Pyogenic Liver Abscess Secondary to Staphylococcus aureus Infection without Primary Source of Infection

We observed a number of cases of sepsis from bacteremia in children from community-associated methicillin-resistant Staphylococcus aureus (MRSA), which led us to study its patterns of infection and outcome. A retrospective review identifying children admitted to our institution with blood culture-proven community-associated MRSA sepsis over a 2-year period was performed. The inclusion criteria were younger than 19 years old, two or more blood cultures for MRSA within 48 hours of admission, evidence of systemic inflammatory response syndrome, and no prior hospital admissions within 6 months. Eight patients were included; seven required mechanical ventilation. Vasopressors were required in seven patients. Four patients required extra-corporeal membrane oxygenation. Four patients had culture-proven septic arthritis or thrombophlebitis and three of these patients developed bilateral necrotizing pneumonia. Bilateral necrotizing pneumonia was identified in the other four patients, but the primary source of infection was never identified. The overall intact neurologic survival was 50 per cent. Children with severe community-associated MRSA sepsis can rapidly progress to cardiorespiratory failure. Mortality appears to be high, and children may benefit from a search of their soft tissues and joints to identify the source of infection to prevent embolic dissemination.

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Clinical, Demographic, and Aetiological Profile of Liver Abscess in Children Admitted at a Tertiary Care Hospital - North India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/629 ◽

2021 ◽

Vol 8 (40) ◽

pp. 3470-3476

Author(s):

Navya Sree Manugu ◽

Narayana Lunavath ◽

Ramu Pedada

Keyword(s):

Staphylococcus Aureus ◽

Informed Consent ◽

Liver Abscess ◽

Methicillin Resistant Staphylococcus Aureus ◽

Tertiary Care ◽

Pyogenic Liver Abscess ◽

Salmonella Typhi ◽

Amoebic Liver Abscess ◽

Care Hospital ◽

Methicillin Resistant

BACKGROUND Amoebic liver abscess is the commonest extra intestinal site of invasive amoebiasis which mainly affects infants and young children. The incidence of pyogenic liver abscess is much higher among children in developing countries than those in developed countries. Diagnosis of liver abscess can be challenging and is often delayed; a high index of suspicion is necessary in children with risk factors. Children have unique set of predisposing causes for liver abscesses. The purpose of this study was to assess the clinical, demographic, and etiological profile of liver abscess in children between 1 month to 12 years of age. METHODS This is a prospective observational study conducted in the Department of Pediatrics, Chacha Nehru Bal Chikistalaya (An Autonomous Institute under Govt. of NCT (National Capital Territory) of Delhi, affiliated to University of Delhi), Delhi from July 2016 to August 2017. All children aged 1 month to 12 years admitted with liver abscess (included consecutively) were enrolled after considering inclusion and exclusion criteria. Written and informed consent was taken from parents/guardians of children aged less than 7 years. Informed assent was taken from children aged more than 7 years, along with written and informed consent from their parents/guardians. Their clinical characteristics, radiological features and laboratory data were analysed. RESULTS Most common age group suffering from liver abscess was 5 - 10 years with male preponderance. Majority of the children belonged to lower socio-economic class and half of them were suffering from malnutrition. Most common clinical presentation of children suffering from liver abscess was fever with pain abdomen and tender hepatomegaly. Majority of the children had leucocytosis, high level of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Deranged liver function test with coagulopathy was noted in more than half of the children suffering from liver abscess. Commonest bacterial pathogen was methicillin resistant Staphylococcus aureus followed by Salmonella typhi, Stenotrophomonas maltophilia, coagulase negative Staphylococcus aureus and Staphylococcus hominis. Entamoeba histolytica is a common parasitic agent causing liver abscess in children. CONCLUSIONS Liver abscess should be considered in children presenting with fever and abdominal pain. Most cases involve a single lesion on right lobe of the liver. Methicillin resistant Staphylococcus aureus followed by Salmonella typhi are the two most common pathogens. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Children

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Pyogenic liver abscess in a child with concomitant infections – Staphylococcus aureus, Echinococcus multilocularis and Mycobacterium tuberculosis

Helminthologia ◽

10.1515/helmin-2016-0026 ◽

2016 ◽

Vol 53 (3) ◽

pp. 270-275 ◽

Cited By ~ 3

Author(s):

D. Antolová ◽

D. Hudáčková ◽

M. Fecková ◽

A. Feketeová ◽

M. Szilágyová

Keyword(s):

