Hepatic Abscess in Neonates

Moss, Thomas J.

doi:10.1001/archpedi.1981.02130320040014

Cited by 32 publications

(46 citation statements)

References 8 publications

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“…2 When present in children, they occur up to 5 years of age and are associated with thrombophlebitis of the umbilical vein, abdominal trauma or immunosuppressive disease. 3 In adults, pyogenic liver abscesses are frequently polymicrobial, usually due to enteric Gram-negative bacilli (e.g., Escherichia coli) and anaerobic bacteria. In general, Staphylococcus aureus liver abscesses are associated with infection in other organs or related to generalized hematogenous dissemination in children with impaired host defenses.…”

Section: Introductionmentioning

confidence: 99%

Pathogenic aspects of pyogenic liver abscess associated with experimental schistosomiasis.

Teixeira

Coelho²,

Filho³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. Schistosomiasis mansoni infection that occurs concurrently with Staphylococcus aureus bacteremia favors the formation of pyogenic liver abscess. The present experimental study in mice evaluated the following aspects of the relationship between infection with Schistosoma mansoni and liver abscess caused by S. aureus: a) the role of the eggs of S. mansoni in the genesis of the abscesses; b) the influence of different phases of schistosomiasis in the development of liver abscesses; and c) the effect of the treatment of schistosomiasis on the development of the abscesses. Macroscopic and histopathological study showed multiple liver abscesses around granulomas of S. mansoni in the acute and chronic phases of schistosomiasis. Treatment of acute schistosomiasis before experimentally-induced bacteremia did not prevent the formation of liver abscess. The study findings indicate that granulomas around S. mansoni eggs and worms lodged in the liver provide a focus and substrate for pyogenic abscesses caused by S. aureus.

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Section: Introductionmentioning

confidence: 99%

Pathogenic aspects of pyogenic liver abscess associated with experimental schistosomiasis.

Teixeira

Coelho²,

Filho³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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“…The diagnosis is often missed, or delayed, because of the absence of specific signs or symptoms; these are usually the result of sepsis [3,4]. Out of 13 reported cases, only one was recognized before death [4]. The delay of diagnosis in our case, despite the presence of many risk factors, such as umbilical vein catheter [5], asphyxia neonatorum and sepsis, was due to the absence of specific signs and symptoms.…”

mentioning

confidence: 62%

“…This is particularly true in the neonates reported by Moss and Pysher [4], where only 3 out of thirteen neonates were significantly pyrexial. This is in contrast with other reports, where a number of children older than one month were febrile.The peripheral blood picture shows a wide variation in leukocyte and platelet counts [3,4], and the liver enzymes are inconsistent. Therefore the need for a high index of suspicion is necessary.…”

mentioning

confidence: 99%

“…In an extensive review of literature, Moss and Pysher [4] found only 24 reported cases and added 13 from their institution; but the prevalence will remain unknown, because autopsies are not done routinely, and many cases will escape diagnosis. The diagnosis is often missed, or delayed, because of the absence of specific signs or symptoms; these are usually the result of sepsis [3,4]. Out of 13 reported cases, only one was recognized before death [4].…”

mentioning

confidence: 99%

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Management of Pyogenic Liver Abscess in Neonates

Al-Arfaj

1991

Ann Saudi Med

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A 35-day-old Saudi boy developed respiratory distress from bilateral pneumonitis due to meconium aspiration. He required ventilation for 8 days, and an umbilical vein catheterization for 2 days. He had thrombocytopenia of 16 × 103/cmm. Leukocytosis of 32 × 103/cmm and Hgb of 15.3 × g/L. Two days later he developed fresh signs of sepsis with hepatosplenomegaly, abdominal distension, and generalized erythematous rash. At this stage he had Hgb 15.3 g/L, WBC 45 × 103/cmm and platelet count of 32 × 103; liver enzymes were within normal limits, and PT and PTT were prolonged > 100 sec. Culture of blood, cerebrospinal fluid, and urine were sterile; but that of umbilical venous catheter tip grew Staph epidermidis sensitive to cephalothin, cloxacillin and cefatoxin. The boy was started on cefatoxin.Because of the continuing signs of sepsis, an ultrasound and CT scan of the abdomen were done. The results showed a lesion measuring 2.5 cm consistent with a liver abscess (Figure 1). He was referred to our hospital a week later for further management of the liver abscess.On examination the infant looked healthy, alert, and active, with no dysmorphic feature, except premature closure of coronal suture, with small anterior fontanelle. The liver was palpable 2 cm below the costal margin. The spleen was just palpable. Hgb was 13.2 g/L, WBC 16.8 × 103, platelets 147 × 103/cmm. PT, PTT, and liver enzymes were within normal limits. A radioisotope, sonographic, and CT scanning of the abdomen revealed markedly decreased liver abscess.Because of favorable clinical and radiological data, it was decided to continue the conservative management, using a combination of Cephalothin, Cefatoxin and Cloxacillin. Three weeks later, chest x-rays and CT scanning showed a normal lung and complete resolution of the liver abscess. Antibiotics were stopped and the boy discharged in good health, which continued to be evident when the patient was seen a month later.Pyogenic liver abscess is rare in children, and rarer still in neonates. In an extensive review of literature, Moss and Pysher [4] found only 24 reported cases and added 13 from their institution; but the prevalence will remain unknown, because autopsies are not done routinely, and many cases will escape diagnosis. The diagnosis is often missed, or delayed, because of the absence of specific signs or symptoms; these are usually the result of sepsis [3,4]. Out of 13 reported cases, only one was recognized before death [4]. The delay of diagnosis in our case, despite the presence of many risk factors, such as umbilical vein catheter [5], asphyxia neonatorum and sepsis, was due to the absence of specific signs and symptoms. Moreover, the presence of aspiration pneumonitis overshadowed the true lesion. Fever, as a symptom, may not be specific of hepatic lesion. This is particularly true in the neonates reported by Moss and Pysher [4], where only 3 out of thirteen neonates were significantly pyrexial. This is in contrast with other reports, where a number of children older than one month were febri...

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“…Also, in developed countries, hepatic abscesses are rare in children but, when present, they occur up to 5 years of age and can be associated with thrombophlebitis of the umbilical vein, abdominal traumatism and immunosuppressive disease (Moss & Pysher 1981).…”

Section: Association With Staphylococcus Aureusmentioning

confidence: 99%