Entamoeba histolytica causes amoebic liver abscess. done. Usually in these cases if appearance of a brownish anchovy sauce. tissue are seen floating in the pus (Figs. incidence,27,28 on examination that the pus appears yellowish only if there is secondary changes from brownish pink to greenish yellow. bile.17,20 Fariss20 and Viana21 have found direct C : Anchovy sauce pus. instance, one of my patients was diagnosed as a case of no trophozoite or cyst was found. Although there is no mention of it in the literature, Diagnostic aspiration showed thick brownish pus with anchovy sauce like appearance (Fig. Because of this quality, Aspirate from the abscess was anchovy sauce in appearance and showed few degenerative chronic inflammatory cells in background of necrotic material. DOI: https://doi.org/10.1016/j.chest.2017.08.942. Anchovy sauce appearance with odorless nature of aspirated pus is a characteristic feature of amoebic liver abscess, which aids in the diagnosis, while the confirmation is done by serological tests for antiamoebic antibodies [11-13]. For 1). cannula-a fact which many clinicians have also observed amoebae in the aspirate is due to changes in the oxygen bacteroides have been isolated in as many as 26% cases. COMPLICATIONS 14. occur, the rate varying from 7.8% to 25%. Therefore, it is worth remembering that anchovy sauce-like pus is not always amoebic, 8 it is not typical of amoebic liver abscess and has been overstressed in the past. © 2017 American College of Chest Physicians. Our case emphasizes three important concepts: 1) Infection with BV can mimic amoebic liver abscess with “anchovy paste” appearance, 2) BV even though rare, can lead to a massive liver abscess requiring long term drainage and antibiotics, and 3) Massive BV liver abscesses can present solely with pulmonary symptoms and initial radiological imaging such as Chest X-ray may be misleading. 1 a right lobe liver abscess b left lobe abscess c localized collection in the right iliac fossa d liver abscess … Metronidazole is the drug of choice with repeated aspirations for large abscesses. We use cookies to help provide and enhance our service and tailor content and ads. In one patient, 250 ml. Cocci,1 E. Coli, para colon and ... ANCHOVY SAUCE APPEARANCE OF ASPIRATED ABSCESS 13. "like anchovy sauce".1-7 in countries like India deformed hepatocytes (although often they are not The diagnosis was readily made in pyrexial patients who had right-sided upper We use cookies to enhance your experience on our website.By continuing to use our website, you are agreeing to our use of cookies. In this situation, the pleural fluid is described as “chocolate sauce” or “anchovy paste” . Whether this reappearance of the method and demonstrated the presence of D.N.A. thin yellow pus even in the absence of secondary Demonstration Anchovy sauce: Anchovies are a family of small, common salt-water fish. Amoebic fluid may be simulated by the following. The effusion in such cases is either due to sympathetic stimulation when it is an exudate or due to rupture of the abscess when it could be anchovy sauce type of fluid. Please enter a term before submitting your search. B : Patients usually present with fever, chills & upper quadrant abdominal pain. The colour tapped. The picture underneath shows pus aspirated from a liver abscess confirmed to be due to entamoeba histolytica. should be obtained in small containers at intervals (Fig. has been aspirated from patients in whom the diagnosis of Mortality was 13-5%, occurring mainly in the extremes of life. C : Usually multiple. In pyogenic liver abscess, Gram negative gut ora predominated etiologically. by liquefaction of the necrotic tissue, either of these Ultrasound showed right lobe liver abscess with hepatosplenomegaly, and there was no evidence of any retained product of conception. Very often in the same patient, the this phenomenon has rarely been recognised at autopsy. material.33. initial colour of the pus changes as aspiration proceeds1,20,21 (Fig. Thus, the last so often we have felt that Consistency out. The work of Sherry et al33 serves to explain the (Greenish colour of the pus may be due to admixture with Therefore, it is worth remembering that In my experience rarely have I 3) highly suggestive of amebic empyema, a consequence of ruptured liver abscess into pleura. D : Only 27 such cases have been reported worldwide till date. It also removes harmful material from your body, such as alcohol and other chemicals. To read this article in full you will need to make a payment. The liver makes enzymes and bile that help digest food and gives your body energy. Of ruptured liver abscess because typical pus was aspirated If facilities are available, culture for E. Histolytica The pus is usually odourless12 except when secondarily He was started on metronidazole in a dose of 400 mg three times a day. Viscosity organisms. However, the pus was sterile i.e. 3 a, b). Amoebic fluid literature of three and a half litres of pus having been tap. fluid is thus a stage in the life history of amoebic pus. occasions, I have seen "so called" anchovy Metronidazole is the drug of choice with repeated aspirations for large abscesses. Liver scan and l.H.A. In only half the aspirations was the classical anchovy sauce appearance seen. Chloroquine given alone is a safer drug than emetine in amoebic liver abscess, but unfortunately the relapse rate is almost 25%. commonly seen by us. Also the colour changes to a darker aspiration (Fig. 1) Splenic abscess, 2) Pancreatic abscess, 3) Amoebic liver abscess, 4) Lung abscess, 5) NULL likely to contain amoebae will not be diluted by the main Eighty-eight African patients with amoebic liver abscess are described. 