Concurrent fusobacterial pyogenic liver abscess and empyema

Unraveling a Unique Encounter of Fusobacterium nucleatum With Empyema: A Case Report and Review of Literature

We report a case of Fusobacterium nucleatum (F. nucleatum) empyema in a 34-year-old male with no significant past medical history or obvious risk factors who presented with shortness of breath and chest pain. His imaging showed complicated parapneumonic effusion which grew F. nucleatum. He was started on piperacillin-tazobactam. The patient's clinical condition deteriorated despite initial therapeutic efforts, leading to escalated antibiotic therapy and further investigations. The patient's subsequent clinical course included pigtail catheter placement with drainage of fluid requiring tpa and dornase alpha, leading to significant improvement and eventual discharge on oral amoxicillin-clavulanic acid.

Pleural empyema secondary to perforated diverticulosis due to biliary neoplasia infiltration

A long-term female smoker presented to the emergency department with cough, greenish mucus and dyspnoea, without fever. The patient also reported abdominal pain and significant weight loss in recent months. Laboratory tests showed leucocytosis with neutrophilia, lactic acidosis and a faint left lower lobe consolidation on chest X-ray, for which she was admitted to the pneumology department and started on broad-spectrum antibiotherapy. After 3 days of clinical stability, the patient deteriorated rapidly, with worsening of analytical parameters and coma. The patient died a few hours later. Given the rapid and unexplained evolution of the disease, a clinical autopsy was requested, which revealed a left pleural empyema caused by perforated diverticula by neoplastic infiltration of biliary origin.

Vertebral osteomyelitis caused by Fusobacterium nucleatum with an associated asymptomatic liver abscess in an immunocompetent adult: a case report and literature review

Fusobacterium nucleatum rarely causes vertebral osteomyelitis or liver abscesses, and no reports exist of it concurrently causing vertebral osteomyelitis and pyogenic liver abscess. A 58-year-old woman with a history of periodontitis presented with worsening lumbago, left lower leg pain, numbness, and fever for a week. Physical examination indicated knocking pain at the L2-L3 levels with a psoas sign on the left side. A magnetic resonance image showed L2-S1 vertebral osteomyelitis and intervertebral discitis, with a left psoas major muscle abscess. Vertebral osteomyelitis caused by Staphylococcus aureus was suspected; blood cultures were obtained, and intravenous cefazolin was administered. Computed tomography, which was performed to detect disseminated foci, revealed a multilocular liver abscess. On day 4 of incubation, the anaerobic blood culture bottles were positive for characteristic filamentous gram-negative rods. The empiric antimicrobial therapy was changed to ampicillin/sulbactam. The isolate was identified as F. nucleatum based on 16S rRNA gene sequencing. The liver abscess was drained on day 12. Based on the antimicrobial susceptibility test results, the patient was treated with intravenous ampicillin/sulbactam for 4 weeks followed by oral amoxicillin/clavulanate for an additional 8 weeks and remained disease-free at the 1-year follow-up. Clinicians should consider F. nucleatum as the causative organism for vertebral osteomyelitis presenting with asymptomatic pyogenic liver abscess. The gold standard for identifying and diagnosing F. nucleatum infections is 16S rRNA gene sequencing, and gram staining helps determine appropriate antimicrobials.

Clinical Characteristics of Diabetes Complicated by Bacterial Liver Abscess and Nondiabetes-Associated Liver Abscess

Background. Bacterial liver abscess (BLA) is a secondary infectious disease caused by hepatic parenchymal inflammation and bacterial necrosis. Studies have shown that diabetic patients with BLA have higher rates of related adverse events than patients without diabetes. Aim. To explore the clinical characteristics of BLA complicated with diabetes and nondiabetes-related BLA. Methods. From January 2019 to June 2020, 61 diabetic patients with BLA were included as the study group, and 61 BLA patients without diabetes were included as the control group. Clinical manifestations, laboratory examination index (prothrombin activity (PTA), albumin (propagated), white blood cell count (WBC), red blood cell count (RBC), plasma fibrinogen (FIB), C-reactive protein (CRP), neutrophil percentage (NEUT), and prealbumin (PA)) levels, blood cultivation, and fester situation in the two groups were analyzed. Results. No differences of Fever, right upper abdominal pain, jaundice, vomiting and nausea, liver tenderness, and liver pain upon percussion were observed between the study and control groups. However, chill, cough and expectoration, and liver pain upon percussion were higher in the study group, while abdominal distension was lower. WBC, RBC, PA, PTA, FIB, and CRP were higher than the control group. NEUT was higher in the study group than in the control group and Alb was lower than that in the control group. There was no significant difference between the positivity of blood bacterial culture in the study and control groups. The positivity rate of Klebsiella pneumoniae in Gram-negative aerobic bacteria in the study group was higher than that in the control group. There was no significant difference between the positivity of fester culture of the two groups. The positivity of K. pneumoniae in Gram-negative aerobic bacteria in the study group was higher than that in the control group. The positivity of E. coli was lower in the study group than in the control group. Conclusion. Clinical manifestations and laboratory results of BLA patients with and without diabetes mellitus were significantly different. The symptoms of diabetics with BLA were serious.

