肿溶血,在数小时内出现严重溶血和肝脏大量产气的结果。尽管考虑了手术引流,在到达我们医院后3小时内,低血压导致死亡。第二天,血培养证实产气荚膜梭菌,证明诊断。改善患者预后需要提高对疾病的认识和早期发现。
    Clostridium perfringens is notorious for causing skin and soft tissue infections and food poisoning. Rarely, C. perfringens infections are associated with severe haemolysis, with a mortality rate of >80%. A previously healthy man in his 70s who presented with fever as his chief symptom was promptly admitted to a regional core hospital. Over the next 3 hours, shock and multiple organ failure ensued, leading to referral to our hospital for intensive care. We suspected a liver abscess caused by C. perfringens infection with haemolysis, findings of severe haemolysis and a liver mass with gas production that appeared within a few hours. Though surgical drainage was contemplated, low blood pressure resulted in death within 3 hours of arrival at our hospital. The next day, a blood culture confirmed C. perfringens, proving the diagnosis. Improving patient outcomes requires increased awareness of the disease and early detection.
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  • 文章类型: Journal Article
    肝脓肿是一种潜在的危及生命的医疗紧急情况。有或没有经皮抽吸或引流的经验性抗菌药物是治疗性的。预先使用经验性静脉内广谱抗生素代替口服氟喹诺酮或头孢菌素的合理性存在争议。在这项双盲随机对照临床试验中,69名参与者接受环丙沙星(每12小时500mg),71名参与者口服头孢克肟(每12小时200mg),为期2周。两组均口服甲硝唑(每8小时800mg)2周,并根据适应症进行经皮引流或脓肿抽吸,并随访8周。在140名参与者中,89.3%(N=125)达到临床治愈,环丙沙星组59例(85.5%),头孢克肟组66例(93%)(p=0.154)。抗菌治疗的平均持续时间为16.2±4.3天,环丙沙星组15.1±4.5天,头孢克肟组16.0±4.2天(p=0.223)。共有15名(10.7%)参与者治疗失败,环丙沙星组10例(14.5%),头孢克肟组5例(7.0%)(p=0.154)。治疗失败的最常见原因是需要延长(>4周)抗菌治疗,由于持续的肝收集需要引流,环丙沙星(14.5%,N=10)组,与头孢克肟(4.2%,N=3)组。总之,两者,持续2~3周的环丙沙星或头孢克肟联合甲硝唑作为经验性口服抗菌方案以及及时经皮引流或抽吸治疗单纯性肝脓肿的疗效相似.口服头孢克肟优于环丙沙星,由于持续收集,治疗失败的机会较小,需要在更大的临床试验中进一步研究。试用注册:clinicaltrials.govPRSID:NCT03969758,2019年5月31日。
    Liver abscess is a potentially life-threatening medical emergency. Prompt empirical antimicrobial with or without percutaneous aspiration or drainage is therapeutic. The rational for using empirical intravenous broad-spectrum antimicrobials upfront instead of oral Fluoroquinolone or Cephalosporin is contentious. In this double blind randomized control clinical trial 69 participants received Ciprofloxacin (500 mg q 12 hourly) and 71 participants received Cefixime (200 mg q 12 hourly) orally for 2 weeks. Both the group received oral Metronidazole (800 mg q 8 hourly) for 2 weeks and percutaneous drainage or aspiration of the abscess was done as per indication and followed-up for 8 weeks. Out of 140 participants, 89.3% (N = 125) achieved clinical cure, 59 (85.5%) in Ciprofloxacin group and 66 (93%) in Cefixime group (p = 0.154). Mean duration of antimicrobial therapy was 16.2 ± 4.3 days, 15.1 ± 4.5 days in Ciprofloxacin group and 16.0 ± 4.2 days in Cefixime group (p = 0.223). Total 15 (10.7%) participants had treatment failure, 10 (14.5%) in Ciprofloxacin group and 5 (7.0%) in Cefixime group (p = 0.154). The most common reason for treatment failure was need of prolong (> 4 weeks) antimicrobial therapy due to persistent hepatic collection requiring drainage, which was significantly (p = 0.036) higher in Ciprofloxacin (14.5%, N = 10) group, compared to the Cefixime (4.2%, N = 3) group. In conclusion, both, the Ciprofloxacin or Cefixime plus Metronidazole for duration of 2-3 weeks were efficacious as empirical oral antimicrobial regimen along with prompt percutaneous drainage or aspiration for the treatment of uncomplicated liver abscess with similar efficacy. Oral Cefixime was better than Ciprofloxacin in term of lesser chance of treatment failure due to persistent collection which is required to be investigated further in larger clinical trial.Trial registration: clinicaltrials.gov PRS ID: NCT03969758, 31/05/2019.
