Objective:To compare the efficacy of three different tissue stains,namely haematoxylin and eosin(H&E),periodic-acid Schiff(PAS)and immunohistochemical(1HC)stains for detection of Entamoeba histolytica(E.histolytic...Objective:To compare the efficacy of three different tissue stains,namely haematoxylin and eosin(H&E),periodic-acid Schiff(PAS)and immunohistochemical(1HC)stains for detection of Entamoeba histolytica(E.histolytica)trophozoites in abscessed liver tissues of hamster.Methods:Amoebic liver abscess was experimentally induced in a hamster by injecting 1×10~6of axenically cultured virulent E.histolytica trophozoites(HM1-IMSS strain)into the portal vein.After a week post-inoculation,the hamster was sacrificed and the liver tissue sections were stained with H&E,PAS and IHC stains to delect the amoebic trophozoite.Results:The three stains revealed tissue necrosis and amoebic trophozoites,but with varying clarity.H&E and PAS stained the trophozoites pink and magenta,respectively,however it was difficult to differentiate the stained trophozoites from the macrophages because of their similarity in size and morphology.On the other hand,IHC stain revealed distinct brown appearance of the trophozoites in the infected liver tissues.Conclusions:It can be concluded that out of the three stains.IHC is the best for identification of E.histolytica trophozoites in tissue sections.展开更多
Infective colitis can be a cause of massive lower gastrointestinal bleeding requiring acute surgical intervention. Causative organisms include entamoeba and histoplasma species. However, concurrent colonic infection w...Infective colitis can be a cause of massive lower gastrointestinal bleeding requiring acute surgical intervention. Causative organisms include entamoeba and histoplasma species. However, concurrent colonic infection with both these organisms is very rare, and the in vivo consequences are not known. A 58-year-old male presented initially to the physicians with pyrexia of unknown origin and bloody diarrhea. Amoebic colitis was diagnosed based on biopsies, and he was treated with metronidazole. Five days later, the patient developed massive lower gastrointestinal bleeding with hemorrhagic shock. Emergency total colectomy with end-ileostomy was performed. However, he deteriorated and died on the second postoperative day. Histopathological examination revealed multiple deep ulcers at the hepatic flexure where fungal bodies of mycelial and yeast forms were noted. Isolated lymph nodes showed abscess formation with fungal bodies. Infective fungal colitis with Histoplasma capsilatum was diagnosed. In vitro, amoebic parasites can increase virulence and pathogenicity of histoplasma which may account for the fulminant presentation in this patient. Although rare, this unusual dual infection should be considered in the differential diagnosis of infective colitis, as appropriate antimicrobial treatment may prevent progression to massive lower gastrointestinal bleeding, obviating the need for urgent surgical intervention.展开更多
Objective:To characterize the Entamoeba histolytica(E.histolytica)antigen(s)recognized by moribound amoebic liver abscess hamsters.Methods:Crude soluble antigen of E.histolytica was probed with sera of moribund hamste...Objective:To characterize the Entamoeba histolytica(E.histolytica)antigen(s)recognized by moribound amoebic liver abscess hamsters.Methods:Crude soluble antigen of E.histolytica was probed with sera of moribund hamsters in 1D-and 2D-Westem blot analyses.The antigenic protein was then sent for tandem mass spectrometry analysis.The corresponding gene was cloned and expressed in Escherichia coli BL21-AI to produce the recombinant E.histolytica ADP-forming acetyl-CoA synthetase(EhACS)protein.A customised ELISA was developed to evaluate the sensitivity and specificity of the recombinant protein.Results:A^75 kDa protein band with a pl value of 5.91-6.5 was found to be antigenic;and not detected by sera of hamsters in the control group.Tandem mass spectrometry analysis revealed the protein to be the 77 kDa E.histolytica ADP-forming acetyl-CoA synthetase(EhACS).The customised ELISA results revealed 100%sensitivity and 100%specificity when tested against infected(n=31)and control group hamsters(n=5)serum samples,respectively.Conclusions:This rinding suggested the significant role of EhACS as a biomarker for moribund hamsters with acute amoebic liver abscess(ALA)infection.It is deemed pertinent that future studies explore the potential roles of EhACS in better understanding the pathogenesis of ALA;and in the development of vaccine and diagnostic tests to control ALA in human populations.展开更多
We reported a case of amoebic liver abscess(ALA) in a 6-year-old Malaysian boy who presented with fever,lethargy,diarrhea and right hypochondriac pain.On admission he was diagnosed with perforated acute appendicitis a...We reported a case of amoebic liver abscess(ALA) in a 6-year-old Malaysian boy who presented with fever,lethargy,diarrhea and right hypochondriac pain.On admission he was diagnosed with perforated acute appendicitis and a laparotomy was done.After surgery he developed acute respiratory distress.Ultrasonography,chest X-Ray and CT scan revealed two ALAs in the posterior segment of right lobe of liver,pleural effusion and collapsed consolidation of lungs bilaterally.Percutaneous liver abscesses drainage was done and intravenous Metronidazole was started.PCR carried out on the pus from the abscess was positive for Entamoeba histolytica.Patient however succumbed to the infection one week after admission.展开更多
