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Liu J, Liu Y, Li C, Peng W, Jiang C, Peng S, Fu L. Characteristics of Klebsiella pneumoniae pyogenic liver abscess from 2010-2021 in a tertiary teaching hospital of South China. J Glob Antimicrob Resist 2024; 36:210-216. [PMID: 38154752 DOI: 10.1016/j.jgar.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES Pyogenic liver abscess (PLA) is a severe and potentially fatal infectious disease. Klebsiella pneumoniae (K. pneumoniae) is the predominant pathogen responsible for PLA. This study aims to investigate the clinical characteristics and prognostic factors of K. pneumoniae-induced pyogenic liver abscess (KP-PLA), particularly those caused by carbapenem-resistant K. pneumoniae (CRKP). METHODS Analyses were performed on PLA patients from January 2010 to December 2021, to investigate the differences of K. pneumoniae from other etiologically infected PLA patients. Univariate and multivariate logistic regression analyses were used to compare prognostic factors between patients with carbapenem-resistant K. pneumoniae PLA (CRKP-PLA) and patients with carbapenem-sensitive K. pneumoniae PLA. RESULTS Univariate analysis demonstrated a significant association between KP-PLA and factors including diabetes mellitus (P < 0.001), cholecystitis and cholelithiasis (P = 0.032), single abscess (P = 0.016), and abscesses with a diameter over 50 mm (P = 0.004). The CRKP group exhibited a higher prevalence of therapeutic interventions before K. pneumoniae infection, including abdominal surgery, mechanical ventilation, sputum suction, tracheal cannula, routine drainage of the abdominal cavity, and peripherally inserted central venous catheters (P < 0.05). Multivariate logistic regression analysis revealed that admission to the intensive care unit was an independent risk factor associated with CRKP-PLA (odds ratio 36; 95% confidence interval 1.77-731.56; P = 0.020). CONCLUSION The KP-PLA patients were significantly associated with diabetes and were more likely to have single abscesses larger than 50 mm. PLA patients with a history of admission to intensive care unit or invasive therapeutic procedures should be given special consideration if combined with CRKP infection.
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Affiliation(s)
- Jinqing Liu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yao Liu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chunhui Li
- Centre for Healthcare-Associated Infection Control, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenting Peng
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chuan Jiang
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shifang Peng
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lei Fu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Canouï E, Rossi G, Nguyen Y, Lafont E, Rossi B, Roux O, Dokmak S, Bert F, Leflon-Guibout V, Fantin B, Lefort A. Analysis of 15 cases from a monocentric cohort of 307 liver abscesses. Mycoses 2023; 66:984-991. [PMID: 37534436 DOI: 10.1111/myc.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/06/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Out of the context of haematological patients, Candida sp. is rarely retrieved from pyogenic liver abscesses (PLA). OBJECTIVES Our objective was to assess the risk factors for occurrence, and clinical, microbiological characteristics, management and outcome of Candida pyogenic liver abscesses (C-PLA). PATIENTS/METHODS We retrospectively analysed C-PLA cases and compared them to pyogenic liver abscesses exclusively due to bacteria (B-PLA) included in our monocentric database on liver abscesses. Unfavourable course was defined as the occurrence of a primary treatment failure (PTF), recurrence after an initial cure, or death within 3 months after diagnosis. RESULTS Between 2010 and 2018, 15 C-PLA and 292 B-PLA were included. All C-PLA had a biliary origin and were polymicrobial. All patients with C-PLA had at least one comorbidity at risk for Candida infection and 7 (53.3%) presented with sepsis requiring an admission in intensive care unit. Median duration of antifungal treatment was 42 days [24-55]. In multivariate analysis, compared with B-PLA, a medical history of malignancy (OR 4.16; 95%CI 1.15-18.72) or liver abscess (OR 7.39; 95%CI 2.10-26.62), and sepsis with severity criteria (OR 3.52; 95%CI 1.07-11.90) were independently associated with the occurrence of C-PLA. In multivariate analysis, C-PLA was associated with a higher risk of recurrence (HR 3.08; 95%CI 1.38-11.22). CONCLUSION Candida liver abscesses in non-neutropenic is a rare and severe disease. The high rate of recurrence should lead to discuss a more intensive treatment.
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Affiliation(s)
- Etienne Canouï
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Geoffrey Rossi
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Yann Nguyen
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Emmanuel Lafont
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Benjamin Rossi
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Olivier Roux
- Department of Hepatology, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
| | - Safi Dokmak
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Beaujon Hospital, GHU AP-HP.Nord-Université Paris Cité, Paris, France
| | - Frédéric Bert
- Department of microbiology, Beaujon Hospital, GHU AP-HP.Nord-Université Paris Cité, Paris, France
| | - Véronique Leflon-Guibout
- Department of microbiology, Beaujon Hospital, GHU AP-HP.Nord-Université Paris Cité, Paris, France
| | - Bruno Fantin
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
- IAME, UMR1137, Université Paris-Cité, Paris, France
| | - Agnès Lefort
- Department of Internal Medicine, Beaujon Hospital, GHU AP-HP. Nord-Université Paris Cité, Paris, France
- IAME, UMR1137, Université Paris-Cité, Paris, France
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Kim E, Byon I, Lee JJ, Seol YM, Kwon HJ, Park SW, Lee JE. Endogenous Endophthalmitis From a Klebsiella pneumoniae Liver Abscess: The Incidence, Risk Factors, and Utility of Imaging. Am J Ophthalmol 2023; 252:69-76. [PMID: 36963602 DOI: 10.1016/j.ajo.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE We investigated the rate of ophthalmologic examinations to detect endogenous endophthalmitis in patients with pyogenic liver abscesses (PLAs) and the incidence and risk factors of endophthalmitis from a PLA caused by Klebsiella pneumoniae (PLA-K). DESIGN Retrospective case series. METHODS A total of 536 patients admitted to a university hospital in Korea to treat PLAs during 2012-2022 were included. The proportion of patients who were referred for ophthalmologic examinations was investigated and the incidence of endophthalmitis in 248 patients with PLA-K was calculated. Univariate and multivariate logistic regression analyses were performed to define risk factors including demographic characteristics, underlying diseases, radiologic findings, and systemic conditions. RESULTS A comprehensive ophthalmologic examination was performed in 73.7% of all patients with PLAs, and the incidence of endophthalmitis from a PLA-K was 7.3%. A liver abscess >5 cm increased the incidence of endogenous endophthalmitis 4-fold compared with smaller abscesses (odds ratio [OR] = 4.01 [95% confidence interval {CI}, 1.02-15.78], P = .047) and portal or hepatic vein thrombophlebitis increased the incidence approximately 4-fold (OR = 4.04 [95% CI, 1.10-14.83], P = .036). Acute cholangitis was approximately 8-fold (OR = 8.33 [95% CI, 1.25-55.71], P = .029), and disseminated intravascular coagulation was approximately 6-fold (OR = 5.76 [95% CI, 1.22-27.21], P = .027) more related to prevalence of endophthalmitis. Other extrahepatic infections increased the incidence approximately 43-fold (OR = 43.06 [95% CI, 10.14-182.90], P < .001). CONCLUSIONS Clinicians should consider the risk of endogenous endophthalmitis when PLA-K patients have large liver abscesses (>5 cm), acute cholangitis, portal or hepatic vein thrombophlebitis, disseminated intravascular coagulation, or other extrahepatic infections.
