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Chin WV, Khaw MJ. Gas Forming Pyogenic Liver Abscess Diagnosed by Point of Care Ultrasound. POCUS JOURNAL 2024; 9:41-43. [PMID: 38681154 PMCID: PMC11044940 DOI: 10.24908/pocus.v9i1.16854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Gas-forming pyogenic liver abscess (GFLPA) carries a high mortality rate. Early identification of the source of infection in sepsis results in better survival. Bedside point of care ultrasound (POCUS) can be used to help localize a source of infection. A 59-year-old man presented with systemic inflammatory response syndrome (SIRS) and was diagnosed with GFLPA on the initial encounter via clinical assessment and POCUS examination. After commencing antibiotics, optimal glucose control, adequate fluid resuscitation, and early infective source control, he achieved full recovery and was followed up in outpatient medical and surgical clinics. This case illustrates the role of POCUS as a diagnostic tool in sepsis and raises awareness among clinicians to recognize the features of GFLPA on POCUS.
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Affiliation(s)
- Wei Ven Chin
- Acute Internal Medicine, Sarawak General HospitalSarawakMalaysia
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2
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Wu L, Mo C, Xiong Y, Chen Y, Jin M, Han K, Fu X. Klebsiella pneumoniae invasive syndrome with pneumocephalus and extensive cerebral infarction: Case report. Heliyon 2024; 10:e25745. [PMID: 38380024 PMCID: PMC10877252 DOI: 10.1016/j.heliyon.2024.e25745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 01/12/2024] [Accepted: 02/01/2024] [Indexed: 02/22/2024] Open
Abstract
A 54-year-old female with diabetes was admitted with fever and altered consciousness. Laboratory tests revealed venous blood glucose level of 43.79 mmol/L. Computed tomography (CT) scans of the head, chest, and abdomen showed a right-sided pneumothorax, consolidation, and atelectasis in the right lung; a large heterogeneous density lesion with fluid and gas-fluid levels in the liver; and scattered gas shadows in both kidneys, respectively. Blood and puncture fluid cultures indicated infection with Klebsiella pneumoniae. Based on the susceptibility profiles of the isolates, imipenem was administered intravenously to treat the infection. On the third day of hospitalization, the patient's condition worsened, with head CT showing an extensive cerebral infarction and multiple gas accumulations in the right cerebral hemisphere, as well as a large-area cerebral infarction in the left parietal and occipital lobes. Ultimately, the patient died of multiple organ dysfunction on the fourth day after initial presentation. Although the Klebsiella pneumoniae isolates from the patient showed sensitivity to imipenem, this antibiotic shows poor entry into the central nervous system. The death of the patient indicates that the selection of antibiotics that can cross the blood-brain barrier may be crucial in the outcome of this type of case. Therefore, antibiotics that can penetrate the blood-brain barrier should be selected as soon as possible, and empirical treatment must be initiated immediately after clinical suspicion of invasive Klebsiella pneumoniae, even if the diagnosis has not been determined.
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Affiliation(s)
- Liangzhe Wu
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Changhong Mo
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Yihan Xiong
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Yanhui Chen
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Meng Jin
- Department of Intensive Care Unit, Shenzhen People's Hospital, 518020, Shenzhen, China
| | - Kunning Han
- The Second Clinical Medical College, Jinan University, 518020, Shenzhen, China
| | - Xuejun Fu
- Department of Neurology, Shenzhen People's Hospital, 518020, Shenzhen, China
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Ojuka A, Lesetedi C, Jabo C, Mompati KF. Raptured gas forming pyogenic liver abscess with a biliary fistula in Botswana: a case report. Pan Afr Med J 2023; 46:107. [PMID: 38435408 PMCID: PMC10908293 DOI: 10.11604/pamj.2023.46.107.42256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 03/05/2024] Open
Abstract
We report a case of gas-forming pyogenic liver abscess (GFPLA) with a ruptured abscess and biliary fistula presenting with peritonitis. The patient had poorly controlled diabetes mellitus and was extremely ill at presentation. The diagnosis was delayed until the abscess ruptured, owing to nonspecific abdominal symptoms at the initial presentation and delayed follow-up radiological investigations. The patient had a high-output biliary fistula post-operatively, which was managed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting with fistula drainage reduction within four weeks. This case highlights the need for follow-up radiological investigations and prompt intervention in patients with diabetes mellitus presenting with fever and vague abdominal pain.
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Chen W, Fang M, Chen C. Gas embolism caused by gas-forming pyogenic liver abscess. J Transl Int Med 2023; 11:189-192. [PMID: 37408572 PMCID: PMC10318918 DOI: 10.2478/jtim-2023-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Affiliation(s)
- Weisheng Chen
- Department of Emergency Intensive Care Unit, Huizhou Third People’s Hospital, Guangzhou Medical University, Huizhou516000, Guangdong Province, China
| | - Miaoxian Fang
- Department of Intensive Care Unit of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou510080, Guangdong Province, China
| | - Chunbo Chen
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou510080, Guangdong Province, China
- Department of Critical Care Medicine, Maoming People's Hospital, Maoming525000, Guangdong Province, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou510080, Guangdong Province, China
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Lo YN, Wu JS, Chiang HC. A Pseudo-Gastric Bubble. Gastroenterology 2023; 165:e16-e18. [PMID: 36966940 DOI: 10.1053/j.gastro.2023.03.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Yi-Ning Lo
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Juei-Seng Wu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Hsueh-Chien Chiang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Tran M, Tran P. Giant Klebsiella pneumoniae pyogenic liver abscess in the left liver lobe presenting with dyspepsia and vaginal discharge. BMJ Case Rep 2023; 16:e254474. [PMID: 37185248 PMCID: PMC10151981 DOI: 10.1136/bcr-2022-254474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Pyogenic liver abscess (PLA) commonly occurs in the right liver lobe, causing the typical symptoms of fever and right upper quadrant pain. Less than one-third of cases occur in the left lobe. We describe an unusual presentation of a giant left-sided PLA that was compressing the stomach and surrounding venous vasculature, causing the respective symptoms of gastro-oesophageal reflux and vaginal discharge from secondary pelvic congestion syndrome. CT revealed a solitary 14 cm×10 cm×10 cm multiloculated lesion, replacing most of the left liver lobe. It was successfully treated with intravenous antibiotics and percutaneous drainage, resulting in complete resolution at 1-year follow-up. This case explores the predisposing risk factor of diabetes in PLA and its association with Klebsiella pneumoniae, which was the offending pathogen in our patient. We also discuss the phenomenon of secondary pelvic venous congestion syndrome and compare similar cases of left-sided PLA, highlighting the different modes of presentation and treatment options.
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Affiliation(s)
- Melanie Tran
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Patrick Tran
- Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Liu Y, Liu J, Fu L, Jiang C, Peng S. Demographics and Clinical Outcomes of Culture-Positive versus Culture-Negative Pyogenic Liver Abscess in an Asian Population. Infect Drug Resist 2023; 16:903-911. [PMID: 36814829 PMCID: PMC9940495 DOI: 10.2147/idr.s395428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/12/2023] [Indexed: 02/17/2023] Open
Abstract
Objective Despite its high case-fatality risk, pyogenic liver abscess (PLA) lacks clear management guidelines in patients with negative microbial cultures. Our aim was to evaluate differences in clinical characteristics between patients with culture-negative liver abscess (CNLA) and those with culture-positive liver abscess (CPLA), and identify differences in the main causative pathogen. Methods In this study, we retrospectively collected medical records of PLA patients admitted to a teaching hospital from January 2010 to December 2019. Results In total, 324 PLA patients were enrolled in this study. Of these, 202 (62.3%) cases were confirmed cultural positive, including 109 patients (54%) and 20 (9.9%) patients infected with Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E.coli), respectively. Patients in the CPLA group were older (p=0.029) and had higher prevalence of abscesses larger than 5 cm in diameter (p = 0.003), gas-forming rate (p = 0.016), and percutaneous drainage (p < 0.001) compared with CNLA group. Patients with CPLA had significantly longer hospitalizations than those with CNLA (p = 0.010). Nevertheless, there was no significant difference in in-hospital mortality between the two groups (p = 0.415). Compared with patients with E. coli, those with K. pneumoniae had higher incidence of diabetes mellitus (p = 0.041), solitary abscess (p < 0.001), localization in the right hepatic lobe (p = 0.033), abscess size larger than 5 cm (p < 0.001) and percutaneous drainage (p = 0.002), but mortality was not significantly different (p = 1.000). Conclusion No significant difference in in-hospital mortality was found between patients with CNLA and those with CPLA group. However, clinical characteristics and management were different between the main causative pathogens, including K. pneumoniae and E. coli.