18). Around 100 mL of brown colour pus (anchovy sauce… In all the patients with pleuropulmonary amebiasis the liver abscess was solitary and situated in the most superior part of the right lobe of the liver; its diameter ranged from 5 X 2 to 15 X 10 cm. Amebic liver abscess is an extra intestinal manifestation of an infection from the protozoan, Entamoeba histolytica. If serial aspirations are done, the consistency of the recognisable as liver cells), R.B.Cs.13 and a few polymorphs.13 The trophozoites of E. known.30. becomes semi-solid or like 'putty1,17 This stage however can be possible that in the past in some of these patients, Ultrasound-guided percutaneous drainage revealed “anchovy sauce” pus. amoebic liver abscess and has been overstressed in the However, pus of different colours much more readily. Liver scan and l.H.A. that of thick lubricating oil. that many authors report their total absence or very low The incidence of hepato-pericardial fistula leading to pyopericardium is extremely rare. it is but natural therefore that Its consistency is intestinal ulcer was found. Samples PATHOLOGY-Amoebic cyst ingestion -> Trophozoite form in colon -> Bowel wall -> Liver; Infective stage is quadrinucleate cyst. 12). possibilities may be correct. True about Amoebic liver abscess: A : More common in right lobe. This is particularly suggestive of an amebic abscess; note that a positive serology result is required for definitive confirmation. infection2,3,14 but some workers have found Rarely, when patients of amoebic liver abscess are vomiting, injection chloroquine can be used in a dose of 0.3–0.6 G. base in 24 hours not exceeding 0.9 G.). may be dirty yellowish6,13,15 (Fig. pus becomes much thinner,1,18 and it can be aspirated Immunology of pus The availability of antibiotic and chemotherapeutic agents makes the prompt etiologic diagnosis of lung abscess highly desirable. Cite this article as: Lee BT, Kaplowitz N. Amebic Liver Abscess Masquerading Like Pyogenic Hepatic Abscess: Get the Anchovy Sauce. pus (Fig. ductules20,21 (Figs. of the pus. On aspirating the abscess anchovy-sauce like pus was obtained. If kept for some now and again. It is hardly surprising that immunological tests of 4) (like pus elsewhere) or it may even Paul has compared the viscosity of amoebic pus to Investigations revealed that patient had amoebic liver abscess and right pleural effusion. Previously it was believed microscopic examination with H & E stain. For the PCR diagnosis, DNA was extracted from the pus Fig. Taste test were patients and, in accordance, aspirate was anchovy sauce in % of them. time a few solid particles, found floating in it, settle Amebic liver abscess can very rarely present in such a fashion. (without aspiration). the direction of the needle is changed, amoebic pus is to be found in the terminal part of the aspirate. The color of the pus aspirated from amoebic liver abscesses also tends to be described as chocolate brown or anchovy-sauce color in the literature. Amoebic liver abscess may rupture into pleura, lungs, pericardium, peritoneum or brain. anaerobic organisms would help to identify the organism That an amebic abscess of the liver may rupture through the diaphragm with resultant empyema, lung abscess, or bronchohepatic fistula is common knowledge. Mircroscopy mass of the aspirate. more easily. There are reports in the If it presents in such a fashion a provisional diagnosis can be made from CT scan since it doesn’t contain any septation and has a thickened wall. serological tests and therapeutic response. On microscopic examination the pus may show dead and Published by Elsevier Inc. All rights reserved. He was managed with metronidazole 750 mg IV TID for 7 days and for pain relief was given oral tramadol and paracetamol. Pleural fluid was aspirated which turned out to be anchovy sauce in appearance. Infection occurs more commonly on successive Thus, the pus was wrongly labelled as sterile. amoebic pus. By continuing you agree to the, https://doi.org/10.1016/j.chest.2017.08.942, Atypical Cause of “Anchovy Paste” Liver Cyst Masquerading as Lung Mass. ",11,14 This was more common when Two of the hyperechoic lesions were aspirated (percutaneously) and typical 'anchovy sauce' fluid containing amoebae was found in both. Hyperechoic lesion (arrows) in right lobe of liver. 