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PubMed1993

[A case of liver abscess associated with endophthalmitis caused by Klebsiella pneumoniae].

A 54-year-old female was admitted to our hospital because of a spiking fever, right hypochondriac pain, right orbital pain and visual disturbance. Before admission she was treated with systemic antibiotics infusion for a diagnosis of liver abscess at the other hospital and the liver abscess almost diminished for a while. With the diagnosis of liver abscess and endophthalmitis, liver drainage and evisceration were carried out. The culture of pus from the eye and liver yielded K. pneumoniae. After liver drainage, evisceration, and direct injection of antibiotics into the eye, inflammatory findings tended to improve. Seven cases of metastatic K. pneumoniae endophthalmitis have been reported so far in Japan. The cases had liver abscess as the primary disease and 3 cases had bilateral endophthalmitis. Five cases with liver abscess survived except one who died of sepsis, but unfortunately, all cases became blind in the affected eyes. The prognosis of bacterial endophthalmitis, especially associated with K. pneumoniae liver abscess, is poor and as the outcome could appear to depend on time when treatment is started, a more aggressive diagnostic approach is required. Moreover systemic antibiotic infusion alone is inadequate for treatment of liver abscess and endophthalmitis, and liver drainage, evisceration and intravitreal injection of antibiotics must be given in early stage.

Endophthalmitis↗
PubMed2006

[Sonographic diagnosis of a liver abscess caused by an enterohepatic fistula in a patient with Crohn's disease].

Liver abscesses in patients with Crohn's disease are rare. We report on a patient with Crohn's disease and a liver abscess of the left lobe caused by an enterohepatic fistula. With treatment of antibiotics and Infliximab the abscess showed complete regression. Percutaneous drainage of the liver abscess was not performed because the abscess was shown not to be completely liquefied at echo-enhanced ultrasound. This case report demonstrates the usefulness of percutaneous conventional and echo-enhanced ultrasound for the diagnosis of liver abscesses. Furthermore, this case also shows that enterohepatic fistulas can be diagnosed precisely with percutaneous ultrasound.

Adult↗
PubMed2005

Liver abscess after percutaneous radiofrequency ablation for hepatocellular carcinomas: frequency and risk factors.

OBJECTIVE: The purpose of this study was to clarify the frequency and risk factors of liver abscess formation after percutaneous radiofrequency ablation in patients with hepatocellular carcinoma. MATERIALS AND METHODS: Over a 4-year period, 603 patients with 831 hepatocellular carcinomas measuring 5 cm or less in maximum diameter who underwent a total of 751 percutaneous radiofrequency ablation procedures were enrolled in this study. We retrospectively reviewed the medical records and analyzed the overall frequency of liver abscess, risk factors for abscess, and clinical features of the patients. The relationships between liver abscess and potential risk factors were analyzed using either generalized estimating equations or multiple logistic regression analysis. RESULTS: Liver abscess developed in 14 tumors of 13 patients after 13 (13/751 [1.7%]) ablation procedures. Generalized estimating equations and multiple logistic regression analysis of various potential risk factors revealed that preexisting biliary abnormality prone to ascending biliary infection (p = 0.0088), tumor with retention of iodized oil from previous transcatheter arterial chemoembolization (p = 0.040), and treatment with an internally cooled electrode system (p = 0.016) were associated with a significant risk of liver abscess formation. No patient died of liver abscess, and all successfully recovered from liver abscess with parenteral antibiotics and percutaneous clearance of pus. CONCLUSION: Although liver abscess formation was infrequent in patients who underwent percutaneous radiofrequency ablation for hepatocellular carcinoma, the patients with significant risk factors-preexisting biliary abnormality prone to ascending biliary infection, tumor with retention of iodized oil, and treatment with an internally cooled electrode system-for liver abscess formation should be closely monitored after treatment.

Anesthesia, Local↗
PubMed2002

Klebsiella pneumoniae liver abscess in Taiwan is not caused by a clonal spread strain.