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Affiliation(s)
- Yao Liu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Jinqing Liu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Lei Fu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Chuan Jiang
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Shifang Peng
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Key Laboratory of Viral Hepatitis of Hunan Province, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Correspondence: Shifang Peng, Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People’s Republic of China, Email
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A Case of Complicated Liver Abscess in the Emergency Department. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Alzibdeh AH, Alamami AA, Adam M, Almaslamani M, Hadi HA. A complex presentation of an uncommon disease: Gas-forming pyogenic liver abscess complicated by septic pulmonary emboli and muscle abscesses, a case report and review of the literature. IDCases 2022; 31:e01673. [PMID: 36632483 PMCID: PMC9827024 DOI: 10.1016/j.idcr.2022.e01673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background Pyogenic liver abscess (PLA) is the most common type of visceral abscess. Its variable clinical presentation depends on patient demography, underlying conditions, causative pathogens as well as the size of the abscess. Most cases are secondary to enteric pathogens that cause focal liver disease. Gas-forming pyogenic liver abscess (GFPLA) is a rare subgroup of PLA characterized by the presence of gas within the abscess. The disease is associated with diabetes mellitus (DM) while Klebsiella penumoniae is the most frequently isolated pathogen. Despite appropriate evaluation and management, secondary complications are common with significant morbidity and mortality that necessitate prompt recognition and management. Case presentation We present a case of a 46-year-old gentleman from Bangladesh who presented to the emergency department with fever, chills, and right upper quadrant abdominal discomfort. Evaluation revealed elevated inflammatory markers with high blood glucose and a subdiaphragmatic lucency on a plain chest radiograph. The suspected underlying visceral infection was confirmed by abdominal ultrasonography and computed tomography which demonstrated an emphysematous abscess of 8 cm in diameter in the right liver lobe.Because of clinical instability, the patient was admitted to the medical intensive care unit (MICU) where he received appropriate supportive management with antimicrobials and percutaneous drainage of the abscess. Cultures collected from blood, the abscess, and urine grew a sensitive strain of Klebsiella pneumoniae. During his stay in the MICU, he complained of dyspnea. A CT pulmonary angiography was suggestive of septic emboli. A few days later, the patient started to complain of left gluteal pain and an US revealed a deep left gluteal abscess which required drainage. Cultures of the pus grew the same sensitive strain of Klebsiella pneumoniae. After receiving 6 weeks of parenteral antimicrobial therapy a repeated US revealed complete resolution of the abscess in the liver. Outpatient follow up showed favorable recovery. Conclusion Gas-forming pyogenic liver abscess (GFPLA) is a rare manifestation of pyogenic liver abscess that usually occurs in patients with poorly controlled DM. Despite appropriate evaluation, morbidity remains high therefore timely recognition and anticipation of complications is important.
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Affiliation(s)
- Aseel H. Alzibdeh
- Communicable Diseases Centre, Hamad Medical Corporation, Qatar,Weill Cornell Medicine Qatar, Qatar,Correspondence to: Hamad Medical Corporation, P O Box 3050, Doha, Qatar.
| | - Ans A. Alamami
- Department of Critical Care, Hamad General Hospital, Hamad Medical Corporation, Qatar
| | - Mohammad Adam
- Communicable Diseases Centre, Hamad Medical Corporation, Qatar
| | - Muna Almaslamani
- Communicable Diseases Centre, Hamad Medical Corporation, Qatar,Weill Cornell Medicine Qatar, Qatar
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Chan KS, Junnarkar SP, Low JK, Huey CWT, Shelat VG. Aging is Associated with Prolonged Hospitalisation Stay in Pyogenic Liver Abscess-A 1:1 Propensity Score Matched Study in Elderly Versus Non-Elderly Patients. Malays J Med Sci 2022; 29:59-73. [PMID: 36474543 PMCID: PMC9680999 DOI: 10.21315/mjms2022.29.5.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Mortality of pyogenic liver abscess (PLA) is high ranging 10%-40%. Old age predicts outcomes in many diseases but there is paucity of data on PLA outcomes. We aim to compare the morbidity and mortality between elderly and non-elderly in PLA. METHODS This is a retrospective study from 2007-2011 comparing elderly (≥ 65 years old) and non-elderly (< 65 years old) with PLA. A 1:1 propensity score matching (PSM) was performed. Baseline clinical profile and outcomes were compared. RESULTS There were 213 patients (elderly patients = 90 [42.3%], non-elderly patients = 123 [57.7%]). Overall median age is 62 (interquartile range [IQR] = 53-74) years old. PSM resulted in 102 patients (51 per arm). Length of hospitalisation stay (LOS) was significantly longer in elderly patients in both unmatched (16 [IQR = 10-24.5] versus 11 [IQR = 8-19] days; P < 0.001) and matched cohorts (17 [IQR = 13-27] versus 11 [IQR = 7-19] days; P = 0.001). In-hospital mortality was significantly higher in elderly patients in the unmatched cohort (elderly patients = 21.1%, non-elderly patients = 7.3%; P = 0.003) but was insignificant following PSM (elderly patients = 15.7%, non-elderly patients = 9.8%; P = 0.219). Duration of antibiotic therapy and need for percutaneous drainage (PD) were comparable before and after PSM. CONCLUSION Age ≥ 65 years old is associated with longer LOS. In-hospital mortality though higher in elderly patients, was not statistically significant.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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van der Mark M, Hartslief M. Massive emphysematous pancreatitis associated with duodenal microperforation. J Surg Case Rep 2022; 2022:rjac392. [PMID: 36118994 PMCID: PMC9473518 DOI: 10.1093/jscr/rjac392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
Emphysematous pancreatitis (EP) is a rare variant of necrotizing pancreatitis which may result from bacterial superinfection of pancreatic tissue with gas-forming organisms such as Escherichia coli and Klebsiella pneumoniae. Gas formation is a consequence of mixed acid fermentation by these species, which may colonize the inflamed pancreatic tissue by intestinal translocation, hematogenous spread or direct seeding by penetrating ulcer. Previously described cases of EP associated with penetrating ulcer are exceedingly rare and typified by focal emphysema confined to the site of fistulation, often the head of pancreas. We present a case of massive emphysematous pancreatitis with pseudoaneurysm involvement and associated duodenal microperforation. Furthermore, we describe the successful operative management of this patient, who remains well in the community.
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Affiliation(s)
| | - Merwe Hartslief
- Department of General Surgery, Cairns Hospital , Queensland , Australia
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12
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Chen G, Tuan S, Ou T. Unusual abdominal gas bubbles in a middle‐aged diabetic female. ADVANCES IN DIGESTIVE MEDICINE 2022. [DOI: 10.1002/aid2.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Guan‐Bo Chen
- Department of Internal Medicine Kaohsiung Armed Forces General Hospital Kaohsiung Taiwan
| | - Sheng‐Hui Tuan
- Department of Rehabilitation Medicine Cishan Hospital, Ministry of Health and Welfare Kaohsiung Taiwan
- Department of Physical Therapy Shu‐Zen Junior College of Medicine and Management Kaohsiung Taiwan
| | - Tzu‐Ming Ou
- Department of Internal Medicine Kaohsiung Armed Forces General Hospital Kaohsiung Taiwan
- Division of Gastroenterology, Department of Internal Medicine Tri‐Service General Hospital, National Defense Medical Center Taipei Taiwan
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Nayak AR, Ramadoss R, Ramanathan V, Honnarudraiah NK. Emphysematous Liver Abscess and Disseminated Hypervirulent Klebsiella pneumoniae Infection in a Patient from Southern India. Indian J Crit Care Med 2022; 26:381-383. [PMID: 35519904 PMCID: PMC9015942 DOI: 10.5005/jp-journals-10071-24131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The pyogenic liver abscess is usually polymicrobial and is seen as a complication of biliary disease or peritonitis. Over the past three decades, monomicrobial liver abscess caused by Klebsiella pneumoniae is being increasingly reported from South East Asian countries like Taiwan and Korea. It is a community-acquired infection caused by a distinct strain, hypervirulent K. pneumoniae, different from classical strain related to the healthcare-associated Klebsiella infections. Diabetes mellitus is a significant risk factor. Reports of the disseminated infection due to hypervirulent Klebsiella are very few in Indian literature. We report the successful management of a diabetic patient with emphysematous liver abscess, brain abscess, and meningitis caused by hypervirulent K. pneumoniae infection.
