MyMedR

Parallel ELISAs using crude soluble antigen and excretory-secretory antigen for improved serodiagnosis of amoebic liver abscess

Wong WK, Foo PC, Olivos-Garcia A, Noordin R, Mohamed Z, Othman N, et al.

Acta Trop, 2017 Aug;172:208-212.

PMID: 28506795 DOI: 10.1016/j.actatropica.2017.05.017

Crude soluble antigen (CSA) produced from Entamoeba histolytica trophozoite is conventionally used for serodiagnosis of invasive amoebiasis. However, high background seropositivities by CSA-assay in endemic areas complicate the interpretation of positive result in clinical settings. Instead, incorporating a second assay which indicates active or recent infection into the routine amoebic serology could possibly complement the limitations of CSA-assay. Hence, the present study aimed to evaluate the diagnostic efficacies of indirect ELISAs using CSA and excretory-secretory antigen (ESA) for serodiagnosis of amoebic liver abscess (ALA). Reference standard for diagnosis of ALA at Hospital Universiti Sains Malaysia is based on clinical presentation, radiological imaging and positive indirect haemagglutination assay (titer ≥256). Five groups of human serum samples collected from the hospital included Group I - ALA diagnosed by the reference standard and pus aspirate analysis using real-time PCR (n=10), Group II - ALA diagnosed by the reference standard only (n=41), Group III - healthy control (n=45), Group IV - other diseases control (n=51) and Group V - other infectious diseases control (n=31). For serodiagnosis of ALA serum samples (Group I and II), CSA-ELISA showed sensitivities of 100% for both groups, while ESA-ELISA showed sensitivities of 100% and 88%, respectively. For serodiagnosis of non-ALA serum samples (Group III, IV and V), CSA-ELISA showed specificities of 91%, 75% and 100%, respectively; while ESA-ELISA showed specificities of 96%, 98% and 100%, respectively. Indirect ELISAs using CSA and ESA have shown distinct strength for serodiagnosis of ALA, in terms of sensitivity and specificity, respectively. In conclusion, parallel analysis by both assays improved the overall efficacies of amoebic serology as compared to either single assay.

Matched MeSH terms: Liver Abscess, Amebic/blood; Liver Abscess, Amebic/diagnosis*; Liver Abscess, Amebic/epidemiology; Liver Abscess, Amebic/parasitology

Hepatic resection. Pillars of success built on the foundation of 15 years of experience

Balasegaram M, Joishy SK

Am J Surg, 1981 Mar;141(3):360-5.

PMID: 6259961

Two hundred eight-eight hepatic resections performed over the past 15 years are discussed. The safety and success achieved are attributed to the original work in Malaysia on the anatomy of the liver and its anomalies, the use of surgical instruments specially designed for hepatic resection, various types of resections devised and studies on aids to liver regeneration after resection. The diversity of the principles and practice of surgery in the Western countries compared with those in Malaysia is illustrated.

Matched MeSH terms: Liver Abscess/surgery

Fulltext New concepts of hepatic amoebiasis

Balasegaram M

Ann Surg, 1972 Apr;175(4):528-34.

PMID: 4259839

Matched MeSH terms: Liver Abscess, Amebic/diagnosis*; Liver Abscess, Amebic/surgery*

Fulltext Detection of Entamoeba histolytica in experimentally induced amoebic liver abscess: comparison of three staining methods

Ning TZ, Kin WW, Mustafa S, Ahmed A, Noordin R, Cheong TG, et al.

Asian Pac J Trop Biomed, 2012 Jan;2(1):61-5.

PMID: 23569836 DOI: 10.1016/S2221-1691(11)60191-3

To compare the efficacy of three different tissue stains, namely haematoxylin and eosin (H&E), periodic-acid Schiff (PAS) and immunohistochemical (IHC) stains for detection of Entamoeba histolytica (E. histolytica) trophozoites in abscessed liver tissues of hamster.

Matched MeSH terms: Liver Abscess, Amebic/diagnosis*; Liver Abscess, Amebic/pathology*

Liver abscess caused by tuberculosis and melioidosis

Azali HY, Norly S, Wong LM, Tan KS, Safian NM

Asian J Surg, 2007 Apr;30(2):138-40.

