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PubMed1986

Pyogenic liver abscesses in nonimmunocompromised children.

Pyogenic liver abscesses are rare in previously healthy children. This review reports ten such cases of pyogenic abscess seen between 1963 and 1984. The mean age in these children was 6.3 years. One child died. Of the nine survivors, five had successful open surgical drainage. Two abscesses were drained percutaneously. Another abscess drained spontaneously into the biliary system, and one abscess was treated with antibiotics alone. The single most helpful diagnostic test was abdominal ultrasonography. Our experience is evaluated in the context of other reports of pyogenic abscesses in children.

Adolescent↗

PubMed2000

Pyogenic liver abscess.

BACKGROUND: A current assessment of liver abscesses should allow for better understanding of the pathogenesis of the disease and improve the effectiveness of diagnosis and treatment. Amebic liver abscess occurs more commonly than pyogenic liver abscess on a worldwide basis. However, in the United States, pyogenic liver abscess predominates. The purpose of our study was to evaluate the etiology, management, morbidity, and mortality of all patients admitted to our medical center with diagnoses of pyogenic liver abscess between 1983 and 1996. METHODS: A retrospective chart review was performed on all patients admitted to our medical center, Louisiana State University Medical Center, Shreveport, with diagnoses of pyogenic liver abscess. RESULTS: Twenty patients were admitted with diagnoses of pyogenic liver abscess. The subjects were 65% (13/20) male and 65% (13/20) African-American and had an average age of 52 years. The most common presenting symptoms were fever and pain. The most common physical finding was right upper-quadrant tenderness. The most common etiologies of pyogenic liver abscesses were cryptogenic, trauma, and biliary, while portal vein was the source for only 10% of the cases. The right lobe of the liver was involved in 95% of the cases, and 70% of these liver abscesses were solitary. Computed tomography (CT)-and ultrasound-guided percutaneous drainage were performed in 85% (17/20) of patients with liver abscesses. One patient was treated by open drainage, three patients were treated with antibiotics alone, and three patients did not respond to aspiration and catheter placement, which subsequently required open drainage. The culture results were as follows: 50% were gram-negative organisms, 25% were gram-positive organisms, 10% were anaerobic organisms, and 15% of the abscess were sterile. Sixty percent of the positive abscess cultures were polymicrobial. CONCLUSIONS: CT scan- and ultrasound-guided percutaneous drainage of pyogenic liver abscesses were safe and effective methods of treatment. The right lobe of the liver was involved in 95% of cases. Although no one species predominated, gram-negative bacteria were the most common organism cultured, and 60% of the abscesses were polymicrobial. There was no in-house mortality in this review.

Adult↗

PubMedDate not supplied

Acute Budd-Chiari syndrome resulting from a pyogenic liver abscess.

Budd-Chiari syndrome is a rare condition resulting from outflow obstruction of the liver. This syndrome due to a pyogenic abscess is rarely documented in the English literature. Here a male patient with acute Budd Chiari syndrome is presented. A 21-year-old male patient was admitted to the hospital because of severe right upper quadrant pain, jaundice, hepatomegaly and fever. The examination of liver by computerized tomography and ultrasound revealed a large lesion 120 x l00 mm in size located in the right lobe of liver, which was compressing the inferior vena cava, the right and middle hepatic veins. Twenty-three days after percutaneous catheter drainage and medical treatment, the patient was discharged with complete healing. Although many disorders including malignant diseases can cause Budd-Chiari Syndrome, a pyogenic liver abscess compressing the inferior vena cava, and hepatic veins leading to acute Budd-Chiari syndrome has been rarely reported in English medical literature. Patients presenting with abdominal pain, hepatomegaly, and ascites should be carefully evaluated from this point of view.

Adult↗

PubMed1982

Difficulties in the diagnosis and management of pyogenic liver abscess.

Thirty patients with pyogenic liver abscess were admitted to King's College Hospital between 1967 and 1978. The overall mortality was 43 per cent (13 patients). The diagnosis was often difficult and in 10 patients the correct diagnosis was not made until post-mortem. Of the 20 patients diagnosed and treated, 17 had a unilocular abscess, of whom 16 survived. The remaining 3 had a multicentric abscess, and only 1 of them survived. Difficulty in diagnosis was sometimes increased by misleading results fom special investigations. Clinical awareness leading to early diagnosis, drainage and broad spectrum antibiotic treatment remain the prerequisites for cure.

