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PubMed1984

Pyogenic liver abscess caused by Streptococcus milleri. Case reports.

In recent years Streptococcus milleri has emerged as an important cause of pyogenic liver abscess. Whether this represents a changing epidemiological pattern or merely reflects the more widespread application of routine anaerobic bacterial culture techniques is unclear. The isolation of Strept. milleri on culture of a blood specimen from a patient presenting with a pyrexial illness should alert the clinician to the possibility of an underlying liver abscess. Although it is isolated anaerobically this organism should not be mistaken for an obligate anaerobe, especially since it is resistant to metronidazole. Two cases of primary pyogenic liver abscess caused by this organism are reported.

Female↗
PubMed2005

An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses larger than 5 cm.

OBJECTIVE: To determine whether first-line treatment with percutaneous or surgical drainage of liver abscesses larger than 5 cm results in better clinical outcome. SUMMARY BACKGROUND DATA: Pyogenic liver abscesses larger than 5 cm are currently treated by intravenous antibiotics and either percutaneous (PD) or surgical drainage (SD). Percutaneous techniques have been increasingly performed in place of open drainage as first-line treatment. This paradigm shift has been fueled by the drive for low-risk and less-invasive procedures and the surgical option being reserved for percutaneous failures. Yet there is a lack of data to support percutaneous drainage over open surgical drainage as first-line treatment. METHODS: Over a 3-year period, 80 patients with liver abscesses larger than 5 cm amenable to PD and SD were included in the study. This situation was possible as 1 team of surgeons favored the use of PD and 1 team favored the use of SD as first-line treatment. The treatment outcomes in both groups were compared, and clinical end-points included time to defervescence of fever, failure of treatment, secondary procedures, hospital stay, morbidity, and mortality. RESULTS: PD was performed in 36 patients and SD in 44 patients as first-line treatment. Clinical, laboratory, and abscess parameters were comparable in both groups. Sixty-four of 80 patients (80%) had multiloculated abscess. The time to defervescence of fever was not statistically significant (PD versus SD, 4.85 versus 4.38 days; P = 0.09). However, SD had less treatment failures (3 versus 10, P = 0.013), less requirement for secondary procedures (5 versus 13, P = 0.01), and shorter length of hospital stay (8 versus 11 days, P = 0.03). There was no difference in morbidity or mortality rates. CONCLUSIONS: The results of our study show that for large liver abscesses more than 5 cm, SD provides better clinical outcomes than PD in terms of treatment success, number of secondary procedures, and hospital stay with comparable morbidity and mortality rates. SD should be considered as first-line treatment of large liver abscesses.

Adult↗
PubMed1985

Pyogenic liver abscess: changing epidemiology and prognosis.

We reviewed the clinical features, methods of diagnosis, and outcome of 31 patients with pyogenic liver abscess seen at a private community hospital between 1973 and 1980. Two patient groups emerged. Group 1 consisted of 25 patients who had classical signs and symptoms of primary liver abscess. Group 2 consisted of six patients, most with underlying malignancy, in whom liver abscess(es) occurred as part of a septicemic process involving multiple other sites. The mortality was 0% in group 1 and 100% in group 2. Further analysis of the patients in group 1 revealed that (1) in contrast to findings of older studies, pyogenic liver abscess in now largely a disease of older adults who often have no identifiable predisposing process; (2) newer noninvasive imaging techniques greatly facilitate a firm diagnosis; and (3) the prognosis for such patients has become remarkably good, perhaps because of earlier diagnosis.

Adolescent↗
PubMed1995

[Presentation, diagnosis and treatment of pyogenic liver abscess: analysis of a series of 63 cases].

BACKGROUND: The aim of this study was to know the clinical, etiopathogenic and microbiologic characteristics of pyogenic liver abscesses (PLA). METHODS: A retrospective analysis of the cases of PLA diagnosed from 1978 to 1992 in the Internal Medicine, Infectious Disease, and Gastrointestinal Surgery Departments of the Hospital de Bellvitge in Barcelona, Spain was performed. RESULTS: A total of 63 cases of PLA (43 males and 20 females, mean age 54 +/- 19 years) were analyzed. The most frequent clinical and analytical data included fever (92%), leucocytosis (84%) and abnormal levels of alkaline phosphatase (81%). The PLA were single in 65% and multiple in 35%. Echography was diagnostic in 91% of the cases. A positive culture of the abscess was obtained in 40 cases, being monomicrobial in 27 cases (67.5%). Eleven of the 13 polymicrobial cultures were from single PLA. The most frequent bacteria found were the enterobacteria (44%) followed by the microaerophilic streptococci (28%) and the anaerobes (17%). The PLA was of biliary origin in 31.8%, contiguous in 12.7% and unknown in 38%. Percutaneous drainage was performed in 34 patients (54%). Mortality attributable to the abscess was 3%. CONCLUSIONS: The clinical presentation of pyogenic liver abscess has not varied over time. There has, however, been a change with respect to its epidemiology and therapeutic management. At present, the possibility of rapid diagnosis and image guided percutaneous drainage offers a better prognosis for this disease.