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Affiliation(s)
- EunAh Kim
- Department of Ophthalmology (E.K., I.B., H.J.K., S.W.P., J.E.L.), Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea; Department of Ophthalmology (E.K.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
| | - Iksoo Byon
- Department of Ophthalmology (E.K., I.B., H.J.K., S.W.P., J.E.L.), Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | | | - Young Mi Seol
- Department of Internal Medicine (Y.M.S.), Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Han Jo Kwon
- Department of Ophthalmology (E.K., I.B., H.J.K., S.W.P., J.E.L.), Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sung Who Park
- Department of Ophthalmology (E.K., I.B., H.J.K., S.W.P., J.E.L.), Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Ji Eun Lee
- Department of Ophthalmology (E.K., I.B., H.J.K., S.W.P., J.E.L.), Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea; Lee Eye Clinic (J.E.L.), Busan, South Korea
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Yang S, Zhao J, Liu Q. Occult colon cancer with liver abscess and pancreatitis as the first manifestations: A case report. Medicine (Baltimore) 2023; 102:e32654. [PMID: 36701699 PMCID: PMC9857361 DOI: 10.1097/md.0000000000032654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Klebsiella pneumoniae-induced liver abscess (KP-PLA) is a common type of pyogenic liver abscess, severe acute pancreatitis (SAP) has high mortality, and poor prognosis in advanced colon cancer. There have been no report of SAP complicated with colon cancer after KP-PLA as so far. In this study, we reported a case of SAP secondary to KP-PLA with colon cancer for the first time, so as to provide reference for clinical diagnosis and treatment of these diseases. PATIENT CONCERNS AND DIAGNOSIS A 64-year-old woman with a history of diabetes visited our hospital with abdominal pain for 5 + days. He was diagnosed with KP-PLA a month ago, which had not healed when he was admitted. He was diagnosed with SAP, and histological examination of colonic biopsy confirmed the diagnosis of moderately differentiated adenocarcinoma. INTERVENTIONS AND OUTCOMES He was treated with intravenous antibiotics and underwent modified endoscopic mucosal resection under colonoscopy. We conducted a 2-month follow-up, and there was no recurrence of liver abscess and pancreatitis. CONCLUSION Screening for intestinal tumors is necessary in patients with cryptogenic liver abscess, especially KP-PLA with diabetes.
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Affiliation(s)
- Shan Yang
- Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Jin Zhao
- Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
| | - Qi Liu
- Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China
- * Correspondence: Qi Liu, Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, People’s Republic of China (e-mail: )
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Zeng X, Luo H, Yang P. Laparoscopic hepatectomy for the treatment of pyogenic liver abscess: A retrospective case-control study. Medicine (Baltimore) 2022; 101:e31745. [PMID: 36397374 PMCID: PMC9666222 DOI: 10.1097/md.0000000000031745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Percutaneous catheter drainage is the first-line treatment for pyogenic liver abscess (PLA). Some patients need hepatectomy because of underling hepatobiliary pathology or unresponsiveness to nonoperative treatment, the traditional method is open hepatectomy (OH). Laparoscopic hepatectomy (LH) for PLA is rarely reported. The purpose of this study is to describe our experience of LH for treating PLA and to compare LH with OH. The medical records of patients who underwent LH for treating PLA were retrospectively analyzed, and the results were compared with those of patients with OH. From January 2015 to December 2021, 61 patients with PLA underwent hepatectomy, and 28 patients who underwent LH (LH group) were compared with 33 patients who underwent OH (OH group). There were no significant differences in the basic data between the 2 groups. Two patients in the LH group were converted to open surgery due to hemorrhage and dense perihepatic adhesions, there was no significant difference between the 2 groups in the operation time (186.2 ± 85.6 vs. 175.9 ± 76.7 minutes, P = .239), Institut Mutualiste Montsouris classification, extent of hepatectomy and drainage tube removal time, however, the blood loss (200.0 ± 100.5 vs. 470.9 ± 120.1 mL, P = .003), numerical rating scale (5.2 ± 1.8 vs. 9.1 ± 1.6, P = .042), the time to resume oral diet (12.3 ± 6.5 vs. 24.6 ± 10.2 hours, P = .005), the ambulant time (20.2 ± 7.3 vs. 40.2 ± 10.8 hours, P = .010), incidence of postoperative complications (14.3% vs.33.3%, P = .002), comprehensive complication index (46.2 vs. 60.6, P = .013), postoperative hospital stay (8.5 ± 7.3 vs. 13.5 ± 10.2 days, P = .025) in the LH group was significantly less than that in the OH group. Wit experience laparoscopic surgeons, treating PLA by LH is safe and feasible and compares favorably with OH.
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Affiliation(s)
- Xintao Zeng
- Department of Hepatobiliary Surgery of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Hua Luo
- Department of Hepatobiliary Surgery of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Pei Yang
- Department of Hepatobiliary Surgery of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
- * Correspondence: Pei Yang, Department of Hepatobiliary Surgery of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, China (e-mail: )
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Chae KJ, Lee J, Hwang JH, Hwang JH. Invasive Hypervirulent Klebsiella pneumoniae Syndrome Originating from an Anorectal Abscess as Opposed to a Pyogenic Liver Abscess. Medicina (B Aires) 2022; 58:medicina58101450. [PMID: 36295610 PMCID: PMC9611788 DOI: 10.3390/medicina58101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 12/03/2022] Open
Abstract
An immunocompetent 49-year-old man presented with swelling and pain in the lower region of his left leg that had lasted for 4 weeks. The diagnosis was severe pyomyositis and osteomyelitis in the lower left leg caused by hypervirulent Klebsiella pneumoniae (hvKP) along with multiple metastatic infections in the kidneys, lungs, and brain originating from an anorectal abscess. A virulence-gene analysis revealed that the isolated K. pneumoniae harbored rmpA, entB, ybtS, kfu, iutA, mrkD, and allS-virulence genes and belonged to the K1 capsular serotype. After repeated abscess drainage procedures, intravenous ceftriaxone was administered for more than 10 weeks, and the patient's infection was controlled. We focused on the clinical features of hvKP originating from an anorectal abscess without a pyogenic liver abscess. We suggest that hvKP be considered a causative pathogen of pyomyositis and osteomyelitis resulting in multiple metastatic infections in an immunocompetent patient, and more information on the unexpected multiple metastatic infections should be obtained from a virulence analysis of K. pneumoniae.
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Affiliation(s)
- Kum Ju Chae
- Department of Radiology, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea
- Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
| | - Jaehyeon Lee
- Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
- Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea
| | - Joo-Hee Hwang
- Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea
- Correspondence: (J.-H.H.); (J.-H.H.); Tel.: +82-63-275-1660 (Jeong-Hwan Hwang)
| | - Jeong-Hwan Hwang
- Research Institute of Clinical Medicine, Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea
- Correspondence: (J.-H.H.); (J.-H.H.); Tel.: +82-63-275-1660 (Jeong-Hwan Hwang)
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Dasari SP, Patel MA, Saravanan V, Jha S, O'Sullivan KL, Gill HS, Acharya P, Jha P. Clostridioides difficile Pyogenic Liver Abscess With an Empyema. WMJ 2022; 121:E5-E9. [PMID: 35442586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Reports of extraintestinal manifestations of Clostridioides difficile (C difficile) infections are rare. The frequency of these infections comprises approximately 0.17% to 0.6% of all C difficile infections. While they are becoming more frequent worldwide, the precise trend is unclear. CASE PRESENTATION An 83-year-old female patient presented with pleuritic chest pain 2 to 3 months after a needle biopsy of her liver abscess confirmed C difficile. She was found to have extension of the liver abscess into the chest cavity, leading to empyema, and was treated with intravenous antimicrobials. DISCUSSION This is the fifth known reported case of C difficile leading to a pyogenic liver abscess and the first case where the C difficile liver abscess was associated with an empyema. While long-term metronidazole is considered effective for managing extra intestinal C difficile infection, our patient was treated with vancomycin and meropenem. CONCLUSION To determine epidemiology and a proper treatment regimen for extraintestinal C difficile infection, a greater accumulation of cases is necessary.