We report a case of acute fulminant amoebic colitis that resulted in the development of a perianal ulcer in a 29-year-old Japanese homosexual man with acquired immunodeficiency syndrome (AIDS). The patient was admitte...We report a case of acute fulminant amoebic colitis that resulted in the development of a perianal ulcer in a 29-year-old Japanese homosexual man with acquired immunodeficiency syndrome (AIDS). The patient was admitted to our hospital with a persistent perianal abscess that was refractory to antibiotic therapy adminis-tered at another hospital. On admission, we observed a giant ulcer in the perianal region. At first, cytomega-lovirus colitis was suspected by blood investigations. Ganciclovir therapy was initiated; however, the patient developed necrosis of the skin around the anus during therapy. We only performed end-sigmoidostomy and necrotomy to avoid excessive surgical invasion. Histopathological examination of the surgical specimen revealed the presence of trophozoite amoebae, indicating a final diagnosis of acute fulminant amoebic colitis. The patient's postoperative course was favorable, and proctectomy of the residual rectum was performed 11 mo later. Amoebic colitis is one of the most severe complications affecting patients with AIDS. Particularly, acute fulminant amoebic colitis may result in a poor prognosis; therefore, staged surgical therapy as a lessinvasive procedure should be considered as one of the treatment options for these patients.展开更多
A 52-year-old man had bloody stools during chemo-therapy for gastric cancer. A colonoscopy revealed necrotizing ulcer-like changes. A biopsy confirmed the presence of amoebic trophozoites. Subsequently, peritonitis wi...A 52-year-old man had bloody stools during chemo-therapy for gastric cancer. A colonoscopy revealed necrotizing ulcer-like changes. A biopsy confirmed the presence of amoebic trophozoites. Subsequently, peritonitis with intestinal perforation developed, and emergency peritoneal lavage and colostomy were performed. After surgery, endotoxin adsorption therapy was performed and metronidazole was given. Symptoms of peritonitis and colonitis resolved. However, the patient's general condition worsened with the progression of gastric cancer. The patient died 50 d after surgery. Fulminant amoebic colitis is very rarely associated with chemotherapy. Amoebic colitis should be considered in the differential diagnosis of patients who have bloody stools during chemotherapy.展开更多
BACKGROUND: Pyogenic and amoebic liver abscesses are rare, potentially lethal conditions. In this study, we aimed to examine the clinical and pathological differences between them. METHODS: Patients with confirmed liv...BACKGROUND: Pyogenic and amoebic liver abscesses are rare, potentially lethal conditions. In this study, we aimed to examine the clinical and pathological differences between them. METHODS: Patients with confirmed liver abscesses were divided into two groups: the pyogenic (n = 47) and amoebic group (n = 21), which were analyzed for differences in clinical and laboratory findings. RESULTS: Amoebic liver abscesses presented most frequently in young adults (14 - 30 years;71%), whereas pyogenic liver abscesses were most commonly observed in adults 41 - 50 years (49%). Indirect hemagglutination test revealed a 100% positive response in the amoebic group, whereas 68% of the pyogenic group presented with blood/pus culture. Multiple abscesses were observed in 66% and 24% of patients in the pyogenic and amoebic group, respectively. CONCLUSIONS: Pyogenic abscesses were commonly observed in older patients, and were associated with features such as markedly deranged liver function test, higher prothrombin time, and multiple abscesses, compared to amoebic abscess. Early and improved diagnoses and differentiation between the two conditions, followed by the correct treatment, can help prevent serious complications and lead to an overall improved mortality rate.展开更多
Background: Liver abscess (LA) is a suppurated collection in the hepatic parenchyma. In Africa, liver abscesses are most often of amoebic origin, but more recently, the rate of pyogenic liver abscesses (PLA) has incre...Background: Liver abscess (LA) is a suppurated collection in the hepatic parenchyma. In Africa, liver abscesses are most often of amoebic origin, but more recently, the rate of pyogenic liver abscesses (PLA) has increased. Objective: to assess the epidemiological characteristics, clinical features, biological radiological findings, and outcomes of patients with PLA and with amebic liver abscess (ALA) in order to determine the potential factors that may help improve diagnosis and treatment for LA in the context of secondary care centers with limited medical supports. Methods: Retrospective review of LA diagnosed and treated at three secondary care centers in Thiès over 11 years. Results: 61 patients, were included, 52.45% had ALA and 47.54% had PLA. Males were predominant (79.31% in PLA vs 65.63% in ALA, p = 0.2). The median age was 38 years for the