Adolescent↗

PubMed1989

Actinomycetes in pyogenic liver abscess.

Three patients with pyogenic liver abscesses had actinomycetes cultured from aspirated pus, although it is unusual for hepatic actinomycosis to present in this way. The spectrum of bacteria found in liver abscesses appears to be changing, with the increased isolation of anaerobes partly due to improved techniques. It is important to recognise the presence of actinomycetes so that appropriate chemotherapy can be given.

Actinomyces↗

PubMed1997

Laparoscopic management of ruptured pyogenic liver abscess.

Intraperitoneal rupture of pyogenic liver abscess is a rare but potentially fatal disease, often involving the elderly, who are commonly of poor surgical risk with background of significant medical illness. Accurate preoperative diagnosis is difficult and often necessitates exploratory laparotomy for peritonitis. We report a case of ruptured cryptogenic solitary liver abscess presented with acute peritonitis that was successfully treated laparoscopically. The laparoscopic approach obviated the access trauma, confirmed the diagnosis, was able to drain the abscess, as well as provided microbiology and histology samples. A thorough peritoneal lavage could be also performed. The use of laparoscopic ultrasound could also localize concomitant abscesses and detect associated biliary tract pathology.

Aged↗

PubMed1993

Clinico-therapeutic profile of pyogenic liver abscess.

Nineteen consecutive patients of pyogenic liver abscess (13 males, 6 females, mean age 45.2 +/- 6, 5 years) were studied over a period of 5 years for the clinical profile and therapeutic efficacy of percutaneous aspiration. Majority of them presented with spiking fever (94.7%), pain over right upper quadrant of abdomen (53.8%) and often with prostration and shock (31.6%). The onset has been rather acute in patients with multiple abscesses (7 cases). Ascites (10.5%), clubbing of fingers (15.8%) and splenomegaly (10.5%) were observed in cases with long duration of illness. There has been the polymorphonuclear leucocytosis (89.5%) and mild to moderate anaemia (52.6%). Jaundice (42.1%) was usually mild degree (serum bilirubin 4.6 +/- 2.4 mg/dl). The serum transaminases and alkaline phosphatase were raised in 94.9% of cases. Ultrasonography revealed predominantly hypoechoic (54.1%) areas with frequent distal acoustic enhancement and internal echoes (21.6%). Seven patients had multiple abscesses with 25 lesions (size 5.2 +/- 4.6 cms) situated mainly over antero-inferior segment of the right lobe (45.9%) of the liver. The blood and pus cultures demonstrated the micro-organisms (positive in 63.9% and 86.6% respectively) predominantly of bowel flora including facultative gram negative rods and anaerobes. Mortality was 26.5% and pleuro-pulmonary complications were the commonest (26.4%) one. 15 cases were treated by percutaneous aspiration, proper antibiotic and metronidazole with encouraging results (only two deaths). Complete resolution of abscess took place in 14.2 +/- 1.2 weeks (range 6 weeks to 7.5 months). It is emphasized that percutaneous needle aspiration is useful both for diagnosis and treatment of pyogenic liver abscess.

Adolescent↗

PubMed1978

Pyogenic liver abscess.

A review of 20 cases of pyogenic liver abscesses seen from 1971 through 1976 is presented. In this five-year interval, no amebic liver abscesses were found. The primary inflammatory processes were evenly divided among those patients with biliary, urinary, and intraperitoneal disease. Intensive antibiotic therapy was less efficient in sterilizing the abscess than the blood stream. The nebulous histories, clinical findings, and routine laboratory studies emphasize the difficulty in establishing an early diagnosis of liver abscess. Radioisotopic scanning of the liver proved to be the most reliable tool not only for the diagnosis but also for monitoring the postoperative course of the drained cavities. The overall mortality of pyogenic liver abscesses was 45% and the greatest mortality occurred in those patients over 40. Closed needle aspiration of pyogenic liver abscess in the elderly poor-risk patient in conjunction with the appropriate antibiotics may offer an acceptable alternative.

Adolescent↗

PubMed1982

Pyogenic liver abscesses in children.