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Affiliation(s)
- Amiya R Nayak
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ramu Ramadoss
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
- Ramu Ramadoss, Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, Phone: +91 9910952320, e-mail:
| | - Venkateswaran Ramanathan
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Niveditha K Honnarudraiah
- Department of Radiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Maliyakkal AM, Naushad VA, Al Mokdad OI, Hanana F, Basheer SM, Palaki JA. Gas Under Diaphragm: A Rare Case of Ruptured Liver Abscess With Gas Forming Organism. Cureus 2022; 14:e21672. [PMID: 35242462 PMCID: PMC8884540 DOI: 10.7759/cureus.21672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/07/2022] Open
Abstract
Acute abdominal pain with free air under the diaphragm visible on chest/abdomen X-ray (pneumoperitoneum) is a medical emergency. Most of such cases of pneumoperitoneum are attributable to perforated hollow viscus; however, other possibilities like rupture of liver abscess (by a gas-forming organism) also need to be considered. Further imaging like a CT scan might help in the diagnosis and would also obviate the need for laparotomy in some of such cases. We report a case of acute abdominal pain with gas under the diaphragm due to a ruptured liver abscess caused by Klebsiella pneumoniae. The patient was managed successfully with ultrasound-guided percutaneous aspiration and insertion of a drain along with antibiotics and supportive measures, and no laparotomy was performed.
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15
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A Case of Nonclostridial Gas-Producing Soft Tissue Infection in a Neutropenic Leukemia Patient With Literature Review. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2022. [DOI: 10.1097/ipc.0000000000001099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Wu N, Yu YS, Zhang Y. Gas-forming pyogenic liver abscess due to Klebsiella pneumonia. Rev Soc Bras Med Trop 2022; 55:e0635. [PMID: 35239916 PMCID: PMC8909450 DOI: 10.1590/0037-8682-0635-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/17/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Na Wu
- Shanghai Jiao Tong University, China
| | | | - Yi Zhang
- Shanghai Jiao Tong University, China
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17
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Ruptured Emphysematous Liver Abscess: An Unusual Presentation in Kochs. Clin Pract 2021; 11:200-204. [PMID: 33918109 PMCID: PMC8167796 DOI: 10.3390/clinpract11020029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/30/2021] [Accepted: 02/24/2021] [Indexed: 12/03/2022] Open
Abstract
Gas forming liver abscess (GFLA) though rare is seen in diabetic patients. Rupture of such abscesses usually requires surgical intervention. These cases are associated with high morbidity and mortality due to sepsis. Tuberculous liver abscesses are more often silent in presentation. GFLA formed in the background of a tuberculous liver abscess is rare. We present a case of ruptured GFLA with underlying tuberculous pathology in a normoglycemic patient. The abscess was managed by image guided intervention. A brief case report along with review of literature is presented.
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18
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C S N, K L H. Unusual pneumoperitoneum secondary to ruptured liver abscess-A case report. Int J Surg Case Rep 2021; 80:105499. [PMID: 33609947 PMCID: PMC7903301 DOI: 10.1016/j.ijscr.2020.12.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 11/30/2022] Open
Abstract
Pneumoperitoneum secondary to ruptured gas containing pyogenic liver abscess is rare. Klebsiella is frequently associated with gas-forming abscesses. Ultrasound and CT are the mainstays of diagnostic modalities for hepatic abscess. Surgery is essential to drain the abscess and to clean the contaminated abdominal cavity for a ruptured abscess.
Introduction Pyogenic liver abscess is important cause of hospitalization and life threatening disease in low-middle income countries. Clinical spectrum of ruptured GFPLA can mimic hollow viscus perforation as it usually accompanied by pneumoperitoneum and peritonitis. Case presentation We reported here a case with pneumoperitoneum caused by ruptured liver abscess in a 27-year-old man with a history of uncontrolled type II diabetes mellitus. He had an abdominal pain, distension of abdomen associated with a high fever. Patient was diagnosed peritonitis and pneumoperitoneum presumed to be secondary to perforation of a hollow viscus and subjected to emergency laparotomy. We did not find any gastrointestinal perforation. Surprisingly, we detected a ruptured liver abscess in the right lobe of the liver.. The patient was in septic shock and hence shifted to ICU with inotropic support. Antibiotic therapy was started according to pus culture sensitivity. Even with the above treatment patient was not improved and on 4th postoperative day the patient collapsed and declared dead. Discussion Pneumoperitoneum secondary to ruptured gas containing pyogenic liver abscess is rare and could represent as life threatening infection. It should be distinguished from perforation of hollow organ by clinical symptoms and image examinations, particularly like CT. Accurate diagnosis with adequate drainage and antibiotic therapy would bring good outcome. Conclusion We are aware that not every case of pneumoperitoneum is attributable to a perforated hollow viscus. A rapid and prompt surgical intervention with appropriate antibiotics are essential to save a life.
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Affiliation(s)
- Nagamallesh C S
- Dept of General Surgery, Sapthagiri Institute of Medical Sciences & Research Centre, Karnataka, 570001, India.
| | - Harish K L
- Dept of General Surgery, Sapthagiri Institute of Medical Sciences & Research Centre, Karnataka, 570001, India
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19
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Chan KS, Thng CB, Chan YH, Shelat VG. Outcomes of Gas-Forming Pyogenic Liver Abscess Are Comparable to Non-Gas-Forming Pyogenic Liver Abscess in the Era of Multi-Modal Care: A Propensity Score Matched Study. Surg Infect (Larchmt) 2020; 21:884-890. [PMID: 32216699 DOI: 10.1089/sur.2019.278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Gas-forming pyogenic liver abscess (GFPLA) occurs in 7%-24% of all PLAs and has been associated traditionally with high mortality rates. Studies have suggested that the use of a proactive approach of prompt resuscitation, parenteral antibiotic agents, percutaneous drainage, and a dedicated multi-disciplinary team may improve clinical outcomes. Hence, we aim to investigate whether the clinical outcomes of PLA are determined by gas formation. Methods: This is a retrospective study of patients with PLA from 2007 to 2011. A 1:2 propensity score matching (PSM) analysis was performed using age, co-morbid diabetes mellitus, presence of septic shock, hemoglobin levels, international normalized ratio, creatinine, total bilirubin, positive blood culture and pus culture, and the size of abscess. Baseline demographics, clinical profile, and peri-operative data were compared. Results: There were 213 patients who had PLA: 41 (19.2%) patients had GFPLA and 172 (80.8%) patients had non-GFPLA. The PSM analysis resulted in a total of 108 patients (36 GFPLA and 72 non-GFPLA). Median duration of parenteral antibiotic agents was significantly lower in the GFPLA group (9.5 d vs. 14 d, p = 0.044), but median total duration of antibiotic use was comparable (GFPLA 39 d vs. non-GFPLA 37 d, p = 0.634). Median length of stay (days) did not differ significantly between GFPLA and non-GFPLA (14 vs. 15, p = 0.299). There were no statistically significant differences between GFLPA and non-GFLPA in the need for percutaneous drainage (26/36 (72.2%) vs. 47/72 (65.3%), respectively, p = 0.467) and in-hospital all-cause death (4/36 (11.1%) vs. 7 (9.7%), p = 0.822) Conclusions: Outcomes of GFPLA are comparable to those of non-GFPLA in the era of multi-modal care.
