Causative agents of liver abscess in Thai hepatitis B carriers.
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Liver abscess and hepatitis B virus (HBV) infection are two significant tropical gastrointestinal disorders. The concurrence between these two disorders yields poor prognosis, which then often leads to the need for intensive care. The aim of this study was to investigate the causal pathogens of liver abscess in HBV carriers. This retrospective case review was conducted on 35 Thai hospitalized HBV carriers who had diagnosis of liver abscess. A high rate of amoebic liver abscess in this series (37.1%) was demonstrated; Gram-negative aerobes were the major abscess pathogens. The causative pathogens of HBV carriers were similar to those in the overall patient population with abscess. The treatment plan for liver abscess in the general population can also be applied to HBV carriers. (+info)
Pyogenic liver abscess: recent trends in etiology and mortality.
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BACKGROUND: Pyogenic liver abscess, a potentially life-threatening disease, has undergone significant changes in epidemiology, management, and mortality over the past several decades. METHODS: We reviewed the data for patients admitted to Bellevue Hospital and New York University Downtown Hospital (New York, New York) over a 10-year period. RESULTS: Of 79 cases reviewed, 43% occurred in patients with underlying biliary disease. The most common symptoms were fever, chills, and right upper quadrant pain or tenderness. The most common laboratory abnormalities were an elevated white blood cell count (in 68% of cases), temperature >or=38.1 degrees C (90%), a low albumin level (70.2%), and an elevated alkaline phosphatase level (67%). Seventy percent of the abscesses were in the right lobe, and 77% were solitary. Klebsiella pneumoniae was identified in 41% of cases in which a pathogen was recovered. Eighteen (50%) of 36 Asian patients had K. pneumoniae isolated, in contrast to 6 (27.3%) of 22 non-Asian patients (not statistically significant). Fifty-six percent of cases involved treatment with percutaneous drainage. Although prior reports noted mortality of 11%-31%, we observed only 2 deaths (mortality, 2.5%). CONCLUSIONS: The data suggest that K. pneumoniae has become the predominant etiology of pyogenic liver abscess and that mortality from this disease has decreased substantially. (+info)
Pyogenic liver abscess due to Rhodococcus equi in an immunocompetent host.
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A case of pyogenic liver abscess (PLA) due to Rhodococcus equi in an immunocompetent individual was successfully treated by combining surgery and antibiotics. The R. equi-targeted antimicrobial agents erythromycin and rifampin were used only after surgical resection of the lesion and identification of the infective organism. (+info)
An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses larger than 5 cm.
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OBJECTIVE: To determine whether first-line treatment with percutaneous or surgical drainage of liver abscesses larger than 5 cm results in better clinical outcome. SUMMARY BACKGROUND DATA: Pyogenic liver abscesses larger than 5 cm are currently treated by intravenous antibiotics and either percutaneous (PD) or surgical drainage (SD). Percutaneous techniques have been increasingly performed in place of open drainage as first-line treatment. This paradigm shift has been fueled by the drive for low-risk and less-invasive procedures and the surgical option being reserved for percutaneous failures. Yet there is a lack of data to support percutaneous drainage over open surgical drainage as first-line treatment. METHODS: Over a 3-year period, 80 patients with liver abscesses larger than 5 cm amenable to PD and SD were included in the study. This situation was possible as 1 team of surgeons favored the use of PD and 1 team favored the use of SD as first-line treatment. The treatment outcomes in both groups were compared, and clinical end-points included time to defervescence of fever, failure of treatment, secondary procedures, hospital stay, morbidity, and mortality. RESULTS: PD was performed in 36 patients and SD in 44 patients as first-line treatment. Clinical, laboratory, and abscess parameters were comparable in both groups. Sixty-four of 80 patients (80%) had multiloculated abscess. The time to defervescence of fever was not statistically significant (PD versus SD, 4.85 versus 4.38 days; P = 0.09). However, SD had less treatment failures (3 versus 10, P = 0.013), less requirement for secondary procedures (5 versus 13, P = 0.01), and shorter length of hospital stay (8 versus 11 days, P = 0.03). There was no difference in morbidity or mortality rates. CONCLUSIONS: The results of our study show that for large liver abscesses more than 5 cm, SD provides better clinical outcomes than PD in terms of treatment success, number of secondary procedures, and hospital stay with comparable morbidity and mortality rates. SD should be considered as first-line treatment of large liver abscesses. (+info)
A nationwide study of the incidence and 30-day mortality rate of pyogenic liver abscess in Denmark, 1977-2002.