PLA group vs 39 years for the ALA group (p = 0.4). In both groups, the most common symptom was right upper abdominal pain (81.97%), hepatomegaly (81.97%). The PLA group had a higher prevalence of fever (79.31% vs 46.88%, p = 0,009), chills (51.72% vs 18.75%, p = 0.007), right basi-thoracic pain (55.17% vs 28.13%, p = 0.032), and jaundice (55.17% vs 28%, p = 0.032). There was no difference in radiological features between PLA and ALA. Patients with PLA had a higher level of White blood cell (20.600 vs 15.400, p = 0.014). The most common bacteria identified in PLA were Escherichia coli (58.8%). All patients had received antibiotic therapy, which was combined with aspiration puncture (37.3%), transcutaneous drainage (43.3%), and surgery (9.0%). Seven patients had received antibiotic therapy alone and all had amoebic abscesses. Elsewhere, the occurrence of complications was higher in PLA cases (75.86% vs 37.5%, p = 0.003). The overall hospital mortality rate was 13.11%, higher in cases of PLA (24.14% vs 3.13%, p = 0.022). Conclusion: Clinical and biological features were more severe in PLA. But radiological features cannot be used to distinguish between PLA and ALA.展开更多
Entamoeba histolytica (Eh) is a protozoan parasite that causes amoebiasis characterized by intestinal damage and amoebic liver development and is an important cause of hospitalization in low-middle income countries. T...Entamoeba histolytica (Eh) is a protozoan parasite that causes amoebiasis characterized by intestinal damage and amoebic liver development and is an important cause of hospitalization in low-middle income countries. The aims of this study were to determine the prevalence and the titer of IgG anti Eh in ALA (Amoebic Liver Abscess) patients’ in Bangui according sex, age and other risk factors. This was a cross sectional study where data was collected between January 2018 and October 2020. The diagnosis of ALA was suspected based on clinical symptoms of;fever, abdominal pain (usually in the right hypochondrium or epigastrium) and clinical signs of hepatomegaly and/or tender liver with or without jaundice and abdominal ultra-sonography. ALA patients’ IgG antibody titers were measured by Indirect Hemmaglutination Assay and Chi-square test was used. A total of 1249 ALA patients were included, among whom 570 (45.64%) were positive. Of these, 244 (42.08%) had titer 1:160 or less, 223 patients’ (39.13%) had titer ranging from 1:320 to 1:640 and 103 patients (18.07%) had strong titer ranging from 1:1280 to 1:2560. The association between antibody titer results, age and sex was no significant (p = 1.0000). Our findings indicate a high prevalence of ALA and show no significant difference between the sex and age ALA patients.展开更多
This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incid...This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incidence rate in Europe is lower than in developing countries,but it is a major complication with high morbidity,particularly in immunocompromised patients.They are most frequently caused by Enterobacterales infections,but hypervirulent Klebsiella strains are an emerging problem in Western countries.Amoebiasis has been a public health problem in Europe,primarily imported from other endemic foci.At the same time,this infection is becoming an emerging disease,as the number of infected patients who have not traveled to endemic areas is rising.Treatment options for hydatid liver cyst include chemotherapy,open or laparoscopic surgery,percutaneous treatment(percutaneous aspiration,re-aspiration and injection and its modification)and“wait and watch”strategy.Most hydatid liver cyst patients in Pillay et al’s study received surgical treatment,but several studies have confirmed the safety and efficacy of percutaneous aspiration,re-aspiration and injection.展开更多
We examined the case report written by Ke et al,describing a rare clinical case.In this editorial,we would like to emphasize the differential diagnosis of rectal masses through a rare case.We describe a case of amebom...We examined the case report written by Ke et al,describing a rare clinical case.In this editorial,we would like to emphasize the differential diagnosis of rectal masses through a rare case.We describe a case of ameboma,which manifested itself as a mass in the rectum in terms of imaging and rectoscopic features,in an immunocompetent patient who had complaints of constipation and rectal bleeding for weeks.The initial diagnosis suggested malignancy due to imaging and rectoscopic features,but the pathology report reported it as amoebiasis.After ten days of metronidazole and oral amebicide(diloxanide furoate)treatment,the patient’s symptoms and radiological findings were successfully regressed.展开更多
A middle aged, non-addict male presented with right upper abdominal pain and swelling with respiratory distress. Examination revealed central cyanosis, bipedal pitting edema with prominent epigastric and back veins. L...A middle aged, non-addict male presented with right upper abdominal pain and swelling with respiratory distress. Examination revealed central cyanosis, bipedal pitting edema with prominent epigastric and back veins. Liver was enlarged, tender, spanned 20 cm without any splenomegaly or ascites. Other systems were clinically normal. Laboratory investigations showed polymorphonuclear leucocytosis with slightly deranged liver function. Abdominal ultrasonography showed an abscess in the right lobe of the liver with compressed inferior vena cava （IVC）, middle and left hepatic veins. Arterial blood gas （ABG） documented hypoxia with orthodeoxia and air-contrast echocardiography was suggestive of an intrapulmonary shunt. A diagnosis of hepato-pulmonary syndrome （HPS） was made with near normal liver function secondary to amebic liver abscess. It reversed completely following successful treatment of the liver abscess.展开更多
