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Results for “Liver Abscess, Pyogenic”

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PubMed1994

Liver abscess after hemorrhoidectomy. Report of two cases.

PURPOSE: Pyogenic liver abscess after hemorrhoidectomy is extremely rare. Only two such cases have been previously reported; the diagnosis in each was made intraoperatively. We report two additional cases of hepatic abscess after hemorrhoidectomy, both treated nonoperatively with a successful outcome. METHODS: The two cases were analyzed for history, presentation, laboratory data, radiologic studies, and bacteriology. RESULTS: In both cases, the patients presented within one week of the hemorrhoidectomy. Treatment with broad-spectrum intravenous antibiotics was successful in achieving significant clinical improvement. The liver function test values reverted back to normal and follow-up computed tomography (CT) scans of the liver revealed marked improvement of the abscesses. Laparotomy was avoided in both of the patients. CONCLUSIONS: Increased awareness of this serious complication will afford earlier diagnosis. In addition, proper aerobic and anaerobic bacterial isolation techniques will allow appropriate nonoperative therapy, decreasing the high morbidity and mortality rates associated with this complication.

Adult↗
PubMed1996

[Liver abscess caused by Streptococcus intermedius, following hemorrhoidectomy].

The pyogenic liver abscess is an uncommon but potentially lethal complication of colo-anal surgery. The authors report a case due to Streptococcus intermedius, a pathogen with a known ability to produce visceral abscesses, after haemorrhoidectomy. According to the French consensus conference, the patient had received a prophylactic preoperative antibiotic regimen consisting of metronidazole, active against S intermedius. Despite surgical therapy and adequate antibiotics, the patient died of hepatic failure.

Fatal Outcome↗
PubMed1999

[Liver abscess caused by Klebsiella pneumoniae in diabetic patients].

Pyogenic liver abscess are macroscopic collections of pus within the hepatic parenchyma after a bacterial infection. These infections are usually polymicrobial in nature, and in most occasions due to biliary tract diseases or cryptogenetic in origin. Monomicrobial hepatic abscess caused by Klebsiella pneumoniae are uncommon lesions in western countries. These lesions are associated with underlying diseases, particularly diabetes mellitus, and are frequently complicated with septic metastasis. We report here three cases of monomicrobial liver abscess caused by Klebsiella pneumoniae in diabetic patients, without septic metastasis and a favourable outcome.

Aged↗
PubMed1990

Prognostic factors and treatment tactics in the surgery of liver abscesses.

The prognostic factors of 21 patients with pyogenic liver abscess were analyzed. It was stated that survival is unfavourably influenced by hyperbilirubinaemia, the mixed bacterial population, the associated diseases as well as the tumorous process. As a result of portal antibiotic perfusion, there was no difference in the mortality rates of multiple and solitary liver abscesses. Based on the analysis of the prognostic factors, the surgical tactics is developed, i.e. a need for surgical exposure is supported, which imposes three tasks: exposure of the abscess/es, management of the primary process inducing the abscess and introduction of a cannula for portal antibiotic perfusion. Besides some criteria, although the author do not have experience in this field, they suggest the use of percutaneous drainage controlled by echography or CT, basically because of the lower mortality rate.

Aged↗
PubMed2006

Nosocomial liver abscess caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae.

A nosocomial pyogenic liver abscess caused by an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolate presented in a man with adenocarcinoma of the stomach. The K. pneumoniae strain isolated from blood and liver aspirate cultures after antibiotic therapy for recurrent bacteremia was resistant to all extended-spectrum beta-lactams except imipenem and differed from K. pneumoniae strains causing community-acquired liver abscesses.

Adenocarcinoma↗
PubMed1990

"Spontaneous sump syndrome": Successful treatment by duodenoscopic sphincterotomy.

"Sump syndrome" is a rare complication of side-to-side choledochoenterostomy operations which develops in the distal, nonfunctioning limb of the common bile duct where lithogenic bile, gastrointestinal contents, and debris accumulate. We report here a patient who developed spontaneous sump syndrome as a result of the formation of choledochoduodenal fistula, and who presented with multiple pyogenic liver abscesses. The patient's symptoms and liver abscesses resolved completely after treatment by endoscopic sphincterotomy and antibiotics. This case demonstrates that sump syndrome may occur spontaneously, that it can be a cause for pyogenic liver abscess formation, and that it may be treated effectively by endoscopic sphincterotomy.

Biliary Fistula↗
PubMed2001

[Clinical features in six patients with liver abscess caused by Streptococcus milleri].

