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PubMed2003

[Septic shock associated with pyogenic liver abscess rescued with percutaneous transhepatic abscess drainage].

We report a case of septic shock associated with pyogenic liver abscess rescued with percutaneous transhepatic abscess drainage (PTAD). A 70-year-old male patient was admitted to our outpatient department of internal medicine with general fatigue, dullness of bilateral shoulders and extremities, appetite loss, weight loss, headache, and vertigo. Laboratory tests showed severe inflammatory indications, anemia, and high values of hepatobiliary enzymes and blood sugar. Abdominal ultrasonography and enhanced CT showed a pyogenic liver abscess of 10 cm in diameter at S 6-7 in the right hepatic lobe. The patient's condition deteriorated suddenly that night. From the results of abdominal ultrasonography and enhanced CT, we made diagnosis of septic shock associated with pyogenic liver abscess. Emergency abdominal ultrasound-guided PTAD was performed under local anesthetic. Postoperatively, the antibiotic was infused daily through a PTAD tube into the liver abscess space. He recovered and his laboratory tests improved gradually. On abdominal ultrasonography and enhanced CT, the liver abscess disappeared by 19th postoperative day, and PTAD tube was removed. There was no complication during PTAD treatment. We conclude that patients in septic shock should undergo further examinations immediately and treatment of the infected tissue should be started as soon as possible. PTAD may be an additional effective procedure for pyogenic liver abscess in septic shock. Furthermore, local antibiotic lavage through a PTAD tube into the liver abscess space may be an important supplementary method in the management of the illness.

Aged↗
PubMedDate not supplied

Liver abscess: a clinicopathological analysis of 82 cases.

Liver abscesses are a common pathology in India, but a strategy for effective treatment has not been established. Eighty-two patients with liver abscess were studied over a 4-year period. Clinical features, ultrasound findings, laboratory studies, and outcome of therapy were evaluated. Treatment options were antibiotics alone, needle aspiration, catheter drainage, or open surgical drainage; 51.2% of all abscesses were amebic, 23.2% were pyogenic, and 25.6% had unknown causes. A total of 75.6% of the abscesses were solitary, with 62.2% confined to the right lobe. Pyogenic abscesses were more likely to have anemia, leukocytosis, and deranged liver function. Amebic abscesses tended to have a larger volume. Patients undergoing catheter drainage showed a more rapid reduction in initial abscess volume, whereas resolution of the abscess cavity took longer with antibiotic therapy alone. Ultrasound-guided needle aspiration and catheter drainage are safe and effective in the management of liver abscess. Drug therapy alone may be useful only in select cases.

Adult↗
PubMed2002

Amoebic versus pyogenic liver abscess.

OBJECTIVES: To study the differences between the clinical presentation and complications of amoebic and pyogenic liver abscess. To correlate the diagnostic significance of Entamoeba Indirect Haemagglutination test (E.IHA) in establishing the diagnosis of amoebic liver abscess. DESIGN: Open cohort observational study. SETTING: Department of Medicine (Medical Unit II) Jinnah Postgraduate Medical Centre, Karachi. PARTICIPANTS: Fifty two patients aged 13-70 years admitted in Medical Unit II and diagnosed to have liver abscess. INTERVENTIONS: Group A comprised of patients clinically diagnosed to have amoebic liver abscess and received Metronidazole 500mg iv x 8 hourly for atleast 10 days or more if patient developed complications. Group B comprised of patients diagnosed to have pyogenic abscess and received Cefotaxime 1g iv x 8 hourly for the same duration or more if complicated (antibiotic reviewed in accordance with culture and sensitivity report). MAIN OUTCOME MEASURES: Differences in the clinical presentation, complications and diagnostic parameters between the two groups of patients. RESULTS: It was not possible to differentiate between amoebic and pyogenic liver abscess on clinical grounds, routine investigations and imaging techniques. Aspiration of pus, especially if the abscess was multiple, was most helpful in differentiating the two types of abscesses. Serological test of E.IHA was highly specific and sensitive for amoebic liver abscess. CONCLUSION: Majority of liver abscesses in Karachi are due to Entamoeba Histolytica. Pyogenic abscess though less frequent, must be excluded by pus aspiration and culture and sensitivity. E.IHA is a good rapid method of discriminating between the two types of abscesses.

