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At least 217 records · Page 12Linked to original sources
PubMed2005

Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics.

OBJECTIVES: Pyogenic liver abscess is a common intraabdominal infection. Historically, Escherichia coli (E. coli) has been the predominant causative agent. Klebsiella liver abscess (KLA) was first reported in Taiwan and has surpassed E. coli as the number one isolate from patients with hepatic abscesses in that country and reports from other countries, including the United States, have increased. We examined the microbiologic trends of pyogenic liver abscess at our institution to determine if a similar shift in etiologic agents was occurring. METHODS: We examined all cases of liver abscess at our institution from 1999 to 2003 via a retrospective chart review of inpatient records and reviewed the English literature via a MEDLINE search for all U.S. cases of KLA. RESULTS: Since 1966, only 12 cases of KLA have been reported in the United States. We report six cases of KLA at our institution alone; 2 patients were not Asian, and 4 were not diabetic. Klebsiella pneumoniae (K. pneumoniae) was the most common cause of pyogenic hepatic abscess at our institution over the last 5-yr period. When comparing Klebsiella versus other causes of pyogenic liver abscess, there were no significant differences in demographics or laboratory findings; however, most of our Klebsiella cases occurred among Filipinos. Review of the 18 cases of K. pneumoniae liver abscess in the United States showed that Klebsiella cases occurred predominantly among middle-aged men; 83% had concurrent bacteremia and 28% had metastatic complications. An increasing number of cases were reported from the United States since the mid-1990s. CONCLUSIONS: These data suggest that KLA may represent an emerging disease in Western countries, such as the United States. The diagnosis of K. pneumoniae should be considered in all cases of liver abscess, and appropriate antibiotic therapy and a diagnostic work-up for metastatic complications should be employed.

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PubMed1997

[Ultrasonography of amebic liver abscesses. Proposal of a new classification].

The different classifications used for amebic liver abscesses seem to be usually without direct therapeutic benefit. Echographic assessment was used to propose a new classification of amebic liver abscesses. This report is a prospective study conducted over 3 years and concerning 118 patients involved by 119 amebic liver abscesses. They were 109 males and 9 females aged from 13 to 68 years (mean, 36 years). All cases were correctly diagnosed by clinical and ultrasound findings, aspect of the pus, course under treatment and rarely by serologic examinations (3 patients). Patients were followed up with clinical and sonographic examinations as requested. Our classification was based on the initial echographic examination findings, the therapeutic indications and the type of healing obtained. In total, 93 abscesses (80, 67%) were treated by medical therapy alone and 26 cases (21, 84%) by combined US-guided evacuation and medical therapy. In the 119 abscesses, 112 (94, 11%) completely recovered with reconstitution of a normal liver parenchyma. In the remaining 7 cases (5, 88%) the abscesses persisted for several months (12 to 36 months). Our study suggests that ultrasonographic features of amebic liver abscesses can be segregated in three forms: noncollected form which needs to be treated by medical therapy alone, collected form which can be treated medically or by association with US-guided evacuation, and the healing forms. This classification appears to us to be simple but very precise, reliable and useful especially for therapeutic indications of amebic liver abscesses.

Adult↗
PubMedDate not supplied

Entamoeba histolytica: diffuse liver inflammation in gerbils (Meriones unguiculatus) with experimentally induced amebic liver abscess.

The histopathological changes that occur in the uninfected liver lobes of gerbils with a localized amebic liver abscess (left lobe) were studied from 5 to 60 days after inoculation. Early parenchymal changes (10 days) in the right and median liver lobes showed a lymphocytic infiltrate and bile duct proliferation in the portal areas. Maximum alterations occurred at 20 to 30 days after inoculation and were characterized by a dense portal infiltrate, hepatocyte degeneration, granulocytic infiltrate and marked glycogen depletion. In drug-treated infections with metronidazole, the diffuse liver inflammation was terminated. The results of this study suggest that the diffuse liver injury was directly or indirectly induced by the presence of a proliferating amebic liver abscess and that the pathology caused by amebic liver abscess is more extensive than previously thought.