In Taiwan, the incidence of pyogenic liver abscess caused by Klebsiella pneumoniae has been increasing over the past 2 decades. Although most of the patients have no concurrent biliary tract disease, diabetes mellitus is thought to be an important risk factor for the disease. The incidence of metastatic infections in K. pneumoniae liver abscess, such as endogenous endophthalmitis and other extrahepatic infections, is also higher than that in liver abscess caused by other microbes. Furthermore, the incidence of metastatic infections in K. pneumoniae liver abscess in Taiwan is higher than Western countries. The reasons why K. pneumoniae liver abscess is so common in Taiwan and why diabetes mellitus is a risk factor for the disease are not clear. In this study, blood isolates from 40 patients with K. pneumoniae liver abscess treated at the Taipei Veterans General Hospital from 1995 through 2000 were randomly selected for study. Pulsed-field gel electrophoresis, ribotyping, and serotyping were used for cluster analysis. A total of 15 strains were of serotype K1 and 25 strains were of a serotype other than K1. No major cluster or a closely related strain of K. pneumoniae was found. In conclusion, the results obtained from pulse-field gel electrophoresis and ribotyping of K. pneumoniae isolates do not suggest that liver abscess in Taiwan is primarily caused by a single genetically related strain.

Cluster Analysis↗
PubMed1975

Tinidazole for the treatment of amoebic liver abscess.

Ten patients suffering from amoebic liver abscess were treated with tinidazole (Fasigyn) 800 mg t.d.s. for 5 days. Nine were cured, and 1 patient required further treatment with other drugs. Following this, a double-blind trial was carried out to compare a group of patients treated with tinidazole with a similar group treated with metronidazole. Each series consisted of 14 patients. In the tinidazole series 13 patients were cured and for 1 patient the result of treatment was dubious. All patients in the metronidazole series were cured, but 1 patient admitted to the trial had previously not been cured by metronidazole. It appears that tinidazole and metronidazole are equally efficaceous in the treatment of amoebic liver abscess.

Clinical Trials as Topic↗
PubMed1985

[Diagnosis of liver abscesses].

The author observed 298 patients with abscesses of the liver of different etiology. The frequency of symptoms detected by clinical, laboratory abd roentgenological examinations is analysed. The value of special methods of examination (such as scanning and radiography of the liver, electrorentgenoscanography, echography, laparoscopy) is shown.

Adolescent↗
PubMed1998

Pyogenic liver abscess complicating a ventriculoperitoneal shunt.

Pyogenic liver abscess is a rare complication of ventriculoperitoneal (VP) shunting. We report a 4-month-old female with this complication who was successfully treat ed by computed tomography-guided percutaneous transhepatic catheter drainage, shunt externalization, and parenteral antibiotics. Liver abscess is a possible intra-abdominal complication of VP shunting, and imaging studies are good adjuncts in making the clinical diagnosis.

Female↗
PubMed1992

Profile of amebic liver abscess.

Two hundred cases of amebic liver abscess diagnosed between 1989 and 1991 at the Kasturba Medical College, Manipal were analyzed in this retrospective study. The clinical features and investigation reports were studied and the treatment and its response were analyzed. Amebic liver abscess constituted 0.6% of total hospital admissions during the study period. The male to female ratio was 13:1 with the most common age group of presentation between the fourth and fifth decades of life. Abdominal pain was the most common symptom (92%) and hepatomegaly was observed in 94% of the cases. Ultrasonogram of the abdomen served as the most useful diagnostic aid. Right lobe abscess was observed in 87% of the cases. Abscess was single in 81.5% of cases. Abscess size of more than 4 cm was observed in 46.5% of the cases. Metronidazole and chloroquine were found to be effective in most cases. Aspiration was done in 35.5% of cases. The complications encountered in this study were pleural effusion (two cases), pneumonic consolidation (four cases), pericardial effusion (one case) and ascitis (two cases).

Adolescent↗
PubMed1999

Ascaris-induced liver abscess.