BACKGROUND Hepatic abscesses represent infections of the liver parenchyma from bacteria,fungi,and parasitic organisms.Trends in both abscess microbiology and manage-ment of abscesses(infective collections)have changed...BACKGROUND Hepatic abscesses represent infections of the liver parenchyma from bacteria,fungi,and parasitic organisms.Trends in both abscess microbiology and manage-ment of abscesses(infective collections)have changed over the past decade.There is a paucity of published data regarding the clinicopathological features of liver abscesses in sub-Saharan Africa and other low-income and middle-income coun-tries.AIM To evaluate the clinical presentations of liver abscesses and hydatid liver disease at two South African tertiary-level hospitals.METHODS Information accessed from electronic discharge summaries of patients from two South African referral hospitals in Johannesburg,South Africa from January 2016 to December 2020 were reviewed and analyzed.All patients older than 13 years presenting with infective liver collections(pyogenic,amoebic)and hydatid di-sease were included.Clinical findings and laboratory,microbiology,and radio-logy results and outcomes were collated and analyzed.RESULTS In total,222 patients were included.There were 123 males(55.41%)and 99 females(44.59%),with a median age of 48 years.Comorbidities included HIV(24.23%),hypertension(20.57%),and diabetes mellitus(16.83%).The majority(74.77%)of abscesses were pyogenic,while amoebic and hydatid abscesses represented 16.22%and 9.01%,respectively.The predominant etiology of the pyogenic liver abscesses(PLA)was biliary-related disease.WBC and C-reactive protein were significantly higher in the pyogenic group(P<0.0002 and P<0.007,respectively)when compared to the amoebic and hydatid groups.In patients with PLAs,organisms were cultured on blood in 17.58%and abscess fluid in 56.60%.Klebsiella,Escherichia coli and Streptococci were the most cultured organisms.Sixteen percent of the cultures were polymicrobial.In the overall group,76.00%(n=169)of patients requiring drainage had a percutaneous transhepatic catheter drain placed,while 8.76%(n=19)had open surgery.The median length of hospital stay was 13 days.The mortality rate was 3.02%.CONCLUSION In this study,the most common type of liver abscess was PLAs of biliary origin in middle-aged males.The microbiology was similar to those described in Asian populations,and non-surgical management via percutaneous drainage was sufficient in the majority of cases with acceptable morbidity and mortality.展开更多
Introduction: Abscesses of the liver are due to an infection of bacterial, parasitic or fungal origin. Through amoebiological imaging and serology, their diagnosis was facilitated. The aim of this study was to determi...Introduction: Abscesses of the liver are due to an infection of bacterial, parasitic or fungal origin. Through amoebiological imaging and serology, their diagnosis was facilitated. The aim of this study was to determine the epidemiological, clinical, diagnostic and evolutionary aspects of these liver abscesses at the Department of Infectious and Tropical Diseases in Fann Teaching University Hospital. Patients and Methods: This was a retrospective and descriptive study, based on records of patients hospitalized for abscess of the liver over a period of 8 years, from January 1, 2008 to December 31, 2015. Results: We collected 20 cases of abscesses including 12 cases of confirmed amoebic abscesses and 5 cases of pyogenic abscesses. The mean age of the patients was 43.15 ± 15.12 years. There were 18 men and 2 women. The average hospital stay was 32 days. The most common clinical signs were abdominal pain (100%), fever (75%), hepatomegaly (80%). A leukocytosis greater than 12,000 Gb/mm3 was found in 13 patients. The amoebic serology was positive in 71% of cases and negative in 29% of cases. No germ was isolated from the blood culture. On hepatic ultrasound the abscess was unique in 90%. Treatment was exclusively medical in 11 patients (55%). The trend was favorable in 85% of cases. Conclusion: The incidence of liver abscesses has significantly decreased. It is important to develop diagnostic tools better in the case of pyogenic abscesses.展开更多
