Bacterial Liver Abscess

[rak sa_ngop]

I would appreciate some ideas/advice from the medical experts on this forum on how to proceed with my medical situation (I am 53 years old).

Following Songkran this year I developed a fever. On Day 6 I went to the doctor and was prescribed antibiotics for mild bronchitis symptoms and fungal infection of tongue.

On Day 10 I was admitted to hospital (BNH) following an ultra-sound scan of the liver which identified an abscess about 36 sq.cm.

Following liver draining, analysis of the fluid identified Staphylococcus aureus bacteria i.e. bacteria commonly found in the mucous membranes on the outside of the body (30% of people have this bacteria).

Due to a lung reaction which resulted in fluid build-up around the lung it was considered best to remain hospitalised for 11 days to administer IV antibiotics. I had my lung aspirated but the fluid was clear and not infected. I had a second liver aspiration which successfully removed most of the remaining abscess fluid. I was then prescribed oral antibiotics for a further 6 weeks.

During my stay in hospital I had numerous tests : ultrasound scan of abdomen, US scan of heart, body CT scan, chest X-rays, blood tests (blood count, HIV, ALT, ALP).

All tests were negative and NO explanation for the source of the infection could be identified.

Presently about 2 1/2 months later my liver is now clear on the US scan although the lung has not yet completely cleared of fluid. My breathing is good but I still get twinges and odd pains from my liver/lung area.

In order to try and identify the reason why my body did not successfully fight off the S. Aureus infection I consulted the BNH immunologist and had the following immune system tests carried out:

Repeat of HIV test

Blood Sugar (for Diabetes)

DST Skin tests using PPT (tuberculosis), tetanus, hepatitisB

Immunoglobulin (IgA, IgG, IgM)

Phagocytosis DHR test (PMA stimulated)

All these tests were negative or indicated normal immune system responses.

The immunology specialist basically stated the liver abscess just happened, and as my immune system is normal if I looked after myself it is unlikely to occur again. The immunologist did not see much point in seeking a second opinion as the tests did not identify any problems.

According to my web searches a bacterial liver abscess is a rare condition. Usually patients would have had recent surgery, be IV drug users, or have suppressed immune systems. Therefore having a bacterial liver abscess with no contributing factors must be even rarer.

What should I do now? Just carry on with my life as normal, or try and chase after a problem that may not be there?

Any suggestions?

Thanks

[solo siam]

Whats the background?

How long have you been here? Do you drink the water? Eat strange foods? etc...

[rak sa_ngop]

Whats the background?

How long have you been here? Do you drink the water? Eat strange foods? etc...

I have been living in SE Asia for 17 years but food and drink as far as I know have nothing to do with it.

My bacterial liver abscess infection was identified as Staphylococus Aureus (same general type as the MRSA hospital bug) but luckily was tested to be sensitive to a number of antibiotics. This bug is commonly found on the human body especially in the mucous membranes.

A food or drink infection could result in an amoebic liver abscess which I believe is easier to treat and less life threatening.

I am no medical expert in these matters which is why I would be interested to hear opinions on how my infection could have come about.

[Sheryl]

A staphylococcal liver abscess is the result of staphylococcus somehow entering the blood-- could happen from a skin infection, or dental work; and, as the doctor indicated, sometimes the point of entry cannot be identified. Once in the blood it travels to the liver. Abcess formation is the body's defense against the infection and actually indicates a functioning immune system.

If you recall having had a skin infection -- even just an infected pimple or boil, anywhere on the body -- anytime in the month before the abscess was diagnosed, that is probably the point of entry. Ditto if you had an dental work. Or any invasive medical procedures or injections.

And if no to both...well, it happens. There was some point of entry but sometimes it goes unnoticed.

It sounds to me like you have had a very thorough work up and appropriate treatment.

[rak sa_ngop]

A staphylococcal liver abscess is the result of staphylococcus somehow entering the blood-- could happen from a skin infection, or dental work; and, as the doctor indicated, sometimes the point of entry cannot be identified. Once in the blood it travels to the liver. Abcess formation is the body's defense against the infection and actually indicates a functioning immune system.

If you recall having had a skin infection -- even just an infected pimple or boil, anywhere on the body -- anytime in the month before the abscess was diagnosed, that is probably the point of entry. Ditto if you had an dental work. Or any invasive medical procedures or injections.

And if no to both...well, it happens. There was some point of entry but sometimes it goes unnoticed.

It sounds to me like you have had a very thorough work up and appropriate treatment.

Sheryl, thanks for your advice. Yes, as you suggest I had some boils about 2 or 3 weeks prior to my problem. One was in my nose and I foolishly picked causing it to bleed.

My main concern is that my immune system did not successfully deal with this infection. Hopefully it was just one of those one-off things that cannot be explained. I am thankful that the immune system tests I had were normal, as being told that I might have a congenital immune deficiency at the age of 53 was a bit hard to take.

Thanks again.

[Sheryl]

Sheryl, thanks for your advice. Yes, as you suggest I had some boils about 2 or 3 weeks prior to my problem. One was in my nose and I foolishly picked causing it to bleed.