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  • 文章类型: Journal Article
    Invasive infection caused by hypervirulent Klebsiella pneumoniae (HvKP) has been reported worldwide. Most of the patients are community population, related to diabetes mellitus (DM), chronic liver disease and other basic diseases, which prone to systemic migratory infection. In this study, we collected 377 patients with community acquired Klebsiella pneumoniae liver abscess in our hospital from January 2013 to December 2018, 65.8% of whom were male, and 49.6% had DM. Patients with DM are prone to eye and central nervous system (CNS) infection, which need continuous local abscess drainage during treatment. Among them, patients with poor blood glucose control have a higher rate of blood stream infections (BSI). 219 strains of HvKP were obtained, with K1/K2 Serotype accounted for 81.7%. The incidence of BSI in K2 patients was higher than that in K1 patients. The PCR results indicate that the carrying rate of virulence genes (rmpA、areo、kfu、allS、iroN、magA、uge、wcaG) in K1/K2 type strains is significantly higher than that in non K1/K2 type strains. ST23 and ST65 are the most common multilocus sequence typing (MLST), which belong to K1 and K2 Serotype respectively. All of HvKP strains showed high sensitivity to commonly used clinical antibiotics other than ampicillin, with 54.3% of the strains exhibiting high viscosity characteristics. Meanwhile, 35 classic Klebsiella pneumoniae (cKP) strains were collected, and their serum typing is mainly non K1/K2. The carrying rate of virulence genes and viscosity degree in HvKP are significantly higher than those in cKP. Primary liver abscess caused by HvKP is prone to multiple tissue and organ infections, but it shows higher sensitivity to most commonly used antibiotics in clinical practice except for ampicillin. After effective treatment, the overall prognosis of patients is better. This study analyzes the pathogenic characteristics of HvKP and elaborates on the clinical characteristics of patients, which can provide reference for clinical and scientific research work.
    高毒力肺炎克雷伯菌(hypervirulent Klebsiella pneumoniae,HvKP)造成侵袭性感染已在全球范围内被广泛报道,其感染者主要集中在患有糖尿病(diabetes mellitus,DM)、慢性肝病等基础疾病的社区人群,且容易发生全身迁徙性感染。本研究收集了本院2013年1月~2018年12月社区获得性肺炎克雷伯菌肝脓肿患者377名,男性占65.8%,其中49.6%有DM。DM患者易发生眼部及中枢神经系统(central nervous system,CNS)感染,治疗过程中更需要持续的局部脓肿引流,其中血糖控制差的患者继发血流感染(bloodstream infections,BSI)的比率更高。共获得HvKP菌株219株,K1/K2血清型占总数81.7%,K2型患者发生BSI的比率高于K1型。PCR检测结果表明,毒力基因(rmpA、areo、kfu、allS、iroN、magA、uge、wcaG)在K1/K2型菌株的携带率明显高于non-K1/K2型,ST23和ST65是最常见的多位点序列分型(multilocus sequence typing, MLST),分别属于K1及K2血清型。另外收集35株经典肺炎克雷伯菌(classic Klebsiella pneumoniae,cKP),其血清分型主要以非K1/K2型为主。HvKP的毒力基因携带率及黏性程度明显高于cKP,前者造成的原发性肝脓肿患者易出现多组织器官感染,但对除氨苄西林以外的临床常用抗菌药物表现出更高敏感性,经过有效的治疗,患者的总体预后较好。本研究对社区获得性高毒肺炎克雷伯菌的病原学特征进行分析,并结合患者临床特征进行阐述,可对临床及科研工作起到一定参考价值。.
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