Animals↗
PubMed2000

[A recurrent case of amebic liver abscess seventeen years after the first occurrence].

A 49-year-old male who had been diagnosed as having amebic liver abscess when he was 32-year-old was admitted to our hospital with fever and watery diarrhea. Ultrasonography and CT examination demonstrated a solitary abscess in the right lobe of the liver. Cysts of Entamoeba histolytica were detected in the stool and an aspiration of the liver abscess looked like anchovy paste. Serum amebic antibody by the IFA method was positive and the case was diagnosed as amebic liver abscess. The patient was treated with metronidazole, and percutaneous transhepatic abscess drainage was performed. The liver abscess decreased remarkably in size and serum amebic antibody was negative after the treatment. Recurrence of amebic liver abscess is rare and we report this case with some literature.

Humans↗
PubMed2003

Ocular manifestations and complications of pyogenic liver abscess.

In anecdotal reports, septic metastatic lesions from a pyogenic liver abscess can result in endogenous endophthalmitis, an infection of intraocular contents. Recent reports suggest that this devastating complication is increasing in frequency. The initial presentation may be nonspecific and easily misdiagnosed by the surgical team. When the infecting organism is virulent, it tends to be rapidly progressive and often leads to permanent visual deterioration or blindness despite medical intervention. We conducted a study to determine the incidence of endophthalmitis associated with pyogenic liver abscess, to identify its associations, and to determine the outcome of treatment. A retrospective review of 289 patients with a clinical diagnosis of pyogenic liver abscess admitted between January 1995 and March 2001 revealed 10 patients (3.5%) with the complication of endogenous endophthalmitis. Among them, seven had a previous history of diabetes mellitus. The offending organism was Klebsiella pneumoniae in all cases. There was no mortality in this series. Final visual outcomes of our patients were as follows: Five had no light perception (two had undergone evisceration), one had light perception only, and four were able to visualize hand motion only. There is a trend toward a worse outcome when ocular symptoms are not diagnosed and treated within 24 hours of onset. Of the five patients who lost their eyesight completely, three were initially misdiagnosed, and referral to the ophthalmologist was delayed. Surgeons must be alert to the complication of endogenous endophthalmitis. Ocular symptoms in patients treated for pyogenic liver abscess must be referred early for an ophthalmologic consult. Increased awareness and a high index of suspicion are required for salvage of visual function.

Adult↗
PubMed2001

Amoebic liver abscess in pregnancy.

We describe the case of an amoebic liver abscess (ALA) presenting in the third trimester of pregnancy which raised both diagnostic and treatment dilemmas as well as being associated with preterm labour. Amoebic liver abscess is caused by the protozoan organism Entamoeba histolytica which is endemic in many parts of the developing world. Invasion of the colonic mucosa results in the clinical syndrome of amoebic dysentery and in some cases dissemination to the liver or other organs occurs resulting in abscess formation. Amoebic liver abscess is a rare complication of pregnancy and there are few reports in the world literature, these being mostly from endemic areas. We present here the case of a caucasian female who presented with an amoebic liver abscess in the third trimester of pregnancy, thirteen months after returning to Australia from a short holiday in Bali.

Adult↗
PubMed2006

Liver abscess that responded well to pazufloxacin therapy.

Pazufloxacin (PZFX), an injectable, new quinolone antibacterial drug, has strong antibacterial activity against gram-negative bacteria (which often account for liver abscess) and transfers well to liver tissue, gallbladder tissue, and bile. Therefore, it is probable that PZFX could be extremely useful for patients with liver abscess. Here, we report two cases of liver abscess that resolved with PZFX. PZFX was intravenously administered to patients who had undergone abscess drainage, at a dose level of 500 mg x 2/day. PZFX therapy thereby allowed the patients to shorten the period of hospital stay. Liver abscess has been considered as a poor-prognosis disorder, due to delay in diagnosis of the disorder and the high incidence of septicemia that subsequently occurs. However, now, appropriate antibacterial drug therapy in combination with abscess drainage successfully allows excellent prognosis of patients with liver abscess without the reduction in the activities of daily living (ADL) that accompanies hepatic artery injection.