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Affiliation(s)
- Kai Siang Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Yiong-Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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20
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Pham Van T, Vu Ngoc S, Nguyen Hoang NA, Hoang Huu D, Dinh Duong TA. Ruptured liver abscess presenting as pneumoperitoneum caused by Klebsiella pneumoniae: a case report. BMC Surg 2020; 20:228. [PMID: 33028298 PMCID: PMC7542763 DOI: 10.1186/s12893-020-00858-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background Spontaneous gas-forming pyogenic liver abscess (GFPLA) is a rare complication with a high fatality rate in spite of aggressive management. Clinical spectrum of GFPLA can mimic hollow viscus perforation as it usually accompanied by pneumoperitoneum and peritonitis. Up to now, GFPLA has not been well studied in Vietnam. Case presentation We reported here a case with pneumoperitoneum caused by ruptured liver abscess in a 41-year-old man with a history of treated duodenal ulcer and uncontrolled type II diabetes mellitus. He had an epigastric pain associated with a high fever. Patient was diagnosed peritonitis and pneumoperitoneum presumed to be secondary to perforation of a hollow viscus and subjected to emergency laparotomy. We did not find any gastrointestinal perforation. Surprisingly, we detected a 4 cm × 4 cm pus-containing abscess in the left liver lobe of the liver. The abscess was ruptured. Pus was running into abdominal cavity through one hole. The abscess and abdominal cavities were cleaned up and abscess and abdominal drainages were performed. K. pneumoniae was isolated from culture of the abscess. The histopathological examination of the abscess did not yield any evidence of malignancy. Blood glucose levels were controlled. Antibiotic therapy was used according to antibiogram. A reassessment chest X-ray showed no air-fluid level or subdiaphragmatic air by the hospital day 14. Patient eventually made a full recovery and was discharged home 23 days after the operation. Conclusions Ruptured GFPLA is a life-threatening complication. It is usually accompanied by peritonitis and pneumoperitoneum and can imitate hollow viscous perforation. In these cases, CT scan should be performed whenever it is possible to make a correct diagnosis. When the abscess has small size, partial hepatectomy might not be necessary and could be replaced by a careful cleaning and drainage of the abscess. Patient could show a good postoperative recovery following an appropriate antibiotic therapy.
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Affiliation(s)
- Thuong Pham Van
- Department of General Surgery, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Son Vu Ngoc
- Department of General Surgery, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Ngoc Anh Nguyen Hoang
- Department of General Surgery, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Doan Hoang Huu
- Department of General Surgery, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Tung Anh Dinh Duong
- Pediatrics Department, Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam.
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21
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Zhang J, Gao Y, Du Z, Ren Y, Bi J, Wu Z, Lv Y, Wu R. Clinical Features and Prognosis of Gas-Forming and Non-Gas-Forming Pyogenic Liver Abscess: A Comparative Study. Surg Infect (Larchmt) 2020; 22:427-433. [PMID: 32857017 DOI: 10.1089/sur.2020.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Gas-forming pyogenic liver abscess (GFPLA) accounts for up to 30% of all pyogenic liver abscess (PLA) cases. However, little is known of the differences in clinical features and prognosis between GFPLA and non-GFPLA. Aim: This retrospective study compared the clinical features and prognosis of GFPLA and non-GFPLA. Patients and Methods: Data for 392 patients with PLA treated from January 1, 2007 to December 31, 2016 were reviewed. Gas-forming pyogenic liver abscess was defined as gas in the abscess. Liver abscesses were considered non-GFPLA (n = 326) or GFPLA (n = 66). The clinical features and outcomes of patients with GFPLA were compared with that of patients without GFPLA. Results: The groups were similar in gender ratio, age, smoking, drinking, and comorbidities. Klebsiella pneumoniae was the most common pathogenic bacteria, but the negative rate of bacterial culture of the non-GFPLA group was higher than that of the GFPLA. In etiologies, the GFPLA group had more biliary source infection and less cryptogenic infection. In addition, the GFPLA group had a higher rate of previous hepatobiliary surgery, especially biliary enteric anastomosis. Compared with the non-GFPLA group, the percentage of the GFPLA group with antibiotic agents combined with percutaneous drainage was higher, whereas the percentages given antibiotic agents alone and antibiotic agents combined with surgical drainage were lower. Patients with GFPLA had higher rates of sepsis and pleural effusion, and longer hospital stays than did non-GFPLA patients. No patient died during hospitalization. Conclusions: The GFPLA group had more biliary source infection and less cryptogenic infection in etiologies. Gas-forming pyogenic liver abscess is associated with past hepatobiliary surgery, especially biliary enteric anastomosis and has high rates of sepsis and long hospitalization. Thus, the patients with PLA with a history of hepatobiliary surgery should be monitored more closely in the early stage of the PLA. It needs to be recognized as a distinct clinical entity.
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Affiliation(s)
- Jia Zhang
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yi Gao
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Gastrointestinal Surgery Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Province, China
| | - Zhaoqing Du
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yifan Ren
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jianbin Bi
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Rongqian Wu
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
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22
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Mustafa MA, Fauzi MH, Abu Bakar MA, Mohd Noor N, Mohamed Hussain M. Man With Abdominal Pain. Ann Emerg Med 2020; 76:362-378. [PMID: 32828330 DOI: 10.1016/j.annemergmed.2020.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Mohamad A Mustafa
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; Department of Emergency and Trauma, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia
| | - Mohd H Fauzi
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mimi A Abu Bakar
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Nurathirah Mohd Noor
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Madheeh Mohamed Hussain
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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23
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Khim G, Em S, Mo S, Townell N. Liver abscess: diagnostic and management issues found in the low resource setting. Br Med Bull 2019; 132:45-52. [PMID: 31836890 PMCID: PMC6992887 DOI: 10.1093/bmb/ldz032] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/29/2019] [Accepted: 09/16/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Liver abscesses are mainly caused by parasitic or bacterial infection and are an important cause of hospitalization in low-middle income countries (LMIC). The pathophysiology of abscesses is different depending on the etiology and requires different strategies for diagnosis and management. This paper discusses pathophysiology and epidemiology, the current diagnostic approach and its limitations and management of liver abscess in low resource settings. SOURCES OF DATA We searched PubMed for relevant reviews by typing the following keywords: 'amoebic liver abscess' and 'pyogenic liver abscess'. AREAS OF AGREEMENT Amoebic liver abscess can be treated medically while pyogenic liver abscess usually needs to be percutaneously drained and treated with effective antibiotics. AREAS OF CONTROVERSY In an LMIC setting, where misuse of antibiotics is a recognized issue, liver abscesses are a therapeutic conundrum, leaving little choices for treatment for physicians in low capacity settings. GROWING POINTS As antimicrobial resistance awareness and antibiotic stewardship programs are put into place, liver abscess management will likely improve in LMICs provided that systematic adapted guidelines are established and practiced. AREAS TIMELY FOR DEVELOPING RESEARCH The lack of a quick and reliable diagnostic strategy in the majority of LMIC makes selection of appropriate treatment challenging.
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Affiliation(s)
- Gaetan Khim
- Diagnostic Microbiology Development Program, 12152, Phnom-Penh, Cambodia
| | - Sokhom Em
- Siem Reap Referral Hospital, 17252, Siem Reap, Cambodia
| | - Satdin Mo
- Siem Reap Referral Hospital, 17252, Siem Reap, Cambodia
| | - Nicola Townell
- Diagnostic Microbiology Development Program, 12152, Phnom-Penh, Cambodia
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24
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Chou DW, Wey KC. Emphysematous liver abscess with hepatic portal venous gas. Intern Emerg Med 2019; 14:1335-1336. [PMID: 31485818 DOI: 10.1007/s11739-019-02184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Deng-Wei Chou
- Department of Critical Care Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan.