PMID: 17475585

We report an unusual co-existence of Burkholderia pseudomallei and acid fast bacilli in a young Malay gentleman with liver abscess. He was treated with antibiotics and surgical drainage. This phenomenon has not been reported in previous literature and the dilemma of its management is discussed.

Matched MeSH terms: Liver Abscess/microbiology*

Fulltext Evaluation of Entamoeba histolytica recombinant phosphoglucomutase protein for serodiagnosis of amoebic liver abscess

Ning TZ, Kin WW, Noordin R, Cun ST, Chong FP, Mohamed Z, et al.

BMC Infect Dis, 2013;13:144.

PMID: 23514636 DOI: 10.1186/1471-2334-13-144

Amoebic liver abscess (ALA) is the most frequent clinical presentation of extra-intestinal amoebiasis. The diagnosis of ALA is typically based on the developing clinical symptoms, characteristic changes on radiological imaging and serology. Numerous serological tests have been introduced for the diagnosis of ALA, either detecting circulating amoebic antigens or antibodies. However those tests show some pitfalls in their efficacy and/or the preparation of the tests are costly and tedious. The commercial IHA kit that used crude antigen was reported to be useful in diagnosis of ALA, however high antibody background in endemic areas may cause problems in its interpretation. Thus, discovery of well-defined antigen(s) is urgently needed to improve the weaknesses of current serodiagnostic tests.

Matched MeSH terms: Liver Abscess, Amebic/blood; Liver Abscess, Amebic/diagnosis*; Liver Abscess, Amebic/immunology

Fulltext Honeycomb and necklace signs in liver abscesses secondary to melioidosis

Ong SCL, Alemam MMM, Zakaria NA, Abdul Halim NA

BMJ Case Rep, 2017 Oct 19;2017.

PMID: 29054959 DOI: 10.1136/bcr-2017-222342

Melioidosis is endemic in Southeast Asia and tropical Australia with varying clinical features from benign skin lesions to fatal septicaemia. Imaging plays an important role in evaluation of the melioid liver abscesses. A 45-year-old man with underlying diabetes presented with fever and lethargy for 2 weeks and abdominal pain for 2 days. His liver was enlarged on examination. Blood investigations revealed mild leucocytosis and raised liver enzymes. Ultrasound showed multiple multiloculated hypoechoic lesions throughout the liver and spleen. CT of abdomen confirmed that some liver lesions were made up of asymmetric locules of varying sizes (honeycomb sign), while others had hypodense centre with small symmetric peripheral locules in radial fashion (necklace sign). Blood culture was positive for Burkholderia pseudomallei He was subsequently treated with ceftazidime for a month followed by oral trimethoprim-sulfamethoxazole for 3 months. Follow-up CT of abdomen a month after diagnosis and treatment showed resolving hepatic and splenic lesions.

Matched MeSH terms: Liver Abscess/etiology

Chromobacterium violaceum infection

Tee HP, Francis AL, How SH

Br J Hosp Med (Lond), 2006 Apr;67(4):208-9.

PMID: 16681318 DOI: 10.12968/hmed.2006.67.4.20869

Matched MeSH terms: Liver Abscess, Pyogenic/diagnosis*; Liver Abscess, Pyogenic/drug therapy

Fulltext Analysis of Entamoeba histolytica excretory-secretory antigen and identification of a new potential diagnostic marker

Wong WK, Tan ZN, Othman N, Lim BH, Mohamed Z, Olivos Garcia A, et al.

Clin Vaccine Immunol, 2011 Nov;18(11):1913-7.

