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Among 16 with pyogenic liver abscess, two were found to have Papillon-Lefevre syndrome. The two cases are reported herein. Bacteremia from involved periodontal tissues and a possible impaired immune response could indicate an increased risk of pyogenic liver abscess among children with Papillon-Lefevre syndrome.
OBJECTIVES: To study the role of human toxocariasis in the pathogenesis of pyogenic liver abscess. METHODS: We compared the serology for toxocariasis and serum levels of IgE in 16 patients with pyogenic liver abscess to those in 32 matched (age and gender) controls to define the possible association between these two entities. RESULTS: The serology for toxocariasis was positive in 10 of 16 patients compared with 4 of 32 controls. The relative odds and 95% confidence interval (conditional logistic regression), comparing cases and matched controls, was significant (1.4; 95% confidence interval, 1.1-1.7) for Toxocara serology. Regarding IgE serum levels, there was no difference between cases and controls. CONCLUSIONS: Human toxocariasis can be one of the predisposing causes of pyogenic liver abscess, especially in tropical countries in which this parasitic disease is common. Treatment of human toxocariasis may prevent morbid complications like hepatic abscess and should be considered in patients with clinical and/or serological evidence of Toxocara infection.
Between 1976 and 1978, 6 patients with proven or probable pyogenic liver abscess were successfully treated at Los Angeles County-University of Southern California Medical Center without surgical drainage. Although surgical therapy is necessary in patients with coexisting intraabdominal pathology, antibiotic therapy without surgical intervention is an option to be considered in patients with pyogenic liver abscess and no evidence of other intraabdominal disease.
OBJECTIVES: The aim of this study is to delineate the clinical features of pyogenic liver abscesses of biliary and cryptogenic origin, and to compare the differences in outcome of patients between the two groups. METHODS: We studied 86 patients, aged 19 years or older, with pyogenic liver abscess admitted to Chung Shan Medical University Hospital, Taichung, Taiwan, between January 1996 and December 2003. The demographic data and medical information of the patients were reviewed and recorded. Of the 86 patients, 34 were classified into the biliary group and 52 were classified into the cryptogenic group. RESULTS: Patients with pyogenic liver abscesses of biliary origin had a higher frequency of underlying malignancy and Murphy's sign compared to those with pyogenic liver abscesses of cryptogenic origin. With respect to specific pathogens, Escherichia coli were more prevalent in the biliary group while Klebsiella pneumoniae were more prevalent in the cryptogenic group. Anaerobic isolates were less frequently cultured in the cryptogenic group than in the biliary group. After adjustment for age, sex, and the duration of symptoms before admission, there was no difference in mortality between both groups (biliary vs cryptogenic: 15% vs 8%; adjusted OR, 1.43; 95% CI, 0.24-8.25; p = 0.899). After adjustment for confounders, patients in the biliary group had higher frequencies of time to defervesce >1 week after admission (68% vs 40%; adjusted OR, 3.05; 95% CI, 1.09-9.04, p = 0.030) and hospital stay >3 weeks (47% vs 15%; adjusted OR, 4.34; 95% CI, 1.45-13.91; p = 0.007) than those in the cryptogenic group. CONCLUSIONS: This report highlights that pyogenic liver abscesses of cryptogenic origin had a benign clinical response, which was associated with shorter duration of hospitalisation and time to defervesce after admission, compared to those of biliary origin.
OBJECTIVE: To evaluate whether older patients with pyogenic liver abscess have distinctive presenting features or if their management differs from that of younger patients. DESIGN: Retrospective chart review of all cases occurring from 1982 to 1992. SETTING: A regional trauma centre and two large community hospitals. PATIENTS: A total of 38 individuals with a final diagnosis of pyogenic liver abscess. Seventeen patients aged 70 or older comprised the study group and 21 patients under age 70 the comparison group. MEASUREMENTS: Clinical features, laboratory data, therapeutic interventions and outcomes were sought. The presumed aetiology of the abscess was determined. RESULTS: The study group had fewer men (47% vs 81%, P=0.028), less abdominal tenderness on physical examination (41% vs 76%, P=0.028) and fewer positive blood cultures in those sampled (31% vs 67%, P=0.04) than the comparison group. No study group patient had a history of trauma. Times to diagnosis were 3.2 and 5.9 days (P=0.14) and lengths of stay 21.6 and 29.3 days (P=0.08) for study and comparison groups, respectively. There were no differences in mortality or other demographic, clinical, laboratory or pathological variables. CONCLUSIONS: Elderly patients with pyogenic liver abscess have some subtle differences in clinical and laboratory presentation, but these do not appear to delay diagnosis. Active management is tolerated well, with no difference in mortality.