The prevalence, symptomatology, and outcome of Ascaris-induced liver abscess was studied prospectively in Kashmir, India, which is an endemic area of ascariasis, from December 1987 to December 1997. Of 510 patients with liver abscess admitted during this period, 74 had biliary ascariasis as the cause (14.51%). Of these 74 patients, 11 had intact ascaridae (live or dead) within the abscess. Six patients had a single abscess, and five had multiple abscesses. Seven patients had associated worms in the bile ducts. Ultrasonography was the main diagnostic procedure used. Ten patients were diagnosed based on clinical and ultrasound findings, and one was diagnosed during laparotomy. Most of the patients were young (age range 3-40 years) with a mean age of 17.20 years. Seven were females, and four were males. Ten patients underwent surgery; nine recovered completely, and one died postoperatively due to septicemia. Another patient died as well: a young child who presented late, was in refractory septic shock following suppurative cholangitis and liver abscess, and could not be taken for surgery. The mortality thus was 9.9%. Liver abscess following invasion of intrahepatic biliary radicles by ascaridae through the ampulla is an unusual complication of an otherwise common disease in Kashmir Valley, affecting children and young adults. The outcome depends on early diagnosis and surgical drainage of the abscess with extraction of worms from the ducts.

Adolescent↗
PubMed1991

[The relationship between predisposing factors in liver abscesses and the causative bacteria].

In order to assess the correlation between bacteria isolated from liver abscesses and factors predisposing to liver abscesses, a retrospective study of clinical and bacteriological data on 21 patients with 27 episodes of pyogenic abscesses was carried out at the University Medical Centre, Amsterdam. Out of 27 episodes, 15 (55%) were associated with biliary or pancreatic disease; in seven of these 15 episodes more than one microorganism was cultured. Enterobacteriaceae were isolated in 13 (85%) of 15 episodes. Anaerobic bacteria were recovered only when operations in the pancreatico-biliary area had been performed previously. Seven episodes (26%) were related to extrahepatic disease; anaerobic bacteria (Bacteroides and Fusobacterium spp.) were isolated in five of these seven episodes. Streptococcus milleri seemed especially prominent, since this bacterium was cultured in six of seven episodes. Enterobacteriaceae were not involved in these seven episodes. Other factors predisposing to liver abscesses (15%) were diabetes mellitus n = 2), paraproteinaemia (n = I), and metastatic carcinoid (n = I). Blood cultures were positive in 65% of 23 episodes, but 40% of the positive cultures contained a smaller number of bacterial species than could be cultured from the abscess itself. Bacteria isolated from liver abscesses are related to the underlying predisposing condition. For diagnosis of the underlying condition and antibiotic therapy, puncture and bacteriologic examination of the abscess is essential.

Adult↗
PubMedDate not supplied

Amoebic liver abscess: a comparative study of needle aspiration versus conservative treatment.

BACKGROUND: Amoebic liver abscess is a serious problem in Pakistan. Its management includes antimicrobial drugs, needle aspiration and surgical drainage. This study was done to see the therapeutic efficacy, safety and outcome of ultrasound guided needle aspiration of amoebic liver abscess combined with antiamoebic drugs. METHODS: This was a prospective study with a minimum follow up of six months comparing the results of needle aspiration plus antiamoebic drugs with drug treatment alone in Amoebic Liver Abscess. It was carried in Surgical 'B' Unit of Ayub Teaching Hospital from July 1998 to June 2001. The patients were divided into two groups. Group A with abscess < 300 cm3 were treated with drugs alone. Group B patients with abscess > 300 cm3 or smaller abscesses which failed to respond to medical treatment were treated with both needle aspiration and drugs. Main outcome measures were abdominal pain, fever, anorexia, hepatomegaly, resolution of amoebic liver abscess on ultrasound, length of hospital stay and any complications. RESULTS: There were 46 patients in the study group. 21 (45.5%) patients were in Group A and 25 (54.5%) in Group B. The ages ranged from 15-70 years. 38 patients were male and 8 were females. The right lobe was involved in 44 (95.5%) patients and left lobe in 2 (4.5%) patients. Mean volume of abscess in Group A was 225 cm3 and in Group B was 560 cm3. Needle aspiration was successful in 24 (96.3%) patients and failed in 1 (3.7%) patient. The mean time of clinical improvement was 7 and 3 days respectively in Groups A and B. The mean hospital stay was shorter in Group B (3.5 day) than Group A (7.5 days). The resolution of abscess seen on ultrasound was rapid in Group B. Complications occurred in only one patient in Group B. No mortality was seen in any group. CONCLUSIONS: Needle aspiration combined with antiamoebic drugs is more effective than drug treatment alone in the management of amoebic liver abscess.