Five children with pyogenic liver abscess were admitted to Institute of Child Health, Kabul during the period 1978 to 1980. All patients were males, and their ages ranged from 4 to 10 years. The clinical picture was characterized by fever, upper abdominal pain, enlarged tender liver with raised right dome of the diaphragm. The abscesses were located in the right lobe of liver in all cases, and they were solitary in three cases. Staphylococcus aureus was the etiologic agent in four cases and Escherichia coli in one. Open surgical drainage coupled with prompt parenteral antibiotic therapy in all cases seem to have favorably influenced the outcome. With a high index of suspicion pyogenic liver abscess in children can be diagnosed clinically without the aid of hepatic radionuclide scanning.

Child↗

PubMed2006

Pyogenic liver abscess associated with large colonic tubulovillous adenoma.

Pyogenic liver abscesses usually occur in association with a variety of diseases. Rarely, liver abscess has been reported as the presenting manifestation of colonic tubulovillous adenoma. We report two cases of pyogenic liver abscess without hepatobiliary disease or other obvious etiologies except that one had a history of diabetes mellitus (DM). The pathogen in the patient with DM was Klebsiella pneumonia (KP). In both of the patients, ileus developed about two to three weeks after the diagnosis of liver abscess. Colonoscopy revealed large polypoid tumors with pathological findings of tubulovillous adenoma in both cases. Two lessons were learned from these two cases: (1) an underlying cause should be aggressively investigated in patients with cryptogenic liver abscess; (2) DM could be one of the etiologies but not necessarily the only cause of KP liver abscess.

Adenoma↗

PubMed2005

Genomic heterogeneity in Klebsiella pneumoniae strains is associated with primary pyogenic liver abscess and metastatic infection.

BACKGROUND: Primary pyogenic liver abscess (PLA) with septic complication by Klebsiella pneumoniae is an emerging infectious disease. METHODS AND RESULTS: Using DNA microarray hybridization, we identified a 20-kb chromosomal region that contained 15 open-reading frames (ORFs), including an iron-uptake system (kfu), a phosphoenolpyruvate sugar phosphotransferase system (PTS), and 6 unknown ORFs. The region was more prevalent among tissue-invasive strains (35/46) than among noninvasive strains (19/98) (P<.0001, chi2 test). To test the role played by this region in pathogenesis, 3 different deletion mutants (NTUH-K2044 [Delta kfu], K2044 [Delta ORF7-9], and K2044 [Delta PTS]) were constructed. Only the Delta kfuABC mutants showed decreased virulence in mice, compared with the wild-type strain. An in vitro assay confirmed the involvement of kfu in iron acquisition. There was a high correlation rate (85%) between the kfu/PTS region and 2 tissue invasion-associated chromosomal regions (allS and magA). Moreover, all 3 regions were present in strains that caused PLA plus endophthalmitis or meningitis. CONCLUSION: Our results suggest that chromosomal heterogeneity is present in tissue-invasive K. pneumoniae strains. A genotype containing all 3 regions is strongly associated with PLA and metastatic infection. These regions may serve as convenient markers for the rapid diagnosis of emergent tissue-invasive strains.

Animals↗

PubMed2004

Pyogenic liver abscess: recent trends in etiology and mortality.

BACKGROUND: Pyogenic liver abscess, a potentially life-threatening disease, has undergone significant changes in epidemiology, management, and mortality over the past several decades. METHODS: We reviewed the data for patients admitted to Bellevue Hospital and New York University Downtown Hospital (New York, New York) over a 10-year period. RESULTS: Of 79 cases reviewed, 43% occurred in patients with underlying biliary disease. The most common symptoms were fever, chills, and right upper quadrant pain or tenderness. The most common laboratory abnormalities were an elevated white blood cell count (in 68% of cases), temperature >or=38.1 degrees C (90%), a low albumin level (70.2%), and an elevated alkaline phosphatase level (67%). Seventy percent of the abscesses were in the right lobe, and 77% were solitary. Klebsiella pneumoniae was identified in 41% of cases in which a pathogen was recovered. Eighteen (50%) of 36 Asian patients had K. pneumoniae isolated, in contrast to 6 (27.3%) of 22 non-Asian patients (not statistically significant). Fifty-six percent of cases involved treatment with percutaneous drainage. Although prior reports noted mortality of 11%-31%, we observed only 2 deaths (mortality, 2.5%). CONCLUSIONS: The data suggest that K. pneumoniae has become the predominant etiology of pyogenic liver abscess and that mortality from this disease has decreased substantially.