Adolescent↗
PubMed2004

Population-based study of the epidemiology of and the risk factors for pyogenic liver abscess.

BACKGROUND & AIMS: Pyogenic liver abscess (PLA) is relatively uncommon in North America but is associated with significant morbidity and mortality. Our objective was to characterize the incidence of, risk factors for, and outcomes of PLA in a nonselected population. METHODS: Population-based surveillance was conducted in the Calgary Health Region (CHR) between April 1, 1999 and March 31, 2003. All adult CHR residents with PLA were identified, and charts were reviewed. RESULTS: Seventy-one CHR residents developed a PLA for an annual incidence of 2.3 per 100,000 population. There was an increasing incidence of PLA with advancing age. Men were at much higher risk of acquiring a PLA as compared to women (3.3 vs 1.3 per 100,000; relative risk [RR], 2.6; 95% confidence interval [CI], 1.5-4.6; P < .001), and this was observed across all age groups. A number of comorbid conditions were associated with significantly higher risk for developing a PLA including liver transplantation patients (RR, 444.8; 95% CI, 89.5-1356.0; P < .0001), diabetics (RR, 11.1; 95% CI, 6.3-19; P < .0001), and patients with a history of malignancy (RR, 13.3; 95% CI, 6.9-24.4; P < .0001). No other solid organ transplantation patient was at increased risk. All patients required admission to hospital (median length of stay, 16 days), and 7 (10%) patients died in hospital, corresponding to a mortality rate of 0.22 per 100,000 population. CONCLUSIONS: This study provides important data on the burden of PLA and identifies risk groups that might potentially benefit from preventive efforts.

Adult↗
PubMed1997

[Pyogenic liver abscess in children].

2 children with pyogenic liver abscesses were hospitalized during the past 2 years. A 6-year-old boy had high fever and hepatomegaly, and a large liver abscess was found in the right hepatic lobe. Streptococcus milleri was isolated from the pus. Treatment with a combination of prolonged drainage of the abscess and antibiotic therapy was successful. A 4-month-old girl who had prolonged fever was found to have osteomyelitis of 3 thoracic vertebrae and 2 liver abscesses in the right lobe. She was treated successfully with broad spectrum antibiotics. Additional workup revealed that she had chronic granulomatous disease.

Anti-Bacterial Agents↗
PubMedDate not supplied

Gadoteridol dose dependence in MR imaging of a liver abscess model.

A necrotic liver abscess model was studied with magnetic resonance (MR) imaging at 1.5 T before and after intravenous administration of gadoteridol at doses of 0.1, 0.25, and 0.5 mmol/kg in 24 rabbits. Enhancement characteristics and lesion delineation were assessed with both breath-hold and non-breath-hold imaging techniques. Lesion delineation, as assessed both by signal intensity measurements and evaluations by two image readers blinded to imaging technique, was greatest on high-dose (0.5 mmol/kg) breath-hold images. Lesion rim enhancement was seen consistently only on postcontrast images obtained at a dose of 0.5 mmol/kg and progressed with time after injection of contrast material.

Animals↗
PubMedDate not supplied

A case of multiple amoebic liver abscesses: clinical improvement after percutaneous aspiration.

