Liver abscess: demographic, clinical, biochemical, imaging and microbial spectrum

Background: Liver abscesses are localized suppurative destruction of liver tissue due to infections of either bacterial (Pyogenic) or protozoa (Amoebic). Historically; pyogenic liver abscess has been described since the time of hippocrates (400 BC). Despite the more aggressive approach to treatment, the mortality rate remained at 60-80%.Methods: This Cross-sectional analytical study carried out at Department of Medicine, Al-Tibri Medical College Hospital, Karachi, from June 2017 to December 2018. All participants of either gender with diagnosis of liver abscess were included in this prospective study. Patients with co morbidities like malignancy, autoimmune disease or on immunosuppressive treatment for any reason were excluded from the study. Following confirmation of the diagnosis; different characteristics of either type of liver abscess like demographic, clinical features, biochemical and imaging findings were evaluated.Results: Data of 73 subjects, 65(89.0%) males and 08(11.0%) females were analyzed with mean age was 45.42±14.518 years. Fifty-four (73.97%) patients had pyogenic liver abscess while amoebic liver abscess was found in 19(26.03%) subjects. Clinically, the most common symptom was abdominal pain, found in 66(90.4%) subjects, followed by fever in 61(83.6%), hepatomegaly in 47(64.4%), jaundice in 18(24.7%) and vomiting in 10(13.7%) cases. Demographics and clinical features are shown in (Table 1).Conclusions: Local trends have been changing and majority of liver abscess were of pyogenic liver abscesses. Clinically, clear differentiation between two types of abscesses is not possible always but few manifestations like typical symptoms, raised alkaline phosphatase and leucocytosis may be helpful.

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Clinicopathological study on presentation, diagnosis and management of liver abscess in Bhopal region

International Surgery Journal ◽

10.18203/2349-2902.isj20173391 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2572

Author(s):

Anshul Siroliya ◽

Mahendra Damor ◽

M. C. Songra

Keyword(s):

Observational Study ◽

Liver Abscess ◽

Prospective Observational Study ◽

Pyogenic Liver Abscess ◽

Amoebic Liver Abscess ◽

Age Group ◽

Catheter Drainage ◽

Liver Abscesses ◽

Male Preponderance ◽

Amoebic Abscess

Background: This prospective observational study is carried out to study cases of liver abscess and to determine demographic profile, spectrum of clinical presentations, aetiology, laboratory investigations. The objective of the study was to evaluate efficacy of Ultrasonographic (radiological) studies in determining the aetiology and in differentiating from other liver pathologies which may change the treatment outcome, bacteriological and serological characteristics, to study the influence of alcohol, diabetics and immunocompromised diseases (esp. HIV) leading to increased incidence of liver abscess and to evaluate efficacy, recurrence rate, complications, morbidity and mortality, duration of hospital stay associated with different management Strategies.Methods: This prospective observational study was carried out in Department of Surgery, Gandhi Medical College Bhopal and Associated Hamidia Hospital, Bhopal between July 2015 to October 2016.Results: Amoebic abscess (74%) is more common than pyogenic abscess (26%). Amoebic abscess is common in the age group of 31-50 years (73%), pyogenic in the age group of 51-70 years (73.1%). Male preponderance is found in case of amoebic liver abscess (90.5%). Right lobe involvement in common. Right upper quadrant pain, tenderness and fever are the most common clinical features. Alcoholism is most common risk factor (71.6%) and diabetes mellitus has strong association with pyogenic liver abscess (15.4%). E coli (19.2%) and klebsiella (11.5%) are the most common organisms cultured. Medical therapy is more useful in case of amoebic liver abscess (58.1%) while catheter drainage is more useful in case of pyogenic liver abscess (61.5%). Pleuropulmonary complications are much more common and complications rate is more common among pyogenic group.Conclusions: In our study, alcohol was found to be the most common predisposing factor for liver abscesses (68%), this underpin the finding of other studies. Amoebic liver abscess is a medically treated common infection prevailing in unhygienic condition, affecting people mostly between 30-40 years of age whereas pyogenic liver abscess patient commonly falls between 50-70 years age group. Both liver abscesses show a male preponderance. The present study also corroborates the catheter drainage procedure as a superior modality in treating pyogenic liver abscess.

