Pyogenic Liver Abscess: A Retrospective Study of 105 Cases in an Emergency Department from East China

Clinical characteristics and management of 106 patients with pyogenic liver abscess in a traditional Chinese hospital

This is a retrospective study of clinical data from 106 patients with pyogenic liver abscess (PLA) treated in a traditional Chinese hospital during the eight years preceding this publication. We aimed to provide evidence to improve the diagnosis accuracy and the treatment strategies for PLAs. We collected records of patients treated at the Guangxing Hospital, which is affiliated to the Zhejiang Traditional Chinese University in Hangzhou, and we collected their general background information, laboratory and imaging features, and clinical manifestations and outcomes to perform a retrospective analysis. Diabetes mellitus (45.3%, 48/106), biliary calculi (36.8%, 39/106), and history of abdominal surgery (15.1%, 16/106) were the three most common PLA risk factors present in our cohort. Fever and chills (95.3%, 101/106), right upper quadrant pain/epigastric discomfort (68.9%, 73/106), nausea and vomiting (38.8%, 41/106), and cough and sputum (14.2%, 15/106) were the most common clinical manifestations of PLA. Most patients had the abscesses in the right liver lobe, and the most commonly found bacteria were Klebsiella pneumoniae (54.8%, 42/76), Escherichia coli (35.1%, 27/76), and Streptococcus pneumoniae (3.9%, 3/76). Liver Doppler ultrasound is a conventional and effective method to identify liver abscesses. Most patients were treated using a percutaneous puncture under B-ultrasound guidance. Most patients (n = 104 or 98.1%) were cured, one patient (0.9%) died, and one was discharged with multiple abscesses post treatment.

Evaluation of the Diagnostic Performance of mNGS in Detecting Intra-Abdominal Infections of the Emergency Department Patients

Purpose

Intra-abdominal infections (IAI) are gradually becoming common in the emergency department, though the incidence is low and the prognosis is fair, as the symptoms are similar to other intra-abdominal diseases, rapid and accurate diagnosis of the causative agents is essential for clinical management. This study aimed to evaluate the diagnostic performance of metagenomic next-generation sequencing (mNGS) in detecting IAI in the emergency department.

Patients and Methods

This was a retrospective, single-centered study including patients admitted to the emergency department from January 1st, 2021 to August 31st, 2022 with diagnosis of IAI. The comparison between mNGS and microbial culture using paracentesis fluid samples was performed to evaluate the diagnostic performance of mNGS for IAI. Meanwhile, paracentesis fluid and peripheral blood mNGS were compared to explore the sample specificity. Further, the microbial community structure of the patients with pyogenic liver abscesses (PLA) was analyzed.

Results

Thirty-four IAI patients including 23 with pyogenic liver abscesses (PLA), 3 with parapancreatic abscesses, and 8 with other IAI were included in this study. Compared with the conventional microbial culture of paracentesis fluid, mNGS using paracentesis fluid detected more positive cases of IAI (93.75% vs 81.25%), and identified more species of pathogens, especially in obligate anaerobes and viral pathogens. Peripheral blood mNGS presented a relatively high consistency with the paracentesis fluid mNGS (91% mutual positive). The microbial community structure of PLA patients with diabetes is less diverse than that of those without diabetes. Patients with diabetes are at high risk of PLA caused by Klebsiella pneumonia.

Conclusion

mNGS has advantages in detecting IAI in the emergency department, and peripheral blood mNGS can be a non-invasive choice for early diagnosis.

Varicella-zoster virus meningitis coincident with bacteremia caused by liver abscess: a case report

Varicella-zoster virus (VZV) meningitis is sometimes associated with herpes zoster, which is also associated with various other infectious diseases. However, there are limited case reports of VZV meningitis with concomitant infectious diseases. Herein, we report a unique case of VZV meningitis concomitant with a pyogenic liver abscess. VZV meningitis was associated with herpes zoster ophthalmicus, Klebsiella pneumoniae bacteremia, and liver abscess. When VZV meningitis is suspected, clinicians should be aware of its relatively rare epidemiology, nonspecific presentation, and many background risks shared with other infections and should never omit thorough examinations to rule out other infectious causes.

Point-of-care ultrasound diagnosis of a pyogenic liver abscess in the emergency department

Pyogenic liver abscess (PLA) is a rarely encountered condition in the emergency department (ED) that necessitates a timely diagnosis by the emergency physician. An early ED diagnosis is challenging as the presenting symptoms of PLA are often variable and nonspecific. The rapid bedside diagnosis of PLA with point-of-care ultrasound (POCUS) performed by emergency physicians has not been investigated thoroughly. This case report describes the expeditious identification and ED management of PLA by implementing emergency physician-performed POCUS as the initial diagnostic modality.