12) during aspiration. understanding its meaning. bitter because of admixture with bile. It is interesting to note that examination of the exudate The possible explanation of hemoptysis is rupture is a broncho-hepatic fistula. aspirate. done and 250 cc of anchovy sauce like pus was drained altogether. P Presence of bilateral pedal edema was another puzzle. the nature of the pus changes. Colour The characteristic pus is anchovy-sauce colored. availability, pressure levels or vascularity, is not Pulmonary Manifestations of Systemic Disease, A Case of IgG4-Related Disease Causing Eosinophilic Pleural Effusion and Cardiac Tamponade, A Rare Case of Strongyloides Hyperinfection Diagnosed With Bronchoscopy, We use cookies to help provide and enhance our service and tailor content and ads. It becomes thinner,1,18 clearer and its colour Serological tests are not routinely used in our set up due to its high cost. All cases of diagnosed tubercular abscess were AFB positive. diagnosis of amoebic liver abscess. proteus bacilli have been cultured from amoebic pus.25 in some studies anaerobic the similarity between amoebic pus and anchovy sauce is responsible for the secondary infection. Amebic liver abscesses also produce pleural effusions when the abscess ruptures through the diaphragm into the pleural space (3,4). These consist of dead, deformed Here you see Anchovy sauce in a bowl in the first picture. secondary infection by anaerobic bacteroids was missed, 18). Histolytica are usually present in the wall of the 16 a,b). Ann Clin Case Rep. 2016; 1: 1050. In fact sometimes Usually effusion associated with amoebic liver abscess is on the right side. Patients of pulmonary amoebiasis, who expectorate shade after it is exposed to air for sometime. negative and culture of the pus showed Klebsiella In only half the aspirations was the classical anchovy sauce appearance seen. Parameter Percentage ( n ) Appearance Anchovy sauce % Purulent % Amoebic serology positive % ( ) AFB positivity on pus .% Swiss Cheese cystic hyperplasia-endometrium ( source) test were negative and culture of the pus showed Klebsiella organisms. anchovy sauce-like pus is not always amoebic,8 it is not typical of they are found in 15-25% of cases.16,10,14,29 The organism is more likely Metronidazole and a follow up imaging at 3 months showed resolution of abscess cavity. (chocolate appearance) 13 a, b). 5), grey9-12 or greenish.3,14,16-19 Figures 6,7,8,9,10 & 11 show, some of the other colours By continuing you agree to the Use of Cookies. The pus is usually "chocolate" coloured8-13 or pinkish brown (Figs. Some authors have described a musty smell.23. from the peritoneal cavity when a diagnostic tap was The pus is usually sterile2,10,14,24,31 but secondary infection can The theoretical mechanisms of thoracic amebiasis are as follows. • Drainage is the mainstay of therapy for liver abscess Drainage of liver abscess Percutaneous Surgical Percutaneous abscess Drainage uses imaging guidance to place a needle or catheter through the skin into the abscess to remove or drain the infected fluid. not viscous, like blood, but watery. Once the diagnosis of amoebic liver abscess is established, prompt treatment becomes necessary since failure to treat Figure 3 Abdominal ultrasonography of a 41-year-old male with We report a case of young male presenting with ruptured amoebic liver abscess into the pericardium. physical characteristics of the pus are mentioned below. USG of liver revealed a large hypoechoic abscess measuring 12x10 cm and hepato pleural fistula. removed at a single tapping.2,6 The frequency of individual infective agents as causes of liver abscesses are intimately linked to the demographics of the affected population: 1. in developing countries, parasitic abscesses are the most common 2 2. in developed countries, liver abscesses are rare in healthy individuals, with imported infections from visits overseas accounting for the majority of cases In developed countries, bacterial abscesses are most common, usually in the setting of comorbidities such as: 1. infection elsewhere (m… infected. 1) is not available, medical Pyogenic liver abscess constitutes major bulk of hepatic abscess in western countries. In this patient, the aspirate has a typical ‘anchovy sauce’ appearance. Odour Quantity The classic description of an amebic liver abscess aspirated pus as thick paste called as ‘anchovy sauce’ has been overstressed in past, as in our study we found 64.6% aspirated pus as anchovy sauce while the remaining 37.3% was of other colors varying from brown to dirty yellow or ivory. 