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Affiliation(s)
- Suhas P Dasari
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin,
| | - Mit A Patel
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Vishmayaa Saravanan
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sanjana Jha
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kayla L O'Sullivan
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Harpreet S Gill
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pramod Acharya
- Department of Infectious Disease, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pinky Jha
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Spindel J, Grigorov M, Baker M, Marsano L. Cardiac tamponade due to perforation of a Roseomonas mucosa pyogenic hepatic abscess as initial presentation of hepatoid carcinoma. BMJ Case Rep 2022; 15:e248947. [PMID: 35304358 PMCID: PMC8935167 DOI: 10.1136/bcr-2022-248947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/03/2022] Open
Abstract
Hepatic abscesses can rarely cause pericardial disease by erosion into the pericardial space and present with haemodynamic instability due cardiac tamponade. While rare, these dramatic presentations are more often due to amoebic abscesses than bacterial abscesses. Importantly, a cause must be found for any cryptogenic hepatic abscess regardless of presentation, as there is a high association with underlying malignancy. We report a previously healthy man in his 30s who presented with cardiac tamponade from perforation of a Roseomonas mucosa pyogenic hepatic abscess into the pericardium in the absence of bacteremia and biliary disease. One year later, he was found to have diffusely metastatic hepatoid carcinoma.
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Affiliation(s)
- Jeffrey Spindel
- Internal Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Mladen Grigorov
- Internal Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Molly Baker
- Internal Medicine and Pediatrics, University of Louisville, Louisville, Kentucky, USA
| | - Luis Marsano
- Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, Kentucky, USA
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Kim HY, Lee HJ. A case report of a lung abscess as a rare complication of a pyogenic liver abscess. Medicine (Baltimore) 2021; 100:e27789. [PMID: 35049176 PMCID: PMC9191369 DOI: 10.1097/md.0000000000027789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE A hepatobronchial fistula and lung abscess following a pyogenic liver abscess is a rare entity and it is not easy to diagnose this condition based on the symptoms and chest radiography. PATIENT CONCERNS An 81-year-old man presented with productive cough and dyspnea. DIAGNOSIS Chest radiography indicated increased opacities in the right lower lung field with an air-fluid level suggestive of pneumonia complicated by a lung abscess. Chest and abdominal computed tomography revealed an abscess in the right lower lung field that bordered an abscess at segment 7 of the liver. Tubography confirmed a fistula between the liver and lung abscesses. INTERVENTIONS Due to communication between 2 abscesses, transhepatic approach was done instead of transpleural approach to avoid complications. OUTCOMES A liver abscess complicated by a lung abscess was resolved following percutaneous transhepatic drainage of the liver abscess and antibiotic administration. LESSONS Though uncommon, the lack of suspicion of sub-diaphragmatic liver abscess often lead to a delay in diagnosis and proper treatment. Our case implies the importance of computed tomography in early diagnosis of liver abscess in case of lung abscess in the right lower lung field.
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Abstract
The global incidence of pyogenic liver abscess (PLA) is increasing, but related reports of malignant tumor-related PLA are infrequent. Potential malignant tumors of PLA have been reported, but there is no relevant predictive model for this subsection of patients.To explore the risk factors of malignant tumor-related PLA.A retrospective analysis about a total of 881 patients who had been diagnosed with PLA from January 2005 to May 2018 was performed. The incidence of malignant tumor-related PLA in the study was 9.99% (88/881) out of all PLA cases. And that of potential malignant tumors with PLA was 4.65% (41/881). There were 62 patients with malignant tumor-related PLA in the observation group, while 146 cases without malignant tumor-related PLA were considered as control group. The data from 52 cases of malignant tumor and nonmalignant tumor-related PLA was verified.The malignant tumor type was mainly hepatobiliary malignant tumor, which occupies 72.3% (45/62) in all malignant tumor related PLA cases used to the model. Compared with nonmalignant tumor group, the rate of ineffective and mortality was higher in the malignant tumor group [19.4%(12/62) vs 7.5%(11/148), P = .01]. Multivariate analysis suggested that hepatobiliary interventional therapy or surgery, hepatitis B virus infection, multiple abscesses, portal embolism, and bile duct dilatation were independent risk factors for potential malignant tumors within the patients who combined with PLA.PLA could be considered as an early warning sign of potential malignant tumors. Malignant tumor-related PLA had a poor prognosis. Patients with PLA who have more than one independent risk factor or logit(P) > -1.694 may be considered as the high risk group for potential hepatobiliary or colorectal malignant tumors.
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Abstract
We report 2 cases of endogenous endophthalmitis associated with pyogenic liver abscess caused by Klebsiella pneumoniae. Case 1 involved a 70-year-old woman and case 2 involved a 50-year-old man who were admitted to our hospital with diagnoses of liver abscess and endogenous endophthalmitis, respectively. The liver abscess resolved with antibiotics and percutaneous transhepatic drainage in case 1 and with antibiotics alone in case 2. Even though both cases underwent ophthalmic surgery, they were discharged from our hospital without the recovery of their eyesight. An earlier diagnosis and treatment are needed to improve the prognosis of endophthalmitis.
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Affiliation(s)
- Masashi Fujita
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Atsushi Takahashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Hiromichi Imaizumi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Manabu Hayashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Ken Okai
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Kazumichi Abe
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Japan
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Date K, Hayashi M, Kodama T, Yamasuji A, Fukumori K, Maehara N. Pyogenic liver abscesses concomitant with advanced gastric cancer: a case report. Clin J Gastroenterol 2019; 13:186-190. [PMID: 31407269 DOI: 10.1007/s12328-019-01032-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/05/2019] [Indexed: 11/26/2022]
Abstract
It has been reported that gastric cancer rarely causes pyogenic liver abscesses because of its mucosal acid barrier. Herein, we describe a rare case of pyogenic liver abscesses concomitant with advanced gastric cancer. A 61-year-old man was transferred to our hospital with persistent nausea and fever. Computed tomography showed a lobulated lesion in the caudate lobe of the liver, slightly rim-enhanced lesions in the right lobe, enhanced mass on the lesser curvature of the upper gastric body, and enlarged regional lymph nodes. Subsequent upper gastrointestinal endoscopy revealed a type 3 tumor on the lesser curvature of the upper gastric body; pathological examination of a biopsy showed adenocarcinoma. After treatment with antibiotics, the lesion in the caudate lobe decreased in size and the enhanced lesions in the right lobe resolved. The patient underwent curative gastrectomy; the pathological diagnosis was gastric cancer, T4aN3aM0 stage IIIB, according to the Japanese classification of gastric carcinoma (Third English edition). The patient was discharged without complications and underwent adjuvant chemotherapy. Gastric cancer can cause pyogenic liver abscesses. Although differentiating between liver abscesses and hepatic metastases can be difficult, multidisciplinary and appropriate treatment strategies are needed.
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Affiliation(s)
- Kenjiro Date
- Department of Surgery, Fujimoto General Hospital, 17-1 Hayasuzu-cho, Miyakonojo, Miyazaki, 885-0055, Japan.
| | - Masataka Hayashi
- Department of Surgery, Fujimoto General Hospital, 17-1 Hayasuzu-cho, Miyakonojo, Miyazaki, 885-0055, Japan
| | - Tomoko Kodama
- Department of Gastroenterology, Fujimoto General Hospital, 17-1 Hayasuzu-cho, Miyakonojo, Miyazaki, 885-0055, Japan
| | - Akihiro Yamasuji
- Department of Gastroenterology, Fujimoto General Hospital, 17-1 Hayasuzu-cho, Miyakonojo, Miyazaki, 885-0055, Japan
| | - Kou Fukumori
- Department of Gastroenterology, Fujimoto General Hospital, 17-1 Hayasuzu-cho, Miyakonojo, Miyazaki, 885-0055, Japan
| | - Naoki Maehara
- Department of Surgery, Fujimoto General Hospital, 17-1 Hayasuzu-cho, Miyakonojo, Miyazaki, 885-0055, Japan
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Chia DWJ, Kuan WS, Ho WH, Sim TB, Chua MT. Early predictors for the diagnosis of liver abscess in the emergency department. Intern Emerg Med 2019; 14:783-791. [PMID: 30847718 DOI: 10.1007/s11739-019-02061-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/25/2019] [Indexed: 01/21/2023]
Abstract
Diagnosing pyogenic liver abscess (PLA) in the emergency department (ED) is challenging due to its non-specific clinical presentation. We aim to identify predictors that aid in diagnosis of PLA in ED patients. This retrospective chart review included patients diagnosed with PLA in a tertiary hospital between January 2008 and December 2012. We compared the demographics, clinical characteristics, investigations and outcomes between patients with PLA diagnosed and missed in the ED. During the study period, 155 patients were admitted via the ED with a cause of death or discharge diagnosis of PLA. Mean age was 58.1 (standard deviation [SD] 15.8) years, with male predominance of 69.7%. There were 79.4% of patients with diagnosis of PLA missed in the ED. Fulfillment of SIRS criteria was associated with increased odds of diagnosing PLA in the ED (adjusted OR 3.20, 95% CI 1.03-9.92), while a higher SpO2/FiO2 ratio was associated with decreased odds of a timely ED diagnosis (adjusted OR 0.993, 95% CI 0.988-0.998). Missed ED diagnosis of PLA did not result in significant differences in mortality or treatment failure (p = 0.939), and median length of stay (11 days [IQR 8-16] vs. 11 days [IQR 7-17], p = 0.48). Non-fulfillment of the SIRS criteria and a higher SpO2/FiO2 ratio at ED presentation were associated with higher likelihood of missed diagnosis. Despite that, a missed diagnosis of PLA in the ED did not appear to affect outcomes.
