Search Results (131)

Amebiasis is a rare condition in industrialised countries but is epidemiologically growing. Clinical manifestations may range from asymptomatic to invasive disease. An amebic abscess can be the result of extraintestinal amebiasis, and it is associated with relatively high morbidity and mortality. We present three indigenous cases of amoebic liver abscesses observed within a few weeks (October–November 2023) in patients living in a small area near Lucca in Tuscany, Central Italy. Fever accompanied by abdominal pain and liver abscess was observed in all three patients, and one of them presented necrotising colitis and pleural effusion, too. The parasitological diagnosis was performed by microscopy and confirmed with real-time PCR in liver abscess drainage fluid and stools. Full article

Background: Klebsiella pneumoniae liver abscess (KLAS) is a potentially life-threatening condition with variable outcomes. Identifying risk factors for mortality is crucial for improving patient management. We aimed to analyze factors associated with in-hospital mortality in a cohort of patients with KLAS and review current diagnostic and treatment challenges. Methods: We retrospectively analyzed clinical, laboratory, microbiological, and treatment data from 20 patients admitted with KLAS. Patients were divided into survivor (n = 15) and non-survivor (n = 5) groups. Univariate analyses were performed using appropriate statistical tests to compare groups and identify mortality-related factors. Results: The overall in-hospital mortality rate was 25.0% (5/20). Factors significantly associated with mortality included undergoing laparotomy drainage (60.0% vs. 6.7%, p = 0.018) and developing in-hospital complications (80.0% vs. 6.7%, p = 0.002). Laparoscopic drainage was significantly associated with survival (93.3% vs. 40.0%, p = 0.026). Trends toward increased mortality were observed with diabetes mellitus and higher glucose levels at admission. Despite p-values < 0.05 from prior Fisher’s exact test, and the fact that ESBL positivity (OR = 22, 95% CI 0.86–571.32) and septic shock at admission (OR = 16.08, 95% CI 0.75–343.64) showed a very high point estimate for risk of mortality, the association was not statistically significant in our study. Conclusions: Mortality in this KLAS cohort was considerable. The necessity for open drainage and the development of in-hospital complications emerged as significant predictors of death, while other independent risk factor such as diabetes mellitus, high blood glucose levels at admission, septic shock at admission, and ESBL-positive strains indicated a trend towards unfavorable outcomes. These findings underscore the importance of aggressive sepsis management and addressing antimicrobial resistance. Conflicting results regarding the statistical significance of independent risk factors due to a limited sample size highlight the need for larger studies to confirm these findings. Full article

Hepatic mucormycosis is a rare but often fatal opportunistic fungal infection, primarily affecting immunocompromised patients. Herein, we report such a case from MD Anderson Cancer Center (Houston, TX, USA) and systematically review published cases in patients ≥ 19 years of age to better characterize clinical presentation, diagnostic challenges, and treatment outcomes of hepatic mucormycosis. Among the 40 identified cases (including ours), hematologic malignancies (55%) and solid organ transplantation (30%) were the most common underlying conditions. Fever (70%) and abdominal pain (63%) were the predominant symptoms. Imaging revealed multiple hepatic lesions in 72% of cases. Diagnosis was primarily based on histopathology (73%), whereas culture positivity was low (36%), underscoring the difficulty of pathogen isolation. Mucorales-active antifungal therapy was often delayed but eventually used in 85% of cases (all amphotericin B +/− Mucorales-active triazoles), while 45% underwent additional surgical intervention. Despite treatment, 1-year all-cause mortality remained high at 46%, with a trend towards lower mortality for those who underwent surgery compared to non-surgical management (35% vs. 55%, p = 0.334). These findings highlight the aggressive nature of hepatic mucormycosis and the importance of early recognition as well as the need for non-culture-based diagnostics and multimodal treatment approaches. Improved awareness and further research into optimized management strategies are crucial to improve the outcomes of this challenging infection. Full article

Community-acquired infections caused by Klebsiella pneumoniae (K. pneumoniae) have become a significant global health concern, particularly with the emergence of hypervirulent strains (hvKP). These strains are associated with severe infections, such as pyogenic liver abscesses, even in otherwise healthy individuals. Initially reported in Taiwan in the 1980s, hvKP has now spread worldwide. The pathogenicity of hvKP is attributed to an array of virulence factors that enhance its ability to colonize and evade host immune defenses. Additionally, the convergence of hypervirulence with antibiotic resistance has further complicated treatment strategies. As a member of the ESKAPE group of pathogens, K. pneumoniae exhibits high resistance to multiple antibiotics, posing a challenge for healthcare settings. This review provides a comprehensive overview of hvKP, highlighting its structural and pathogenic differences from classical K. pneumoniae strains, key virulence factors, mechanisms of antibiotic resistance, and the increasing threat of multidrug-resistant hvKP. Lastly, we discuss current treatment guidelines and emerging therapeutic strategies to combat this formidable pathogen. Full article