BACKGROUND/AIMS: With the advance of antibiotics and the development of newer imaging techniques, marked changes in etiology, diagnosis, treatment and prognosis of liver abscess have been reported. METHODS: We reviewed the clinical data related to 94 patients with pyogenic liver abscess. RESULTS: Of the 94 patients in the study group, the male to female ratio was 1.4:1 and the peak incidence of liver abscess was in the 7th decade. About three quarters (74.5%) of the abscesses were of unknown origin. The predominant location was in the right lobe (70.3%). Single lesion was found in 80 patients and multiple lesions in 14 patients. Pathogens were identified in 67 patients, of which Klebsiella pneumoniae (65.7%) and E. coli (16.4%) were the most common. The modalities of treatment were percutaneous drainage with antibiotics (73.4%), percutaneous aspiration with antibiotics (16.0%), or antibiotics alone (8.5%). The case fatality rate, mainly from associated underlying diseases, was 9 cases (9.6%). Associated diseases were diabetes mellitus (14.9%) and malignancy (10.6%). CONCLUSIONS: Our study revealed that the most common organism was Klebsiella pneumoniae and percutaneous needle aspiration and/or catheter drainage were safe and effective treatment modalities for pyogenic liver abscess. Prognosis was determined by the underlying condition.
Amebic liver abscess is an uncommon disease in the northern states of North America with 11 cases seen among approximately 500,000 Mount Sinai Hospital admissions over a 16-year period. Five of 11 cases originated in, or had recently visited South America. In three of these, and two patients with concomitant intestinal amebiasis, the diagnosis was suspected on admission. Diagnosis after admission was rapid, mean 5 days, compared with a mean of 13 days in pyogenic liver abscess. There was a higher incidence of male patients, nine males versus two females which was greater than the excess found in our pyogenic abscesses, 22 versus 16. Multiplicity was less common than in pyogenic abscess, 27 versus 50%, respectively. All three patients with multiple abscesses survived with surgical drainage and antibiotic therapy despite numerous complicating factors, including secondary bacterial infection. One patient resolved with drug treatment only; all others were treated with drugs and concomitant drainage; surgical drainage in earlier cases, and percutaneous drainage more recently. There was a single postoperative death. Drug treatment is the first therapeutic modality, and if recovery is delayed more than 2 days percutaneous aspiration should be carried out. This was successful in four cases. Surgery should seldom be required with present methods of accurately localizing amebic liver abscess, but is essential for ruptured abscess with peritonitis, and liver abscess with associated intestinal problems such as toxic megacolon, colonic perforation, or fulminating colitis. There has been a significant reduction in mortality of amebic liver abscess over the past 50 years and particularly within the past decade.(ABSTRACT TRUNCATED AT 250 WORDS)
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A case of pyogenic liver abscess (PLA) due to Rhodococcus equi in an immunocompetent individual was successfully treated by combining surgery and antibiotics. The R. equi-targeted antimicrobial agents erythromycin and rifampin were used only after surgical resection of the lesion and identification of the infective organism.
Pyogenic liver abscess (PLA) is a potentially life-threatening disease, and early diagnosis may be difficult. In order to provide diagnostic clues and to enhance the prompt management of such cases, we retrospectively investigated the clinical characteristics of PLA during a 3-year period in a tertiary-care hospital. The crude incidence rate of PLA in our study was 446.1 per 100,000 hospital admissions. Male predominance and a mean age of 57.6 +/- 14.4 years were observed. Diabetes mellitus was the most common concomitant disease, and biliary pathologies were the most common predisposing cause of this type of abscess. The most common clinical features were fever, chills, and abdominal pain. Leukocytosis was found in 67.3% of the patients, and the observed C-reactive protein (CRP) values were high. The most common pathogen was Klebsiella pneumoniae. The mortality rate was 6.5%. A complete history, physical examination, evaluation of the white blood cell count and CRP, and the prompt arrangement of imaging studies may lead to an earlier diagnosis. The aggressive performance of image-guided catheter drainage and the appropriate administration of antibiotics may reduce the mortality rate of PLA.