Adolescent↗
PubMed1984

Pyogenic liver abscess: diagnosis, bacteriology and treatment.

Pyogenic liver abscess is an uncommon but potentially fatal disease. The accuracy of diagnosis made on clinical grounds can now be greatly improved with the use of modern organ-imaging techniques. The condition is often polymicrobial: Escherichia coli and other enteric gram-negative rods are major pathogens, with anaerobic gram-negative rods and Streptococcus milleri being increasingly recognised. Staphylococcal liver abscesses are less common, often arising in association with neutrophil disorders. Open surgical drainage along with antimicrobial chemotherapy has long been regarded as standard treatment, however, in many centres it is being displaced by percutaneous drainage under the guidance of computed tomography or ultrasound. Some patients have been successfully treated with antimicrobial chemotherapy alone. Once specimens have been taken for culture, empiric antimicrobial therapy should include a combination of an anti-anaerobe agent, an aminoglycoside and a beta-lactam drug such as ampicillin. Early diagnosis and treatment of this condition is essential for patient survival.

Anti-Bacterial Agents↗
PubMed2000

Klebsiella pneumoniae isolates causing liver abscess in Taiwan.

Klebsiella pneumoniae has been the leading cause of pyogenic liver abscess in Taiwan during the period from 1985 to 1999, which is different from other countries. The present study investigated the in vitro antimicrobial susceptibilities of 51 K. pneumoniae isolates collected from blood cultures of patients with liver abscess in Taiwan during the period from 1993-1997, and typed by pulsed-field gel electrophoresis (PFGE). All 51 isolates were resistant to ampicillin, but susceptible to other antimicrobial agents. The minimum inhibitory concentrations (MICs) were less than 1 microg/ml for the third- and fourth-generation cephalosporins, monobactam, carbapenems, and ciprofloxacin. In comparison, 62 isolates of K. pneumoniae from community-acquired bacteremic patients without liver abscess had similar antimicrobial susceptibilities, while 142 isolates from patients with hospital-acquired bacteremia without liver abscess were much less susceptible to all of the tested antimicrobial agents. PFGE molecular epidemiologic analysis found 20 out of 51 isolates belonged to eight clusters of genetically related strains, with two or three isolates in each clusters. The other 31 isolates were genetically distinct strains. This study demonstrated that K. pneumoniae isolates which cause liver abscess in Taiwan remained susceptible to a wide range of antimicrobial agents and that they were not genetically related.

Abscess↗
PubMed1982

Liver abscess: a changing entity.

Over the past 12 years, 25 patients with liver abscess have been treated at the Medical University of South Carolina. Their clinical course was compared with a previous series of 22 patients from this institution reported in 1968. Our findings were discussed in the light of clinical aspects of liver abscess reported in the surgical literature over the past four decades. These comparisons show a diminishing role of amebic infection and appendicitis as etiologic factors in the development of liver abscess. Immunologic deficiencies are emerging as an important etiologic category. Over the past decade, anaerobic organisms have demonstrated a more obvious role in this infection. The clinical presentation of these patients in recent years has been characterized by an increasingly chronic pattern rather than the frequent septic presentation of the preantibiotic era. Over the past two decades, the mortality of liver abscess has diminished markedly in spite of few changes in operative approach. This is partly due to earlier, accurate diagnosis with the use of liver scanning. Hopefully, this trend will continue with the more frequent use of new diagnostic techniques, such as computerized axial tomography, and with improvement of pre- and postoperative care.

Adolescent↗
PubMed2000

[Pyogenic liver abscess as a complication of Crohn's disease].