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Clinical Features and Development of Sepsis in Klebsiella Pneumoniae Infected Liver Abscess Patients: A Retrospective Analysis of 135 Cases

10.21203/rs.3.rs-154544/v1 ◽

2021 ◽

Author(s):

Shixiao Li ◽

Sufei Yu ◽

Minfei Peng ◽

Jiajia Qin ◽

Chunyan Xu ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Clinical Features ◽

Liver Abscess ◽

Pyogenic Liver Abscess ◽

High Rate ◽

Sepsis Group ◽

Common Symptom ◽

Tertiary Teaching ◽

Infected Liver ◽

And Control

Abstract Background Klebsiella pneumoniae is a primary pathogen of pyogenic liver abscess (PLA). However, little data are available on combination with sepsis. In this study, we aimed to evaluate the clinical characteristics and prognostic differences of PLA patients with sepsis. Methods This retrospective cohort study was conducted to investigate 135 patients with confirmed Klebsiella pneumoniae-caused liver abscesses (KPLA) from a tertiary teaching hospital, from 2013 to 2019. The patients were divided into two groups based on comorbidity with sepsis. The demographic characteristics, clinical features as well as laboratory and microbiologic findings was analyzed. Results The 135 patients were analyzed, with a mean age of 60.9 ± 12.7 years, and 59.3% were men. Among them, 37/135 (27.4%) had comorbid sepsis and mortality rate was 1.5%. The most common symptom was fever (91.1%). KPLA patients with sepsis had a significantly higher proportion of frailty, diarrhea, fatty liver, chronic renal insufficiency, and hepatic dysfunction (p < 0.05). Antibiotic therapy and percutaneous drainage were most frequently used. The incidences of sepsis shock, acute respiratory distress syndrome was higher in the sepsis group compared to the non-sepsis group. As for metastatic infections, the lung was the most common site. Respiratory symptoms were found in 11 patients, and endophthalmitis coexisted in 4 patients, and meningitis occurred in 1 patient. Conclusion Our findings emphasize that KPLA patients combined with and without sepsis have different clinical features, but KPLA patients with sepsis have a high rate of complications and metastatic infections. Further surveillance and control of septic spread is essential in KPLA patients.

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Clinical features and development of Sepsis in Klebsiella pneumoniae infected liver abscess patients: a retrospective analysis of 135 cases

BMC Infectious Diseases ◽

10.1186/s12879-021-06325-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shixiao Li ◽

Sufei Yu ◽

Minfei Peng ◽

Jiajia Qin ◽

Chunyan Xu ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Clinical Features ◽

Liver Abscess ◽

Pyogenic Liver Abscess ◽

Sepsis Group ◽

Common Symptom ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital ◽

Infected Liver ◽

And Control

Abstract Background Klebsiella pneumoniae is a primary pathogen of pyogenic liver abscess (PLA). However, little data are available on combination with sepsis. In this study, we aimed to evaluate the clinical characteristics and prognostic differences of PLA patients with sepsis. Methods This retrospective cohort study was conducted to investigate 135 patients with confirmed Klebsiella pneumoniae-caused liver abscesses (KPLA) from a tertiary teaching hospital, from 2013 to 2019. The patients were divided into two groups, KPLA with sepsis and KPLA without sepsis. The demographic characteristics, clinical features as well as laboratory and microbiologic findings were analyzed. Results A total of 135 patients with KPLA were analyzed. The mean age of patients was 60.9 ± 12.7 years, and the percentage of men was 59.3%. Among them, 37/135 (27.4%) of patients had sepsis and the mortality rate was 1.5%. The most common symptom was fever (91.1%). KPLA patients with sepsis had a significantly higher proportion of frailty, diarrhea, fatty liver, chronic renal insufficiency, and hepatic dysfunction compared to KPLA patients without sepsis (p < 0.05). Antibiotic therapy and percutaneous drainage were most frequently therapeutic strategy. Furthermore, the incidences of sepsis shock and acute respiratory distress syndrome were higher in the sepsis group compared to the non-sepsis group. As for metastatic infections, the lung was the most common site. In addition, KPLA patients with sepsis showed respiratory symptoms in 11 patients, endophthalmitis in 4 patients, and meningitis in 1 patient. Conclusion Our findings emphasize that KPLA patients combined with or without sepsis have different clinical features, but KPLA patients with sepsis have higher rates of complications and metastatic infections. Taken together, further surveillance and control of septic spread is essential for KPLA patients.