Amoebic liver abscesses are by far the most common extra-intestinal manifestation of invasive amoebiasis. The classical clinical picture consists of fever, right upper quadrant pain and hepatomegaly. Ultrasound and serology make an early diagnosis possible. Amoebic liver abscesses usually appear singly and are normally situated in the right lobe of the liver. This case report refers to a white Belgian woman, living in an endemic area for amoebiasis, presenting with 25 amoebic liver abscesses, who did not improve clinically despite appropriate anti-amoebic therapy, is described. Only percutaneous drainage of the larger abscesses led to clinical recovery. Amoebic abscess aspiration and evacuation under ultrasonographic guidance is of limited risk, but in experienced hands may enhance clinical recovery, particularly in patients with large abscesses not responding to conservative medical treatment. Aspiration of large abscesses (> 5 cm) is rarely necessary but should be considered if there is no clinical improvement after 3 days of nitroimidazole treatment with amoebicides.

Adult↗
PubMedDate not supplied

Liver abscess in children: a single institutional experience in southern Taiwan.

Liver abscess is uncommon in children. The purpose of this study is to evaluate the predisposing factors, pathogens, duration of hospitalization, and the managements of liver abscess in children. From 1986 to 2001, fifteen children were admitted to our hospital under the diagnosis of liver abscess. Thirteen cases were older than 8 years old and two were younger than one year old. Fever (15/15, 100%) and abdominal pain (13/15, 87%) were the most common symptoms. Twelve patients (80%) had prolonged fever (fever for 7 days or longer before diagnosis). Eleven (73%) cases were cryptogenic in origin. Most of the microorganisms were obtained solely from cultures of pus. Klebsiella pneumoniae was the most common organism isolated (6/15, 40%). Beside administration of antibiotics, percutaneous catheter drainage (PCD) was performed in 11 patients (73%); only one underwent surgical intervention due to poor response to PCD management. All of our patients were surviving after at least one year follow-up. In conclusion, liver abscess should be suspected in the patients with prolonged fever of unknown origin and abdominal pain. PCD combined with adequate antibiotics were sufficient for therapy of liver abscess in most cases. K. pneumoniae was the most common isolated pathogen in southern Taiwan.

Adolescent↗
PubMed2006

Genetic determinants of capsular serotype K1 of Klebsiella pneumoniae causing primary pyogenic liver abscess.

BACKGROUND: Primary pyogenic liver abscess (PLA) caused by Klebsiella pneumoniae is an emerging infectious disease. Capsular serotype K1 and the magA gene have been reported to be associated with this disease. METHODS: The prevalence of magA was determined by polymerase chain reaction (PCR). The sequences of the magA flanking region were completed by inverse PCR and direct sequencing. Serotyping was performed by double immunodiffusion. Insertion mutations and trans-complementation were used to define the K1 genetic determination region. RESULTS: Thirty-five of 42 strains from patients with PLA were magA positive, whereas only 1 of 32 non-PLA strains was magA positive. All 36 magA-positive strains were serotype K1, and the 38 magA-negative strains were not (36/36 vs. 0/38; P<.0001). Sequencing of the magA flanking region revealed a putative capsular polysaccharide synthesis (cps) region; this region was 25 kb in length and contained 20 open reading frames (ORFs); of these ORFs, 9 were cotranscribed as part of an operon and differed from both MGH78578 and the Chedid strain. Mutation of 4 genes in this region turned the mutant strains anti-K1 negative. Trans-complementation restored the K1 phenotype. CONCLUSIONS: The operon containing magA is responsible for capsular serotype K1 of K. pneumoniae. Several loci in the operon are unique determinants of K1 strains.

Antigens, Bacterial↗
PubMed2001

Liver abscess after transcatheter oily chemoembolization for hepatic tumors: incidence, predisposing factors, and clinical outcome.