Among 39 patients with pyogenic liver abscess who were admitted to our institute, six (15%) were infected by Streptococcus milleri (S. milleri). We investigated clinical features of these six patients. There were five males and one female, aged 43-81 years old (mean: 61). Five of the six patients had underlying illness. All patients had fever, and three of them complained of abdominal pain. Three patients had mixed infections; particularly intraoral anaerobes, Fusobacterium, were found in two of the three patients. There were no differences in clinical features between patients with S. milleri liver abscess and those with other bacterial liver abscess. In conclusion, on selecting antibiotics for the treatment of liver abscess, it is necessary to consider the S. milleri and intraoral anaerobes.

Adult↗
PubMed2006

[Diagnosis and treatment of a liver abscess with contrast-enhanced ultrasound].

We report on a patient with pyogenic liver abscess. Using a ultrasound contrast agent improves the characterization of pyogenic hepatic abscesses and facilitates repetitive therapeutic punctures. The use of ultrasound contrast agents opens new aspects in the diagnosis of liver abscesses and gives additional confidence in diagnostic and therapeutic procedures.

Aged, 80 and over↗
PubMed1997

[Pyogenic hepatic abscess. Review of 59 cases and experience with imipenem].

OBJECTIVES: To study the different etiopathogenic, microbiological, clinical, evolutive, and therapeutic aspects in patients with pyogenic liver abscesses, with a special emphasis in the usefulness of imipenem-cilastatin therapy. MATERIALS AND METHODS: The clinical records of 59 patients with liver abscesses (45 single abscess and 14 multiple abscesses) diagnosed at our institution in the last eleven years were studied. RESULTS: The most common predisposing conditions included biliary (35.6%) and colon (15.3%) diseases, and abdominal trauma (15.3%). The microorganisms responsible for these abscesses included E. coli, Bacteroides spp., and different streptococci. CT and/or abdominal echography were the diagnostic techniques most commonly used. Twenty-three patients were treated with percutaneous drainage and antibiotics, 22 with surgical drainage and antibiotics, 6 with both types of drainage and antibiotics, and 8 exclusively with antibiotics. Twenty-three patients received imipenem (1 g/IV/8 h) and 29 other antibiotics. Twelve patients died and 9 required admission at the ICU. With regard to patients treated with imipenem, 17 (73.9%) cured, 3 of them (one single abscess and two multiple abscesses) without drainage. Two patients treated with imipenem (8.7%) and 4 treated with other antibiotics (13.8%) relapsed. CONCLUSIONS: Imipenem can be a useful antibiotic in association with percutaneous or surgical drainage for the treatment of pyogenic liver abscesses.

Adolescent↗
PubMed1982

Pyogenic hepatic abscesses.

A review of pyogenic liver abscess at the University of Alabama in Birmingham revealed 29 cases, of which 22 were single and seven were multiple. Etiology was cryptogenic in 11, secondary to biliary tract disease in seven, trauma in six, and pyelophlebitis in four, and secondary infection in a primary neoplasm in one. No single set of specific diagnostic criteria could be elucidated, but fever occurred in every patient. Leukocytosis, hypoalbuminemia, and elevated alkaline phosphatase were present in more than 80 per cent of patients. Other clinical findings and routine laboratory abnormalities were less consistently present. In suspect patients, a technetium-99 scan was positive in 18 of 19. Ten patients died, including six of seven with multiple abscesses, seven of seven with positive abscess and blood cultures, and seven of 11 in whom liver abscess was not suspected prior to operation or autopsy. Diagnosis demands a high index of suspicion, in patients in whom suggestive factors are present, and liberal use of the technetium-99 scan. Successful treatment requires exploratory laparotomy, with care of discern any underlying septic focus or the presence of multiple abscesses, and wide drainage of the abscesses, as well as vigorous supportive care and appropriate antibiotics.

Adolescent↗
PubMedDate not supplied

Schistosomiasis: predisposing cause for the formation of hepatic abscesses? Case report.

An adult patient with chronic schistosomiasis from an endemic area, complained about a seven day fever, along with jaundice and lumbar backache on the right side. Image exams showed multiple pyogenic liver abscesses. All the classic etiologies were discarded through clinical, radiological and laboratorial criteria. Schistosomiasis can cause pylephlebitis as a complication, along with immunesuppression, granulomatous reaction with central lobular liver necrosis and a greater risk of infection. The authors suggest that schistosomiasis in its chronic form may be the predisposing cause of multiple pyogenic liver abscesses, especially in endemic areas.