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan.
| | - Keh-Cherng Wey
- Department of Internal Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
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25
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Shiryajev YN, Ryllo AG, Grechukhin SN, Karpenko MO, Busheva AI, Koronnova EN, Glebova AV, Kokhanenko NY. Ruptured Pyogenic Liver Abscess with Pneumoperitoneum 19 Years After Pancreatoduodenectomy. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1039-1045. [PMID: 31316049 PMCID: PMC6659458 DOI: 10.12659/ajcr.916755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Rupture of a pyogenic liver abscess is rare but serious complication. In patients after pancreatoduodenectomy, there are some conditions causing the development of liver abscesses (e.g., chronic reflux-cholangitis, efferent jejunal loop stasis, stenosis of the biliary anastomosis, and pancreatogenic diabetes). However, the number of published cases of liver abscess after pancreatoduodenectomy is small. CASE REPORT A 42-year-old male was admitted with severe abdominal pain, fever, and jaundice. Nineteen years previously, he had undergone pancreatoduodenectomy and cholecystectomy for chronic pancreatitis with obstructive jaundice. Two years later, diabetes mellitus was diagnosed, with subsequent insulin treatment. At admission, symptoms of peritonitis were present. Plain abdominal radiography showed free gas under the right hemidiaphragm and heterogeneous liver shade with small gas-fluid levels. The rupture of a liver abscess was suspected. Laparotomy with adhesiolysis, debridement of the liver abscess cavity, and abdominal drainage were performed. The postoperative period was complicated by sepsis, right lower lobe pneumonia, and two-sided pleural effusions, on the background of insulin-dependent diabetes and malnutrition. The patient was discharged on the 40th day and the subdiaphragmatic drains were removed on the 114th day. Sixteen months after surgery, the patient's condition was satisfactory. Magnetic resonance imaging and echography showed the absence of biliary hypertension. The liver tissue had healed completely. CONCLUSIONS A unique case of ruptured liver abscess after pancreatoduodenectomy is presented. To the best of our knowledge, this is the first published case with such a long time interval (19 years) between pancreatoduodenectomy and the formation of a pyogenic liver abscess.
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Affiliation(s)
- Yuri N Shiryajev
- Fourth Department of Surgery, Saint Petersburg City Hospital #15, Saint Petersburg, Russian Federation
| | - Andrey G Ryllo
- Fourth Department of Surgery, Saint Petersburg City Hospital #15, Saint Petersburg, Russian Federation
| | - Sergey N Grechukhin
- Fourth Department of Surgery, Saint Petersburg City Hospital #15, Saint Petersburg, Russian Federation
| | - Maria O Karpenko
- Department of Hospital Surgery #2, I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Anna I Busheva
- Department of Hospital Surgery #2, I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Elena N Koronnova
- Fourth Department of Surgery, Saint Petersburg City Hospital #15, Saint Petersburg, Russian Federation
| | - Anna V Glebova
- Department of Faculty Surgery named after Professor A.A. Rusanov, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russian Federation.,Sixth Department of Surgery, Mariinsky Hospital, Saint Petersburg, Russian Federation
| | - Nikolay Y Kokhanenko
- Department of Faculty Surgery named after Professor A.A. Rusanov, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russian Federation
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26
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Watanabe N, Kobayashi K, Hashikita G, Taji Y, Ishibashi N, Sakuramoto S, Mitsutake K, Ikebuchi K, Ebihara Y. Hepatic gas gangrene caused by Clostridium novyi. Anaerobe 2019; 57:90-92. [PMID: 30953694 DOI: 10.1016/j.anaerobe.2019.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 11/27/2022]
Abstract
We report the case of a patient with advanced gastric cancer and multiple liver metastases, who presented with bacteremia and hepatic gas gangrene caused by Clostridium novyi (C. novyi). The gas gangrene caused abscesses to form within metastatic lesions. This case highlights the antitumor effects of C. novyi in human.
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Affiliation(s)
- Noriyuki Watanabe
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kiyoko Kobayashi
- Department of Laboratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan
| | - Giichi Hashikita
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yoshitada Taji
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, Japan
| | - Noriomi Ishibashi
- Department of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shinichi Sakuramoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kotaro Mitsutake
- Department of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kenji Ikebuchi
- Department of Laboratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan; Department of Laboratory Medicine, University Hospital, Saitama Medical University, Saitama, Japan
| | - Yasuhiro Ebihara
- Department of Laboratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan.
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27
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Affiliation(s)
- S Kosasih
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan BA, Brunei Darussalam
| | - P L Chong
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan BA, Brunei Darussalam
| | - V H Chong
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan BA, Brunei Darussalam
| | - V H Chong
- PAPRSB, Institute of Health Sciences, University Brunei Darussalam, Gadong BE, Brunei Darussalam
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28
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Kim YK, Jo KM, Jang JH, Heo CM, Lee JH, Park JH, Kim S, Jang HJ, Kim HK, Kiem S. Rapidly Fatal Emphysematous Osteomyelitis with Multiple Septic Emboli and Liver Abscess Caused by Klebsiella pneumoniae. Infect Chemother 2018; 50:268-273. [PMID: 30270587 PMCID: PMC6167512 DOI: 10.3947/ic.2018.50.3.268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/09/2017] [Indexed: 02/07/2023] Open
Abstract
Emphysematous osteomyelitis, characterized by intraosseous gas, is a rare but potentially fatal condition that requires prompt diagnosis and aggressive therapy. Causative organisms are members of the bacterial family Enterobacteriaceae or anaerobes in most cases and significant comorbidities such as diabetes mellitus and malignancy, may predispose an individual to the development of emphysematous osteomyelitis. We report a case of extensive emphysematous osteomyelitis via hematogenous spread from Klebsiella pneumoniae liver abscess, complicated by gas-containing abscesses in adjacent soft tissues and epidural space, and multiple systemic septic emboli in a diabetic patient.
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Affiliation(s)
- Yong Kyun Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kyeong Min Jo
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji Hoon Jang
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang Min Heo
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Ha Lee
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Han Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sunyoung Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hang Jae Jang
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyeon Kuk Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sungmin Kiem
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
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29
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Kwon YK, Cheema FA, Maneckshana BT, Rochon C, Sheiner PA. Clostridium paraputrificum septicemia and liver abscess. World J Hepatol 2018; 10:388-395. [PMID: 29599902 PMCID: PMC5871859 DOI: 10.4254/wjh.v10.i3.388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/30/2018] [Accepted: 03/01/2018] [Indexed: 02/06/2023] Open
Abstract
We report the first case of a healthy 23-year-old female who underwent an interventional radiology-guided embolization of a hepatic adenoma, which resulted in a gas forming hepatic liver abscess and septicemia by Clostridium paraputrificum. A retrospective review of Clostridial liver abscesses was performed using a PubMed literature search, and we found 57 clostridial hepatic abscess cases. The two most commonly reported clostridial species are C. perfringens and C. septicum (64.9% and 17.5% respectively). C. perfringens cases carried a mortality of 67.6% with median survival of 11 h, and 70.2% of the C. perfringens cases experienced hemolysis. All C. septicum cases were found to have underlying liver malignancy at the time of the presentation with a mortality of only 30%. The remaining cases were caused by various Clostridium species, and this cohort’s clinical course was significantly milder when compared to the above C. perfringens and C. septicum cohorts.
