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PubMed2006

Liver abscess in children.

Liver abscesses are frequently observed in pediatric clinical practice in tropics and subtropics especially in developing countries. Children have unique set of predisposing factors which have been highlighted. Expected microbiology and setting for unusual organisms are mentioned. Clinical presentations', including importance of location and number of abscesses has been discussed. Role of each modality of treatment clarified. Importance and limitations of investigations and imaging explained and complications and mortality discussed.

Child↗
PubMed1992

[Biliogenic liver abscess caused by acute obstructive suppurative cholangitis].

Biliogenic liver abscess was found by autopsy in 52 of 61 (85.2%) cases died of acute obstructive suppurative cholangitis (AOSC) at our hospital from 1957 to 1980. Of the 52 cases with liver abscess, 44 (84.6%) had multiple abscesses and 47 (90.4%) suffered complications of the rupture of liver abscess. Liver abscess was clinically diagnosed in only 7 of 52 cases who underwent emergency operation, with the predeath definite diagnosis of 13.5% (7/52). The authors considered biliogenic liver abscess an inevitable outcome not an accidental complication of AOSC when the high pressure in bile duct could not be relieved, and emphasized the importance of prevention, early diagnosis and treatment of liver abscess in order to decrease the mortality of AOSC.

Acute Disease↗
PubMed2005

Treatment of patients with pyogenic liver abscess.

BACKGROUND: Pyogenic liver abscess (PLA) remains a serious disease with a mortality of 6-14%. METHODS: Clinical data of 76 patients with PLA were analyzed. Treatment options comprised antibiotics, percutaneous puncture/drainage, endoscopic papillotomy/stenting and/or surgery as indicated. RESULTS: Fifty-eight patients (76%) had single and 18 patients multiple PLA (right lobe: 65%; both lobes: 22%). The most frequent etiologies were: biliary (38%), hematogenous and posttraumatic (11%). Factors associated with the need for surgery included gallbladder empyema, biliary fistulas, malignancy, perforation, multicentricity, vascular complications and foreign bodies (e.g. infected ventriculo-peritoneal shunt, toothpick). CONCLUSIONS: Microbiological testing provides important information for treatment monitoring and modification. Complementary assessment of risk factors for a complicated course is crucial for timely identification of patients requiring additional treatment.

Anti-Bacterial Agents↗
PubMed1998

Liver abscesses in feedlot cattle: a review.

Liver abscesses in slaughtered beef cattle result from aggressive grain-feeding programs. The incidence, averaging from 12 to 32% in most feedlots, is influenced by a number of dietary and management factors. Liver abscesses represent a major economic liability to producers, packers, and ultimately consumers. Besides liver condemnation, economic impacts include reduced feed intake, reduced weight gain, decreased feed efficiency, and decreased carcass yield. Fusobacterium necrophorum, a member of the ruminal anaerobic bacterial flora, is the primary etiologic agent. Actinomyces pyogenes is the second most frequently isolated pathogen. Ruminal lesions resulting from acidosis generally are accepted as the predisposing factors for liver abscesses. F. necrophorum possesses or produces a number of virulence factors that participate in the penetration and colonization of the ruminal epithelium and subsequent entry and establishment of infection in the liver. However, only a few virulence factors have been characterized well. Control of liver abscesses in feedlot cattle generally has depended on the use of antimicrobial compounds. Five antibiotics (i.e., bacitracin methylene disalicylate, chlortetracycline, oxytetracycline, tylosin, and virginiamycin) are approved for prevention of liver abscesses in feedlot cattle. Tylosin is the most effective and the most commonly used feed additive. Tylosin feeding reduces abscess incidence by 40 to 70%. The mode of action of antibiotics in preventing liver abscesses is believed to be via inhibition of ruminal F. necrophorum. Protective immunity against F. necrophorum induced by a variety of antigenic components has ranged from ineffectual to significant protection.

Actinomyces↗
PubMed1981

Microbiology of pyogenic liver abscess.