This study evaluates the effects of a proprietary tannin blend (BX), supplemented with or without sodium monensin (MON), on beef cattle performance, carcass traits, and health. Steers (n = 2986; initial shrunk body weight (SBW) 254 ± 9.2 kg) were allocated into 48 pens (61–62 steers/pen; 12 pens/treatment) fed for 230 d. Treatments included: (1) no feed additives (CTL); (2) BX (7.95 g/animal daily); (3) MON + Tylosin phosphate (TYL; 437.52 mg MON/animal daily + 80 mg TYL/animal daily); or (4) MON + BX (437.52 mg MON/animal daily + 7.95 g BX/animal daily). Data were analyzed in R 4.2.1 using a randomized block design with pen as the experimental unit. Dry matter intake was lower (p < 0.001) in MON + TYL and MON + BX than in CTL. Steers fed MON + BX had greater carcass-adjusted final SBW (p = 0.002), average daily gain (p = 0.002), fat thickness (p = 0.035), and marbling score (p = 0.046) than BX. Feed conversion improved in MON + TYL and MON + BX (p < 0.001). CLT and BX had higher (p < 0.001) liver abscess prevalence compared to MON + BX and MON + TYL. The addition of BX did not improve the parameters measured. Steers fed MON + BX showed reduced liver abscesses and similar feed efficiency compared to MON + TYL. Full article

Urinary actinomycosis is a rare condition, often mimicking a urinary tract tumor. Due to its low prevalence, it can be challenging to diagnose and may be mistaken for malignancies. A 33-year-old female patient with a history of type 2 Diabetes Mellitus and recurrent urinary tract infections presented to the emergency room with right renal fossa pain radiating to the right hypochondrium, fever with chills, nausea, and vomiting. Physical examination revealed a positive Giordano sign and tenderness at the ipsilateral middle and upper ureteral points. A contrast-enhanced CT scan showed a mass infiltrating the distal third of the right ureter, causing retrograde dilatation and hydronephrosis. Additionally, a liver injury with both liquid and solid components was observed. Therefore, given the suspicion of a urothelial tumor, a diagnostic cystoscopy and ureteroscopy were performed. Using interventional radiology, an abscessed liver lesion was drained, yielding purulent fluid. The histopathological examination revealed no evidence of malignancy. However, due to the strong suspicion of upper urinary tract urothelial carcinoma, a right radical nephroureterectomy with bladder cuff excision and retroperitoneal lymphadenectomy was performed. Histopathological examination ultimately confirmed urinary actinomycosis. Consequently, antibiotic therapy with oral amoxicillin 2 g every 12 h was initiated, leading to a good clinical response. Despite its low incidence, urinary actinomycosis should be considered as a differential diagnosis in cases suspected of urothelial tumors in the upper urinary tract. Increased awareness of this rare condition may help prevent unnecessary surgical interventions. Full article

Melioidosis, caused by Burkholderia pseudomallei, is a potentially fatal infection, particularly affecting individuals with chronic conditions such as diabetes or kidney or liver diseases. This review examines melioidosis in India over the past two decades, focusing on its prevalence, risk factors and clinical manifestations. A PubMed search (2000–2024) identified a rise in melioidosis publications, with most from Southern India, followed by Eastern India, and an increase post-2019. Eight studies from 2010–2022 identified fever (86%), cough (26%) and joint pain (23%) as the most common symptoms, while diabetes (75%), alcohol abuse (19%) and cancer (6%) were primary predisposing factors. Severe clinical manifestations were also observed, including bacteremia (50%), pneumonia (37%) and splenic abscess (18%). Although environmental exposure risks were not significantly high, individuals with diabetes or chronic kidney disease, particularly those working in high-risk environments, were more likely to contract melioidosis. Cryptic environmental factors that might bridge known epidemiological risk factors are also addressed. The review emphasizes the increasing awareness and research in clinical epidemiology and also highlights a gap in studies on antimicrobial treatments, vaccines and environmental surveillance. Targeted interventions in diabetes and poverty hotspots could help control the disease more effectively. Full article