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Affiliation(s)
- Yong K Kwon
- Department of Transplant, Hartford Hospital, Hartford, CT 06106, United States
| | - Faiqa A Cheema
- Department of Transplant, Hartford Hospital, Hartford, CT 06106, United States
| | - Bejon T Maneckshana
- Department of Transplant, Hartford Hospital, Hartford, CT 06106, United States
| | - Caroline Rochon
- Department of Transplant, Hartford Hospital, Hartford, CT 06106, United States
| | - Patricia A Sheiner
- Department of Transplant, Hartford Hospital, Hartford, CT 06106, United States
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30
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Tzeng BW, Liu PY, Hu SY. Acute respiratory distress syndrome associated with femoral osteomyelitis. Br J Hosp Med (Lond) 2018. [DOI: 10.12968/hmed.2018.79.3.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bo-Wei Tzeng
- Consultant, Department of Emergency Medicine, Nantou Hospital, Ministry of Health and Welfare, Nantou County, Taiwan
| | - Po-Yu Liu
- Consultant, Division of Infectious Disease, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Sung-Yuan Hu
- Consultant, Department of Emergency Medicine, Taichung Veterans General Hospital; School of Medicine, Institute of Medicine, Chung Shan Medical University; Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung 40705, Taiwan
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31
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Abstract
BACKGROUNDS/AIMS Gas-forming pyogenic liver abscess (GFPLA) has an incidence of up to 30% of all pyogenic liver abscesses (PLA). GFPLA has higher mortality compared to non-GFPLA. Mere presence of gas within abscess may not determine clinical outcome. Hence it is important to study biologic characteristics that make GFPLA a distinct clinical entity. The aim of this study was to conduct a world review on GFPLA. METHODS We conducted literature searches in PubMed using the following MeSH terms: "gas forming" AND "Liver abscess, pyogenic", "gas" AND "Liver abscess, pyogenic", "gas" AND "Liver abscess", "gas forming" AND "Liver abscess". Thirteen case series including 313 GFPLA patients were included. Age, gender, diabetes mellitus (DM), bacteriology, underlying etiology, symptoms, investigations, operative indications, and mortality rates were tabulated. RESULTS GFPLA is often cryptogenic. There was no difference in age, gender, or symptomatology between GFPLA and non-GFPLA patients. DM was more common in patients with GFPLA compared to that in non-GFPLA patients (mean: 83.5% vs. 38.3%). Klebsiella pneumoniae is the most common causative pathogen. GFPLA has higher mortality compared to non-GFPLA (mean: 30.3% vs. 9%). CONCLUSIONS GFPLA is associated with DM and monomicrobial Klebsiella pneumoniae infection. GFPLA has high mortality. It needs to be recognized as a distinct clinical entity.
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Affiliation(s)
- Coeway Boulder Thng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yen Pin Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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32
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Lee KJ, Ryu SH. Ruptured Gas-forming Pyogenic Liver Abscess into the Peritoneal Cavity Treated Successfully with Medical Treatment. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:45-48. [PMID: 29361813 DOI: 10.4166/kjg.2018.71.1.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Gas-forming pyogenic liver abscess (GFPLA) is very rare and has a very high mortality in case of rupture into the abdominal cavity, which usually require surgical treatment. We experienced a case of a ruptured GFPLA due to Klebsiella pneumoniae complicated with peritonitis and sepsis in a 68-year-old diabetic woman. Immediate and aggressive medical treatments including intravenous antibiotics, percutaneous drainage, and continuous renal replacement therapy dramatically improved the liver abscess, peritonitis, and metabolic problems. We report an unusual case of a ruptured GFPLA without surgical management, treated successfully with only medical treatment.
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Affiliation(s)
- Kyung Jin Lee
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Soo Hyung Ryu
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Wong OF, Chan SMM. Film quiz: A 76-year-old patient presented with fever and hyperglycemia. HONG KONG J EMERG ME 2017; 24:303-305. [DOI: 10.1177/1024907917735070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Oi Fung Wong
- Accident and Emergency Department, North Lantau Hospital, Tung Chun, Hong Kong
| | - Sze Man Mandy Chan
- Department of Anaesthesia and Intensive care, Tuen Mun Hospital, Tuen Mun, Hong Kong
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Kong H, Yu F, Zhang W, Li X. Clinical and microbiological characteristics of pyogenic liver abscess in a tertiary hospital in East China. Medicine (Baltimore) 2017; 96:e8050. [PMID: 28906397 PMCID: PMC5604666 DOI: 10.1097/md.0000000000008050] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Pyogenic liver abscess (PLA) is a potentially life-threatening disease affecting many parts of the world, especially Asia. In this study, we explored the clinical and microbiological characteristics of PLA in Chinese patients.A 5-year (2010-2014) retrospective review of medical records on all PLA patients who were admitted to a tertiary teaching hospital was performed.Among 217 PLA cases who were confirmed cultural positive, Klebsiella pneumonia (K pneumonia) was the most common pathogen (n = 165, 76.0%), followed by Escherichia coli (n = 21, 9.7%). Notably, there is a higher incidence of diabetes mellitus in patients with K pneumoniae-induced PLA (KP-PLA) than that with non-K pneumoniae-induced PLA (non-KP-PLA)(43.0% vs 21.2%, P = .005). However, it was less prevalent for concomitant hepatobiliary disease (20.0% vs 34.6%, P = .039) and history of intraabdominal trauma or surgery (13.3% vs 38.5%, P < .001) in patients with KP-PLA. Although K pneumoniae are sensitive to most common antibiotics (antibiotic resistance rates below 10%), some strains (1.2%) developed resistant to carbapenem. These results confirmed K pneumoniae as the predominant pathogen of PLA in the area in which the study was conducted. More attention should be directed toward monitoring the emergence of carbapenem-resistant K pneumoniae.KP-PLA is frequently diagnosed in patients with metabolic diseases accompanied by serious consequences, and it is therefore prudent to see that they receive sensitivity-directed antibiotic therapy.
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Affiliation(s)
- Haishen Kong
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fei Yu
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Weili Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Xuefen Li
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Botha WJ, Mukorera V, Kirberger RM. Septic pericarditis and pneumopericardium in a dog with an oesophageal foreign body. J S Afr Vet Assoc 2017; 88:e1-e5. [PMID: 28582985 PMCID: PMC6138164 DOI: 10.4102/jsava.v88i0.1496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/08/2017] [Accepted: 04/10/2017] [Indexed: 11/01/2022] Open
Abstract
A 5-year-old, intact, male Yorkshire Terrier presented with a 6-day history of lethargy and anorexia. Clinical examination revealed dental plaque accumulation, abdominal effort during respiration and muffled heart sounds. Thoracic radiographs revealed an enlarged globoid cardiac silhouette and mild pneumopericardium, transthoracic ultrasonography revealed a pericardial effusion after which pericardiocentesis, cytology and culture diagnosed septic pericarditis. Three multidrug-resistant bacteria were isolated, two of which have been implicated in gas-producing infections before. Medical management failed to resolve the pericarditis and euthanasia was opted for. A chronic osseocartilaginous oesophageal foreign body cranial to the heart base was found on necropsy. Septic pericarditis and pneumopericardium are rare conditions in dogs. This is the first case to describe a multidrug-resistant polybacterial aetiology causing mild pneumopericardium and only the second case to describe septic pericarditis associated with an oesophageal foreign body.
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Affiliation(s)
- Willem J Botha
- Department of Companion Animal Clinical Studies, University of Pretoria.
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Takano Y, Hayashi M, Niiya F, Nakanishi T, Hanamura S, Asonuma K, Yamamura E, Gomi K, Kuroki Y, Maruoka N, Inoue K, Nagahama M. Life-threatening emphysematous liver abscess associated with poorly controlled diabetes mellitus: a case report. BMC Res Notes 2017; 10:117. [PMID: 28264703 PMCID: PMC5340034 DOI: 10.1186/s13104-017-2445-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/01/2017] [Indexed: 12/13/2022] Open
Abstract
Background Emphysematous liver abscesses are defined as liver abscesses accompanied by gas formation. The fatality rate is extremely high at 27%, necessitating prompt intensive care. Case presentation The patient was a 69-year-old Japanese man with type 2 diabetes. He visited the emergency outpatient department for fever and general malaise that had been ongoing for 2 weeks. Abdominal computed tomography revealed an abscess 5 cm in diameter accompanied by gas formation in the right hepatic lobe. Markedly impaired glucose tolerance was observed with a blood sugar level of 571 mg/dL and a glycated hemoglobin level of 14.6%. The patient underwent emergency percutaneous abscess drainage, and intensive care was subsequently initiated. Klebsiella pneumoniae was detected in both the abscess cavity and blood cultures. The drain was removed 3 weeks later, and the patient was discharged. Conclusion Emphysematous liver abscesses are often observed in patients with poorly controlled diabetes, and the fatality rate is extremely high. Fever and malaise occasionally mask life-threatening infections in diabetic patients, necessitating careful examination.
