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
BACKGROUND Acute pancreatitis(AP)is an inflammatory disease,which presents with epigastric pain and is clinically diagnosed by amylase and lipase three times the upper limit of normal.The 2012 Atlanta classification s...BACKGROUND Acute pancreatitis(AP)is an inflammatory disease,which presents with epigastric pain and is clinically diagnosed by amylase and lipase three times the upper limit of normal.The 2012 Atlanta classification stratifies the severity of AP as one of three risk categories namely,mild AP(MAP),moderately severe AP(MSAP),and severe AP(SAP).Challenges in stratifying AP upon diagnosis suggest that a better understanding of the underlying complex pathophysiology may be beneficial.AIM To identify the role of the chemokine receptor 8(CCR8),expressed by T-helper type-2 Lymphocytes and peritoneal macrophages,and its possible association to Interleukin(IL)-6 and AP stratification.METHODS This study was a prospective case-control study.A total of 40 patients were recruited from the Chris Hani Baragwanath Academic Hospital and the Charlotte Maxeke Johannesburg Academic Hospital.Bioassays were performed on 29 patients(14 MAP,11 MSAP,and 4 SAP)and 6 healthy controls as part of a preliminary study.A total of 12 mL of blood samples were collected at Day(D)1,3,5,and 7 post epigastric pain.Using multiplex immunoassay panels,real-time polymerase chain reaction(qRT-PCR)arrays,and multicolour flow cytometry analysis,immune response-related proteins,genes,and cells were profiled respectively.GraphPad Prism^(TM) software and fold change(FC)analysis was used to determine differences between the groups.P<0.05 was considered significant.RESULTS The concentration of IL-6 was significantly different at D3 post epigastric pain in both the MAP group and MSAP group with P=0.001 and P=0.013 respectively,in a multiplex assay.When a FC of 2 was applied to identify differentially expressed genes using RT2 Profiler,CCR8 was shown to increase steadily with disease severity from MAP(1.33),MSAP(38.28)to SAP(1172.45)median FC.Further verification studies using RT-PCR showed fold change increases of CCR8 in MSAP and SAP ranging from 1000 to 1000000 times when represented as Log10,compared to healthy control respectively at D3.The findings also showed differing lymphocyte and monocyte cell frequency between the groups.With monocyte population frequency as high as 70%in MSAP at D3.CONCLUSION The higher levels of CCR8 and IL-6 in the severe patients and immune cell differences compared to MAP and controls provide an avenue for exploring AP stratification to improve management.展开更多
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.
基金Supported by the South African National Research Foundation,No.121277the University of the Witwatersrand Individual Research,No.001283844110151211055142the Faculty of Health Sciences,University of the Witwatersrand Seed Funding,No.0012518441101512110500000000000000004550.
文摘BACKGROUND Acute pancreatitis(AP)is an inflammatory disease,which presents with epigastric pain and is clinically diagnosed by amylase and lipase three times the upper limit of normal.The 2012 Atlanta classification stratifies the severity of AP as one of three risk categories namely,mild AP(MAP),moderately severe AP(MSAP),and severe AP(SAP).Challenges in stratifying AP upon diagnosis suggest that a better understanding of the underlying complex pathophysiology may be beneficial.AIM To identify the role of the chemokine receptor 8(CCR8),expressed by T-helper type-2 Lymphocytes and peritoneal macrophages,and its possible association to Interleukin(IL)-6 and AP stratification.METHODS This study was a prospective case-control study.A total of 40 patients were recruited from the Chris Hani Baragwanath Academic Hospital and the Charlotte Maxeke Johannesburg Academic Hospital.Bioassays were performed on 29 patients(14 MAP,11 MSAP,and 4 SAP)and 6 healthy controls as part of a preliminary study.A total of 12 mL of blood samples were collected at Day(D)1,3,5,and 7 post epigastric pain.Using multiplex immunoassay panels,real-time polymerase chain reaction(qRT-PCR)arrays,and multicolour flow cytometry analysis,immune response-related proteins,genes,and cells were profiled respectively.GraphPad Prism^(TM) software and fold change(FC)analysis was used to determine differences between the groups.P<0.05 was considered significant.RESULTS The concentration of IL-6 was significantly different at D3 post epigastric pain in both the MAP group and MSAP group with P=0.001 and P=0.013 respectively,in a multiplex assay.When a FC of 2 was applied to identify differentially expressed genes using RT2 Profiler,CCR8 was shown to increase steadily with disease severity from MAP(1.33),MSAP(38.28)to SAP(1172.45)median FC.Further verification studies using RT-PCR showed fold change increases of CCR8 in MSAP and SAP ranging from 1000 to 1000000 times when represented as Log10,compared to healthy control respectively at D3.The findings also showed differing lymphocyte and monocyte cell frequency between the groups.With monocyte population frequency as high as 70%in MSAP at D3.CONCLUSION The higher levels of CCR8 and IL-6 in the severe patients and immune cell differences compared to MAP and controls provide an avenue for exploring AP stratification to improve management.