PURPOSE: To evaluate the incidence of, predisposing factors for, and clinical outcome of liver abscess developing in patients with hepatic tumors after transcatheter oily chemoembolization (TOCE). MATERIALS AND METHODS: During the past 6-year period, 2,439 patients with hepatic tumors underwent a total of 6,255 TOCE procedures. With a retrospective review of medical records, the authors evaluated the occurrence of liver abscess, the statistical significance of potential predisposing factors including portal vein obstruction, metastatic tumors, biliary abnormalities (type 1, simple biliary obstruction; type 2, status prone to ascending biliary infection), malignant gastrointestinal mucosal lesions, and additional gelatin sponge particle embolization in liver abscess formation, and the clinical outcome of abscess. RESULTS: Fifteen liver abscesses occurred in 14 patients (0.2%). Liver abscesses developed in three of 987 (0.3%) TOCE procedures for portal vein obstruction, three of 114 (2.6%) procedures for metastatic tumors, one of 49 (1.8%) for type 1 biliary abnormality, four of 55 (7.4%) for type 2 biliary abnormality, two of 18 (11.1%) for malignant gastrointestinal mucosal lesion, and nine of 2,108 (0.4%) for additional gelatin sponge particle embolization. Univariate and multivariate statistical analysis showed that type 2 biliary abnormality was a significant predisposing factor. The mortality related to liver abscess occurred in two patients (13.3%). Thirteen liver abscesses were successfully treated with parenteral antibiotics and percutaneous catheter drainage. However, irreversible deterioration of liver function occurred in two patients. Two of nine further TOCE procedures in three patients caused recurrent septicemia and liver abscess. CONCLUSION: The biliary abnormality prone to ascending biliary infection was the most important predisposing factor to the development of liver abscess after TOCE. Postembolic liver abscess could be effectively managed with percutaneous catheter drainage.

Anti-Bacterial Agents↗
PubMed1984

Peritoneoscopy in the diagnosis of liver abscess. Experience with 108 cases during a 10-year period.

Among 4569 cases of peritoneoscopy performed in a period of 10 years (1972-1981), 108 patients with liver abscesses were encountered. The diagnosis of hepatic abscess was made on the basis of gross liver inspection and confirmed or disproved by needle puncture biopsy, histopathologic study, or surgery. Peritoneoscopy is a valuable procedure for the diagnosis of liver abscess. Liver aspiration under direct vision during peritoneoscopy yields more dependable material for the diagnosis of liver abscess than blind liver aspiration. Moreover, during peritoneoscopy one can choose more accurately the site for the insertion of the aspirating needle.

Adolescent↗
PubMed1987

[Results of treatment of pyogenic liver abscesses].

In the last 7 years 53 patients with liver abscesses were treated at surgical clinic of Charité. Since November 1982 we treated in 27 cases with solitary and multiloculary liver abscesses by percutaneous drainage of the abscess diameter more than 3 to 4 cm. 12 patients with multiloculary small biliary liver abscesses were treated by antibiotics. The bacteriological examination were performed after CT-supported puncture of the abscess. Seven patients with complicated abscesses could not be healed with CT-drainage. Surgical drainage via laparotomy was necessary. The diagnostic clarification of the dignity is important in every case. The lethality of all treated liver abscesses was 5.6% and the causes of death were the existing basic diseases.

Adolescent↗
PubMed1986

CT-guided percutaneous aspiration and catheter drainage of pyogenic liver abscesses.

Surgical drainage has been the accepted method of treatment for pyogenic liver abscesses. Modern imaging techniques have revolutionized the diagnosis and management of liver abscesses. Percutaneous aspiration and drainage have been reported as a treatment modality of pyogenic liver abscesses in the literature before. We treated 15 patients with pyogenic liver abscesses by percutaneous aspiration and drainage. All patients responded except two. No mortality was observed. Review of the literature and our experience with 15 patients suggest that because of the high recovery rate and few complications percutaneous aspiration and drainage should be the first line of treatment in the management of pyogenic liver abscesses.

Adult↗
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↗
PubMed1990

Management of pyogenic liver abscess in the era of computed tomography.