Sixteen patients with pyogenic liver abscesses were studied over 10 years to discover the causative organisms of the condition. Pus was subjected to Gram-negative smear or gas-liquid chromatography to detect volatile acids characteristic of anaerobes and then cultured. All isolates were identified by conventional methods and tested for sensitivity to appropriate antimicrobial agents. Bacteria were grown from the liver abscesses in all 16 patients. Streptococcus milleri Lancefield group F was the commonest organism isolated from the pyogenic liver abscesses, being found in 13 patients. If Strep milleri is isolated care should be taken not to mistake it for an anaerobe, and finding the organism in the blood should alert the clinician to the possible presence of a liver abscesses.

Adult↗
PubMed1978

Endoscopic retrograde cholangiography (ERC) in nonamebic liver abscesses.

Two cases of liver abscess are reported in whom the diagnosis was suggested by a combination of liver scanning, ultrasonography, arteriography, and liver biopsy. The diagnosis was confirmed by ERC which showed intrahepatic extravasation of contrast from the biliary tree, a characteristic of liver abscess. The value of ERC in the search for an underlying cause as well as in delineating certain features of the absceses is shown.

Adolescent↗
PubMed2004

Causative agents of liver abscess in Thai hepatitis B carriers.

Liver abscess and hepatitis B virus (HBV) infection are two significant tropical gastrointestinal disorders. The concurrence between these two disorders yields poor prognosis, which then often leads to the need for intensive care. The aim of this study was to investigate the causal pathogens of liver abscess in HBV carriers. This retrospective case review was conducted on 35 Thai hospitalized HBV carriers who had diagnosis of liver abscess. A high rate of amoebic liver abscess in this series (37.1%) was demonstrated; Gram-negative aerobes were the major abscess pathogens. The causative pathogens of HBV carriers were similar to those in the overall patient population with abscess. The treatment plan for liver abscess in the general population can also be applied to HBV carriers.

AIDS-Related Opportunistic Infections↗
PubMed2003

Liver abscess caused by an infected ventriculoperitoneal shunt.

Pyogenic liver abscess in Taiwan is most commonly due to Klebsiella pneumoniae infection in diabetic patients, and less frequently due to biliary tract infections. Liver abscess caused by ventriculoperitoneal (VP) shunt is very rare. We report a case of liver abscess caused by methicillin-resistant Staphylococcus aureus (MRSA), which developed as a complication of an infected VP shunt. A 53-year-old woman, who had shad a VP shunt implanted 3 months previously for hydrocephalus due to intracranial hemorrhage, presented with fever off and on, drowsiness and seizure attacks for 1 week. Computed tomography (CT) of the brain showed only mild right-sided hydrocephalus, and was negative for intracranial hemorrhage and intracranial mass. Analysis of cerebrospinal fluid showed significant pleocytosis and hypoglycorrhachia. CT scan of the abdomen disclosed a huge abscess in the right lobe of the liver. Cultures of both the cerebrospinal fluid and aspirated liver abscess isolated MRSA. The patient was treated with intraventricular and intravenous vancomycin, intravenous teicoplanin and oral rifampicin, followed by oral chloramphenicol and rifampicin. Percutaneous drainage of the liver abscess and externalization of the VP shunt were performed. The liver abscess had resolved almost completely on ultrasonography after 2 weeks of therapy. Liver abscess in patients with a VP shunt should be considered a possible abdominal complication of the VP shunt, and may be caused by unusual pathogens. Diagnosis requires CT scan and direct aspiration and culture of the liver abscess. Treatment requires management of both the liver abscess and the infected shunt.

Female↗
PubMed1997

Ribotyping to compare Fusobacterium necrophorum isolates from bovine liver abscesses, ruminal walls, and ruminal contents.

