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PubMed1995

Septic pulmonary emboli secondary to pyogenic liver abscess in a diabetic patient.

A 70-year-old woman with poorly controlled diabetes mellitus was admitted because of persistent remittent fever. Soon a liver abscess was detected as the cause of the fever by ultrasonography, and antibiotic therapy was started. However, suddenly serious dyspnea with chest and back pain developed. The morbid condition was definitely diagnosed as septic pulmonary emboli (SPE) with pulmonary perfusion scan. It should be recognized that liver abscess can be a latent focus of systemic metastatic complications such as SPE, and not only early detection but also prompt appropriate drainage of liver abscesses is essential.

Aged↗

PubMedDate not supplied

Amebic liver abscess in children.

Five children with amebic liver abscesses are presented, and the distinctive clinical and laboratory features for these and 119 other children are described. The majority (91%) were less than 3 years old, and 77% had an isolated abscess in the right hepatic lobe. Each child presented with a history of fever and gastrointestinal symptoms, and two-thirds presented with cough or difficulty breathing. Most (81%) patients had hepatomegaly on physical examination and some had a well-defined mass. Hematologic abnormalities including anemia, neutrophilia and an increased ratio (greater than 0.15) of immature neutrophils to total neutrophils were commonly observed at the time of admission. Of interest, intravenous pyelograms revealed deviation of the right kidney due to hepatomegaly in each of three children studied. All patients evaluated had one or more filling defects demonstrated by liver-spleen scan or abdominal ultrasound. Most patients underwent either an open (9%) or closed (77%) drainage procedure. Fifty-six children (46%) died, in some cases before specific therapy was instituted. Of those who recovered all received therapy with metronidazole or a combination of chloroquine with emetine or dehydroemetine.

Amebicides↗

PubMed1988

Gardnerella vaginalis: an unusual case of pyogenic liver abscess.

We present a case of pyogenic liver abscess caused by Gardnerella vaginalis, a previously unreported suppurative complication of infection with this organism. The development of the pylephlebitis originating from endometritis and the possible synergistic interaction of an anaerobic and aerobic organism is reviewed. G. vaginalis has been infrequently isolated in the laboratory; perhaps with refined culturing techniques and recognition of the pathogenic potential of this organism, further cases of suppurative complications will be described.

Adult↗

PubMed1988

Pyogenic liver abscess with two normal ultrasound scans.

I report a case of a large liver abscess causing a severe debilitating condition in which the diagnosis was delayed by several weeks following two normal ultrasound scans at days 5 and 19 of the illness. Up to one in four cases of liver abscess can be missed on ultrasound. A high degree of clinical suspicion must be maintained and repeated or alternative imaging methods used if the diagnosis of this rare, curable but often fatal condition is not to be missed.

Adult↗

PubMed1999

Amebic liver abscess: epidemiology, clinical features, and outcome.

Amebic liver abscess (ALA) is a serious, but readily treatable form of hepatic infection. In order to understand the clinical features of this condition in the United States, we reviewed the medical histories of 56 patients with ALA at two large San Francisco Hospitals from 1979 to 1994. Patients were divided into the following groups based on the presumed manner in which they had acquired ALA: those born or raised in the United States, with a history of travel to an endemic area (Tr-ALA); those from an endemic area, but living in the United States for less than one year (En-ALA); and those neither from nor having traveled to an endemic area (N-ALA). We found distinct clinical patterns in patients from different epidemiological groups. Patients with Tr-ALA were a decade older than those from endemic regions, were more likely to be male, and tended to have an insidious onset. Furthermore, compared to patients with En-ALA, those with Tr-ALA were more likely to have hepatomegaly (P < 0.0001) and large abscesses (ALA > 10 cm; P < 0.01). One third of the patients studied had no associated travel history or endemic origin as risk factors. Of these, 63% had a condition consistent with severe immunosuppression, such as infection with the human immunodeficiency virus (HIV), malnourishment with severe hypoalbuminemia, or chronic infection. In patients with N-ALA, the presence of a presumed immunosuppressed state increased significantly, as compared to patients with endemic or travel risk factors for ALA. During the last five years of the study, one third of all patients diagnosed with ALA were HIV positive (including 2 with a new diagnosis of AIDS), many of whom were discovered to be HIV-infected only after presentation with ALA. We conclude that travel to and origin in an endemic area are important risk factors for the development of ALA, and patients in these different epidemiological groups appear to have distinct clinical features. Further, in the absence of recognized risk factors, the development of ALA may suggest an immunocompromised host.