PMID: 21918120 DOI: 10.1128/CVI.05356-11

Serodiagnosis of amoebiasis remains the preferred method for diagnosis of amoebic liver abscess (ALA). However, the commercially available kits are problematic in areas of endemicity due to the persistently high background antibody titers. Human serum samples (n = 38) from patients with ALA who live in areas of endemicity were collected from Hospital Universiti Sains Malaysia during the period of 2008 to 2010. Western blots using excretory-secretory antigen (ESA) collected from axenically grown Entamoeba histolytica were probed with the above serum samples. Seven antigenic proteins of ESA with various reactivities were identified, i.e., 152 kDa, 131 kDa, 123 kDa, 110 kDa, 100 kDa, 82 kDa, and 76 kDa. However, only the 152-kDa and 110-kDa proteins showed sensitivities above 80% in the Western blot analysis. All the antigenic proteins showed undetectable cross-reactivity when probed with healthy human serum samples (n = 30) and serum samples from other infections (n = 33). From the matrix-assisted laser desorption ionization-two-stage time of flight (MALDI-TOF/TOF) analysis, the proteins were identified as heavy subunits of E. histolytica lectin and E. histolytica pyruvate phosphate dikinase, respectively. Use of the E. histolytica lectin for diagnosis of ALA has been well reported by researchers and is being used in commercialized kits. However, this is the first report on the potential use of pyruvate phosphate dikinase for diagnosis of ALA; thus, this molecule merits further evaluation on its diagnostic value using a larger panel of serum samples.

Matched MeSH terms: Liver Abscess, Amebic/diagnosis*

Fulltext Utilization of Point-of-Care Ultrasound to Detect Splenic Microabscesses in Pediatric Melioidosis

Sakulchit T, Ngu L, Chor YK, Ong GY

Cureus, 2021 Mar 08;13(3):e13760.

PMID: 33842136 DOI: 10.7759/cureus.13760

Melioidosis is an infectious disease most commonly found in places with tropical climates. Definitive diagnosis can be confirmed by culture or pathological results of blood or infected organ. However, imaging study is helpful in providing early provisional diagnosis and guiding therapy. Point-of-care ultrasound can be currently performed bedside by non-radiological staff such as emergency physicians or intensivists. We present the case of a pediatric patient who got diagnosed with melioidosis after detection of multiple splenic and hepatic abscesses by point-of-care ultrasound, leading to early diagnosis and appropriate empirical antibiotic selection, resulting in good treatment outcome.

Matched MeSH terms: Liver Abscess

Entamoeba histolytica antigenic protein detected in pus aspirates from patients with amoebic liver abscess

Othman N, Mohamed Z, Yahya MM, Leow VM, Lim BH, Noordin R

Exp Parasitol, 2013 Aug;134(4):504-10.

PMID: 23680184 DOI: 10.1016/j.exppara.2013.05.001

Entamoeba histolytica is a causative agent of amoebic liver abscess (ALA) and is endemic in many underdeveloped countries. We investigated antigenic E. histolytica proteins in liver abscess aspirates using proteomics approach. Pus samples were first tested by real-time PCR to confirm the presence of E. histolytica DNA and the corresponding serum samples tested for E. histolytica-specific IgG by a commercial ELISA. Proteins were extracted from three and one pool(s) of pus samples from ALA and PLA (pyogenic liver abscess) patients respectively, followed by analysis using isoelectric focussing, SDS-PAGE and Western blot. Unpurified pooled serum samples from infected hamsters and pooled human amoebic-specific IgG were used as primary antibodies. The antigenic protein band was excised from the gel, digested and analysed by MALDI-TOF/TOF and LC-MS/MS. The results using both primary antibodies showed an antigenic protein band of ∼14kDa. Based on the mass spectrum analysis, putative tyrosine kinase is the most probable identification of the antigenic band.

Matched MeSH terms: Liver Abscess, Amebic/immunology*; Liver Abscess, Amebic/parasitology

Ultrasound in the diagnosis of liver abscess

Sathyamoorthy P

Family Physician, 1990;2:28-31.

A retrospective analysis of 49 patients with 55 liver abscesses evaluated by diagnostic ultrasonography was made. The sonographic appearances were varied and non-specific. 96% of the abscesses were in the right lobe of the liver. Sonographic features which were frequently observed include (a) predominantly hypoechoic internal echotexture (64%) (b) distal sonic enhancement (98%) (c) well-defined margin with an abrupt transition between normal liver parenchyma and lesion (96%) and (d) absence of wall echoes (89%). A combination of these features has considerable diagnostic value. Distal sonic enhancement is of particular diagnostic importance. In equivocal cases the diagnosis can be quickly determined by percutaneous needle aspiration under ultrasound guidance.