Among various genera of free-living amoebae prevalent in nature,some members are identified as causative agents of human encephalitis,in which Naegleria fowleri followed by Acanthamoeba spp.and Balamuthia mandrillaris...Among various genera of free-living amoebae prevalent in nature,some members are identified as causative agents of human encephalitis,in which Naegleria fowleri followed by Acanthamoeba spp.and Balamuthia mandrillaris have been successively discovered.As the three dominant genera responsible for infections,Acanthamoeba and Balamuthia work as opportunistic pathogens of granulomatous amoebic encephalitis in immunocompetent and immunocompromised individuals,whereas Naegleria induces primary amoebic meningoencephalitis mostly in healthy children and young adults as a more violent and deadly disease.Due to the lack of typical symptoms and laboratory findings,all these amoebic encephalitic diseases are difficult to diagnose.Considering that subsequent therapies are also affected,all these brain infections cause significant mortality worldwide,with more than 90%of the cases being fatal.Along with global warming and population explosion,expanding areas of human and amoebae activity in some regions lead to increased contact,resulting in more serious infections and drawing increased public attention.In this review,we summarize the present information of these pathogenic free-living amoebae,including their phylogeny,classification,biology,and ecology.The mechanisms of pathogenesis,immunology,pathophysiology,clinical manifestations,epidemiology,diagnosis,and therapies are also discussed.展开更多
基金Supported by a grant from Universiti Sains Malaysia(grant No.1001/PPSK/813009)received financial support through the USM Fellowship
文摘Objective:To compare the efficacy of three different tissue stains,namely haematoxylin and eosin(H&E),periodic-acid Schiff(PAS)and immunohistochemical(1HC)stains for detection of Entamoeba histolytica(E.histolytica)trophozoites in abscessed liver tissues of hamster.Methods:Amoebic liver abscess was experimentally induced in a hamster by injecting 1×10~6of axenically cultured virulent E.histolytica trophozoites(HM1-IMSS strain)into the portal vein.After a week post-inoculation,the hamster was sacrificed and the liver tissue sections were stained with H&E,PAS and IHC stains to delect the amoebic trophozoite.Results:The three stains revealed tissue necrosis and amoebic trophozoites,but with varying clarity.H&E and PAS stained the trophozoites pink and magenta,respectively,however it was difficult to differentiate the stained trophozoites from the macrophages because of their similarity in size and morphology.On the other hand,IHC stain revealed distinct brown appearance of the trophozoites in the infected liver tissues.Conclusions:It can be concluded that out of the three stains.IHC is the best for identification of E.histolytica trophozoites in tissue sections.
文摘Infective colitis can be a cause of massive lower gastrointestinal bleeding requiring acute surgical intervention. Causative organisms include entamoeba and histoplasma species. However, concurrent colonic infection with both these organisms is very rare, and the in vivo consequences are not known. A 58-year-old male presented initially to the physicians with pyrexia of unknown origin and bloody diarrhea. Amoebic colitis was diagnosed based on biopsies, and he was treated with metronidazole. Five days later, the patient developed massive lower gastrointestinal bleeding with hemorrhagic shock. Emergency total colectomy with end-ileostomy was performed. However, he deteriorated and died on the second postoperative day. Histopathological examination revealed multiple deep ulcers at the hepatic flexure where fungal bodies of mycelial and yeast forms were noted. Isolated lymph nodes showed abscess formation with fungal bodies. Infective fungal colitis with Histoplasma capsilatum was diagnosed. In vitro, amoebic parasites can increase virulence and pathogenicity of histoplasma which may account for the fulminant presentation in this patient. Although rare, this unusual dual infection should be considered in the differential diagnosis of infective colitis, as appropriate antimicrobial treatment may prevent progression to massive lower gastrointestinal bleeding, obviating the need for urgent surgical intervention.
基金Supported by Malaysia Ministry of Education Long-Term Research Grant Scheme(LRGS)No.203/PSK/6722002
文摘Objective:To characterize the Entamoeba histolytica(E.histolytica)antigen(s)recognized by moribound amoebic liver abscess hamsters.Methods:Crude soluble antigen of E.histolytica was probed with sera of moribund hamsters in 1D-and 2D-Westem blot analyses.The antigenic protein was then sent for tandem mass spectrometry analysis.The corresponding gene was cloned and expressed in Escherichia coli BL21-AI to produce the recombinant E.histolytica ADP-forming acetyl-CoA synthetase(EhACS)protein.A customised ELISA was developed to evaluate the sensitivity and specificity of the recombinant protein.Results:A^75 kDa protein band with a pl value of 5.91-6.5 was found to be antigenic;and not detected by sera of hamsters in the control group.Tandem mass spectrometry analysis revealed the protein to be the 77 kDa E.histolytica ADP-forming acetyl-CoA synthetase(EhACS).The customised ELISA results revealed 100%sensitivity and 100%specificity when tested against infected(n=31)and control group hamsters(n=5)serum samples,respectively.Conclusions:This rinding suggested the significant role of EhACS as a biomarker for moribund hamsters with acute amoebic liver abscess(ALA)infection.It is deemed pertinent that future studies explore the potential roles of EhACS in better understanding the pathogenesis of ALA;and in the development of vaccine and diagnostic tests to control ALA in human populations.