Restriction fragment length polymorphism analysis of rRNA genes was employed to genetically compare Fusobacterium necrophorum subsp. necrophorum and F. necrophorum subsp. funduliforme isolates from multiple abscesses of the same liver and isolates from liver abscesses, the ruminal wall, and ruminal contents from the same animal. Four livers with multiple abscesses and samples of ruminal contents, ruminal walls, and liver abscesses were collected from 11 cattle at slaughter. F. necrophorum was isolated from all liver abscesses, nine ruminal walls, and six ruminal content samples. Chromosomal DNA of the isolates was extracted and single or double digested with restriction endonucleases (EcoRI, EcoRV, SalI, and HaeIII); then restriction fragments were hybridized with a digoxigenin-labeled cDNA probe transcribed from a mixture of 16S and 23S rRNAs from Escherichia coli. EcoRI alone or in combination with EcoRV yielded the most discriminating ribopatterns for comparison. Within the subspecies multiple isolates from the same liver were indistinguishable based on the ribopattern obtained with EcoRI. The hybridization patterns of liver abscess isolates were concordant with those of the corresponding isolates from ruminal walls in eight of nine sets of samples. None of the six ruminal content isolates matched either the liver abscess isolates or the ruminal wall isolates. The genetic similarity between the isolates from liver abscesses and ruminal walls supports the hypothesis that F. necrophorum isolates of liver abscesses originate from the rumen.

Animal Feed↗
PubMed1993

Liver abscess due to Listeria monocytogenes: case report and review.

Involvement of the liver in cases of Listeria monocytogenes infection is uncommon but has been manifested as solitary liver abscess, multiple liver abscesses, and hepatitis. We describe a 73-year-old diabetic woman who presented with a solitary liver abscess and prolonged fever, and we review the world literature on hepatic manifestations of L. monocytogenes infection. Patients presenting with solitary liver abscesses uniformly recovered with antimicrobial therapy and abscess drainage, whereas almost all patients presenting with multiple liver abscesses died.

Adult↗
PubMed1999

Bacterial flora of liver abscesses in feedlot cattle fed tylosin or no tylosin.

Bacterial flora of liver abscesses from cattle fed tylosin or no tylosin and susceptibilities of the predominant bacterial isolates to tylosin and other antimicrobial compounds were determined. Abscessed livers were collected at slaughter from cattle originating from feedlots that had fed tylosin (n = 36) or no tylosin (n = 41) for at least 2 yr, and segments of livers with one or two intact abscesses were transported to the laboratory. Abscesses were cultured for anaerobic and facultative bacteria. Fusobacterium necrophorum, either as single culture or mixed with other bacteria, was isolated from all abscesses. The incidence of subsp. necrophorum, as part of the mixed infection, was lower (P < .05) in the tylosin group than in the no-tylosin group (33 vs 61%). However, the incidence of Actinomyces pyogenes was higher (P < .01) in the tylosin group than in the no-tylosin group (53 vs 10%). Totals of 119 F. necrophorum and 21 A. pyogenes isolates were used for determinations of susceptibilities to bacitracin, oxytetracycline, chlortetracycline, lasalocid, monensin, tylosin, tilmicosin, and virginiamycin. The minimum inhibitory concentrations (MIC) of antibiotics were determined with a broth microdilution method. The mean MIC of tylosin for F. necrophorum and A. pyogenes were not different between isolates from tylosin and no-tylosin groups. We concluded that continuous feeding of tylosin did not induce resistance in F. necrophorum or A. pyogenes. Also, the higher incidence of mixed infection of F. necrophorum and A. pyogenes in liver abscesses of tylosin-fed cattle suggests a potential synergistic interaction between the two organisms in causing liver abscesses.

Actinomyces↗
PubMed1992

Percutaneous catheter drainage of amoebic liver abscess.

Fifteen patients with amoebic liver abscesses underwent percutaneous catheter drainage under ultrasonographic guidance. Thirteen patients had solitary abscesses (right lobe 12, left lobe 1), two had associated subdiaphragmatic collections, while two patients had multiple abscesses. The indications for the drainage included lack of response to medical therapy: imminent rupture in five cases; ruptured liver abscesses in three; enlarging abscesses after hospitalization in three; persistent symptoms in two; and large left lobe abscesses in two. The volume of the abscesses before drainage was 102-1008 ml (mean 432 ml). Pigtail catheters (8 F) were used in nine of the patients and 12 F sump catheters in six. When multiple abscesses and associated subdiaphragmatic collection were present, each was drained separately. The catheters were removed (mean 7 days, range 3-20 days) when patients became apyrexial, catheter drainage was less than 10 ml in 24 h and cavitogram showed a negligible cavity (mean residual volume 5.5 ml, range 3-15 ml). Complications included minor blood loss through the catheter for 12 h in one patient and reappearance of the abscess in another requiring further drainage. Our experience suggests that catheter drainage of amoebic liver abscesses in selected cases is safe and effective, and results in prompt and early resolution of the abscess cavity with restoration of normal parenchyma.