The advent of high-resolution imaging has allowed earlier diagnosis of pyogenic liver abscess. Because radiologically guided percutaneous drainage (PCD) of liver abscesses is controversial, the authors studied 40 patients with liver abscess admitted to the Toronto Hospital between 1982 and 1987 to determine the role of PCD versus operative drainage (OD). The diagnosis of pyogenic liver abscess was made at autopsy (4 patients), at laparotomy (6) or by radiologically guided aspiration of pus (30). Ultrasonography and computed tomography were highly sensitive (85% and 96% respectively) in detecting liver abscess. Of the 36 patients treated for liver abscess all received antibiotics intravenously; 31 also underwent a drainage procedure. Treatment with antibiotics alone was associated with a success rate of 80% and a death rate of 20%. The success rate for those who had PCD was 75% with a death rate of 13%; 2 patients in this group of 16 subsequently required OD for cure. In the 15 patients initially treated with OD, success and death rates were 87% and 13% respectively. For solitary abscesses, success rates wer comparable for PCD and OD (86% and 90% respectively). For unilobar multiple abscesses the success rate was 100% for both PCD and OD, but for bilobar multiple abscesses the rates were only 40% and 67% respectively. Complication rates were similar for both methods of drainage. The authors conclude that pyogenic liver abscess can now be safely and efficaciously managed with a combination of antibiotics and PCD.

Adult↗
PubMed1988

Metastatic septic endophthalmitis in pyogenic liver abscess.

In a consecutive series of 180 patients with pyogenic liver abscess, three patients (two men and one woman, between 46 and 75 years of age) had metastatic Klebsiella endophthalmitis. The incidence of metastatic endophthalmitis was 1.7% in patients with pyogenic liver abscess, 5.2% in patients with Klebsiella liver abscess, and 7.8% in patients with Klebsiella liver abscess having Klebsiella bacteremia. Despite aggressive therapeutic measures, the men permanently lost their vision and the woman eventually required an evisceration of her right eye. Delayed recognition and/or treatment as well as the nature of bacteria probably contributed to the tragic outcome. The findings suggest that a high index of suspicion is critical and a combined effort of the internist and ophthalmologist is mandatory.

Aged↗
PubMed2006

Emerging invasive liver abscess caused by K1 serotype Klebsiella pneumoniae in Korea.

OBJECTIVES: The high incidence of invasive liver abscess caused by Klebsiella pneumoniae in Taiwan, contrasted with the rareness of this disease in Western countries, has aroused special interest. There have been few detailed reports from other Asian countries. To investigate a current epidemiology of K. pneumoniae liver abscess in Korea and to determine K serotype distribution in K. pneumoniae strains causing liver abscess, we performed a nationwide prospective study. METHODS: Community-acquired, culture-proven liver abscess cases were enrolled between 2004 and 2005. Etiologies and clinical features were analyzed. K. pneumoniae isolates were serotyped according to K antigen. Meta-analysis was done to determine the time trend of the etiologies of liver abscess in Korea. RESULTS: Out of 371 cases collected prospectively, 290 (78.2%) were caused by K. pneumoniae. Most K. pneumoniae liver abscesses were monomicrobial. Diabetes mellitus was the most common underlying disease (39.9%). Distant metastatic infections were frequently observed (8.7%). magA PCR revealed that 95 (59.4%) out of 160 K. pneumoniae isolates belonged to the K1 serotype. CONCLUSIONS: Our study indicates that K. pneumoniae has emerged as a major etiologic agent of liver abscess in Korea, and these emerging infections seem to be attributable to invasive K. pneumoniae strains with capsular K1 serotype.

Aged↗
PubMed2005

[Liver abscess caused by Gemella morbillorum].

Gemella morbillorum, an anaerobic-to-aerotolerant Gram-positive coccus, is a normal flora of the oral cavity, respiratory tract, urogenital organ and gastrointestinal tract, and infections caused by this organism are unusual. It has been associated mainly with endocarditis and bacteremia, and rarely with arthritis, spondylodiscitis, meningitis, brain abscess and septic shock. Liver abscess caused by G. morbillorum is very rare, and only a few cases were reported. We experienced a case of liver abscess by G. morbillorum in a 56-year-old woman presented with fever. We report this case with a review of literatures.

Female↗