Adult↗

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↗

PubMed2003

Drainage of liver abscess via laparoscopic trocar with local anesthesia.

There are several methods for treatment of liver abscess. These include drainage by open surgery, laparoscopic surgery, or percutaneous catheterization. In this report a new therapeutic approach is presented. A 47-year-old man admitted to the hospital had an abscess 12 cm in diameter, originating from the left liver lobe. After the patient's permission was obtained, a laparoscopic trocar was inserted into the abscess with the patient under local anesthesia in the operating room. A 28-French chest tube catheter was introduced through the trocar cannula, and approximately 1,000 mL of pus was drained. There were no complications, and the patient was discharged on the same day. After computed tomography showed an obliterated abscess cavity, the drain was removed on postoperative day 7. The pus culture, performed on the day of surgery, was found to be positive for Escherichia coli, which was responsive to cefaclor. Oral antibiotic therapy was given for 1 month. At follow-up 2 months after surgery, the patient was asymptomatic. This report describes the first case of a liver abscess drained by a laparoscopic trocar with local anesthesia. This method can be the treatment of choice for some easily accessible liver abscesses.

Anesthesia, Local↗

PubMed2003

Intestinal antilectin immunoglobulin A antibody response and immunity to Entamoeba dispar infection following cure of amebic liver abscess.

We followed 93 subjects with amebic liver abscess (ALA) and 963 close associate controls at 3-month intervals for 36 months to characterize intestinal and humoral antibody responses to the amebic galactose-inhibitable lectin and to determine whether immunity developed to Entamoeba histolytica or Entamoeba dispar infection following cure of ALA. We found that ALA subjects had a higher prevalence and level of intestinal antilectin immunoglobulin A (IgA) and serum anti-LC3 (cysteine-rich recombinant lectin protein) IgA and IgG antibodies, P < 0.01 and P < 0.05, respectively, compared to controls. The intestinal antilectin IgA antibody response was sustained over a longer time period in ALA subjects (71.8% remained positive at 18 months and 52.6% at 36 months, P < 0.001 compared to 17.6% and 10.3% of controls, respectively). ALA subjects were highly immune to E. dispar infection throughout the study (0% infected at 6 and 36 months, compared to 6.5% and 4.9% of control subjects, respectively, P < 0.05). Upon entry into the study, 6.3% of ALA subjects were infected with E. histolytica; the incidence of new E. histolytica infections in controls (as determined by culture) was too low (1.4%) to determine whether ALA subjects exhibited immunity to new infections. We found that stool cultures every 3 months markedly underestimated the occurrence of new E. histolytica infections, as 15.3% of controls seroconverted after 12 months of follow-up. Unfortunately, under the field conditions present in Durban, South Africa, enzyme-linked immunosorbent assay for detection of lectin antigen in stool yielded unreliable results. In summary, subjects cured of ALA exhibited sustained mucosal IgA antibody responses to the amebic galactose-inhibitable lectin and a high level of immunity to E. dispar infection. Determination of immunity to E. histolytica following cure of ALA will require the use of more sensitive and reliable diagnostic methods.

Adult↗

PubMed2006

APACHE II score and primary liver cancer history had risk of hospital mortality in patients with pyogenic liver abscess.

BACKGROUND: The Acute Physiology and Chronic Health Evaluation II classification system has been extensively used for predicting the patient mortality in various diseases. However, its utilisation on the pyogenic liver abscess has not yet been well studied. AIMS: The purpose of this study was to validate this system on this high death rate disease. PATIENTS: A retrospective study was conducted to assess 314 patients with pyogenic liver abscesses admitted to tertiary medical centre in past 12 years. METHODS: The outcome measurement was the in-hospital mortality. A multiple logistic regression model was used to assess the association between mortality and Acute Physiology and Chronic Health Evaluation II score while controlling for the potential confounding factors. RESULTS: The overall in-hospital mortality was 8.3%. The mean Acute Physiology and Chronic Health Evaluation II score of the expired patients was higher (P<0.0001). The mortality rate increased rapidly when Acute Physiology and Chronic Health Evaluation II score >or=15. After controlling for the potential confounding factors, patient with high admission Acute Physiology and Chronic Health Evaluation II score >or=15 had a higher chance of in-hospital mortality (P<0.01). In addition, the primary liver cancer history is also a risk factor (P=0.03). CONCLUSIONS: The Acute Physiology and Chronic Health Evaluation II score and the primary liver cancer history predict the in-hospital mortality of the pyogenic liver abscess patient.