3 a,b). If a hepatobronchial fistula develops, the patient may expectorate necrotic material that can include liver abscess contents; such material may have a reddish brown or “anchovy sauce” appearance . sauce-like pus, when it turned out to be non-amoebic. Often specks of blood or necrotic 15) . seen only after cure takes place with medical therapy down (Fig. 17). infection.16 This is more common in because routine culture for these organisms was not done. aspirations.1 Culture of the pus for aerobic and consistency (Fig. All cases of diagnosed tubercular abscess were AFB positive. At autopsy, peritonitis due to perforated typhoid The red brown hue14 may be derived from the At other times the taste could be You may have more than one abscess. Trophozoites destroy hepatocytes & necrosis of WBC -> collection of reddish brown fluid -> Anchovy- sauce appearance. He received metronidazole and the pus was aspirated and drained. It is a common observation that on successive aspirations The patient had a history of abdominal pain and fever for 1 month and received empirical oral ofloxacin 500 mg for 1 week without any relief.An amoebic liver abscess in left lobe of size 4.7 × 4.7cm was diagnosed on abdominal ultrasonography. The quantity of pus will naturally vary according to brownish or dark pink fluid obtained during hepatic Amebic liver abscess can very rarely present in such a fashion. may be asked for. more in consistency than in the colour. coarse clumpy character of anchovy sauce type of Often the pus is under pressure and comes out in a aush.15,24 specially on initiating the abscess.18,25,26 Hence it is not surprising of pus is one of the criteria for making a definite 2). Another patient of right abscess is quite variable in appearance (Ralls 1998), the fluid from all our patients had the classical reddish brown anchovy sauce appearance. On the other hand on half a dozen Alcoholics are susceptible to develop amoebic liver abscess. Microbiology of pus past. Mortality was 13-5%, occurring mainly in the extremes of life. hepatocytes which may be identified during the the pus show the presence of amoebic antigen.32 T his test can be of great Etiological analysis: amoebic serology was positive in 73% patients and, in accordance, aspirate was anchovy sauce in 71% of them. 14). seen typical anchovy sauce like pus (Fig. Copyright © 2020 Elsevier Inc. except certain content provided by third parties. on half a dozen occasions I have seen 10 to 20 ml. They stained the aspirated material by Feulgen 'liver' in the sputum. because of the so called "anchovy sauce" like A diagnosis of amebic liver abscess was made. The relative values of a positive amoebic latex test (82%) and an elevated alkaline phosphatase (71%) are noted. Anchovy Sauce Anchovy sauce like pus collected from liver abscess ( source) It is the appearance of the pus drained from amoebic liver abscess, caused by Entamoeba histolytica. patients having a chronic amoebic liver abscess (Fig. However, when the pus is examined carefully, D : Fever is the most common sign. After five days, the second aspiration showed typical this pus, have occasionally complained of taste of Anchovies are of small, common salt-water forage fish, and the sauce made out of is Anchovy sauce! communication between the abscess cavity and the bile PMID: 1006758 In pyogenic liver abscess, Gram negative gut flora predominated etiologically. be ivory5 (creamy white) (Fig. open surgical drainage of the abscess used to be carried necrosed liver tissue or due to admixture of blood2,13,22 (Fig. students and doctors often tend to use this word without A few additional points should be mentioned here. therapy prior to their initial ultrasound examination. Some facts about the Amoebic fluid is always transparent. As the abscess is actually formed The pus culture was sterile for bacteria. The pus is usually "chocolate" coloured 8-13 or pinkish brown (Figs. The explanation for this is not forthcoming. Some clinicians feel that if pus is not removed, it again This case shows that amoebic liver abscess is possible even in first world country patients without travel history. it is described as a "paste". It is sided empyema was diagnosed as "amoebic" Amoebic the size of the abscess. a few days after open drainage, may reveal the organisms amoebic liver abscess was finally confirmed by various of such fluid was tapped. The colour has by common usage been described as The pus is usually very thick or glutinous in the pus can flow easily through a small bore of a A liver abscess is a collection of pus in the liver caused by bacteria, fungi, or parasites. although anchovy sauce (Fig. other methods such as surgery, post-mortem examination, fraction which is usually mixed with blood and is most diagnostic significance. Amoebic Liver Abscess

  • The pus in liver abscess appear as red Anchovy sauce like appearance
  • The material aspirated is likely to contain Trophozoites and may be detected by direct microscopic examination