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Affiliation(s)
- Dennis Wen Jie Chia
- Emergency Department, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, 9 Lower Kent Ridge Road, Level 4, Singapore, 119085, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Weng Hoe Ho
- Emergency Medicine Department, National University Hospital, National University Health System, 9 Lower Kent Ridge Road, Level 4, Singapore, 119085, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tiong Beng Sim
- Emergency Medicine Department, National University Hospital, National University Health System, 9 Lower Kent Ridge Road, Level 4, Singapore, 119085, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mui Teng Chua
- Emergency Medicine Department, National University Hospital, National University Health System, 9 Lower Kent Ridge Road, Level 4, Singapore, 119085, Singapore.
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Abstract
RATIONALE Currently, percutaneous catheter drainage (PCD) is regarded as the first-line treatment modality of pyogenic liver abscess. Severe complications associated with PCD were uncommon. Hepatic rupture is an uncommon but life-threatening liver trauma with high mortality. Its management is challenging because a delay in the diagnosis may lead to fatal hemorrhagic shock. To our knowledge, PCD-associated hepatic rupture has never been reported. PATIENT CONCERNS We report herein a rare case of PCD-associated hepatic rupture. Its clinical courses and our therapeutic approaches are presented. Moreover, the clinical significance, underlying causes, and current views on severe liver trauma management will be discussed briefly. DIAGNOSES A diabetic patient suffering from fever and malaise was diagnosed with a pyogenic liver abscess. PCD was performed because intravenous antibiotics were ineffective. The patient developed a liver rupture following PCD, with clinical and imaging confirmation but without further progression. INTERVENTIONS Surgical repair and vascular intervention were both inappropriate. As a result, medical treatments with supportive care were adopted and were found to be effective. OUTCOMES The patient's condition improved gradually, with stabilized imaging and laboratory performance. He recovered uneventfully during follow-ups. LESSONS Hepatic rupture should be listed as an extremely rare but severe complication of PCD. Immediate suspicion and effective intervention may avoid an unfavorable consequence.
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Affiliation(s)
- Liang Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
- Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Key Lab of Organ Transplantation, P.R. China
| | - DaLong Wan
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
- Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Key Lab of Organ Transplantation, P.R. China
| | - LeLe Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
- Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Key Lab of Organ Transplantation, P.R. China
| | - ShiGuo Xu
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
- Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Key Lab of Organ Transplantation, P.R. China
| | - HaiYang Xie
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
- Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Key Lab of Organ Transplantation, P.R. China
| | - ShengZhang Lin
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
- Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Key Lab of Organ Transplantation, P.R. China
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Watanabe I, Kanauchi N, Watanabe H, Hamada A. [Successful Treatment of Acute Empyema Due to Rupture of Pyogenic Liver Abscess]. Kyobu Geka 2017; 70:750-754. [PMID: 28790240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Cases of rescue after rupture of pyogenic liver abscess into the thorax are rare. Here, we report 2 cases of rescue in patients with acute empyema due to rupture of a suppurative abscess into the thorax. Case 1:A 61-year-old male had high fever of 39 °C and right abdominal pain. Thoracic computed tomography(CT) showed encapsulated pleural effusion in the right thorax and ring-like enhancement in the right liver. The diagnosis was acute empyema caused by rupture of liver abscess. The pathogenic bacteria were Streptococcus group. The drain was removed after 6 days and the patient was discharged 32 days after surgery without reefing the diaphragm. Case 2:A 74-year-old male had a high fever of 39 °C and right chest pain. CT showed encapsulated pleural effusion in the right thorax, but not in the lung, and a low density area in the posterior segment of the liver. The diagnosis was acute empyema caused by rupture of liver abscess. The pathogenic bacteria were Streptococcus group and Bacteroides. The drain was removed after 8 days and the patient was discharged 32 days after surgery without reefing the diaphragm. CONCLUSION Pathogenic bacteria in a pyogenic liver abscess are usually Gram-negative rods, but recently have also been reported to be Streptococcus anginosus group( SAG). Coinfection with SAG and anaerobic bacteria occurs in elderly patients, compromised hosts, and patients with a severe malignant disease. Therefore, early drainage using surgical treatment regardless of reefing the diaphragm should be considered to control severe infection due to liver abscess rupture.
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MESH Headings
- Aged
- Drainage
- Empyema, Pleural/diagnostic imaging
- Empyema, Pleural/etiology
- Empyema, Pleural/surgery
- Humans
- Liver Abscess, Pyogenic/complications
- Liver Abscess, Pyogenic/diagnostic imaging
- Liver Abscess, Pyogenic/surgery
- Male
- Middle Aged
- Rupture, Spontaneous/diagnostic imaging
- Rupture, Spontaneous/etiology
- Rupture, Spontaneous/surgery
- Tomography, X-Ray Computed
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Affiliation(s)
- Isamu Watanabe
- Department of General Thoracic Surgery, Nihonkai General Hospital, Sakata, Japan
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Sung CC, Lin CS, Lin SH, Lin CL, Jhang KM, Kao CH. Pyogenic Liver Abscess is Associated With Increased Risk of Acute Kidney Injury: A Nationwide Population-Based Cohort Study. Medicine (Baltimore) 2016; 95:e2489. [PMID: 26817884 PMCID: PMC4998258 DOI: 10.1097/md.0000000000002489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this large population-based cohort study was to determine whether pyogenic liver abscess (PLA) is associated with the risk of acute kidney injury (AKI).A total of 31,815 patients aged 20 years or older diagnosed with PLA for the first time during hospitalization between 2000 and 2011 were included in a PLA cohort, and 127,620 age- and sex-matched patients without PLA were included in a non-PLA cohort. The incidence and the risk of the first attack of AKI at the end of 2011 were measured. Cox proportional hazard regression models were used to analyze the risk of AKI.In mean follow-up periods of 4.36 and 4.94 years for the PLA and non-PLA cohorts, respectively, the overall incidence of AKI was 1.51-fold greater in the PLA cohort than in the non-PLA cohort (9.25 vs 6.11 events per 1000 person-years; 95% confidence intervals [CIs] = 1.42-1.61). After we controlled for potential confounding factors, the adjusted hazard ratio (aHR) of AKI was 1.36 (95% CIs = 1.27-1.46) for the PLA cohort compared with the non-PLA cohort. Moreover, among patients without comorbidities, the risk of AKI remained higher in the PLA cohort compared with the non-PLA cohort (aHR: 1.91, 95% CIs = 1.59-2.29).This study suggests that PLA associates with an increased risk of AKI. Clinicians should be aware of the potential risk of AKI after diagnosis of PLA.