Matched MeSH terms: Liver Abscess

Application of real-time polymerase chain reaction in detection of Entamoeba histolytica in pus aspirates of liver abscess patients

Othman N, Mohamed Z, Verweij JJ, Huat LB, Olivos-García A, Yeng C, et al.

Foodborne Pathog Dis, 2010 Jun;7(6):637-41.

PMID: 20132028 DOI: 10.1089/fpd.2009.0427

Entamoeba histolytica is the second major cause of liver abscess disease in humans, particularly in developing countries. Recently, DNA molecular-based methods have been employed to enhance the detection of E. histolytica in either pus or stool specimens. In this study, the results of real-time polymerase chain reaction (PCR) to detect E. histolytica DNA in pus from liver abscess cases were compared with those of indirect hemagglutination assay on the corresponding serum samples. Bacterial cultures were also performed on the pus samples for the diagnosis of pyogenic liver abscess. The real-time PCR detected E. histolytica DNA in 23 of 30 (76.7%) pus samples, when compared with 14 of 30 (46.7%) serum samples in which anti-Entamoeba antibodies were detected by indirect hemagglutination assay and 4 of 30 (13.3%) pus samples that showed bacterial infection by culture. The use of real-time PCR is a promising detection method for diagnosis and epidemiology assessment of amoebic liver abscess.

Matched MeSH terms: Liver Abscess, Amebic/blood; Liver Abscess, Amebic/diagnosis; Liver Abscess, Amebic/parasitology*; Liver Abscess, Pyogenic/diagnosis; Liver Abscess, Pyogenic/microbiology

Caecal tumour with hepatic metastases?

Rajendra S, Kutty K

Gut, 2005 Feb;54(2):178, 200.

PMID: 15647173

Matched MeSH terms: Liver Abscess, Amebic/radiography*

Fulltext Liver abscess from retained cystic stones following laparoscopic cholecystectomy: A case report

Marjmin Osman, Razman, J., Shaharin, S.

International Medical Journal Malaysia, 2007;6(1):1-5.

MyJurnal

One of the causes of post cholecystectomy pain is due to stone in the cystic duct. This is a very rare occurrence although it can be debilitating to the patient. We report a case of a 64 year old man presented with retained cystic duct stone post cholecystectomy complicated by liver abscess and biloma. The management of this unusual presentation is discussed.

Matched MeSH terms: Liver Abscess

Fulltext Amoebic colitis with liver abscess

Mansharan Kaur Chaincel Singh

International e-Journal of Science, Medicine & Education, 2018;12(1):27-31.

MyJurnal

Amoebiasis is a parasitic infection caused by the
intestinal protozoan Entamoeba histolytica, most
prevalent in developing countries. It results in 40,000 to
100,000 deaths each year from amoebic colitis and extra
intestinal infections. Amoebic liver abscess (ALA)
is the most common extra intestinal site of infection
with an incidence of between 3% and 9% of all cases of
amoebiasis. Ultrasound which has a sensitivity of more
than 90% for detecting ALA is highly recommended
as an initial investigation followed by serological
demonstration of circulating antibodies specific to
Entamoeba histolytica.

Matched MeSH terms: Liver Abscess, Amebic

Fulltext Detection of spleen abscesses facilitates diagnosis of melioidosis in Malaysian children

Mohan A, Manan K, Tan LS, Tan YC, Chin ST, Ahmad R, et al.

Int J Infect Dis, 2020 Sep;98:59-66.

PMID: 32535300 DOI: 10.1016/j.ijid.2020.06.025

OBJECTIVES: Melioidosis is associated with extremely high case fatality ratios. The aim of this study was to determine whether detection of abdominal visceral abscesses can facilitate diagnosis of melioidosis in children.

METHODS: We conducted a retrospective analysis of all children who had liver and/or spleen abscesses on abdominal ultrasonography admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2014 until December 2018.