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Affiliation(s)
- Yuichi Takano
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
| | - Masafumi Hayashi
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Fumitaka Niiya
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Toru Nakanishi
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Shotaro Hanamura
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Kunio Asonuma
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Eiichi Yamamura
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Kuniyo Gomi
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Yuichiro Kuroki
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Naotaka Maruoka
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Kazuaki Inoue
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Masatsugu Nagahama
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
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Ramachar Sreevathsa M, Melanta K. R gas under diaphragm. Int J Surg Case Rep 2016; 28:314-316. [PMID: 27771601 PMCID: PMC5079354 DOI: 10.1016/j.ijscr.2016.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/03/2016] [Accepted: 10/06/2016] [Indexed: 11/20/2022] Open
Abstract
The most common cause of gas under diaphragm is hollow viscous perforation. This is a case report of a rare cause of gas under diaphragm on a plain chest radiograph. A case of pancreatic abscess presenting as gas under diaphragm is discussed and literature is reviewed.
Introduction The most common cause of gas under diaphragm is hollow viscous perforation. In 10% of cases it can be due to rare causes, both abdominal and extra-abdominal, one of them being intra abdominal infection by gas forming organisms. Presentation of the case A 51 year old male patient, a poorly controlled diabetic, presented with a second episode of severe pain abdomen and abdominal distention, with lower abdominal tenderness. Plain Xray of the abdomen in erect posture showed gas under the right dome of diaphragm and ultrasound abdomen confirmed gross pneumoperitoneum. On emergency laparotomy, a pancreatic abscess was discovered, which had ruptured through the inferior leaf of the transverse mesocolon. Discussion There are many obscure causes for extra-intestinal and extra abdominal sources for gas under diaphragm which contribute to 10% of the etiology for the same.These are as follows: post laparotomy status, ruptured liver abscess, retroperitoneal air, biliary-enteric fistula, gall stone ileus, incompetent sphincter of Oddi, focal biliary lipomatosis, post scuba diving, post adeno-tonsillectomy, post dental extraction, following arthroscopy of the knee, intra abdominal sepsis by gas forming organisms and pneumatosis coli to name a few. In this case, Klebsiella was responsible for producing gas under the diaphragm. Conclusion Pancreatic abscess, in particular, as a extraintestinal source for gas under diaphragm has not been reported in English literature.
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Affiliation(s)
| | - Khyati Melanta
- Department of General Surgery, MS Ramaiah Medical College and Hospital, Bangalore, 560094, India.
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Kyang LS, Bin Traiki TA, Alzahrani NA, Morris DL. Microwave ablation of liver metastasis complicated by Clostridium perfringens gas-forming pyogenic liver abscess (GPLA) in a patient with past gastrectomy. Int J Surg Case Rep 2016; 27:32-35. [PMID: 27529833 PMCID: PMC4987502 DOI: 10.1016/j.ijscr.2016.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/06/2016] [Indexed: 02/07/2023] Open
Abstract
GPLA is one rare complication of liver microwave ablation. It can be diagnosed with CT scan which shows gas-containing infective focus. Patients with gastrectomy may have an increased risk of such infection due to gut flora change. To date, data on effectiveness of empirical antibiotic is not convincing. Close monitoring following ablation should be prioritised to allow timely intervention and prevent escalation of infection.
Introduction Gas-forming pyogenic liver abscess (GPLA) caused by C. perfringens is rare but fatal. Patients with past gastrectomy may be prone to such infection post-ablation. Presentation of case An 84-year-old male patient with past gastrectomy had MW ablation of his liver tumors complicated by GPLA. Computerised tomography scan showed gas-containing abscess in the liver and he was managed successfully with antibiotic and percutaneous drainage of the abscess. Discussion C. perfringens GPLA secondary to MW ablation in a patient with previous gastrectomy has not been reported in the literature. Gastrectomy may predispose to such infection. Even in high-risk patients, empirical antibiotic before ablation is not a standard of practice. Therefore following the procedure, close observation of patients’ conditions is necessary to allow early diagnosis and intervention that will prevent progression of infection. Conclusion Potential complication of liver abscess following MW ablation can never be overlooked. The risk may be enhanced in patients with previous gastrectomy. Early diagnosis and management may minimise mortality and morbidity.
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Affiliation(s)
- Lee S Kyang
- St. George Clinical School, University of New South Wales, New South Wales, Australia
| | - Thamer A Bin Traiki
- Department of Surgery, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Nayef A Alzahrani
- Department of Surgery, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia; Imam Muhammad ibn Saud Islamic University College of Medicine, Riyadh, Saudi Arabia
| | - David L Morris
- Department of Surgery, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia.
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An unusual cause of a gas-forming liver abscess. Enferm Infecc Microbiol Clin 2016; 35:678-679. [PMID: 27435038 DOI: 10.1016/j.eimc.2016.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/20/2016] [Indexed: 11/23/2022]
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41
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Tsai YC, Tsai MC, Yeh CB, Ho SW. Febrile Man with Pneumoperitoneum. J Emerg Med 2016; 50:e37-8. [DOI: 10.1016/j.jemermed.2015.06.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/12/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
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Gas-Forming Pyogenic Liver Abscess with Septic Shock. Case Rep Crit Care 2015; 2015:632873. [PMID: 26090240 PMCID: PMC4458291 DOI: 10.1155/2015/632873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/06/2015] [Accepted: 05/11/2015] [Indexed: 02/08/2023] Open
Abstract
The pyogenic liver abscess caused by Clostridium perfringens (C. perfringens) is a rare but rapidly fatal infection. The main virulence factor of this pathogen is its α-toxin (lecithinase), which decomposes the phospholipid in cell membranes leading to cell lysis. Once the bacteria are in blood stream, massive intravascular hemolysis occurs. This can present as anemia on admission with evidence of hemolysis as indicated by low serum haptoglobin, high serum lactate dehydrogenase (LDH), elevated indirect bilirubin, and spherocytosis. The clinical course of C. perfringens septicemia is marked by rapidly deteriorating course with a mortality rate ranging from 70 to 100%. The very rapid clinical course makes it difficult to diagnose on time, and most cases are diagnosed at autopsy. Therefore it is important to consider C. perfringens infection in any severely ill patient with fever and evidence of hemolysis. We present a case of seventy-seven-year-old male with septic shock secondary to pyogenic liver abscess with a brief review of existing literature on C. perfringens.
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Eltawansy SA, Merchant C, Atluri P, Dwivedi S. Multi-organ failure secondary to a Clostridium perfringens gaseous liver abscess following a self-limited episode of acute gastroenteritis. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:182-6. [PMID: 25807198 PMCID: PMC4376230 DOI: 10.12659/ajcr.893046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Clostridium perfringens is an unusual pathogen responsible for the development of a gas-forming pyogenic liver abscess. Progression to septicemia with this infection has amplified case fatality rates. CASE REPORT We report a case of an 81-year-old lady with pyogenic liver abscess with gas formation that was preceded by an acute gastroenteritis. The most common precipitating factors are invasive procedures and immunosuppression. Clostridium perfringens was unexpectedly isolated in the drained abscess, as well as blood. It is a normal inhabitant of the human bowel and a common cause of food poisoning, notoriously leading to tissue necrosis and gas gangrene. CONCLUSIONS We report a case of gas-forming pyogenic liver abscess and bacteremia progressing to fatal septic shock, caused by an uncommon Clostridium perfringens isolate.