基金supported by University of Malaya(H-20001-00-E00051)
文摘We reported a case of amoebic liver abscess(ALA) in a 6-year-old Malaysian boy who presented with fever,lethargy,diarrhea and right hypochondriac pain.On admission he was diagnosed with perforated acute appendicitis and a laparotomy was done.After surgery he developed acute respiratory distress.Ultrasonography,chest X-Ray and CT scan revealed two ALAs in the posterior segment of right lobe of liver,pleural effusion and collapsed consolidation of lungs bilaterally.Percutaneous liver abscesses drainage was done and intravenous Metronidazole was started.PCR carried out on the pus from the abscess was positive for Entamoeba histolytica.Patient however succumbed to the infection one week after admission.
文摘We report a case of acute fulminant amoebic colitis that resulted in the development of a perianal ulcer in a 29-year-old Japanese homosexual man with acquired immunodeficiency syndrome (AIDS). The patient was admitted to our hospital with a persistent perianal abscess that was refractory to antibiotic therapy adminis-tered at another hospital. On admission, we observed a giant ulcer in the perianal region. At first, cytomega-lovirus colitis was suspected by blood investigations. Ganciclovir therapy was initiated; however, the patient developed necrosis of the skin around the anus during therapy. We only performed end-sigmoidostomy and necrotomy to avoid excessive surgical invasion. Histopathological examination of the surgical specimen revealed the presence of trophozoite amoebae, indicating a final diagnosis of acute fulminant amoebic colitis. The patient's postoperative course was favorable, and proctectomy of the residual rectum was performed 11 mo later. Amoebic colitis is one of the most severe complications affecting patients with AIDS. Particularly, acute fulminant amoebic colitis may result in a poor prognosis; therefore, staged surgical therapy as a lessinvasive procedure should be considered as one of the treatment options for these patients.
文摘A 52-year-old man had bloody stools during chemo-therapy for gastric cancer. A colonoscopy revealed necrotizing ulcer-like changes. A biopsy confirmed the presence of amoebic trophozoites. Subsequently, peritonitis with intestinal perforation developed, and emergency peritoneal lavage and colostomy were performed. After surgery, endotoxin adsorption therapy was performed and metronidazole was given. Symptoms of peritonitis and colonitis resolved. However, the patient's general condition worsened with the progression of gastric cancer. The patient died 50 d after surgery. Fulminant amoebic colitis is very rarely associated with chemotherapy. Amoebic colitis should be considered in the differential diagnosis of patients who have bloody stools during chemotherapy.
文摘BACKGROUND: Pyogenic and amoebic liver abscesses are rare, potentially lethal conditions. In this study, we aimed to examine the clinical and pathological differences between them. METHODS: Patients with confirmed liver abscesses were divided into two groups: the pyogenic (n = 47) and amoebic group (n = 21), which were analyzed for differences in clinical and laboratory findings. RESULTS: Amoebic liver abscesses presented most frequently in young adults (14 - 30 years;71%), whereas pyogenic liver abscesses were most commonly observed in adults 41 - 50 years (49%). Indirect hemagglutination test revealed a 100% positive response in the amoebic group, whereas 68% of the pyogenic group presented with blood/pus culture. Multiple abscesses were observed in 66% and 24% of patients in the pyogenic and amoebic group, respectively. CONCLUSIONS: Pyogenic abscesses were commonly observed in older patients, and were associated with features such as markedly deranged liver function test, higher prothrombin time, and multiple abscesses, compared to amoebic abscess. Early and improved diagnoses and differentiation between the two conditions, followed by the correct treatment, can help prevent serious complications and lead to an overall improved mortality rate.