Staphylococcus Aureus ◽

Mycobacterium Tuberculosis ◽

Liver Abscess ◽

Echinococcus Multilocularis ◽

Clinical Presentation ◽

Pyogenic Liver Abscess ◽

Diagnostic Process ◽

Bacterial Aetiology ◽

Life Threatening ◽

Altered Liver

SummaryPyogenic liver abscess is an uncommon but important and potentially life-threatening disease that occurs whenever there is failure of clearance of an infection in the liver. Work presents a rare case of pyogenic liver abscess with confirmed bacterial aetiology ofStaphylococcus aureus, subsequently confirmedEchinococcus multilocularisand suspectedMycobacterium tuberculosisliver infection in 6 years old child. Moreover, several other parasitic diseases were recorded. According to clinical presentation of diseases, it could be supposed that liver impairment caused by alveolar echinococcosis and potentially also byM. tuberculosiscould be the predisposition site for the capture ofStaphylococcus aureusin altered liver tissues during its haematogenous spreading, and thus contributed to the development and subsequent clinical presentation of pyogenic liver abscess. The presence of three different aetiological agents complicated the diagnostic process as well as the therapy of the patient and made her prognosis uncertain. Proper diagnosis of multiloculated liver abscesses, with echinococcosis and hepatic tuberculosis considered in the differential diagnosis, is therefore crucial to administration of early and appropriate treatment.

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Cryptogenic Pyogenic Liver Abscess Due to Fusobacterium nucleatum in an Immunocompetent Patient

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_001741 ◽

2020 ◽

Author(s):

Neeraja Swaminathan ◽

Francisco Aguilar

Keyword(s):

Liver Abscess ◽

Fusobacterium Nucleatum ◽

Pyogenic Liver Abscess ◽

Immunocompetent Patient ◽

Immunocompetent Host ◽

Source Of Infection ◽

Function Test ◽

History Of ◽

Anaerobic Infections ◽

Dental Work

In this case, a 76-year-old female presented with 3–4 days of fever with no other localizing signs. Notably, she had had an untreated Fusobacterium bacteraemia approximately 8 weeks prior to admission. She underwent abdominal imaging which demonstrated a liver abscess and had percutaneous drainage of the same. Blood and pus cultures both grew Fusobacterium nucleatum, which is an unusual organism to be associated with a liver abscess, especially in an immunocompetent host with no risk factors for this condition. Interestingly, this patient did not have any history of dental work, instrumentation, liver function test (LFT) abnormalities and no extrahepatic source for the abscess. This case highlights the importance of having a high index of clinical suspicion for an occult source of infection and emphasizes the importance of following up on cultures even after discharge of a patient, since anaerobic infections such as those caused by Fusobacterium can have a largely indolent course.

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Corneal Endotheliitis Associated with a Methicillin Resistant Pyogenic Liver Abscess

Journal of Clinical & Experimental Immunology ◽

10.33140/jcei.05.03.03 ◽

2020 ◽

Vol 5 (3) ◽

Keyword(s):

Liver Abscess ◽

Methicillin Resistant Staphylococcus Aureus ◽

Bacterial Pathogen ◽

Pyogenic Liver Abscess ◽

Methicillin Resistant ◽

Source Of Infection ◽

Corneal Inflammation ◽

Subsequent Loss ◽

First Time ◽

Corneal Endotheliitis

Endotheliitis is the inflammation of the corneal endothelium resulting in edema and subsequent loss of vision. Bacterial causes of corneal inflammation primarily of the epithelium with subsequent, secondary involvement of the endothelium have previously been described. Notably, however, there are no reports of isolated endotheliitis related to a bacterial pathogen. We report, for the first time, a case of corneal endotheliitis associated with a pyogenic liver abscess caused by methicillin resistant Staphylococcus aureus (MRSA). Treatment targeting the underlying source of infection led to visual recovery in our patient.

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Pyogenic Liver Abscess Caused by Methicillin-Susceptible Staphylococcus aureus in a 21-Year-Old Male

Case Reports in Hepatology ◽

10.1155/2018/9868701 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Samuel Igbinedion ◽

Meher S. Mavuram ◽

Moheb Boktor ◽

John Bienvenu

Keyword(s):

Staphylococcus Aureus ◽

Liver Abscess ◽

Liver Enzymes ◽

Pyogenic Liver Abscess ◽

Severe Illness ◽

Percutaneous Catheter ◽

Liver Abscesses ◽

Elevated Liver Enzymes ◽

Antibiotic Coverage

Liver abscesses are the most common types of visceral abscesses. Pyogenic liver abscesses, a particular type of liver abscesses, are uncommonly encountered. We present a rare case of pyogenic liver abscess caused by methicillin-susceptible Staphylococcus aureus in a young man. A 21-year- old man presented from prison to the hospital with fever, nausea, vomiting, diarrhea, and abdominal pain for five days. Labs were significant for leukocytosis with predominant neutrophilia and elevated liver enzymes. CT abdomen with contrast revealed an 8.4 cm multiloculated right hepatic mass extending to the kidney. Patient was started on broad spectrum antibiotics, given septic presentation. Peripheral blood cultures returned positive for methicillin-susceptible Staphylococcus aureus (MSSA). The culture from percutaneous drainage also revealed MSSA. He received a total of four weeks of IV Nafcillin therapy along with drainage of his abscess via percutaneous catheter. Follow-up revealed clinical resolution. This case highlights the importance of obtaining an aspirate from the liver abscess to better guide treatment strategy. Clinicians must consider broadening antibiotic coverage to include gram-positive organisms if the patient presents with severe illness and risk factors for Staphylococcus aureus infections.

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