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Affiliation(s)
- Chih-Chien Sung
- From the Division of Nephrology (C-CS, S-HL), Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei; Graduate Institute of Life Science (C-CS), National Defense Medical Center, Taipei; Division of Cardiology (C-SL), Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei; Management Office for Health Data (C-LL), China Medical University Hospital, Taichung; College of Medicine (C-LL), China Medical University, Taichung; Department of Neurology (K-MJ), Lu-Tung Christian Hospital, Changhua; School of Public Health (K-MJ), Chung Shan Medical University, Taichung (K-MJ); Graduate Institute of Clinical Medical Science and School of Medicine (C-HK), College of Medicine, China Medical University, Taichung; and Department of Nuclear Medicine and PET Center (C-HK), China Medical University Hospital, Taichung, Taiwan
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Sahni N, Mandal AK, Maheshwari N. Secondary viral encephalitis in a patient with pyogenic liver abscess. Anaesth Intensive Care 2014; 42:528-530. [PMID: 24967776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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18
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Vedula RS, Britt G, Kopelman RI, Rencic J. Complementary medicine. J Gen Intern Med 2014; 29:412-6. [PMID: 24197631 PMCID: PMC3912295 DOI: 10.1007/s11606-013-2636-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 08/06/2013] [Accepted: 09/10/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Rahul S Vedula
- Tufts University School of Medicine, 180 Washington St. Apt. 1, Brighton, Boston, MA, 02135, USA,
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Okumura Y, Sugimoto R, Hisano T, Furukawa M, Fujiyama T, Taguchi K, Funakoshi A. [Multiple pyogenic liver abscesses with the decline in neutrophil phagocytic function: a case report]. Nihon Shokakibyo Gakkai Zasshi 2013; 110:1487-1494. [PMID: 23912009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 51-year-old man presenting with fever, weight loss and general fatigue was diagnosed with jaundice and liver tumors and admitted to our hospital for further investigation and treatment. We diagnosed multiple pyogenic liver abscesses, obstructive jaundice, and silent syphilis. The patient was successfully treated with endoscopic biliary stenting, endoscopic nasobiliary drainage, percutaneous transhepatic abscess drainage, and, most effectively, transcatheter regional hepatic arterial infusion with antibiotics. We speculated that the decline in neutrophil phagocytic function may concern to occur the pyogenic liver abscess.
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Liao WI, Sheu WHH, Chang WC, Hsu CW, Chen YL, Tsai SH. An elevated gap between admission and A1C-derived average glucose levels is associated with adverse outcomes in diabetic patients with pyogenic liver abscess. PLoS One 2013; 8:e64476. [PMID: 23724053 PMCID: PMC3665809 DOI: 10.1371/journal.pone.0064476] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 04/14/2013] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To assess whether chronic glycemic control and stress-induced hyperglycemia, determined by the gap between admission glucose levels and A1C-derived average glucose (ADAG) levels adversely affects outcomes in diabetic patients with pyogenic liver abscess (PLA). METHODS Clinical, laboratory, and multi-detector computed tomography (MDCT) findings of 329 PLA patients (2004-2010) were retrospectively reviewed. HbA1C levels were used to determine long-term glycemic control status, which were then converted to estimated average glucose values. For the gap between admission glucose levels and ADAG levels, we used receiver operating characteristic (ROC) curve to determine the optimal cut-off values predicting adverse outcomes. Univariate and multivariate logistic regressions were used to identify predictors of adverse outcomes. RESULTS Diabetic PLA patients with poorer glycemic control had significantly higher Klebsiella pneumoniae (KP) infection rates, lower albumin levels, and longer hospital stays than those with suboptimal and good glycemic control. The ROC curve showed that a glycemic gap of 72 mg/dL was the optimal cut-off value for predicting adverse outcomes and showed a 22.3% relative increase in adverse outcomes compared with a glycemic gap<72 mg/dL. Multivariate analysis revealed that an elevated glycemic gap≥72 mg/dL was important predictor of adverse outcomes. CONCLUSIONS A glycemic gap≥72 mg/dL, rather than admission hyperglycemia or chronic glycemic control, was significantly correlated with adverse outcomes in diabetic PLA patients. Poorer chronic glycemic control in diabetic PLA patients is associated with high incidence of KP infection, hypoalbuminemia and longer hospital stay.
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Affiliation(s)
- Wen-I Liao
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Wang Hsu
- Department of Emergency and Critical Care Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Yu-Long Chen
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
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22
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23
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Kao WY, Su CW. Letter: pyogenic liver abscess and colorectal cancer - authors' reply. Aliment Pharmacol Ther 2013. [PMID: 23205486 DOI: 10.1111/apt.12114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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24
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Lai SW. Letter: pyogenic liver abscess is a red flag sign of hepatocellular carcinoma. Aliment Pharmacol Ther 2012; 36:906; author reply 906-7. [PMID: 23163563 DOI: 10.1111/apt.12054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 09/02/2012] [Indexed: 01/08/2023]
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Lai KC, Cheng KS, Jeng LB, Huang CC, Lee YT, Chang HR, Chen CC, Chen SC, Lee MC. Factors associated with treatment failure of percutaneous catheter drainage for pyogenic liver abscess in patients with hepatobiliary-pancreatic cancer. Am J Surg 2012; 205:52-7. [PMID: 22794706 DOI: 10.1016/j.amjsurg.2012.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 03/04/2012] [Accepted: 03/04/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this study was to identify predictors of treatment failure of percutaneous catheter drainage (PCD) in patients with hepatobiliary-pancreatic cancer with pyogenic liver abscess (PLA). METHODS Medical records of 44 patients with PLA with underlying hepatobiliary-pancreatic cancer who underwent PCD under computed tomographic guidance as primary treatment between January 2001 and December 2010 were collected and reviewed. Included patients were diagnosed with cholangiocarcinoma (n = 16), hepatocellular carcinoma (n = 12), pancreatic carcinoma (n = 9), carcinoma of the ampulla of Vater (n = 6), and gallbladder cancer (n = 1). The clinical factors related to failure of PCD were determined using logistic regression. RESULTS The median age of the 44 patients with PLA was 68 years, and 48% were men. PCD failed in 15 patients (34%). Of the 15 patients with PCD failure, 12 subsequently required surgical intervention because of either clinical deterioration or imaging that demonstrated failure of abscess resolution with PCD. Three of these patients died with the initial drain in place before resolution of the abscess. In patients requiring surgery after PCD failure, the frequency of cure or abscess resolution reached 67%. Fourteen patients (32%) died during hospitalization. Multivariate analysis identified that multiloculated abscesses (P = .005) and abscesses with biliary communication (P = .036) were associated with failure of PCD. CONCLUSIONS Multiloculated abscesses and lesions with biliary communication pose a greater likelihood of failure of PCD in patients with hepatobiliary-pancreatic cancer with PLA. Early surgical intervention after PCD failure should be considered for these patients.
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Affiliation(s)
- Kuang-Chi Lai
- Department of Surgery, China Medical University Beigang Hospital, Yunlin 65152, Taiwan
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Kang SC, Hwang SJ. Impact of advanced age on inpatients with pyogenic liver abscess in Taiwan: a nationwide claim-based analysis. J Chin Med Assoc 2011; 74:539-43. [PMID: 22196468 DOI: 10.1016/j.jcma.2011.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 09/20/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pyogenic liver abscess (PLA) is seen as an endemic disease in population of Taiwan. The impact of advanced age on inpatients with PLA remains unclear. METHODS Data was collected and analyzed from claims of discharges by inpatients with PLA, using the National Health Insurance Research Database of 2007. RESULTS A total of 2319 subjects and 2651 related discharges were enrolled, including 939 subjects/1077 discharges ≥65 years and 1380 subjects/1574 discharges <65 years. Subjects ≥65 years had significantly higher ratios of females to males, nephropathy, biliary tract diseases, liver cirrhosis and gastroenterological cancers than those <65 years. Hepatic/intra-hepatic duct cancers accounted for the most comorbid gastroenterological cancers. Discharged of subjects ≥65 years had longer hospital stays, more in-hospital death/critical discharge, and a higher ratio of acute low respiratory conditions (ALRC) and urological infections than those of subjects <65 years (p<0.05). The inpatient costs for subjects ≥65 years were significantly higher than those for subjects age<65 years in blood products, hemodialysis and total hospitalization. Co-morbidities, such as nephropathy, biliary tract diseases, liver cirrhosis, gastroenterological cancers, ALRC and urological infections were predictive variables associated with age ≥65 years in patients with PLA, as were being female and in-hospital death/critical discharge. Nephropathy and gastroenterological cancers were predictive variables associated with poor prognosis (in-hospital death/critical discharge) in both PLA patients age < and ≥65 years (p<0.05). Diabetes mellitus featured predominantly, but had no impact on distribution and prognosis. CONCLUSION Advanced age (≥65 years) had an impact on the aforementioned characteristics and predictive variables in inpatients with PLA. Physicians should pay attention and treat aged PLA patients with greater care, especially those cares with comorbid nephropathy or gastroenterological cancers.