The tapeworms Echinococcus granulosus and Echinococcus multilocularis cause two different clinical manifestations in humans: cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. Both forms of echinococcosis manifest primarily in the liver, while other organs or tissues are less frequently affected. Simultaneous occurrence of CE and AE is extremely rare, and all previously reported patients exhibited affected livers, while simultaneous infection without liver involvement has not yet been described. Herein, we present an exclusively extrahepatic E. granulosus and E. multilocularis coinfection localized between the calf muscles of a patient. Due to progressive painful local swelling, an abscess was suspected, but there was no improvement after the administration of multiple courses of antibiotics. When imaging diagnostics suggested a parasitic origin of the two identified cystic lesions, positive serology for both species indicated a dual infection. Albendazole therapy was started, and extensive surgical excision was performed. Both species were confirmed using PCR and sequencing from intraoperative samples. The current case shows that coinfection without liver involvement can occur, even in patients from low-incidence regions, which should be considered in the differential diagnosis of patients with unusual clinical presentation. Full article

Umbilical disorders are common in equids, although scarce information is available in donkeys compared to horses. Foals with these disturbances have high morbidity and mortality rates. The conventional omphalectomy technique does not remove the whole umbilical vein, which can lead to infection in the remnant vein or even liver abscess. At the moment, if the whole umbilical vein needs to be removed, a longer ventral midline incision must be performed, which is linked with several complications. This retrospective case series study focused on a modified two-step omphalectomy using the LigaSure^TM device in each step in five neonate foals (4 horses and 1 donkey) with umbilical disorders. Using this modified technique, the whole umbilical vein (from the stump to the liver) can be removed without the need of incision extension. Two foals in this series had complications not related with the surgery and had to be euthanized. In the surviving foals (three of five), no long-term complications have been reported. Therefore, this modified two-step technique using the LigaSure^TM device could be a suitable surgical option to decrease short- and long-term complications in neonate foals undergoing umbilical surgery. However, a multicentric prospective study on a larger number of animals is required. Full article

Trueperella pyogenes is a widely distributed opportunistic pathogenic bacterium that can infect livestock, wildlife, community animals, and humans, resulting in suppurative infection of tissue and organ mucosa, including pneumonia, liver abscessation, mastitis, metritis, endocarditis, and osteoarthritis. TP1804 and TP1808 were isolated from the uterine lavage fluid of cows with endometritis. This study analyzed the prokaryotic transcriptomics and proteomics of two strains of T. pyogenes with similar growth curves but different cytotoxicity. Studying the metabolic mechanisms of these differentially expressed genes and proteins can greatly promote the discovery of new biomarkers and improve the accuracy of biomarker identification, which is of great value for molecular mechanisms, biomarkers, early diagnosis of diseases, molecular typing, and prognosis. Our results indicate that the control of the virulence by tRNAs to bacteria during ribosome biosynthesis is crucial. Full article

Fusobacterium necrophorum subspecies necrophorum, a resident of the rumen, is the causative agent of bovine liver abscesses. Currently, tylosin, a macrolide, is used in the feed to reduce liver abscesses. Because macrolides are medically important antibiotics, their use in food animal production is of public health concern. There is significant interest in finding antimicrobial alternatives. Bacteriophages that lyse subsp. necrophorum have the potential to replace tylosin. Our objective was to isolate bacteriophages lytic to subsp. necrophorum. Pooled ruminal fluid from slaughtered cattle and pooled sewage samples were collected and incubated overnight with lysine, and subsp. necrophorum strains and filtrates were spotted on F. necrophorum lawns. Phage plaques were harvested and purified. Bacteriophage isolation frequencies were compared between sample types, sampling dates, and necrophorum strains. Overall relative frequency of isolated bacteriophages lytic to subsp. necrophorum was 17.1%. The frequency of bacteriophage isolation ranged from 0 to 25.4% for ruminal fluid, and from 13.7 to 32.0% for sewage. Isolation frequency was significantly higher in sewage than in ruminal fluid samples (p < 0.01). Isolation rates varied significantly between necrophorum strains. Sewage was a rich source of bacteriophages lytic to necrophorum, which have the potential to be used to prevent liver abscesses. Full article

Intracranial abscesses are a common cause of morbidity and mortality in neurologic free-ranging white-tailed deer (Odocoileus virginianus). These infections are typically attributed to Trueperella pyogenes and occur most often in adult males with concurrent antler and skull infections. A subset of intracranial abscesses in white-tailed deer are localized to the pituitary gland, with previously described reports in five white-tailed deer. In this case series, five additional free-ranging white-tailed deer in Pennsylvania were diagnosed with pituitary abscesses at necropsy. Two cases were female deer, and four cases were yearling or juvenile deer. Two cases presented with conjunctivitis and keratitis due to extension of pituitary abscesses into the retrobulbar and peri-orbital spaces. One case had a concurrent liver abscess. This case series demonstrates a unique clinical presentation of keratitis and conjunctivitis and emphasizes the potentially unique pathogenesis for pituitary abscesses compared to other intracranial abscesses described in white-tailed deer. Full article