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Clinical profile of amoebic liver abscess patients admitted in a tertiary care hospital

Bangladesh Medical Journal Khulna ◽

10.3329/bmjk.v48i1-2.27093 ◽

2016 ◽

Vol 48 (1-2) ◽

pp. 20-23 ◽

Cited By ~ 1

Author(s):

Bishnupada Paik ◽

Swapan Kumar Sarkar ◽

Poritosh Kumar Chowdhury ◽

Saad Ahmed

Keyword(s):

Clinical Features ◽

Liver Abscess ◽

Tertiary Care ◽

Needle Aspiration ◽

Clinical Profile ◽

Amoebic Liver Abscess ◽

Care Hospital ◽

College Hospital ◽

Female Ratio ◽

The Mean

Amoebic liver abscess is an important cause of space occupying lesions of the liver, especially in tropical and sub tropical regions. It is the most frequent complication of invasive amebiasis. It may be found in all age groups but relatively rare in children. The signs and symptoms vary according to the severity of illness. The present study was done to evaluate the clinical profile of patients with amoebic liver abscess for age, gender, clinical features, site of abscess, number of abscess, treatment modality by intravenous metronidazole along with percutaneous needle aspiration and prognosis. A prospective study of 86 admitted patients of amoebic liver abscess were included in this study which was carried out in the medicine department of Khulna Medical College Hospital over a period of 2 years from July 2010 to June 2012. Mean age of patients was 45 years. Male female ratio was 7:1. The mean duration of fever was 17.9 days and the mean duration of pain was 14.1 days. The duration of fever for more than 2 weeks was seen in 38 cases. Regarding clinical features, the major symptoms of fever, pain abdomen and dysentery were seen in 81, 78 and 10 cases respectively. The major signs as determined by clinical and radio imaging studies were hepatomegaly in 76, right lobe abscess in 60, left lobe abscess in 12, multiple abscesses in both lobes in 18, ascites in 5 and right sided pleural effusion in 12 cases respectively. All the cases underwent percutaneous needle aspiration. 5 cases died out of 86 patients.Bang Med J (Khulna) 2015; 48 : 20-23

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Liver abscess: diagnostic and management issues found in the low resource setting

British Medical Bulletin ◽

10.1093/bmb/ldz032 ◽

2019 ◽

Vol 132 (1) ◽

pp. 45-52 ◽

Cited By ~ 5

Author(s):

Gaetan Khim ◽

Sokhom Em ◽

Satdin Mo ◽

Nicola Townell

Keyword(s):

Liver Abscess ◽

Pyogenic Liver Abscess ◽

Amoebic Liver Abscess ◽

Diagnostic Strategy ◽

Middle Income ◽

Low Resource ◽

Liver Abscesses ◽

Resource Setting ◽

Low Resource Setting ◽

Low Middle Income Countries

Abstract Introduction Liver abscesses are mainly caused by parasitic or bacterial infection and are an important cause of hospitalization in low-middle income countries (LMIC). The pathophysiology of abscesses is different depending on the etiology and requires different strategies for diagnosis and management. This paper discusses pathophysiology and epidemiology, the current diagnostic approach and its limitations and management of liver abscess in low resource settings. Sources of data We searched PubMed for relevant reviews by typing the following keywords: ‘amoebic liver abscess’ and ‘pyogenic liver abscess’. Areas of agreement Amoebic liver abscess can be treated medically while pyogenic liver abscess usually needs to be percutaneously drained and treated with effective antibiotics. Areas of controversy In an LMIC setting, where misuse of antibiotics is a recognized issue, liver abscesses are a therapeutic conundrum, leaving little choices for treatment for physicians in low capacity settings. Growing points As antimicrobial resistance awareness and antibiotic stewardship programs are put into place, liver abscess management will likely improve in LMICs provided that systematic adapted guidelines are established and practiced. Areas timely for developing research The lack of a quick and reliable diagnostic strategy in the majority of LMIC makes selection of appropriate treatment challenging.

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A clinical study of liver abscess in patients attending the surgical department. A single center experience.