APACHE↗

PubMed2003

Hepatic ultrasound in a population with high incidence of invasive amoebiasis: evidence for subclinical, self-limited amoebic liver abscesses.

About 10% of successfully treated amoebic liver abscesses (ALA) do not completely resolve and can be detected by ultrasound as typical residual liver lesions. The frequency of these residues should be an indicator for the prevalence of ALA in a given population, and may help to solve the question whether non-clinical, self-healing ALAs occur. We have performed hepatic ultrasound in 1036 adult individuals living in a high-risk area for ALA in Central Vietnam and identified typical ALA residual lesions in about 1.2% of the subjects. As expected, these lesions were associated with positive amoeba serology and were found in 11.9% of individuals with a previous ALA history. However, more than 50% of the residues were identified in individuals who had never developed symptoms suspected for ALA and who never received any ALA specific treatment, suggesting that subclinical, self-limited hepatic amoeba abscesses truly exist.

Adult↗

PubMed2002

Percutaneous transhepatic alcoholization: a new therapeutic strategy in children with chronic granulomatous disease and liver abscess.

Children affected with chronic granulomatous disease develop severe infections, which frequently evolve to abscess. In most instances the liver is involved. We report a case of liver abscess successfully treated by percutaneous transhepatic alcoholization after antibiotic therapy and percutaneous drainage had failed. This procedure avoided the need for hepatic resection, which is associated with high morbidity in such patients.

Administration, Cutaneous↗

PubMed1992

Percutaneous debridement of complex pyogenic liver abscesses.

The author's approach and technique in the treatment of complex liver abscesses that persisted or recurred following percutaneous drainage are described. Six patients were treated by percutaneous debridement using an instrument specially designed for that purpose. Four patients were chronically ill but stable, while the other two were septic, hypotensive and considered to be life threatened. All patients had primary pyogenic abscesses. Four had demonstrated mixed bacterial flora consisting of E. coli, Klebsiella, Proteus and gram-positive cocci and two were caused by E. coli only. Contrast enhanced CT of the abdomen in all cases revealed multiloculated or septated abscesses containing large central debris and peripheral shell or halo of compromised hepatic parenchyma. Debridement was successful in all cases, resulting in complete healing within 12 days. Follow-up for 1-4.5 years revealed no recurrences. Three cases of infected tumors of the liver were referred for treatment. CT findings in these cases demonstrated a well developed external capsule and internal septations, and the absence of a surrounding halo of compromised parenchyma distinguishes them from primary abscesses. This preliminary experience makes the authors to conclude that percutaneous debridement of pyogenic liver abscesses is a safe and curative procedure in selected cases of life-threatening chronic liver abscesses.

Debridement↗

PubMed1994

Conservative initial treatment for liver abscesses in children.

A total of 124 children aged less than 14 years with a liver abscess were seen in a 16-year period (1974-1990) and treated by non-operative initial management. Of the abscesses 98 occurred in the right liver and 26 in the left. The abscesses were solitary in 93 patients. Overall, 77 of the solitary and 21 of the multiple abscesses were confined to the right liver. In 78 of the right-sided and 20 of the left-sided abscesses the infection was primarily pyogenic in nature with Staphylococcus aureus being the usual organism cultured. The remainder were of amoebic origin. Clinical features were similar in patients with amoebic and pyogenic abscesses. Clinical and ultrasonographic follow-up demonstrated successful non-operative management and healing in 37 per cent of all patients submitted to an initial protocol of medical supportive care and antibiotic therapy. Of the multiple abscesses 60 per cent responded to non-operative management. Fourteen of the 16 solitary left-sided liver abscesses required drainage and three left-sided abscesses ruptured before drainage. Patients with a solitary left-sided abscess warrant early operative intervention.

Anti-Bacterial Agents↗

PubMed1983

Liver abscess as a complication of regional enteritis: interventional considerations.

Although intra-abdominal abscesses are relatively frequent in the setting of regional enteritis, liver abscesses are rare. Pylephlebitis, steroid administration, and biliary fistulization have been suggested as inciting factors. This report describes the first attempted percutaneous drainage of a liver abscess which was a complication of regional enteritis. The percutaneous drainage proved inadequate therapy due to significant disease outside the liver involving the bowel. A review of all cases reported to date in the literature suggests that although percutaneous drainage might prove to be a satisfactory temporizing measure, all patients will require surgical exploration for definitive therapy.