Female↗

PubMedDate not supplied

Pyogenic liver abscess in children: some observations in the Espírito Santo State, Brazil.

Pyogenic liver abscess in children is uncommon in developed countries and there are few reports about the disease in developing countries including Brazil. As pyogenic liver abscesses in children are frequently diagnosed in Vitória (E. Santo State, Brazil), the records of admissions at the Children's Hospital (Hospital Infantil N.S. da Glória) were surveyed. Sixty-five cases of pyogenic liver abscess were observed over a period of three years, from May 1991 through April 1994 (mean of admissions of 2800 children/year). Fourty-seven cases occurred in boys (mean of ages 8.1 +/- 3.5 yr, median 8 yr) and 18 in girls (mean of ages 6.1 +/- 3.3 yr, median 7 yr) with a 2.7:1 male/female ratio. Predisposing factors were skin infections (23 cases), bile duct ascariasis (six cases), trauma (two cases) but in 30 cases a predisposing factor was not evident. Staphylococcus aureus was the bacteria most frequently isolated (16/29 examined). Entamoeba histolytica trophozoites were never found in the exudate of abscesses and cysts were found once in fecal examination. Clinical manifestations were similar to those observed in other reports about pyogenic liver abscess in children. There was a high frequency of intestinal helminth infection (80.6% of 36 cases in which a fecal examination was recorded) and eosinophilia in the peripheral blood (36.2% of 61 cases). In addition most cases came from the urban periphery of Vitória, where intestinal parasites are frequent. These data showed that the frequency of pyogenic liver abscess is higher in Vitória (one case/138 admissions) than in developed countries (25 cases or less/10,000 admissions in USA). We hypothesyse that the helminth infection (mainly with ascaris and toxocara), whose larvae migrate through the liver inducing granulomas, could enhance the localization of bacteria, increasing the risk for pyogenic liver abscess.

Brazil↗

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↗

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↗

PubMed1983

Pyogenic liver abscess.

The primary source of pyogenic liver abscess is undetermined in about 30 percent of cases. Escherichia coli, microaerophilic streptococci and Bacteroides fragilis are among the common pathogens. Some cases can be treated with antibiotics alone; others require surgical management. With improved methods of diagnosis and therapy, the mortality rate is now 10 percent or less.

Adult↗

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

Increased risk and case fatality rate of pyogenic liver abscess in patients with liver cirrhosis: a nationwide study in Denmark.

BACKGROUND: Patients with liver cirrhosis are at increased risk of serious bacterial infections carrying a high case fatality rate. Case reports have suggested an association between liver cirrhosis and pyogenic liver abscess. AIMS: To estimate the risk and case fatality rate of pyogenic liver abscess in Danish patients with liver cirrhosis compared with the background population. METHODS: Identification of all patients with liver cirrhosis and pyogenic liver abscess over a 17 year period in the National Registry of Patients. Information on death was obtained from the Danish Central Person Registry. RESULTS: We identified 22 764 patients with liver cirrhosis and 665 patients with pyogenic liver abscess, of whom 21 were cirrhotics and 644 were non-cirrhotics. The crude incidence rate of liver abscess in cirrhotics was 23.3 (95% CI 14.4-35.6) per 100 000 person years. The age adjusted risk of liver abscess was increased 15-fold in patients with cirrhosis compared with the background population. The 30 day case fatality rates in patients with liver abscess and cirrhosis were 38.5% (13.9-68.4) in alcoholic cirrhosis and 62.5% (24.5-91.5) in non-alcoholic cirrhosis compared with 26.9% (23.5-30.5) in liver abscess patients from the background population. After adjustment for sex, age, and comorbidity, the relative risk of death was increased more than fourfold in alcoholic cirrhosis and non-alcoholic cirrhosis compared with the background population. CONCLUSIONS: Liver cirrhosis is a strong risk factor for pyogenic liver abscess associated with a poor prognosis.

Adult↗