Chronic Disease↗
PubMed1980

Management of liver abscess.

Thirteen patients with amebic liver abscess and 26 with pyogenic abscess were identified during a 10 year period. All but one patient with an amebic abscess had emigrated or traveled to areas where amebiasis was endemic. Half of the patients in whom pyogenic abscesses developed had debilitating disease and anemia. Factors predisposing to multiple rather than solitary hepatic abscess were biliary tract disease before surgery, cancer, chemotherapy, steroid administration and alcoholism. Elevated levels of alkaline phosphatase and hypoalbuminemia were present in most patients. Three patients with amebic abscess died, two of whom has massive gastrointestinal hemorrhage from associated amebic colitis. No patient with a solitary pyogenic liver abscess died. Fifteen of 16 patients with multiple liver abscesses died. Failure to consider the diagnosis of liver abscess, confusion over interpretation of the scan, failure to operate or provide a timely operation and failure to adequately explore the abdomen or identify all abscesses were factors responsible for eight unnecessary deaths.

Adult↗
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.

Aged↗
PubMed2004

Community-acquired brain abscess in Taiwan: etiology and probable source of infection.

Brain abscess is a life-threatening infection caused by spread from infected parameningeal or remote foci. Historically, streptococci have been the predominant organisms reported while brain abscess metastatic from liver abscess caused by Klebsiella pneumoniae has been a more recent emerging problem. This study retrospectively analyzed the characteristics of community-acquired brain abscess admitted during an 11-year period. There were 17 men and 7 women with age from 20 to 82 years (median, 41 years). The most common source of infection was liver abscess, followed by otitic infection and sinusitis. The classic triad of fever, headache and focal neurologic deficit was noted in only 25% of cases. Spread of the abscess to multiple lobes was common (n = 6). The most commonly identified organisms were Streptococcus spp. (n = 7) and K. pneumoniae (n = 5). All 5 cases of K. pneumoniae brain abscess also had concomitant pyogenic liver abscess and 4 of them had diabetes mellitus. In this study, brain abscess was common in young patients and in patients with diabetes mellitus. In Taiwan, Streptococcus spp. and K. pneumoniae are leading etiologies for community-acquired brain abscess. Liver abscess is the most likely source of K. pneumoniae brain abscess.

Adolescent↗
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↗
PubMedDate not supplied

Liver abscess caused by Streptococcus milleri.

There is now convincing evidence that Streptococcus milleri is an important cause of pyogenic liver abscesses. The clinical course is no different from that of pyogenic infections of the liver arising from other causes. A positive blood culture should alert the clinician to the possibility of hepatic suppuration. Treatment consists of drainage by laparotomy or percutaneous aspiration combined with approximately 6 weeks of penicillin administration. Patients with liver abscesses who receive metronidazole may not respond if S. milleri is the infecting organism.

Aged↗
PubMed1998

Biochemical and biological characterizations and ribotyping of Actinomyces pyogenes and Actinomyces pyogenes-like organisms from liver abscesses in cattle.

Actinomyces pyogenes is the second most frequently encountered pathogen, next only to Fusobacterium necrophorum, in liver abscesses of feedlot cattle. Ninety-one isolates, presumptively identified as A. pyogenes, isolated from liver abscesses of cattle were studied. Biochemical characteristics determined by the API 20 Strep kit were similar to those reported previously for A. pyogenes isolated from other infections, except that 18% of isolates hydrolyzed esculin. Nine isolates that resembled A. pyogenes in morphology and in certain biochemical characteristics, but fermented mannitol and/or raffinose, were called A. pyogenes-like (APL) organisms. The five antimicrobial agents, bacitracin, chlortetracycline, oxytetracycline, tylosin, and virginiamycin were inhibitory to all strains of A. pyogenes and APLs. Generally, APL organisms had higher mean hemolytic and leukotoxic activities than A. pyogenes. All isolates of A. pyogenes and APLs produced proteases and neuraminidases. Ribotyping with endonucleases, including BstEII, ClaI, EcoRI, EcoRV, HaeIII, MboI, PvuII, SalI, and SmaI alone or in combinations, showed considerable genetic heterogeneity in both A. pyogenes and APLs. No specific ribopattern characteristic of each group was observed with any of the endonuclease used. The origin of A. pyogenes and APLs and the relative importance of APLs in causing liver abscesses in feedlot cattle are not known.

Actinomyces↗