文摘Background: Liver abscess (LA) is a suppurated collection in the hepatic parenchyma. In Africa, liver abscesses are most often of amoebic origin, but more recently, the rate of pyogenic liver abscesses (PLA) has increased. Objective: to assess the epidemiological characteristics, clinical features, biological radiological findings, and outcomes of patients with PLA and with amebic liver abscess (ALA) in order to determine the potential factors that may help improve diagnosis and treatment for LA in the context of secondary care centers with limited medical supports. Methods: Retrospective review of LA diagnosed and treated at three secondary care centers in Thiès over 11 years. Results: 61 patients, were included, 52.45% had ALA and 47.54% had PLA. Males were predominant (79.31% in PLA vs 65.63% in ALA, p = 0.2). The median age was 38 years for the PLA group vs 39 years for the ALA group (p = 0.4). In both groups, the most common symptom was right upper abdominal pain (81.97%), hepatomegaly (81.97%). The PLA group had a higher prevalence of fever (79.31% vs 46.88%, p = 0,009), chills (51.72% vs 18.75%, p = 0.007), right basi-thoracic pain (55.17% vs 28.13%, p = 0.032), and jaundice (55.17% vs 28%, p = 0.032). There was no difference in radiological features between PLA and ALA. Patients with PLA had a higher level of White blood cell (20.600 vs 15.400, p = 0.014). The most common bacteria identified in PLA were Escherichia coli (58.8%). All patients had received antibiotic therapy, which was combined with aspiration puncture (37.3%), transcutaneous drainage (43.3%), and surgery (9.0%). Seven patients had received antibiotic therapy alone and all had amoebic abscesses. Elsewhere, the occurrence of complications was higher in PLA cases (75.86% vs 37.5%, p = 0.003). The overall hospital mortality rate was 13.11%, higher in cases of PLA (24.14% vs 3.13%, p = 0.022). Conclusion: Clinical and biological features were more severe in PLA. But radiological features cannot be used to distinguish between PLA and ALA.
文摘Entamoeba histolytica (Eh) is a protozoan parasite that causes amoebiasis characterized by intestinal damage and amoebic liver development and is an important cause of hospitalization in low-middle income countries. The aims of this study were to determine the prevalence and the titer of IgG anti Eh in ALA (Amoebic Liver Abscess) patients’ in Bangui according sex, age and other risk factors. This was a cross sectional study where data was collected between January 2018 and October 2020. The diagnosis of ALA was suspected based on clinical symptoms of;fever, abdominal pain (usually in the right hypochondrium or epigastrium) and clinical signs of hepatomegaly and/or tender liver with or without jaundice and abdominal ultra-sonography. ALA patients’ IgG antibody titers were measured by Indirect Hemmaglutination Assay and Chi-square test was used. A total of 1249 ALA patients were included, among whom 570 (45.64%) were positive. Of these, 244 (42.08%) had titer 1:160 or less, 223 patients’ (39.13%) had titer ranging from 1:320 to 1:640 and 103 patients (18.07%) had strong titer ranging from 1:1280 to 1:2560. The association between antibody titer results, age and sex was no significant (p = 1.0000). Our findings indicate a high prevalence of ALA and show no significant difference between the sex and age ALA patients.
文摘This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incidence rate in Europe is lower than in developing countries,but it is a major complication with high morbidity,particularly in immunocompromised patients.They are most frequently caused by Enterobacterales infections,but hypervirulent Klebsiella strains are an emerging problem in Western countries.Amoebiasis has been a public health problem in Europe,primarily imported from other endemic foci.At the same time,this infection is becoming an emerging disease,as the number of infected patients who have not traveled to endemic areas is rising.Treatment options for hydatid liver cyst include chemotherapy,open or laparoscopic surgery,percutaneous treatment(percutaneous aspiration,re-aspiration and injection and its modification)and“wait and watch”strategy.Most hydatid liver cyst patients in Pillay et al’s study received surgical treatment,but several studies have confirmed the safety and efficacy of percutaneous aspiration,re-aspiration and injection.
文摘We examined the case report written by Ke et al,describing a rare clinical case.In this editorial,we would like to emphasize the differential diagnosis of rectal masses through a rare case.We describe a case of ameboma,which manifested itself as a mass in the rectum in terms of imaging and rectoscopic features,in an immunocompetent patient who had complaints of constipation and rectal bleeding for weeks.The initial diagnosis suggested malignancy due to imaging and rectoscopic features,but the pathology report reported it as amoebiasis.After ten days of metronidazole and oral amebicide(diloxanide furoate)treatment,the patient’s symptoms and radiological findings were successfully regressed.
文摘A middle aged, non-addict male presented with right upper abdominal pain and swelling with respiratory distress. Examination revealed central cyanosis, bipedal pitting edema with prominent epigastric and back veins. Liver was enlarged, tender, spanned 20 cm without any splenomegaly or ascites. Other systems were clinically normal. Laboratory investigations showed polymorphonuclear leucocytosis with slightly deranged liver function. Abdominal ultrasonography showed an abscess in the right lobe of the liver with compressed inferior vena cava （IVC）, middle and left hepatic veins. Arterial blood gas （ABG） documented hypoxia with orthodeoxia and air-contrast echocardiography was suggestive of an intrapulmonary shunt. A diagnosis of hepato-pulmonary syndrome （HPS） was made with near normal liver function secondary to amebic liver abscess. It reversed completely following successful treatment of the liver abscess.