Journal of Surgical Arts ◽

10.14717/jsurgarts-210102 ◽

2021 ◽

pp. 7-10

Keyword(s):

Liver Abscess ◽

Tamil Nadu ◽

Complete Blood Count ◽

Pyogenic Liver Abscess ◽

Needle Aspiration ◽

Amoebic Liver Abscess ◽

Treatment Modalities ◽

College Hospital ◽

X Ray ◽

Surgical Department

Liver abscess is a condition that is seen by surgeons all over the world. The patients present to the surgical department with features of right hypocondrial pain, fever and jaundice. Investigations such as ultrasound of the abdomen and CT scan of the abdomen are extremely useful in diagnosing a case of liver abscess. The two main causes of liver abscess are amoebic and pyogenic liver abscess. Occasionally a liver abscess may also occur due to fungal infection. Treatment modalities include the use of drugs such as metronidazole for amoebic liver abscess, as well as needle aspiration and pigtail catheter drainage when required. This was a prospective study was carried out from August 2015 to July 2018, for a period of three years. The study was conducted at SRM Medical College Hospital and Research Center, Kattankulathur, Tamil Nadu, India. Investigations such as complete blood count (CBC), chest x-ray, x-ray abdomen, ultrasound of the abdomen and CECT of the abdomen were done. A total of 57 patients were studied and the results obtained were analysed.

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Clinicopathological study and management of liver abscess in tertiary care center

International Surgery Journal ◽

10.18203/2349-2902.isj20191272 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1332 ◽

Cited By ~ 1

Author(s):

Jigar Ratnottar ◽

Harish Chauhan ◽

Foram Modh

Keyword(s):

Socioeconomic Status ◽

Clinical Features ◽

Liver Abscess ◽

Early Recognition ◽

Care Center ◽

Tertiary Care ◽

Cost Effective ◽

Amoebic Liver Abscess ◽

Percutaneous Catheter Drainage ◽

Liver Abscesses

Background: Liver abscess is a burning problem in tropical nations, with often lethal consequences and diagnostic/therapeutic challenges. We have determined etiopathology, clinical, radiological, and bacteriological characteristics of this condition and review its management strategies.Methods: During the period of the month from August 2017 to August 2018, a prospective study was performed involving 125 patients admitted to the in-patient ward of the Department of General Surgery of SMIMER Medical College their diagnosis was made on the basis of clinical features (such as right upper abdomen pain, and fever), laboratory investigations and radiological evidence of liver abscess.Results: Amoebic liver abscess was the most common (88%) type of liver abscess among the study groups. There was a strong correlation with the occurrence of liver abscesses and addiction to alcohol, history of diabetes mellitus and low socioeconomic status. The most common etiology of pyogenic liver abscess was Escherichia coli. Ultrasonography (USG) of the abdomen was accurate and cost-effective in diagnosis of liver abscesses. Percutaneous catheter drainage was the most effective method of treatment (with a 100% success rate).Conclusions: Most patients in our study had liver abscess of amoebic origin and had temporal relationship with diabetes, alcoholism, and staggering socioeconomic status. We suggest early recognition of clinical features and prompt abdominal USG as cost-effective means for treatment initiation and reducing complications.

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Management of Liver Abscesses at a Teaching Hospital in Rural Haryana- A Prospective Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/47920.14796 ◽

2021 ◽

Author(s):

Pratul Arora ◽

Pawan Tiwari ◽

Prem Narayan Agarwal ◽

Priti A garwal ◽

Akhil Kumar Kainth ◽

...

Keyword(s):

Prospective Study ◽

Liver Abscess ◽

Treatment Modality ◽

Tertiary Care ◽

Imaging Modalities ◽

Amoebic Liver Abscess ◽

Common Symptom ◽

Liver Abscesses ◽

Appropriate Treatment ◽

A Prospective Study

Introduction: With the rise of change in imaging modalities like Computed Tomography (CT) scan or Ultrasonography (USG) the treatment of liver abscess has changed leading to reduction in morbidity and mortality. Liver abscess is more common in developing countries like India. Aim: To determine the methods for aetiological diagnosis of liver abscesses and to evaluate various methods for treatment of liver abscesses and select appropriate treatment modality on the basis of clinicomicrobiological findings. Materials and Methods: The present study was a prospective study of 60 cases diagnosed as liver abscesses both amoebic and pyogenic which were managed in rural tertiary care centre between the period of November 2018 to April 2020 were included in the study. A preformed protocol was made for the management of all patients diagnosed with liver abscess and various parameters contributing to the illness like age, gender, associated conditions and clinical features. The prognosis was evaluated and assessed by using laboratory investigations, radiological findings to check the response to treatment by selecting appropriate treatment modality. Statistical analysis was done with the help of Statistical Package for the Social Sciences (SPSS) 20.0 for windows; Chicago, USA. Results: In this study amoebic liver abscess was more common as compared to pyogenic liver abscess {42 (70%) and 18 (30%)}. Liver abscess was more common in males as compared to females (4:1). History of alcohol consumption was strongly associated with the aetiology of liver abscess. Abdominal pain was the most common symptom in these patients. Conclusion: Proper clinical evaluation along with radiological imaging modalities has led to the early diagnosis of liver abscess. Microbiological investigations like blood antibody Enzyme Linked Immuno Sorbent Assay (ELISA) for Entamoeba histolytica is not in favour of diagnosing amoebic liver abscess. Conservative management is effective for minor abscesses.

