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      Multiloculated Liver Abscess Caused by Fusobacterium: Role of Karius Testing in Diagnosis

      case-report
      1 , , 1 , 1 , 1 , 1
      ,
      Cureus
      Cureus
      pyogenic abscess, karius test, fusobacterium

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          Abstract

          Pyogenic liver abscess can be a major diagnostic and therapeutic challenge despite advances in cutting edge technologies. A patient presented with fever, right upper quadrant pain and diarrhea. CT revealed multiple hypodensities in both lobes of liver. The largest lesion was in the left lobe of liver and was multiloculated with thick septations. The causative organism was identified to be Fusobacterium nucleatum by Karius testing. The patient was discharged on six weeks of ertapenem therapy, which resulted in complete resolution. This is the first case of liver abscess where Karius testing was used to identify microorganism. It also highlights that multiloculated and difficult to drain liver abscesses caused by highly sensitive organisms can potentially be treated by intravenous antibiotics alone in immunocompetent patients.

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          Most cited references8

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          Liquid biopsy for infectious diseases: sequencing of cell-free plasma to detect pathogen DNA in patients with invasive fungal disease

          Diagnosis of life-threatening deep-seated infections currently requires invasive sampling of the infected tissue to provide a microbiologic diagnosis. These procedures can lead to high morbidity in patients and add to healthcare costs. Here we describe a novel next-generation sequencing assay that was used to detect pathogen-derived cell-free DNA in peripheral blood of patients with biopsy-proven invasive fungal infections. The noninvasive nature of this approach could provide rapid, actionable treatment information for invasive fungal infections when a biopsy is not possible.
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            Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration.

            This study aims to compare the therapeutic effectiveness of continuous catheter drainage versus intermittent needle aspiration in the percutaneous treatment of pyogenic liver abscesses. Over a 5-year period, 64 consecutive patients with pyogenic liver abscess were treated with intravenous antibiotics (ampicillin, cefuroxime, and metronidazole) and randomized into two percutaneous treatment groups: continuous catheter drainage (with an 8F multi-sidehole pigtail catheter); and intermittent needle aspiration (18G disposable trocar needle). There was no statistically significant difference between the two groups regarding patient demographics, underlying coexisting disease, abscess size, abscess number, number of loculation of abscess, the presenting clinical symptoms such as fever, abdominal pain, and pretreatment liver function test. Although not statistically significant, the duration of intravenous antibiotics treatment before percutaneous treatment was longer with the catheter group, and the change of antibiotics after the sensitivity test was more frequent with the needle group. The needle group was associated with a higher treatment success rate, a shorter duration of hospital stay, and a lower mortality rate, although this did not reach statistical significance. In conclusion, this study suggests that intermittent needle aspiration is probably as effective as continuous catheter drainage for the treatment of pyogenic liver abscess, although further proof with a large-scale study is necessary. Due to the additional advantages of procedure simplicity, patient comfort, and reduced price, needle aspiration deserves to be considered as a first-line drainage approach.
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              Liver abscess: diagnostic and management issues found in the low resource setting

              Abstract Introduction Liver abscesses are mainly caused by parasitic or bacterial infection and are an important cause of hospitalization in low-middle income countries (LMIC). The pathophysiology of abscesses is different depending on the etiology and requires different strategies for diagnosis and management. This paper discusses pathophysiology and epidemiology, the current diagnostic approach and its limitations and management of liver abscess in low resource settings. Sources of data We searched PubMed for relevant reviews by typing the following keywords: ‘amoebic liver abscess’ and ‘pyogenic liver abscess’. Areas of agreement Amoebic liver abscess can be treated medically while pyogenic liver abscess usually needs to be percutaneously drained and treated with effective antibiotics. Areas of controversy In an LMIC setting, where misuse of antibiotics is a recognized issue, liver abscesses are a therapeutic conundrum, leaving little choices for treatment for physicians in low capacity settings. Growing points As antimicrobial resistance awareness and antibiotic stewardship programs are put into place, liver abscess management will likely improve in LMICs provided that systematic adapted guidelines are established and practiced. Areas timely for developing research The lack of a quick and reliable diagnostic strategy in the majority of LMIC makes selection of appropriate treatment challenging.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                25 June 2020
                June 2020
                : 12
                : 6
                : e8823
                Affiliations
                [1 ] Internal Medicine, AdventHealth Orlando, Orlando, USA
                Author notes
                Article
                10.7759/cureus.8823
                7384737
                8a0ef622-357f-4505-8571-b8dbc27442b9
                Copyright © 2020, Zafar et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 4 May 2020
                : 24 June 2020
                Categories
                Internal Medicine
                Gastroenterology
                Infectious Disease

                pyogenic abscess,karius test,fusobacterium
                pyogenic abscess, karius test, fusobacterium

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