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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 1  |  Issue : 2  |  Page : 49-51

Haemophilus parainfluenzae as a rare cause of pyogenic liver abscess: A case report and literature review


Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar

Date of Web Publication7-Nov-2017

Correspondence Address:
Fahmi Yousef Khan
Department of Medicine, Hamad General Hospital, P. O. Box 3050, Doha
Qatar
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_18_17

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  Abstract 

We report a case of Haemophilus parainfluenzae pyogenic liver abscess in a 53-year-old Filipino female who was admitted with a 3-day history of abdominal pain and fever. Clinical examination showed tenderness in right hypochondrium, and the liver edge was just palpable. Abdominal ultrasound revealed heterogeneous lesion in the left liver lobe, consistent with liver abscess, which was aspirated and the patient received ceftriaxone and metronidazole empirically. Two days after admission, pus culture grew profuse growth of H. parainfluenzae which was sensitive to ampicillin and ceftriaxone, accordingly metronidazole was stopped and ceftriaxone was continued 2 g daily intravenously. The drain was removed on 14th hospital day. Patient made a good recovery and was discharged home on oral cefuroxime for 2 weeks more.

Keywords: Ampicillin, Haemophilus parainfluenzae, pyogenic liver abscess


How to cite this article:
Athreya A, Hrastar K, Khan FY. Haemophilus parainfluenzae as a rare cause of pyogenic liver abscess: A case report and literature review. Libyan J Med Sci 2017;1:49-51

How to cite this URL:
Athreya A, Hrastar K, Khan FY. Haemophilus parainfluenzae as a rare cause of pyogenic liver abscess: A case report and literature review. Libyan J Med Sci [serial online] 2017 [cited 2021 May 10];1:49-51. Available from: https://www.ljmsonline.com/text.asp?2017/1/2/49/217799


  Introduction Top


Pyogenic liver abscess (PLA) is an uncommon clinical entity, which requires prompt diagnosis and treatment to prevent unwanted outcomes. Klebsiella pneumoniae has emerged as the most common organism seen in PLA in the Asian population, whereas in Western countries, K. pneumoniae accounted for about a quarter of all cases of PLA.[1] Hepatic abscess due to Haemophilus parainfluenzae (Gram-negative coccobacilli) is extremely rare. A literature review revealed that only four cases had been reported.[2],[3],[4],[5] In this report, we present a case of PLA caused by H. parainfluenzae with a summary of previously reported cases.


  Case Report Top


A 53-year-old Filipino female was admitted with a 3-day history of abdominal pain and fever. The pain was localized in the right upper abdominal quadrant and epigastric area. It was moderate and dull in nature, nonradiating, aggravated by food, and relieved by paracetamol. She had associated fever and generalized body ache. There was no nausea, no vomiting, and no loose motions. She has never had similar symptoms before. She had been working as a hairdresser in Doha for the past 6 years, and her last travel was to Lebanon 3 years ago. She denied any sick contacts, alcohol, tobacco use, or illicit drug use. On examination, she was afebrile, not in distress, not jaundiced, and vitally stable. Her abdomen was soft with tenderness in right hypochondrium and the liver edge was just palpable. The rest of her examination was unremarkable.

Investigations revealed hemoglobin of 11.5 g/dl, normal MCV and MCH. WBC count was 15.8 × 103/μL with neutrophil count 12.7 × 103/μL and platelets 553 × 103/μL. Liver function tests showed total bilirubin 14 μmol/L, alkaline phosphatase 309 U/L, ALT 93 U/L, and AST was 58 U/L. Hepatitis B and C serology was negative. HIV serology was negative. Entamoeba histolytica antibody was negative. Three sets of blood cultures were also negative. No signs of endocarditis were found in transthoracic echocardiogram. Abdominal ultrasound revealed heterogeneous lesion in the left liver lobe, measuring 7 cm × 7.3 cm consistent with liver abscess.

Patient was admitted in the medical ward and intravenous ceftriaxone 2 g/daily and intravenous metronidazole 500 mg every 8 h were started empirically. The liver abscess was drained under ultrasound guidance with percutaneous drain placement, and 150 ml of thick pus was obtained. Two days after admission, pus culture grew profuse growth of H. parainfluenzae which was sensitive to ampicillin, cefuroxime, ceftriaxone, and clarithromycin, accordingly metronidazole was stopped and intravenous ceftriaxone 2 g daily was continued. The drain was removed on 14th hospital day. Patient made good recovery and was discharged home on oral cefuroxime for 2 weeks more.


  Discussion Top


H. parainfluenzae is a Gram-negative coccobacillary facultatively microorganism that is found in the oral cavity, respiratory, gastrointestinal, and urogenital tracts. Although it is an unusual pathogen in human infections, it can be responsible for a broad spectrum of serious infections such as endocarditis, bacteremia, pneumonia, empyema, epiglottitis, meningitis, arthritis, cerebral abscess, urethritis, and genital infections.[6]H. parainfluenzae is a rare cause of PLA. The novelty of our case comes from being one of few cases reported in the literature worldwide.[2],[3],[4],[5] [Table 1] summarizes the clinical aspects of the reported cases. As noted in [Table 1], the disease affected all age groups and both sexes. The clinical picture is indistinguishable from other forms of PLA. In adult patients, it presented as abdominal pain and fever whereas, in children, the presentation was nonspecific. Most cases occurred in immunocompromised individuals; however, it can present, as in our case, in otherwise healthy individuals. As observed, all patients in [Table 1] had the abscess in the right hepatic lobe except ours. The susceptibility profile of H. parainfluenzae isolates to ampicillin is shown in [Table 1]. Most of the isolates were sensitive to ampicillin, and the outcome was good in all cases.
Table 1: The demographic and clinical data of patients with pyogenic liver abscess

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  Conclusion Top


PLA from H. parainfluenzae is a rare clinical entity. As the clinical picture was indistinguishable from other forms of PLA, there needs to be a high index of suspicion for this diagnosis. Prompt drainage of the abscess and initiating suitable antibiotic remains the cornerstone of management.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Abbas MT, Khan FY, Muhsin SA, Al-Dehwe B, Abukamar M, Elzouki AN, et al. Epidemiology, clinical features and outcome of liver abscess: A single reference center experience in Qatar. Oman Med J 2014;29:260-3.  Back to cited text no. 1
    
2.
Black CT, Kupferschmid JP, West KW, Grosfeld JL. Haemophilus parainfluenzae infections in children, with the report of a unique case. Rev Infect Dis 1988;10:342-6.  Back to cited text no. 2
[PUBMED]    
3.
Desir G, Helman D, Herlich M, Turka L, Bia MJ. Haemophilus parainfluenzae liver abscess in a recipient of a renal transplant who had polycystic disease. JAMA 1986;255:1878.  Back to cited text no. 3
    
4.
Chattopadhyay B, Silverstone PH, Winwood RS. Liver abscess caused by haemophilus parainfluenzae. Postgrad Med J 1983;59:788-9.  Back to cited text no. 4
[PUBMED]    
5.
Friedl J, Stift A, Berlakovich GA, Taucher S, Gnant M, Steininger R, et al. Haemophilus parainfluenzae liver abscess after successful liver transplantation. J Clin Microbiol 1998;36:818-9.  Back to cited text no. 5
[PUBMED]    
6.
Cobo F, Jiménez G, Rodríguez-Granger J, Sampedro A, Aliaga-Martínez L. A rare case of osteomyelitis caused by Haemophilus parainfluenzae. J Bone Jt Infect 2017;2:104-6.  Back to cited text no. 6
    



 
 
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Abstract
Introduction
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Discussion
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