RESULTS: Fifty-three children had liver and/or spleen abscesses. Spleen abscesses were present in 48 (91%) cases; liver abscesses in 15 (28%). Melioidosis was confirmed by culture in 9 (17%) children; small occult splenic abscesses were present in all cases. In 78% of these cases, the lesions were detected before any positive culture (or serology) results were available. Four (8%) children had bacteriologically-confirmed tuberculosis. Two (4%) had Staphylococcus aureus infection. Of the remaining 38 (72%) culture-negative cases, 36 (95%) had clinical and imaging characteristics similar to that of children with culture-confirmed melioidosis and improved with empirical melioidosis antibiotic therapy.

CONCLUSIONS: A large number of children in Bintulu Hospital in Sarawak, Malaysia, were found to have spleen abscesses. Melioidosis was the most common etiology identified in these children. Abdominal ultrasonography is extremely useful in facilitating the diagnosis of pediatric melioidosis.

Matched MeSH terms: Liver Abscess/diagnosis; Liver Abscess/epidemiology

Tuberculous liver abscess

Goh KL, Pathmanathan R, Chang KW, Wong NW

J Trop Med Hyg, 1987 Oct;90(5):255-7.

PMID: 3669128

Tuberculous liver abscess is uncommonly seen in our experience. We report a case of a 17-year-old boy who presented with typical clinical features of liver abscess, where a diagnosis of tuberculous liver abscess was made on laparotomy and biopsy of the abscess wall.

Matched MeSH terms: Liver Abscess/diagnosis*; Liver Abscess/pathology

Fulltext Keeping an eye out for klebsiella endopthalmitis: klebsiella pneumoniae invasive liver abscess syndrome

Jia Ying S, Ian C, Azlanudin A, Zamri Z, Hairol O

Journal of Surgical Academia, 2018;8(2):35-38.

MyJurnal

Hypervirulent Klebsiella pneumoniae strain is a major cause of liver abscess and this bacteria has metastatic properties. This distinct liver abscess syndrome has been increasingly reported in Asia over the past two decades, but is emerging as a global disease. We described an 81-year-old lady, who presented to the emergency department with 1-week prior duration of fever and right eye swelling. She had been admitted for recurrent liver abscess prior to this. Hence, she was initially treated as sepsis secondary to recurrent liver abscess. Meanwhile, she was managed concurrently by ophthalmology team for endophtalmitis. Despite the initiation of treatment with antibiotics, she did not show any improvement and required right eye evisceration to treat the sepsis. Invasive liver abscess syndrome with metastatic endophthalmitis should be screened in patient with Klebsiella liver abscess. They should be monitored for ocular symptoms as early recognition can prohibit delays in treatment, which has debilitating consequences.

Matched MeSH terms: Liver Abscess

Clinical characteristics and outcomes of bacteraemic melioidosis in a teaching hospital in a northeastern state of Malaysia: a five-year review

Deris ZZ, Hasan H, Siti Suraiya MN

J Infect Dev Ctries, 2010 Aug 04;4(7):430-5.

PMID: 20818090

BACKGROUND: Melioidosis is an important public health problem causing community acquired sepsis in the northeastern part of Malaysia.

METHODOLOGY: From January 2001 to December 2005, we reviewed case reports of all bacteraemic melioidosis admitted to a tertiary teaching hospital, Hospital Universiti Sains Malaysia.

RESULTS: Thirty-five patients had positive blood culture for meliodosis and 27 case reports were traceable for further analysis. The mean age was 46.8 + 20.0 years. Twenty patients (74.1%) were male. The main clinical presentation was fever that occurred in 23 (85.2%) patients. Eighteen patients (66.7%) had lung involvement and three patients had liver abscess. Two patients presented with scrotal swelling, one of whom further developed Fournier's Gangrene. Nineteen (70.4%) patients had underlying diabetes, five of whom were newly diagnosed during the admission. Thirteen (48.1%) patients were treated with high-dose ceftazidime and six (22.2%) patients were treated with imipenem. Eight (29.6%) patients were not given anti-melioidosis therapy because the causative agents were not identified until after the patients died. The patients were admitted 16.8 days + 18.1. Seventeen patients (63.0%) died in this series, 13 patients of whom died within four days of admission.

CONCLUSIONS: The wide range of clinical presentations and the fatal outcomes of melioidosis require a high level of suspicion among physicians to develop an early appropriate therapy and reduce the mortality rate.

Matched MeSH terms: Liver Abscess/pathology

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