Adolescent↗
PubMed1995

The comparison of clinical course and results of treatment between gas-forming and non-gas-forming pyogenic liver abscess.

OBJECTIVES: To study and review the clinical manifestations, courses, and results of treatment in 83 cases of verified gas-forming pyogenic liver abscess. DESIGN: Case series. SETTING: Both primary and referral hospital care. PATIENTS: Four hundred twenty-four patients with clinical diagnosis of pyogenic liver abscess were enrolled in the study. Eighty-three patients had gas-forming abscesses and 341 had non-gas-forming abscesses. The clinical manifestations, duration of symptoms, incidence of septic shock, laboratory findings, concurrent diabetes mellitus, cause of abscess, size of abscess, and results of treatment were recorded. MAIN OUTCOME MEASURES: A chi 2 test for qualitative data and Student's test for quantitative data. RESULTS: Duration of symptoms were shorter (mean +/- SD, 5.2 +/- 5.3 vs 7.6 +/- 10 days) (P < .005) and the incidence of septic shock was higher in the gas-forming than in the non-gas-forming group (32.5% vs 11.7%) (P < .01). Laboratory findings revealed high levels of blood glucose, aspartate aminotransferase, alkaline phosphatase, and serum urea nitrogen in the gas-forming group. The size of abscess was usually bigger (> 5 cm) in this group. In the gas-forming group, 71 patients (85.5%) had diabetes mellitus and 65 patients (78.3%) had conditions of cryptogenic origin. Klebsiella pneumoniae was the main bacteria, in blood culture and liver aspirates, especially in gas-forming liver abscess. Medical treatment and/or aspiration carried a high mortality rate (44.4%) in the gas-forming group; also, the overall mortality rate was higher in this group than in the non-gas-forming group (27.7% vs 14.4%) (P < .01). CONCLUSIONS: The gas-forming liver abscess may be a disease of wide spectrum of severity and may run a fulminating course. Strong antibiotics with early adequate drainage are mandatory. Surgery should not be delayed if necessary.

Adult↗
PubMedDate not supplied

Pyogenic liver abscess: multivariate analysis of risk factors.

Seventy-three patients with pyogenic liver abscess during the year 1978-1988 were studied in the Kaohsiung Medical College Hospital. The overall mortality rate was 19.2% in this study. By using univariate analysis, it was revealed that clinical jaundice, pleural effusion, bilobar abscess, profound hypoalbuminemia (less than 2.5 g/dl), hyperbilirubinemia (less than 2 mg/dl), elevated level of serum AST (greater than 100 IU/L), alkaline phosphatase (greater than 150 IU/L), and marked leukocytosis (greater than 20,000 mm3) were associated with a higher mortality rate. Multivariate stepwise logistic regression analysis detected only 3 factors of marked leukocytosis (greater than 20,000 mm3), profound hypoalbuminemia (less than 2.5 g/dl), and presence of pleural effusion with independent significance in predicting mortality. Meanwhile, it was also revealed that the laboratory data could not predict a risk factor to mortality unless they became markedly abnormal.

Adult↗
PubMed1975

Pyogenic liver abscess caused by Streptococcus milleri.

Three clinically typical cases of multiple pyogenic liver abscesses are presented. In all three cases Streptococus milleri was isolated from the pus and in two cases it was isolated from blood cultures also. The patients were successfully treated by surgical drainage and antibiotics.

Administration, Oral↗
PubMed2001

Pyogenic liver abscess complicated by endogenous endophthalmitis.

BACKGROUND: Endogenous endophthalmitis is an inflammation of ocular tissues that can lead to deterioration of and loss of vision. Rarely, this can complicate the course of a patient with pyogenic liver abscess. METHODS: Over an 18-month period, 68 patients were treated for pyogenic liver abscesses. Three patients, all of whom were male and with diabetes, were diagnosed with a Klebsiella pneumoniae liver abscess complicated by endogenous endophthalmitis. Open surgical or percutaneous drainage of the liver abscess was undertaken and the symptomology and outcome of the endophthalmitis reviewed. RESULTS: There was no mortality in our series. Two patients presented with simultaneous abdominal and ocular symptoms and one patient had ocular symptoms 3 days after surgical drainage of the liver abscess. Despite aggressive treatment, all patients had permanent deterioration of visual function with one patient becoming blind and requiring evisceration of the infected eye. CONCLUSION: Ocular symptoms in patients treated for pyogenic abscesses must be dealt with urgently with an ophthalmologic consultation. Increased awareness of this complication and a high index of suspicion are paramount for salvage of visual function.

Endophthalmitis↗
PubMed1991

Pyogenic liver abscess: a 7-year experience in a large community hospital.