My main concern is that my immune system did not successfully deal with this infection. Hopefully it was just one of those one-off things that cannot be explained. I am thankful that the immune system tests I had were normal, as being told that I might have a congenital immune deficiency at the age of 53 was a bit hard to take.

Thanks again.

Mystery solved...it was the boils without a doubt. "Boils" are actually just a staphylococcal abscess on the skin surface.

I am not sure why you say your immune system didn't appropriately deal with the infection, as to me it sounds like it functioned just fine. Had it not, you would have had septicemia ("blood poisoning") and gone into septic shock, with damage to all body organs and quite possibly death. Instead the infection gained a foothold only in the liver and the body's defenses were able to contain it there by walling it off (which is what an abscess is -- an infection that the body's defenses have successfully walled off.) And a normal course of antibiotics apparently cleared it up.

Sounds like a perfectly normal immune system to me. Relax!

[rak sa_ngop]

Sheryl, thanks for your advice. Yes, as you suggest I had some boils about 2 or 3 weeks prior to my problem. One was in my nose and I foolishly picked causing it to bleed.

My main concern is that my immune system did not successfully deal with this infection. Hopefully it was just one of those one-off things that cannot be explained. I am thankful that the immune system tests I had were normal, as being told that I might have a congenital immune deficiency at the age of 53 was a bit hard to take.

Thanks again.

Mystery solved...it was the boils without a doubt. "Boils" are actually just a staphylococcal abscess on the skin surface.

I am not sure why you say your immune system didn't appropriately deal with the infection, as to me it sounds like it functioned just fine. Had it not, you would have had septicemia ("blood poisoning") and gone into septic shock, with damage to all body organs and quite possibly death. Instead the infection gained a foothold only in the liver and the body's defenses were able to contain it there by walling it off (which is what an abscess is -- an infection that the body's defenses have successfully walled off.) And a normal course of antibiotics apparently cleared it up.

Sounds like a perfectly normal immune system to me. Relax!

Thanks Cheryl, you have now given me a better insight into what happened.

Although as you describe the immune system containing the infection, in the case of a liver abscess the mortality rate is supposed to be 100 pc without treatment. The normal course of antibiotics for me consisted of 11 days of IV antibiotics in hospital (4 times a day) followed by 6 weeks of high dosage tablets. This should serve as a pretty strong warning for those zit-pickers out there!

[simcity]

i did have a other problem, went on CIPROBAY for 2 months, after 2 week on IV antibiotic and it did not clear !

Went to see a specialist who give me OMNICEF and told me today problems , are antibiotic do not work as the should !

Anyway you must be relive to be in good health again ..

keep this way !

[rak sa_ngop]

i did have a other problem, went on CIPROBAY for 2 months, after 2 week on IV antibiotic and it did not clear !

Went to see a specialist who give me OMNICEF and told me today problems , are antibiotic do not work as the should !

Anyway you must be relive to be in good health again ..

keep this way !

Sounds pretty scary Simcity. In my case I had the abscess drained in hospital and the lab identified which antibiotics would work with the bacteria. After about 10 days of antibiotics another ultrasound scan showed how the antibiotics were working and liquifying the bacterial pus, so that a second draining could remove most of the remaining fluid. Draining (aspiration) of the abscess in conjunction with antibiotics seems to be the best way to deal with this type of problem.

Hopefully never again!

[Bangyai]

For what its worth I had an Amoebic Liver Abscess last year and I was nearly pushing up daisies on account of an early misdiagnosis at the Kasemarat Hospital. The symptoms are a high fever , a constant dull ache in the upper abdominal region and a complete loss of appetite. This naturaly leads to rapid weight loss. After 10 days on two kinds of wrong antibiotics and with my condition deteriorating rapidly I felt I had to try a better hospital. But where ? A friend recommended the Bangkok Pattaya hospital so after quaffing two paracetamol I manage to nurse my old Nissan Sunny down to Pattaya in the nick of time. I was immediatly admitted and after a CT scan and all the usual tests ( blood and urine etc ) I was diagnosed with Amoebic Liver Abscess. They had only ever had one previous case but that was a Thai guy and mine was a lot worse than his having progressed further. Although not usually fatal it can kill you if not treated. I thus became a sort of novelty patient and several doctors popped in to see ' the bloke with the liquified liver . ' Suffice to say they put me on the correct antibiotic ( metranidazole ) , drained my liver of half a litre of blackcurrent smoothie ( don't remember eating that ) , kept me in for 5 nights and saved my bacon. Even made an in house documentry of me and gave me a free clock. I needed something free as the total bill was 130,000 baht. For the full sp on this unusual disease check it out on wikipedia. Briefly, it is caught by eating contaminated food after someone has done a numer 2's and not bothered washing their hands properly. So next time you say the food somewhere ' tastes like shit ' there might be some real substance to your complaint.

[huggybear]

"Briefly, it is caught by eating contaminated food after someone has done a numer 2's and not bothered washing their hands properly. So next time you say the food somewhere ' tastes like shit ' there might be some real substance to your complaint."

I'm glad you got better as you're freakin hilarious ! Carry on mate !!

[geriatrickid]

I needed something free as the total bill was 130,000 baht.

I think you'd agree that your life is a bargain at only 130K.

Your good sense of humour is worth millions as a stand alone asset.