PYOGENIC LIVER ABSCESS: DIAGNOSTIC AND THERAPEUTIC MANAGEMENT

ABSTRACT Background: The pyogenic liver abscess has an incidence of 1.1/1,000 habitants. Mortality can reach 100%. The use of less invasive procedures diminish morbidity and hospital stay. Aim: Identify risk factors in patients who underwent percutaneous drainage guided by ultrasound as treatment. Method: Were analyzed 10 patients submitted to the method. Epidemiological characteristics, laboratory markers and imaging exams (ultrasound and CT) were evaluated. Results: The majority of the patients were men with mean age of 50 years old. Liver disease, alcoholism and biliary tract disease were the most common prodromes. Abdominal pain (90%), fever (70%) and jaundice (40%) were the most common clinical manifestations. Mortality of 20% was observed in this series. Hypoalbuminemia and days of hospitalization had a statistically significant positive association with death. Conclusion: The pyogenic liver abscess has subacute evolution which makes the diagnosis difficult. Image exams have high sensitivity in diagnosis, particularly computed tomography. Percutaneous drainage associated with antibiotic therapy is safe and effective therapeutic resource.

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Clinical, microbiological, and molecular epidemiological characteristics of Klebsiella pneumoniae-induced pyogenic liver abscess in southeastern China

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0615-2 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 3

Author(s):

Siqin Zhang ◽

Xiucai Zhang ◽

Qing Wu ◽

Xiangkuo Zheng ◽

Guofeng Dong ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Liver Abscess ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Pyogenic Liver Abscess ◽

Multidrug Resistant ◽

Southeastern China ◽

Antimicrobial Drugs ◽

Tertiary Teaching ◽

Epidemiological Characteristics

Abstract Background Klebsiella pneumoniae-induced pyogenic liver abscess (KP-PLA) has emerged as a life-threatening disease worldwide. However, to date, a limited number of scholars have attempted to systematically elucidate the characteristics of KP-PLA. The aim of the present study was to analyze clinical, microbiological, and molecular epidemiological characteristics of KP-PLA patients in Southeastern China. Methods The KP-PLA cases from a tertiary teaching hospital in China from January 2016 to December 2017 were systemically studied and elucidated comprehensively. The virulence factors, resistant spectrum, and clones of K. pneumoniae isolates were identified with string test, polymerase chain reaction (PCR), antimicrobial susceptibility test, and multilocus sequence typing. Moreover, the characteristics in KP-PLA patients with and without other hepatobiliary diseases (OHD) were also been compared. Results A total of 163 KP-PLA cases were enrolled, in which the majority of those cases were senior males, and often associated with multiple underlying diseases, including diabetes (49.7%). The remaining cases belonged to healthy individuals (50.3%). The clinical symptoms were common but nonspecific, characterized by increased inflammatory parameters and abnormal liver function parameters. The abscess was often right-sided solitary presentation (58.3%). Cephalosporin or carbapenem plus metronidazole combined with percutaneous puncture or catheter drainage were favorable therapeutics. Although low resistance rates of commonly used antimicrobial drugs (< 10%) were observed, twelve strains were identified as multidrug resistant (MDR) strains, and were mainly isolated from the OHD patients. The hypermucoviscosity, as well as K1 and K2 serotypes accounted for 30.7, 40.5, and 19.0%, respectively. Except for iroN (24.5%) and magA (45.4%), the high prevalence of virulence genes (e.g. aerobactin, rmpA, mrkD, fimH, uge, ureA, entB, ybtA, kfuBC, and wcaG) was identified (68.7–100.0%). Additionally, ST23 was found as a predominant sequence type (ST; 38.7%), and three novel STs (ST3507, ST3508 and ST3509) were noted as well. Conclusions The present study reported the abundant hvKp strains in KP-PLA, as well as convergence of hypervirulent and MDR K. pneumoniae isolates from the KP-PLA patients, particularly those cases with OHD. Given the various clinical manifestations and destructive pathogenicity, determination of the comprehensive characteristics of such isolates is highly essential to effectively carry out for optimal management and treatment of KP-PLA.