Adolescent↗
PubMed2002

Metastatic peripheral primitive neuroectodermal tumor (PNET) masquerading as liver abscess: a case report of liver metastasis in orbital PNET.

Adult primitive neuroectodermal tumor (PNET) of the orbit is an extremely rare malignant tumor. We report the case of a 37-year-old woman with PNET metastasis of the liver 3 years after treatment of the primary right intraconal orbital PNET with resection and chemoradiation adjuvant therapy. Literature review revealed eight previous cases of orbital PNET, but this is the first case report of liver metastasis arising from orbital PNET.

Adult↗
PubMed1989

"False positive" immunoscintigraphic diagnosis of liver abscesses in a patient with a necrotic liver tumour.

The following report describes the scintigraphic findings in a patient who underwent immunoscintigraphy with anti granulocyte Mab because of septic fever. Focal tracer accumulation in the liver corresponding with hypoechoic and hypodense areas documented by sonography and computed tomography was believed to represent liver abscesses, yet surgery and autopsy revealed a large necrotic cholangiocellular liver carcinoma. The possible mechanisms, which had led to the false positive immunoscintigraphic image are discussed and we conclude that a necrotic neoplasm has to be a major differential diagnosis in any case of positive liver uptake in an anti granulocyte scan.

Adenoma, Bile Duct↗
PubMed1987

[Liver abscess secondary to ventriculoperitoneal shunt].

Liver abscess is a rare complication following the ventriculoperitoneal (V-P) shunt operation. There has been only one case reported in the literature. We present a case of liver abscess developed about 3 months after V-P shunt operation. A 31-year-old female was admitted to our hospital in comatose condition due to second bleeding from an aneurysm of the right internal carotid artery on January 1, 1984. Obliteration of the aneurysm was performed on the following day. She received V-P shunt operation for the marked hydrocephalus on February 4, but she developed low spinal fluid pressure syndrome. She was able to walk by herself after the replacement of shunt valve on March 4. In the middle of April, she suffered from abdominal pain with a pyrexia for about 5 days. On May 13, a new peritoneal tube was placed in another part of the peritoneal cavity because of the recurrence of hydrocephalus. On the following day, she developed severe abdominal and back pains with a high fever. Abdominal CT scans and ultrasonogram were performed on May 22, showing a well-defined, cystic mass lesion in the liver and the peritoneal tube lying just beneath the mass lesion. Approximately 100 ml of white creamy pus was aspirated from the cystic mass by ultrasound-guided percutaneous puncture, and a 8.3 French pigtail nephrostomy catheter was left in place for 9 days until purulent drainage stopped. Microbiologic examination demonstrated staphylococcus epidermidis in the cerebrospinal fluid (CSF) from the shunt tube but was negative in the abscess fluid. The ventricular fluid was drained externally with the V-P shunt tube for a while, but the new ventricular drainage was instituted because of continuous positive cultures in the CSF from the shunt tube. Thereafter, the cultures of the CSF became negative and ventriculoatrial (V-A) shunt operation was performed on July 2. Postoperative course was uneventful. It is considered that the formation of the liver abscess seems to be caused by the focal injury to the liver surface by the insidiously infected peritoneal tube with St. epidermidis, and by the decrease in systemic resistance to infection. Percutaneous aspiration and drainage under the guidance of abdominal computed tomography or ultrasonography are very useful and efficient for the diagnosis and the treatment of liver abscess. When patients show signs of infection to the V-P shunt, we should remove the shunting system and place a new external ventricular drainage, and institute a V-A shunt after confirming negative cultures of the CSF.

Adult↗