This is a retrospective study of 27 consecutive patients with a diagnosis of pyogenic liver abscess (PLA) seen over a period of 7 years. There were 10 males and 17 females whose ages ranged from 5 to 86 years (mean 56). Fever, abdominal pain and vomiting were the commonest symptoms, and abdominal tenderness was the commonest physical finding. An elevated alkaline phosphatase was seen in 78% of all patients and was the commonest biochemical abnormality. Biliary disease accounted for a third of all cases, and in 22% of the patients the abscesses were considered to be idiopathic. Ultrasonography and/or CT scanning was employed in the diagnosis and follow-up of all patients. Percutaneous needle aspiration (PNA) and percutaneous drainage (PCD) under ultrasound or CT guidance was employed as the primary therapy in 24 patients. The procedure failed in 5 patients (18.5%), there was 1 complication (3.7%) and no deaths were seen as a result of these procedures. Three patients (11%) ultimately died of their abscesses. This study emphasizes the important role of percutaneous drainage as a complementary form of therapy to surgical drainage in the management of pyogenic liver abscesses.

Drainage↗
PubMedDate not supplied

[Pyogenic liver abscess and schistosomiasis mansoni in the state of Espírito Santo].

A possible association of the acute toxemic form of schistosomiasis and pyogenic liver abscess (PLA) has been recently suggested. As in the west of the Espírito Santo state schistosomiasis is endemic and PLA are frequently diagnosed in the Children's Hospital of Vitória we reviewed the records of the Hospital during the period from May 1991 to April 1993 to: a) identify all cases of PLA in which Schistosoma mansoni infection was present and b) annotate the procedence of each case to verify if there is an association of the two diseases. 65 cases of PLA were recorded and 39 had the result of a stool examination, being three positive for Schistosoma mansoni (7.6%) and 26 for other helminth (mainly Ascaris and Trichocephalus). The procedence of the patients showed that only 7 (10.7%) came from endemic areas. These results show that an association of Schistosoma mansoni infection and PLA was not significative in the country, where the acute toxemic form is not frequent. The great majority of PLA in this study came from the urban periphery of Vitória, where transmission of schistosomiasis does not occur but intestinal helminth infections are extremely frequent. The great majority of PLA in this study came from the urban periphery of Vitória, where transmission of schistosomiasis does not occur but intestinal helminth infections are extremely frequent. As 40% of these PLA were cryptogenetic it is possible that the immunomodulation induced by intestinal parasites and the liver granulomas produced by the larvae of these helminths would be predisposing factors for pyogenic liver abscess.

Animals↗
PubMed1990

Pyogenic liver abscess: clinical manifestations and value of percutaneous catheter drainage treatment.

One hundred and sixty-two patients with solitary or multiple pyogenic liver abscesses received surgical or medical treatment in the past 8 years. Fifty-seven patients were treated medically (medical group), 62 patients received medical treatment plus sonogram-guided percutaneous drainage (PCD group), and 43 patients received surgical drainage (surgical group). Aerobic gram-negative rods were the predominant causative microorganisms. Klebsiella pneumoniae was the most common microorganism, occurring in 46.9% (76/162) of the cases. Anaerobes occurred in 16.7% (27/162) of the cases. In the evaluation of treatment, the success rates for these three groups were: medical group, 59.6% (34/57); PCD group, 90.3% (56/62); and surgical group, 83.7% (36/43). This retrospective study confirms evidence from a small series that medical treatment plus percutaneous catheter drainage is efficient and more convenient than conventional surgical drainage for pyogenic liver abscesses. The frequent severe septic emboli to distant organs noted in this series (11.1%; 18/162) are quite unusual and should be anticipated in the future.

Adult↗
PubMed2005

Pyogenic liver abscesses with Escherichia coli: etiology, clinical course, outcome, and prognostic factors.

BACKGROUND: To investigate the clinical characteristics, outcome, and prognostic factors related to mortality in patients with Escherichia coli liver abscess. METHODS: We retrospectively analyzed 72 patients aged 18 years and older who were diagnosed as having E. coli liver abscesses from July 1996 to June 2002 at two medical centers in Taiwan. RESULTS: The overall mortality rate was 26.4%. The majority of E. coli liver abscesses was solitary, involved the right lobe of the liver, and comprised polymicrobial infections. The cause of the liver abscess involved the biliary system in 48 patients (66.7%). The most common concomitant diseases were diabetes mellitus (30.6%) and underlying malignancy (30.6%). Metastatic infection was found in 4 patients (5.6%). Multivariate analysis revealed that underlying malignancy (p = 0.034), profound hypoalbuminemia (<2.5 g/dl) (p = 0.008), and multiple abscesses (p = 0.004) were the most significantly prognostic factors for mortality. CONCLUSION: The predominant causes of E. coli liver abscess were biliary diseases. This report also highlights that E. coli liver abscess has a relatively high mortality rate, which is associated with underlying malignancy, multiple abscesses and profound hypoalbuminemia.

Adolescent↗