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Crohn’s Disease Presenting with Pyogenic Liver Abscess: A Case Report

Case Reports in Gastrointestinal Medicine ◽

10.1155/2012/762480 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Sharon McGreal ◽

Rupert Sayers ◽

Peter Wurm ◽

Kevin West

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Case Report ◽

Crohn's Disease ◽

Liver Abscess ◽

Percutaneous Drainage ◽

Severe Disease ◽

Pyogenic Liver Abscess ◽

Initial Manifestation ◽

Laboratory Findings

Pyogenic liver abscess (PLA) is a rare extraintestinal complication of Crohn’s disease (CD), and the clinical and laboratory findings may emulate the reactivation of CD, therefore, delaying diagnosis. In this paper the patient presented with PLA as the initial manifestation of CD and experienced severe disease. The finding of PLA was established by computed tomography and initial treatment involved percutaneous drainage and antibiotics. The diagnosis of CD was made after colonoscopy and histological investigations.

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HEPATECTOMY FOR PYOGENIC LIVER ABSCESS TREATMENT: EXCEPTION APPROACH?

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020180001e1394 ◽

2018 ◽

Vol 31 (3) ◽

Author(s):

Sergio Renato PAIS-COSTA ◽

Sergio Luiz Melo ARAUJO ◽

Victor Netto FIGUEIREDO

Keyword(s):

Liver Abscess ◽

Percutaneous Drainage ◽

Therapeutic Option ◽

Hepatic Abscess ◽

Pyogenic Liver Abscess ◽

Surgical Approaches ◽

Morbidity Rate ◽

Median Hospital Stay ◽

The Mean

ABSTRACT Background: Percutaneous drainage for pyogenic liver abscess has been considered the gold-standard approach for the treatment on almost of the cases. However, when percutaneous drainage fails or even in some especial situations, as multiloculate abscess, lobe or segment surgical resection can solve infectious clinical condition. Aim: To report a series of patients who underwent hepatectomy for pyogenic liver abscess performed by a single surgical team. Methods: Eleven patients were operated with ages ranging from 45-73 years (mean and median 66 years). There were eight men and three women. The etiologies were: idiopathic (n=4), biliary (n=2), radiofrequency (n=2), direct extension (n=1), portal (n=1), and arterial (n=1). The mean lesion diameter was 9.27 cm (6-20 cm). Results: The mean operation length was 180 min (120-300). The mean intra-operative blood loss was 448 ml (50-1500). Surgical approaches were: right hepatectomy (n=4), left hepatectomy (n=3), left lateral sectioniectomy (n=1), right posterior sectioniectomy (n=2), resection of S8 (n=1), and S1 (n=1). Postoperative morbidity rate was 30%, while mortality was null. Median hospital stay was 18 days (5-45). The median follow-up period was 49 months (13-78). There was single lesion recurrence. Conclusion: Hepatectomy can be done as exception approach for pyogenic hepatic abscess treatment; it is a good therapeutic option in special situations.

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Spontaneous rupture of liver abscess with biliary communication presenting as a lumbar mass

International Surgery Journal ◽

10.18203/2349-2902.isj20214400 ◽

2021 ◽

Vol 8 (11) ◽

pp. 3484

Author(s):

Ajay Bhandarwar ◽

Amarjeet Tandur ◽

Geoffrey Kharmutee ◽

Akshay Rathod ◽

Kaustubh Dodke ◽

...

Keyword(s):

Liver Abscess ◽

Percutaneous Drainage ◽

Spontaneous Rupture ◽

Pyogenic Liver Abscess ◽

Primary Treatment ◽

Minimal Invasive ◽

Endoscopic Management ◽

Primary Treatment Modality ◽

Biliary Communication ◽

Minimal Invasive Techniques

Pyogenic liver abscess was first reported in the writings of Hippocrates, which was based on the type of fluid recovered from the abscess related to a high mortality rate ranging between 15% and 19% at that time. However in 1938, Ochsner and De Bakey described the recommended surgical treatment as the primary treatment modality. Surgery remained the therapy of choice until the mid-1980s, when percutaneous drainage was shown to be a safer alternative in many cases. Spontaneous rupture of liver abscess may occur free in the peritoneal cavity or in neighbouring organs, an event which is generally considered as a surgical emergency, while localized rupture can be managed with drainage, either percutaneous or surgical/minimal invasive techniques and addition of appropriate antibiotic treatment. In cases where there is uneventful rupture of abscess and localized to the neighbouring organs and tissues can be successfully treated by a combination of broad-spectrum antibiotics and percutaneous drainage and endoscopic management.