文摘BACKGROUND Hepatic abscesses represent infections of the liver parenchyma from bacteria,fungi,and parasitic organisms.Trends in both abscess microbiology and manage-ment of abscesses(infective collections)have changed over the past decade.There is a paucity of published data regarding the clinicopathological features of liver abscesses in sub-Saharan Africa and other low-income and middle-income coun-tries.AIM To evaluate the clinical presentations of liver abscesses and hydatid liver disease at two South African tertiary-level hospitals.METHODS Information accessed from electronic discharge summaries of patients from two South African referral hospitals in Johannesburg,South Africa from January 2016 to December 2020 were reviewed and analyzed.All patients older than 13 years presenting with infective liver collections(pyogenic,amoebic)and hydatid di-sease were included.Clinical findings and laboratory,microbiology,and radio-logy results and outcomes were collated and analyzed.RESULTS In total,222 patients were included.There were 123 males(55.41%)and 99 females(44.59%),with a median age of 48 years.Comorbidities included HIV(24.23%),hypertension(20.57%),and diabetes mellitus(16.83%).The majority(74.77%)of abscesses were pyogenic,while amoebic and hydatid abscesses represented 16.22%and 9.01%,respectively.The predominant etiology of the pyogenic liver abscesses(PLA)was biliary-related disease.WBC and C-reactive protein were significantly higher in the pyogenic group(P<0.0002 and P<0.007,respectively)when compared to the amoebic and hydatid groups.In patients with PLAs,organisms were cultured on blood in 17.58%and abscess fluid in 56.60%.Klebsiella,Escherichia coli and Streptococci were the most cultured organisms.Sixteen percent of the cultures were polymicrobial.In the overall group,76.00%(n=169)of patients requiring drainage had a percutaneous transhepatic catheter drain placed,while 8.76%(n=19)had open surgery.The median length of hospital stay was 13 days.The mortality rate was 3.02%.CONCLUSION In this study,the most common type of liver abscess was PLAs of biliary origin in middle-aged males.The microbiology was similar to those described in Asian populations,and non-surgical management via percutaneous drainage was sufficient in the majority of cases with acceptable morbidity and mortality.
文摘Introduction: Abscesses of the liver are due to an infection of bacterial, parasitic or fungal origin. Through amoebiological imaging and serology, their diagnosis was facilitated. The aim of this study was to determine the epidemiological, clinical, diagnostic and evolutionary aspects of these liver abscesses at the Department of Infectious and Tropical Diseases in Fann Teaching University Hospital. Patients and Methods: This was a retrospective and descriptive study, based on records of patients hospitalized for abscess of the liver over a period of 8 years, from January 1, 2008 to December 31, 2015. Results: We collected 20 cases of abscesses including 12 cases of confirmed amoebic abscesses and 5 cases of pyogenic abscesses. The mean age of the patients was 43.15 ± 15.12 years. There were 18 men and 2 women. The average hospital stay was 32 days. The most common clinical signs were abdominal pain (100%), fever (75%), hepatomegaly (80%). A leukocytosis greater than 12,000 Gb/mm3 was found in 13 patients. The amoebic serology was positive in 71% of cases and negative in 29% of cases. No germ was isolated from the blood culture. On hepatic ultrasound the abscess was unique in 90%. Treatment was exclusively medical in 11 patients (55%). The trend was favorable in 85% of cases. Conclusion: The incidence of liver abscesses has significantly decreased. It is important to develop diagnostic tools better in the case of pyogenic abscesses.
文摘Among various genera of free-living amoebae prevalent in nature,some members are identified as causative agents of human encephalitis,in which Naegleria fowleri followed by Acanthamoeba spp.and Balamuthia mandrillaris have been successively discovered.As the three dominant genera responsible for infections,Acanthamoeba and Balamuthia work as opportunistic pathogens of granulomatous amoebic encephalitis in immunocompetent and immunocompromised individuals,whereas Naegleria induces primary amoebic meningoencephalitis mostly in healthy children and young adults as a more violent and deadly disease.Due to the lack of typical symptoms and laboratory findings,all these amoebic encephalitic diseases are difficult to diagnose.Considering that subsequent therapies are also affected,all these brain infections cause significant mortality worldwide,with more than 90%of the cases being fatal.Along with global warming and population explosion,expanding areas of human and amoebae activity in some regions lead to increased contact,resulting in more serious infections and drawing increased public attention.In this review,we summarize the present information of these pathogenic free-living amoebae,including their phylogeny,classification,biology,and ecology.The mechanisms of pathogenesis,immunology,pathophysiology,clinical manifestations,epidemiology,diagnosis,and therapies are also discussed.