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TO STUDY THE MANAGEMENT OF LIVER ABSCESS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i8.462 ◽

2019 ◽

Vol 3 (8) ◽

Author(s):

Dr. Kalpana Agarwal ◽

Dr. Shiv Kumar Bunkar ◽

Dr. Dony Devasia ◽

Dr. Kush Verma

Keyword(s):

Liver Abscess ◽

Early Recognition ◽

Effective Means ◽

Cost Effective ◽

Pyogenic Liver Abscess ◽

Cross Sectional Study ◽

The Body ◽

Amoebic Liver Abscess ◽

Cross Sectional ◽

Surgery Department

Background: Liver is an important and vital organ of the body. This organ is subjected to numerous systemic infections viral, bacterial and parasitic and lies at the distal end of the portal circulation; it is therefore bathed with portal blood containing viruses, bacteria parasites, ova, products of digestion and other antigens. Methods: This study was a cross sectional study of patients attending surgery department in J L N Medical College, Ajmer Rajasthan. The study was conducted over a period of 1 year on 100 patients of liver abscess. Results: 3 mortalities were found in amoebic liver abscess patients who had ruptured liver abscess and was undertaken for surgical intervention Conclusion: We suggest early recognition of clinical features and prompt abdominal USG as cost-effective means for treatment initiation and reducing complications. Keywords: Amoebic liver abscess, Pyogenic liver abscess, Treatment.

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Importation of Entamoeba histolytica and predominance of Klebsiella pneumoniae in liver abscesses: a 7-year retrospective cohort study from the United Arab Emirates

Tropical Diseases Travel Medicine and Vaccines ◽

10.1186/s40794-021-00140-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Hussam Mousa ◽

Ghada Salameh Mohammed Al-Bluwi ◽

Zainab Fathi Mohammed Al Drini ◽

Huda Imam Gasmelseed ◽

Jamal Aldeen Alkoteesh ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

United Arab Emirates ◽

Liver Abscess ◽

Hospital Admissions ◽

Indian Subcontinent ◽

Pyogenic Liver Abscess ◽

Primary Diagnosis ◽

Incidence Rates ◽

Liver Abscesses ◽

Potential Risk Factors

Abstract Background There is a dearth of information on liver abscesses in the United Arab Emirates. Herein, we describe the clinical features of liver abscesses and determine their incidence rates and clinical outcomes. Methods We retrospectively reviewed the clinical charts of adult patients with a primary diagnosis of liver abscess at a major hospital over a 7-year period. Results Amongst 45 patients, 82.2% (37/45) had a pyogenic liver abscess (PLA) and 17.8% (8/45) had amoebic liver abscesses (ALA). Overall, patients were young (median age 42 years, IQR 35–52), mostly males (77.8%, 35/45) from the Indian subcontinent (55.6%, 25/45), presented with fever (88.9%, 40/45) and abdominal pain (88.9%, 40/45), and had a solitary abscess on imaging (71.1% (32/45). Crude annual incidence rates were 35.9/100,000 hospital admissions (95% CI 26.2–48.0) and 5.9/100,000 inhabitants (95% CI 4.3–7.9). All ALA patients were from the Indian subcontinent (100%, 8/8). Klebsiella pneumoniae was the most frequent pathogen in PLA (43.2% [16/37], 95% CI 27.1–60.5%). The hospital stay was shorter in ALA (7.5 days, IQR 7–8.5) than in PLA (14 days, IQR 9–17). No deaths were recorded within 30 days of hospitalisation. Conclusions ALA was exclusively seen in migrants from the Indian subcontinent, suggesting importation. Further research to characterise K. pneumoniae isolates and assess potential risk factors is needed.

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