Parasite-Induced Th2 Polarization—An Unusual Cause of Paediatric Hepatic Abscess

Liver abscess (LA) is a serious infectious disease, but is relatively rare in the paediatric population, especially in developed countries. Mostly, hepatic abscesses are pyogenic, caused by Staphylococcus aureus, while in extremely rare cases can be caused by parasites, such as Ascaris lumbricoides. Antimicrobial therapy and percutaneous drainage are the treatments of choice, lowering the mortality caused by this infection. We report a case of a 3-year-old girl admitted to the hospital for abdominal pain and a low-grade fever, with abdominal ultrasonography revealing a hepatic lesion. Initial laboratory tests showed moderate anaemia, thrombocytosis, eosinophilia, high inflammatory markers, and normal liver function. A computed tomography scan revealed two liver abscesses located subdiaphragmatically, and a high immunoglobulin E (IgE) value (22,300 U/mL). After excluding other possible etiologies, the patient was tested for parasitic infections. IgE for Ascaris lumbricoides came slightly higher. In addition to empirical antibiotic treatment, the patient received albendazole and made an uneventful recovery, with the full remission of the abscesses and without the need for drainage. In certain cases, parasites such as Ascaris lumbricoides are capable of inducing a T helper 2 (Th2) dominated immune response, predisposing the host to eosinophilia, hyperIgE, and increased susceptibility to bacterial infections. Early diagnosis and treatment in these cases may lead to less invasive therapy options in order to obtain a full recovery. To the best of our knowledge, this is the only reported case in the literature of a paediatric patient with parasite-induced liver abscesses, with extremely high IgE values, minimal symptomatology, that made a fast, full recovery without the need of drainage.

Complete Genome Sequences of Mycobacterium farcinogenes Strains Isolated from Clinical Specimens from Patients in Thailand

Mycobacterium farcinogenes is a nonchromogenic, slowly growing mycobacterium that is responsible for bovine farcy. Here, we report two complete genome sequences of Mycobacterium farcinogenes strains isolated from skin and liver abscesses from patients in Thailand.

134. Impact of an Antibiotic Stewardship Treatment and Management Algorithm for Liver Abscesses

Background Antibiotic prescribing for pyogenic liver abscess(es) (PLA) is highly variable with literature primarily aimed at assessing surgical intervention with a scarcity of data for antibiotic selection and duration of therapy. Given the lack of data, there is no clear consensus for treatment options or length of treatment. Our Antimicrobial Support Network (ASN) in collaboration with the hepatopancreatobiliary (HPB) team created a treatment and management algorithm to guide duration of therapy and antibiotic selection. Methods A retrospective, quasi-experimental cohort study was performed at Carolinas Medical Center in hospitalized patients with PLA with an HPB and/or infectious diseases consult. The primary outcome was antipseudomonal beta-lactam days of therapy (DOT) per 1000 patient days (PD) in the pre-versus post-intervention group. Secondary outcomes included rates of treatment failure at 90 days, 90-day all-cause and abscess-related hospital readmission, C. difficile and multi-drug resistant organism (MDRO) colonization at 90 days from diagnosis, and hospital length of stay (LOS). Additional a priori subgroup analyses of duration of therapy, treatment failure, all-cause and abscess-related readmissions were also conducted based on surgical intervention. Results A total of 93 patients were included, 49 patients in the pre-intervention group and 44 patients in the post-intervention group. Baseline characteristics were similar between the groups. The majority of liver abscesses were unilocular and monomicrobial. Anti-pseudomonal beta-lactam DOT per 1000 PD decreased by 13.8% (507.4 versus 437.5 DOT/1000 PD). Treatment failure occurred in 30.6% of pre-intervention patients and 18.2% of post-intervention patients (p = 0.165). Patients in the post-intervention group were discharged a median of 2.4 days sooner than the pre-intervention period (12.2 days vs. 9.8 days, p = 0.159). No significant differences resulted in 90-day readmission rates or 90-day C. difficile or MDRO rates. Table 1. Primary Outcome for Patients with Pyogenic Liver Abscesses Treated Pre- and Post-Antibiotic Stewardship Algorithm Table 2. Secondary Outcomes for Patients with Pyogenic Liver Abscesses Treated Pre- and Post-Antibiotic Stewardship Algorithm Conclusion The implementation of a PLA treatment and management algorithm led to a decrease in anti-pseudomonal beta-lactams without impacting clinical outcomes and a trend towards decreased LOS. Disclosures All Authors: No reported disclosures

PSIII-10 The effect of a direct-fed microbial (10-G) on live animal performance and carcass characteristics of fed beef heifers

Heifers (n = 1,394; 291 ± 9.9 kg) were used to test the effects of a direct-fed microbial (10-G) on live growth performance and carcass characteristics. Heifers were blocked by arrival day and randomly allocated to treatment (0 or 2g/animal/d; CON and 10-G, respectively) in a randomized complete block design with ten pens per treatment. Heifers were fed for an average of 192 days. Growth and carcass outcomes were analyzed using mixed models with pen as experimental unit and block as random effect. Dry matter intake (P = 0.63), average daily gain (P = 0.69), gain:feed (P = 0.95) and final body weight (P = 0.79) did not differ between treatments. Neither deads and removals (P = 0.52) nor first or second treatment morbidity rates (P ≥ 0.84) were different between treatments. Hot carcass weight (P = 0.19), dressed carcass yield (P = 0.33), 12th rib fat depth (P = 0.73), ribeye area (P = 0.13), calculated empty body fat (P = 0.71) or marbling score (P = 0.20) were not different between treatments. Yield grade distributions did not differ between treatments (P ≥ 0.44), however cattle fed 10-G tended (P = 0.09; 15.78 vs 20.34%) to be represented by fewer USDA Select carcasses. Livers from cattle fed 10-G tended (P = 0.10; 1.02 vs 2.19%) to have a lower frequency of abscesses when compared to CON. Heifers fed 10-G also had fewer (P < 0.05; 5.27 vs 8.51%) severe liver abscesses. These results suggest that supplementing fed beef heifers with 10-G decreased rates of severe liver abscesses without altering live animal performance or carcass characteristics.

A Pyogenic Liver Abscess Leading to Massive Pleural Effusion: A Case Report

Pyogenic liver abscesses are common in tropical developing countries. They are typically present with right and upper abdominal pain; nevertheless, occasionally, we encounter atypical presentations. Here we present a rare case of complicated large liver abscesses caused by Klebsiella pneumonia, which manifests in massive pleural effusion in a young, healthy gentleman. The patient stayed ten days in the hospital for drainage and to receive appropriate antibiotics.