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Fusobacterium Nucleatum : An Atypical Cause of Pyogenic Liver Abscess in an Apparently Immunocompetent Patient

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v20i1.1769 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Yusoff AR ◽

Abd Razak NA ◽

Samsuddin S ◽

Mokhtar S

Keyword(s):

Liver Abscess ◽

Percutaneous Drainage ◽

Fusobacterium Nucleatum ◽

Pyogenic Liver Abscess ◽

Enteric Bacteria ◽

Operative Management ◽

Immunocompetent Patient ◽

Immunocompromised Status ◽

Anaerobic Infections ◽

Non Operative Management

Pyogenic liver abscess is an uncommon but potentially lethal infection if left untreated. Enteric bacteria and anaerobes are the most common causative organisms of pyogenic liver abscess. Although most infections are of a polymicrobial nature, monomicrobial infections are possible. An immunocompromised status and the presence of periodontal disease are the risk factors for liver abscess caused by these rare, monomicrobial anaerobic infections. Here, we report on a successful non-operative management of a case of multiloculated pyogenic liver abscess caused by Fusobacterium nucleatum in a young, healthy, immunocompetent male patient. The diagnosis was established by radiological imaging and was based on a positive aspirate culture, whereas the mainstay of treatment comprised percutaneous drainage and a prolonged course of antibiotics. Thus, the patient was successfully treated with a 2-week course of intravenous imipenem/cilastatin while he was on percutaneous drainage, and he is now doing well.

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Successful Percutaneous Drainage of Pyogenic Liver Abscess Complicated by Bronchobiliary Fistula

Southern Medical Journal ◽

10.1097/00007611-198707000-00024 ◽

1987 ◽

Vol 80 (7) ◽

pp. 907-909 ◽

Cited By ~ 4

Author(s):

THOMAS V. BILFINGER ◽

KEITH T. OLDHAM ◽

THOM E. LOBE ◽

SCOTT BARRON ◽

C KEITH HAYDEN

Keyword(s):

Liver Abscess ◽

Percutaneous Drainage ◽

Pyogenic Liver Abscess ◽

Bronchobiliary Fistula

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Clinical profile and management of pyogenic liver abscesses in a tertiary care hospital

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195643 ◽

2019 ◽

Vol 8 (1) ◽

pp. 52 ◽

Cited By ~ 1

Author(s):

Shyam K. Gupta ◽

Ashufta Rasool ◽

Aamir H. Hela ◽

Rohit Goel ◽

Zahur Hussain

Keyword(s):

Liver Abscess ◽

Percutaneous Drainage ◽

Tertiary Care ◽

Management Strategies ◽

Standard Of Care ◽

Pyogenic Liver Abscess ◽

Modern World ◽

Care Hospital ◽

Medical College ◽

Liver Abscesses

Background: Pyogenic Liver abscesses are potentially life threatening if left untreated. They pose a major Diagnostic and therapeutic challenge to modern world. Interventional radiology is becoming standard of care for liver Abscesses.Methods: All patients of pyogenic liver abscess admitted to Government Medical College and hospital Jammu, J and K, India from October 2018 to November 2019 were prospectively studied. Demographics, presentation, lab reports and management strategies were evaluated.Results: Total of 60 patients of pyogenic liver abscesses were studied with 81.7% males. Alcohol was found to be most common risk factor with 55% of patients being alcoholic. Right lobe of liver was involved in 66.7% of patients. Segment VI and VII were involved in 50% of patients. The most common clinical symptom was right upper quadrant pain (98.3%), followed by fever (91.7%). The most common clinical sign was right upper quadrant tenderness (91.7%). Percutaneous drainage with catheter placement was the most common and successful modality of management associated with least hospital stay.Conclusions: Pyogenic liver abscess is a rare but serious problem. Early diagnosis and treatment are necessary to avoid mortality. Percutaneous drainage along with I.V antibiotics is the best form of management.