Adult↗
PubMed2004

Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases.

Distinguishing amoebic from pyogenic liver abscesses is crucial because their treatments and prognoses differ. We retrospectively reviewed the medical records of 577 adults with liver abscess in order to identify clinical, laboratory, and radiographic factors useful in differentiating these microbial aetiologies. Presumptive diagnoses of amoebic (n = 471; 82%) vs. pyogenic (n = 106; 18%) abscess were based upon amoebic serology, microbiological culture results, and response to therapy. Patients with amoebic abscess were more likely to be young males with a tender, solitary, right lobe abscess (P = 0.012). Univariate analysis found patients with pyogenic abscess more likely to be over 50 years old, with a history of diabetes and jaundice, with pulmonary findings, multiple abscesses, amoebic serology titres <1:256 IU, and lower levels of serum albumin (P < 0.04). Multivariate logistic regression analysis confirmed that age >50 years, pulmonary findings on examination, multiple abscesses, and amebic serology titres <1:256 IU were predictive of pyogenic infection. Several clinical and laboratory parameters can aid in the differentiation of amebic and pyogenic liver abscess. In our setting, amebic abscess is more prevalent and, in most circumstances, can be identified and managed without percutaneous aspiration.

Adolescent↗
PubMed1984

Entamoeba histolytica: antibody responses and lymphoreticular changes in gerbils (Meriones unguiculatus) in response to experimental liver abscess and amebic extract infection.

Antibody responses and histological changes in hepatic lymph nodes and spleen of gerbils (Meriones unguiculatus) during the course of experimental hepatic amebiasis (5-60 days), or in those injected with extracts of Entamoeba histolytica, are described. Lymph node and spleen responses in infected animals paralleled the proliferation of the amebic liver abscess. However, spleen follicle responses were similar in animals that received low or high doses of the amebic extract and differed histologically from those with amebic liver abscess. Liver abscesses, up to 30 days postinfection (pi), doubled in weight between 10 and 15 and between 20 and 30 days pi. Early changes (10 days pi) in the lymphoreticular tissues were characterized by increased size and weight of the organs, hyperplastic follicles, and blastogenesis in the T-dependent areas. At 20 and 30 days pi, the size of spleen follicles increased and there was depletion of lymphocytes from the periarterial area (PAA), as well as gross extension of the red pulp, accompanied by extramedullary erythropoiesis and megakaryocytosis. The paracortical areas (PCA) of lymph nodes were depleted of lymphocytes and histiocytosis throughout the organ, and there was intense plasma cell activity in the medulla. At 60 days pi, lymphocyte repopulation was noted in the PCA and PAA; germinal centers were depleted of blast cells and the spleen red pulp had contracted. Antiamebic antibody titers were low throughout the infection. Changes in the cellularity of the lymphoid organs are discussed in relation to the proliferation of the amebic liver abscesses in infected animals and in those which were injected with the amebic extract.

Animals↗
PubMed2006

Pyogenic liver abscess in ESRD patients undergoing maintenance dialysis therapy.