Adult↗

PubMed1993

[Pyogenic liver abscess. Analysis and follow-up examination of a personal patient sample 1981-1992].

From January 1, 1981 to January 1, 1992 a total of 30 liver abscesses were treated in the University Clinic for Surgery in Cologne. 23 patients underwent an primary operative treatment and seven patients received a controlled guided percutaneous drainage. During the observation period four patients (13.3%) died by the effect of the liver abscess. 20 patients (66.7%) were subjected to clinical, laboratorical and computertomographical post examinations. The primary rate of operation success amounted to 47.8%, that of controlled guided percutaneous drainage of 42.8% (NS). The secondary success rate (that means after successful operative reintervention) amounted to 86.9% by the operative and to 85.7% by the percutaneous drainaged cases. During the post examination no relapse was determinated. Larger or chambered liver abscesses as well as extrahepatic spreading required operative drainage and, in cases of multifocal spreading, a resection with concomitant antibiotics. In case of solitary abscesses the controlled guided percutaneous drainage is the least harmful and low-prices method.

Cause of Death↗

PubMed2003

[Amoebic liver abscess. Study of 20 cases with literature review].

PURPOSE: The management of amoebic liver abscess includes antiamoebic drugs combined or not with percutaneous puncture or surgical drainage. This study was to suggest a decision tree for the therapeutic approach of such feature. METHODS: We report a retrospective analysis of 20 imported cases with amoebic liver abscesses admitted at the Department of Tropical Diseases during 1995-1999 at the Bordeaux University Hospital Centre, France, and a review of the literature. RESULTS: The twenty patients were 14 males and 6 females, mainly 20 to 40 years old. The clinical presentation was mainly accounting a painful liver enlargement with hyperthermia. The echographic picture was mostly represented by a unique liver element located at the liver right lobe. They were numerous in an HIV infected patient. Thirteen patients have been treated using a medical therapeutic approach. A percutaneous puncture has been necessary for 4 cases. A percutaneous drainage has been realised for two patients as regard to the persistence of the hepatalgia occurrence. A surgical drainage has been experienced by two patients after a lack of efficacy of a percutaneous drainage, after rupture of an abscess treated medically, respectively. A review of the literature and the analysis of the 20 cases history have been used to determine a therapeutic algorithm. CONCLUSION: The occurrence of immediate complications at onset must indicate a first line surgical drainage procedure. Beside this situation, risk factors for rupture must be assessed (high size abscess, pejorative localization), as well as poor prognosis feature (liver failure, bacteraemia). If no pejorative condition occurs, a first-line exclusive medical approach can be undertaken with a clinical efficacy evaluation at H72. Otherwise, the indication of the percutaneous drainage must be discussed.

Adult↗

PubMed1999

Amebic liver abscess in an elderly AIDS patient.

An elderly bisexual male AIDS patient, whose CD4 cell count was 128/mm3 and HIV-RNA was 3.0x10(5) copies/ml, was admitted because of amebic liver abscess and poor nutritional condition. He was treated with daily doses of 1,500 mg of metronidazole for 14 days for amebic liver abscess and with anti-HIV drugs; good therapeutic results were observed. Our study indicates that amebic liver abscess is easily treated by appropriate administration of metronidazole even in an old AIDS patient receiving anti-HIV drugs with low CD4 cell counts and high HIV-RNA values.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Gas-containing liver abscess: radiological findings and clinical significance.

Sixty-two cases of verified gas-containing pyogenic liver abscess were reviewed to study the radiological and clinical prognostic factors. A mortality rate of 37.1% (23 cases) was observed. Among these patients, the survival time of 13 patients with alveolar gas pattern or pneumoperitoneum (6.15 +/- 7.36 days) was significantly shorter than that of the other 10 patients (17.70 +/- 13.32 days) despite immediate diagnosis and aggressive treatment. The poor radiological prognostic signs were: (1) alveolar gas pattern and pneumoperitoneum as viewed on radiographs; and (2) globular configuration, shaggy margin, alveolar internal structure, and total gas content on computed tomographic (CT) scans. High serum creatinine and glucose levels and a short time to diagnosis were the poor clinical prognostic factors. The aggressive treatment did not change the outcome. We conclude that, in addition to the clinical evaluation, meticulous radiological study of the abscess morphology should be done in cases of gas-containing liver abscess in an effort to provide further aggressive treatment for those patients with poor radiological prognostic signs.

Aged↗