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Clinical Significance of Serum Albumin/Globulin Ratio in Patients With Pyogenic Liver Abscess

Frontiers in Surgery ◽

10.3389/fsurg.2021.677799 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jia Zhang ◽

Tao Wang ◽

Yi Fang ◽

Mengzhou Wang ◽

Wuming Liu ◽

...

Keyword(s):

Serum Albumin ◽

Clinical Significance ◽

Liver Abscess ◽

Clinical Manifestations ◽

Pyogenic Liver Abscess ◽

Peritoneal Effusion ◽

Positive Rate ◽

Treatment Plans ◽

The Mean ◽

Clinical Characteristic

Pyogenic liver abscess (PLA) remains a significant challenge for modern clinicians. Serum albumin/globulin ratio (AGR) can reflect the progress of many diseases. However, the clinical significance of AGR in PLA has not been evaluated. The aim of this study was to explore the effect of AGR on the clinical characteristic and prognosis in PLA patients. This retrospective study included 392 PLA patients who admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January, 2007 to December, 2016. The medical records on admission were collected. Compared with the healthy controls and the patients with extraperitoneal infection or non-infectious liver disease, PLA patients had lower levels of AGR. The mean level of AGR in PLA patients was 1.02 ± 0.25. There were 179 (45.4%) patients with AGR > 1.02 and 213 (54.6%) patients with AGR ≤ 1.02. The baseline data and treatment plans of PLA patients with high or low AGR were comparative. However, PLA patients with a low AGR had higher body temperature, leukocytes and neutrophils, lower hemoglobin, poorer liver and coagulation function, larger abscess diameter, higher positive rate of pus culture and proportion of Escherichia coli, and were more susceptible to multiple bacteria. Moreover, PLA patients with a low AGR had more complications, including systemic inflammatory response syndrome (SIRS), peritoneal effusion and pleural effusion. And it also needs longer time for temperature normalization and hospital stay. In conclusion, PLA patients have lower AGR and lower AGR is associated with worse clinical manifestations, more complications and poorer prognosis. Thus, monitoring of AGR is of great clinical significance for evaluating the progress of PLA patients.

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Clinical research of primary liver cancer mimicking liver abscess

International Surgery Journal ◽

10.18203/2349-2902.isj20170857 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1033

Author(s):

Kong Jun ◽

Leng Tongmin ◽

Gong Jianping ◽

Tang Maoming

Keyword(s):

Liver Cancer ◽

Liver Abscess ◽

Early Stage ◽

Primary Liver Cancer ◽

Clinical Manifestations ◽

Pyogenic Liver Abscess ◽

Diagnosis And Treatment ◽

Hepatic Arteriography ◽

Laboratory Findings ◽

Post Operation

Background: Aiming at diagnosing at an early stage, minimizing the misdiagnosis rate and improving the prognosis, the author has investigated the clinical characteristics, diagnosis and treatment of primary liver cancer mimicking liver abscess with a summary and discussion.Methods: All of the 11 cases of primary liver cancer mimicking liver abscess, diagnosed during January 2009 to December 2015, were retrospectively viewed in terms of clinical manifestations, laboratory tests, radiological feature, diagnosis and treatment. And statistic analysis was made in all aspects mentioned above with that of pyogenic liver abscess and other types of liver cancer diagnosed in the corresponding period. Results: The clinical manifestations of the 11 cases were mostly characterized by fever, abdominal pain and weight loss. There was no significantly statistic difference between the study group and any of the three matched groups in underlying disease and lab results. All of the 11 patients were treated with enhanced antibiotics as basic therapy. Furthermore, eight cases accepted surgical operation, among them, one object underwent puncture and drainage of the liver abscess by ultrasound (PDLA) twice pre-operation, one object underwent PDLA and hepatic arteriography pre-operation and death in hospital post-operation, one object suffered myocardial infarction post-operation. In addition, three cases received conservative treatment only, in which, one object died in hospital.Conclusions: It is difficult to distinguish primary liver cancer mimicking liver abscess from pyogenic liver abscess as there are no specific clinical manifestations and laboratory findings which is prone to leading to misdiagnosis. What’s worse, the prognosis is so poor that high alert and close follow-up are required as well as early diagnosis and treatment.

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