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Affiliation(s)
- Shih-Chao Kang
- Division of Family Medicine, National Yang-Ming University Hospital, Yilan, Taiwan, ROC
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Aydin C, Kayaalp C, Kutlu R, Yilmaz S. Fistulisation of pyogenic liver abscess into the portal vein and bile ducts. Singapore Med J 2011; 52:e153-e155. [PMID: 21808949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report pyogenic liver abscess complicated by fistulisation into the portal vein and bile ducts in a 58-year-old diabetic woman, who was admitted to the hospital with fever, chills and rigors. Abdominal ultrasonography and computed tomography demonstrated a 7-cm multiloculated abscess in segment III, close to the left branch of the portal vein. The abscess was drained under fluoroscopic guidance in a single pass. Pus was aspirated, and diluted water-soluble contrast was injected into the cavity. Early films revealed filling of the cavity. Later, the contrast appeared in the bile ducts and left branch of the portal vein. Radiological intervention was discontinued. Immediate surgery, including left lateral segmentectomy, was performed. The preoperative course was uneventful, except for superficial surgical site infection. We opine that a hepato-venous fistula is an indication for surgical intervention, and that early resection of the fistula can prevent severe septic complications.
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Affiliation(s)
- C Aydin
- Department of General Surgery, Inonu University, Turgut Ozal Medical Centre, Malatya 44315, Turkey
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Affiliation(s)
- Christina To
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Chong VH, Zainal-Abidin Z, Hassan H, Chong CF. Rare complications of pyogenic liver abscess. Singapore Med J 2010; 51:e169-e172. [PMID: 21103806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Pyogenic liver abscess (PLA) is still associated with significant morbidity and mortality. With advances in imaging, most cases are now diagnosed early and effectively treated. However, complications, although considered rare, may still occur. We report three cases of PLA that were associated with rare and significant complications. Two patients had an abscess rupture that resulted in pyopericardium in one patient and sub-diaphragmatic abscess in the other. Another patient with Klebsiella pneumoniae PLA had bilateral endophthalmitis that resulted in blindness. Death secondary to overwhelming sepsis occurred in the patient with Escherichia coli-related pyopericardium. Delay in diagnosis contributed to the complications in two of the patients.
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Affiliation(s)
- V H Chong
- Gastroenterology Unit, Department of Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BA 1710, Brunei Darussalam.
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Gambí Pisonero D, Garrido Menéndez F, Sancho Calatrava E, Serantes Gómez A. [Rupture of a pyogenic liver abscess: a rare cause of pneumoperitoneum]. Gastroenterol Hepatol 2009; 33:99-101. [PMID: 19889477 DOI: 10.1016/j.gastrohep.2009.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 09/09/2009] [Accepted: 09/15/2009] [Indexed: 11/18/2022]
Abstract
Spontaneous pneumoperitoneum is a common finding in patients with abdominal disorders. In 90% of cases, this entity results from hollow viscera perforation. Rupture of a pyogenic liver abscess is an infrequent complication occurring in 5 to 15% of cases. Pneumoperitoneum secondary to intraperitoneal rupture of an abscess is extremely rare and very few cases have been reported in the literature. Given its clinical interest, we report a case of pneumoperitoneum due to spontaneous rupture of a gas-containing pyogenic liver abscess.
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MESH Headings
- Abdomen, Acute/diagnostic imaging
- Abdomen, Acute/etiology
- Aged, 80 and over
- Cholangiography
- Cholangiopancreatography, Magnetic Resonance
- Drainage
- Emergencies
- Escherichia coli Infections/complications
- Escherichia coli Infections/surgery
- Female
- Follow-Up Studies
- Humans
- Laparotomy
- Liver Abscess, Pyogenic/complications
- Liver Abscess, Pyogenic/diagnostic imaging
- Liver Abscess, Pyogenic/surgery
- Pneumoperitoneum/diagnostic imaging
- Pneumoperitoneum/etiology
- Radiography, Thoracic
- Rupture, Spontaneous
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Daniel Gambí Pisonero
- Servicios de Cirugía General y de Aparato Digestivo, Hospital Santa Bárbara, Puertollano, Ciudad Real, España.
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Husa P, Freibergerová M, Svacinka R, Nebeský T, Neubauer J, Robek O, Turanská K, Zimová I. [Liver abscesses - one of possible causes of fever of unknown origin]. Klin Mikrobiol Infekc Lek 2009; 15:58-64. [PMID: 19488962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Liver abscess is a focal suppurative liver process. According to the etiology liver abscesses are divided into bacterial (pyogenic), and parasiti (amebic). Parasitic cysts (e.g. caused by Echinococcus granulosus) can be secondary bacterial infected and their clinical and laboratory manifestations are like pyogenic abscesses. In clinical manifestation of liver abscesses dominates fever of unknown origin. Authors present two characteristic cases of liver abscesses as a Case reports. The origin of multiple pyogenic abscesses of mixed etiology (Enterococcus faecium, E. coli ESBL, Candida albicans, Candida tropicalis) in 73-years old man was either in secondary infected liver hematomas after his fall and injury or in intrascapular subcutaneous abscess with spreading of microbes by blood stream into liver. Some of liver abscesses were evacuated during surgical laparotomy; the residual ones were puncted by radiologist under CT control. The patient was treated with combination of meropenem, vancomycin, metronidazol (4 weeks), and fluconazole (20 days). Antibiotic treatment with per oral doxycycline was continuing after patient's discharge from the hospital for 3 weeks. Three amebic liver abscesses were diagnosed in 27-years old man of Indian origin. The treatment was based on drainage of abscesses under CT control a long-term metronidazol treatment.
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Affiliation(s)
- P Husa
- Klinika Infekcních Chorob Lékarské Fakulty Masarykovy Univerzity a Fulkultní Nemocnice Brno.
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Abstract
We describe an 83-year-old woman who developed a pyogenic liver abscess complicated with early bile duct carcinoma. After percutaneous abscess drainage, endoscopic retrograde cholangiography revealed a filling defect in the extrahepatic bile duct suggestive of a bile duct tumor. Resection of the extrahepatic bile duct with regional lymph node dissection was carried out. The resected specimen showed a polypoid tumor in the middle bile duct and histologic examination revealed well-differentiated tubular adenocarcinoma limited to the mucosal layer. These findings suggest that careful investigation of the biliary tract is necessary in patients with pyogenic liver abscess, because of the possible association of bile duct cancer.