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Affiliation(s)
| | - Chandni Merchant
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ, USA
| | - Paavani Atluri
- Department of Internal Medicine, Monmouth Medical Center,, Long Branch, NJ, USA
| | - Sukrut Dwivedi
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ, USA
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Jung J, Park KH, Park SY, Song EH, Lee EJ, Choi SH, Choo EJ, Kwak YG, Sung H, Kim SH, Lee SO, Kim MN, Kim YS, Woo JH, Choi SH. Comparison of the clinical characteristics and outcomes of Klebsiella pneumoniae and Streptococcus pneumoniae meningitis. Diagn Microbiol Infect Dis 2015; 82:87-91. [PMID: 25752203 DOI: 10.1016/j.diagmicrobio.2015.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 02/11/2015] [Accepted: 02/14/2015] [Indexed: 11/17/2022]
Abstract
This multicenter, retrospective cohort study compared the clinical characteristics and outcomes of community-acquired Klebsiella pneumoniae meningitis (CA-KPM) with those of community-acquired Streptococcus pneumoniae meningitis (CA-SPM). Eighty-three adult patients, 27 with CA-KPM and 56 with CA-SPM, were included. Diabetes mellitus (48.1% versus 21.4%; P=0.01) and liver cirrhosis (22.2% versus 5.4%; P=0.05) were more commonly associated with CA-KPM. Comatose mental status (40.7% versus 12.5%; P=0.01), septic shock (44.4% versus 8.9%; P<0.001), and concomitant extrameningeal infections (40.7% versus 7.1%; P=0.001) were also more common in the CA-KPM group. The 28-day mortality (44.4% versus 10.7%; P<0.001) and inhospital mortality (51.9% versus 14.3%; P<0.001) were higher in the CA-KPM group. In conclusion, diabetes mellitus and liver cirrhosis are more common in the CA-KPM patients who were also more likely to present with severe manifestations and poor outcomes.
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Affiliation(s)
- Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Ki-Ho Park
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Seong Yeon Park
- Division of Infectious Diseases, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Eun Hee Song
- Department of Infectious Diseases, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Eun Jung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - Seong-Ho Choi
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Eun Ju Choo
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Yee Gyung Kwak
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Mi-Na Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea.
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Su TM, Lan CM, Lee TH, Hsu SW. Gas-containing brain abscess: etiology, clinical characteristics, and outcome. Kaohsiung J Med Sci 2014; 30:619-24. [PMID: 25476100 DOI: 10.1016/j.kjms.2014.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/21/2014] [Accepted: 10/08/2014] [Indexed: 11/26/2022] Open
Abstract
Gas-containing brain abscess remains a life-threatening disease that requires immediate diagnostic and therapeutic intervention. The aim of this study is to report on a series of gas-containing brain abscess and discuss its pathological mechanism and therapeutic consideration. This study included 11 patients with gas-containing brain abscess at Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan during a 27-year period. The predisposing factors to infection included hematogenous spread in five patients, contiguous infection in one patient, and abnormal fistulous communication due to head injury in four patients. In one patient, the predisposing factor might be contiguous infection from frontal sinusitis or abnormal fistulous communication due to previous sinus surgery. Klebsiella pneumoniae was the most common causative pathogen that was isolated from the gas-containing abscess not related to skull base defect. Among these 11 patients, six underwent excision and five accepted aspiration for the surgical treatment of abscess. In the five patients who underwent aspiration, two required repeated craniotomy to excise the recurrent abscess and repair the abnormal fistulous communication through the skull base. When encountered with a gas-containing abscess in patients with an impaired host defense mechanism, K. pneumoniae infection should be suspected, and further attention should be paid to discovering if other metastatic septic abscesses exist. For patients with a history of basilar skull fracture or surgery involving the skull base, craniotomy is indicated to excise the abscess and repair the potential fistulous communication through the cranium. Aspiration may be a reasonable alternative to treat deep-seated lesions, lesions in an eloquent area, patients with severe concomitant medical disease, or patients without a history of basilar skull fracture or surgery involving the skull base. Prompt diagnosis, appropriate antibiotic use, and meticulous surgical treatment are the only way to obtain a favorable outcome.
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Affiliation(s)
- Tsung-Ming Su
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Chu-Mei Lan
- Department of Health Psychology, Chang Jung Christian University, Tainan, Taiwan
| | - Tsung-Han Lee
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Wei Hsu
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Chiou YW, Lin YT. Gas-forming Klebsiella pneumoniae liver abscess in a patient without diabetes. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 48:709-10. [PMID: 25066705 DOI: 10.1016/j.jmii.2014.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/19/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Yu-Wei Chiou
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Tsung Lin
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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The association of haemoglobin A₁C levels with the clinical and CT characteristics of Klebsiella pneumoniae liver abscesses in patients with diabetes mellitus. Eur Radiol 2014; 24:980-9. [PMID: 24563159 DOI: 10.1007/s00330-014-3113-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 01/29/2014] [Accepted: 01/31/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare the characteristics of Klebsiella pneumoniae liver abscesses (KPLA) in diabetic patients with different levels of glycaemic control. METHODS The institutional review board approved this retrospective study. A total of 221 patients with KPLA were included. Clinical features of KPLA were compared. We divided the 120 diabetic patients with KPLA into three subgroups based on haemoglobin A1C (HbA1C) concentration (good, HbA1C ≤ 7.0 %; suboptimal, 7.0 % < HbA1C ≤ 9.0 %; poor, HbA1C > 9.0 %). In this study, we used a semiautomated quantitative method to assess the gas and total abscess volumes in KPLA. Statistical analysis was performed with the chi-squared test and one-way analysis of variance. RESULTS The mortality rate did not significantly differ between the nondiabetic and diabetic groups. However, patients with poor glycaemic control had significantly more complications and therefore a longer hospital stay (P < 0.05). In our study, CT and quantitative analyses found that patients in the group with poor glycaemic control had a significantly higher incidence of gas formation and hepatic venous thrombophlebitis and a higher gas-to-abscess volume ratio than patients with suboptimal and good glycaemic control (P < 0.05). CONCLUSIONS Diabetic patients with a high HbA1C concentration (>9.0 %) have an association with hepatic venous thrombophlebitis, gas formation and metastatic infection complications associated with KPLA. KEY POINTS • Poorly controlled diabetes is associated with complications in Klebsiella pneumoniae liver abscesses. • Hepatic venous thrombosis and gas are important signs of metastatic infection. • Hepatic venous thrombophlebitis is associated with 72.7 % of metastatic infections.
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48
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Imoto A, Ooi Y, Edogawa S, Ogura T, Masuda D, Mohamed M, Takii M, Umegaki E, Kawahara R, Ukimura A, Higuchi K. Liver abscess caused by CTX-M-55-type extended-spectrum β-lactamase (ESBL)-producing Salmonella enteritidis. Intern Med 2014; 53:1699-703. [PMID: 25088889 DOI: 10.2169/internalmedicine.53.2407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Liver abscesses secondary to Salmonella species are rarely described in the general population. We herein describe a case of a liver abscess caused by CTX-M-55-type extended-spectrum β-lactamase (ESBL)-producing Salmonella enteritidis, which has not been reported in the literature. A 54-year-old male was admitted due to a high fever and was clinically diagnosed with a liver abscess. Culture of the fluid from the liver abscess revealed CTX-M-55-type ESBL-producing S. enteritidis. Although the patient underwent percutaneous transhepatic abscess drainage and antibiotic therapy, he died one month later. It should be noted that liver abscesses are potentially fatal depending on the causative pathogen.
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Affiliation(s)
- Akira Imoto
- The Second Department of Internal Medicine, Osaka Medical College, Japan
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An unusual cause of acute abdomen-Gas-forming liver abscess due to Salmonella enteritidis. Asian J Surg 2013; 40:66-69. [PMID: 23978428 DOI: 10.1016/j.asjsur.2013.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/25/2013] [Accepted: 07/09/2013] [Indexed: 01/10/2023] Open
Abstract
Gas-forming pyogenic liver abscess (GFPLA) is considered to be a very severe form of PLA and carries a high mortality. Klebsiella pneumoniae is the most common pathogen responsible for the disease, whereas cases where Salmonella is cited as the cause are very uncommon. We report the first case of a 53-year-old lady suffering from GFPLA due to Salmonella, who was successfully treated with surgical drainage. To the best of our knowledge, this is the first case of GFPLA caused by Salmonella enteritidis to be reported in the English literature.
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Safe IP, Couceiro KDN, Martins AG. Gas-forming pyogenic liver abscess. Rev Soc Bras Med Trop 2013; 46:528. [DOI: 10.1590/0037-8682-0043-2013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 06/25/2013] [Indexed: 11/21/2022] Open
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