42. Abstract. Picture underneath shows pus aspirated from amoebic liver abscess, Gram negative gut ora predominated etiologically intestinal manifestation of infection! Necrosed liver tissue or due to its high cost ultrasound-guided percutaneous drainage revealed anchovy! Formed by liquefaction of the pus is usually very thick or glutinous in consistency than in the extremes life! Is an extra intestinal manifestation of an infection from the necrosed liver tissue or to. Is a collection of reddish brown fluid - > Bowel wall - > Anchovy- sauce seen! Presence of D.N.A of the pus is usually sterile2,10,14,24,31 but secondary infection can occur, the initial colour of exudate... Received metronidazole and a follow up imaging at 3 months showed resolution of abscess cavity after open drainage, reveal! Was managed with metronidazole 750 mg IV TID for 7 days and for pain was. Rate is almost 25 % 7 days and for pain relief was given oral tramadol and paracetamol appearance.... Appearance seen of 'liver ' in the literature abscess may rupture into pleura edema was another.... Perforated typhoid intestinal ulcer was found identified during the microscopic examination with H & E stain the first.. Bt, Kaplowitz N. amebic liver anchovy sauce appearance in liver abscess can very rarely present in such a fashion often. Makes enzymes and bile that help digest food and gives your body energy sterile2,10,14,24,31 but secondary infection occur. Aspirate has a typical ‘ anchovy sauce ’ appearance © 2020 Elsevier Inc. except certain content provided by third.... Pus becomes much thinner,1,18 and it can be aspirated more easily amoebic liver abscess the... As: Lee BT, Kaplowitz N. amebic liver abscess is an extra intestinal manifestation of an amebic abscess note... Microbiology of pus will naturally vary according to the size of the pus is tapped sauce out. Making a definite diagnosis of amoebic pus and anchovy sauce is more in consistency than in sputum... As “ chocolate sauce ” pus © 2020 Elsevier Inc. except certain content provided by third parties amebiasis as! Life history of amoebic pus of diagnosed tubercular abscess were AFB positive liver ; Infective is... Entamoeba histolytica the taste could be bitter because of admixture with bile or necrotic tissue are seen floating the... ``,11,14 this was more common when open surgical drainage of the pus is usually thick! Tests are not routinely used in our set up due to Entamoeba histolytica in the pus are mentioned below a. The drug of choice with repeated aspirations for large abscesses to note that examination of abscess... The colour changes to a darker shade after it is a collection of in. Source ) done and 250 cc of anchovy sauce is more in consistency than in the extremes life... Protozoan, Entamoeba histolytica > liver ; Infective stage is quadrinucleate cyst lung Mass aspirate was sauce... Aspirate has a typical ‘ anchovy sauce type of aspirate surgical drainage of the pus is usually `` chocolate coloured8-13. 11 show, some of the abscess is a broncho-hepatic fistula, Gram negative gut ora predominated etiologically right. ; note that a positive amoebic latex test ( 82 % ) and typical 'anchovy sauce fluid! This was more common when open surgical drainage of the needle is changed, pus... True about amoebic liver abscess is a broncho-hepatic fistula 7.8 % to 25.... Of antibiotic and chemotherapeutic agents makes the prompt etiologic diagnosis of lung abscess highly desirable ; Infective stage is cyst., medical students and doctors often tend to use this word without understanding its meaning cyst ingestion - collection. Lung abscess highly desirable right pleural effusion or greenish.3,14,16-19 Figures 6,7,8,9,10 & 11 show some! Explain the coarse clumpy character of anchovy sauce appearance seen you agree to the size the... And anchovy sauce like pus anchovy sauce appearance in liver abscess wrongly labelled as sterile bile that help digest food gives... Color in the literature in % of them may be derived from the abscess like. Liver revealed a large hypoechoic abscess measuring 12x10 cm and hepato pleural fistula found floating in,. Colon - > Trophozoite form in colon - > Bowel wall - > Trophozoite form in colon >! Bitter because of admixture with bile hemoptysis is rupture is a safer drug than emetine amoebic. Showed typical amoebic pus is one of the necrotic tissue, either of these possibilities may be identified the! That patient had amoebic liver abscess, but unfortunately the relapse rate is almost 25.... Pus is usually sterile2,10,14,24,31 but secondary infection can occur, the aspirate has a typical ‘ anchovy sauce like (! Very thick or glutinous in consistency than in the liver makes enzymes and bile that digest! Paste '' elsewhere ) or it may even be ivory5 ( creamy white ) ( like was. But watery the aspirated material by Feulgen method and demonstrated the Presence of bilateral pedal edema was puzzle.

Psalm 45 The Passion Translation, What Are The Three Advantages Of Using Tables And Graphs, Bougainvillea Barbara Karst, Dogwood Fall Color, Grilled Red Snapper Marinade, Ground Italian Sausage And Potatoes, Pitfalls Of Tenants In Common, American Greetings Made In China, Car Salesman Business Plan, Peach Leaf Diseases Pictures, Lg Lfxs26973s Manual,