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Affiliation(s)
- Chiah-Yang Chai
- Department of Surgery, Taipei Medical University Hospital, Taiwan
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Abstract
BACKGROUND In the majority of pneumoperitoneum cases we diagnose perforated viscus. We present herein a case of ruptured hepatic abscess mimicking perforated viscus. CASE REPORT A 40-year-old man presented to the emergency room with fever and right upper quadrant abdominal pain. The fever had been on/off for a period of 1 month. On physical examination, diffuse abdominal pain with rebounding tenderness was noted. Blood tests showed leukocytosis with left shift, hyperglycemia, and elevated liver function tests. A chest X-ray showed a subdiaphragmatic region air-fluid level, indicating a hepatic abscess. Pneumoperitoneum was also seen. Owing to the status of peritonitis, computed tomography (CT) of the abdomen was performed and revealed an air-containing liver abscess in the right lobe of the liver. Perforation of a hollow organ was also suspected because of the pneumoperitoneum. An emergent laparotomy was immediately performed for the suspicion of a hollow organ perforation. No perforation of the hollow viscus was found. The ruptured hepatic abscess was attributed to the pneumoperitoneum. A blood culture grew Klebsiella pneumoniae four days later, and the same organism was also found in a surgical specimen culture of the abscess. CONCLUSIONS For a ruptured hepatic abscess, surgical intervention with draining of the abscess and cleaning of the abdominal cavity are essential to save patient lives.
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Affiliation(s)
- Yen-Chun Lai
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan
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36
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Blas-Macedo J, Márquez-Ramírez MD. [Gas-forming liver abscess in diabetic patient]. Rev Med Inst Mex Seguro Soc 2008; 46:205-210. [PMID: 19133194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Pyogenic liver abscess is still considered a medical challenge due to the seriousness of the clinical course, late diagnosis, and usually high mortality. Gas-forming liver abscess is not uncommon, the incidence among all pyogenic liver abscess is around 7 to 24 %, mostly in individuals in their sixth and seventh decades ,and with diabetes mellitus disease. The epidemiology of gas-forming liver abscess has been changing with a shift from young to older diabetic adults. A clinical case of a 71 year old diabetic female with gas-forming liver abscess is presented; we describe the clinical course and treatment is analyzed.
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Affiliation(s)
- Jorge Blas-Macedo
- Departamento de medicina interna, Hospital Regional 1, Instituto Mexicano del Seguro Social, Durango, Durango, Mexico.
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Hara N, Kato M, Fuse K, Nagata T, Kimura Y, Sugiura H, Saito A, Fujita S, Ikeda Y, Kitazawa H, Takahashi M, Sato M, Okabe M. A rare case of pyogenic liver abscess complicated with cardiac tamponade. Intern Med 2008; 47:563-4. [PMID: 18344649 DOI: 10.2169/internalmedicine.47.0854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Nobuhiro Hara
- Cardiovascular Center, Tachikawa General Hospital, Nagaoka
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39
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Monge-Fresse AS, Siriez JY, Bricaire F. Spontaneous fistulisation of a liver abscess into the stomach. Neth J Med 2007; 65:456-457. [PMID: 18079570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Chen SC, Wu WY, Yeh CH, Lai KC, Cheng KS, Jeng LB, Wang PH, Lin DB, Chen CC, Lee MC, Bell WR. Comparison of Escherichia coli and Klebsiella pneumoniae liver abscesses. Am J Med Sci 2007; 334:97-105. [PMID: 17700198 DOI: 10.1097/maj.0b013e31812f59c7] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Escherichia coli and Klebsiella pneumoniae are the most common causative pathogens of pyogenic liver abscesses. The objective of this study was to compare outcome between patients with liver abscesses due to E coli and those with liver abscesses caused by K pneumoniae; we also aimed to identify separately the predictors of mortality in the 2 groups. METHODS We conducted a retrospective study of 202 patients who presented with pyogenic liver abscesses caused by either E coli or K pneumoniae from July 2000 to June 2005. Outcome of the patients was analyzed by exact logistic regression with adjustment for baseline and clinical covariates. Significant predictors of mortality in the E coli and the K pneumoniae groups were investigated by multivariate analysis of demographic and clinical variables in each group. RESULTS Of the 202 patients (128 men and 74 women; age range, 19 to 89 years), pyogenic liver abscess was due to E coli infection in 55 patients and K pneumoniae in 147 patients. In contrast to patients with K pneumoniae, patients with E coli liver abscess were more likely to be older and female, have a biliary abnormality or malignancy, pleural effusion, polymicrobial infection with anaerobic or multi-drug-resistant organisms, a higher APACHE II score, and to have been treated initially with ineffective antibiotics; they were also less likely to have diabetes mellitus. The cause of K pneumoniae liver abscess was often cryptogenic. The sensitivity, specificity, positive predictive value, and likelihood ratio of the presence of biliary disorders and coexisting malignancy as a predictive parameter of E coli liver abscess were 25%, 96%, 67%, and 5.45/1, respectively. The sensitivity, specificity, positive predictive value, and likelihood ratio of the presence of diabetes mellitus with an abscess of cryptogenic origin as a predictive parameter of K pneumoniae liver abscess were 39%, 84%, 81%, and 2.36/1, respectively. There was no significant difference in mortality between patients with E coli and those with K pneumoniae infections (26% vs 4%; adjusted OR, 4.2; 95% CI, 0.63 to 27; P = 0.105). However, for patients with liver abscess caused by E coli, the APACHE II score at admission (OR, 1.7; 95% CI, 1.1 to 2.6; P = 0.021), malignancy (OR, 26; 95% CI, 1.8 to 370; P = 0.016), and right-lobe abscess (OR, 0.0029; 95% CI, 0.00010 to 0.15; P = 0.004) were significant predictors of death, whereas uremia (OR, 52; 95% CI, 3.5 to 750; P = 0.004) and multi-drug-resistant isolates (OR, 26; 95% CI, 2.3 to 290; P = 0.009) were significant predictors of death in the K pneumoniae group. CONCLUSIONS A higher APACHE II score at admission and a higher frequency of coexisting malignancy may have contributed to the higher, although not significant, mortality rate in patients with liver abscess caused by E coli infection. Clinicians should begin with broad antibiotic coverage such as a second-generation cephalosporin and an aminoglycoside with metronidazole when treating liver abscesses with E coli as the likely pathogen due to the high frequency of multi-drug-resistant isolates among E coli isolates.
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Affiliation(s)
- Shiuan-Chih Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Ruiz-Hernández JJ, León-Mazorra M, Conde-Martel A, Marchena-Gómez J, Hemmersbach-Miller M, Betancor-León P. Pyogenic liver abscesses: mortality-related factors. Eur J Gastroenterol Hepatol 2007; 19:853-8. [PMID: 17873608 DOI: 10.1097/meg.0b013e3282eeb53b] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
GOAL To analyse the characteristics and mortality-related factors in a series of patients hospitalized for pyogenic liver abscess (PLA). BACKGROUND Pyogenic liver abscesses are infrequent but potentially life threatening. Factors related to mortality have been less studied. STUDY The medical records of 84 patients, 56 men and 28 women, mean age of 64.4 years (SD: 14) who were hospitalized between 1992 and 2005 owing to a PLA were reviewed. The past medical history, clinical signs and symptoms, laboratory values, imaging studies, microbiological features, treatment, complications and mortality were recorded. Factors related to complications and mortality were analysed. RESULTS One or more bacteria were isolated in 65 patients (77.4%), being Streptococcus spp. (40.5%), Escherichia coli (27.4%), Klebsiella spp. (14.3%) and anaerobics (17.9%) the most frequent isolates. Complications developed in 60.7% of the cases, the most common one being a right pleural effusion (34.5%). Mortality rate was 19% (95% confidence interval: 10-28%). Mortality was associated with age (P=0.005), a previous history of coronary heart disease (P=0.016), absence of fever (P=0.001), development of sepsis and/or septic shock (P<0.001), raise of bilirubin levels (P=0.004), a biliary (P=0.035), or cryptogenetic origin (P=0.039), infection owing to E. coli (P=0.01) or to Candida (P=0.009) and development of pneumonia (P<0.001). Logistic regression revealed sepsis and/or septic shock as an independent risk factor for mortality. CONCLUSIONS Mortality associated with PLA is high. The main risk factor for mortality is the development of sepsis and/or septic shock.