P. micra and F. necrophorum: Hepatic Abscesses in a Healthy Soldier

Parvimonas micra (P. micra) and Fusobacterium necrophorum (F. necrophorum) are two pathogens known to cause odontogenic and oropharyngeal infections. It is exceedingly rare for these bacteria to cause coinfection and even systemic infection. There is limited literature on liver abscesses and bacteremia involving P. micra. Most cases are found in elderly patients with associated gastrointestinal malignancy (24%) or laryngeal pharynx malignancy (28%). However, a substantial portion of described cases were unable to identify a source (36%). A 36-year-old, otherwise healthy male presented for fevers and chills for 2 weeks. After testing negative for initial infectious workup, including COVID-19 multiple times, he was found to have multiple liver abscesses which grew P. micra and F. necrophorum. This case highlights a rare coinfection of hepatic abscesses in an otherwise healthy young immunocompetent adult with a solitary dental caries, resulting in septic shock.

A Rare Case of Hepatic Abscess That Resolved after Drainage of Pleural Empyema

Empyema has rarely been associated with hepatic abscess. In patients with concurrent empyema and hepatic abscess, hepatic abscess drainage is usually required after drainage of the pleura. We present a rare case of a 91-year-old Caucasian man who presented with a 2-week history of productive cough, fever, shortness of breath, and generalized malaise. The patient was found to have concurrent streptococci empyema and hepatic abscess, and, interestingly, the hepatic abscess resolved after the drainage of the empyema and initiation of antibiotics.

Lactococcus lactis ssp lactis a rare cause of liver abscesses: A case report and literature review

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Lactococcus lactis is a rare cause of liver abscesses.

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Lactococcus lactis ssp lactis can cause liver abcesses in immunocompetent people.

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The exposition to unpasteurized dairy products may lead to liver abcess due to L. lactis ssp lactis.

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Young and immunocompetent people can develop liver abscesses, even for bacteria considered as non-pathogenic.

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Antibiotics and percutaneous drainage are the first line for treatment of liver abscesses and have improved the death rate.

Introduction

We present a liver abscess due to Lactococcus lactis ssp lactis.

Case presentation

It is a 27-year-old male patient without history who presented the right hypochondrium pain over 10 days. The physical examination noted right hypochondrium pain and hépatomegally. The ultrasound showed hepatomegaly with liver abcess for the segments IV and V as well as VII and VIII measuring 13 × 8 cm and 7.6 × 4.3 cm respectively. A computed tomography (CT) revealed an abscess for segments IV and V and VI and VII measuring respectively 107 × 89 mm and 55 × 50 mm. He underwent a surgical drainage after a radiologic drainage and antibiotherapy failure with success.

Discussion

Liver abscesses are rare; affect men over 60 years with co-morbidities and those due to L. Lactis ssp lactis are exceptional. Their prevalence is 0.29–1.47% in series of autopsies and 0.008 to 0.16% in hospitalized patients. The most frequently found germs are gram-negative bacilli (40–60%) and anaerobic bacteria (40–50%). Ultrasound and CT scan make the diagnosis in 90% of cases and orients to the etiology. Percutaneous drainage is the first line for treatment, surgical drainage is reserved for percutaneous drainage failures.

Conclusion

Liver abscess due to Lactococcus lactis ssp lactis is very rare. The clinic, diagnostic methods and treatment of this abscess are identical to other abscesses due to other etiologies. The antibiotics and percutaneous drainage of abscesses have improved the death rate from 40% to 10%–25%.

Fusobacterium nucleatum causing a pyogenic liver abscess: a rare complication of periodontal disease that occurred during the COVID-19 pandemic

Fusobacterium nucleatum is a periodontal commensal and pathogen. In rare cases, these anaerobic gram-negative bacilli have been reported to cause pyogenic liver abscesses (PLAs). We describe a patient who developed a periodontal abscess during the COVID-19 pandemic and was unable to access the restricted General Dental Services at this time. She subsequently developed a F. nucleatum bacteraemia and liver abscess. The non-specific signs and symptoms experienced meant the patient self-isolated due to suspected COVID-19 infection and presentation to hospital was delayed. We also include the results of a literature search of other cases of PLAs attributed to F. nucleatum PLAs often develop insidiously. They require percutaneous drainage and prolonged antimicrobial therapy. Clinicians should be aware of this rare complication of a dentoalveolar infection in a patient who is systemically unwell.