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BACKGROUND: Pyogenic liver abscess is a life-threatening disease. Accurate data on incidence and prognosis are important, but scarce. AIM: To examine changes in the incidence and 30-day mortality rate of patients with pyogenic liver abscess in Denmark. METHODS: Using nationwide administrative registers, we identified all patients diagnosed with pyogenic liver abscess in Denmark, 1977-2002, and their dates of death. We computed annual standardized incidence and 30-day mortality rates, and used Poisson regression to adjust gender-specific mortality rates for year-by-year differences in age at diagnosis. RESULTS: We identified 1448 patients with pyogenic liver abscess, of whom 54% were men. The crude incidence rate for the entire study period was 11.8 per 1,000,000 for men and 9.7 per 1,000,000 for women. Between 1977 and 2002, the incidence rate increased from 6 to 18 per 1,000,000 for men and from 8 to 12 per 1,000,000 for women. The cumulative 30-day mortality rate was 15% for men and 23% for women. The adjusted 30-day mortality rate decreased from 40% for men and 50% for women to around 10% for both genders. CONCLUSIONS: In this large nationwide study spanning a 26-year period, we found an increasing incidence rate and a decreasing mortality rate of pyogenic liver abscess. We believe that these changes are primarily explained by more sensitive diagnostic tools. (+info)
Lemierre's syndrome: Porphyromonas asaccharolytica as a putative pathogen.
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A case of Lemierre's syndrome is reported in which metastatic abscesses resulted from septic thrombophlebitis of the internal jugular vein secondary to bacterial pharyngitis. A 32-year-old male suffering from a painful left-sided neck mass, sore throat, and fever was admitted to our hospital. Computed tomography revealed thrombosis of the left internal jugular vein, septic pulmonary emboli, and a liver abscess. Blood culture showed Porphyromonas asaccharolytica. Although empyema occurred transiently during the treatment, the patient recovered following prolonged antimicrobial therapy. Although Fusobacterium species are a well-known cause of Lemierre's syndrome, cases in whom Porphyromonas species was isolated have scarcely been reported. Moreover, case reports from Japan have been few. (+info)
Genomic heterogeneity in Klebsiella pneumoniae strains is associated with primary pyogenic liver abscess and metastatic infection.
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BACKGROUND: Primary pyogenic liver abscess (PLA) with septic complication by Klebsiella pneumoniae is an emerging infectious disease. METHODS AND RESULTS: Using DNA microarray hybridization, we identified a 20-kb chromosomal region that contained 15 open-reading frames (ORFs), including an iron-uptake system (kfu), a phosphoenolpyruvate sugar phosphotransferase system (PTS), and 6 unknown ORFs. The region was more prevalent among tissue-invasive strains (35/46) than among noninvasive strains (19/98) (P<.0001, chi2 test). To test the role played by this region in pathogenesis, 3 different deletion mutants (NTUH-K2044 [Delta kfu], K2044 [Delta ORF7-9], and K2044 [Delta PTS]) were constructed. Only the Delta kfuABC mutants showed decreased virulence in mice, compared with the wild-type strain. An in vitro assay confirmed the involvement of kfu in iron acquisition. There was a high correlation rate (85%) between the kfu/PTS region and 2 tissue invasion-associated chromosomal regions (allS and magA). Moreover, all 3 regions were present in strains that caused PLA plus endophthalmitis or meningitis. CONCLUSION: Our results suggest that chromosomal heterogeneity is present in tissue-invasive K. pneumoniae strains. A genotype containing all 3 regions is strongly associated with PLA and metastatic infection. These regions may serve as convenient markers for the rapid diagnosis of emergent tissue-invasive strains. (+info)
Comparison of pyogenic liver abscesses of biliary and cryptogenic origin. An eight-year analysis in a University Hospital.
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OBJECTIVES: The aim of this study is to delineate the clinical features of pyogenic liver abscesses of biliary and cryptogenic origin, and to compare the differences in outcome of patients between the two groups. METHODS: We studied 86 patients, aged 19 years or older, with pyogenic liver abscess admitted to Chung Shan Medical University Hospital, Taichung, Taiwan, between January 1996 and December 2003. The demographic data and medical information of the patients were reviewed and recorded. Of the 86 patients, 34 were classified into the biliary group and 52 were classified into the cryptogenic group. RESULTS: Patients with pyogenic liver abscesses of biliary origin had a higher frequency of underlying malignancy and Murphy's sign compared to those with pyogenic liver abscesses of cryptogenic origin. With respect to specific pathogens, Escherichia coli were more prevalent in the biliary group while Klebsiella pneumoniae were more prevalent in the cryptogenic group. Anaerobic isolates were less frequently cultured in the cryptogenic group than in the biliary group. After adjustment for age, sex, and the duration of symptoms before admission, there was no difference in mortality between both groups (biliary vs cryptogenic: 15% vs 8%; adjusted OR, 1.43; 95% CI, 0.24-8.25; p = 0.899). After adjustment for confounders, patients in the biliary group had higher frequencies of time to defervesce >1 week after admission (68% vs 40%; adjusted OR, 3.05; 95% CI, 1.09-9.04, p = 0.030) and hospital stay >3 weeks (47% vs 15%; adjusted OR, 4.34; 95% CI, 1.45-13.91; p = 0.007) than those in the cryptogenic group. CONCLUSIONS: This report highlights that pyogenic liver abscesses of cryptogenic origin had a benign clinical response, which was associated with shorter duration of hospitalisation and time to defervesce after admission, compared to those of biliary origin. (+info)