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Affiliation(s)
- José Juan Ruiz-Hernández
- Department of Internal Medicine, University Hospital of Gran Canaria Dr Negrín, Las Palmas, Gran Canaria, Spain
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Tomiyama Y, Ohmoto K, Yoshioka N, Kawase T, Shibata N, Yoshida K, Kuboki M, Yamamoto S, Irei I, Urakami A, Tsunoda T. [Pyogenic liver abscess complicated by gastric fistula and bacterial meningitis]. Nihon Shokakibyo Gakkai Zasshi 2007; 104:1512-1518. [PMID: 17917400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A 77-year-old woman was admitted suffering from fever and headache. On laboratory examination, bacterial meningitis and sepsis due to Klebsiella pneumoniae were diagnosed. In addition, a hepatic cystic lesion measuring 13 cm in diameter in the left lobe was indicated on diagnostic imaging. After treatment with antibiotics, her signs of infection improved and the hepatic lesion decreased in size. After discharge, however, the cystic liver mass increased and a gastric fistula developed. Hepatic and gastric resections were performed because of the possibility of biliary cystadenocarcinoma and gastric invasion. Pathologically, a pyogenic liver abscess complicated by gastric fistula was diagnosed.
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Affiliation(s)
- Yasuyuki Tomiyama
- Division of Hepatology, Department of Medicine, Kawasaki Medical School
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Méric de Bellefon L, Legrand JC, Codden T, Carlier E, Vanhaeverbeek M. [Klebsiella pneumoniae septicaemia and meningitis in a diabetic patient with an hepatic abscess]. Rev Med Brux 2007; 28:460-463. [PMID: 18069521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Klebsiella pneumoniae infections show particular features depending on the geographical localization as well as comorbidity factors. We are presenting the case of a european patient with diabetes mellitus who presented a septicaemia, a meningitis as well as an hepatic abscess due to a K. pneumoniae and whose evolution was excellent under antibiotics. Usually described among Asian patients, the primary hepatic K. pneumoniae abscess, which is a clinical entity recently described, can give rise to potentially serious and multiple septic metastasis. We also discuss the diagnostic and therapeutic attitudes related to this infection.
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Affiliation(s)
- L Méric de Bellefon
- Services de Médecine Interne, C.H.U. de Charleroi, Hôpital André Vésale, Montigny-le-Tilleul.
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Sánchez-Fernández P, Sánchez-Reyes K, Blanco-Benavides R. [Clinical images in gastroenterology. Pyogenic liver abscess with pleural complication and Papillón-Lefevre syndrome]. Rev Gastroenterol Mex 2007; 72:249. [PMID: 18402216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Patricio Sánchez-Fernández
- Departamento de Cirugía Gastrointestinal, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS
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Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL, Chang SC. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis 2007; 45:284-93. [PMID: 17599305 DOI: 10.1086/519262] [Citation(s) in RCA: 447] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 04/18/2007] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Since 1986, researchers have noted a syndrome of Klebsiella pneumoniae pyogenic liver abscess that is complicated by endophthalmitis or central nervous system infections. There are limited data regarding the role of bacterial genotype in the pathogenesis of this syndrome. METHODS We conducted a retrospective cohort study involving 177 cases of K. pneumoniae pyogenic liver abscess treated during 1997-2005 at a tertiary university hospital in Taiwan. We performed bacterial cps genotyping by polymerase chain reaction detection of serotype-specific alleles at wzy and wzx loci and used an in vitro serum assay to evaluate the virulence of bacterial strains. RESULTS Septic ocular or central nervous system complications developed in 23 patients (13%). Logistic regression analysis showed that genotype K1 was the only significant risk factor (adjusted odds ratio, 4.8; 95% confidence interval, 1.5-15.7, P=.009). The serum resistance assay indicated that, on average, K1 strains (n=100) were significantly more virulent than were strains of K2 (n=36), K20/K5/K54 (n=21), or other genotypes (n=20) (P<.001 for each comparison). In addition to the serotype-specific cps region, the genomic background of K1 strains also differed significantly from that of non-K1 strains (20-kb kfu/PTS region, 97/100 vs. 13/77; P<.001). Of the 19 cases in which genotype K1 strains caused complications, 8 patients (42%) did not have identifiable underlying medical diseases. CONCLUSIONS K. pneumoniae genotype K1 is an emerging pathogen capable of causing catastrophic septic ocular or central nervous system complications from pyogenic liver abscess independent of underlying diseases in the host.
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Affiliation(s)
- Chi-Tai Fang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Abstract
Primary Klebsiella pneumoniae liver abscess with metastatic complications is a globally emerging infectious disease and is the leading cause of liver abscess in Taiwan. Host immunity and bacterial virulence, especially of the capsular polysaccharide type, are important in determining clinical manifestations. Investigators retrospectively studied the K pneumoniae genotype and capsular serotype from patients with 37 strains of liver abscess; no correlation was noted with genotype, and many genetically different strains caused liver abscess. Although K pneumoniae is prevalent in patients with diabetes, it can attack healthy or alcoholic people as well. Additional studies are needed to explore the mechanisms of bacterial virulence and to optimize treatment strategies. Physicians should be alert to the illness and its complications.
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Affiliation(s)
- Ken-Sheng Cheng
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, ROC.
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Shiba H, Aoki H, Misawa T, Kobayashi S, Saito R, Yanaga K. Pneumoperitoneum caused by ruptured gas-containing liver abscess. ACTA ACUST UNITED AC 2007; 14:210-1. [PMID: 17384917 DOI: 10.1007/s00534-006-1136-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Accepted: 05/17/2006] [Indexed: 10/23/2022]
Abstract
An 84-year-old woman was admitted to our hospital with high fever, and she suddenly complained of severe abdominal pain the next day. Computed tomography revealed a gas-containing abscess in the lateral segment of the liver, with spontaneous pneumoperitoneum. An emergency lateral segmentectomy was performed, and Klebsiella pneumoniae was cultured from the liver tissue, abscess, and blood. The patient made a satisfactory recovery and was discharged on the thirty-first postoperative day. Pneumoperitoneum caused by the rupture of a gas-containing liver abscess is rare, and to our best knowledge, this is the first report, in the English-language literature, of a patient who has undergone successful hepatectomy for such a condition.
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Affiliation(s)
- Hiroaki Shiba
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Tokyo 105-8461, Japan
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Baca B, Hamzaoğlu I, Karahasanoğlu T, Hamzaoğlu HO. Laparoscopic treatment of pyogenic liver abscess complicating Crohn's disease: a case report. Turk J Gastroenterol 2007; 18:58-61. [PMID: 17450499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Pyogenic liver abscess in patients with Crohn's disease is not common, but the mortality has been reported to be high if diagnosis or treatment is delayed. Herein, we report the case of a 42-year-old man in whom multi-locular liver abscess was encountered in the right lobe of the liver as a complication of Crohn's disease. On his admission to the emergency unit, he had right upper quadrant pain, fever of 39 degrees C and hepatomegaly. Ultrasonography and abdominal computerized tomography demonstrated multi-locular pyogenic liver abscess in the right lobe of the liver. Percutaneous drainage failed because of the density of the pus; laparoscopic exploration was subsequently performed and 1500 ml pus was successfully drained. The patient became clinically stable without fever and with a decreasing white blood cell count on the third postoperative day.
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Affiliation(s)
- Bilgi Baca
- Department of General Surgery, Istanbul University Cerrahpasa Medical School, Istanbul
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50
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Kandaswamy GV, Kumar ST, Jeyasingh R. Acute abdomen due to eosinophilic colitis with liver abscess. Indian J Gastroenterol 2006; 25:208-9. [PMID: 16974040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Eosinophilic colitis is an uncommon condition and rarely presents as acute abdomen. We report a 65-year-old man who presented with acute abdomen-- severe pain in upper abdomen, with pyrexia, tachycardia, guarding and right-sided intercostal tenderness--secondary to eosinophilic colitis and was successfully managed. He had additional problems in form of cirrhosis, chronic hepatitis, cholangitis, pyogenic liver abscesses and gout.
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Affiliation(s)
- Gokul Vignesh Kandaswamy
- Department of General and GI Surgery, PSG Institute of Medical Sciences and Hospitals, Peelamedu, Coimbatore, Tamilnadu 641 004, India.
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