Intrahepatic abscess is an exceedingly rare complication of locoregional therapy for patients with liver cancer. However, in patients who underwent prior hepatobiliary intervention, the incidence of liver abscess increases significantly, causing morbidity and even mortality in such patients. Here, we will review the relative risk of developing a liver abscess after intraarterial and ablative locoregional therapies in patients with liver cancer depending on whether they underwent any kind of prior hepatobiliary procedures that resulted in violation of the Ampulla of Vater. As a result, patients deemed at high risk of developing a liver abscess were treated prophylactically, with the combination of bowel preparation and antibiotics nearly eliminating the occurrence of a liver abscess after locoregional therapy. Therefore, given the significant risk of developing a liver abscess in patients with prior hepatobiliary procedures, management consisting of prophylactic bowel preparation with antibiotic coverage followed by antibiotics post-locoregional therapy is recommended. Full article

This study aimed to provide insights into the main causes of postmortem carcass and organ condemnations in a pig slaughterhouse and evaluate the resulting financial impact of the rejection of edible parts of animals. A population of 307,866 pigs, admitted for slaughter between January 2021 and December 2022 in a Bavarian abattoir, was studied. Regarding the examined carcasses, 2.09% (n = 6422) presented pathological conditions. Of these, 8.12% (n = 522) and 91.88% (n = 5900) were totally and partially confiscated, respectively. The main reason for the complete rejection of carcasses was the occurrence of generalized diseases (62.6%), while the presence of abscesses and traumatic and/or tail lesions was the most frequently implicated (70.7%) in partial condemnations. In the case of the organs, 17.59% (n = 54,145) presented abnormalities, with distributions of 14.71% (n = 45,290), 1.94% (n = 5968), 0.72% (n = 2213), and 0.22% (n = 674) within the examined liver, lung, kidney, and heart specimens, respectively. The principal reasons for liver, lung, kidney, and heart condemnations were the occurrence of parasitic diseases (53.4%), bacterial/viral infections (63.5%), dystrophies/anomalies (98.4%), and bacterial/viral infections (98.5%), respectively. The total financial loss attributable to carcass and organ condemnations was estimated at EUR 392,744.2, which represents 0.40% of the total achievable net revenue without rejections. Of this, EUR 197,120 (0.20%) and EUR 195,624.2 (6.95%) were related to carcass and offal seizures, respectively. The study results offer useful information for veterinarians, stockowners, and epidemiologists to make and set up policies to increase the efficiency and benefits of the swine production system and protect public health. Full article

Objectives: This study aimed to investigate the association between nonalcoholic fatty liver disease (NAFLD), assessed by the Fatty Liver Index (FLI), and the occurrence of lung abscess within a large population-based cohort. Method: We conducted a nationwide retrospective study using data from 367,930 subjects who underwent National Health check-ups between 2009 and 2018. Cox proportional hazards regression was performed to evaluate the association between the FLI and the incidence of lung abscess and community-acquired pneumonia (CAP) after adjusting for age, sex, and relevant covariates. Results: Among the study population, 455 (0.12%) and 44,934 (12.2%) patients were diagnosed with lung abscesses and CAP, respectively. The cumulative incidence of lung abscess was higher in individuals with elevated FLI values (FLI < 30, 0.10%; 30 ≤ FLI < 60, 0.16%; FLI ≥ 60, 0.18%; p < 0.001), whereas the incidence of CAP decreased across FLI groups (FLI < 30, 12.4%; 30 ≤ FLI < 60, 12.3%; FLI ≥ 60, 11.0%; p < 0.001). After adjusting for covariates, the risk of lung abscess significantly increased in the 30 ≤ FLI < 60 (Hazard ratio (HR) = 1.26; 95% confidence interval (CI), 0.95–1.68; p = 0.115) and the FLI ≥ 60 (HR = 1.67; 95% CI, 1.37–2.29; p < 0.001) groups, although the risk of CAP was relatively small in both groups (30 ≤ FLI < 60; HR = 1.06; 95% CI, 1.03–1.09; p < 0.001) (FLI ≥ 60; HR = 1.13; 95% CI, 1.08–1.12; p < 0.001). Conclusions: Our study provides compelling evidence supporting a potential link between NAFLD, as measured by FLI, and the incidence of lung abscess. These findings suggest the importance of vigilant monitoring of respiratory health in patients with NAFLD and emphasise the need for early detection of possible complications. Full article