Pyogenic liver abscess in patients with Crohn's disease is not common, but the mortality has been reported to be high if diagnosis and treatment is delayed. Intra-abdominal abscesses, fistulous disease, and steroid therapy have all been reported to be important predisposing factors in the pathogenesis of this entity. We present a patient with Crohn's disease in whom multiple abscesses were encountered in the right lobe of the liver. The diagnosis of liver abscess was established by abdominal computed tomography and the patient was treated by percutaneous catheter drainage. Awareness of this rare complication is important because diagnosis is difficult to make and a high index of suspicion is required. Once suspected, aggressive diagnostic workup and treatment is indicated. Most patients with liver abscess can be successfully managed by percutaneous catheter drainage combined with antibiotic therapy if it is diagnosed before extensive necrosis has occurred.

Adult↗
PubMed2005

Risk factors for spontaneous rupture of liver abscess caused by Klebsiella pneumoniae.

To identify risk factors for spontaneous rupture of liver abscess (SRLA), a retrospective study on patients with liver abscess caused by Klebsiella pneumoniae was performed. Of the 140 enrolled patients with liver abscess caused by K. pneumoniae, 8 (5.7%) experienced SRLA. In comparison to those with nonruptured liver abscess (NRLA), patients with SRLA were found to have significantly higher proportions of diabetic mellitus (100% versus 62.1%, P = 0.003), larger abscess size (mean of maximal diameter 7.8 versus 6.1 cm, P = 0.043), gas formation in abscess (87.5% versus 23.5%, P < 0.001), and left hepatic lobe involvement (50.0% versus 16.5%, P = 0.018). K. pneumoniae serotypes K1 and K2 were the predominant microorganisms isolated in both patients with NRLA and SRLA. Pulsed-field gel electrophoresis-generated fingerprinting of K. pneumoniae isolates from patients with SRLA revealed that these pathogens were nongenetically related.

Aged↗
PubMedDate not supplied

Management of 240 cases of liver abscess.

The clinical features and surgical management of 240 cases of liver abscess admitted during a period of five years are presented. Incidence of liver abscess was 0.20 per cent of hospital admissions. A peak age incidence in the 4th decade, male preponderance, pain and fever were the striking features. The majority of the abscesses were localised to a single lobe (90.0%). The abscess was sited in the right lobe in 75.1 per cent, in the left lobe in 18.3 per cent and in both lobes in 6.7 per cent. Elevation and limitation of movement of the right dome of the diaphragm was present in 89.5 per cent of cases. Depending upon therapeutic response, aspiration or/and surgical drainage was undertaken. Aspiration was done in 169 patients and surgical drainage in 63 patients. Management of pyogenic liver abscess included early operative intervention preceded by appropriate antibiotic therapy. Surgical intervention is required less often in amoebic abscess and is recommended only after amoebicidal therapy. Open drainage is recommended for the cases associated with complications, left lobe abscess and big abscess.

Adolescent↗
PubMed2002

Xanthogranulomatous cholecystitis with a liver abscess and metastatic endophthalmitis: report of a case.

There have been no reported cases of xanthogranulomatous cholecystitis with a liver abscess and metastatic endophthalmitis in the literature. There has been only one other case of xanthogranulomatous cholecystitis associated with a liver abscess in Japan prior to the present report. A 53-year-old man was admitted to a local hospital complaining of high fever. Abdominal ultrasonography and computed tomography showed a liver abscess. After percutaneous transhepatic abscess drainage, he complained of an abnormal sensation in his left eyeball and was diagnosed to have endophthalmitis. After being treated for the endophthalmitis, he was referred to our hospital to have the liver abscess evaluated. Endoscopic retrograde cholangiopancreatography showed a normal biliary system without any communication with the liver abscess. Two weeks after endoscopic retrograde cholangiopancreatography he complained of right hypochondralgia. Ultrasonography revealed the presence of sludge in the swollen gallbladder. Under a diagnosis of cholecystitis with a liver abscess, a cholecystectomy was performed. A histological examination indicated xanthogranulomatous cholecystitis based on the findings of a granulomatous lesion consisting of foamy cells in the gallbladder wall. We herein present the first known case of xanthogranulomatous cholecystitis with a liver abscess and metastatic endophthalmitis, while also making a review of the literature.

Cholangiopancreatography, Endoscopic Retrograde↗