Pyogenic and Amebic Infections of the Liver

Pyogenic liver abscesses are classified by the bacteria that have caused the abscess because this guides treatment and can point to the underlying cause. The most common cause is biliary disease. The diagnosis is made by imaging. Treatment is a combination of antibiotics and percutaneous drainage. Amebic liver abscess is caused by extraintestinal spread of Entamoeba histolytica. E histolytica is spread by fecal-oral transmission and typically colonizes the gastrointestinal tract. It is diagnosed based on imaging and the mainstay of treatment is metronidazole. Only about 15% of cases require percutaneous drainage. The prognosis is good, with almost universal recovery.

Management of pyogenic liver abscess: a South Australian experience

BACKGROUND

There have been declining mortality rates associated with pyogenic liver abscess (PLA) in recent decades due to improvements in percutaneous drainage techniques, access to imaging and improvements in supportive care. The aim of this study was to analyse the aetiology, management and outcome of PLA at a tertiary hospital in Adelaide.

METHODS

Data was collected retrospectively from 80 patients who were admitted with a PLA between 2011 and 2018. The data points covered demographic variables, presumed aetiology, microbiology results, abscess imaging characteristics, interventions, antibiotic treatment, complications and mortality.

RESULTS

The majority of patients were Caucasian (86%) and the most common predisposing conditions were biliary tract disease (39%), intra-abdominal infection (20%) and diabetes (18%). Escherichia coli (21%), Klebsiella species (18%), Streptococcus anginosus group (14%) and anaerobes (18%) were the most frequent pathogens isolated. Fifty-one percent of patients were bacteraemic. Percutaneous catheter insertion (45%) was the most common form of drainage followed by percutaneous aspiration (13%), surgery (11%) and endoscopic retrograde cholangiopancreatography (6%), while 25% of patients did not undergo any form of drainage. Twenty-four patients (30%) suffered a complication with the highest proportion occurring in the medically managed group. The overall mortality rate was 9% with only 1% mortality rate attributable to PLA.

CONCLUSION

This study demonstrates a continued preference for percutaneous drainage techniques over surgery in the management of PLA. A significant proportion of patients did not undergo abscess drainage and the risk of subsequent complications appeared to concentrate in this group, although the mortality rate from PLA was low.

Next generation sequencing-guided anti-infective therapy of large liver abscess due to Edwardsiella tarda: a case report

Background

Liver abscess is a potentially fatal disease, however identification of its causative pathogen remains challenging, which is crucial for guiding appropriate antibiotic therapy. To the best of our knowledge, the use of plasma next-generation sequencing (NGS) based pathogen analysis in patients with liver abscess has never been reported.

Case presentation

We report a case with large liver abscess due toEdwardsiella tardathat was diagnosed by the plasma-based NGS assay within 24 h. After a 2-week single agent anti-infection therapy, the patient completely recovered. A second NGS assay following anti-infection therapy failed to detect the pathogenic DNA. Follow-up magnetic resonance imaging (MRI) of the abdomen on 1 month and 3 months showed a gradually decrease in size of the liver abscess, and the 6-month MRI showed that the abscess disappeared completely.

Conclusions

Our data indicated that the plasma NGS test can sensitively and minimal-invasively detect pathogens within a clinically actionable timeframe, and antibiotic alone is an alternative to first-line treatment for large liver abscess with the aid of NGS for accurate detection of the pathogenic bacterial genome.

A comparison of pyogenic liver abscess in patients with or without diabetes: a retrospective study of 246 cases

Background

Pyogenic liver abscess(PLA) has become common in patients with diabetes mellitus (DM), but it is unclear whether differences exist between patients with and without DM. A retrospective study was performed to identify these differences, summarize the clinical experience, and improve the diagnosis and treatment of PLA.

Methods

The patients were enrolled in a teaching hospital from January 2012 to December 2016. The patients were separated into two groups based on comorbidity with diabetes mellitus (DM). The DM group was further separated into two subgroups according to the HbA1C concentration to investigate whether glycaemic control affected the clinical characteristics of PLA patients with DM. Chi-square, Fisher’s exact test, and t-tests were used to analyse and evaluate differences between the two groups.

Results

Two hundred and forty-six PLA patients were identified and 90 (36.6%) had comorbid DM. Patients with DM were older, had higher levels of alkaline phosphatase and γ-glutamyl transferase, hypertension, a loss of body weight, a single abscess, and combined antibiotic therapy with the use of carbapenems and Klebsiella pneumoniae in their blood cultures but a less frequent history of abdominal surgery and Escherichia coli in their pus cultures. When DM patients were compared to non-DM patients, each of these differences was significant (P < 0.05). Diabetic PLA patients with poor glycaemic control had a significantly higher proportion of fever and both lobes abscess(P < 0.05).

Conclusion

PLA patients with diabetes are older, have more serious complications, a higher prevalence of cardiovascular disease, an increased use of combined antibiotic therapy with carbapenem, and K. pneumoniae as the predominant pathogen, but these patients had fewer abdominal surgeries and fewer E. coli infections. In addition, poorly controlled glycaemia in diabetic PLA patients is associated with high incidence of fever and both lobes abscess.

