anchovy sauce appearance in liver abscess

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

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