OBJECTIVE: To analyze and clarify the clinical behaviour and outcome of patients with pyogenic liver abscess of cryptogenic origin and, moreover, to observe if there are any differential characteristics in relation to those found in patients with a known pathogenesis. MATERIAL AND METHODS: Multicenter and retrospective study of two groups of patients diagnosed of pyogenic liver abscess, during a period of 13 years. Group 1: 34 cases with abscess of cryptogenic origin and Group 2: 99 patients with a known pathogenesis. Clinical, laboratory, and microbiologic data, morphology and topography of the lesions, treatment and outcome were assessed and compared in both groups. RESULTS: The duration of symptomatology was higher in Group 1 (9.4 +/- 6.5 vs 8.1 +/- 4.4 days; p = 0.05). Although, in this category of patients, it was also observed a lower frequency of jaundice (6 vs 26%; p = 0.02) and lower level of bilirubinemia (0.9 +/- 0.9 vs 2.6 +/- 4.4 mg/dl; p = 0.05), the majority of clinical and laboratory data were similar in both groups. The rate of patients with abscesses on the left lobe (26% vs 12%; p = 0.04) was higher in Group 1. The therapeutic modality carried out in the two groups was not significantly different, neither were hospital stay, and morbidity and mortality rates. CONCLUSIONS: The patients with pyogenic liver abscesses of cryptogenic origin present few specific clinical characteristics which facilitate the diagnosis. Besides, their outcome was no significantly different from that found in patients with abscesses of known pathogenesis.
BACKGROUND: Chronic pancreatitis uncommonly causes common bile duct stricture, and common bile duct stricture rarely leads to pyogenic liver abscess. METHODS: We describe a 51-year-old man who developed a pyogenic liver abscess after the development of a common bile duct stricture due to chronic pancreatitis. RESULTS: The patient required open drainage of the liver abscess and decompressive choledochoduodenostomy. His infection was persistent and he required percutaneous and subsequent open drainage of a second hepatic abscess. The patient died of refractory sepsis and multi-organ failure. CONCLUSIONS: The relevant English literature concerning pyogenic liver abscesses, specifically in the setting of common bile duct stricture due to chronic pancreatitis, is reviewed and discussed.
OBJECTIVES: To audit our experience in managing patients with pyogenic liver abscesses since 1984 and to identify any risk factor associated with hospital mortality. DESIGN: Retrospective review. SETTING: A tertiary referral center. PATIENTS: Eighty-three patients with pyogenic liver abscesses were studied to determine demographic characteristics; clinical features, laboratory, imaging, and microbiologic findings; methods of treatment; and final outcome. The median follow-up period was 9.8 months. INTERVENTION: All patients were treated with intravenous antibiotic drugs. Fifty-three patients were to image-guided percutaneous aspiration of the abscess. A percutaneous drainage catheter was inserted after aspiration in 27 patients. Laparotomy was performed in 27 patients; seven of them underwent an elective operation. MAIN OUTCOME MEASURE: Hospital mortality, defined as death within the same hospital admission for management of liver abscess. RESULTS: Biliary tract disease was the most frequently identifiable cause. The right lobe abscess was more frequently cryptogenic, while the left lobe abscess was more frequently related to intrahepatic stones (P < .001). The overall hospital mortality rate was 18% (15/83). On univariate analysis, female gender, rupture on presentation, emergency laparotomy, management without aspiration or catheter drainage, presence of malignancy, hyperglycemia, hyperbilirubinemia, elevated prothrombin time, and elevated activated partial thromboplastin time were significantly associated with hospital mortality. On multivariate logistic regression analysis, presence of malignancy, hyperbilirubinemia, and elevated activated partial thromboplastin time were found to be independent risk factors. CONCLUSIONS: Pyogenic liver abscess is still a disease with significant mortality. Early diagnosis and prompt treatment are necessary to further improve our results of management.