Denture-Associated Oral Microbiome and Periodontal Disease Causing an Anaerobic Pyogenic Liver Abscess in an Immunocompetent Patient: A Case report and Review of the Literature

Pyogenic liver abscesses (PLA) develop from the spread of infection through the portal circulation, biliary infections or arterial hematogenous seeding in the setting of systemic infections. PLA are often poly-microbial and are uncommonly reported to be due to anaerobic species. We report the case of a previously healthy, immunocompetent 63-year-old man with hepatic abscesses as a result of Fusobacterium nucleatum periodontal disease. In addition, a systemic review of the literature is performed. Fusobacterium is a very rare cause of PLA in immunocompetent hosts with only a handful of cases reported in the literature. Although anaerobic infections such as Fusobacterium most often occur in immunocompromised individuals, clinicians should have a high index of suspicion in immunocompetent patients with periodontal disease or chronic stomatitis.

Characteristics and management of pyogenic liver abscess: A European experience

Pyogenic liver abscess (PLA) are space-occupying lesions in the liver associated with high morbidity and mortality. The aim of this study is to review an Italian hospital experience in epidemiological, clinical patterns, and management of PLA.We performed a retrospective, descriptive case series at a single center assessing demographic characteristics, presentation patterns, etiological factors, microbiological etiology, and management for patients treated for PLA between 2000 and 2016.Around 109 patients were identified. The majority of patients presented with fever (73%); right upper abdominal pain in 63.3%, vomiting and nausea in 28.4%. The most common laboratory abnormality among included items was increased C-reactive protein and fibrinogen blood levels, respectively, in 98% and 93.9% of cases. Abdominal ultrasound was the diagnostic investigation in 42.4% of cases; CT scan and MR imaging were performed in 51.1% and 3.3% of cases respectively. We observed blood or pus culture study in 99 cases of which only 53.5% came with positive microbial reports. The most common organism identified was Escherichia coli (26.5%), followed by Streptococcus spp (13.2%). Early antibiotic treatment started on all patients and 66.7% of cases required different approaches, Ultrasound or CT-guided needle aspiration of PLA was performed in 13 patients (11%) and percutaneous abscess drainage was performed on 72 patients (67%).PLA is a diagnostically challenging problem due to nonspecific presenting characteristics. The microbiological yield identified was a typical European spectrum with a preponderance of Escherichia coli infections. Once recognized, percutaneous drainage and antibiotic treatment are the mainstay of management for PLA.

Effect of lipopolysaccharide on proliferation, secretion and ultrastructure of murine liver Kupffer cells under high glucose conditions

AIM

To investigate the effect of lipopolysaccharide (LPS) on the proliferation, secretion and ultrastructure of liver Kupffer cells (KCs) under high glucose conditions.

METHODS

Murine liver KCs were cultured, amplified, and then randomly divided into a high glucose group [(HG), 25.0 mmol/L D-glucose], a normal glucose group [(CON), 11.1 mmol/L D-glucose], a LPS + high glucose group [(LPS-HG), 25.0 mmol/L D-glucose], and a LPS + normal glucose group [(LPS-CON), 11.1 mmol/L D-glucose)]. The KCs in each group were cultured for 24 h, and then LPS was added for the LPS-HG and LPS-CON groups. After 6 h of continuous cultivation, cell proliferation and cell cycle were detected by MTT colorimetric assay and flow cytometry, respectively. Cell supernatants were collected to determine the levels of tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β and IL-6 by Luminex xMAP technique. The ultrastructure of KCs was observed by transmission electron microscopy (TEM).

RESULTS

MTT colorimetric assay showed that the optical density (OD) of murine liver KCs treated with LPS for 6 h under high glucose conditions increased significantly, but the OD values decreased significantly in the HG and LPS-HG groups compared with those of the CON and LPS-CON groups (P < 0.05). Flow cytometry revealed that high glucose arrested the cell cycle in G0/G1 phase; the percentage of G0/G1 phase cells decreased and that of S + G2/M phase cells increased significantly (P < 0.01) after KCs were treated with LPS for 6. The Luminex xMAP assay showed that the levels of TNF-α, IL-1β and IL-6 increased significantly after murine liver KCs were treated with LPS for 6 h under high glucose conditions, and the changes in TNF-α and IL-1β were more obvious. TEM revealed obvious ultrastructural alterations of KCs treated with LPS for 6 h under high glucose conditions. A large number of autophagosomes were observed in the LPS-HG group, and only few were noted in the HG group. Only vacuolar degenerations were visible in the CON and LPS-CON groups.

CONCLUSION

LPS can activate and enhance the proliferation and secretion of murine liver Kupffer cells under high glucose conditions. Both LPS and hyperglycemia can induce ultrastructural alterations of KCs including autophagy.