BACKGROUND: Patients with end-stage renal disease (ESRD) on dialysis therapy have increased susceptibility to bacterial infection. Data regarding pyogenic liver abscess in this population are rare. METHODS: We retrospectively examined all cases of pyogenic liver abscess in patients undergoing maintenance dialysis therapy in 2 tertiary referral centers. Medical records of patients with ESRD with a pyogenic liver abscess from January 1995 to September 2004 were studied. RESULTS: Twenty-seven of 20,676 admitted patients with ESRD were found to have a pyogenic liver abscess. The major predisposing factor was diabetes mellitus (59.3%). The most common clinical symptoms were fever and chills (85.2%). A rare presentation of hiccup was noted in 2 peritoneal dialysis patients, and endophthalmitis was noted in 2 patients with liver abscess caused by Klebsiella pneumoniae. Abscesses were located mainly in the right lobe (70.4%) and presented as a solitary mass (74.1%). K pneumoniae was the most common bacteria isolated in blood cultures (51.9%) and liver abscess aspirates (37%). Invasive drainage approaches performed in 17 patients (63%) resulted in a unique complication of peritonitis in 4 peritoneal dialysis patients. The difference in mortality rates between patients who underwent invasive procedures and those who did not was not significant (P = 0.68). The overall in-hospital mortality rate of patients with ESRD with a pyogenic liver abscess was 33.3%. CONCLUSION: Although pyogenic liver abscess is uncommon in patients with ESRD undergoing maintenance dialysis therapy, it is still a disease of significant mortality.

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PubMed1994

[Clinical aspects, etiology, diagnosis and therapy of liver abscess. A retrospective study 1984-1991].

In a retrospective study (1984-1991) we evaluated 56 patients with pyogenic (44 patients) and with amebic (12 patients) liver abscesses. Patients with pyogenic liver abscesses usually belong to the older generation (70-80 years). Pyogenic abscesses are mainly due to a severe underlying disease and patients are in poor general condition. Therapy includes antibiotics and in most cases drainage (nowadays mainly percutaneous; surgical drainage should only be used with a simultaneous intraabdominal procedure for treatment of the underlying disease). The mean hospitalization time is 33 days. Prognosis is good, the mortality of 14% being mainly due to severe underlying disease. This latter can be found in 75% of the patients and should be treated electively. In amebic liver abscesses the patients are much younger (around 30 years). Patients are in good general condition and antibiotics alone are sufficient for radical treatment. The mean hospitalization time is 16.5 days and mortality is zero. Symptoms and clinical signs are the same in both groups: fever, right upper quadrant tenderness, jaundice and hepatomegaly. Diagnosis by ultrasonography and/or computed tomography is very reliable. History and serology are reliable for differentiation of the two types. With a correct diagnostic approach and treatment, liver abscesses are today benign conditions with a low mortality.

Adult↗
PubMed1998

Listeria monocytogenes causing solitary liver abscess. Case report and review of the literature.

The authors report on a case of a solitary liver abscess due to Listeria monocytogenes in a 53-year-old diabetic white male and review all published cases of solitary listerial abscesses of the liver. L. monocytogenes is a rare cause of solitary liver abscess which occurs in elderly patients with diabetes mellitus. The clinical signs are variable and often mimic malignancy, with epigastric pain, night sweats and weight loss. Prevalent features are poor control of glycemia, temperature up to 38.5 degrees C and elevated alkaline phosphatase. Optimal treatment includes percutaneous drainage of the hepatic abscess and antibiotic therapy with an aminopenicillin or trimethoprim/sulfamethoxazole. Outcome of the reviewed patients was favourable with no mortality and no relapse of the disease.

Anti-Bacterial Agents↗
PubMed2004

[Liver abscesses secondary to sigmoid diverticulitis: report of four cases].

INTRODUCTION: Pyogenic liver abscess often revealed by right sided abdominal pain and fever is a serious and life-threatening pathology. Biliary tract disease is the origin of the abscess in most cases but sometimes remains unidentified. A sigmoid septic source sometimes paucisymptomatic or hidden by an immunosuppressive treatment must be looked for. EXEGESIS: Here are four observations of liver abscesses, which are secondary to unknown sigmoiditis. The etiologic diagnosis was made either by abdomino-pelvic computed tomography or by enema with water-soluble products completed by a coloscopy. Each patient's liver abscesses were emptied by aspiration or catheter drainage in conjunction with antibiotics. Surgical treatment of sigmoiditis was performed either at the same time or later. CONCLUSION: Any liver abscess of unknown origin must lead to a search for unknown or disguised septic sigmoid pathology. Most of the time, injected abdomino-pelvic computed tomography makes the diagnosis possible, but enema associated with coloscopy is sometimes necessary.

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