An unexplained increase in the frequency of pyogenic liver abscesses of unknown etiology has, fourtunately, been paralleled by significant advances in diagnostic and therapeutic methods. This report reviews experience with 14 patients operated upon at NYU Medical Center since 1971. Eight cases (57%) were cryptogenic. Other abscesses were associated with biliary disease (3); abdominal sepsis (2); and trauma (1). Abscesses were present on hospitalization in 12 patients. Clinical findings included fever (101-108 F); 100%; leucocytosis, 71%; anorexia and vomiting, 50%; localized tenderness and hepatomegaly, 50%; hypoalbuminemia, 86%; hypocholesterolemia, 78%; elevated SGOT, 71%; and elevated aikaline phosphatase, 43%. Technetium hepatic scintiscans showed focal defects in 10 of 12 patients (83%), but did not detect multiple abscesses in 2 of these. Hepatic arteriography performed in 10 patients was highly accurate, outlining single abscesses in 6 and multiple abscesses in 4. Furthermore, in one patient a false positive scintiscan was demonstrated by negative arteriography, confirmed by autopsy. In 4 patients, arteriography indicated an abscess in the posterior-superior area of the right hepatic lobe. With precise anatomical localization, a trans-thoracic approach permitted uncomplicated drainage in each case. This approach provides excellent exposure and direct drainage for abscesses in this area. An additional therapeutic adjunct in two patients, with 4 and 11 abscesses each, was postoperative intraportal infusion of antibiotics through the umbilical vein. Thirteen patients (83%) recovered, one dying from pulmonary embolism. Primary hepatic abscesses occur with increasing frequency. Primary hepatic abscesses occur with increasing frequency. Primary hepatic abscesses occur with increasing frequency. The methods described allow more precise preoperative diagnosis and direct surgical drainage.
We have presented an unusual case of pyogenic liver abscess due to gamma streptococci group D, which remained undiagnosed for about seven months, and which ruptured spontaneously into subcutaneous tissue, resulting in self-cure. Despite the large hepatic abscess seen on liver scan and ultrasound, results of liver function tests remained normal. A mass seen on liver scan or ultrasound in patients with a malignancy does not necessarily indicate metastasis, and a more aggressive approach is required to treat a potentially curable disease.
Pyogenic liver abscess in patients with Crohn's disease is not common, but the mortality has been reported to be high if diagnosis and treatment is delayed. Intra-abdominal abscesses, fistulous disease, and steroid therapy have all been reported to be important predisposing factors in the pathogenesis of this entity. We present a patient with Crohn's disease in whom multiple abscesses were encountered in the right lobe of the liver. The diagnosis of liver abscess was established by abdominal computed tomography and the patient was treated by percutaneous catheter drainage. Awareness of this rare complication is important because diagnosis is difficult to make and a high index of suspicion is required. Once suspected, aggressive diagnostic workup and treatment is indicated. Most patients with liver abscess can be successfully managed by percutaneous catheter drainage combined with antibiotic therapy if it is diagnosed before extensive necrosis has occurred.
Pyogenic liver abscess is a serious condition with a high mortality rate. New diagnostic techniques have improved the diagnostic accuracy. Alternative therapeutic methods to open surgical drainage, such as percutaneous drainage and in certain cases antibiotics alone, are now available. Have changes in management of liver abscesses at our hospital improved the outcome? Two 5-year periods (I: n = 12; II: n = 14) were compared concerning diagnostic procedures, principles of treatment, and outcome. A shift from scintigraphy in the first period (I) to ultrasonography (US) in the second period (II) as prime diagnostic procedure was obvious. In I open surgical drainage dominated. 4/12, major surgical risks, were treated by anti-aerobic drugs alone, and died. In II US-guided percutaneous drainage was performed in 7/14, together with antibiotics active against aerobes as well as anaerobes, without complications. 4/14 were treated by an antibiotic combination alone and only 3/14 were treated by open surgical drainage. The change in management during these two periods has resulted in improved diagnostic and therapeutic routines as demonstrated by reduction in mortality rate.
A patient with multiple pyogenic abscesses in both lobes of the liver secondary to asymptomatic sigmoid diverticulitis is presented. The rarity of this illness is noted. It is suggested that barium enema be performed in patients who present with pyogenic liver abscess of unknown etiology because of the association with asymptomatic sigmoid diverticulitis.